Sodium-Bearing Waste Treatment Alternatives Implementation Study

Energy Technology Data Exchange (ETDEWEB)

Charles M. Barnes; James B. Bosley; Clifford W. Olsen

2004-07-01

The purpose of this document is to discuss issues related to the implementation of each of the five down-selected INEEL/INTEC radioactive liquid waste (sodium-bearing waste - SBW) treatment alternatives and summarize information in three main areas of concern: process/technical, environmental permitting, and schedule. Major implementation options for each treatment alternative are also identified and briefly discussed. This report may touch upon, but purposely does not address in detail, issues that are programmatic in nature. Examples of these include how the SBW will be classified with respect to the Nuclear Waste Policy Act (NWPA), status of Waste Isolation Pilot Plant (WIPP) permits and waste storage availability, available funding for implementation, stakeholder issues, and State of Idaho Settlement Agreement milestones. It is assumed in this report that the SBW would be classified as a transuranic (TRU) waste suitable for disposal at WIPP, located in New Mexico, after appropriate treatment to meet transportation requirements and waste acceptance criteria (WAC).

Adaptive noise cancellation

International Nuclear Information System (INIS)

Akram, N.

1999-01-01

In this report we describe the concept of adaptive noise canceling, an alternative method of estimating signals corrupted by additive noise of interference. The method uses 'primary' input containing the corrupted signal and a 'reference' input containing noise correlated in some unknown way with the primary noise, the reference input is adaptively filtered and subtracted from the primary input to obtain the signal estimate. Adaptive filtering before subtraction allows the treatment of inputs that are deterministic or stochastic, stationary or time variable. When the reference input is free of signal and certain other conditions are met then noise in the primary input can be essentially eliminated without signal distortion. It is further shown that the adaptive filter also acts as notch filter. Simulated results illustrate the usefulness of the adaptive noise canceling technique. (author)

Bacteriocins - exploring alternatives to antibiotics in mastitis treatment.

Science.gov (United States)

Pieterse, Reneé; Todorov, Svetoslav D

2010-07-01

Mastitis is considered to be the most costly disease affecting the dairy industry. Management strategies involve the extensive use of antibiotics to treat and prevent this disease. Prophylactic dosages of antibiotics used in mastitis control programmes could select for strains with resistance to antibiotics. In addition, a strong drive towards reducing antibiotic residues in animal food products has lead to research in finding alternative antimicrobial agents. In this review we have focus on the pathogenesis of the mastitis in dairy cows, existing antibiotic treatments and possible alternative for application of bacteriocins from lactic acid bacteria in the treatment and prevention of this disease.

An alternative treatment for anastomotic leakage after oesophageal resection

DEFF Research Database (Denmark)

Damm, P; Hoffmann, J.

1988-01-01

An alternative non-operative method for treatment for anastomotic leakage after oesophageal resection is presented. A mediastinal abscess cavity was drained by an ordinary nasogastric tube introduced via the nose through the anastomotic defect and into the cavity.......An alternative non-operative method for treatment for anastomotic leakage after oesophageal resection is presented. A mediastinal abscess cavity was drained by an ordinary nasogastric tube introduced via the nose through the anastomotic defect and into the cavity....

Treatment, promotion, commotion: Antibiotic alternatives in food-producing animals

Science.gov (United States)

Alternatives to antibiotics in animal agriculture are urgently needed but present a complex problem because of their various uses: disease treatment, disease prevention, and feed efficiency improvement. Numerous antibiotic alternatives, such as feed amended with pre- and probiotics, have been propos...

[Use of alternative medicine in the treatment of allergic diseases].

Science.gov (United States)

Félix Berumen, José Alfredo; González Díaz, Sandra Nora; Canseco González, Carlos; Arias Cruz, Alfredo

2004-01-01

The alternative medicine and the complementary medicine are forms of treatment very spread and frequently demanded by patients with allergic diseases. According to recent studies, homeopathy, acupuncture and herbal medicine are the most commonly used types of alternative medicine. To know the frequency in the use of different types of alternative medicine for the treatment of allergic diseases in patients attended at the Centro Regional de Alergia e Immunologia Clínica of the Hospital Universitario de Monterrey, Nuevo León. A transversal, descriptive and observational study was done by the use of questionnaires applied to patients and/or patients' relatives attended in this Center. This survey included questions to focus the investigation in the use of a Iternative medicine for the treatment of any allergic disease. The data analysis was done by descriptive statistics. Four hundred one questionnaires were applied. The average age of the patients was of 14 years (range from 1 to 73 years). Fourty-seven percent (189 patients) were female and 58.2% (212 patients) were male. The diagnoses included: allergic rhinitis in 215 patients (53.6), asthma in 97 (24.2%), rhinitis and asthma in 73 (18.2) and atopic dermatitis in 16 (4%). Out of the patients 34.4% (138) had used at least one type of alternative medicine for the treatment of their allergic disease. Homeopathy was the most commonly used type of alternative medicine (78.2%), followed by the natural medicine (31.5%). Alternative medicine for the treatment of allergic diseases is frequent in patients who attend to this center. Homeopathy and the natural medicine are the most used.

Bacteriocins: exploring alternatives to antibiotics in mastitis treatment

Directory of Open Access Journals (Sweden)

Reneé Pieterse

2010-10-01

Full Text Available Mastitis is considered to be the most costly disease affecting the dairy industry. Management strategies involve the extensive use of antibiotics to treat and prevent this disease. Prophylactic dosages of antibiotics used in mastitis control programmes could select for strains with resistance to antibiotics. In addition, a strong drive towards reducing antibiotic residues in animal food products has lead to research in finding alternative antimicrobial agents. In this review we have focus on the pathogenesis of the mastitis in dairy cows, existing antibiotic treatments and possible alternative for application of bacteriocins from lactic acid bacteria in the treatment and prevention of this disease.

On-line Adaptive Radiation Treatment of Prostate Cancer

National Research Council Canada - National Science Library

Zhang, Tiezhi

2008-01-01

.... The specific aims of this project are to develop the key technical components for online adaptive treatment, which include parallel deformable image registration algorithm, parallel dose calculation...

Bacteriocins – Exploring Alternatives to Antibiotics in Mastitis Treatment

Science.gov (United States)

Pieterse, Reneé; Todorov, Svetoslav D.

2010-01-01

Mastitis is considered to be the most costly disease affecting the dairy industry. Management strategies involve the extensive use of antibiotics to treat and prevent this disease. Prophylactic dosages of antibiotics used in mastitis control programmes could select for strains with resistance to antibiotics. In addition, a strong drive towards reducing antibiotic residues in animal food products has lead to research in finding alternative antimicrobial agents. In this review we have focus on the pathogenesis of the mastitis in dairy cows, existing antibiotic treatments and possible alternative for application of bacteriocins from lactic acid bacteria in the treatment and prevention of this disease. PMID:24031528

Alternative Financial Policy Rules in an Open Economy Under Rational and Adaptive Expectations

OpenAIRE

Blackburn, Keith; Currie, David; Whittaker, R; Wren-Lewis, Simon

1985-01-01

The potential instability of a fixed monetary rule combined with automatic fixed stabilisers is a well-established feature of closed economy IS/LM models with wealth effects and asset accumulation. This paper examines the stability issue in a general open economy macromodel with alternative expectations mechanisms (rational or adaptive) in both the labour market and the foreign exchange market. The fixed monetary rule is found to be stabilising only in special cases, notably when post-tax rea...

The strategy of alternate direction adapted to a coarse mesh method for the solution of neutron diffusion problems

International Nuclear Information System (INIS)

Watson, F.V.

1982-01-01

An adaptation of the alternate direction method for coarse mesh calculation, is presented. The algorithm is applicable to two-and three dimensional problems, the last being the more interesting one. (E.G.) [pt

Online Adaptive Hyperthermia Treatment Planning During Locoregional Heating to Suppress Treatment-Limiting Hot Spots.

Science.gov (United States)

Kok, H Petra; Korshuize-van Straten, Linda; Bakker, Akke; de Kroon-Oldenhof, Rianne; Geijsen, Elisabeth D; Stalpers, Lukas J A; Crezee, Johannes

2017-11-15

Adequate tumor temperatures during hyperthermia are essential for good clinical response, but excessive heating of normal tissue should be avoided. This makes locoregional heating using phased array systems technically challenging. Online application of hyperthermia treatment planning could help to improve the heating quality. The aim of this study was to evaluate the clinical benefit of online treatment planning during treatment of pelvic tumors heated with the AMC-8 locoregional hyperthermia system. For online adaptive hyperthermia treatment planning, a graphical user interface was developed. Electric fields were calculated in a preprocessing step using our in-house-developed finite-difference-based treatment planning system. This allows instant calculation of the temperature distribution for user-selected phase-amplitude settings during treatment and projection onto the patient's computed tomographic scan for online visualization. Online treatment planning was used for 14 treatment sessions in 8 patients to reduce the patients' reports of hot spots while maintaining the same level of tumor heating. The predicted decrease in hot spot temperature should be at least 0.5°C, and the tumor temperature should decrease less than 0.2°C. These predictions were compared with clinical data: patient feedback about the hot spot and temperature measurements in the tumor region. In total, 17 hot spot reports occurred during the 14 sessions, and the alternative settings predicted the hot spot temperature to decrease by at least 0.5°C, which was confirmed by the disappearance of all 17 hot spot reports. At the same time, the average tumor temperature was predicted to change on average -0.01°C (range, -0.19°C to 0.34°C). The measured tumor temperature change was on average only -0.02°C (range, -0.26°C to 0.31°C). In only 2 cases the temperature decrease was slightly larger than 0.2°C, but at most it was 0.26°C. Online application of hyperthermia treatment planning is

Formulating adaptive radiation therapy (ART) treatment planning into a closed-loop control framework

International Nuclear Information System (INIS)

Zerda, Adam de la; Armbruster, Benjamin; Xing Lei

2007-01-01

While ART has been studied for years, the specific quantitative implementation details have not. In order for this new scheme of radiation therapy (RT) to reach its potential, an effective ART treatment planning strategy capable of taking into account the dose delivery history and the patient's on-treatment geometric model must be in place. This paper performs a theoretical study of dynamic closed-loop control algorithms for ART and compares their utility with data from phantom and clinical cases. We developed two classes of algorithms: those Adapting to Changing Geometry and those Adapting to Geometry and Delivered Dose. The former class takes into account organ deformations found just before treatment. The latter class optimizes the dose distribution accumulated over the entire course of treatment by adapting at each fraction, not only to the information just before treatment about organ deformations but also to the dose delivery history. We showcase two algorithms in the class of those Adapting to Geometry and Delivered Dose. A comparison of the approaches indicates that certain closed-loop ART algorithms may significantly improve the current practice. We anticipate that improvements in imaging, dose verification and reporting will further increase the importance of adaptive algorithms

Proven Alternatives for Aboveground Treatment of Arsenic in Groundwater

Science.gov (United States)

This issue paper, developed for EPA's Engineering Forum, identifies and summarizes experiences with proven aboveground treatment alternatives for arsenic in groundwater, and provides information on their relative effectiveness and cost.

Candidiasis: predisposing factors, prevention, diagnosis and alternative treatment.

Science.gov (United States)

Martins, Natália; Ferreira, Isabel C F R; Barros, Lillian; Silva, Sónia; Henriques, Mariana

2014-06-01

Candidiasis is the most common opportunistic yeast infection. Candida species and other microorganisms are involved in this complicated fungal infection, but Candida albicans continues to be the most prevalent. In the past two decades, it has been observed an abnormal overgrowth in the gastrointestinal, urinary and respiratory tracts, not only in immunocompromised patients, but also related to nosocomial infections and even in healthy individuals. There is a widely variety of causal factors that contribute to yeast infection which means that candidiasis is a good example of a multifactorial syndrome. Due to rapid increase in the incidence in these infections, this is the subject of numerous studies. Recently, the focus of attention is the treatment and, above all, the prevention of those complications. The diagnosis of candidiasis could become quite complicated. Prevention is the most effective "treatment," much more than eradication of the yeast with antifungal agents. There are several aspects to consider in the daily routine that can provide a strength protection. However, a therapeutic approach is necessary when the infection is established, and therefore, other alternatives should be explored. This review provides an overview on predisposition factors, prevention and diagnosis of candidiasis, highlighting alternative approaches for candidiasis treatment.

Knowledge-light adaptation approaches in case-based reasoning for radiotherapy treatment planning.

Science.gov (United States)

Petrovic, Sanja; Khussainova, Gulmira; Jagannathan, Rupa

2016-03-01

Radiotherapy treatment planning aims at delivering a sufficient radiation dose to cancerous tumour cells while sparing healthy organs in the tumour-surrounding area. It is a time-consuming trial-and-error process that requires the expertise of a group of medical experts including oncologists and medical physicists and can take from 2 to 3h to a few days. Our objective is to improve the performance of our previously built case-based reasoning (CBR) system for brain tumour radiotherapy treatment planning. In this system, a treatment plan for a new patient is retrieved from a case base containing patient cases treated in the past and their treatment plans. However, this system does not perform any adaptation, which is needed to account for any difference between the new and retrieved cases. Generally, the adaptation phase is considered to be intrinsically knowledge-intensive and domain-dependent. Therefore, an adaptation often requires a large amount of domain-specific knowledge, which can be difficult to acquire and often is not readily available. In this study, we investigate approaches to adaptation that do not require much domain knowledge, referred to as knowledge-light adaptation. We developed two adaptation approaches: adaptation based on machine-learning tools and adaptation-guided retrieval. They were used to adapt the beam number and beam angles suggested in the retrieved case. Two machine-learning tools, neural networks and naive Bayes classifier, were used in the adaptation to learn how the difference in attribute values between the retrieved and new cases affects the output of these two cases. The adaptation-guided retrieval takes into consideration not only the similarity between the new and retrieved cases, but also how to adapt the retrieved case. The research was carried out in collaboration with medical physicists at the Nottingham University Hospitals NHS Trust, City Hospital Campus, UK. All experiments were performed using real-world brain cancer

Synthesis of wood treatment alternatives for timber railroad structures.

Science.gov (United States)

2011-12-01

A wealth of information exists on various wood preservatives, treatment techniques, curing practices, and other engineered : controls, along with alternative materials for replacement. This study was initiated to review and synthesize available : inf...

Involvement of alternative oxidase (AOX) in adventitious rooting of Olea europaea L. microshoots is linked to adaptive phenylpropanoid and lignin metabolism.

Science.gov (United States)

Santos Macedo, E; Sircar, D; Cardoso, H G; Peixe, A; Arnholdt-Schmitt, B

2012-09-01

Alternative oxidase (AOX) has been proposed as a functional marker candidate in a number of events involving cell differentiation, including rooting efficiency in semi-hardwood shoot cuttings of olive (Olea europaea L.). To ascertain the general importance of AOX in olive rooting, the auxin-induced rooting process was studied in an in vitro system for microshoot propagation. Inhibition of AOX by salicylhydroxamic acid (SHAM) significantly reduced rooting efficiency. However, the inhibitor failed to exhibit any effect on the preceding calli stage. This makes the system appropriate for distinguishing dedifferentiation and de novo differentiation during root induction. Metabolite analyses of microshoots showed that total phenolics, total flavonoids and lignin contents were significantly reduced upon SHAM treatment. It was concluded that the influence of alternative respiration on root formation was associated to adaptive phenylpropanoid and lignin metabolism. Transcript profiles of two olive AOX genes (OeAOX1a and OeAOX2) were examined during the process of auxin-induced root induction. Both genes displayed stable transcript accumulation in semi-quantitative RT-PCR analysis during all experimental stages. In contrary, when the reverse primer for OeAOX2 was designed from the 3'-UTR instead of the ORF, differential transcript accumulation was observed suggesting posttranscriptional regulation of OeAOX2 during metabolic acclimation. This result confirms former observations in olive semi-hardwood shoot cuttings on differential OeAOX2 expression during root induction. It further points to the importance of future studies on the functional role of sequence and length polymorphisms in the 3'-UTR of this gene. The manuscript reports the general importance of AOX in olive adventitious rooting and the association of alternative respiration to adaptive phenylpropanoid and lignin metabolism.

Waste management system alternatives for treatment of wastes from spent fuel reprocessing

International Nuclear Information System (INIS)

McKee, R.W.; Swanson, J.L.; Daling, P.M.

1986-09-01

This study was performed to help identify a preferred TRU waste treatment alternative for reprocessing wastes with respect to waste form performance in a geologic repository, near-term waste management system risks, and minimum waste management system costs. The results were intended for use in developing TRU waste acceptance requirements that may be needed to meet regulatory requirements for disposal of TRU wastes in a geologic repository. The waste management system components included in this analysis are waste treatment and packaging, transportation, and disposal. The major features of the TRU waste treatment alternatives examined here include: (1) packaging (as-produced) without treatment (PWOT); (2) compaction of hulls and other compactable wastes; (3) incineration of combustibles with cementation of the ash plus compaction of hulls and filters; (4) melting of hulls and failed equipment plus incineration of combustibles with vitrification of the ash along with the HLW; (5a) decontamination of hulls and failed equipment to produce LLW plus incineration and incorporation of ash and other inert wastes into HLW glass; and (5b) variation of this fifth treatment alternative in which the incineration ash is incorporated into a separate TRU waste glass. The six alternative processing system concepts provide progressively increasing levels of TRU waste consolidation and TRU waste form integrity. Vitrification of HLW and intermediate-level liquid wastes (ILLW) was assumed in all cases

Adaptive radiotherapy for long course neo-adjuvant treatment of rectal cancer

International Nuclear Information System (INIS)

Nijkamp, Jasper; Marijnen, Corrie; Herk, Marcel van; Triest, Baukelien van; Sonke, Jan-Jakob

2012-01-01

Purpose: To quantify the potential margin reduction with adaptive radiotherapy (ART) during neo-adjuvant treatment of locally-advanced rectal cancer. Methods and materials: Repeat CT scans were acquired for 28 patients treated with 25 × 2 Gy, daily during the first week, and followed by weekly scans. The CTV was delineated on all scans, and shape variation was estimated. Five ART strategies were tested, consisting of an average CTV over the planning CT and one to five repeat CTs. Required PTV margins were calculated for adapted and non-adapted treatment. The strategy with the least PTV volume over the whole treatment was selected and bowel area dose reduction was estimated. Results: Substantial systematic and random shape variation demanded for a PTV margin up to 2.4 cm at the upper-anterior part of the CTV. Plan adaptation after fraction 4 resulted in a maximum 0.7 cm margin reduction and a significant PTV reduction from 1185 to 1023 cc (p < 0.0001). The bowel area volume receiving 15, 45, and 50 Gy was reduced from 436 to 402 cc, 111 to 81 cc, and 49 to 29 cc, respectively (p < 0.0001). Conclusions: With adaptive radiotherapy, maximum required PTV margins can be reduced from 2.4 to 1.7 cm, resulting in significantly less dose to the bowel area.

Alternate day treatment and late effects: The concept of an effective dose per fraction

International Nuclear Information System (INIS)

Courdi, A.; Hery, M.; Gabillat, J.M.

1990-01-01

Although most institutions treat all fields each day, some radiotherapists continue to adopt an alternate day schedule. The resulting daily variations of the dose per fraction in laterally located targets have been analyzed using the linear-quadratic model. Patients with breast carcinoma treated with definitive radiotherapy in 1974-1975 with one field a day were studied. An effective dose per fraction was derived, with a value higher than the average dose per fraction received by the reference point. The greater the fluctuations between the doses per fraction on successive days, the higher the effective dose per fraction. The corresponding cell survival due to alternate treatment as compared to survival with daily treatment depends on the alpha/beta ratio. For a late effect with low alpha/beta ratio, an alternate treatment may lead to almost 10-fold increase in cell kill in these lateral targets such as those responsible for subcutaneous sclerosis as compared to daily treatment of all fields with the same total dose. Taking the average effective dose per fraction in our series, the increase in cell kill was 4-fold. Acute effects would suffer less damage due to alternate treatment because of a high alpha/beta ratio. Treatment on an alternate schedule should be restricted to palliative radiotherapy

Complementary and alternative medicine treatments for low back pain.

Science.gov (United States)

Marlowe, Dan

2012-09-01

Complementary and alternative medicine, often referred to as integrated medicine, is often used for the treatment of low back pain. This article presents 6 therapies (ie, behavioral treatment, acupuncture, manipulation, prolotherapy, neuroreflexotherapy, and herbal treatments), which are discussed in terms of the specifics of the modality, as well as the empirical evidence related to their effectiveness. Copyright © 2012 Elsevier Inc. All rights reserved.

Alternative adaptive immunity in invertebrates

DEFF Research Database (Denmark)

Kurtz, Joachim; Armitage, Sophie Alice Octavia

2006-01-01

Vertebrate adaptive immunity is characterized by challenge-specific long-term protection. This specific memory is achieved through the vast diversity of somatically rearranged immunological receptors such as antibodies. Whether or not invertebrates are capable of a comparable phenotypic plasticity...

Alternative approaches to conventional treatment of acute uncomplicated urinary tract infection in women.

Science.gov (United States)

Foxman, Betsy; Buxton, Miatta

2013-04-01

The increasing resistance of uropathogens to antibiotics and recognition of the generally self-limiting nature of uncomplicated urinary tract infection (UTI) suggest that it is time to reconsider empirical treatment of UTI using antibiotics. Identifying new and effective strategies to prevent recurrences and alternative treatment strategies are a high priority. We review the recent literature regarding the effects of functional food products, probiotics, vaccines, and alternative treatments on treating and preventing UTI.

An integrated method for assessing climate-related risks and adaptation alternatives in urban areas

Directory of Open Access Journals (Sweden)

Yvonne Andersson-Sköld

2015-01-01

Full Text Available The urban environment is a complex structure with interlinked social, ecological and technical structures. Global warming is expected to have a broad variety of impacts, which will add to the complexity. Climate changes will force adaptation, to reduce climate-related risks. Adaptation measures can address one aspect at the time, or aim for a holistic approach to avoid maladaptation. This paper presents a systematic, integrated approach for assessing alternatives for reducing the risks of heat waves, flooding and air pollution in urban settings, with the aim of reducing the risk of maladaptation. The study includes strategies covering different spatial scales, and both the current climate situation and the climate predicted under climate change scenarios. The adaptation strategies investigated included increasing vegetation; selecting density, height and colour of buildings; and retreat or resist (defend against sea-level rise. Their effectiveness was assessed with regard to not only flooding, heat stress and air quality but also with regard to resource use, emissions to air (incl. GHG, soil and water, and people’s perceptions and vulnerability. The effectiveness of the strategies were ranked on a common scale (from −3 to 3 in an integrated assessment. Integrated assessments are recommended, as they help identify the most sustainable solutions, but to reduce the risk of maladaptation they require experts from a variety of disciplines. The most generally applicable recommendation, derived from the integrated assessment here, taking into account both expertise from different municipal departments, literature surveys, life cycle assessments and publics perceptions, is to increase the urban greenery, as it contributes to several positive aspects such as heat stress mitigation, air quality improvement, effective storm-water and flood-risk management, and it has several positive social impacts. The most favourable alternative was compact, mid

Evaluation of a software module for adaptive treatment planning and re-irradiation.

Science.gov (United States)

Richter, Anne; Weick, Stefan; Krieger, Thomas; Exner, Florian; Kellner, Sonja; Polat, Bülent; Flentje, Michael

2017-12-28

The aim of this work is to validate the Dynamic Planning Module in terms of usability and acceptance in the treatment planning workflow. The Dynamic Planning Module was used for decision making whether a plan adaptation was necessary within one course of radiation therapy. The Module was also used for patients scheduled for re-irradiation to estimate the dose in the pretreated region and calculate the accumulated dose to critical organs at risk. During one year, 370 patients were scheduled for plan adaptation or re-irradiation. All patient cases were classified according to their treated body region. For a sub-group of 20 patients treated with RT for lung cancer, the dosimetric effect of plan adaptation during the main treatment course was evaluated in detail. Changes in tumor volume, frequency of re-planning and the time interval between treatment start and plan adaptation were assessed. The Dynamic Planning Tool was used in 20% of treated patients per year for both approaches nearly equally (42% plan adaptation and 58% re-irradiation). Most cases were assessed for the thoracic body region (51%) followed by pelvis (21%) and head and neck cases (10%). The sub-group evaluation showed that unintended plan adaptation was performed in 38% of the scheduled cases. A median time span between first day of treatment and necessity of adaptation of 17 days (range 4-35 days) was observed. PTV changed by 12 ± 12% on average (maximum change 42%). PTV decreased in 18 of 20 cases due to tumor shrinkage and increased in 2 of 20 cases. Re-planning resulted in a reduction of the mean lung dose of the ipsilateral side in 15 of 20 cases. The experience of one year showed high acceptance of the Dynamic Planning Module in our department for both physicians and medical physicists. The re-planning can potentially reduce the accumulated dose to the organs at risk and ensure a better target volume coverage. In the re-irradiation situation, the Dynamic Planning Tool was used to

Complementary and alternative treatments for chronic pelvic pain.

Science.gov (United States)

Carinci, Adam J; Pathak, Ravi; Young, Mark; Christo, Paul J

2013-02-01

Chronic pelvic pain (CPP) is a significant clinical entity that affects both men and women alike. The etiologies of CPP are multifactorial, and treatments are myriad. Complementary and Alternative Medicine (CAM) refers to non-allopathic health systems, and its use is popular in the United States. In particular, several recent studies have investigated the efficacy of various CAM practices in the treatment of CPP. The authors systematically evaluated recent literature in this area by searching the PubMed database for English-language studies published between January 2007 and August 2012.

Feature-based plan adaptation for fast treatment planning in scanned ion beam therapy

International Nuclear Information System (INIS)

Chen Wenjing; Gemmel, Alexander; Rietzel, Eike

2013-01-01

We propose a plan adaptation method for fast treatment plan generation in scanned ion beam therapy. Analysis of optimized treatment plans with carbon ions indicates that the particle number modulation of consecutive rasterspots in depth shows little variation throughout target volumes with convex shape. Thus, we extract a depth-modulation curve (DMC) from existing reference plans and adapt it for creation of new plans in similar treatment situations. The proposed method is tested with seven CT serials of prostate patients and three digital phantom datasets generated with the MATLAB code. Plans are generated with a treatment planning software developed by GSI using single-field uniform dose optimization for all the CT datasets to serve as reference plans and ‘gold standard’. The adapted plans are generated based on the DMC derived from the reference plans of the same patient (intra-patient), different patient (inter-patient) and phantoms (phantom-patient). They are compared with the reference plans and a re-positioning strategy. Generally, in 1 min on a standard PC, either a physical plan or a biological plan can be generated with the adaptive method provided that the new target contour is available. In all the cases, the V95 values of the adapted plans can achieve 97% for either physical or biological plans. V107 is always 0 indicating no overdosage, and target dose homogeneity is above 0.98 in all cases. The dose received by the organs at risk is comparable to the optimized plans. The plan adaptation method has the potential for on-line adaptation to deal with inter-fractional motion, as well as fast off-line treatment planning, with either the prescribed physical dose or the RBE-weighted dose. (paper)

Yeasts acquire resistance secondary to antifungal drug treatment by adaptive mutagenesis.

Directory of Open Access Journals (Sweden)

David Quinto-Alemany

Full Text Available Acquisition of resistance secondary to treatment both by microorganisms and by tumor cells is a major public health concern. Several species of bacteria acquire resistance to various antibiotics through stress-induced responses that have an adaptive mutagenesis effect. So far, adaptive mutagenesis in yeast has only been described when the stress is nutrient deprivation. Here, we hypothesized that adaptive mutagenesis in yeast (Saccharomyces cerevisiae and Candida albicans as model organisms would also take place in response to antifungal agents (5-fluorocytosine or flucytosine, 5-FC, and caspofungin, CSP, giving rise to resistance secondary to treatment with these agents. We have developed a clinically relevant model where both yeasts acquire resistance when exposed to these agents. Stressful lifestyle associated mutation (SLAM experiments show that the adaptive mutation frequencies are 20 (S. cerevisiae -5-FC, 600 (C. albicans -5-FC or 1000 (S. cerevisiae--CSP fold higher than the spontaneous mutation frequency, the experimental data for C. albicans -5-FC being in agreement with the clinical data of acquisition of resistance secondary to treatment. The spectrum of mutations in the S. cerevisiae -5-FC model differs between spontaneous and acquired, indicating that the molecular mechanisms that generate them are different. Remarkably, in the acquired mutations, an ectopic intrachromosomal recombination with an 87% homologous gene takes place with a high frequency. In conclusion, we present here a clinically relevant adaptive mutation model that fulfils the conditions reported previously.

Treatment Alternatives to Negotiate Peri-Implantitis

Directory of Open Access Journals (Sweden)

Eli E. Machtei

2014-01-01

Full Text Available Peri-implant diseases are becoming a major health issue in dentistry. Despite the magnitude of this problem and the potential grave consequences, commonly acceptable treatment protocols are missing. Hence, the present paper reviews the literature treatment of peri-implantitis in order to explore their benefits and limitations. Treatment of peri-implantitis may include surgical and nonsurgical approaches, either individually or combined. Nonsurgical therapy is aimed at removing local irritants from the implants’ surface with or without surface decontamination and possibly some additional adjunctive therapies agents or devices. Systemic antibiotics may also be incorporated. Surgical therapy is aimed at removing any residual subgingival deposits and additionally reducing the peri-implant pockets depth. This can be done alone or in conjunction with either osseous respective approach or regenerative approach. Finally, if all fails, explantation might be the best alternative in order to arrest the destruction of the osseous structure around the implant, thus preserving whatever is left in this site for future reconstruction. The available literature is still lacking with large heterogeneity in the clinical response thus suggesting possible underlying predisposing conditions that are not all clear to us. Therefore, at present time treatment of peri-implantitis should be considered possible but not necessarily predictable.

PTSD and comorbid AUD: a review of pharmacological and alternative treatment options

Directory of Open Access Journals (Sweden)

Ralevski E

2014-03-01

Full Text Available Elizabeth Ralevski, Lening A Olivera-Figueroa, Ismene Petrakis Yale University School of Medicine, Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA Background: Although posttraumatic stress disorder (PTSD and alcohol use disorders (AUD frequently co-occur there are no specific treatments for individuals diagnosed with these comorbid conditions. The main objectives of this paper are to review the literature on pharmacological options for PTSD and comorbid AUD, and to summarize promising behavioral and alternative interventions for those with these dual diagnoses. Methods: We conducted a comprehensive search on PsycINFO and MEDLINE/PubMed databases using Medical Subject Headings terms in various combinations to identify articles that used pharmacotherapy for individuals with dual diagnoses of PTSD and AUD. Similar strategies were used to identify articles on behavioral and alternative treatments for AUD and PTSD. We identified and reviewed six studies that tested pharmacological treatments for patients with PTSD and comorbid AUD. Results: The literature on treatment with US Food and Drug Administration approved medications for patients with dual diagnosis of PTSD and AUD is very limited and inconclusive. Promising evidence indicates that topiramate and prazosin may be effective in reducing PTSD and AUD symptoms in individuals with comorbidity. Seeking safety has had mixed efficacy in clinical trials. The efficacy of other behavioral and alternative treatments (mindfulness-based, yoga, and acupuncture is more difficult to evaluate since the evidence comes from small, single studies without comparison groups. Conclusion: There is a clear need for more systematic and rigorous study of pharmacological, behavioral, and alternative treatments for patients with dual diagnoses of PTSD and AUD. Keywords: dual diagnosis, PTSD, AUD, pharmacotherapy

[Reimbursement for alternative medical treatment in the Netherlands, incomprehensible].

NARCIS (Netherlands)

Hoogen, M.W.F. van den; Popa, C.; Elving, L.D.; Meer, J.W.M. van der

2012-01-01

It is remarkable that, at a time when not only doctors but also the Health Care Inspectorate (IGZ) and the health insurance companies are paying increasing attention to the quality of conventional medicine, many alternative methods of treatments without a scientific basis are accepted in the

Longer treatment with alternative non-drug reinforcement fails to reduce resurgence of cocaine or alcohol seeking in rats.

Science.gov (United States)

Nall, Rusty W; Craig, Andrew R; Browning, Kaitlyn O; Shahan, Timothy A

2018-04-02

Provision of alternative non-drug reinforcement is among the most effective methods for treating substance use disorders. However, when alternative reinforcers become unavailable during treatment interruptions or upon cessation of treatment, relapse often occurs. Relapse following the loss of alternative reinforcement is known as resurgence. One factor that could reduce resurgence is longer duration of treatment with alternative reinforcement, but the available data are mixed. Further, the effects of length of treatment have previously only been examined with food seeking. The present experiments directly examined if duration of treatment impacted the magnitude of resurgence of cocaine or alcohol seeking in rats. First, rats were trained to self-administer cocaine (Experiment 1) or alcohol (Experiment 2) by performing a target behavior. Second, target behavior was extinguished and performing an alternative behavior produced an alternative non-drug (i.e., food) reinforcer. Finally, resurgence was assessed following removal of alternative reinforcement after either 5 or 20 sessions of treatment. Treatment duration did not differentially affect resurgence of cocaine seeking in Experiment 1 or Alcohol seeking in Experiment 2. These results suggest that extended treatment with alternative non-drug reinforcement may not decrease propensity to relapse. Further, these results may have implications for treatment of substance use disorders and for theories of resurgence. Copyright © 2017 Elsevier B.V. All rights reserved.

Evaluation of treatment alternatives for wastes from both spent fuel rod consolidation and miscellaneous commercial activities

International Nuclear Information System (INIS)

Ross, W.A.; Schneider, K.J.; Oma, K.H.; Smith, R.I.; Bunnell, L.R.

1986-07-01

Alternative treatments were considered for both existing commercial transuranic wastes and future wastes from spent fuel rod consolidation. Waste treatment was assumed to occur at a hypothetical central treatment facility (a Monitored Retrieval Storage [MRS] facility was used as a reference). Disposal of the waste in a geologic repository was also assumed. The waste form charcteristics, process characteristics, and costs were evaluated for each waste treatment alternative. The evaluation indicated that selection of a high volume reduction alternative can save almost $1 billion in life-cycle costs for the management of transuranic and high-activity wastes from 70,000 MTU of spent fuel compared to the reference MRS waste treatment processes. The supercompaction, arc pyrolysis and melting, and maximum volume reduction alternatives are recommended for further consideration; the latter two are recommended for further testing and demonstration

Comparative LCA of decentralized wastewater treatment alternatives for non-potable urban reuse.

Science.gov (United States)

Opher, Tamar; Friedler, Eran

2016-11-01

Municipal wastewater (WW) effluent represents a reliable and significant source for reclaimed water, very much needed nowadays. Water reclamation and reuse has become an attractive option for conserving and extending available water sources. The decentralized approach to domestic WW treatment benefits from the advantages of source separation, which makes available simple small-scale systems and on-site reuse, which can be constructed on a short time schedule and occasionally upgraded with new technological developments. In this study we perform a Life Cycle Assessment to compare between the environmental impacts of four alternatives for a hypothetical city's water-wastewater service system. The baseline alternative is the most common, centralized approach for WW treatment, in which WW is conveyed to and treated in a large wastewater treatment plant (WWTP) and is then discharged to a stream. The three alternatives represent different scales of distribution of the WW treatment phase, along with urban irrigation and domestic non-potable water reuse (toilet flushing). The first alternative includes centralized treatment at a WWTP, with part of the reclaimed WW (RWW) supplied back to the urban consumers. The second and third alternatives implement de-centralized greywater (GW) treatment with local reuse, one at cluster level (320 households) and one at building level (40 households). Life cycle impact assessment results show a consistent disadvantage of the prevailing centralized approach under local conditions in Israel, where seawater desalination is the marginal source of water supply. The alternative of source separation and GW reuse at cluster level seems to be the most preferable one, though its environmental performance is only slightly better than GW reuse at building level. Centralized WW treatment with urban reuse of WWTP effluents is not advantageous over decentralized treatment of GW because the supply of RWW back to consumers is very costly in materials and

Effects of ecological restoration alternative treatments on nonnative plant species establishment

Science.gov (United States)

Michael T. Stoddard; Christopher M. McGlone; Peter Z. Fule

2008-01-01

Disturbances generated by forest restoration treatments have the potential for enhancing the establishment of nonnative species thereby impeding long-term native plant recovery. In a ponderosa pine forest next to the Fort Valley Experimental Forest, Arizona, we examined the establishment of nonnative species after three alternative treatments with different intensities...

Noninvasive treatment alternative for intractable startle epilepsy

Directory of Open Access Journals (Sweden)

Sylvia Klinkenberg

2014-01-01

Full Text Available We describe a treatment alternative for intractable, startle-provoked, epileptic seizures in four children aged between 8 and 14. Three of the four children had symptomatic localization-related epilepsy. They all suffered from intractable epilepsy precipitated by sudden sounds. The fact that seizures tended to occur with high frequency – more than one seizure a day – had a clear impact on daily life. Clinical seizure pattern demonstrated asymmetric tonic posturing in all four children. Three children experienced several seizure types including focal seizure onset. All children had focal neurological signs or learning disabilities or a combination of both. Our noninvasive treatment method using psychoeducational counseling and sound generators was applied in four children, resulting in a seizure frequency reduction of ≥50% in two of them.

Alternative prosthodontic-based treatment of a patient with hypocalcified type Amelogenesis Imperfecta.

Science.gov (United States)

Jivanescu, Anca; Miglionico, Antonio; Barua, Souman; Hategan, Simona Ioana

2017-07-01

The Amelogenesis Imperfecta is associated with malocclusion and usually requires an interdisciplinary treatment. Due to the patient's refusal of orthodontic treatment, prosthodontics-based treatments alternative was considered and planned. The patient was treated with zirconia-based fixed partial dentures, which resulted in improved occlusion, better oral health, and improved esthetic appearance.

[An alternative to aortopexy in the treatment of severe tracheomalacia].

Science.gov (United States)

Sánchez Martín , R; Matute Cárdenas , J A; Barrientos Fernández , G; Romero Ruiz , R; García-Casillas, M A; Vázquez Estévez , J

2000-09-01

The classic treatment of severe tracheomalacia is aortopexy. In the 1980s endoscopic insertion of the Palmaz stent, originally designed for use in the treatment of vascular stenosis, began to be used in the treatment of relapsing or residual tracheomalacia. We present a patient with severe tracheomalacia who had previously undergone surgery for esophageal atresia with distal tracheoesophageal fistula in which aortopexy was contraindicated due to a complex congenital heart disease. Treatment consisted of endoscopic insertion of a Palmaz stent. This stent provides an effective alternative to conventional surgery, although each case should be individually evaluated.

Necessary alternatives: patients’ views of asthma treatment

Directory of Open Access Journals (Sweden)

Helen Kopnina

2010-06-01

Full Text Available Helen Kopnina1, Joke Haafkens21Amsterdam Institute for Advanced Labor Studies, University of Amsterdam; 2Department of General Practice, Academic Medical Centre of the University of Amsterdam, The NetherlandsAbstract: This article is based on semistructured interviews and focus groups conducted with 27 asthma patients in The Netherlands who chose complementary and alternative medicine (CAM for treatment of their condition. All subjects were contacted through an online forum for asthma patients hosted by the Dutch Asthma Foundation. Nineteen subjects (12 women and seven men between the ages of 29 and 65 years participated in the interviews, held between June 2009 and January 2010. All of the participating subjects had experience with conventional medications, including anti-inflammatory corticosteroids and bronchodilators. For the focus group meeting, held in February 2010, the sample included seven subjects (four women and three men between the ages of 31 and 46 years, none of whom had ever used conventional medication and all of whom were using CAM. All subjects in the sample had been diagnosed with asthma by their physician or lung specialist. The study examined the causes of patient noncompliance with the prescribed medical regime. It is argued that evidence-based rationality on the part of subjects is an overlooked dimension of their experience of asthma. This study demonstrates the role that the patients’ social network, including medical practitioners, friends, and family, and other asthmatics, plays in the process of decision-making and choices about treating asthma. It also demonstrates the role of patients’ information-searching strategies. The author concludes that patient noncompliance with commonly prescribed medication and selection of alternative medical treatment is less a matter of denial of their diagnosis or the severity of their illness, but more a matter of choice informed by evidence-based rationality.Keywords: asthma

SCIENTIFIC BASED OF ACUPUNCTURE AS ALTERNATIVE TREATMENT OF DIABETES MELLITUS

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Koosnadi Saputra

2012-11-01

Full Text Available Background: Acupuncture its traditional form is based upon the stimulation of well defined points on the body by insertion of metal needles, such needling is considered necessary influenced biological mechanism by intrinsic and extrinsic activation after acupuncture points stimulation. Many clinical report therapeutic effect acupuncture treatment of Diabetes Mellitus especially Non Insulin dependent, the effectiveness of mild or middle type of disease is better that severe one and accompanying With controlling diet and doing more exercise will contribute recovery. Methods: Modem research indicates that acupuncture treatment can control blood sugar level, mainly by adjusting insulin molecular level, enhance insulin secretion and recontrol insulin by regulating central nervous system. Of the all, the improved function of the receptor of insulin target cells is probably the most important one. Results: The basic research approach to animal laboratory (rabbit,rat and mice by electro stimulation, streptozotocin and alloxan monohydrate injection visualizing correlation 13 cell pancreas inorphofunction, insulin receptor and electrical profile of specific pancreas point in body surface. Conclusion: Relationship between biophysical, morphology and physiological study of acupuncture points in diabetic animal and diabetic patient tobase acupuncture model as alternative treatment to diabetes mellitus. Key words: acupuncture, alternative treatment, diabetes mellitus

Assessment of alternatives to correct inventory difference statistical treatment deficiencies

International Nuclear Information System (INIS)

Byers, K.R.; Johnston, J.W.; Bennett, C.A.; Brouns, R.J.; Mullen, M.F.; Roberts, F.P.

1983-11-01

This document presents an analysis of alternatives to correct deficiencies in the statistical treatment of inventory differences in the NRC guidance documents and licensee practice. Pacific Northwest Laboratory's objective for this study was to assess alternatives developed by the NRC and a panel of safeguards statistical experts. Criteria were developed for the evaluation and the assessment was made considering the criteria. The results of this assessment are PNL recommendations, which are intended to provide NRC decision makers with a logical and statistically sound basis for correcting the deficiencies

Adaptive servo ventilation for central sleep apnoea in heart failure: SERVE-HF on-treatment analysis.

Science.gov (United States)

Woehrle, Holger; Cowie, Martin R; Eulenburg, Christine; Suling, Anna; Angermann, Christiane; d'Ortho, Marie-Pia; Erdmann, Erland; Levy, Patrick; Simonds, Anita K; Somers, Virend K; Zannad, Faiez; Teschler, Helmut; Wegscheider, Karl

2017-08-01

This on-treatment analysis was conducted to facilitate understanding of mechanisms underlying the increased risk of all-cause and cardiovascular mortality in heart failure patients with reduced ejection fraction and predominant central sleep apnoea randomised to adaptive servo ventilation versus the control group in the SERVE-HF trial.Time-dependent on-treatment analyses were conducted (unadjusted and adjusted for predictive covariates). A comprehensive, time-dependent model was developed to correct for asymmetric selection effects (to minimise bias).The comprehensive model showed increased cardiovascular death hazard ratios during adaptive servo ventilation usage periods, slightly lower than those in the SERVE-HF intention-to-treat analysis. Self-selection bias was evident. Patients randomised to adaptive servo ventilation who crossed over to the control group were at higher risk of cardiovascular death than controls, while control patients with crossover to adaptive servo ventilation showed a trend towards lower risk of cardiovascular death than patients randomised to adaptive servo ventilation. Cardiovascular risk did not increase as nightly adaptive servo ventilation usage increased.On-treatment analysis showed similar results to the SERVE-HF intention-to-treat analysis, with an increased risk of cardiovascular death in heart failure with reduced ejection fraction patients with predominant central sleep apnoea treated with adaptive servo ventilation. Bias is inevitable and needs to be taken into account in any kind of on-treatment analysis in positive airway pressure studies. Copyright ©ERS 2017.

The feasibility of cognitive adaptation training for outpatients with schizophrenia in integrated treatment

DEFF Research Database (Denmark)

Hansen, Jens Peter; Østergaard, Birte; Nordentoft, Merete

2013-01-01

Cognitive adaptation training (CAT) has been tested as a psychosocial treatment, showing promising results. To date there are no reported tests of CAT treatment outside the United States. Thus, we decided to adjust CAT treatment and apply it to an Integrated Treatment setting in Denmark. In this ...

Approach for systematic evaluation of transuranic waste management alternatives

International Nuclear Information System (INIS)

Hong, K.; Koebnick, B.; Kotek, T.

1994-01-01

This paper describes an approach for systematic evaluation of management alternatives that are being considered for the treatment, storage, and disposal of transuranic waste (TRUW) at U.S. Department of Energy sites. The approach, which is currently under development, would apply WASTE-MGMT, a database application model developed at Argonne National Laboratory, to estimate projected environmental releases and would evaluate impact measures such as health risk and costs associated with each of the waste management alternatives. The customized application would combine site-specific TRUW inventory and characterization data with treatment and transportation parameters to estimate the quantities and characteristics of the wastes to be treated, emissions of hazardous substances from the treatment facilities, and the quantities and characteristics of the wastes to be shipped between sites. These data would then be used to estimate for several TRUW management scenarios the costs and health risks of constructing and operating the required treatment facilities and of transporting TRUW for treatment and final disposal. Treatment, storage, and disposal of TRUW at DOE sites is composed of many variables and options at each stage. The approach described in this paper would provide for efficient consideration of all of these facets when evaluating potentially feasible TRUW management alternatives. By expanding existing databases, this model could eventually be adapted to accommodate the introduction of new treatment technologies, updated TRUW characterization data, and/or revised waste acceptance criteria

Alternatives for the treatment and disposal of healthcare wastes in developing countries

International Nuclear Information System (INIS)

Diaz, L.F.; Savage, G.M.; Eggerth, L.L.

2005-01-01

Waste production in healthcare facilities in developing countries has brought about a variety of concerns due to the use of inappropriate methods of managing the wastes. Inappropriate treatment and final disposal of the wastes can lead to adverse impacts to public health, to occupational health and safety, and to the environment. Unfortunately, most economically developing countries suffer a variety of constraints to adequately managing these wastes. Generally in developing countries, few individuals in the staff of the healthcare facility are familiar with the procedures required for a proper waste management program. Furthermore, the management of wastes usually is delegated to poorly educated laborers who perform most activities without proper guidance and insufficient protection. This paper presents some of the most common treatment and disposal methods utilized in the management of infectious healthcare wastes in developing countries. The methods discussed include: autoclave; microwave; chemical disinfection; combustion (low-, medium-, and high-technology); and disposal on the ground (dump site, controlled landfill, pits, and sanitary landfill). Each alternative for treatment and disposal is explained, including a description of the types of wastes that can and cannot be treated. Background information on the technologies also is included in order to provide information to those who may not be familiar with the details of each alternative. In addition, a brief presentation of some of the emissions from each of the treatment and disposal alternatives is presented

Local adaptive capacity as an alternative approach in dealing with hydrometeorological risk at Depok Peri-Urban City

Science.gov (United States)

Fitrinitia, I. S.; Junadi, P.; Sutanto, E.; Nugroho, D. A.; Zubair, A.; Suyanti, E.

2018-03-01

Located in a tropical area, cities in Indonesia are vulnerable to hydrometeorological risks such as flood and landslide and thus become prone to the climate change effects. Moreover, peri-urban cities had double burden as the consequences of main city spill over and also lack of urban facilities in overcoming the disaster. In another perspective, the city has many alternative resources to recover, so its create urban resiliency. Depok city becomes a case study of this research regarding with its development following the impact of Jakarta growth. This research purposes to capture how the local city dwellers could anticipate and adaptive with flood and landslide with their own mitigation version. Through mix method and spatial analysis using GIS techniques, it derives the two comparison approach, the normative and alternative that had been done by the city dwellers. It uses a spatial analysis to have a big picture of Depok and its environmental changing. It also divided into 4 local group of communities as a representative of city dwellers regarding the characteristic of a settlement with their level of risk. The result found type or characteristic of settlement which influenced the local adaptive capacity, from the establishment of infrastructure, health fulfillment and social livelihood with different kind of methods.

Increasing spelling achievement: an analysis of treatment procedures utilizing an alternating treatments design.

OpenAIRE

Ollendick, T H; Matson, J L; Esveldt-Dawson, K; Shapiro, E S

1980-01-01

Two studies which examine the effectiveness of spelling remediation procedures are reported. In both studies, an alternating treatment design was employed. In the first study, positive practice overcorrection plus positive reinforcement was compared to positive practice alone and a no-remediation control condition. In the second study, positive practice plus positive reinforcement was compared to a traditional corrective procedure plus positive reinforcement and a traditional procedure when u...

Alternatives for OSAHS treatment: selection of patients for upper airway surgery and oral appliances

Directory of Open Access Journals (Sweden)

A. Boudewyns

2007-12-01

Full Text Available Although continuous positive airway pressure (CPAP is considered to represent the standard treatment for patients with moderate-to-severe obstructive sleep apnoea/hypopnoea syndrome (OSAHS, poor treatment compliance and/or refusal is an issue in 20–30% of these patients. As an alternative to life-long CPAP treatment, conservative procedures exist with dental appliances for mandibular advancement, as well as curative surgical techniques. Surgical treatment of OSAHS can be divided into the following two main groups: 1 upper airway surgery by soft tissue resection (uvulopalatopharyngoplasty, etc., and 2 skeletal procedures, such as maxillo-mandibular advancement. Proper selection of patients for the different treatment modalities is the key for full treatment success. Patient-related factors, such as the site of upper airway collapse, craniofacial characteristics, dental health, obesity, age, profession and positional dependence, as well as treatment-related factors, should be evaluated before a final proposal for these treatment alternatives is formulated.

Treatability studies of alternative wastewaters for Metal Finishing Effluent Treatment Facility

International Nuclear Information System (INIS)

Wittry, D.M.; Martin, H.L.

1994-01-01

The 300-M Area Liquid Effluent Treatment Facility (LETF) of the Savannah River Site (SRS) is an end-of-pipe industrial wastewater treatment facility that uses precipitation and filtration, which is the EPA Best Available Technology economically achievable for a Metal Finishing and Aluminum Form Industries. Upon the completion of stored waste treatment, the LETF will be shut down, because production of nuclear materials for reactors stopped at the end of the Cold War. The economic use of the LETF for the treatment of alternative wastewater streams is being evaluated through laboratory bench-scale treatability studies

Alternative Immune Systems

Directory of Open Access Journals (Sweden)

Luis Fernando Cadavid Gutierrez

2011-09-01

Full Text Available The immune system in animals is a complex network of molecules, cells and tissues that coordinately maintain the physiological and genetic integrity of the organism. Traditionally, two classes of immunity have been considered, the innate immunity and the adaptive immunity. The former is ancestral, with limited variability and low discrimination. The latter is highly variable, specific and limited to jawed vertebrates. Adaptive immunity is based on antigen receptors that rearrange somatically to generate a nearly unlimited diversity of molecules. Likely, this mechanism of somatic recombination arose as a consequence of a horizontal transfer of transposons and transposases from bacterial genomes in the ancestor of jawed vertebrates. The recent discovery in jawless vertebrates and invertebrates of alternative adaptive immune mechanisms, suggests during evolution different animal groups have found alternative solutions to the problem of immune recognition.

A Clinical Concept for Interfractional Adaptive Radiation Therapy in the Treatment of Head and Neck Cancer

Energy Technology Data Exchange (ETDEWEB)

Jensen, Alexandra D., E-mail: Alexandra.Jensen@med.uni-heidelberg.de [Department of Radiation Oncology, University of Heidelberg, Heidelberg (Germany); Nill, Simeon [Department of Medical Physics, German Cancer Research Centre (DKFZ), Heidelberg (Germany); Huber, Peter E. [Clinical Co-Operation Unit Radiation Oncology, German Cancer Research Centre (DKFZ), Heidelberg (Germany); Bendl, Rolf [Department of Medical Physics, German Cancer Research Centre (DKFZ), Heidelberg (Germany); Debus, Juergen; Muenter, Marc W. [Department of Radiation Oncology, University of Heidelberg, Heidelberg (Germany)

2012-02-01

Purpose: To present an approach to fast, interfractional adaptive RT in intensity-modulated radiation therapy (IMRT) of head and neck tumors in clinical routine. Ensuring adequate patient position throughout treatment proves challenging in high-precision RT despite elaborate immobilization. Because of weight loss, treatment plans must be adapted to account for requiring supportive therapy incl. feeding tube or parenteral nutrition without treatment breaks. Methods and Materials: In-room CT position checks are used to create adapted IMRT treatment plans by stereotactic correlation to the initial setup, and volumes are adapted to the new geometry. New IMRT treatment plans are prospectively created on the basis of position control scans using the initial optimization parameters in KonRad without requiring complete reoptimization and thus facilitating quick replanning in daily routine. Patients treated for squamous cell head and neck cancer (SCCHN) in 2006-2007 were evaluated as to necessity/number of replannings, weight loss, dose, and plan parameters. Results: Seventy-two patients with SCCHN received IMRT to the primary site and lymph nodes (median dose 70.4 Gy). All patients received concomitant chemotherapy requiring supportive therapy by feeding tube or parenteral nutrition. Median weight loss was 7.8 kg, median volume loss was approximately 7%. Fifteen of 72 patients required adaptation of their treatment plans at least once. Target coverage was improved by up to 10.7% (median dose). The increase of dose to spared parotid without replanning was 11.7%. Replanning including outlining and optimization was feasible within 2 hours for each patient, and treatment could be continued without any interruptions. Conclusion: To preserve high-quality dose application, treatment plans must be adapted to anatomical changes. Replanning based on position control scans therefore presents a practical approach in clinical routine. In the absence of clinically usable online

A Clinical Concept for Interfractional Adaptive Radiation Therapy in the Treatment of Head and Neck Cancer

International Nuclear Information System (INIS)

Jensen, Alexandra D.; Nill, Simeon; Huber, Peter E.; Bendl, Rolf; Debus, Jürgen; Münter, Marc W.

2012-01-01

Purpose: To present an approach to fast, interfractional adaptive RT in intensity-modulated radiation therapy (IMRT) of head and neck tumors in clinical routine. Ensuring adequate patient position throughout treatment proves challenging in high-precision RT despite elaborate immobilization. Because of weight loss, treatment plans must be adapted to account for requiring supportive therapy incl. feeding tube or parenteral nutrition without treatment breaks. Methods and Materials: In-room CT position checks are used to create adapted IMRT treatment plans by stereotactic correlation to the initial setup, and volumes are adapted to the new geometry. New IMRT treatment plans are prospectively created on the basis of position control scans using the initial optimization parameters in KonRad without requiring complete reoptimization and thus facilitating quick replanning in daily routine. Patients treated for squamous cell head and neck cancer (SCCHN) in 2006–2007 were evaluated as to necessity/number of replannings, weight loss, dose, and plan parameters. Results: Seventy-two patients with SCCHN received IMRT to the primary site and lymph nodes (median dose 70.4 Gy). All patients received concomitant chemotherapy requiring supportive therapy by feeding tube or parenteral nutrition. Median weight loss was 7.8 kg, median volume loss was approximately 7%. Fifteen of 72 patients required adaptation of their treatment plans at least once. Target coverage was improved by up to 10.7% (median dose). The increase of dose to spared parotid without replanning was 11.7%. Replanning including outlining and optimization was feasible within 2 hours for each patient, and treatment could be continued without any interruptions. Conclusion: To preserve high-quality dose application, treatment plans must be adapted to anatomical changes. Replanning based on position control scans therefore presents a practical approach in clinical routine. In the absence of clinically usable online

A clinical concept for interfractional adaptive radiation therapy in the treatment of head and neck cancer.

Science.gov (United States)

Jensen, Alexandra D; Nill, Simeon; Huber, Peter E; Bendl, Rolf; Debus, Jürgen; Münter, Marc W

2012-02-01

To present an approach to fast, interfractional adaptive RT in intensity-modulated radiation therapy (IMRT) of head and neck tumors in clinical routine. Ensuring adequate patient position throughout treatment proves challenging in high-precision RT despite elaborate immobilization. Because of weight loss, treatment plans must be adapted to account for requiring supportive therapy incl. feeding tube or parenteral nutrition without treatment breaks. In-room CT position checks are used to create adapted IMRT treatment plans by stereotactic correlation to the initial setup, and volumes are adapted to the new geometry. New IMRT treatment plans are prospectively created on the basis of position control scans using the initial optimization parameters in KonRad without requiring complete reoptimization and thus facilitating quick replanning in daily routine. Patients treated for squamous cell head and neck cancer (SCCHN) in 2006-2007 were evaluated as to necessity/number of replannings, weight loss, dose, and plan parameters. Seventy-two patients with SCCHN received IMRT to the primary site and lymph nodes (median dose 70.4 Gy). All patients received concomitant chemotherapy requiring supportive therapy by feeding tube or parenteral nutrition. Median weight loss was 7.8 kg, median volume loss was approximately 7%. Fifteen of 72 patients required adaptation of their treatment plans at least once. Target coverage was improved by up to 10.7% (median dose). The increase of dose to spared parotid without replanning was 11.7%. Replanning including outlining and optimization was feasible within 2 hours for each patient, and treatment could be continued without any interruptions. To preserve high-quality dose application, treatment plans must be adapted to anatomical changes. Replanning based on position control scans therefore presents a practical approach in clinical routine. In the absence of clinically usable online correction methods, this approach allows significant

Mini-implants: alternative for oral rehabilitation of a child with ectodermal dysplasia.

Science.gov (United States)

Mello, Bianca Zeponi Fernandes; Silva, Thiago Cruvinel; Rios, Daniela; Machado, Maria Aparecida Andrade Moreira; Valarelli, Fabrício Pinelli; Oliveira, Thais Marchini

2015-01-01

Ectodermal dysplasia is a rare congenital disease that affects several structures of ectodermal origin. The most commonly related oral characteristics are hypodontia, malformed teeth and underdeveloped alveolar ridges. New alternative treatments are needed due to the failure of the conventional prosthesis retention. This case report outlines the oral rehabilitation treatment of a 9-year-old girl with ectodermal dysplasia. The treatment was performed with conventional prosthesis upon mini-implants. The mini-implants provided prosthetic retention. The patient reported a good adaptation of the dental prosthesis and satisfaction with the treatment. The increased self-esteem improved the socialization skills of the girl. In this case report, use of prosthesis with mini-implants was satisfactory for prosthetic retention. However, clinical studies with long-term follow-up are needed to test the mini-implants as an alternative for oral rehabilitation of children with ectodermal dysplasia.

Benzo[a]pyrene treatment leads to changes in nuclear protein expression and alternative splicing

Energy Technology Data Exchange (ETDEWEB)

Yan Chunlan; Wu Wei [Department of Toxicology, Zhejiang University School of Public Health, 388 Yu-Hang-Tang Road, Hangzhou, Zhejiang 310058 (China); Li Haiyan [Department of Toxicology, Zhejiang University School of Public Health, 388 Yu-Hang-Tang Road, Hangzhou, Zhejiang 310058 (China); Huzhou Maternity and Child Care Hospital, Huzhou, Zhejiang 313000 (China); Zhang Guanglin [Department of Toxicology, Zhejiang University School of Public Health, 388 Yu-Hang-Tang Road, Hangzhou, Zhejiang 310058 (China); Duerksen-Hughes, Penelope J. [Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA 92354 (United States); Zhu Xinqiang, E-mail: zhuxq@zju.edu.cn [Department of Toxicology, Zhejiang University School of Public Health, 388 Yu-Hang-Tang Road, Hangzhou, Zhejiang 310058 (China); Yang Jun, E-mail: gastate@zju.edu.cn [Department of Toxicology, Zhejiang University School of Public Health, 388 Yu-Hang-Tang Road, Hangzhou, Zhejiang 310058 (China); Zhejiang-California International Nanosystems Institute, Hangzhou, Zhejiang 310029 (China)

2010-04-01

Benzo[a]pyrene (BaP) is a potent pro-carcinogen generated from the combustion of fossil fuel and cigarette smoke. Previously, using a proteomic approach, we have shown that BaP can induce changes in the expression of many cellular proteins, including transcription regulators. In the present study, using a similar approach, we examined the nuclear protein response to BaP in HeLa cells and found that BaP treatment caused expression changes in many nuclear proteins. Twenty-four of these proteins were successfully identified, several of which are involved in the alternative splicing of mRNA, DNA replication, recombination, and repair. The changed expression levels were further confirmed by immunoblot analysis using specific antibodies for two proteins, Lamin A and mitotic checkpoint protein Bub3. The nuclear localization of these two proteins was also confirmed by confocal microscopy. To determine whether alternative splicing was activated following BaP treatment, we examined Fas and CD44, two genes previously shown to be targets of alternative splicing in respond to DNA damage. While no significant activation of alternative splicing was observed for Fas, CD44 splicing variants were found after BaP treatment. Together, these data show that DNA damage induces dramatic changes in nuclear protein expression, and that alternative splicing might be involved in the cellular response to DNA damage.

Adaptive therapy.

Science.gov (United States)

Gatenby, Robert A; Silva, Ariosto S; Gillies, Robert J; Frieden, B Roy

2009-06-01

A number of successful systemic therapies are available for treatment of disseminated cancers. However, tumor response is often transient, and therapy frequently fails due to emergence of resistant populations. The latter reflects the temporal and spatial heterogeneity of the tumor microenvironment as well as the evolutionary capacity of cancer phenotypes to adapt to therapeutic perturbations. Although cancers are highly dynamic systems, cancer therapy is typically administered according to a fixed, linear protocol. Here we examine an adaptive therapeutic approach that evolves in response to the temporal and spatial variability of tumor microenvironment and cellular phenotype as well as therapy-induced perturbations. Initial mathematical models find that when resistant phenotypes arise in the untreated tumor, they are typically present in small numbers because they are less fit than the sensitive population. This reflects the "cost" of phenotypic resistance such as additional substrate and energy used to up-regulate xenobiotic metabolism, and therefore not available for proliferation, or the growth inhibitory nature of environments (i.e., ischemia or hypoxia) that confer resistance on phenotypically sensitive cells. Thus, in the Darwinian environment of a cancer, the fitter chemosensitive cells will ordinarily proliferate at the expense of the less fit chemoresistant cells. The models show that, if resistant populations are present before administration of therapy, treatments designed to kill maximum numbers of cancer cells remove this inhibitory effect and actually promote more rapid growth of the resistant populations. We present an alternative approach in which treatment is continuously modulated to achieve a fixed tumor population. The goal of adaptive therapy is to enforce a stable tumor burden by permitting a significant population of chemosensitive cells to survive so that they, in turn, suppress proliferation of the less fit but chemoresistant

MRI-based treatment plan simulation and adaptation for ion radiotherapy using a classification-based approach

International Nuclear Information System (INIS)

Rank, Christopher M; Tremmel, Christoph; Hünemohr, Nora; Nagel, Armin M; Jäkel, Oliver; Greilich, Steffen

2013-01-01

In order to benefit from the highly conformal irradiation of tumors in ion radiotherapy, sophisticated treatment planning and simulation are required. The purpose of this study was to investigate the potential of MRI for ion radiotherapy treatment plan simulation and adaptation using a classification-based approach. Firstly, a voxelwise tissue classification was applied to derive pseudo CT numbers from MR images using up to 8 contrasts. Appropriate MR sequences and parameters were evaluated in cross-validation studies of three phantoms. Secondly, ion radiotherapy treatment plans were optimized using both MRI-based pseudo CT and reference CT and recalculated on reference CT. Finally, a target shift was simulated and a treatment plan adapted to the shift was optimized on a pseudo CT and compared to reference CT optimizations without plan adaptation. The derivation of pseudo CT values led to mean absolute errors in the range of 81 - 95 HU. Most significant deviations appeared at borders between air and different tissue classes and originated from partial volume effects. Simulations of ion radiotherapy treatment plans using pseudo CT for optimization revealed only small underdosages in distal regions of a target volume with deviations of the mean dose of PTV between 1.4 - 3.1% compared to reference CT optimizations. A plan adapted to the target volume shift and optimized on the pseudo CT exhibited a comparable target dose coverage as a non-adapted plan optimized on a reference CT. We were able to show that a MRI-based derivation of pseudo CT values using a purely statistical classification approach is feasible although no physical relationship exists. Large errors appeared at compact bone classes and came from an imperfect distinction of bones and other tissue types in MRI. In simulations of treatment plans, it was demonstrated that these deviations are comparable to uncertainties of a target volume shift of 2 mm in two directions indicating that especially

The irradiation as alternative treatment for laboratory wastes

International Nuclear Information System (INIS)

Borrely, Sueli Ivone; Romanelli, Maria Fernanda; Silva, Giovana Pasqualini da; Castro, Daniela Marques

2005-01-01

The irradiation of effluents may be done by electron accelerator or gamma radiation source (cobalt-60). This technology has been developed as an alternative for several contaminants from different processes and sources. This paper shows the results of electron beam applied to liquid laboratories residues (effluents and standard solutions). Radiation doses were determined for the improvement of laboratories residues measured by detoxification of them. New technologies for residues treatment as well as decreasing contaminants generation is essential part of laboratories activities for environmental management for industry, universities and research institutions. (author)

Alternatives for managing wastes from reactors and post-fission operations in the LWR fuel cycle. Volume 2. Alternatives for waste treatment

International Nuclear Information System (INIS)

1976-05-01

Volume II of the five-volume report is devoted to the description of alternatives for waste treatment. The discussion is presented under the following section titles: fuel reprocessing modifications; high-level liquid waste solidification; treatment and immobilization of chop-leach fuel bundle residues; treatment of noncombustible solid wastes; treatment of combustible wastes; treatment of non-high-level liquid wastes; recovery of transuranics from non-high-level wastes; immobilization of miscellaneous non-high-level wastes; volatile radioisotope recovery and off-gas treatment; immobilization of volatile radioisotopes; retired facilities (decontamination and decommissioning); and, modification and use of selected fuel reprocessing wastes

Alternatives for managing wastes from reactors and post-fission operations in the LWR fuel cycle. Volume 2. Alternatives for waste treatment

Energy Technology Data Exchange (ETDEWEB)

1976-05-01

Volume II of the five-volume report is devoted to the description of alternatives for waste treatment. The discussion is presented under the following section titles: fuel reprocessing modifications; high-level liquid waste solidification; treatment and immobilization of chop-leach fuel bundle residues; treatment of noncombustible solid wastes; treatment of combustible wastes; treatment of non-high-level liquid wastes; recovery of transuranics from non-high-level wastes; immobilization of miscellaneous non-high-level wastes; volatile radioisotope recovery and off-gas treatment; immobilization of volatile radioisotopes; retired facilities (decontamination and decommissioning); and, modification and use of selected fuel reprocessing wastes. (JGB)

Alternative Remedies

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... Home › Aging & Health A to Z › Alternative Remedies Font ... medical treatment prescribed by their healthcare provider. Using this type of alternative therapy along with traditional treatments is ...

Cryosurgery as an effective alternative for treatment of oral lesions in children.

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Rezende, Karla Mayra; Moraes, Paulo de Camargo; Oliveira, Luciana Butini; Thomaz, Luiz Alexandre; Junqueira, José Luiz Cintra; Bönecker, Marcelo

2014-01-01

Children can exhibit a wide variety of oral pathologies, such as oral lesions, bone lesions, tumors, cysts and cutaneous lesions. Different techniques have been described for the treatment of these lesions, but all of them are invasive. This paper presents a series of cases that demonstrate the clinical efficacy of cryosurgery as an alternative to invasive surgical treatments of the most common oral lesions in children. This technique has been well tolerated by patients due to the absence of anesthesia, rapid healing and minimal bleeding. Cryotherapy has many applications in oral medicine and is an extremely useful alternative in patients to whom surgery is contraindicated due to age or medical history. It is a simple procedure to perform, minimally invasive, low-cost and very effective in pediatric dentistry clinic.

Amoxicillin and Ceftriaxone as Treatment Alternatives to Penicillin for Maternal Syphilis.

Science.gov (United States)

Katanami, Yuichi; Hashimoto, Takehiro; Takaya, Saho; Yamamoto, Kei; Kutsuna, Satoshi; Takeshita, Nozomi; Hayakawa, Kayoko; Kanagawa, Shuzo; Ohmagari, Norio

2017-05-01

There is no proven alternative to penicillin for treatment of maternal syphilis. We report 2 case-patients with maternal syphilis who were successfully treated without penicillin. We used amoxicillin and probenecid for the first case-patient and amoxicillin, probenecid, and ceftriaxone for the second case-patient.

Effect of Treatment Education Based on the Roy Adaptation Model on Adjustment of Hemodialysis Patients.

Science.gov (United States)

Kacaroglu Vicdan, Ayse; Gulseven Karabacak, Bilgi

2016-01-01

The Roy Adaptation Model examines the individual in 4 fields: physiological mode, self-concept mode, role function mode, and interdependence mode. Hemodialysis treatment is associated with the Roy Adaptation Model as it involves fields that might be needed by the individual with chronic renal disease. This research was conducted as randomized controlled experiment with the aim of determining the effect of the education given in accordance with the Roy Adaptation Model on physiological, psychological, and social adaptation of individuals undergoing hemodialysis treatment. This was a random controlled experimental study. The study was conducted at a dialysis center in Konya-Aksehir in Turkey between July 1 and December 31, 2012. The sample was composed of 82 individuals-41 experimental and 41 control. In the second interview, there was a decrease in the systolic blood pressures and body weights of the experimental group, an increase in the scores of functional performance and self-respect, and a decrease in the scores of psychosocial adaptation. In the control group, on the other hand, there was a decrease in the scores of self-respect and an increase in the scores of psychosocial adaptation. The 2 groups were compared in terms of adaptation variables and a difference was determined on behalf of the experimental group. The training that was provided and evaluated for individuals receiving hemodialysis according to 4 modes of the Roy Adaptation Model increased physical, psychological, and social adaptation.

Rifampicin for Idiopathic Granulomatous Lobular Mastitis: A Promising Alternative for Treatment.

Science.gov (United States)

Farouk, Omar; Abdelkhalek, Mohamed; Abdallah, Ahmed; Shata, Ahmed; Senbel, Ahmed; Attia, Essam; Elghaffar, Mohamed Abd; Mesbah, Mahmoud; Soliman, Nermine; Amin, Maha; El-Tantawy, Dina

2017-05-01

Idiopathic granulomatous lobular mastitis (IGLM) is a chronic, non-caseating, inflammatory breast disease of obscure aetiology characterized by multiple masses, abscesses and sinus formation. There is no standard treatment to date, but surgical procedures and systemic corticosteroids are effective in its treatment despite high recurrence rates. This prospective study including 30 patients with IGLM between November 2012 and May 2016 aimed to investigate the possibility of administration of Rifampicin (300 mg twice daily for a period of 6-9 months) as an alternative therapy for both surgery and corticosteroids in patients with IGLM. All patients were diagnosed by core needle biopsy. All patients were of reproductive age and had a history of breast feeding, which is the most important predisposing factor for IGLM. The mean age was 31.6 ± 5.8 years (range 23-42 years). Eighteen patients (60%) were treated by Rifampicin for 6 months, whereas 12 patients (40%) were treated for 9 months. Twelve months after the beginning of therapy, all patients showed complete clinical and ultrasonographic responses. No serious side effects were reported to stop the treatment course. The median follow-up after finishing the course of treatment was 15.5 months (average 3-35 months) with no episodes of disease relapse. Rifampicin is effective in the treatment of patients with IGLM with complete clinical and ultrasonographic response after 6-9 months and could be used as a solo medical therapy alternative to both surgery and corticosteroids.

Cultural Adaptations of Prolonged Exposure Therapy for Treatment and Prevention of Posttraumatic Stress Disorder in African Americans

Directory of Open Access Journals (Sweden)

Monnica T. Williams

2014-05-01

Full Text Available Posttraumatic stress disorder (PTSD is a highly disabling disorder, afflicting African Americans at disproportionately higher rates than the general population. When receiving treatment, African Americans may feel differently towards a European American clinician due to cultural mistrust. Furthermore, racism and discrimination experienced before or during the traumatic event may compound posttrauma reactions, impacting the severity of symptoms. Failure to adapt treatment approaches to encompass cultural differences and racism-related traumas may decrease treatment success for African American clients. Cognitive behavioral treatment approaches are highly effective, and Prolonged Exposure (PE in particular has the most empirical support for the treatment of PTSD. This article discusses culturally-informed adaptations of PE that incorporates race-related trauma themes specific to the Black experience. These include adding more sessions at the front end to better establish rapport, asking directly about race-related themes during the assessment process, and deliberately bringing to the forefront race-related experiences and discrimination during treatment when indicated. Guidelines for assessment and the development of appropriate exposures are provided. Case examples are presented demonstrating adaptation of PE for a survivor of race-related trauma and for a woman who developed internalized racism following a sexual assault. Both individuals experienced improvement in their posttrauma reactions using culturally-informed adaptations to PE.

[Aripiprazole - a medical treatment alternative for Tourette Syndrome in childhood and adolescence].

Science.gov (United States)

Frölich, Jan; Starck, Martina; Banaschewski, Tobias; Lehmkuhl, Gerd

2010-07-01

We report a case-series of seven patients with a medical history of at least two years of tic disorder treated with the partial dopamine agonist aripiprazole to illustrate its efficacy as a treatment alternative for motor and vocal tics in children and adolescents. A case series of five patients with Tourette Syndrome (TS) and two with chronic motor tic disorder (age range 8; 7-18; 1 year), the majority of whom had been refractory to treatment with other neuroleptics or had ceased treatment due to intolerable side effects, were treated for eight weeks with aripiprazole. Before and after treatment, parents rated the severity of motor and vocal tic symptoms on the Yale Tourette Syndrome Checklist. Within eight weeks mean motor tic symptoms decreased by 66% and mean vocal tic symptoms decreased by 26%. Mean effective dosage was 14.3 mg/day (min. 5 mg, max. 30 mg). Symptoms of comorbid ADHD or Obsessive Compulsive Disorder were not significantly influenced. During medication only mild side effects were observed, e.g., abdominal pain, fatigue and increased emotional sensitivity. No patient dropped out of treatment due to side effects. Aripiprazole may be an effective pharmacologic treatment alternative for individuals with chronic motor tic disorder and TS. It induces quick, significant and sustained effects with few generally mild and transient side effects, if anything. Its effectiveness, especially relative to comorbidities, should be verified in double-blind, placebo-controlled studies.

Evaluating alternative fuel treatment strategies to reduce wildfire losses in a Mediterranean area

Science.gov (United States)

Michele Salis; Maurizio Laconi; Alan A. Ager; Fermin J. Alcasena; Bachisio Arca; Olga Lozano; Ana Fernandes de Oliveira; Donatella Spano

2016-01-01

The goal of this work is to evaluate by a modeling approach the effectiveness of alternative fuel treatment strategies to reduce potential losses from wildfires in Mediterranean areas. We compared strategic fuel treatments located near specific human values vs random locations, and treated 3, 9 and 15% of a 68,000 ha study area located in Sardinia, Italy. The...

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

Science.gov (United States)

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

2012-01-01

Although breast cancer is a highly treatable disease, some women reject conventional treatment opting for unproven "alternative therapy" that may contribute to poor health outcomes. This study sought to understand why some women make this decision and to identify messages that might lead to greater acceptance of evidence-based treatment. This study explored treatment decision making through in-depth interviews with 60 breast cancer patients identified by their treating oncologists. Thirty refused some or all conventional treatment, opting for alternative therapies, whereas 30 accepted both conventional and alternative treatments. All completed the Beck Anxiety Inventory and the Rotter Locus of Control scale. Negative first experiences with "uncaring, insensitive, and unnecessarily harsh" oncologists, fear of side effects, and belief in the efficacy of alternative therapies were key factors in the decision to reject potentially life-prolonging conventional therapy. Refusers differed from controls in their perceptions of the value of conventional treatment, believing that chemotherapy and radiotherapy were riskier (p communicate hope, educate them about their options, and allow them time to come to terms with their diagnosis before starting treatment might have led them to better treatment choices.

DOE evaluates nine alternative thermal technologies for treatment of mixed waste

International Nuclear Information System (INIS)

Anon.

1995-01-01

In June 1993, the U.S. Department of Energy's (DOE's) Office of Technology Development commissioned a study to evaluate 19 thermal technologies for treating DOE's mixed waste. The study was divided into two phases: Phase I evaluated ten conventional incineration techniques (primarily rotary kiln), and Phase II looked at nine innovative, alternative thermal treatment technologies. The treatment processes were evaluated as part of an integrated waste treatment system, which would include all of the facilities, equipment, and methods required to treat and dispose DOE mixed waste. The relative merits and life-cycle costs were then developed for each of the 19 waste treatment systems evaluated. The study also identified the additional research and development, demonstration, and testing/evaluation steps that would be necessary for the waste treatment systems to successfully treat DOE mixed waste. 3 tabs., 2 refs

ALTERNATIVE FOR PHENOL BIODEGRADATION IN OIL CONTAMINATED WASTEWATERS USING AN ADAPTED BACTERIAL BIOFILM LAYER

Directory of Open Access Journals (Sweden)

Maria Kopytko

2008-12-01

Full Text Available The project studied the biodegradation potential of phenols in an industrial wastewater from an oil field in the province of Santander, Colombia. An elevated potential was established, according to three important factors: the great abundance of microorganisms found in the wastewater and sludge samples collected, the bacterial adaptation to high phenol concentrations (10 mg/l and the elevated elimination efficiencies (up to 86% obtained in the laboratory tests. The laboratory scale treatment system, which consisted of fixed-bed bioreactors with adapted bacterial biofilm, was optimized using a 22 factorial experimental design. The selected variables, studied in their maximum and minimum level were: HRT (hydraulic retention time and the presence or absence of GAC (granular activated carbon layer. The response variable was phenol concentration. The optimum treatment conditions for low and high phenol concentrations (2.14 y 9.30 mg/l, were obtained with the presence of GAC and 18 hours of HRT. The best result for the intermediate phenol concentration (6.13 mg/l was obtained with a 24 hour HRT and the presence of GAC. Nevertheless, the presence of the GAC layer was not significantly important in terms of phenol removal. Moreover, the increase of HRT from 18 to 24 hours, showed no significant improvement in phenol removal.

Alternative treatment of symptomatic pancreatic fistula.

Science.gov (United States)

Wiltberger, Georg; Schmelzle, Moritz; Tautenhahn, Hans-Michael; Krenzien, Felix; Atanasov, Georgi; Hau, Hans-Michael; Moche, Michael; Jonas, Sven

2015-06-01

The management of symptomatic pancreatic fistula after pancreaticoduodenectomy is complex and associated with increased morbidity and mortality. We here report continuous irrigation and drainage of the pancreatic remnant to be a feasible and safe alternative to total pancreatectomy. Between 2005 and 2011, patients were analyzed, in which pancreaticojejunal anastomosis was disconnected because of grade C fistula, and catheters for continuous irrigation and drainage were placed close to the pancreatic remnant. Clinical data were monitored and quality of life was evaluated. A total of 13 of 202 patients undergoing pancreaticoduodenectomy required reoperation due to symptomatic pancreatic fistula. Ninety-day mortality of these patients was 15.3%. Median length of stay on the intensive care unit and total length of stay was 18 d (range 3-45) and 46 d (range 33-96), respectively. Patients with early reoperation (<10 d) had significantly decreased length of stay on the intensive care unit and operation time (P < 0.05). Global health status after a median time of 22 mo (range 6-66) was nearly identical, when compared with that of a healthy control group. Mean follow-up was 44.4 mo (±27.2). Four patients (36.6 %) died during the follow-up period; two patients from tumor recurrence, one patient from pneumonia, and one patient for unknown reasons. Treatment of pancreatic fistula by continuous irrigation and drainage of the preserved pancreatic remnant is a simple and feasible alternative to total pancreatectomy. This technique maintains a sufficient endocrine function and is associated with low mortality and reasonable quality of life. Copyright © 2015 Elsevier Inc. All rights reserved.

Dosimetric evaluation of three adaptive strategies for prostate cancer treatment including pelvic lymph nodes irradiation.

Science.gov (United States)

Cantin, Audrey; Gingras, Luc; Lachance, Bernard; Foster, William; Goudreault, Julie; Archambault, Louis

2015-12-01

The movements of the prostate relative to the pelvic lymph nodes during intensity-modulated radiation therapy treatment can limit margin reduction and affect the protection of the organs at risk (OAR). In this study, the authors performed an analysis of three adaptive treatment strategies that combine information from both bony and gold marker registrations. The robustness of those treatments against the interfraction prostate movements was evaluated. A retrospective study was conducted on five prostate cancer patients with 7-13 daily cone-beam CTs (CBCTs). The clinical target volumes (CTVs) consisting of pelvic lymph nodes, prostate, and seminal vesicles as well as the OARs were delineated on each CBCT and the initial CT. Three adaptive strategies were analyzed. Two of these methods relied on a two-step patient positioning at each fraction. First step: a bony registration was used to deliver the nodal CTV prescription. Second step: a gold marker registration was then used either to (1) complete the dose delivered to the prostate (complement); (2) or give almost the entire prescription to the prostate with a weak dose gradient between the targets to compensate for possible motions (gradient). The third method (COR) used a pool of precalculated plans based on images acquired at previous treatment fractions. At each new fraction, a plan is selected from that pool based on the daily position of prostate center-of-mass. The dosimetric comparison was conducted and results are presented with and without the systematic shift in the prostate position on the CT planning. The adaptive strategies were compared to the current clinical standard where all fractions are treated with the initial nonadaptive plan. The minimum daily prostate D95% is improved by 2%, 9%, and 6% for the complement, the gradient, and the COR approaches, respectively, compared to the nonadaptive method. The average nodal CTV D95% remains constant across the strategies, except for the gradient approach

Dosimetric evaluation of three adaptive strategies for prostate cancer treatment including pelvic lymph nodes irradiation

International Nuclear Information System (INIS)

Cantin, Audrey; Gingras, Luc; Archambault, Louis; Lachance, Bernard; Foster, William; Goudreault, Julie

2015-01-01

Purpose: The movements of the prostate relative to the pelvic lymph nodes during intensity-modulated radiation therapy treatment can limit margin reduction and affect the protection of the organs at risk (OAR). In this study, the authors performed an analysis of three adaptive treatment strategies that combine information from both bony and gold marker registrations. The robustness of those treatments against the interfraction prostate movements was evaluated. Methods: A retrospective study was conducted on five prostate cancer patients with 7–13 daily cone-beam CTs (CBCTs). The clinical target volumes (CTVs) consisting of pelvic lymph nodes, prostate, and seminal vesicles as well as the OARs were delineated on each CBCT and the initial CT. Three adaptive strategies were analyzed. Two of these methods relied on a two-step patient positioning at each fraction. First step: a bony registration was used to deliver the nodal CTV prescription. Second step: a gold marker registration was then used either to (1) complete the dose delivered to the prostate (complement); (2) or give almost the entire prescription to the prostate with a weak dose gradient between the targets to compensate for possible motions (gradient). The third method (COR) used a pool of precalculated plans based on images acquired at previous treatment fractions. At each new fraction, a plan is selected from that pool based on the daily position of prostate center-of-mass. The dosimetric comparison was conducted and results are presented with and without the systematic shift in the prostate position on the CT planning. The adaptive strategies were compared to the current clinical standard where all fractions are treated with the initial nonadaptive plan. Results: The minimum daily prostate D 95% is improved by 2%, 9%, and 6% for the complement, the gradient, and the COR approaches, respectively, compared to the nonadaptive method. The average nodal CTV D 95% remains constant across the strategies

Guidance: Demonstrating Compliance with the Land Disposal Restrictions (LDR) Alternative Soil Treatment Standards

Science.gov (United States)

This guidance provides suggestions and perspectives on how members of the regulated community, states, and the public can demonstrate compliance with the alternative treatment standards for certain contaminated soils that will be land disposed.

[ARIA Mexico 2014. Adaptation of the Clinical Practice Guide ARIA 2010 for Mexico. Methodology ADAPTE].

Science.gov (United States)

Larenas-Linnemann, Désirée; Mayorga-Butrón, José Luis; Sánchez-González, Andrés; Ramírez-García, Arturo; Medina-Ávalos, Miguel; Figueroa-Morales, Marco Antonio; Montaño-Velázquez, B Beatriz; Montes-Narváez, Gabriel; Romero-Tapia, Sergio; Stone-Aguilar, Héctor; Xochihua-Díaz, Luis; Salas-Hernández, Jorge; Hernán-Ruiz, Héctor; Betancourt-Suárez, Miguel A; Cano-Salas, María Carmen; Curiel-Aceves, Lorenzo; Dibildox-Martínez, Javier; Fernández-Vega, Margarita; García-Bolaños, Carlos; Iduñate-Palacios, Fernando; Jiménez-Chobillon, M Alejandro; López-Lizárraga, Doris N; Matta-Campos, Juan José; Olvera-Salinas, Jorge; Rivera-Gómez, María Antonia; Virgen-Ortega, César; Sienra-Monge, Juan José; Del Río-Navarro, Blanca; Arias-Cruz, Alfredo; Sacre-Hazouri, Antonio; Aguilar-Aranda, Ambrocio; Vásquez Del Mercado-Cordero, Rodrigo; Barnica, Raúl Humberto; Velasco-Hidalgo, Liliana; Solís-Galicia, Cecilia

2014-01-01

The global prevalence of allergic rhinitis is high. International Study of Asthma and Allergies in Childhood (ISAAC) Phase III reports a total estimated prevalence of 4.6% in Mexico. There is evidence based on allergic rhinitis Clinical Practice Guidelines (CPG), but its promotion, acceptance and application is not optimal or adequate in Mexico. To generate a guideline for the treatment of allergic rhinitis and its impact on asthma by adaptating the 2010 ARIA Guideline to Mexican reality, through a transculturation process applying the ADAPTE methodology. Using the ADAPTE Methodology, the original 2010 ARIA CPG recommendations were evaluated by the guideline development group (GDG) into which multiple medical specialities managing patients with allergic rhinitis were incoorporated. The GDG valorated the quality of 2010 ARIA, checked and translated key clinical questions. Moreover, the GDG adjusted recommendations, patient preferences and included comments in the context of the Mexican reality (safety, costs and cultural issues). To accomplish this, we ran Delphi panels with as many rounds as necessary to reach agreement. One extra question, not included in the original 2010 ARIA, on the use of Nasal Lavages for AR was created sustained by a systematic literature review. A total of 45 questions from the original 2010 ARIA were included and divided into six groups covering prevention, medical treatment, immunotherapy and alternative medicine to treat patients with allergic rhinitis with or without asthma. Most of the questions reached agreement in one or two rounds; one question required three rounds. An easy-to-use, adaptated, up-to-date and applicable allergic rhinitis guideline for Mexico is now available.

[Alternative treatment methods in ENT].

Science.gov (United States)

Friese, K H

1997-08-01

In this review, the most important complementary und alternative therapies are discussed, focusing particularly on their use in otorhinolaryngology. These therapies include balneology, Kneipp therapy, microbiological therapy, fasting, excretion therapy, different oxygen therapies, hydro-colon therapy, urine therapy, own-blood therapy, Bach therapy, orthomolecular therapy, order therapy, environmental medicine, phytotherapy, homeopathy, complex homeopathy, anthroposophy, neural therapy, electroaccupuncture according to Voll and similar therapies, nasal reflex therapy, reflex-zone massage, manual therapy, massage, lymph drainage, aroma therapy, thermotherapy, bioresonance, kinesiology, hopi candles, and dietetics. Some of these methods and regimens can be recommended, but others should be rejected. In universities, these methods are only represented to a minor extend, but are more accepted by otorhinolaryngologists in practice. This paper provides a guide to which alternative therapies are sensible and possible in otorhinolaryngology. The aim is to stimulate interest in these methods. It is necessary to discuss these alternative methods reasonably and credibly with patients.

Multidimensional Treatment Foster Care: An Alternative to Residential Treatment for High Risk Children and Adolescents

Directory of Open Access Journals (Sweden)

Philip A. Fisher

2012-07-01

Full Text Available This paper describes the Multidimensional Treatment Foster Care program (MTFC, an evidence based approach for providing psychotherapeutic treatment for very troubled children and adolescents that is an alternative to residential care. Versions of the MTFC program have been developed and validated for young children with a history of maltreatment as well as for older children and adolescents who are involved with the youth justice system. In the paper we describe the development of the MTFC program and its foundations in the social learning model that originated at the Oregon Social Learning Center in the 1960's and 70's. We present information about program elements. We then review the research that has been conducted on MTFC.

The role of complementary and alternative medicine in the treatment of eating disorders: A systematic review.

Science.gov (United States)

Fogarty, Sarah; Smith, Caroline A; Hay, Phillipa

2016-04-01

This systematic review critically appraises the role of complementary and alternative medicine in the treatment of those with an eating disorder. Sixteen studies were included in the review. The results of this review show that the role of complementary and alternative medicine in the treatment of those with an eating disorder is unclear and further studies should be conducted. A potential role was found for massage and bright light therapy for depression in those with Bulimia Nervosa and a potential role for acupuncture and relaxation therapy, in the treatment of State Anxiety, for those with an eating disorder. The role of these complementary therapies in treating eating disorders should only be provided as an adjunctive treatment only. Copyright © 2016 Elsevier Ltd. All rights reserved.

Preliminary engineering assessment of treatment alternatives for groundwater from the Hanford 200 Area 200-BP-5 plumes

International Nuclear Information System (INIS)

1996-05-01

This report presents the results of the Preliminary Engineering Assessment of Treatment Alternatives (PEATA), an engineering evaluation of potential treatment alternatives for groundwater extracted from the 200-BP-5 Area's 216-BY Cribs and 216-B-5 Reverse Well plumes. The primary objective of the PEATA was to identify treatment technologies that are worth further consideration (i.e., treatability testing or a more refined engineering evaluation). It will also provide a basis for evaluating the results of the treatability testing that is currently being conducted on the presumptive remedy of ion exchange with disposal of spent resin and will serve as a guide for selection of other technologies for additional testing. Because there are little data or past experience with groundwater similar to the BY-Crib and B-5 Reverse Well Plumes, treatment efficiencies cannot be predicted with certainty and rigorous treatment system designs and costs cannot be developed. This applies to all alternatives, including the presumptive remedy of ion exchange. The approach for this study was to develop conceptual designs and approximate costs for the treatment technologies that were most likely to be effective on the BY-Crib and B-5 Reverse Well groundwater

Can adaptive treatment improve outcomes in family-based therapy for adolescents with anorexia nervosa? Feasibility and treatment effects of a multi-site treatment study.

Science.gov (United States)

Lock, James; Le Grange, Daniel; Agras, W Stewart; Fitzpatrick, Kathleen Kara; Jo, Booil; Accurso, Erin; Forsberg, Sarah; Anderson, Kristen; Arnow, Kate; Stainer, Maya

2015-10-01

Adolescents with Anorexia Nervosa (AN), treated with family-based treatment (FBT) who fail to gain 2.3 kg by the fourth week of treatment have a 40-50% lower chance of recovery than those who do. Because of the high risk of developing enduring AN, improving outcomes in this group of poor responders is essential. This study examines the feasibility and effects of a novel adaptive treatment (i.e., Intensive Parental Coaching-IPC) aimed at enhancing parental self-efficacy related to re-feeding skills in poor early responders to FBT. 45 adolescents (12-18 years of age) meeting DSM TR IV criteria for AN were randomized in an unbalanced design (10 to standard FBT; 35 to the adaptive arm). Attrition, suitability, expectancy rates, weight change, and psychopathology were compared between groups. There were no differences in rates of attrition, suitability, expectancy ratings, or most clinical outcomes between randomized groups. However, the group of poor early responders that received IPC achieved full weight restoration (>95% of expected mean BMI) by EOT at similar rates as those who had responded early. The results of this study suggest that it is feasible to use an adaptive design to study the treatment effect of IPC for those who do not gain adequate weight by session 4 of FBT. The results also suggest that using IPC for poor early responders significantly improves weight recovery rates to levels comparable to those who respond early. A sufficiently powered study is needed to confirm these promising findings. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Factors determining the selection of treatment options of complementary and alternative medicine].

Science.gov (United States)

Zörgő, Szilvia; Purebl, György; Zana, Ágnes

2016-04-10

Complementary and alternative medicine have undoubtedly been gaining ground on the healthcare market, thus the vital question arises why patients choose these treatments, oftentimes at the cost of discontinuing the Western medical therapy. The aim of the authors was to investigate and scrutinize factors leading to the utilization of various alternative medical services. The basis of this qualitative research was medical anthropological fieldwork conducted at a clinic of Traditional Chinese Medicine including participant observation (355 hours), unstructured interviews with patients (n = 93) and in-depth interviews (n = 14). Patients of alternative medical systems often do not receive a diagnosis, explanation or cure for their illness from Western medicine, or they do not agree with what they are offered. In other instances, patients choose alternative medicine because it exhibits a philosophical congruence with their already existing explanatory model, that is, previous concepts of world, man or illness. A particular therapy is always part of a cultural system and it is embedded in a specific psycho-social context, hence choice of therapy must be interpreted in accordance with this perspective.

Quality assurance for online adapted treatment plans: Benchmarking and delivery monitoring simulation

International Nuclear Information System (INIS)

Li, Taoran; Wu, Qiuwen; Yang, Yun; Rodrigues, Anna; Yin, Fang-Fang; Jackie Wu, Q.

2015-01-01

Purpose: An important challenge facing online adaptive radiation therapy is the development of feasible and efficient quality assurance (QA). This project aimed to validate the deliverability of online adapted plans and develop a proof-of-concept online delivery monitoring system for online adaptive radiation therapy QA. Methods: The first part of this project benchmarked automatically online adapted prostate treatment plans using traditional portal dosimetry IMRT QA. The portal dosimetry QA results of online adapted plans were compared to original (unadapted) plans as well as randomly selected prostate IMRT plans from our clinic. In the second part, an online delivery monitoring system was designed and validated via a simulated treatment with intentional multileaf collimator (MLC) errors. This system was based on inputs from the dynamic machine information (DMI), which continuously reports actual MLC positions and machine monitor units (MUs) at intervals of 50 ms or less during delivery. Based on the DMI, the system performed two levels of monitoring/verification during the delivery: (1) dynamic monitoring of cumulative fluence errors resulting from leaf position deviations and visualization using fluence error maps (FEMs); and (2) verification of MLC positions against the treatment plan for potential errors in MLC motion and data transfer at each control point. Validation of the online delivery monitoring system was performed by introducing intentional systematic MLC errors (ranging from 0.5 to 2 mm) to the DMI files for both leaf banks. These DMI files were analyzed by the proposed system to evaluate the system’s performance in quantifying errors and revealing the source of errors, as well as to understand patterns in the FEMs. In addition, FEMs from 210 actual prostate IMRT beams were analyzed using the proposed system to further validate its ability to catch and identify errors, as well as establish error magnitude baselines for prostate IMRT delivery

Quality assurance for online adapted treatment plans: Benchmarking and delivery monitoring simulation

Energy Technology Data Exchange (ETDEWEB)

Li, Taoran, E-mail: taoran.li.duke@gmail.com; Wu, Qiuwen; Yang, Yun; Rodrigues, Anna; Yin, Fang-Fang; Jackie Wu, Q. [Department of Radiation Oncology, Duke University Medical Center Durham, North Carolina 27710 (United States)

2015-01-15

Purpose: An important challenge facing online adaptive radiation therapy is the development of feasible and efficient quality assurance (QA). This project aimed to validate the deliverability of online adapted plans and develop a proof-of-concept online delivery monitoring system for online adaptive radiation therapy QA. Methods: The first part of this project benchmarked automatically online adapted prostate treatment plans using traditional portal dosimetry IMRT QA. The portal dosimetry QA results of online adapted plans were compared to original (unadapted) plans as well as randomly selected prostate IMRT plans from our clinic. In the second part, an online delivery monitoring system was designed and validated via a simulated treatment with intentional multileaf collimator (MLC) errors. This system was based on inputs from the dynamic machine information (DMI), which continuously reports actual MLC positions and machine monitor units (MUs) at intervals of 50 ms or less during delivery. Based on the DMI, the system performed two levels of monitoring/verification during the delivery: (1) dynamic monitoring of cumulative fluence errors resulting from leaf position deviations and visualization using fluence error maps (FEMs); and (2) verification of MLC positions against the treatment plan for potential errors in MLC motion and data transfer at each control point. Validation of the online delivery monitoring system was performed by introducing intentional systematic MLC errors (ranging from 0.5 to 2 mm) to the DMI files for both leaf banks. These DMI files were analyzed by the proposed system to evaluate the system’s performance in quantifying errors and revealing the source of errors, as well as to understand patterns in the FEMs. In addition, FEMs from 210 actual prostate IMRT beams were analyzed using the proposed system to further validate its ability to catch and identify errors, as well as establish error magnitude baselines for prostate IMRT delivery

Quality assurance for online adapted treatment plans: benchmarking and delivery monitoring simulation.

Science.gov (United States)

Li, Taoran; Wu, Qiuwen; Yang, Yun; Rodrigues, Anna; Yin, Fang-Fang; Jackie Wu, Q

2015-01-01

An important challenge facing online adaptive radiation therapy is the development of feasible and efficient quality assurance (QA). This project aimed to validate the deliverability of online adapted plans and develop a proof-of-concept online delivery monitoring system for online adaptive radiation therapy QA. The first part of this project benchmarked automatically online adapted prostate treatment plans using traditional portal dosimetry IMRT QA. The portal dosimetry QA results of online adapted plans were compared to original (unadapted) plans as well as randomly selected prostate IMRT plans from our clinic. In the second part, an online delivery monitoring system was designed and validated via a simulated treatment with intentional multileaf collimator (MLC) errors. This system was based on inputs from the dynamic machine information (DMI), which continuously reports actual MLC positions and machine monitor units (MUs) at intervals of 50 ms or less during delivery. Based on the DMI, the system performed two levels of monitoring/verification during the delivery: (1) dynamic monitoring of cumulative fluence errors resulting from leaf position deviations and visualization using fluence error maps (FEMs); and (2) verification of MLC positions against the treatment plan for potential errors in MLC motion and data transfer at each control point. Validation of the online delivery monitoring system was performed by introducing intentional systematic MLC errors (ranging from 0.5 to 2 mm) to the DMI files for both leaf banks. These DMI files were analyzed by the proposed system to evaluate the system's performance in quantifying errors and revealing the source of errors, as well as to understand patterns in the FEMs. In addition, FEMs from 210 actual prostate IMRT beams were analyzed using the proposed system to further validate its ability to catch and identify errors, as well as establish error magnitude baselines for prostate IMRT delivery. Online adapted plans were

Alternatives of Treatment and Final Disposition of the Solid Hospital residuals

International Nuclear Information System (INIS)

Meza Monge, K.

1998-01-01

The current handling, treatment and final disposition of the hospital solid waste in Costa Rica are considered inadequate or at least insufficient. This situation represents a serious danger for the population's health and the environment, because they are exposed to infectious agents, toxic substances and even radioactive products that are generated among the residuals of the centers of health. This work, alternatives propose for the treatment and adequate final disposition of the solid waste produced in the hospitals of the country. They take into consideration the characteristics that present these residuals, the advantages and disadvantages of each one of the existent techniques and the technical and economic possibilities of the country. For this purpose, in first instance, a revision about the properties, the quality and the quantity of the solid waste produced by the national hospital centers was carried out. Also, a diagnostic of the current situation of the treatment and final disposition of these residuals in some of the most important hospitals of the country, as well as of the possibilities of physical space with that they count on was carried out. Then, the existent different treatment techniques and final disposition for the solid waste that comes from the centers of health are described, as well as their advantages and disadvantages and a comparative analysis of the same ones is carried out. The objective is completed, since alternatives of treatment and final disposition that are considered appropriate for this type of residuals are planned. Nevertheless, in the future, more detailed investigations and studies of feasibility, with the purpose of developing handling programs and elimination of the solid waste for each one of the hospital centers in Costa Rica should be carried out. (Author) [es

Scanned ion beam therapy for prostate carcinoma. Comparison of single plan treatment and daily plan-adapted treatment

International Nuclear Information System (INIS)

Hild, Sebastian; Graeff, Christian; Rucinski, Antoni; Zink, Klemens; Habl, Gregor; Durante, Marco; Herfarth, Klaus; Bert, Christoph

2016-01-01

Intensity-modulated particle therapy (IMPT) for tumors showing interfraction motion is a topic of current research. The purpose of this work is to compare three treatment strategies for IMPT to determine potential advantages and disadvantages of ion prostate cancer therapy. Simulations for three treatment strategies, conventional one-plan radiotherapy (ConvRT), image-guided radiotherapy (IGRT), and online adaptive radiotherapy (ART) were performed employing a dataset of 10 prostate cancer patients with six CT scans taken at one week intervals. The simulation results, using a geometric margin concept (7-2 mm) as well as patient-specific internal target volume definitions for IMPT were analyzed by target coverage and exposure of critical structures on single fraction dose distributions. All strategies led to clinically acceptable target coverage in patients exhibiting small prostate motion (mean displacement < 4 mm), but IGRT and especially ART led to significant sparing of the rectum. In 20 % of the patients, prostate motion exceeded 4 mm causing insufficient target coverage for ConvRT (V95 mean = 0.86, range 0.63-0.99) and IGRT (V95 mean = 0.91, range 0.68-1.00), while ART maintained acceptable target coverage. IMPT of prostate cancer demands consideration of rectal sparing and adaptive treatment replanning for patients exhibiting large prostate motion. (orig.) [de

Automatic Generation of User Interface Layouts for Alternative Screen Orientations

OpenAIRE

Zeidler , Clemens; Weber , Gerald; Stuerzlinger , Wolfgang; Lutteroth , Christof

2017-01-01

Part 1: Adaptive Design and Mobile Applications; International audience; Creating multiple layout alternatives for graphical user interfaces to accommodate different screen orientations for mobile devices is labor intensive. Here, we investigate how such layout alternatives can be generated automatically from an initial layout. Providing good layout alternatives can inspire developers in their design work and support them to create adaptive layouts. We performed an analysis of layout alternat...

Alternative to chrome in the aluminium surface finishing industry. Low environmental impact surface treatments

International Nuclear Information System (INIS)

Aballe Villero, A.; Bethencourt Nunez, M.; Botana Pedemonte, F. J.; Marco Barcena, M.; Sanchez-Amaya, J. M.

2001-01-01

Chromates are one of the most commonly used compounds in anti corrosive protection systems because of its excellent rate efficiency/cost. In the case of aluminium alloys, these compounds are employed as inhibitors as well as in the anti-corrosive pretreatments to develop protective films. However, chromates are highly toxic and its use involves a high risk for health and environment. Consequently, in the last years intensive efforts have been achieved in the surface treatment industry to find ecological alternatives to this kind of compounds. In this work, the main alternatives proposed in literature to substitute chromates in the surface treatments of aluminium alloys are reviewed. To begin with, the role of chromates in these systems and their environmental consequences has been briefly reviewed. (Author) 16 refs

Use of Complementary and Alternative Medicine (CAM) Treatments by Parents of Children with Autism Spectrum Disorders

Science.gov (United States)

Christon, Lillian M.; Mackintosh, Virginia H.; Myers, Barbara J.

2010-01-01

Parents of children with autism spectrum disorders (ASDs) may elect to use complementary and alternative medicine (CAM) treatments with their children in place of, or in addition to, conventional treatments. CAM treatments are controversial and understudied and, for most, the efficacy has not been established. The current study (n = 248) examined…

Efficiency of enzymatic and other alternative clarification and fining treatments on turbidity and haze in cherry juice

DEFF Research Database (Denmark)

Meyer, Anne Boye Strunge; Köser, C.; Adler-Nissen, Jens

2001-01-01

function. Individual and interactive effects on turbidity and haze formation in precentrifuged and uncentrifuged cherry juice of treatments with pectinase, acid protease, bromelain, gallic acid, and gelatin-silica sol were investigated in a factorial experimental design with 32 different parameter...... combinations. Gelatin-silica sol consistently had the best effect on juice clarity. Centrifugation of cherry juice (10000g for 15 min) prior to clarification treatment significantly improved juice clarity and diminished the rate of haze formation during cold storage of juice. Both treatment of precentrifuged...... cherry juice with Novozym 89L protease and co- addition of pectinase and gallic acid improved cherry juice clarity and diminished haze levels. None of the alternative treatments produced the unwieldy colloids notorious to gelatin- silica sol treatment. The data suggest that several alternative...

Amino-termini isoforms of the Slack K+ channel, regulated by alternative promoters, differentially modulate rhythmic firing and adaptation.

Science.gov (United States)

Brown, Maile R; Kronengold, Jack; Gazula, Valeswara-Rao; Spilianakis, Charalampos G; Flavell, Richard A; von Hehn, Christian A A; Bhattacharjee, Arin; Kaczmarek, Leonard K

2008-11-01

The rates of activation and unitary properties of Na+-activated K+ (K(Na)) currents have been found to vary substantially in different types of neurones. One class of K(Na) channels is encoded by the Slack gene. We have now determined that alternative RNA splicing gives rise to at least five different transcripts for Slack, which produce Slack channels that differ in their predicted cytoplasmic amino-termini and in their kinetic properties. Two of these, termed Slack-A channels, contain an amino-terminus domain closely resembling that of another class of K(Na) channels encoded by the Slick gene. Neuronal expression of Slack-A channels and of the previously described Slack isoform, now called Slack-B, are driven by independent promoters. Slack-A mRNAs were enriched in the brainstem and olfactory bulb and detected at significant levels in four different brain regions. When expressed in CHO cells, Slack-A channels activate rapidly upon depolarization and, in single channel recordings in Xenopus oocytes, are characterized by multiple subconductance states with only brief transient openings to the fully open state. In contrast, Slack-B channels activate slowly over hundreds of milliseconds, with openings to the fully open state that are approximately 6-fold longer than those for Slack-A channels. In numerical simulations, neurones in which outward currents are dominated by a Slack-A-like conductance adapt very rapidly to repeated or maintained stimulation over a wide range of stimulus strengths. In contrast, Slack-B currents promote rhythmic firing during maintained stimulation, and allow adaptation rate to vary with stimulus strength. Using an antibody that recognizes all amino-termini isoforms of Slack, Slack immunoreactivity is present at locations that have no Slack-B-specific staining, including olfactory bulb glomeruli and the dendrites of hippocampal neurones, suggesting that Slack channels with alternate amino-termini such as Slack-A channels are present at

ARIA Mexico 2014 Adaptation of the Clinical Practice Guide ARIA 2010 for Mexico. Methodology ADAPTE

Directory of Open Access Journals (Sweden)

Désirée Larenas-Linnemann

2014-11-01

Full Text Available Background: The global prevalence of allergic rhinitis is high. International Study of Asthma and Allergies in Childhood (ISAAC Phase III reports a total estimated prevalence of 4.6% in Mexico. There is evidence based on allergic rhinitis Clinical Practice Guidelines (CPG, but its promotion, acceptance and application is not optimal or adequate in Mexico. Objective: To generate a guideline for the treatment of allergic rhinitis and its impact on asthma by adaptating the 2010 ARIA Guideline to Mexican reality, through a transculturation process applying the ADAPTE methodology. Material and method: Using the ADAPTE Methodology, the original 2010 ARIA CPG recommendations were evaluated by the guideline development group (GDG into which multiple medical specialities managing patients with allergic rhinitis were incoorporated. The GDG valorated the quality of 2010 ARIA, checked and translated key clinical questions. Moreover, the GDG adjusted recommendations, patient preferences and included comments in the context of the Mexican reality (safety, costs and cultural issues. To accomplish this, we ran Delphi panels with as many rounds as necessary to reach agreement. One extra question, not included in the original 2010 ARIA, on the use of Nasal Lavages for AR was created sustained by a systematic literature review. Results: A total of 45 questions from the original 2010 ARIA were included and divided into six groups covering prevention, medical treatment, immunotherapy and alternative medicine to treat patients with allergic rhinitis with or without asthma. Most of the questions reached agreement in one or two rounds; one question required three rounds. Conclusions: An easy-to-use, adaptated, up-to-date and applicable allergic rhinitis guideline for Mexico is now available.

Development of an Alternative Treatment Scheme for Sr/TRU Removal: Permanganate Treatment of AN-107 Waste

International Nuclear Information System (INIS)

Hallen, R.T.; Bryan, S.A.; Hoopes, F.V.

2000-01-01

A number of Hanford tanks received waste containing organic complexants, which increase the volubility of Sr-90 and transuranic (TRU) elements. Wastes from these tanks require additional pretreatment to remove Sr-90 and TRU for immobilization as low activity waste (Waste Envelope C). The baseline pretreatment process for Sr/TRU removal was isotopic exchange and precipitation with added strontium and iron. However, studies at both Battelle and Savannah River Technology Center (SRTC) have shown that the Sr/Fe precipitates were very difficult to filter. This was a result of the formation of poor filtering iron solids. An alternate treatment technology was needed for Sr/TRU removal. Battelle had demonstrated that permanganate treatment was effective for decontaminating waste samples from Hanford Tank SY-101 and proposed that permanganate be examined as an alternative Sr/TRU removal scheme for complexant-containing tank wastes such as AW107. Battelle conducted preliminary small-scale experiments to determine the effectiveness of permanganate treatment with AN-107 waste samples that had been archived at Battelle from earlier studies. Three series of experiments were performed to evaluate conditions that provided adequate Sr/TRU decontamination using permanganate treatment. The final series included experiments with actual AN-107 diluted feed that had been obtained specifically for BNFL process testing. Conditions that provided adequate Sr/TRU decontamination were identified. A free hydroxide concentration of 0.5M provided adequate decontamination with added Sr of 0.05M and permanganate of 0.03M for archived AN-107. The best results were obtained when reagents were added in the sequence Sr followed by permanganate with the waste at ambient temperature. The reaction conditions for Sr/TRU removal will be further evaluated with a 1-L batch of archived AN-107, which will provide a large enough volume of waste to conduct crossflow filtration studies (Hallen et al. 2000a)

Development of an Alternative Treatment Scheme for Sr/TRU Removal: Permanganate Treatment of AN-107 Waste

Energy Technology Data Exchange (ETDEWEB)

RT Hallen; SA Bryan; FV Hoopes

2000-08-04

A number of Hanford tanks received waste containing organic complexants, which increase the volubility of Sr-90 and transuranic (TRU) elements. Wastes from these tanks require additional pretreatment to remove Sr-90 and TRU for immobilization as low activity waste (Waste Envelope C). The baseline pretreatment process for Sr/TRU removal was isotopic exchange and precipitation with added strontium and iron. However, studies at both Battelle and Savannah River Technology Center (SRTC) have shown that the Sr/Fe precipitates were very difficult to filter. This was a result of the formation of poor filtering iron solids. An alternate treatment technology was needed for Sr/TRU removal. Battelle had demonstrated that permanganate treatment was effective for decontaminating waste samples from Hanford Tank SY-101 and proposed that permanganate be examined as an alternative Sr/TRU removal scheme for complexant-containing tank wastes such as AW107. Battelle conducted preliminary small-scale experiments to determine the effectiveness of permanganate treatment with AN-107 waste samples that had been archived at Battelle from earlier studies. Three series of experiments were performed to evaluate conditions that provided adequate Sr/TRU decontamination using permanganate treatment. The final series included experiments with actual AN-107 diluted feed that had been obtained specifically for BNFL process testing. Conditions that provided adequate Sr/TRU decontamination were identified. A free hydroxide concentration of 0.5M provided adequate decontamination with added Sr of 0.05M and permanganate of 0.03M for archived AN-107. The best results were obtained when reagents were added in the sequence Sr followed by permanganate with the waste at ambient temperature. The reaction conditions for Sr/TRU removal will be further evaluated with a 1-L batch of archived AN-107, which will provide a large enough volume of waste to conduct crossflow filtration studies (Hallen et al. 2000a).

Design of sewage treatment system by applying fuzzy adaptive PID controller

Science.gov (United States)

Jin, Liang-Ping; Li, Hong-Chan

2013-03-01

In the sewage treatment system, the dissolved oxygen concentration control, due to its nonlinear, time-varying, large time delay and uncertainty, is difficult to establish the exact mathematical model. While the conventional PID controller only works with good linear not far from its operating point, it is difficult to realize the system control when the operating point far off. In order to solve the above problems, the paper proposed a method which combine fuzzy control with PID methods and designed a fuzzy adaptive PID controller based on S7-300 PLC .It employs fuzzy inference method to achieve the online tuning for PID parameters. The control algorithm by simulation and practical application show that the system has stronger robustness and better adaptability.

Climate Change, Coastal Vulnerability and the Need for Adaptation Alternatives: Planning and Design Examples from Egypt and the USA

Directory of Open Access Journals (Sweden)

S Jeffress Williams

2015-07-01

Full Text Available Planning and design of coastal protection for high-risk events with low to moderate or uncertain probabilities are a challenging balance of short- and long-term cost vs. protection of lives and infrastructure. The pervasive, complex, and accelerating impacts of climate change on coastal areas, including sea-level rise, storm surge and tidal flooding, require full integration of the latest science into strategic plans and engineering designs. While the impacts of changes occurring are global, local effects are highly variable and often greatly exacerbated by geophysical (land subsidence, faulting, oceanographic (ocean circulation, wind patterns and anthropogenic factors. Reducing carbon emissions is needed to mitigate global warming, but adaptation can accommodate at least near future change impacts. Adaptation should include alternatives that best match region-specific risk, time frame, environmental conditions, and the desired protection. Optimal alternatives are ones that provide protection, accommodate or mimic natural coastal processes, and include landforms such as barrier islands and wetlands. Plans are often for 50 years, but longer-term planning is recommended since risk from climate change will persist for centuries. This paper presents an assessment of impacts of accelerating climate change on the adequacy of coastal protection strategies and explores design measures needed for an optimum degree of protection and risk reduction. Three coastal areas facing similar challenges are discussed: Abu-Qir Bay, Nile River delta plain, Egypt; Lake Borgne, New Orleans, Louisiana delta plain; and the New York City region.

SELENIUM TREATMENT/REMOVAL ALTERNATIVES DEMONSTRATION PROJECT - MINE WASTE TECHNOLOGY PROGRAM ACTIVITY III, PROJECT 20

Science.gov (United States)

This document is the final report for EPA's Mine WAste Technology Program (MWTP) Activity III, Project 20--Selenium Treatment/Removal Alternatives Demonstration project. Selenium contamination originates from many sources including mining operations, mineral processing, abandoned...

Combination of Surgical Drainage and Renal Artery Embolization: An Alternative Treatment for Xanthogranulomatous Pyelonephritis

Energy Technology Data Exchange (ETDEWEB)

Upasani, Anand, E-mail: anand.upasani@gosh.nhs.uk [Great Ormond Street Hospital, Department of Paediatric Urology (United Kingdom); Barnacle, Alex, E-mail: alex.barnacle@gosh.nhs.uk; Roebuck, Derek, E-mail: derek.roebuck@gosh.nhs.uk; Cherian, Abraham, E-mail: abraham.cherian@gosh.nhs.uk [Great Ormond Street Hospital (United Kingdom)

2017-03-15

Conventionally, xanthogranulomatous pyelonephritis is treated with antibiotics and drainage of abscess followed by nephrectomy for definitive treatment. Surgical excision of the affected kidney carries risk of significant complications. An alternative treatment modality is described in the form of embolization of the renal artery to devascularise the renal parenchyma and ablate the renal tissue, thus avoiding a major surgical procedure and the significant risks involved.

Combination of Surgical Drainage and Renal Artery Embolization: An Alternative Treatment for Xanthogranulomatous Pyelonephritis

International Nuclear Information System (INIS)

Upasani, Anand; Barnacle, Alex; Roebuck, Derek; Cherian, Abraham

2017-01-01

Conventionally, xanthogranulomatous pyelonephritis is treated with antibiotics and drainage of abscess followed by nephrectomy for definitive treatment. Surgical excision of the affected kidney carries risk of significant complications. An alternative treatment modality is described in the form of embolization of the renal artery to devascularise the renal parenchyma and ablate the renal tissue, thus avoiding a major surgical procedure and the significant risks involved.

Complementary and alternative treatment of musculoskeletal pain.

Science.gov (United States)

Grazio, Simeon; Balen, Diana

2011-12-01

The use of complementary and alternative medicine (CAM) is high and increasing worldwide. Patients usually use CAM in addition to conventional medicine, mainly to treat pain. In a large number of cases, people use CAM for chronic musculoskeletal pain as in osteoarthritis, back pain, neck pain, or fibromyalgia. Herewith, a review is presented of CAM efficacy in treating musculoskeletal pain for which, however, no scientific research has so far provided evidence solid enough. In some rare cases where adequate pain control cannot be achieved, CAM might be considered in rational and individual approach based on the first general rule in medicine "not to harm" and on the utility theory of each intervention, i.e. according to the presumed mechanism of painful stimulus and with close monitoring of the patient's response. Further high quality studies are warranted to elucidate the efficacy and side effects of CAM methods. Therefore, conventional medicine remains the main mode of treatment for patients with musculoskeletal painful conditions.

From Punishment to Treatment: The “Clinical Alternative to Punitive Segregation” (CAPS Program in New York City Jails

Directory of Open Access Journals (Sweden)

Sarah Glowa-Kollisch

2016-02-01

Full Text Available The proliferation of jails and prisons as places of institutionalization for persons with serious mental illness (SMI has resulted in many of these patients receiving jail-based punishments, including solitary confinement. Starting in 2013, the New York City (NYC jail system developed a new treatment unit for persons with SMI who were judged to have violated jail rules (and previously would have been punished with solitary confinement called the Clinical Alternative to Punitive Segregation (CAPS unit. CAPS is designed to offer a full range of therapeutic activities and interventions for these patients, including individual and group therapy, art therapy, medication counseling and community meetings. Each CAPS unit requires approximately $1.5 million more investment per year, largely in additional staff as compared to existing mental health units, and can house approximately 30 patients. Patients with less serious mental illness who received infractions were housed on units that combined solitary confinement with some clinical programming, called Restrictive Housing Units (RHU. Between 1 December 2013 and 31 March 2015, a total of 195 and 1433 patients passed through the CAPS and RHU units, respectively. A small cohort of patients experienced both CAPS and RHU (n = 90. For these patients, their rates of self-harm and injury were significantly lower while on the CAPS unit than when on the RHU units. Improvements in clinical outcomes are possible for incarcerated patients with mental illness with investment in new alternatives to solitary confinement. We have started to adapt the CAPS approach to existing mental health units as a means to promote better clinical outcomes and also help prevent jail-based infractions. The cost of these programs and the dramatic differences in length of stay for patients who earn these jail-based infractions highlight the need for alternatives to incarceration, some of which have recently been announced in NYC.

Alternative treatments for adults with attention-deficit hyperactivity disorder (ADHD).

Science.gov (United States)

Arnold, L E

2001-06-01

A previous review of alternative treatments (Tx) of ADHD--those other than psychoactive medication and behavioral/psychosocial Tx--was supplemented with an additional literature search focused on adults with ADHD. Twenty-four alternative Tx were identified, ranging in scientific documentation from discrediting controlled studies through mere hypotheses to positive controlled double-blind clinical trials. Many of them are applicable only to a specific subgroup. Although oligoantigenic (few-foods) diets have convincing double-blind evidence of efficacy for a properly selected subgroup of children, they do not appear promising for adults. Enzyme-potentiated desensitization, relaxation/EMG biofeedback, and deleading also have controlled evidence of efficacy. Iron supplementation, magnesium supplementation, Chinese herbals, EEG biofeedback, massage, meditation, mirror feedback, channel-specific perceptual training, and vestibular stimulation all have promising prospective pilot data, many of these tests reasonably controlled. Single-vitamin megadosage has some intriguing pilot trial data. Zinc supplementation is hypothetically supported by systematic case-control data, but no systematic clinical trial. Laser acupuncture has promising unpublished pilot data and may be more applicable to adults than children. Essential fatty acid supplementation has promising systematic case-control data, but clinical trials are equivocal. RDA vitamin supplementation, non-Chinese herbals, homeopathic remedies, and antifungal therapy have no systematic data in ADHD. Megadose multivitamin combinations are probably ineffective for most patients and are possibly dangerous. Simple sugar restriction seems ineffective. Amino acid supplementation is mildly effective in the short term, but not beyond 2-3 months. Thyroid treatment is effective in the presence of documented thyroid abnormality. Some alternative Tx of ADHD are effective or probably effective, but mainly for certain patients. In some

Pollution Impact and Alternative Treatment for Produced Water

Science.gov (United States)

Hedar, Yusran; Budiyono

2018-02-01

Oil and gas exploration and production are two of the activities that potentially cause pollution and environmental damage. The largest waste generated from this activity is produced water. Produced water contains hazardous pollutants of both organic and inorganic materials, so that the produced water of oil and gas production cannot be discharged directly to the environment. Uncontrolled discharge can lead to the environmental damage, killing the life of water and plants. The produced water needs to be handled and fulfill the quality standards before being discharged to the environment. Several studies to reduce the contaminants in the produced water were conducted by researchers. Among them were gravity based separation - flotation, separation technique based on filtration, and biological process treatment. Therefore, some of these methods can be used as an alternative waste handling of produced water.

Allopathic, complementary, and alternative medical treatment utilization for pain among methadone-maintained patients.

Science.gov (United States)

Barry, Declan T; Beitel, Mark; Cutter, Christopher J; Garnet, Brian; Joshi, Dipa; Schottenfeld, Richard S; Rounsaville, Bruce J

2009-01-01

We surveyed 150 methadone maintenance treatment program (MMTP) patients about pain, pain treatment utilization, perceived efficacy of prior pain treatment, and interest in pursuing pain treatment at the MMTP. Respondents with chronic severe pain (CSP) (ie, pain lasting at least six months with moderate to severe pain intensity or significant pain interference) and "some pain" (ie, pain reported in the previous week but not CSP) endorsed similar rates of past-week and lifetime allopathic or standard medical (with the exception of lifetime medical use of non-opiate medication) and complementary and alternative medicine (CAM) utilization for pain reduction. Prior pain treatments were perceived to be less effective by CSP than SP patients but both groups had equivalent high rates of interest in pain treatment associated with the MMTP. These findings may have implications for resource and program planning in MMTPs.

Physiology-driven adaptive virtual reality stimulation for prevention and treatment of stress related disorders.

Science.gov (United States)

Cosić, Kresimir; Popović, Sinisa; Kukolja, Davor; Horvat, Marko; Dropuljić, Branimir

2010-02-01

The significant proportion of severe psychological problems related to intensive stress in recent large peacekeeping operations underscores the importance of effective methods for strengthening the prevention and treatment of stress-related disorders. Adaptive control of virtual reality (VR) stimulation presented in this work, based on estimation of the person's emotional state from physiological signals, may enhance existing stress inoculation training (SIT). Physiology-driven adaptive VR stimulation can tailor the progress of stressful stimuli delivery to the physiological characteristics of each individual, which is indicated for improvement in stress resistance. Following an overview of physiology-driven adaptive VR stimulation, its major functional subsystems are described in more detail. A specific algorithm of stimuli delivery applicable to SIT is outlined.

Virulence comparisons of high-temperature-adapted Heterorhabditis bacteriophora, Steinernema feltiae and S. carpocapsae

Directory of Open Access Journals (Sweden)

Susurluk I. A.

2015-06-01

Full Text Available Entomopathogenic nematodes (EPNs are environmentally safe alternative control agents. Nematodes in the Heterorhabditidae and Steinernematidae families are widely used in biological control frameworks, especially for soil-inhabiting insect pests. In this experiment, Heterorhabditis bacteriophora (Poinar, 1976, Steinernema feltiae (Filipjev, 1934 and S. carpocapsae (Weiser, 1955 adapted at high temperature were assessed in order to detect differences in virulence between adapted and non-adapted populations. All species were exposed to 38 °C for 2 h. After this treatment, live infective juveniles (IJs were used to infect to last instar Galleria mellonella (Linnaeus, 1758. larvae at the following doses: 1, 2, 3, 4 and 5 IJs/larva. The LD50 and LD90 were obtained for these species. Non-adapted populations of the nematode species were used as controls for this experiment. The results indicated that differences in S. feltiae and S. carpocapsae virulence between the adapted and non-adapted populations were significant; no significant difference was observed between the adapted and non-adapted H. bacteriophora populations.

Review of Efficacy of Complementary and Alternative Medicine Treatments for Menopausal Symptoms.

Science.gov (United States)

Moore, Thea R; Franks, Rachel B; Fox, Carol

2017-05-01

Complementary and alternative medicine (CAM) treatments have been used for thousands of years around the world. There has been increased interest in utilizing CAM for menopausal symptoms since the release of results of the Women's Health Initiative elucidated long-term adverse effects associated with hormone therapy. Women looking for more natural or safer means to treat hot flushes, night sweats, and other menopausal symptoms often turn to CAM such as yoga, phytoestrogens, or black cohosh. Yet there have been few well-conducted studies looking at the efficacy of these treatments. This review examines randomized clinical trials, systematic reviews, and meta-analyses evaluating the effectiveness of commonly used CAM for the treatment of menopausal symptoms. © 2017 by the American College of Nurse-Midwives.

F/H Effluent Treatment Facility filtration upgrade alternative evaluations overview

Energy Technology Data Exchange (ETDEWEB)

Miles, W.C. Jr.; Poirier, M.R.; Brown, D.F.

1992-01-01

The F/H Effluent Treatment Facility (ETF) at the Savannah River Site (SRS) was designed to treat process wastewater from the 200-F/H Production Facilities (routine wastewater) as well as intermittent flows from the F/H Retention Basins and F/H Cooling Water Basins (nonroutine wastewater). Since start-up of the ETF at SRS in 1988, the treatment process has experienced difficulties processing routine and nonroutine wastewater. Studies have identified high bacteria and bacterial decomposition products in the wastewater as the cause for excessive fouling of the filtration system. In order to meet Waste Management requirements for the treatment of processed wastewater, an upgrade of the ETF filtration system is being developed. This upgrade must be able to process the nonroutine wastewater at design capacity. As a result, a study of alternative filter technologies was conducted utilizing simulated wastewater. The simulated wastewater tests have been completed. Three filter technologies, centrifugal polymeric ultrafilters, tubular polymeric ultrafilters, and backwashable cartridge filters have been selected for further evaluation utilizing actual ETF wastewater.

F/H Effluent Treatment Facility filtration upgrade alternative evaluations overview

Energy Technology Data Exchange (ETDEWEB)

Miles, W.C. Jr.; Poirier, M.R.; Brown, D.F.

1992-07-01

The F/H Effluent Treatment Facility (ETF) at the Savannah River Site (SRS) was designed to treat process wastewater from the 200-F/H Production Facilities (routine wastewater) as well as intermittent flows from the F/H Retention Basins and F/H Cooling Water Basins (nonroutine wastewater). Since start-up of the ETF at SRS in 1988, the treatment process has experienced difficulties processing routine and nonroutine wastewater. Studies have identified high bacteria and bacterial decomposition products in the wastewater as the cause for excessive fouling of the filtration system. In order to meet Waste Management requirements for the treatment of processed wastewater, an upgrade of the ETF filtration system is being developed. This upgrade must be able to process the nonroutine wastewater at design capacity. As a result, a study of alternative filter technologies was conducted utilizing simulated wastewater. The simulated wastewater tests have been completed. Three filter technologies, centrifugal polymeric ultrafilters, tubular polymeric ultrafilters, and backwashable cartridge filters have been selected for further evaluation utilizing actual ETF wastewater.

F/H effluent treatment facility filtration upgrade alternative evaluations overview

International Nuclear Information System (INIS)

Miles, W.C. Jr.; Poirier, M.R.; Brown, D.F.

1992-01-01

The F/H Effluent Treatment Facility (ETF) at the Savannah River Site (SRS) was designed to treat process wastewater from the 200-F/H Production Facilities (routine wastewater) as well as intermittent flows from the F/H Retention Basins and F/H Cooling Water Basins (nonroutine wastewater). Since start-up of the ETF at SRS in 1988, the treatment process has experienced difficulties processing routine and nonroutine wastewater. Studies have identified high bacteria and bacterial decomposition products in the wastewater as the cause for excessive fouling of the filtration system. In order to meet Waste Management requirements for the treatment of processed wastewater, an upgrade of the ETF filtration system is being developed. This upgrade must be able to process the nonroutine wastewater at design capacity. As a result, a study of alternative filter technologies was conducted utilizing simulated wastewater. The simulated wastewater tests have been completed. Three filter technologies, centrifugal polymeric ultrafilters, tubular polymeric ultrafilters, and backwashable cartridge filters have been selected for further evaluation utilizing actual ETF wastewater. (author)

Kinesiotaping as an alternative treatment method for carpal tunnel syndrome.

Science.gov (United States)

Geler Külcü, Duygu; Bursali, Canan; Aktaş, İlknur; Bozkurt Alp, Selin; Ünlü Özkan, Feyza; Akpinar, Pınar

2016-06-23

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Conservative treatment choices are not always satisfactory. The aim of this study was to investigate the effect of kinesiotaping (KT) on pain level, grip strength, and functional status compared with that of placebo KT and orthotic device (OD) in patients with CTS. In this randomized, placebo-controlled study, participants were allocated into one of three groups: an experimental KT group (Group 1), a placebo KT group (Group 2), and an OD group (Group 3). Visual analogue scale (VAS) and Douleur Neuropathique 4 (DN4) scores, dynamometric grip strength measures, and the Boston CTS questionnaire (BQ) were the outcome measures. All groups significantly improved in terms of VAS scores (P < 0.05), DN4 scores (P < 0.05), and BQ scores (P < 0.05). Grip strength improved in Group 3 (P = 0.001). There was a significant difference among the groups with respect to BQ scores (P < 0.05). KT application for the treatment of CTS should be an alternative treatment choice.

Parents' Views and Experiences about Complementary and Alternative Medicine Treatments for Their Children with Autistic Spectrum Disorder

Science.gov (United States)

Senel, Hatice Gunayer

2010-01-01

Use of complementary and alternative medicine (CAM) treatments have been increasing for children with autistic spectrum disorder (ASD). In this study, 38 Turkish parents of children with ASD were surveyed related with their use of CAM treatments, experiences, and views for each treatment. They mentioned "Vitamins and minerals",…

Scanned ion beam therapy for prostate carcinoma. Comparison of single plan treatment and daily plan-adapted treatment

Energy Technology Data Exchange (ETDEWEB)

Hild, Sebastian [GSI Helmholtzzentrum fuer Schwerionenforschung GmbH, Department of Biophysics, Darmstadt (Germany); University Clinic Erlangen and Friedrich- Alexander-University Erlangen-Nuernberg (FAU), Department of Radiation Oncology, Erlangen (Germany); Graeff, Christian [GSI Helmholtzzentrum fuer Schwerionenforschung GmbH, Department of Biophysics, Darmstadt (Germany); Rucinski, Antoni [University Clinic Heidelberg, Heidelberg Ion-Beam Therapy Center (HIT) and Department of Radiation Oncology, Heidelberg (Germany); Sapienza Universit' a di Roma, Dipartimento di Scienze di Base e Applicate per Ingegneria, Roma (Italy); INFN, Roma (Italy); Zink, Klemens [University of Applied Sciences, Institute for Medical Physics and Radiation Protection, Giessen (Germany); University Medical Center Giessen-Marburg, Department of Radiotherapy and Radiooncology, Marburg (Germany); Habl, Gregor [University Clinic Heidelberg, Heidelberg Ion-Beam Therapy Center (HIT) and Department of Radiation Oncology, Heidelberg (Germany); Klinikum rechts der Isar, Technische Universitaet Muenchen (TUM), Department of Radiation Oncology, Munich (Germany); Durante, Marco [GSI Helmholtzzentrum fuer Schwerionenforschung GmbH, Department of Biophysics, Darmstadt (Germany); Technische Universitaet Darmstadt, Faculty of Physics, Darmstadt (Germany); Herfarth, Klaus [University Clinic Heidelberg, Heidelberg Ion-Beam Therapy Center (HIT) and Department of Radiation Oncology, Heidelberg (Germany); Bert, Christoph [GSI Helmholtzzentrum fuer Schwerionenforschung GmbH, Department of Biophysics, Darmstadt (Germany); University Clinic Erlangen and Friedrich- Alexander-University Erlangen-Nuernberg (FAU), Department of Radiation Oncology, Erlangen (Germany); University Hospital Erlangen, Radiation Oncology, Erlangen (Germany)

2016-02-15

Intensity-modulated particle therapy (IMPT) for tumors showing interfraction motion is a topic of current research. The purpose of this work is to compare three treatment strategies for IMPT to determine potential advantages and disadvantages of ion prostate cancer therapy. Simulations for three treatment strategies, conventional one-plan radiotherapy (ConvRT), image-guided radiotherapy (IGRT), and online adaptive radiotherapy (ART) were performed employing a dataset of 10 prostate cancer patients with six CT scans taken at one week intervals. The simulation results, using a geometric margin concept (7-2 mm) as well as patient-specific internal target volume definitions for IMPT were analyzed by target coverage and exposure of critical structures on single fraction dose distributions. All strategies led to clinically acceptable target coverage in patients exhibiting small prostate motion (mean displacement < 4 mm), but IGRT and especially ART led to significant sparing of the rectum. In 20 % of the patients, prostate motion exceeded 4 mm causing insufficient target coverage for ConvRT (V95{sub mean} = 0.86, range 0.63-0.99) and IGRT (V95{sub mean} = 0.91, range 0.68-1.00), while ART maintained acceptable target coverage. IMPT of prostate cancer demands consideration of rectal sparing and adaptive treatment replanning for patients exhibiting large prostate motion. (orig.) [German] Adaptive Therapieansaetze fuer sich interfraktionell bewegende Zielvolumina in der intensitaetsmodulierten Partikeltherapie (IMPT) befinden sich zurzeit in der Entwicklung. In dieser Arbeit werden drei Behandlungsstrategien auf moegliche Vor- und Nachteile in der IMPT des Prostatakarzinoms hin untersucht. Auf Basis eines anonymisierten Datensatzes aus 10 Patienten mit Prostatakarzinom wurden die drei Bestrahlungsstrategien, konventionelle Ein-Plan-Strahlentherapie (ConvRT), bildunterstuetzte Strahlentherapie (IGRT) und tagesaktuelle Strahlentherapie (adaptive radiotherapy,ART), simuliert

Adapting to climate change in The Netherlands: an inventory of climate adaptation options and ranking of alternatives

NARCIS (Netherlands)

K. de Bruin (Kelly); R.B. Dellink (Rob); A. Ruijs (Arjan); L. Bolwidt; M.W. van Buuren (Arwin); J. Graveland (Jaap); R.S. de Groot; P.J. Kuikman; S. Reinhard; R.P. Roetter (Reimund); V.C. Tassone (Valentina); Verhagen (A.C.); E.C. van Ierland (Ekko)

2009-01-01

textabstractIn many countries around the world impacts of climate change are assessed and adaptation options identified. We describe an approach for a qualitative and quantitative assessment of adaptation options to respond to climate change in the Netherlands. The study introduces an inventory and

Alternating Hemiplegia

Science.gov (United States)

... to the symptoms of the disorder. View Full Definition Treatment Drug therapy including verapamil may help to reduce the ... the more serious form of alternating hemiplegia × ... Definition Alternating hemiplegia is a rare neurological disorder that ...

Control of seed-borne pathogens on legumes by microbial and other alternative seed treatments

NARCIS (Netherlands)

Tinivella, F.; Hirata, L.M.; Celan, M.A.; Wright, S.A.I.; Amein, T.; Schmitt, A.; Wolf, van der J.M.; Koch, E.; Groot, S.P.C.

2009-01-01

Greenhouse trials were carried out in order to test the efficacy of different seed treatments as alternatives to chemicals against Colletotrichum lindemuthianum cause of anthracnose on bean and Ascochyta spp. cause of Ascochyta blights on pea, respectively. Resistance inducers, commercially

SU-C-202-04: Adapting Biologically Optimized Dose Escalation Based On Mid-Treatment PET/CT for Non-Small-Cell Lung Cancer

Energy Technology Data Exchange (ETDEWEB)

Zhang, P; Kuo, L; Yorke, E; Hu, Y; Lockney, N; Mageras, G; Deasy, J; Rimner, A [Memorial Sloan Kettering Cancer Center, New York, NY (United States)

2016-06-15

Purpose: To develop a biological modeling strategy which incorporates the response observed on the mid-treatment PET/CT into a dose escalation design for adaptive radiotherapy of non-small-cell lung cancer. Method: FDG-PET/CT was acquired midway through standard fractionated treatment and registered to pre-treatment planning PET/CT to evaluate radiation response of lung cancer. Each mid-treatment PET voxel was assigned the median SUV inside a concentric 1cm-diameter sphere to account for registration and imaging uncertainties. For each voxel, the planned radiation dose, pre- and mid-treatment SUVs were used to parameterize the linear-quadratic model, which was then utilized to predict the SUV distribution after the full prescribed dose. Voxels with predicted post-treatment SUV≥2 were identified as the resistant target (response arm). An adaptive simultaneous integrated boost was designed to escalate dose to the resistant target as high as possible, while keeping prescription dose to the original target and lung toxicity intact. In contrast, an adaptive target volume was delineated based only on the intensity of mid-treatment PET/CT (intensity arm), and a similar adaptive boost plan was optimized. The dose escalation capability of the two approaches was compared. Result: Images of three patients were used in this planning study. For one patient, SUV prediction indicated complete response and no necessary dose escalation. For the other two, resistant targets defined in the response arm were multifocal, and on average accounted for 25% of the pre-treatment target, compared to 67% in the intensity arm. The smaller response arm targets led to a 6Gy higher mean target dose in the adaptive escalation design. Conclusion: This pilot study suggests that adaptive dose escalation to a biologically resistant target predicted from a pre- and mid-treatment PET/CT may be more effective than escalation based on the mid-treatment PET/CT alone. More plans and ultimately clinical

Alternating treatment with didanosine and zidovudine versus either drug alone for the treatment of advanced HIV infection. The Alter Study. Nordic HIV Therapy Group

DEFF Research Database (Denmark)

Gerstoft, J; Melander, H; Bruun, J N

1997-01-01

The efficacy and safety of an alternating regime with zidovudine and didanosine versus treatment with either drug alone were investigated in a randomized, open, controlled trial, 552 patients with advanced HIV infection, 47% of whom had received prior treatment with zidovudine, were enrolled...... distributed between the 3 treatment groups. In the subgroup of patients with a CD4 count

The role of information search in seeking alternative treatment for back pain: a qualitative analysis.

Science.gov (United States)

McClymont, Hoda; Gow, Jeff; Perry, Chad

2014-01-01

Health consumers have moved away from a reliance on medical practitioner advice to more independent decision processes and so their information search processes have subsequently widened. This study examined how persons with back pain searched for alternative treatment types and service providers. That is, what information do they seek and how; what sources do they use and why; and by what means do they search for it? 12 persons with back pain were interviewed. The method used was convergent interviewing. This involved a series of semi-structured questions to obtain open-ended answers. The interviewer analysed the responses and refined the questions after each interview, to converge on the dominant factors influencing decisions about treatment patterns. Persons with back pain mainly search their memories and use word of mouth (their doctor and friends) for information about potential treatments and service providers. Their search is generally limited due to personal, provider-related and information-supply reasons. However, they did want in-depth information about the alternative treatments and providers in an attempt to establish apriori their efficacy in treating their specific back problems. They searched different sources depending on the type of information they required. The findings differ from previous studies about the types of information health consumers require when searching for information about alternative or mainstream healthcare services. The results have identified for the first time that limited information availability was only one of three categories of reasons identified about why persons with back pain do not search for more information particularly from external non-personal sources.

Pollution Impact and Alternative Treatment for Produced Water

Directory of Open Access Journals (Sweden)

Hedar Yusran

2018-01-01

Full Text Available Oil and gas exploration and production are two of the activities that potentially cause pollution and environmental damage. The largest waste generated from this activity is produced water. Produced water contains hazardous pollutants of both organic and inorganic materials, so that the produced water of oil and gas production cannot be discharged directly to the environment. Uncontrolled discharge can lead to the environmental damage, killing the life of water and plants. The produced water needs to be handled and fulfill the quality standards before being discharged to the environment. Several studies to reduce the contaminants in the produced water were conducted by researchers. Among them were gravity based separation - flotation, separation technique based on filtration, and biological process treatment. Therefore, some of these methods can be used as an alternative waste handling of produced water.

Medicinal plants as alternative treatments for female sexual dysfunction: utopian vision or possible treatment in climacteric women?

Science.gov (United States)

Mazaro-Costa, Renata; Andersen, Monica L; Hachul, Helena; Tufik, Sergio

2010-11-01

Female sexual dysfunction (FSD) is a complex and multifactorial condition. An increased incidence of FSD is especially associated with the decline of estrogen. Thus, menopause is a critical phase for FSD complaints. In this context, medicinal plants may be a therapeutic option. To identify and describe the popular and clinical uses of medicinal plants for FSD treatment in climacteric women. We highlighted the majority of the plants commonly involved with the female reproductive system including: Angelica sinensis, Cimicifuga racemosa, Ferula hermonis, Ginkgo biloba, Humulus lupulus, Lepidium meyenii, Tribulus terrestris, Trifolium pratense, and Vitex agnus-castus. This study is a narrative review of studies of plants that are possible alternative treatments for FSD. The species described have clinical and popular uses in different cultures as well as medical indications for female reproductive disturbances, mainly in climacteric women. We have also analyzed the evidence level of clinical studies. The main outcome assessed is the efficacy of plants in improving the symptoms of FSD. There is little evidence from the literature to recommend the use of medicinal plants when treating FSD. The majority of studies with a strong level of evidence are associated with the treatment of the vasomotor symptoms of menopause. Ferula hermonis, Angelica sinensis, and Gingko biloba may be suggested for arousal disorder studies. Cimicifuga racemosa, Trifolium pratense, and Vitex agnus-castus may be recommended for several FSD. Humulus lupulus and Tribulus terrestris may help with desire disorder studies. Lepidium meyenii should be studied further. Studies of these plants indicate that they may be useful as a possible alternative and/or complementary approach for studies aimed at the treatment of FSD. At this time, however, this review cannot recommend a plant that has a strong enough level of evidence for treatment of FSD. Thus, there is a need for clinical (double-blinded and

Selection of the Best Wastewater Treatment Alternative for RIPI Based on Analytical Hierarchy Process (AHP and Expert Choice Software

Directory of Open Access Journals (Sweden)

faramarz Tarkian

2014-05-01

Full Text Available RIPI as one of the largest and most important research centers in Iran is located in zone 22 of Tehran municipality. According to the environmental priorities in the region taking all necessary measures to control pollution sources is necessary. In this paper, Analytical Hierarchy Process (AHP method is used for the selection of the best wastewater treatment method for RIPI. For this purpose four alternatives including SBR, Extended aeration activated sludge, Rotating MBR, Fix MBR were evaluated. These alternatives were weighted by four main criteria: Environment, Economic, Technical, Management and the defined sub-criteria ,then paired compared with respect to any form of wastewater treatment alternatives and ultimately the results was evaluated by Expert Choice software. The evaluation results indicate that Rotating MBR was the most suitable alternative of wastewater treatment method for RIPI. After the Rotating MBR, the Fix MBR, SBR and Extended activated sludge were considered suitable respectively. Degree of inconsistency is equal to 0.07, indicating that the number of paired comparisons is consistent.

A multi-attribute utility decision analysis for treatment alternatives for the DOE/SR aluminum-based spent nuclear fuel

International Nuclear Information System (INIS)

Davis, Freddie J.; Weiner, Ruth Fleischman; Wheeler, Timothy A.; Sorenson, Ken B.; Kuzio, Kenneth A.

2000-01-01

A multi-attribute utility analysis is applied to a decision process to select a treatment method for the management of aluminum-based spent nuclear fuel (Al-SNF) owned by the US Department of Energy (DOE). DOE will receive, treat, and temporarily store Al-SNF, most of which is composed of highly enriched uranium, at its Savannah River Site in South Carolina. DOE intends ultimately to send the treated Al-SNF to a geologic repository for permanent disposal. DOE initially considered ten treatment alternatives for the management of Al-SNF, and has narrowed the choice to two of these: the direct disposal and melt and dilute alternatives. The decision analysis presented in this document focuses on a formal decision process used to evaluate these two remaining alternatives

Counteracting quasispecies adaptability: extinction of a ribavirin-resistant virus mutant by an alternative mutagenic treatment.

Directory of Open Access Journals (Sweden)

Celia Perales

Full Text Available BACKGROUND: Lethal mutagenesis, or virus extinction promoted by mutagen-induced elevation of mutation rates of viruses, may meet with the problem of selection of mutagen-resistant variants, as extensively documented for standard, non-mutagenic antiviral inhibitors. Previously, we characterized a mutant of foot-and-mouth disease virus that included in its RNA-dependent RNA polymerase replacement M296I that decreased the sensitivity of the virus to the mutagenic nucleoside analogue ribavirin. METHODOLOGY AND PRINCIPAL FINDINGS: Replacement M296I in the viral polymerase impedes the extinction of the mutant foot-and-mouth disease virus by elevated concentrations of ribavirin. In contrast, wild type virus was extinguished by the same ribavirin treatment and, interestingly, no mutants resistant to ribavirin were selected from the wild type populations. Decreases of infectivity and viral load of the ribavirin-resistant M296I mutant were attained with a combination of the mutagen 5-fluorouracil and the non-mutagenic inhibitor guanidine hydrocloride. However, extinction was achieved with a sequential treatment, first with ribavirin, and then with a minimal dose of 5-fluorouracil in combination with guanidine hydrochloride. Both, wild type and ribavirin-resistant mutant M296I exhibited equal sensitivity to this combination, indicating that replacement M296I in the polymerase did not confer a significant cross-resistance to 5-fluorouracil. We discuss these results in relation to antiviral designs based on lethal mutagenesis. CONCLUSIONS: (i When dominant in the population, a mutation that confers partial resistance to a mutagenic agent can jeopardize virus extinction by elevated doses of the same mutagen. (ii A wild type virus, subjected to identical high mutagenic treatment, need not select a mutagen-resistant variant, and the population can be extinguished. (iii Extinction of the mutagen-resistant variant can be achieved by a sequential treatment of a

Effects of a pain education program in Complementary and Alternative Medicine treatment utilization at a VA medical center.

Science.gov (United States)

Cosio, David; Lin, Erica H

2015-06-01

Past studies have shown that U.S. Veterans are consumers of CAM. However, more than 75% of Veteran non-users report they would utilize these treatment options if made available. Thus, Veterans may not be fully aware of the CAM options currently available to them in the current U.S. VA health care system. The current study tested the hypothesis that Veterans would report an increase in CAM utilization after completing a formal pain education program in a VA medical center. The study used a quasi-experimental, one-group, pre/post-test design. Midwestern, U.S. VA Medical Center. The responses from 103 Veterans who elected to participate in the program and the assessment measures were included in the outcome analyses. "Pain Education School" is a 12-week, educational program that is open to all Veterans and their families. It is a comprehensive program that introduces patients to 23 different disciplines at the VA Medical Center that deal with chronic, non-cancer pain. An adaptation of the Complementary and Alternative Medicine Questionnaire(©), SECTION A: Use of Alternative Health Care Providers. There was a significant difference found in overall utilization of CAM after completing the pain education program. The most utilized CAM modality was the chiropractor; the least utilized were hypnosis and aromatherapy. Not all health care systems or providers may have access to an education-focused, professionally driven program as an amenity. However, lessons can be learned from this study in terms of what pain providers may be able to accomplish in their practice. Published by Elsevier Ltd.

Alternative Splicing as a Target for Cancer Treatment.

Science.gov (United States)

Martinez-Montiel, Nancy; Rosas-Murrieta, Nora Hilda; Anaya Ruiz, Maricruz; Monjaraz-Guzman, Eduardo; Martinez-Contreras, Rebeca

2018-02-11

Alternative splicing is a key mechanism determinant for gene expression in metazoan. During alternative splicing, non-coding sequences are removed to generate different mature messenger RNAs due to a combination of sequence elements and cellular factors that contribute to splicing regulation. A different combination of splicing sites, exonic or intronic sequences, mutually exclusive exons or retained introns could be selected during alternative splicing to generate different mature mRNAs that could in turn produce distinct protein products. Alternative splicing is the main source of protein diversity responsible for 90% of human gene expression, and it has recently become a hallmark for cancer with a full potential as a prognostic and therapeutic tool. Currently, more than 15,000 alternative splicing events have been associated to different aspects of cancer biology, including cell proliferation and invasion, apoptosis resistance and susceptibility to different chemotherapeutic drugs. Here, we present well established and newly discovered splicing events that occur in different cancer-related genes, their modification by several approaches and the current status of key tools developed to target alternative splicing with diagnostic and therapeutic purposes.

Developing adaptive interventions for adolescent substance use treatment settings: protocol of an observational, mixed-methods project.

Science.gov (United States)

Grant, Sean; Agniel, Denis; Almirall, Daniel; Burkhart, Q; Hunter, Sarah B; McCaffrey, Daniel F; Pedersen, Eric R; Ramchand, Rajeev; Griffin, Beth Ann

2017-12-19

Over 1.6 million adolescents in the United States meet criteria for substance use disorders (SUDs). While there are promising treatments for SUDs, adolescents respond to these treatments differentially in part based on the setting in which treatments are delivered. One way to address such individualized response to treatment is through the development of adaptive interventions (AIs): sequences of decision rules for altering treatment based on an individual's needs. This protocol describes a project with the overarching goal of beginning the development of AIs that provide recommendations for altering the setting of an adolescent's substance use treatment. This project has three discrete aims: (1) explore the views of various stakeholders (parents, providers, policymakers, and researchers) on deciding the setting of substance use treatment for an adolescent based on individualized need, (2) generate hypotheses concerning candidate AIs, and (3) compare the relative effectiveness among candidate AIs and non-adaptive interventions commonly used in everyday practice. This project uses a mixed-methods approach. First, we will conduct an iterative stakeholder engagement process, using RAND's ExpertLens online system, to assess the importance of considering specific individual needs and clinical outcomes when deciding the setting for an adolescent's substance use treatment. Second, we will use results from the stakeholder engagement process to analyze an observational longitudinal data set of 15,656 adolescents in substance use treatment, supported by the Substance Abuse and Mental Health Services Administration, using the Global Appraisal of Individual Needs questionnaire. We will utilize methods based on Q-learning regression to generate hypotheses about candidate AIs. Third, we will use robust statistical methods that aim to appropriately handle casemix adjustment on a large number of covariates (marginal structural modeling and inverse probability of treatment weights

Complementary and Alternative Medicine in the Treatment of Chronic Pelvic Pain in Women: What Is the Evidence?

Science.gov (United States)

Paiva, Sara; Carneiro, Márcia Mendonça

2013-01-01

Chronic pelvic pain (CPP) is defined as pain of at least 6 months' duration that occurs in the lower abdomen or below the umbilicus and has resulted in functional or psychological disability or required intervention and treatment. Therapeutic interventions center around the treatment of CPP as a diagnosis in and of itself, and treatment of specific disorders that may be related to CPP. A multidisciplinary approach for diagnosis and treatment seems to be most effective for symptomatic relief. This paper reviews the evidence for such interventions as psychological treatments including the use of complementary and alternative medicine techniques for CPP in women. Unfortunately, finding the best evidence in this setting is difficult as only very few randomized controlled trials are available. A combination of treatments is usually required over time for the treatment of refractory CPP. The multifactorial nature of CPP needs to be discussed with the patient and a good rapport as well as a partnership needs to be developed to plan a management program with regular followup. Promotion of a multidisciplinary approach which includes complementary and alternative medicine techniques in managing CPP in women seems to yield the best results.

Comparison of online IGRT techniques for prostate IMRT treatment: Adaptive vs repositioning correction

International Nuclear Information System (INIS)

Thongphiew, Danthai; Wu, Q. Jackie; Lee, W. Robert; Chankong, Vira; Yoo, Sua; McMahon, Ryan; Yin Fangfang

2009-01-01

This study compares three online image guidance techniques (IGRT) for prostate IMRT treatment: bony-anatomy matching, soft-tissue matching, and online replanning. Six prostate IMRT patients were studied. Five daily CBCT scans from the first week were acquired for each patient to provide representative ''snapshots'' of anatomical variations during the course of treatment. Initial IMRT plans were designed for each patient with seven coplanar 15 MV beams on a Eclipse treatment planning system. Two plans were created, one with a PTV margin of 10 mm and another with a 5 mm PTV margin. Based on these plans, the delivered dose distributions to each CBCT anatomy was evaluated to compare bony-anatomy matching, soft-tissue matching, and online replanning. Matching based on bony anatomy was evaluated using the 10 mm PTV margin (''bone10''). Soft-tissue matching was evaluated using both the 10 mm (''soft10'') and 5 mm (''soft5'') PTV margins. Online reoptimization was evaluated using the 5 mm PTV margin (''adapt''). The replanning process utilized the original dose distribution as the basis and linear goal programming techniques for reoptimization. The reoptimized plans were finished in less than 2 min for all cases. Using each IGRT technique, the delivered dose distribution was evaluated on all 30 CBCT scans (6 patientsx5CBCT/patient). The mean minimum dose (in percentage of prescription dose) to the CTV over five treatment fractions were in the ranges of 99%-100%(SD=0.1%-0.8%), 65%-98%(SD=0.4%-19.5%), 87%-99%(SD=0.7%-23.3%), and 95%-99%(SD=0.4%-10.4%) for the adapt, bone10, soft5, and soft10 techniques, respectively. Compared to patient position correction techniques, the online reoptimization technique also showed improvement in OAR sparing when organ motion/deformations were large. For bladder, the adapt technique had the best (minimum) D90, D50, and D30 values for 24, 17, and 15 fractions out of 30 total fractions, while it also had the best D90, D50, and D30 values for

Adapting Dialectical Behavior Therapy for the Treatment of Dissociative Identity Disorder.

Science.gov (United States)

Foote, Brad; Van Orden, Kim

2016-12-31

Dialectical Behavior Therapy (DBT), created by Marsha Linehan, has been shown to be an effective therapy for the treatment of borderline personality disorder (BPD) and for suicidal and self-harming behavior. Dissociative identity disorder (DID) is a complex post-traumatic disorder which is highly comorbid with BPD, shares a number of clinical features with BPD, and which like BPD features a high degree of suicidality. The DID treatment literature emphasizes the importance of a staged approach, beginning with the creation of a safe therapeutic frame prior to addressing traumatic material; DBT is also a staged treatment, in which behavioral and safety issues are addressed in Stage 1, and trauma work reserved for Stage 2. The authors describe adapting DBT, and especially its techniques for Stage 1 safety work, for work with DID patients. Basic theoretical principles are described and illustrated with a case example.

Effect of alternating voltage treatment on corrosion resistance of AZ91D magnesium alloy

Energy Technology Data Exchange (ETDEWEB)

Liu, X. [Corrosion and Protection Laboratory, Key Laboratory of Superlight Materials and Surface Technology (Harbin Engineering University), Ministry of Education, Harbin (China); Zhang, T.; Shao, Y.; Meng, G.; Wang, F. [Corrosion and Protection Laboratory, Key Laboratory of Superlight Materials and Surface Technology (Harbin Engineering University), Ministry of Education, Harbin (China); State Key Laboratory for Corrosion and Protection, Institute of Metal Research, Chinese Academy of Sciences, Shenyang (China)

2012-06-15

AZ91D magnesium alloy was treated by the alternating voltage (AV) treatment technique. The optimal AV-treatment parameters of the alloy were determined by orthogonal experiments. Polarization curve, electrochemical impedance spectroscopy (EIS), and scanning electrochemical microscopy (SECM) were used to understand the effect of AV-treatment on the corrosion resistance of the alloy. AFM, contact angle, and XPS were employed to investigate further the influence of AV-treatment on the properties of the surface film formed on the alloy after AV-treatment. The results showed that a uniform and stable film was formed and the corrosion resistance of AZ91D magnesium alloy was significantly improved after AV-treatment. This was caused by the noticeable change of the chemical structure and semi-conducting properties of the surface film after AV-treatment. (Copyright copyright 2012 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim)

Automated replication of cone beam CT-guided treatments in the Pinnacle(3) treatment planning system for adaptive radiotherapy.

Science.gov (United States)

Hargrave, Catriona; Mason, Nicole; Guidi, Robyn; Miller, Julie-Anne; Becker, Jillian; Moores, Matthew; Mengersen, Kerrie; Poulsen, Michael; Harden, Fiona

2016-03-01

Time-consuming manual methods have been required to register cone-beam computed tomography (CBCT) images with plans in the Pinnacle(3) treatment planning system in order to replicate delivered treatments for adaptive radiotherapy. These methods rely on fiducial marker (FM) placement during CBCT acquisition or the image mid-point to localise the image isocentre. A quality assurance study was conducted to validate an automated CBCT-plan registration method utilising the Digital Imaging and Communications in Medicine (DICOM) Structure Set (RS) and Spatial Registration (RE) files created during online image-guided radiotherapy (IGRT). CBCTs of a phantom were acquired with FMs and predetermined setup errors using various online IGRT workflows. The CBCTs, DICOM RS and RE files were imported into Pinnacle(3) plans of the phantom and the resulting automated CBCT-plan registrations were compared to existing manual methods. A clinical protocol for the automated method was subsequently developed and tested retrospectively using CBCTs and plans for six bladder patients. The automated CBCT-plan registration method was successfully applied to thirty-four phantom CBCT images acquired with an online 0 mm action level workflow. Ten CBCTs acquired with other IGRT workflows required manual workarounds. This was addressed during the development and testing of the clinical protocol using twenty-eight patient CBCTs. The automated CBCT-plan registrations were instantaneous, replicating delivered treatments in Pinnacle(3) with errors of ±0.5 mm. These errors were comparable to mid-point-dependant manual registrations but superior to FM-dependant manual registrations. The automated CBCT-plan registration method quickly and reliably replicates delivered treatments in Pinnacle(3) for adaptive radiotherapy.

Adapting Evaluations of Alternative Payment Models to a Changing Environment.

Science.gov (United States)

Grannemann, Thomas W; Brown, Randall S

2018-04-01

To identify the most robust methods for evaluating alternative payment models (APMs) in the emerging health care delivery system environment. We assess the impact of widespread testing of alternative payment models on the ability to find credible comparison groups. We consider the applicability of factorial research designs for assessing the effects of these models. The widespread adoption of alternative payment models could effectively eliminate the possibility of comparing APM results with a "pure" control or comparison group unaffected by other interventions. In this new environment, factorial experiments have distinct advantages over the single-model experimental or quasi-experimental designs that have been the mainstay of recent tests of Medicare payment and delivery models. The best prospects for producing definitive evidence of the effects of payment incentives for APMs include fractional factorial experiments that systematically vary requirements and payment provisions within a payment model. © Health Research and Educational Trust.

Peroxidase of Brazilian Cerrado grass as an alternative for agro industrial waste treatment

Directory of Open Access Journals (Sweden)

Raquel Pinheiro Reis Souza Ramalho

2016-03-01

Full Text Available Decontamination of wastewater continues to be a challenge for society and the scientific community. Despite the availability of various materials for study, enzymes stand out due to their specificity for decomposition and biodegradability for disposal. New sources of enzymes may represent efficient and low-cost alternatives compared to routinely used techniques. In this survey, the peroxidase profile from Echinolaena inflexa fruits was studied for possible applications in the treatment of wastewater. The protein content was found to be 5.33 mg g-1. The optimum reaction conditions were: 50°C, pH 7.5 at 0.1 mol L-1 of phosphate buffer for 15 min. The enzyme was inactivated after 5 min at 94°C and was inhibited when incubated with ascorbic acid at 10 mmol L-1. In tests using phenols and agro industrial waste, the peroxidase was able to oxidase 87.5% of catechol, 67.8% of pyrogallol, 39.1% of resorcinol and still presented 29.1% of the degradation capacity of raw wastewater phenolic compounds. The results showed that the Echinolaena inflexa peroxidase, a new source of enzymes, is a potential alternative to wastewater treatment.

A two-stage predictive model to simultaneous control of trihalomethanes in water treatment plants and distribution systems: adaptability to treatment processes.

Science.gov (United States)

Domínguez-Tello, Antonio; Arias-Borrego, Ana; García-Barrera, Tamara; Gómez-Ariza, José Luis

2017-10-01

The trihalomethanes (TTHMs) and others disinfection by-products (DBPs) are formed in drinking water by the reaction of chlorine with organic precursors contained in the source water, in two consecutive and linked stages, that starts at the treatment plant and continues in second stage along the distribution system (DS) by reaction of residual chlorine with organic precursors not removed. Following this approach, this study aimed at developing a two-stage empirical model for predicting the formation of TTHMs in the water treatment plant and subsequently their evolution along the water distribution system (WDS). The aim of the two-stage model was to improve the predictive capability for a wide range of scenarios of water treatments and distribution systems. The two-stage model was developed using multiple regression analysis from a database (January 2007 to July 2012) using three different treatment processes (conventional and advanced) in the water supply system of Aljaraque area (southwest of Spain). Then, the new model was validated using a recent database from the same water supply system (January 2011 to May 2015). The validation results indicated no significant difference in the predictive and observed values of TTHM (R 2 0.874, analytical variance distribution systems studied, proving the adaptability of the new model to the boundary conditions. Finally the predictive capability of the new model was compared with 17 other models selected from the literature, showing satisfactory results prediction and excellent adaptability to treatment processes.

Adapting to Population Growth: The Evolutionary Alternative to Malthus

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Axel Kristinsson

2016-06-01

Full Text Available A long-standing debate on the dynamics of population growth in human history has become polarized between a Malthusian stance and a Boserupian one. The former tends to view population growth as limited by carrying capacity, dependent on environment and technology, whereas the latter sees population growth itself as a major inducement to social, economic and technological developments. In this paper the authors experiment with approaching this debate by using recent developments in evolutionary theory. According to these, evolutionary principles, as expounded by Charles Darwin and subsequent evolutionary scientists, apply not only to biological evolution but also to social or cultural evolution. Here, the role of genes is taken over by culture and, since culture is much more pliable than our DNA, evolution speeds up. As the only organisms on Earth whose evolution relies as heavily on culture as on genes, humans have become extremely adaptable. Their hyper-adaptability suggest that humans, through their cultural evolution, have managed increasingly to adapt to their own growing population, thus succeeding in accommodating ever-growing numbers. This hypothesis fits the Boserupian approach to population very well but less so the Malthusian one, perhaps indicating a gradual shift from a Malthusian regime to a Boserupian one in human history. The hypothesis is discussed and examined through four case studies: The beginning of farming around Göbekli Tepe in southeast Turkey, the productive farming systems of Tiwanaku in South America, the population crisis of late medieval and early modern Iceland, and the ‘collapse’ of Rapa Nui (Easter Island.

Adaptive clinical trial designs with pre-specified rules for modifying the sample size: understanding efficient types of adaptation.

Science.gov (United States)

Levin, Gregory P; Emerson, Sarah C; Emerson, Scott S

2013-04-15

Adaptive clinical trial design has been proposed as a promising new approach that may improve the drug discovery process. Proponents of adaptive sample size re-estimation promote its ability to avoid 'up-front' commitment of resources, better address the complicated decisions faced by data monitoring committees, and minimize accrual to studies having delayed ascertainment of outcomes. We investigate aspects of adaptation rules, such as timing of the adaptation analysis and magnitude of sample size adjustment, that lead to greater or lesser statistical efficiency. Owing in part to the recent Food and Drug Administration guidance that promotes the use of pre-specified sampling plans, we evaluate alternative approaches in the context of well-defined, pre-specified adaptation. We quantify the relative costs and benefits of fixed sample, group sequential, and pre-specified adaptive designs with respect to standard operating characteristics such as type I error, maximal sample size, power, and expected sample size under a range of alternatives. Our results build on others' prior research by demonstrating in realistic settings that simple and easily implemented pre-specified adaptive designs provide only very small efficiency gains over group sequential designs with the same number of analyses. In addition, we describe optimal rules for modifying the sample size, providing efficient adaptation boundaries on a variety of scales for the interim test statistic for adaptation analyses occurring at several different stages of the trial. We thus provide insight into what are good and bad choices of adaptive sampling plans when the added flexibility of adaptive designs is desired. Copyright © 2012 John Wiley & Sons, Ltd.

Physical, Complementary, and Alternative Medicine in the Treatment of Pelvic Floor Disorders.

Science.gov (United States)

Arnouk, Alex; De, Elise; Rehfuss, Alexandra; Cappadocia, Carin; Dickson, Samantha; Lian, Fei

2017-06-01

The purpose of the study was to catalog the most recent available literature regarding the use of conservative measures in treatment of pelvic floor disorders. Pelvic floor disorders encompass abnormalities of urination, defecation, sexual function, pelvic organ prolapse, and chronic pain, and can have significant quality of life implications for patients. Current guidelines recommend behavioral modifications and conservative treatments as first-line therapy for pelvic floor disorders. We have reviewed the literature for articles published on physical, complementary, and alternative treatments for pelvic floor disorders over the past 5 years. Review of pelvic floor muscle physiotherapy (PFMT) and biofeedback (BF) shows a benefit for patients suffering from bladder dysfunction (incontinence, overactive bladder), bowel dysfunction (constipation, fecal incontinence), pelvic organ prolapse, and sexual dysfunction (pelvic pain). Combination of PFMT and BF has shown improved results compared to PFMT alone, and some studies find that electrical stimulation can augment the benefit of BF and PFMT. Additionally, acupuncture and cognitive behavioral therapy has shown to be an effective treatment for pelvic floor disorders, particularly with respect to pelvic pain. This update highlights beneficial conservative treatments available for pelvic floor dysfunction, and supplements the current literature on treatment options for patients suffering from these disorders.

Gamma radiation use as a quarantine treatment alternative for cut flowers

International Nuclear Information System (INIS)

Kikuchi, Olivia Kimiko

1999-01-01

Methyl bromide is a broad spectrum pesticide to control insects, nematodes, weeds, pathogens and rodents It is effective to commodity treatment designed for exportation/importation, but is also toxic for human being. Besides, it is an ozone layer depleting substance and many countries are interested in finding other less damaging alternatives. The methyl bromide shall be banned until 2015 and one promising alternative is the radiation. It can be effective for some vegetables, like fresh cut flowers. The tolerance to gamma radiation was observed in some cut flowers. Dianthus (Caryophyllaceae), Gypsophyla (Caryophyllaceae), Gomphrena (Amarantaceae), Celosia (Amarantaceae) and Narcissus (Amaryllidaceae) were tolerant to 750 Gy. Heliconia and Strelitzia (Musaceae) were not tolerant, presenting a severe browning of the colored sepals. Anthurium (Araceae) was also sensitive to 750 Gy, presenting browning of the spike, discoloration and black spots on the sepals. The radiation inhibited the bud opening of Hemerocallis (Liliaceae) and Gladiolus (Iridaceae). Gerbera (Compositae) and Callistemon (Myrtaceae) wilted before the control flowers. Helianthus (Compositae) leaves wilted before the flowers because of the radiation. (author)

Ecological effects of alternative fuel-reduction treatments: highlights of the National Fire and Fire Surrogate study (FFS)

Science.gov (United States)

James D. McIver; Scott L. Stephens; James K. Agee; Jamie Barbour; Ralph E. J. Boerner; Carl B. Edminster; Karen L. Erickson; Kerry L. Farris; Christopher J. Fettig; Carl E. Fiedler; Sally Haase; Stephen C. Hart; Jon E. Keeley; Eric E. Knapp; John F. Lehmkuhl; Jason J. Moghaddas; William Otrosina; Kenneth W. Outcalt; Dylan W. Schwilk; Carl N. Skinner; Thomas A. Waldrop; C. Phillip Weatherspoon; Daniel A. Yaussy; Andrew Youngblood; Steve Zack

2012-01-01

The 12-site National Fire and Fire Surrogate study (FFS) was a multivariate experiment that evaluated ecological consequences of alternative fuel-reduction treatments in seasonally dry forests of the US. Each site was a replicated experiment with a common design that compared an un-manipulated control, prescribed fire, mechanical and mechanical + fire treatments....

LONG-TERM OUTCOME OF THE DIFFERENT TREATMENT ALTERNATIVES FOR RECURRENT AND PERSISTENT CUSHING DISEASE.

Science.gov (United States)

Espinosa-de-Los-Monteros, Ana Laura; Sosa-Eroza, Ernesto; Espinosa, Etual; Mendoza, Victoria; Arreola, Rocio; Mercado, Moises

2017-07-01

Treatment alternatives for persistent and recurrent Cushing disease (CD) include pituitary surgical re-intervention, radiation therapy (RT), pharmacotherapy, and bilateral adrenalectomy (BA). The decision of which of these alternatives is better suited for the individual patient rests on clinical judgment and the availability of resources. This retrospective cohort study was performed at a referral center to evaluate the long-term efficacy of different secondary interventions for persistent and recurrent CD. We evaluated the hospital charts of 84 patients (77 female, median age 34 years, median follow up 6.3 years) with CD diagnosed, treated, and followed at our multidisciplinary clinic according to a pre-established protocol. Of the 81 patients who were initially treated with transsphenoidal surgery (TSS), 61.7% had a long-lasting remission, 16% had persistent disease, and 22% achieved remission but relapsed during follow-up. The most frequently used secondary treatment was pituitary re-intervention, followed by ketoconazole, RT, and BA. Early remissions were observed in 66.6% of the re-operated and in 58.3% of the radiated patients; long-lasting remission was achieved in 33.3% and 41.6% of these patients, respectively. Nelson syndrome developed in 41.6% of the patients who underwent BA. Upon last follow-up, 88% of all the patients are in remission, and 9.5% are biochemically controlled with ketoconazole. The efficacy of treatment alternatives for recurrent or persistent CD varies considerably among patients and multiple interventions are often required to achieve long-lasting remission. ACTH = adrenocorticotrophic hormone; BA = bilateral adrenalectomy; CBG = cabergoline; CD = Cushing disease; CV = coefficient of variation; DXM = dexamethasone; IQR = interquartile range; RT = radiation therapy; SRS = stereotactic radiosurgery; TSS = transsphenoidal surgery; UFC = urinary free cortisol; ULN = upper limit of normal.

ALOE VERA BARBADENSIS MILLER AS AN ALTERNATIVE TREATMENT FOR CHILDREN WITH FEVER

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Siti Choirul Dwi Astuti

2017-10-01

Full Text Available Background: Applying a cooling treatment from outside the body is one way to lower fever in children. Midwives commonly perform a warm water compress in their care, but it is considered less effective. Thus, compress with aloe vera barbadensus miller is proposed in this study as an alternative treatment. Objective: To examine the effect of Aloe vera barbadensis miller compress in reducing body temperature in children with fever. Methods: This was a quasi-experimental study with pretest and posttest with control group design. Forty children were recruited, with twenty of them assigned in each group. Purposive sampling was performed to select the sample. A digital rectal thermometer was used to measure the temperature. Independent t- test and paired test were used for data analysis. Results: Findings showed that the aloe vera compress group showed a higher decrease of body temperature compared to the warm water compress group. The difference of body temperature after 20 minutes in the experiment group was 1.435 while in the control group was only 1.085. There were statistically significant differences in body temperature between the experiment and control group (p=0.013. Conclusion: Aloe vera barbadensis miller compress is an effective alternative therapy in reducing body temperature in children with fever. It is recommended for midwives to apply this intervention to reduce body temperature significantly.

Adaptive servo ventilation for central sleep apnoea in heart failure : SERVE-HF on-treatment analysis

NARCIS (Netherlands)

Woehrle, Holger; Cowie, Martin R.; Eulenburg, Christine; Suling, Anna; Angermann, Christiane; d'Ortho, Marie-Pia; Erdmann, Erland; Levy, Patrick; Simonds, Anita K.; Somers, Virend K.; Zannad, Faiez; Teschler, Helmut; Wegscheider, Karl

2017-01-01

This on-treatment analysis was conducted to facilitate understanding of mechanisms underlying the increased risk of all-cause and cardiovascular mortality in heart failure patients with reduced ejection fraction and predominant central sleep apnoea randomised to adaptive servo ventilation versus the

Ustekinumab as an Alternative Treatment Option for Chronic Pityriasis Rubra Pilaris

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Mudit Chowdhary

2015-03-01

Full Text Available Pityriasis rubra pilaris (PRP is an exceptionally rare, chronic inflammatory dermatosis of unknown etiology. Patients classically present with small, follicular keratosis and salmon-colored plaques that begin at the head and neck and slowly progress to widespread erythroderma including the palms and soles. It is difficult to distinguish PRP from other inflammatory dermatoses; however, features that help aid in the diagnosis include ‘islands' of spared skin, orangish hue and typical findings on biopsy. There are no specific guidelines on therapy and treatment options include corticosteroids, vitamin D analogs, retinoids, methotrexate, cyclosporine, azathioprine and tumor necrosis factor alpha antagonists. Unfortunately options are limited for patients when these drugs do not work. We report a case of chronic PRP, refractory to conventional treatment, successfully treated with ustekinumab monotherapy. The patient was treated with 90 mg subcutaneous ustekinumab injections and began to show improvement within only 8 weeks. Long-term control of the disease has been attained without any significant side effects. We report this case to show that ustekinumab can be used as an alternative treatment method for patients with chronic, unremitting PRP. Treatment response is remarkably rapid and the infrequent dosing leads to patient compliance and a significantly improved quality of life.

Complementary and alternative medicine for the treatment and diagnosis of asthma and allergic diseases.

Science.gov (United States)

Passalacqua, G; Compalati, E; Schiappoli, M; Senna, G

2005-03-01

The use of Complementary/Alternative Medicines (CAM) is largely diffused and constantly increasing, especially in the field of allergic diseases and asthma. Homeopathy, acupuncture and phytotherapy are the most frequently utilised treatments, whereas complementary diagnostic techniques are mainly used in the field of food allergy-intolerance. Looking at the literature, the majority of clinical trials with CAMS are of low methodological quality, thus difficult to interpret. There are very few studies performed in a rigorously controlled fashion, and those studies provided inconclusive results. In asthma, none of the CAM have thus far been proved more effective than placebo or equally effective as standard treatments. Some herbal products, containing active principles, have displayed some clinical effect, but the herbal remedies are usually not standardised and not quantified, thus carry the risk of toxic effects or interactions. None of the alternative diagnostic techniques (electrodermal testing, kinesiology, leukocytotoxic test, iridology, hair analysis) have been proved able to distinguish between healthy and allergic subjects or to diagnose sensitizations. Therefore these tests must not be used, since they can lead to delayed or incorrect diagnosis and therapy.

Vegetable coagulants as alternative for treatment of wastewater in Mexico

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Servando López-León

2017-11-01

Full Text Available This review addresses the various properties of natural coagulants, water, the chemical substance essential for life and the ideal solvent for a large number of compounds, it is commonly used with domestic, commercial and industrial purposes. After its use, it presents sewage to be retired before use it once again. To remove pollutant, water is subject to different physical, chemical and biological processes. Here, the clarification process uses aluminum and iron materials to remove the solids present; these materials are reported as health hazardous and toxic. In Mexico, regulatory frame work stablish that treated wastewater should do not exceed 0.2 mg/L of aluminum even though has been reported an increased risk of Alzheimer's in populations when water exceeds 0.1 mg/L. Natural coagulants have showed coagulation properties when are used in the clarification process, proven its advantages over traditional ones; such as low cost, good coagulant properties and safe health and non-toxic properties. Here, we enlist some vegetable species as alternatives to the traditional based on aluminum and iron. Additionally, these species are known to have origins on Mexico or being present extensively in the territory, making possible to think about them as alternative coagulants in the clarification process of the wastewater treatment process.

Compensated pulsed alternator

International Nuclear Information System (INIS)

Weldon, W.F.; Driga, M.D.; Woodson, H.H.

1980-01-01

This invention relates to an electromechanical energy converter with inertial energy storage. The device, a single phase, two or multi-pole alternator with stationary field coils, and a rotating armature is provided. The rotor itself may be of laminated steel for slower pulses or for faster pulses should be nonmagnetic and electrically nonconductive in order to allow rapid penetration of the field as the armature coil rotates. The armature coil comprises a plurality of power generating conductors mounted on the rotor. The alternator may also include a stationary or counterrotating compensating coil to increase the output voltage thereof and to reduce the internal impedance of the alternator at the moment of peak output. As the machine voltage rises sinusoidally, an external trigger switch is adapted to be closed at the appropriate time to create the desired output current from said alternator to an external load circuit, and as the output current passes through zero a self-commutating effect is provided to allow the switch to disconnect the generator from the external circuit

Can reinforcement-based interventions to reduce drug use successfully be adapted to routine opioid maintenance treatment?

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Michael Specka

2013-12-01

Full Text Available INTRODUCTION: Comorbid substance related disorders are a major health problem for patients in opioid maintenance treatment (OMT. It was investigated whether a reinforcement scheme adapted to the regulatory and financial restrictions of routine treatment reduces concomitant drug use. METHODS: OMT patients from 7 clinics who were using cocaine, benzodiazepines, heroin or amphetamines were randomly allocated to either treatment as usual (n = 64 or treatment with an additional escalating reinforcement scheme (n = 72 in which a patient's number of weekly take-home dosages was increased after 1, 4, 8 and 12 consecutive weeks with drug-free urine specimens. Trial duration was 26 weeks. RESULTS: Completion rates were 64% for controls and 62.5% in the experimental group. Mean number of drug-free weeks was 11.3 (SD 8.5 for the control group and 9.8 (8.9 for the experimental group (p = 0.30. CONCLUSION: The intervention was not effective compared to routine treatment. Additional features might be necessary to achieve an effect, e.g. a higher frequency of urine sampling or use of other reinforcers. It has to be further investigated how interventions which have been proven effective in experimental studies can successfully be adapted to routine care conditions.

Stereotactic body radiation therapy as an alternative treatment for small hepatocellular carcinoma.

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Sang Min Yoon

Full Text Available BACKGROUND: Even with early stage hepatocellular carcinoma (HCC, patients are often ineligible for surgical resection, transplantation, or local ablation due to advanced cirrhosis, donor shortage, or difficult location. Stereotactic body radiation therapy (SBRT has been established as a standard treatment option for patients with stage I lung cancer, who are not eligible for surgery, and may be a promising alternative treatment for patients with small HCC who are not eligible for curative treatment. MATERIALS AND METHODS: A registry database of 93 patients who were treated with SBRT for HCC between 2007 and 2009 was analyzed. A dose of 10-20 Gy per fraction was given over 3-4 consecutive days, resulting in a total dose of 30-60 Gy. The tumor response was determined using dynamic computed tomography or magnetic resonance imaging, which was performed 3 months after completion of SBRT. RESULTS: The median follow-up period was 25.6 months. Median size of tumors was 2 cm (range: 1-6 cm. Overall patients' survival rates at 1 and 3 years were 86.0% and 53.8%, respectively. Complete and partial tumor response were achieved in 15.5% and 45.7% of patients, respectively. Local recurrence-free survival rate was 92.1% at 3 years. Most local failures were found in patients with HCCs > 3 cm, and local control rate at 3 years was 76.3% in patients with HCC > 3 cm, 93.3% in patients with tumors between 2.1-3 cm, and 100% in patients with tumors ≤ 2 cm, respectively. Out-of-field intrahepatic recurrence-free survival rates at 1 and 3 years were 51.9% and 32.4%, respectively. Grade ≥ 3 hepatic toxicity was observed in 6 (6.5%. CONCLUSIONS: SBRT was effective in local control of small HCC. SBRT may be a promising alternative treatment for patients with small HCC which is unsuitable for other curative therapy.

Adaptation responses to increasing drought frequency

Science.gov (United States)

Loch, A. J.; Adamson, D. C.; Schwabe, K.

2016-12-01

Using state contingent analysis we discuss how and why irrigators adapt to alternative water supply signals. This analysis approach helps to illustrate how and why producers currently use state-general and state-allocable inputs to adapt and respond to known and possible future climatic alternative natures. Focusing on the timing of water allocations, we explore inherent differences in the demand for water by two key irrigation sectors: annual and perennial producers which in Australia have allowed a significant degree of risk-minimisation during droughts. In the absence of land constraints, producers also had a capacity to respond to positive state outcomes and achieve super-normal profits. In the future, however, the probability of positive state outcomes is uncertain; production systems may need to adapt to minimise losses and/or achieve positive returns under altered water supply conditions that may arise as a consequence of more frequent drought states. As such, producers must assess whether altering current input/output choice sets in response to possible future climate states will enhance their long-run competitive advantage for both expected new normal and extreme water supply outcomes. Further, policy supporting agricultural sector climate change resilience must avoid poorly-designed strategies that increase producer vulnerability in the face of drought. Our analysis explores the reliability of alternative water property right bundles and how reduced allocations across time influence alternative responses by producers. We then extend our analysis to explore how management strategies could adapt to two possible future drier state types: i) where an average reduction in water supply is experienced; and ii) where the frequency of droughts increase. The combination of these findings are subsequently used to discuss the role water reform policy has to deal with current and future climate scenarios. We argue current policy strategies could drive producers to

Nonlinear PI Control with Adaptive Interaction Algorithm for Multivariable Wastewater Treatment Process

Directory of Open Access Journals (Sweden)

S. I. Samsudin

2014-01-01

Full Text Available The wastewater treatment plant (WWTP is highly known with the nonlinearity of the control parameters, thus it is difficult to be controlled. In this paper, the enhancement of nonlinear PI controller (ENon-PI to compensate the nonlinearity of the activated sludge WWTP is proposed. The ENon-PI controller is designed by cascading a sector-bounded nonlinear gain to linear PI controller. The rate variation of the nonlinear gain kn is automatically updated based on adaptive interaction algorithm. Initiative to simplify the ENon-PI control structure by adapting kn has been proved by significant improvement under various dynamic influents. More than 30% of integral square error and 14% of integral absolute error are reduced compared to benchmark PI for DO control and nitrate in nitrogen removal control. Better average effluent qualities, less number of effluent violations, and lower aeration energy consumption resulted.

Percutaneous CT-Guided Cryoablation as an Alternative Treatment for an Extensive Pelvic Bone Giant Cell Tumor.

Science.gov (United States)

Panizza, Pedro Sergio Brito; de Albuquerque Cavalcanti, Conrado Furtado; Yamaguchi, Nise Hitomi; Leite, Claudia Costa; Cerri, Giovanni Guido; de Menezes, Marcos Roberto

2016-02-01

A giant cell tumor (GCT) is an intermediate grade, locally aggressive neoplasia. Despite advances in surgical and clinical treatments, cases located on the spine and pelvic bones remain a significant challenge. Failure of clinical treatment with denosumab and patient refusal of surgical procedures (hemipelvectomy) led to the use of cryoablation. We report the use of percutaneous CT-guided cryoablation as an alternative treatment, shown to be a minimally invasive, safe, and effective option for a GCT with extensive involvement of the pelvic bones and allowed structural and functional preservation of the involved bones.

Percutaneous CT-Guided Cryoablation as an Alternative Treatment for an Extensive Pelvic Bone Giant Cell Tumor

International Nuclear Information System (INIS)

Panizza, Pedro Sergio Brito; Albuquerque Cavalcanti, Conrado Furtado de; Yamaguchi, Nise Hitomi; Leite, Claudia Costa; Cerri, Giovanni Guido; Menezes, Marcos Roberto de

2016-01-01

A giant cell tumor (GCT) is an intermediate grade, locally aggressive neoplasia. Despite advances in surgical and clinical treatments, cases located on the spine and pelvic bones remain a significant challenge. Failure of clinical treatment with denosumab and patient refusal of surgical procedures (hemipelvectomy) led to the use of cryoablation. We report the use of percutaneous CT-guided cryoablation as an alternative treatment, shown to be a minimally invasive, safe, and effective option for a GCT with extensive involvement of the pelvic bones and allowed structural and functional preservation of the involved bones

Percutaneous CT-Guided Cryoablation as an Alternative Treatment for an Extensive Pelvic Bone Giant Cell Tumor

Energy Technology Data Exchange (ETDEWEB)

Panizza, Pedro Sergio Brito; Albuquerque Cavalcanti, Conrado Furtado de [Sírio Libânes Hospital, Radiology and Imaged Guided Intervention Service (Brazil); Yamaguchi, Nise Hitomi [Instituto Avanços em Medicina (Brazil); Leite, Claudia Costa; Cerri, Giovanni Guido; Menezes, Marcos Roberto de, E-mail: marcos.menezes@hc.fm.usp.br [Sírio Libânes Hospital, Radiology and Imaged Guided Intervention Service (Brazil)

2016-02-15

A giant cell tumor (GCT) is an intermediate grade, locally aggressive neoplasia. Despite advances in surgical and clinical treatments, cases located on the spine and pelvic bones remain a significant challenge. Failure of clinical treatment with denosumab and patient refusal of surgical procedures (hemipelvectomy) led to the use of cryoablation. We report the use of percutaneous CT-guided cryoablation as an alternative treatment, shown to be a minimally invasive, safe, and effective option for a GCT with extensive involvement of the pelvic bones and allowed structural and functional preservation of the involved bones.

Use and costs of prescription medications and alternative treatments in patients with osteoarthritis and chronic low back pain in community-based settings.

Science.gov (United States)

Gore, Mugdha; Tai, Kei-Sing; Sadosky, Alesia; Leslie, Douglas; Stacey, Brett R

2012-09-01

To evaluate the use and direct medical costs of pharmacologic and alternative treatments for patients with osteoarthritis (OA) and chronic low back pain (CLBP). The LifeLink™ Health Plan Claims Database was used to identify patients ≥18 years old, diagnosed with OA (N = 112,951) or CLBP (N = 101,294). Of these patients, 64,085 with OA and 47,386 with CLBP received pain-related treatments during CY2008 and were selected for inclusion. For patients in both cohorts, pharmacologic and alternative treatments, and direct medical costs were examined during CY2008. Opioids were the most frequently prescribed medication (>70%) in both groups, followed by nonselective nonsteroidal anti-inflammatory drugs (>50%). Over 30% received antidepressants, >20% received benzodiazepines, and 15% in each group received sedative hypnotics. Use of alternative treatments was as follows: chiropractor, OA 11%, CLBP 34%; physical therapy, 20% in both groups; transcutaneous electrical nerve stimulations (TENS), OA 14%, CLBP 22%; acupuncture, hydrotherapy, massage therapy, and biofeedback, patients were, OA: $15,638 ($22,595); CLBP: $11,829 ($20,035). Pharmacologic therapies accounted for approximately 20% of these costs, whereas alternative treatments accounted for only 3% to 4% of the total costs. Patients with OA and CLBP used a variety of pain-related and adjunctive medications. Although, alternative treatments are widely recommended, we found limited use of several of these in clinical practice, potentially due to the source of our data (commercial claims). Further research is needed to ascertain the extent to which such therapies contribute to the total costs of OA and CLBP management. © 2012 The Authors. Pain Practice © 2012 World Institute of Pain.

Lawrence Livermore National Laboratory Decontamination and Waste Treatment Facility: Documentation of impact analysis for design alternatives presented in the Draft Environmental Impact Statement

International Nuclear Information System (INIS)

1988-05-01

Lawrence Livermore National Laboratory (LLNL) is proposing to construct and operate a new Decontamination and Waste Treatment Facility (DWTF). The proposed DWTF would replace the existing Hazardous Waste Management (HWM) facilities at LLNL. The US Department of Energy (DOE) is preparing a Draft Environmental Impact Statement (DEIS) to assess the environmental consequences of the proposed DWTF and its alternatives. This report presents the assumptions, methodologies, and analyses used to estimate the waste flows, air emissions, ambient air quality impacts, and public health risks that are presented in the DEIS. Two DWTF design alternatives (Level I and Level II) have been designated as reasonable design alternatives considering available technologies, environmental regulations, and current and future LLNL waste generation. Both design alternatives would include new, separate radioactive and nonradioactive liquid waste treatment systems, a solidification unit, a new decontamination facility, storage and treatment facilities for reactive materials, a radioactive waste storage area, receiving and classification areas, and a uranium burn pan. The Level I design alternative would include a controlled-air incinerator system, while the Level II design alternative would include a rotary kiln incinerator system. 43 refs., 4 figs., 24 tabs

Lawsonia inermis - an alternative treatment for hyperthyroidism?

Science.gov (United States)

Zumrutdal, E; Karateke, F; Daglioglu, K; Gulkaya, M; Colak, O; Koksal, F

2014-01-01

The goal of our study was to determine the effects of Lawsonia inermis (L. inermis) in mice, in which hyperthyroidism had been caused by thyroid stimulant hormone (TSH). The first phase of the study aimed to detect the effects of L. inermis on the amount of ionized hydrogen (pH) in cells. For this aim, the effect of L. inermis on pH levels in the liver tissues of mice, in whom Escherichia coli (E. coli) had caused peritonitis, was examined. In the second phase of the study, the effect of L. inermis on the serum T4 levels in the 24th and 48th hour in mice, whose thyroid cells showed an increased activity by TSH was measured. In the first phase, in mice, in whom E.coli had caused peritonitis, the pH in the liver tissue of the group that had been given L. inermis was found to be significantly alkaline (phyperthyroidism, it was noted that serum total T4 levels were significantly lower than in the group that had been given L. inermis in the 48th hour (phyperthyroidism. These results suggest that L. inermis can be used as an alternative treatment for the Graves' disease (Tab. 2, Fig. 1, Ref. 34).

Male psychological adaptation to unsuccessful medically assisted reproduction treatments

DEFF Research Database (Denmark)

Martins, Mariana Veloso; Basto-Pereira, Miguel; Pedro, Juliana

2016-01-01

BACKGROUND: Similarly to women, men suffer from engaging in fertility treatments, both physically and psychologically. Although there is a vast body of evidence on the emotional adjustment of women to infertility, there are no systematic reviews focusing on men's psychological adaptation...... for psychological maladaptation?' SEARCH METHODS: A literature search was conducted from inception to September 2015 on five databases using combinations of MeSH terms and keywords. Eligible studies had to present quantitative prospective designs and samples including men who did not achieve pregnancy or parenthood...... at follow-up. A narrative synthesis approach was used to conduct the review. OUTCOMES: Twelve studies from three continents were eligible from 2534 records identified in the search. The results revealed that psychological symptoms of maladjustment significantly increased in men 1 year after the first...

Cross-Cultural Adaptation of the Physician Orders for Life-Sustaining Treatment Form to Brazil.

Science.gov (United States)

Mayoral, Vania F S; Fukushima, Fernanda B; Rodrigues, Aniela M; Carvalho, Raissa P; Carvalho, Larissa P; Pinheiro, Leandro A F V; Polegato, Bertha F; Minicucci, Marcos F; Bassett, Rick; Moss, Alvin H; Steinberg, Karl E; Vidal, Edison I O

2018-02-12

The Physician Orders for Life-Sustaining Treatment (POLST) paradigm is considered one of the most important strategies to respect patients' values at the end of life in the United States. The cross-cultural adaptation of POLST entailed several methodological considerations, which may be informative for international researchers who may also consider bringing POLST to their countries as a means to promote care at the end of life that is consistent with patients' preferences. To report the methods and outcome of the cross-cultural adaptation of the POLST form to Brazil. Cross-cultural adaptation study. Twenty physicians and 10 patients at a university hospital participated in the pilot tests. The cross-cultural adaptation process included choosing which existing POLST form(s) to use as a source, deciding the intended reading level, which healthcare professionals should be allowed to sign the form, and consultation with attorneys, bioethicists, and members of the National POLST Paradigm Task Force. Pilot tests occurred in two stages using different approaches. First, 20 physicians were trained about POLST and asked for any unclear aspects related to the form. Second, trained investigators completed POLST forms after engaging in advance care planning conversations with 10 hospitalized patients or patients' surrogates. This report provides a basis for future cross-cultural adaptations of POLST to other countries. The authors hope such new adaptations will broaden the possibilities of research using POLST and also may promote wider provision of care at the end of life that is consistent with patients' preferences.

Adaptive Surveying and Early Treatment of Crops with a Team of Autonomous Vehicles

DEFF Research Database (Denmark)

Kazmi, Wajahat; Bisgaard, Morten; Garcia-Ruiz, Francisco

2011-01-01

The ASETA project (acronym for Adaptive Surveying and Early treatment of crops with a Team of Autonomous vehicles) is a multi-disciplinary project combining cooperating airborne and ground-based vehicles with advanced sensors and automated analysis to implement a smart treatment of weeds...... in agricultural fields. The purpose is to control and reduce the amount of herbicides, consumed energy and vehicle emissions in the weed detection and treatment process, thus reducing the environmental impact. The project addresses this issue through a closed loop cooperation among a team of unmanned aircraft...... system (UAS) and unmanned ground vehicles (UGV) with advanced vision sensors for 3D and multispectral imaging. This paper presents the scientific and technological challenges in the project, which include multivehicle estimation and guidance, heterogeneous multi-agent systems, task generation...

Adaptive Value Normalization in the Prefrontal Cortex Is Reduced by Memory Load

Science.gov (United States)

Burke, C. J.; Seifritz, E.; Tobler, P. N.

2017-01-01

Abstract Adaptation facilitates neural representation of a wide range of diverse inputs, including reward values. Adaptive value coding typically relies on contextual information either obtained from the environment or retrieved from and maintained in memory. However, it is unknown whether having to retrieve and maintain context information modulates the brain’s capacity for value adaptation. To address this issue, we measured hemodynamic responses of the prefrontal cortex (PFC) in two studies on risky decision-making. In each trial, healthy human subjects chose between a risky and a safe alternative; half of the participants had to remember the risky alternatives, whereas for the other half they were presented visually. The value of safe alternatives varied across trials. PFC responses adapted to contextual risk information, with steeper coding of safe alternative value in lower-risk contexts. Importantly, this adaptation depended on working memory load, such that response functions relating PFC activity to safe values were steeper with presented versus remembered risk. An independent second study replicated the findings of the first study and showed that similar slope reductions also arose when memory maintenance demands were increased with a secondary working memory task. Formal model comparison showed that a divisive normalization model fitted effects of both risk context and working memory demands on PFC activity better than alternative models of value adaptation, and revealed that reduced suppression of background activity was the critical parameter impairing normalization with increased memory maintenance demand. Our findings suggest that mnemonic processes can constrain normalization of neural value representations. PMID:28462394

Adapted shared reading at school for minimally verbal students with autism.

Science.gov (United States)

Mucchetti, Charlotte A

2013-05-01

Almost nothing is known about the capacity of minimally verbal students with autism to develop literacy skills. Shared reading is a regular practice in early education settings and is widely thought to encourage language and literacy development. There is some evidence that children with severe disabilities can be engaged in adapted shared reading activities. The current study examines the impact of teacher-led adapted shared reading activities on engagement and story comprehension in minimally verbal 5-6-year-old children with autism using a multiple baseline/alternating treatment design. Four students and three teachers participated. Teachers conducted adapted shared reading activities with modified books (visual supports, three-dimensional objects, simplified text) and used specific strategies for increasing student engagement. Student performance during adapted activities was compared to performance during standard shared reading sessions. All four students showed increased story comprehension and engagement during adapted shared reading. Average percentage of session engaged was 87%-100% during adapted sessions, compared with 41%-52% during baseline. Average number of correct responses to story comprehension questions was 4.2-4.8 out of 6 during adapted sessions compared with 1.2-2 during baseline. Visual supports, tactile objects, and specific teaching strategies offer ways for minimally verbal students to meaningfully participate in literacy activities. Future research should investigate adapted shared reading activities implemented classroom-wide as well as joint engagement, language, and literacy outcomes after using such activities over time.

Adaptive Clinical Trials: Advantages and Disadvantages of Various Adaptive Design Elements.

Science.gov (United States)

Korn, Edward L; Freidlin, Boris

2017-06-01

There is a wide range of adaptive elements of clinical trial design (some old and some new), with differing advantages and disadvantages. Classical interim monitoring, which adapts the design based on early evidence of superiority or futility of a treatment arm, has long been known to be extremely useful. A more recent application of interim monitoring is in the use of phase II/III designs, which can be very effective (especially in the setting of multiple experimental treatments and a reliable intermediate end point) but do have the cost of having to commit earlier to the phase III question than if separate phase II and phase III trials were performed. Outcome-adaptive randomization is an older technique that has recently regained attention; it increases trial complexity and duration without offering substantial benefits to the patients in the trial. The use of adaptive trials with biomarkers is new and has great potential for efficiently identifying patients who will be helped most by specific treatments. Master protocols in which trial arms and treatment questions are added to an ongoing trial can be especially efficient in the biomarker setting, where patients are screened for entry into different subtrials based on evolving knowledge about targeted therapies. A discussion of three recent adaptive clinical trials (BATTLE-2, I-SPY 2, and FOCUS4) highlights the issues. Published by Oxford University Press 2017. This work is written by US Government employees and is in the public domain in the US.

New Metrics for Economic Evaluation in the Presence of Heterogeneity: Focusing on Evaluating Policy Alternatives Rather than Treatment Alternatives.

Science.gov (United States)

Kim, David D; Basu, Anirban

2017-11-01

Cost-effectiveness analysis (CEA) methods fail to acknowledge that where cost-effectiveness differs across subgroups, there may be differential adoption of technology. Also, current CEA methods are not amenable to incorporating the impact of policy alternatives that potentially influence the adoption behavior. Unless CEA methods are extended to allow for a comparison of policies rather than simply treatments, their usefulness to decision makers may be limited. We conceptualize new metrics, which estimate the realized value of technology from policy alternatives, through introducing subgroup-specific adoption parameters into existing metrics, incremental cost-effectiveness ratios (ICERs) and Incremental Net Monetary Benefits (NMBs). We also provide the Loss with respect to Efficient Diffusion (LED) metrics, which link with existing value of information metrics but take a policy evaluation perspective. We illustrate these metrics using policies on treatment with combination therapy with a statin plus a fibrate v. statin monotherapy for patients with diabetes and mixed dyslipidemia. Under the traditional approach, the population-level ICER of combination v. monotherapy was $46,000/QALY. However, after accounting for differential rates of adoption of the combination therapy (7.2% among males and 4.3% among females), the modified ICER was $41,733/QALY, due to the higher rate of adoption in the more cost-effective subgroup (male). The LED metrics showed that an education program to increase the uptake of combination therapy among males would provide the largest economic returns due to the significant underutilization of the combination therapy among males under the current policy. This framework may have the potential to improve the decision-making process by producing metrics that are better aligned with the specific policy decisions under consideration for a specific technology.

Bone Graft Alternatives

Science.gov (United States)

... Spine Treatment Spondylolisthesis BLOG FIND A SPECIALIST Treatments Bone Graft Alternatives Patient Education Committee Patient Education Committee ... procedure such as spinal fusion. What Types of Bone Grafts are There? Bone grafts that are transplanted ...

Adapting Evidence-Based Mental Health Treatments in Community Settings: Preliminary Results from a Partnership Approach

Science.gov (United States)

Southam-Gerow, Michael A.; Hourigan, Shannon E.; Allin, Robert B., Jr.

2009-01-01

This article describes the application of a university-community partnership model to the problem of adapting evidence-based treatment approaches in a community mental health setting. Background on partnership research is presented, with consideration of methodological and practical issues related to this kind of research. Then, a rationale for…

Biofeedback systems and adaptive control hemodialysis treatment

Directory of Open Access Journals (Sweden)

Azar Ahmad

2008-01-01

Full Text Available On-line monitoring devices to control functions such as volume, body temperature, and ultrafiltration, were considered more toys than real tools for routine clinical application. However, bio-feedback blood volume controlled hemodialysis (HD is now possible in routine dialysis, allowing the delivery of a more physiologically acceptable treatment. This system has proved to reduce the incidence of intra-HD hypotension episodes significantly. Ionic dialysance and the patient′s plasma conductivity can be calculated easily from on-line measurements at two different steps of dialysate conductivity. A bio-feedback system has been devised to calculate the patient′s plasma conductivity and modulate the conductivity of the dialysate continuously in order to achieve a desired end-dialysis patient plasma conductivity corresponding to a desired end-dialysis plasma sodium concentration. Another bio-feedback system can control the body tempe-rature by measuring it at the arterial and venous lines of the extra-corporeal circuit, and then modulating the dialysate temperature in order to stabilize the patients′ temperature at constant values that result in improved intra-HD cardiovascular stability. The module can also be used to quantify vascular access recirculation. Finally, the simultaneous computer control of ultrafiltration has proven the most effective means for automatic blood pressure stabilization during hemo-dialysis treatment. The application of fuzzy logic in the blood-pressure-guided biofeedback con-trol of ultrafiltration during hemodialysis is able to minimize HD-induced hypotension. In con-clusion, online monitoring and adaptive control of the patient during the dialysis session using the bio-feedback systems is expected to render the process of renal replacement therapy more physiological and less eventful.

New alternative processes for the treatment of the alkaline solvent wash waste

International Nuclear Information System (INIS)

Cecille, L.; Cumming, I.W.; Gasparini, G.; Dozol, J.F.

1986-09-01

The separate treatment of the solvent wash alkaline waste (ASWW) from the other low and medium level liquid wastes generated during reprocessing operations has been investigated through the development of three alternative processes dealing with solvent extraction, chemical precipitation combined with ultrafiltration and inorganic ion exchange. On the basis of lab-scale experiments performed on the same genuine ASWW sample, a comparison has been made between the respective performances of each of these processes in terms of selectivity, decontamination and volume reduction factors. From this assessment, it evolved that solvent extraction and chemical precipitation combined with utrafiltration processes are good competitors for implementing such kind of treatment although for the alpha DF, solvent extraction appears more flexible. To be really attractive, inorganic ion exchange should exhibit better VRF and DF possibly by pretreating the ASWW. 10 refs

Types of treatment collaboration between conventional and alternative practitioners-results from a research project at a Danish MS hospital.

Science.gov (United States)

Skovgaard, Lasse; Haahr, Niels; Bjerre, Liv; Launsø, Laila

2010-12-23

More than 50% of People with Multiple Sclerosis (PwMS) in Denmark use alternative treatment. Most of them combine alternative and conventional treatment, but PwMS often find that they engage in parallel courses of treatment between which there is no dialogue, coordination or synergy. For this reason the Danish Multiple Sclerosis Society conducted a research project to develop and examine different models for collaboration between conventional and alternative treatment providers. The empirical material consisted of 10 individual interviews with practitioners, a group interview with practitioners, a group interview with professional staff at the Danish Multiple Sclerosis hospital that provided the organisational framework for the project, interviews with 59 patients and written responses from participating treatment providers in connection with 29 practitioner-researcher seminars held during the period 2004-2010. Collaboration between researchers and the treatment team resulted in the development and examination of several models which describe the strengths and weaknesses of various types of collaboration. The models show that the various types of collaboration place different requirements on the degree of 1) mutual acknowledgement and understanding among practitioners and 2) flexibility and resources in the organizational framework. The analyses also point to the fact that the degree of patient activity must be considered in relation to a given type of collaboration. The relationship between integration and pluralism can contribute to a fruitful discussion in regards to the value of treatment collaboration. In addition to the many positive perspectives that characterise integration of different treatment modalities the project points to the importance of not overlooking the opportunities, values and potential inherent in a pluralistic ideal in the form of patients' own active efforts and the dynamism that can arise when the patient becomes a co-informant, co

Laser-mediated Photodynamic Therapy: An Alternative Treatment for Actinic Keratosis?

Science.gov (United States)

Kessels, Janneke P H M; Nelemans, Patty J; Mosterd, Klara; Kelleners-Smeets, Nicole W J; Krekels, Gertruud A M; Ostertag, Judith U

2016-03-01

Photodynamic therapy (PDT) with light emitting diode (LED) illumination is a frequently used treatment modality for actinic keratosis (AK) with excellent cosmetic outcome. A major disadvantage, however, is the high pain score. Pulsed dye laser (PDL) illumination has been suggested, but the long-term efficacy of this treatment is unknown. In this split-face study we prospectively treated 61 patients with AK, with both LED-PDT and PDL-PDT. The mean change in the number of lesions between the end of follow-up and start of therapy was -4.25 (95% confidence interval (95% CI) -5.07; -3.43) for LED-PDT and -3.88 (95% CI -4,76; -2.99) for PDL-PDT, with a non-significant difference (p = 0.258) of -0.46 (95% CI -1.28; 0.35). The percentage decrease from baseline in the total number of AK was 55.8% and 47.8%, respectively, at 12-month follow-up. Visual analogue scale pain score was lower after PDL (mean 2.64) compared with LED illumination (mean 6.47). These findings indicate that PDL-PDT is an effective alternative illumination source fo.

Hazardous waste inventory, characteristics, generation, and facility assessment for treatment, storage, and disposal alternatives considered in the U.S. Department of Energy Waste Management Programmatic Environmental Impact Statement

International Nuclear Information System (INIS)

Lazaro, M.A.; Antonopoulos, A.A.; Esposito, M.P.; Policastro, A.J.

1996-12-01

This report focuses on the generation of hazardous waste (HW) and the treatment of HW being generated by routine US Department of Energy (DOE) facility operations. The wastes to be considered are managed by the DOE Waste Management (WM) Division (WM HW). The waste streams are to be sent to WM operations throughout the DOE complex under four management alternatives: No Action, Decentralization, Regionalized 1, and Regionalized 2. On-site and off-site capabilities for treatment are examined for each alternative. This report (1) summarizes the HW inventories and generated amounts resulting from WM activities, focusing on the largest DOE HW generators; (2) presents estimates of the annual amounts shipped off-site, as well as the amounts treated by various treatment technology groups; (3) describes the existing and planned treatment and storage capabilities of the largest HW-generating DOE installations, as well as the use of commercial treatment facilities by DOE sites; (4) presents applicable technologies (destruction of organics, deactivation/neutralization of waste, removal/recovery of organics, and aqueous liquid treatment); and (5) describes the four alternatives for consideration for future HW management, and for each alternative provides the HW loads and the approach used to estimate the source term for routine treatment operations. In addition, potential air emissions, liquid effluents, and solid residuals associated with each alternative are presented. This report is supplemented with an addendum that includes detailed information related to HW inventory, characteristics, generation, and facility assessment for the treatment alternatives. The addendum also presents source terms, emission rates, and throughput totals by alternative and treatment installation

Force-induced bone growth and adaptation: A system theoretical approach to understanding bone mechanotransduction

International Nuclear Information System (INIS)

Maldonado, Solvey; Findeisen, Rolf

2010-01-01

The modeling, analysis, and design of treatment therapies for bone disorders based on the paradigm of force-induced bone growth and adaptation is a challenging task. Mathematical models provide, in comparison to clinical, medical and biological approaches an structured alternative framework to understand the concurrent effects of the multiple factors involved in bone remodeling. By now, there are few mathematical models describing the appearing complex interactions. However, the resulting models are complex and difficult to analyze, due to the strong nonlinearities appearing in the equations, the wide range of variability of the states, and the uncertainties in parameters. In this work, we focus on analyzing the effects of changes in model structure and parameters/inputs variations on the overall steady state behavior using systems theoretical methods. Based on an briefly reviewed existing model that describes force-induced bone adaptation, the main objective of this work is to analyze the stationary behavior and to identify plausible treatment targets for remodeling related bone disorders. Identifying plausible targets can help in the development of optimal treatments combining both physical activity and drug-medication. Such treatments help to improve/maintain/restore bone strength, which deteriorates under bone disorder conditions, such as estrogen deficiency.

Sacral electrical neuromodulation as an alternative treatment option for lower urinary tract dysfunction.

Science.gov (United States)

Grünewald, Volker; Höfner, Klaus; Thon, Walter F.; Kuczyk, Markus A.; Jonas, Udo

1999-01-01

Temporary electrical stimulation using anal or vaginal electrodes and an external pulse generator has been a treatment modality for urinary urge incontinence for nearly three decades. In 1981 Tanagho and Schmidt introduced chronic electrical stimulation of the sacral spinal nerves using a permanently implanted sacral foramen electrode and a battery powered pulse generator for treatment of different kinds of lower urinary tract dysfunction, refractory to conservative treatment. At our department chronic unilateral electrical stimulation of the S3 sacral spinal nerve has been used for treatment of vesi-courethral dysfunction in 43 patients with a mean postoperative follow up of 43,6 months. Lasting symptomatic improvement by more than 50 % could be achieved in 13 of 18 patients with motor urge incontinence (72,2 %) and in 18 of the 21 patients with urinary retention (85,7 %). Implants offer a sustained therapeutic effect to treatment responders, which is not achieved by temporary neuromodulation. Chronic neuromodulation should be predominantly considered in patients with urinary retention. Furthermore in patients with motor urge incontinence, refusing temporary techniques or in those requiring too much effort to achieve a sustained clinical effect. Despite high initial costs chronic sacral neuromodulation is an economically reasonable treatment option in the long run, when comparing it to the more invasive remaining therapeutic alternatives.

An analysis of adaptation negotiations in Poznan

Energy Technology Data Exchange (ETDEWEB)

Garnaud, B

2009-07-01

Hastily presented as one of the major accomplishments of the 14. United Nations Conference on Climate Change in Poznan, discussions on adaptation actually need careful analysis. Obviously, an increasing number of stakeholders (whether Parties, delegation members, civil society, businesses) see adaptation as a top concern, and this resulted in Poznan in a strong presence of the issue in plenary sessions, contact and informal groups, side events, press conferences, stands, etc. With respect to the historical treatment of adaptation, which has been quite light before COP 13 in Bali (2007), the vogue for adaptation may be good news. However, all the difficulty now lies in translating the semantic success and political momentum into operational outcomes. As the following critical synthesis shows, Poznan can hardly be considered as a major breakthrough in that regard although some significant steps forward have been made. In the past, little importance has been given to adaption in the climate change talks until the middle of this decade. In the early days of discussions (the 80's), climate change was not seen as a pressing matter, impacts were not expected to occur if action to reduce climate change was appropriately taken and there was thus no hurry to adapt. Then, in the late 90's adaptation was seen as a possible alternative to mitigation, and those defending adaptation as being resigned. Adaptation only started to gain some momentum in 2005 in Montreal, and was finally considered on an equal footage with mitigation in 2007 in Bali. Discussions on adaptation are thus still not at the level of those on mitigation, but Poznan was in a sense a major accomplishment in bringing adaptation on top of the agenda. Before Poznan, adaptation under the UNFCCC was limited to a couple of loose work programmes (see below) and three small funds financing adaptation activities in developing countries. One of these activities, arguably the most visible, is the realisation of

An analysis of adaptation negotiations in Poznan

International Nuclear Information System (INIS)

Garnaud, B.

2009-01-01

Hastily presented as one of the major accomplishments of the 14. United Nations Conference on Climate Change in Poznan, discussions on adaptation actually need careful analysis. Obviously, an increasing number of stakeholders (whether Parties, delegation members, civil society, businesses) see adaptation as a top concern, and this resulted in Poznan in a strong presence of the issue in plenary sessions, contact and informal groups, side events, press conferences, stands, etc. With respect to the historical treatment of adaptation, which has been quite light before COP 13 in Bali (2007), the vogue for adaptation may be good news. However, all the difficulty now lies in translating the semantic success and political momentum into operational outcomes. As the following critical synthesis shows, Poznan can hardly be considered as a major breakthrough in that regard although some significant steps forward have been made. In the past, little importance has been given to adaption in the climate change talks until the middle of this decade. In the early days of discussions (the 80's), climate change was not seen as a pressing matter, impacts were not expected to occur if action to reduce climate change was appropriately taken and there was thus no hurry to adapt. Then, in the late 90's adaptation was seen as a possible alternative to mitigation, and those defending adaptation as being resigned. Adaptation only started to gain some momentum in 2005 in Montreal, and was finally considered on an equal footage with mitigation in 2007 in Bali. Discussions on adaptation are thus still not at the level of those on mitigation, but Poznan was in a sense a major accomplishment in bringing adaptation on top of the agenda. Before Poznan, adaptation under the UNFCCC was limited to a couple of loose work programmes (see below) and three small funds financing adaptation activities in developing countries. One of these activities, arguably the most visible, is the realisation of National

Use of conventional, complementary, and alternative treatments for pain among individuals seeking primary care treatment with buprenorphine-naloxone

Science.gov (United States)

Barry, Declan T.; Savant, Jonathan D.; Beitel, Mark; Cutter, Christopher J.; Moore, Brent A.; Schottenfeld, Richard S.; Fiellin, David A.

2012-01-01

Previous studies have not examined patterns of pain treatment use among patients seeking office-based buprenorphine-naloxone treatment (BNT) for opioid dependence. Objectives To examine, among individuals with pain seeking BNT for opioid dependence, the use of pain treatment modalities, perceived efficacy of prior pain treatment, and interest in pursuing pain treatment while in BNT. Methods 244 patients seeking office-based BNT for opioid dependence completed measures of demographics, pain status (i.e. “chronic pain (CP)” [pain lasting at least 3 months] vs. “some pain (SP)” [pain in the past week not meeting the duration criteria for chronic pain]), pain treatment use, perceived efficacy of prior pain treatment, and interest in receiving pain treatment while in BNT. Results In comparison to the SP group (N = 87), the CP group (N = 88) was more likely to report past-week medical use of opioid medication (AOR 3.2, 95% CI 1.2–8.4), lifetime medical use of non-opioid prescribed medication (AOR 2.2, 95% CI 1.1–4.7), and lifetime use of prayer (AOR 2.8, 95% CI 1.2–6.5), and was less likely to report lifetime use of yoga (AOR 0.2, 95% CI 0.1–0.7) to treat pain. While the two pain groups did not differ on levels of perceived efficacy of prior lifetime pain treatments, in comparison to the SP group, the CP group was more likely to report interest in receiving pain treatment while in BNT (P pain seeking BNT for opioid dependence report a wide range of conventional, complementary, and alternative pain-related treatments and are interested (especially those with CP) in receiving pain management services along with BNT. PMID:23041680

Simulations of adaptive temperature control with self-focused hyperthermia system for tumor treatment.

Science.gov (United States)

Hu, Jiwen; Ding, Yajun; Qian, Shengyou; Tang, Xiangde

2013-01-01

The control problem in ultrasound therapy is to destroy the tumor tissue while not harming the intervening healthy tissue with a desired temperature elevation. The objective of this research is to present a robust and feasible method to control the temperature distribution and the temperature elevation in treatment region within the prescribed time, which can improve the curative effect and decrease the treatment time for heating large tumor (≥2.0cm in diameter). An adaptive self-tuning-regulator (STR) controller has been introduced into this control method by adding a time factor with a recursive algorithm, and the speed of sound and absorption coefficient of the medium is considered as a function of temperature during heating. The presented control method is tested for a self-focused concave spherical transducer (0.5MHz, 9cm aperture, 8.0cm focal length) through numerical simulations with three control temperatures of 43°C, 50°C and 55°C. The results suggest that this control system has adaptive ability for variable parameters and has a rapid response to the temperature and acoustic power output in the prescribed time for the hyperthermia interest. There is no overshoot during temperature elevation and no oscillation after reaching the desired temperatures. It is found that the same results can be obtained for different frequencies and temperature elevations. This method can obtain an ellipsoid-shaped ablation region, which is meaningful for the treatment of large tumor. Copyright © 2012 Elsevier B.V. All rights reserved.

The use of non-medical/alternative treatment in multiple sclerosis. A 5 year follow-up study

DEFF Research Database (Denmark)

Stenager, Egon; Stenager, E N; Knudsen, Lone

1995-01-01

Forty-nine patients (22 males, 27 females) were examined and interviewed with 5 years interval in order to determine the extent of the use of non-medical (alternative) treatment and whether the use influenced the natural course of multiple sclerosis (MS). Using clinical course, Kurtzke Disability...

Long-term influence of alternative forest management treatments on total ecosystem and wood product carbon storage

Science.gov (United States)

Joshua J. Puhlick; Aaron R. Weiskittel; Ivan J. Fernandez; Shawn Fraver; Laura S. Kenefic; Robert S. Seymour; Randall K. Kolka; Lindsey E. Rustad; John C. Brissette

2016-01-01

Developing strategies for reducing atmospheric CO2 is one of the foremost challenges facing natural resource professionals today. The goal of this study was to evaluate total ecosystem and harvested wood product carbon (C) stocks among alternative forest management treatments (selection cutting, shelterwood cutting, commercial clearcutting, and...

Alternative detox.

Science.gov (United States)

Ernst, E

2012-01-01

The concept that alternative therapies can eliminate toxins and toxicants from the body, i.e. 'alternative detox' (AD) is popular. Selected textbooks and articles on the subject of AD. The principles of AD make no sense from a scientific perspective and there is no clinical evidence to support them. The promotion of AD treatments provides income for some entrepreneurs but has the potential to cause harm to patients and consumers. In alternative medicine, simplistic but incorrect concepts such as AD abound. AREAS TIMELY FOR RESEARCH: All therapeutic claims should be scientifically tested before being advertised-and AD cannot be an exception.

Technological alternative on environmental management for pipeline installation in the Amazon

Energy Technology Data Exchange (ETDEWEB)

Frade, Amadeu Farage; Teixeira, Ivan Jose [Petroleo Brasileiro S.A. (PETROBRAS), Rio de Janeiro, RJ (Brazil); Riquena, Renata Maria; Freitas, Wanderleia Isabel P. de [CONCREMAT, Rio de Janeiro, RJ (Brazil)

2009-07-01

Usually pipelines construction are located in isolated places which are difficult to access. Due this characteristic the logistical support services are not available as easily as it is in large centers. Even so these enterprises may not release these services mainly due to high demand from stakeholders and the commitment to quality that these pipelines are submitted. This work presents some alternatives in environmental management implemented during an installation of pipelines in the Amazon forest with emphasis on the quality of water bodies and correct effluents destination. Located in western Amazonia in a region with several restrictions like: logistics, low supply of skilled labor and high environmental requirements. The project aligned competence and creativity since from its planning until its delivery to overcome difficulties and meet the demands of stakeholders. Usual techniques to assist legal requirements such as effluent treatment and environmental monitoring had to be adapted to the Amazon reality, always seeking for balance between technical and alignment economic and respect for social and environmental aspects. Using the methodology of 'wetland' (system of alternative treatment of effluents, based on the use of regional plants - macrophytes), the reuse of sludge from sewage treatment station, floating sewage treatment system, was crucial to meet the challenge to deploy this product to work in Amazonia. The aim of this work is to disseminate the techniques used and help other enterprises with the same challenges. (author)

Types of treatment collaboration between conventional and alternative practitioners – results from a research project at a Danish MS hospital

Directory of Open Access Journals (Sweden)

Lasse Skovgaard

2010-12-01

Full Text Available Introduction: More than 50% of the People with Multiple Sclerosis (PwMS in Denmark use alternative treatment. Most of them combine alternative and conventional treatment, but PwMS often find that there is no dialogue, coordination or synergy between the parallel courses of treatment offered. For this reason the Danish Multiple Sclerosis Society conducted a research project to develop and examine different models for collaboration between conventional and alternative treatment providers. Materials and methods: Empirical material consist of individual interviews with practitioners, a group interview with practitioners, a group interview with professional staff at the Danish MS hospital that provided the organisational framework for the project, interviews with patients as well as written responses from participating treatment providers in connection with practitioner-researcher seminars held. Results: Collaboration between researchers and the treatment team resulted in the development examination of several models which describe the strengths and weaknesses of various types of collaboration. The models also show that the various types of collaboration place different requirements on the degree of 1 mutual acknowledgement and understanding among practitioners, 2 flexibility and resources in the organizational framework, and 3 patients' activities and own efforts, respectively.    Perspectives: The relationship between integration and pluralism can contribute to a fruitful discussion in regards to the value of treatment collaboration. In addition to the many positive perspectives the characterise integration of different treatment modalities the project points to the importance of not overlooking the opportunities, values and potential inherent in a pluralistic ideal in the form of patients' own active efforts and the dynamism that can arise when the patient becomes a co-informant, co-coordinator and/or co-integrator.

Treatments for people living with schizophrenia in Sub-Saharan Africa: an adapted realist review.

Science.gov (United States)

Chidarikire, S; Cross, M; Skinner, I; Cleary, M

2018-03-01

To identify the treatments and interventions available and their impact on people living with schizophrenia in Sub-Saharan Africa. Help-seeking behaviour and the choice of treatment are largely influenced by socio-cultural factors and beliefs about the causes of mental illness. This review addresses the gap in knowledge regarding the treatment options available to people living with schizophrenia in Sub-Saharan Africa. Adapted realist literature review. Electronic databases searched in June 2016 included PubMed, EMBASE, PsycINFO, ProQuest and CINAHL. The adapted realist review approach used to synthesize the published research involved identifying the review aim, searching and selecting relevant studies, extracting, iteratively analysing and synthesizing relevant data and reporting results. Forty studies from eight countries were reviewed. Most people were treated by both faith/traditional healers and modern psychiatry. Common treatments included antipsychotics, electroconvulsive therapy and psychosocial interventions. Few treatment options were available outside major centres, there was poor adherence to medication and families reported a high level of burden associated with caring for a relative. Major limitations of this review were the lack of studies, variable quality and low level of evidence available from most countries from Sub-Saharan Africa and lack of generalizability. People living with schizophrenia in Sub-Saharan Africa were treated by faith, traditional healers and modern psychiatry, if at all. Further research is needed to better understand the local situation and the implications for caring for people from this region. Mental health services in Sub-Saharan Africa are limited by fiscal shortages, lack of mental health services and qualified mental health professionals. This review provides evidence to inform nursing and healthcare policy, including recruiting and training mental health professionals and ensuring access to evidence-based, person

The costs of radiosurgical treatment: Comparison between gamma knife and linear accelerator

International Nuclear Information System (INIS)

Koenigsmaier, H.; Pauli-Ferch, B. de; Hackl, A.; Pendl, G.

1998-01-01

Radiosurgical treatment can be carried out by means of a gamma knife or a linear accelerator. The linear accelerator may be either a single-purpose appliance, exclusively employed in radiosurgery, or an adapted appliance which is used primarily for fractioned radiotherapy, and only additionally for radiosurgical purposes. The first alternative will be referred to briefly as a 'dedicated Linac', the latter as an 'adapted Linac'. Cost accounting data for these alternatives will be discussed under three main categories: investment costs. operating costs, and finally staffing costs. Costs are only considered to the extent that this is necessary to facilitate a comprehensive cost comparison. Factors for which the costs remain the same or at least broadly the same will from the outset not be taken into consideration. These include, for instance, the costs of general or special administration, diagnosis, and image processing. The results and conclusions of this study therefore cannot be employed immediately in the evaluation of cost reimbursement schemes of the type carried out by agencies responsible for social insurance. Here, appropriate complete cost analyzes especially for this purpose are required. The final comprehensive cost comparison reveals that the adapted Linac is the most favourable alternative with small annual quantities of patients. With larger numbers of patients the Gamma Knife represents the most favourable from a cost accounting angle. The dedicated Linac accordingly does not have a cost advantage for any of the examined numbers of patients. Clearly the lowest treatment costs per patient can be achieved by employing a Gamma Knife and using it to capacity. (author)

Cone Beam Computed Tomography-Derived Adaptive Radiotherapy for Radical Treatment of Esophageal Cancer

International Nuclear Information System (INIS)

Hawkins, Maria A.; Brooks, Corrinne; Hansen, Vibeke N.; Aitken, Alexandra; Tait, Diana M.

2010-01-01

Purpose: To investigate the potential for reduction in normal tissue irradiation by creating a patient specific planning target volume (PTV) using cone beam computed tomography (CBCT) imaging acquired in the first week of radiotherapy for patients receiving radical radiotherapy. Methods and materials: Patients receiving radical RT for carcinoma of the esophagus were investigated. The PTV is defined as CTV(tumor, nodes) plus esophagus outlined 3 to 5 cm cranio-caudally and a 1.5-cm circumferential margin is added (clinical plan). Prefraction CBCT are acquired on Days 1 to 4, then weekly. No correction for setup error made. The images are imported into the planning system. The tumor and esophagus for the length of the PTV are contoured on each CBCT and 5 mm margin is added. A composite volume (PTV1) is created using Week 1 composite CBCT volumes. The same process is repeated using CBCT Week 2 to 6 (PTV2). A new plan is created using PTV1 (adaptive plan). The coverage of the 95% isodose of PTV1 is evaluated on PTV2. Dose-volume histograms (DVH) for lungs, heart, and cord for two plans are compared. Results: A total of 139 CBCT for 14 cases were analyzed. For the adaptive plan the coverage of the 95% prescription isodose for PTV1 = 95.6% ± 4% and the PTV2 = 96.8% ± 4.1% (t test, 0.19). Lungs V20 (15.6 Gy vs. 10.2 Gy) and heart mean dose (26.9 Gy vs. 20.7 Gy) were significantly smaller for the adaptive plan. Conclusions: A reduced planning volume can be constructed within the first week of treatment using CBCT. A single plan modification can be performed within the second week of treatment with considerable reduction in organ at risk dose.

Cognitive behavioral stress management effects on psychosocial and physiological adaptation in women undergoing treatment for breast cancer.

Science.gov (United States)

Antoni, Michael H; Lechner, Suzanne; Diaz, Alain; Vargas, Sara; Holley, Heather; Phillips, Kristin; McGregor, Bonnie; Carver, Charles S; Blomberg, Bonnie

2009-07-01

A diagnosis of breast cancer and treatment are psychologically stressful events, particularly over the first year after diagnosis. Women undergo many demanding and anxiety-arousing treatments such as surgery, radiation and chemotherapy. Psychosocial interventions that promote psychosocial adaptation to these challenges may modulate physiological processes (neuroendocrine and immune) that are relevant for health outcomes in breast cancer patients. Women with Stages 1-3 breast cancer recruited 4-8 weeks after surgery were randomized to either a 10-week group-based cognitive behavioral stress management (CBSM) intervention or a 1-day psychoeducational control group and completed questionnaires and late afternoon blood samples at study entry and 6 and 12 months after assignment to experimental condition. Of 128 women initially providing psychosocial questionnaire and blood samples at study entry, 97 provided complete data for anxiety measures and cortisol analysis at all time points, and immune assays were run on a subset of 85 of these women. Those assigned to a 10-week group-based CBSM intervention evidenced better psychosocial adaptation (lower reported cancer-specific anxiety and interviewer-rated general anxiety symptoms) and physiological adaptation (lower cortisol, greater Th1 cytokine [interleukin-2 and interferon-gamma] production and IL-2:IL-4 ratio) after their adjuvant treatment compared to those in the control group. Effects on psychosocial adaptation indicators and cortisol appeared to hold across the entire 12-month observation period. Th1 cytokine regulation changes held only over the initial 6-month period. This intervention may have facilitated a "recovery or maintenance" of Th1 cytokine regulation during or after the adjuvant therapy period. Behavioral interventions that address dysregulated neuroendocrine function could play a clinically significant role in optimizing host immunologic resistance during a vulnerable period.

Interactive adaptation of a volumetric imaging radiotherapy treatment: development and validation of tools for its implementation in clinical routine

International Nuclear Information System (INIS)

Huger, Sandrine

2013-01-01

Changing anatomy during radiotherapy can lead to significant dosimetric consequences for organs at risk (OARs) and/or target volumes. Adaptive radiotherapy can compensate for these variations however its deployment for clinical work is hampered by the increased workload for the medical staff and there is still no commercialized software available for clinical use. We developed a simple in vivo dosimetric alert tool allowing rapid identification of patients who might benefit from an adaptive radiotherapy. Dosimetric evaluation of delivered treatment has been conducted onto 3D on board imaging (CBCT) whose dose calculation accuracy has been evaluated. The tool does not require a new volume of interest delineation. Tool alert is based on objectives and quantifiable criteria defined by the exceeding volumes of interest dose thresholds. Tool precision and detectability have been validated and applied in a retrospective study on 10 head and neck patients. The tool allows detecting patients where an adaptive treatment could have been considered. In its clinical implementation, adaptive radiotherapy process requires deformable matching algorithms to follow patient local's deformations occurring during treatment. Nevertheless, their use has not been validated. We conducted an evaluation of the Block Matching deformable algorithm, suitable for multimodality imaging (CT/CBCT), in comparison to rigid algorithm. A study has been conducted for 10 head and neck patients based on volume of interest contours comparison for 76 CBCT. Similarity parameters used consisted on Dice Similarity Index, Robust Hausdorff Distance (in mm) and the absolute volume difference (in cc). (author)

Environmentally-adapted local energy systems

Energy Technology Data Exchange (ETDEWEB)

Moe, N; Oefverholm, E [NUTEK, Stockholm (Sweden); Andersson, Owe [EKAN Gruppen (Sweden); Froste, H [Swedish Environmental Protection Agency, Stockholm (Sweden)

1997-10-01

Energy companies, municipalities, property companies, firms of consultants, environmental groups and individuals are examples of players working locally to shape environmentally adapted energy systems. These players have needed information making them better able to make decisions on cost-efficient, environmentally-adapted energy systems. This book answers many of the questions they have put. The volume is mainly based on Swedish handbooks produced by the Swedish National Board for Industrial and Technical Development, NUTEK, together with the Swedish Environmental Protection Agency. These handbooks have been used in conjunction with municipal energy planning, local Agenda 21 work, to provide a basis for deciding on concrete local energy systems. The contents in brief: -The book throws new light on the concept of energy efficiency; -A section on the environment compares how air-polluting emissions vary with different methods of energy production; -A section contains more than 40 ideas for measures which can be profitable, reduce energy consumption and the impact on the environment all at the same time; -The book gives concrete examples of new, alternative and environmentally-adapted local energy systems. More efficient use of energy is included as a possible change of energy system; -The greatest emphasis is laid upon alternative energy systems for heating. It may be heating in a house, block of flats, office building or school; -Finally, there are examples of environmentally-adapted local energy planning.

Toward an Expanded Definition of Adaptive Decision Making.

Science.gov (United States)

Phillips, Susan D.

1997-01-01

Uses the lifespan, life-space model to examine the definition of adaptive decision making. Reviews the existing definition of adaptive decision making as "rational" decision making and offers alternate perspectives on decision making with an emphasis on the implications of using the model. Makes suggestions for future theory, research,…

Adaptation to TKI Treatment Reactivates ERK Signaling in Tyrosine Kinase-Driven Leukemias and Other Malignancies.

Science.gov (United States)

Bruner, J Kyle; Ma, Hayley S; Li, Li; Qin, Alice Can Ran; Rudek, Michelle A; Jones, Richard J; Levis, Mark J; Pratz, Keith W; Pratilas, Christine A; Small, Donald

2017-10-15

FMS-like tyrosine kinase-3 (FLT3) tyrosine kinase inhibitors (TKI) have been tested extensively to limited benefit in acute myeloid leukemia (AML). We hypothesized that FLT3/internal tandem duplication (ITD) leukemia cells exhibit mechanisms of intrinsic signaling adaptation to TKI treatment that are associated with an incomplete response. Here, we identified reactivation of ERK signaling within hours following treatment of FLT3/ITD AML cells with selective inhibitors of FLT3. When these cells were treated with inhibitors of both FLT3 and MEK in combination, ERK reactivation was abrogated and anti-leukemia effects were more pronounced compared with either drug alone. ERK reactivation was also observed following inhibition of other tyrosine kinase-driven cancer cells, including EGFR-mutant lung cancer, HER2-amplified breast cancer, and BCR-ABL leukemia. These studies reveal an adaptive feedback mechanism in tyrosine kinase-driven cancers associated with reactivation of ERK signaling in response to targeted inhibition. Cancer Res; 77(20); 5554-63. ©2017 AACR . ©2017 American Association for Cancer Research.

Evaluation of radiotherapy methods for adaptative head and neck treatment with RapidArc®

International Nuclear Information System (INIS)

Mazaro, Sarah J.; Vasconcellos, Herminiane L.; Silva, Laura E. da; Bastos, Fernanda M.; Silva, Leonardo P. da; Alvaro S; Migoviski, Igor

2015-01-01

Head and neck cancer is considered a public health problem worldwide. The intensity-modulated techniques have shown benefit in the treatment of these sites, particularly with respect to reduction of deterministic effects of risk, such as parotid. Anatomical variations in cases of head and neck are very frequent and may lead, for example, to an overdose in the parotid. This can be mitigated if making use of adaptive radiation therapy. The work aims to analyze a methodology to redo the planning of treatments, through 02 acquisitions of TC. The results showed that, due to a reduction in the volumes of the parotid, the doses delivered to these organs are underestimated, which is relevant to readapt the treatment, with the addition of only a second scan without the need of the third. (author)

Types of treatment collaboration between conventional and alternative practitioners – results from a research project at a Danish MS hospital

Directory of Open Access Journals (Sweden)

Lasse Skovgaard

2010-12-01

Full Text Available Introduction: More than 50% of the People with Multiple Sclerosis (PwMS in Denmark use alternative treatment. Most of them combine alternative and conventional treatment, but PwMS often find that there is no dialogue, coordination or synergy between the parallel courses of treatment offered. For this reason the Danish Multiple Sclerosis Society conducted a research project to develop and examine different models for collaboration between conventional and alternative treatment providers. Materials and methods: Empirical material consist of individual interviews with practitioners, a group interview with practitioners, a group interview with professional staff at the Danish MS hospital that provided the organisational framework for the project, interviews with patients as well as written responses from participating treatment providers in connection with practitioner-researcher seminars held. Results: Collaboration between researchers and the treatment team resulted in the development examination of several models which describe the strengths and weaknesses of various types of collaboration. The models also show that the various types of collaboration place different requirements on the degree of 1 mutual acknowledgement and understanding among practitioners, 2 flexibility and resources in the organizational framework, and 3 patients' activities and own efforts, respectively.    Perspectives: The relationship between integration and pluralism can contribute to a fruitful discussion in regards to the value of treatment collaboration. In addition to the many positive perspectives the characterise integration of different treatment modalities the project points to the importance of not overlooking the opportunities, values and potential inherent in a pluralistic ideal in the form of patients' own active efforts and the dynamism that can arise when the patient becomes a co-informant, co-coordinator and/or co-integrator. 

Anti-inflammatory salicylate treatment alters the metabolic adaptations to lactation in dairy cattle

Science.gov (United States)

Farney, Jaymelynn K.; Mamedova, Laman K.; Coetzee, Johann F.; KuKanich, Butch; Sordillo, Lorraine M.; Stoakes, Sara K.; Minton, J. Ernest; Hollis, Larry C.

2013-01-01

Adapting to the lactating state requires metabolic adjustments in multiple tissues, especially in the dairy cow, which must meet glucose demands that can exceed 5 kg/day in the face of negligible gastrointestinal glucose absorption. These challenges are met through the process of homeorhesis, the alteration of metabolic setpoints to adapt to a shift in physiological state. To investigate the role of inflammation-associated pathways in these homeorhetic adaptations, we treated cows with the nonsteroidal anti-inflammatory drug sodium salicylate (SS) for the first 7 days of lactation. Administration of SS decreased liver TNF-α mRNA and marginally decreased plasma TNF-α concentration, but plasma eicosanoids and liver NF-κB activity were unaltered during treatment. Despite the mild impact on these inflammatory markers, SS clearly altered metabolic function. Plasma glucose concentration was decreased by SS, but this was not explained by a shift in hepatic gluconeogenic gene expression or by altered milk lactose secretion. Insulin concentrations decreased in SS-treated cows on day 7 compared with controls, which was consistent with the decline in plasma glucose concentration. The revised quantitative insulin sensitivity check index (RQUICKI) was then used to assess whether altered insulin sensitivity may have influenced glucose utilization rate with SS. The RQUICKI estimate of insulin sensitivity was significantly elevated by SS on day 7, coincident with the decline in plasma glucose concentration. Salicylate prevented postpartum insulin resistance, likely causing excessive glucose utilization in peripheral tissues and hypoglycemia. These results represent the first evidence that inflammation-associated pathways are involved in homeorhetic adaptations to lactation. PMID:23678026

Use of traditional herbal medicine as an alternative in dental treatment in Mexican dentistry: a review.

Science.gov (United States)

Cruz Martínez, Cindy; Diaz Gómez, Martha; Oh, Myung Sook

2017-12-01

Herbal therapies are used worldwide to treat health conditions. In Mexico, generations have used them to treat gingivitis, periodontitis, mouth infections, and discoloured teeth. However, few studies have collected scientific evidence on their effects. This study aimed at searching and compiling scientific evidence of alternative oral and dental treatments using medicinal herbs from Mexico. We collected various Mexican medicinal plants used in the dental treatment from the database of the Institute of Biology at the National Autonomous University of Mexico. To correlate with existing scientific evidence, we used the PubMed database with the key term '(scientific name) and (oral or dental)'. Mexico has various medical herbs with antibacterial and antimicrobial properties, according to ancestral medicinal books and healers. Despite a paucity of experimental research demonstrating the antibacterial, antimicrobial, and antiplaque effects of these Mexican plants, they could still be useful as an alternative treatment of several periodontal diseases or as anticariogenic agents. However, the number of studies supporting their uses and effects remains insufficient. It is important for the health of consumers to scientifically demonstrate the real effects of natural medicine, as well as clarify and establish their possible therapeutic applications. Through this bibliographical revision, we found papers that testify or refute their ancestral uses, and conclude that the use of plants to treat oral conditions or to add to the dental pharmacological arsenal should be based on experimental studies verifying their suitability for dental treatments.

An Adaptive Off-Line Procedure for Radiotherapy of Prostate Cancer

International Nuclear Information System (INIS)

Nuver, Tonnis T.; Hoogeman, Mischa S.; Remeijer, Peter; Herk, Marcel van; Lebesque, Joos V.

2007-01-01

Purpose: To determine the planning target volume (PTV) margin for an adaptive radiotherapy procedure that uses five computed tomography (CT) scans to calculate an average prostate position and rectum shape. To evaluate alternative methods to determine an average rectum based on a single delineation. Methods and Materials: Repeat CT scans (8-13) of 19 patients were used. The contoured prostates of the first four scans were matched on the planning CT (pCT) prostate contours. With the resulting translations and rotations the average prostate position was determined. An average rectum was obtained by either averaging the coordinates of corresponding points on the rectal walls or by selecting the 'best' rectum or transforming the pCT rectum. Dose distributions were calculated for various expanded average prostates. The remaining CT scans were used to determine the dose received by prostate and rectum during treatment. Results: For the prostate of the pCT scan and a 10-mm margin, all patients received more than 95% of the prescribed dose to 95% of the prostate. For the average prostate, a margin of 7 mm was needed to obtain a similar result (average PTV reduction 30%). The average rectum overestimated the mean dose to the rectum by 0.4 ± 1.6 Gy, which was better than the pCT rectum (2.1 ± 3.0 Gy) and the alternative average rectums (1.0 ± 2.6 Gy and 1.4 ± 3.2 Gy). Conclusions: Our adaptive procedure allows for reduction of the PTV margin to 7 mm without decreasing prostate coverage during treatment. For accurate estimation of the rectum dose, rectums need to be delineated and averaged over multiple scans

Alternative and complementary medicine in cancer patient

International Nuclear Information System (INIS)

Reckova, M.

2009-01-01

The use of alternative and complementary medicine (CAM) in cancer patients is widespread and it is not surprising as the results gained by conventional treatments are not sufficient. However, the results from the studies with CAM are not always sufficient according to their testing in appropriate clinical studies. Another problem that is present in the use of CAM is the possibility of drug-drug interactions between conventional therapies and CAM. Thus, it is of utmost importance that the oncologist possess a good knowledge of available CAM and provide a sufficient time for discussion with the patient and his/her family about possible alternative treatments and any downside risks. The cornerstone for pertinent discussion is sufficient knowledge on the part of the oncologist about those alternative treatments that are usually presented in the media with incomplete information about their relevant clinical tests and side effects. The following article presents a review of the current alternative treatment methods with a focus on the alternative drugs that have already been clinically tested, and secondarily on the alternative drugs that have been used even without sufficient testing in clinical trials. (author)

Perspectives of complementary and alternative medicine (CAM) practitioners in the support and treatment of infertility.

Science.gov (United States)

O'Reilly, Erin; Sevigny, Marika; Sabarre, Kelley-Anne; Phillips, Karen P

2014-10-14

Infertility patients are increasingly using complementary and alternative medicine (CAM) to supplement or replace conventional fertility treatments. The objective of this study was to determine the roles of CAM practitioners in the support and treatment of infertility. Ten semi-structured interviews were conducted in Ottawa, Canada in 2011 with CAM practitioners who specialized in naturopathy, acupuncture, traditional Chinese medicine, hypnotherapy and integrated medicine. CAM practitioners played an active role in both treatment and support of infertility, using a holistic, interdisciplinary and individualized approach. CAM practitioners recognized biological but also environmental and psychosomatic determinants of infertility. Participants were receptive to working with physicians, however little collaboration was described. Integrated infertility patient care through both collaboration with CAM practitioners and incorporation of CAM's holistic, individualized and interdisciplinary approaches would greatly benefit infertility patients.

Effect of Delayed Reinforcement on Skill Acquisition during Discrete-Trial Instruction: Implications for Treatment-Integrity Errors in Academic Settings

Science.gov (United States)

Carroll, Regina A.; Kodak, Tiffany; Adolf, Kari J.

2016-01-01

We used an adapted alternating treatments design to compare skill acquisition during discrete-trial instruction using immediate reinforcement, delayed reinforcement with immediate praise, and delayed reinforcement for 2 children with autism spectrum disorder. Participants acquired the skills taught with immediate reinforcement; however, delayed…

The Architecture of Chemical Alternatives Assessment.

Science.gov (United States)

Geiser, Kenneth; Tickner, Joel; Edwards, Sally; Rossi, Mark

2015-12-01

Chemical alternatives assessment is a method rapidly developing for use by businesses, governments, and nongovernment organizations seeking to substitute chemicals of concern in production processes and products. Chemical alternatives assessment is defined as a process for identifying, comparing, and selecting safer alternatives to chemicals of concern (including those in materials, processes, or technologies) on the basis of their hazards, performance, and economic viability. The process is intended to provide guidance for assuring that chemicals of concern are replaced with safer alternatives that are not likely to be later regretted. Conceptually, the assessment methods are developed from a set of three foundational pillars and five common principles. Based on a number of emerging alternatives assessment initiatives, in this commentary, we outline a chemical alternatives assessment blueprint structured around three broad steps: Scope, Assessment, and Selection and Implementation. Specific tasks and tools are identified for each of these three steps. While it is recognized that on-going practice will further refine and develop the method and tools, it is important that the structure of the assessment process remain flexible, adaptive, and focused on the substitution of chemicals of concern with safer alternatives. © 2015 Society for Risk Analysis.

Twelve-hour brain lithium concentration in lithium maintenance treatment of manic-depressive disorder: daily versus alternate-day dosing schedule

DEFF Research Database (Denmark)

Jensen, H.V.; Plenge, P; Stensgaard, A

1996-01-01

The 12-h brain lithium concentration was measured by lithium-7 magnetic resonance spectroscopy in ten manic-depressive patients receiving daily or alternate-day lithium carbonate treatment. The median dose of lithium carbonate was 800 mg in the daily treatment group and 1200 mg in the alternate......-day group. Median 12-h serum lithium concentration in the two groups was 0.86 mmol l-1 and 0.55 mmol l-1, respectively, while the corresponding concentration in brain was 0.67 mmol l-1 and 0.52 mmol l-1, respectively. The 12-h brain lithium concentration was independent of lithium dosing schedule (multiple...... linear regression), but correlated significantly with the 12-h serum lithium concentration (P = 0.003; B = 0.53, 95% c.l. 0.24-0.82; beta = 0.83). Thus at identical 12-h serum lithium concentrations the 12-h brain lithium concentration is similar with both treatment regimes. As the risk of manic...

Novel hyperthermia applicator system allows adaptive treatment planning: Preliminary clinical results in tumour-bearing animals.

Science.gov (United States)

Dressel, S; Gosselin, M-C; Capstick, M H; Carrasco, E; Weyland, M S; Scheidegger, S; Neufeld, E; Kuster, N; Bodis, S; Rohrer Bley, C

2017-09-11

Hyperthermia (HT) as an adjuvant to radiation therapy (RT) is a multimodality treatment method to enhance therapeutic efficacy in different tumours. High demands are placed on the hardware and treatment planning software to guarantee adequately planned and applied HT treatments. The aim of this prospective study was to determine the effectiveness and safety of the novel HT system in tumour-bearing dogs and cats in terms of local response and toxicity as well as to compare planned with actual achieved data during heating. A novel applicator with a flexible number of elements and integrated closed-loop temperature feedback control system, and a tool for patient-specific treatment planning were used in a combined thermoradiotherapy protocol. Good agreement between predictions from planning and clinical outcome was found in 7 of 8 cases. Effective HT treatments were planned and verified with the novel system and provided improved quality of life in all but 1 patient. This individualized treatment planning and controlled heat exposure allows adaptive, flexible and safe HT treatments in palliatively treated animal patients. © 2017 John Wiley & Sons Ltd.

Spatial compression impairs prism-adaptation in healthy individuals

Directory of Open Access Journals (Sweden)

Rachel J Scriven

2013-05-01

Full Text Available Neglect patients typically present with gross inattention to one side of space following damage to the contralateral hemisphere. While prism-adaptation is effective in ameliorating some neglect behaviours, the mechanisms involved and their relationship to neglect remain unclear. Recent studies have shown that conscious strategic control processes in prism-adaptation may be impaired in neglect patients, who are also reported to show extraordinarily long aftereffects compared to healthy participants. Determining the underlying cause of these effects may be the key to understanding therapeutic benefits. Alternative accounts suggest that reduced strategic control might result from a failure to detect prism-induced reaching errors properly either because a the size of the error is underestimated in compressed visual space or b pathologically increased error detection thresholds reduce the requirement for error correction. The purpose of this study was to model these two alternatives in healthy participants and to examine whether strategic control and subsequent aftereffects were abnormal compared to standard prism adaptation. Each participant completed three prism-adaptation procedures within a MIRAGE mediated reality environment with direction errors recorded before, during and after adaptation. During prism-adaptation, visual-feedback of the reach could be compressed, perturbed by noise or represented veridically. Compressed visual space significantly reduced strategic control and aftereffects compared to control and noise conditions. These results support recent observations in neglect patients, suggesting that a distortion of spatial representation may successfully model neglect and explain neglect performance while adapting to prisms.

Angina pectoris refractory for conventional therapy--is neurostimulation a possible alternative treatment?

Science.gov (United States)

Hautvast, R W; DeJongste, M J; ter Horst, G J; Blanksma, P K; Lie, K I

1996-07-01

The treatment of angina pectoris as a symptom of coronary artery disease usually is focused on restoring the balance between oxygen demand and supply of the myocardium by administration of drugs interfering in heart rate, cardiac pre- and afterload, and coronary vascular tone. For nonresponders to drug therapy or for those with jeopardized myocardium, revascularization procedures such as coronary bypass surgery and percutaneous transluminal coronary angioplasty are at hand. However, the atherosclerotic process is not stopped by these therapies and, at longer terms, angina may recur. It is not always possible to revascularize all the patients who do not positively react to medical treatment. Those with angina, not responding to adequate medication and who are not suitable anymore for revascularization, are considered to suffer from refractory angina pectoris. This group of patients has a poor quality of life, for their exercise tolerance is severely afflicted. For these patients, neurostimulation has been described repeatedly as an effective and safe therapy. The mechanism of action of neurostimulation is not completely known, but recent studies suggest an anti-ischemic effect, exerted through changes in myocardial blood flow. As soon as its safety is sufficiently established, it may become a useful alternative in the treatment of refractory angina pectoris.

Cetuximab with radiotherapy as an alternative treatment for advanced squamous cell carcinoma of the temporal bone.

Science.gov (United States)

Ebisumoto, Koji; Okami, Kenji; Hamada, Masashi; Maki, Daisuke; Sakai, Akihiro; Saito, Kosuke; Shimizu, Fukuko; Kaneda, Shoji; Iida, Masahiro

2018-06-01

The prognosis of advanced temporal bone cancer is poor, because complete surgical resection is difficult to achieve. Chemoradiotherapy is one of the available curative treatment options; however, its systemic effects on the patient restrict the use of this treatment. A 69-year-old female (who needed peritoneal dialysis) presented at our clinic with T4 left external auditory canal cancer and was treated with cetuximab plus radiotherapy (RT). The primary lesion showed complete response. The patient is currently alive with no evidence of disease two years after completion of the treatment and does not show any late toxicity. This is the first advanced temporal bone cancer patient treated with RT plus cetuximab. Cetuximab plus RT might be a treatment alternative for patients with advanced temporal bone cancer. Copyright © 2017 Elsevier B.V. All rights reserved.

Prospective Evaluation of Psychosocial Impact after One Year of Orthodontic Treatment Using PIDAQ Adapted for Indian Population.

Science.gov (United States)

Garg, Kanika; Tripathi, Tulika; Rai, Priyank; Sharma, Nandini; Kanase, Anup

2017-08-01

The impact of dental appearance, malocclusion and treatment for the same on psychological and functional well-being has drawn increasing attention over the past decade. Various psychometric instruments alongside normative indices have been used to predict orthodontic concerns. Evaluating the patients' experience during the orthodontic treatment can help us understand the true benefits and advantages of orthodontic therapy. The aim of the present study was to evaluate the change in the psychosocial impact of malocclusion using the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) adapted for the Indian population after one year of fixed orthodontic treatment. This interventional study was conducted on 93 patients requiring fixed orthodontic treatment. Brazilian, Chinese, Spanish, Nepali and Moroccan versions of the PIDAQ have been published but the questionnaire is not available in Hindi. In the present study, the original PIDAQ was translated into Hindi language to adapt it for the Indian population and was validated by back translation and pretest. All the subjects answered the Hindi version of the questionnaire at pretreatment (T1) and at one year of orthodontic treatment (T2). Additionally, the Index of Orthodontic Treatment Need (IOTN) was applied to measure the severity and self-perception of malocclusion. The data were analysed using paired t-test, Wilcoxon signed rank test and Kruskal-Wallis test. Significant reduction was found in the total PIDAQ score and each factor's score (porthodontic treatment. There was a positive association of the psychosocial impact of malocclusion with the IOTN-AC (IOTN-Aesthetic Component). Adolescent females were found to be most concerned with their dentofacial appearance. Results showed significant improvement in the psychosocial impact of malocclusion with a reduction in the self-perceived needs of patients with orthodontic treatment. The psychometric instrument used may be recommended as an Oral Health Related

SU-F-J-110: MRI-Guided Single-Session Simulation, Online Adaptation, and Treatment

International Nuclear Information System (INIS)

Hill, P; Geurts, M; Mittauer, K; Bayouth, J

2016-01-01

Purpose: To develop a combined simulation and treatment workflow for MRI-guided radiation therapy using the ViewRay treatment planning and delivery system. Methods: Several features of the ViewRay MRIdian planning and treatment workflows are used to simulate and treat patients that require emergent radiotherapy. A simple “pre-plan” is created on diagnostic imaging retrieved from radiology PACS, where conformal fields are created to target a volume defined by a physician based on review of the diagnostic images and chart notes. After initial consult in radiation oncology, the patient is brought to the treatment room, immobilized, and imaged in treatment position with a volumetric MR. While the patient rests on the table, the pre-plan is applied to the treatment planning MR and dose is calculated in the treatment geometry. After physician review, modification of the plan may include updating the target definition, redefining fields, or re-balancing beam weights. Once an acceptable treatment plan is finalized and approved, the patient is treated. Results: Careful preparation and judicious choices in the online planning process allow conformal treatment plans to be created and delivered in a single, thirty-minute session. Several advantages have been identified using this process as compared to conventional urgent CT simulation and delivery. Efficiency gains are notable, as physicians appreciate the predictable time commitment and patient waiting time for treatment is decreased. MR guidance in a treatment position offers both enhanced contrast for target delineation and reduction of setup uncertainties. The MRIdian system tools designed for adaptive radiotherapy are particularly useful, enabling plan changes to be made in minutes. Finally, the resulting plans, typically 6 conformal beams, are delivered as quickly as more conventional AP/PA beam arrangements with comparatively superior dose distributions. Conclusion: The ViewRay treatment planning software and

Herbs, Supplements and Alternative Medicines

Science.gov (United States)

... A A Listen En Español Herbs, Supplements and Alternative Medicines It is best to get vitamins and minerals ... this section Medication Other Treatments Herbs, Supplements, and Alternative Medicines Types of Dietary Supplements Side Effects and Drug ...

Poster — Thur Eve — 17: In-phantom and Fluence-based Measurements for Quality Assurance of Volumetric-driven Adaptation of Arc Therapy

International Nuclear Information System (INIS)

Schaly, B; Hoover, D; Mitchell, S; Wong, E

2014-01-01

During volumetric modulated arc therapy (VMAT) of head and neck cancer, some patients lose weight which may result in anatomical deviations from the initial plan. If these deviations are substantial a new treatment plan can be designed for the remainder of treatment (i.e., adaptive planning). Since the adaptive treatment process is resource intensive, one possible approach to streamlining the quality assurance (QA) process is to use the electronic portal imaging device (EPID) to measure the integrated fluence for the adapted plans instead of the currently-used ArcCHECK device (Sun Nuclear). Although ArcCHECK is recognized as the clinical standard for patient-specific VMAT plan QA, it has limited length (20 cm) for most head and neck field apertures and has coarser detector spacing than the EPID (10 mm vs. 0.39 mm). In this work we compared measurement of the integrated fluence using the EPID with corresponding measurements from the ArcCHECK device. In the past year nine patients required an adapted plan. Each of the plans (the original and adapted) is composed of two arcs. Routine clinical QA was performed using the ArcCHECK device, and the same plans were delivered to the EPID (individual arcs) in integrated mode. The dose difference between the initial plan and adapted plan was compared for ArcCHECK and EPID. In most cases, it was found that the EPID is more sensitive in detecting plan differences. Therefore, we conclude that EPID provides a viable alternative for QA of the adapted head and neck plans and should be further explored

Cultural Adaptations: Conceptual, Ethical, Contextual, and Methodological Issues for Working with Ethnocultural and Majority-World Populations.

Science.gov (United States)

Bernal, Guillermo; Adames, Cristina

2017-08-01

Mayor advancements have been achieved in research on the cultural adaptation of prevention and treatment interventions that are conducted with diverse ethnocultural groups. This commentary addresses conceptual, ethical, contextual, and methodological issues related to cultural adaptations. The articles in this special issue represent a major contribution to the study of cultural adaptations in prevention science. We frame our analysis of fidelity to core intervention components using a conceptual approach that examines (a) the propositional model (theory of change), (b) the procedural model (theory of action, methods), and (c) the philosophical assumptions that undergird these models. Regarding ethics, we caution against imposing the norms, values, and world views of the Western dominant society onto vulnerable populations such as ethnocultural groups. Given that the assumption of universality in behavioral science has been questioned, and as randomized clinical trials (RCTs) seldom examine the ecological validity of evidence-based interventions and treatments (EBI/T), imposing such interventions onto ethnocultural groups is problematic since these interventions contain values, norms, beliefs, and worldviews that may be contrary to those held by many ethnocultural groups. Regarding methods, several innovative designs are discussed that serve as alternatives to the RCT and represent an important contribution to prevention science. Also, we discuss guidelines for conducting cultural adaptations. Finally, the articles in this special issue make a major contribution to the growing field of cultural adaptation of preventive interventions with ethnocultural groups and majority-world populations.

Adaptation and translation of mental health interventions in Middle Eastern Arab countries: a systematic review of barriers to and strategies for effective treatment implementation.

Science.gov (United States)

Gearing, Robin E; Schwalbe, Craig S; MacKenzie, Michael J; Brewer, Kathryne B; Ibrahim, Rawan W; Olimat, Hmoud S; Al-Makhamreh, Sahar S; Mian, Irfan; Al-Krenawi, Alean

2013-11-01

All too often, efficacious psychosocial evidence-based interventions fail when adapted from one culture to another. International translation requires a deep understanding of the local culture, nuanced differences within a culture, established service practices, and knowledge of obstacles and promoters to treatment implementation. This research investigated the following objectives to better facilitate cultural adaptation and translation of psychosocial and mental health treatments in Arab countries: (1) identify barriers or obstacles; (2) identify promoting strategies; and (3) provide clinical and research recommendations. This systematic review of 22 psychosocial or mental health studies in Middle East Arab countries identified more barriers (68%) than promoters (32%) to effective translation and adaptation of empirically supported psychosocial interventions. Identified barriers include obstacles related to acceptability of the intervention within the cultural context, community and system difficulties, and problems with clinical engagement processes. Whereas identified promoter strategies centre on the importance of partnering and working within the local and cultural context, the need to engage with acceptable and traditional intervention characteristics, and the development of culturally appropriate treatment strategies and techniques. Although Arab cultures across the Middle East are unique, this article provides a series of core clinical and research recommendations to assist effective treatment adaptation and translation within Arab communities in the Middle East.

Adaptive management of social-ecological systems: the path forward

Science.gov (United States)

Allen, Craig R.

2015-01-01

Adaptive management remains at the forefront of environmental management nearly 40 years after its original conception, largely because we have yet to develop other methodologies that offer the same promise. Despite the criticisms of adaptive management and the numerous failed attempts to implement it, adaptive management has yet to be replaced with a better alternative. The concept persists because it is simple, allows action despite uncertainty, and fosters learning. Moving forward, adaptive management of social-ecological systems provides policymakers, managers and scientists a powerful tool for managing for resilience in the face of uncertainty.

The feasibility of utilizing pseudo CT-data for online MRI based treatment plan adaptation for a stereotactic radiotherapy treatment of spinal bone metastases

International Nuclear Information System (INIS)

Hoogcarspel, Stan J; Van der Velden, Joanne M; Lagendijk, Jan J W; Van Vulpen, Marco; Raaymakers, Bas W

2014-01-01

The purpose of this study was to investigate what pseudo-CT (pCT) strategy is sufficient for online MRI based treatment plan adaptation of a stereotactic treatment for spinal bone metastases. For this purpose, the dosimetric accuracy of five increasingly complex pCT strategies was evaluated using the planning CT data of 20 patients suffering from spinal metastases. For each pCT, a treatment plan was developed and simulated on both the pCT and the original CT data of the patient. The two resulting dose distributions were compared using gamma analysis of 2%/2 mm. In this paper, a Gamma Pass Rate (GPR) of ⩾95% within the Target Volume (TV) was considered clinically acceptable. We additionally demonstrated in this paper the automatic generation of each investigated pCT strategy with the use of dedicated MRI data complemented with pre-treatment CT data of a patient in treatment position. The dosimetric accuracy of a pCT increases when additional bulk densities are utilized for a pCT. However, the dosimetric accuracy of even the most complex ‘bulk density’ pCT strategy used in this study had an average GPR of only 78% within the TV. However, if information on the heterogeneous electron density distribution within the affected vertebral body was available, a clinically acceptable 99% mean GPR was observed. All pCTs could successfully be generated using the MRI data in combination with the CT data of a patient in treatment position. The results presented in this study show that a simple ‘bulk density’ pseudo-CT strategy is not feasible for online MRI based treatment plan adaptation for spinal bone metastases. However, a clinically acceptable result is generated if the information on the heterogeneous electron density (ED) distribution within the affected vertebral bone is available. Therefore, any pCT strategy for this tumor site should include a method which can estimate the heterogeneous ED of the affected vertebral bone. (paper)

Alternative Therapies for PKU

Directory of Open Access Journals (Sweden)

Norma Spécola MD

2017-01-01

Full Text Available The phenylalanine (PHE-restricted diet has improved in quality and diversity over time and has proven to be effective in all patients. Nevertheless, this treatment imposes a heavy social and economic burden to patient and family and impacts quality of life. Sustained adherence to PHE restriction is difficult to maintain. Moreover, even patients with phenylketonuria (PKU with normal intelligence quotient (IQ have lower IQ than matched individuals without PKU and can have deficits in multiple other aspects of neuropsychological function, including cognitive and executive function, working memory. They can also have behavior problems, depression, and low self-esteem. In recent years, alternative treatments for PKU have been developed and their use has been indicated for some patients who are candidates for options besides traditional treatment. Sapropterindihydrochloride, large neutral amino acids, and glycomacropeptide are alternative treatment options in use for selected patients. The aim of this article is to review the current knowledge of these new approaches to PKU treatment.

Clastogenic adaption of Vicia faba root tip meristem cells after consecutive treatments with S-phase dependent and S-phase independent agents

International Nuclear Information System (INIS)

Heindorff, K.; Schubert, I.; Rieger, R.; Michaelis, A.

1987-01-01

Pretreatment of Vicia faba root tip meristems with low doses of S-phase independent clastogens, such as X-rays or bleomycin, prior to a high (challenge) dose of S-phase dependent clastogens, such as alkylating agents (TEM, Trenimon) or the pyridazine derivative MH, led to decreased challenge treatment-induced aberration frequencies, i.e., clastogenic adaptation. Using the inverse treatment sequence bleomycin and MH proved to be able to substitute for each other in provoking clastogenic (cross) adaptation while bleomycin and alkylating agents were unable to do so. The data support the assumption of inducible cellular functions that become triggered by low clastogen doses and additionally describe some particular properties of bleomycin when used for conditioning. Bleomycin proved to be capable to exert protection independent of the agent used for challenge treatment. (author)

Melatonin treatment of pediatric residents for adaptation to night shift work.

Science.gov (United States)

Cavallo, Anita; Ris, M Douglas; Succop, Paul; Jaskiewicz, Julie

2005-01-01

Night float rotations are used in residency training programs to reduce residents' sleep deprivation. Night shift work, however, is accompanied by deleterious effects on sleep, mood, and attention. To test whether melatonin reduces the deleterious effects of night shift work on sleep, mood, and attention in pediatric residents during night float rotation. Double-blind, randomized, placebo-controlled crossover. Participants took melatonin (3 mg) or a placebo before bedtime in the morning after night shift; completed a sleep diary and an adverse-effects questionnaire daily; and completed the Profile of Mood States and the Conners Continuous Performance Test 3 times in each study week to test mood and attention, respectively. A university-affiliated, tertiary-care pediatric hospital. Healthy second-year pediatric residents working 2 night float rotations. Standardized measures of sleep, mood, and attention. Twenty-eight residents completed both treatments; 17 completed 1 treatment (10 placebo, 7 melatonin). There was not a statistically significant difference in measures of sleep, mood, and 5 of 6 measures of attention during melatonin and placebo treatment. One measure of attention, the number of omission errors, was significantly lower on melatonin (3.0 +/- 9.6) than on placebo (4.5 +/- 17.5) (z = -2.12, P = .03). The isolated finding of improvement of 1 single measure of attention in a test situation during melatonin treatment was not sufficiently robust to demonstrate a beneficial effect of melatonin in the dose used. Other strategies need to be considered to help residents in adaptation to night shift work.

Single amino acid changes in the 6K1-CI region can promote the alternative adaptation of Prunus- and Nicotiana-propagated Plum pox virus C isolates to either host.

Science.gov (United States)

Calvo, María; Malinowski, Tadeusz; García, Juan Antonio

2014-02-01

Plum pox virus (PPV) C is one of the less common PPV strains and specifically infects cherry trees in nature. Making use of two PPV-C isolates that display different pathogenicity features, i.e., SwCMp, which had been adapted to Nicotiana species, and BY101, which had been isolated from cherry rootstock L2 (Prunus lannesiana) and propagated only in cherry species, we have generated two infective full-length cDNA clones in order to determine which viral factors are involved in the adaptation to each host. According to our results, the C-P3(PIPO)/6K1/N-CI (cylindrical inclusion) region contains overlapping but not coincident viral determinants involved in symptoms development, local viral amplification, and systemic movement capacity. Amino acid changes in this region promoting the adaptation to N. benthamiana or P. avium have trade-off effects in the alternative host. In both cases, adaptation can be achieved through single amino acid changes in the NIapro protease recognition motif between 6K1 and CI or in nearby sequences. Thus, we hypothesize that the potyvirus polyprotein processing could depend on specific host factors and the adaptation of PPV-C isolates to particular hosts relies on a fine regulation of the proteolytic cleavage of the 6K1-CI junction.

Combination Treatment of People with Multiple Sclerosis based on Collaboration between Conventional Healthcare Providers and Alternative Practitioners

DEFF Research Database (Denmark)

Skovgaard, Lasse; Launsø, Laila; Pedersen, Inge Kryger

2011-01-01

The use of alternative and complementary medicine (CAM) is prevalent among People with Multiple Sclerosis (PwMS) in Denmark as well as in other Western countries. Many PwMS combine conventional treatments and CAM; however there is little research-based knowledge about the outcomes that PwMS achieve...... from combined treatments. The purpose of this article is to describe which outcomes PwMS have experienced from combination treatment based on collaboration between conventional healthcare providers and CAM practitioners. A second purpose is to identify and study aspects of the courses of treatment...... that have generally characterized the achieved outcomes. During the course of their treatment, 59 PwMS participated in semi-structured individual or group interviews. The analyses show that the participants’ experienced outcomes can be classified in four ways 1) short-term positive outcomes; 2) long...

Dose-dense paclitaxel with carboplatin for advanced ovarian cancer: a feasible treatment alternative.

Science.gov (United States)

Glaze, Sarah; Teitelbaum, Lisa; Chu, Pamela; Ghatage, Prafull; Nation, Jill; Nelson, Gregg

2013-01-01

Epithelial ovarian cancer is the leading cause of death from gynaecologic cancers in the Western world. If possible, initial cytoreductive surgery is the treatment of choice, followed by adjuvant chemotherapy, usually with a platinum/taxane combination. Increased survival has been recently reported in women who were given adjuvant chemotherapy weekly rather than at three-week intervals, which has been the standard. At our centre, we have been treating patients with advanced ovarian cancer with a dose-dense protocol since March 2010. Treatment is given in an outpatient setting on days 1, 8, and 15 of a 21-day cycle for six cycles. Carboplatin for an AUC of 5 mg/mL/min and paclitaxel 80mg/m² are given on day 1, followed by paclitaxel 80mg/m² on days 8 and 15. Our objective was to determine whether this protocol is a feasible alternative treatment in our population and whether or not the toxicity profile is acceptable. We performed a chart review of 46 patients undergoing treatment with dose-dense chemotherapy for advanced ovarian cancer. Demographic information, patient characteristics, adverse events, and treatment endpoints were recorded. Sixty-one percent of women completed the six-cycle protocol as planned with minimal interruption, which is comparable to the only previously reported trial using this regimen. The most common side effects of treatment were fatigue, neuropathy, and neutropenia. Supplementation with regular magnesium and granulocyte colony-stimulating factor reduced delays. Dose-dense paclitaxel with carboplatin chemotherapy for the treatment of advanced ovarian cancer shows promise in terms of progression-free and overall survival. We have shown this protocol to be practical and feasible in our population.

Chiari malformation and central sleep apnea syndrome: efficacy of treatment with adaptive servo-ventilation

Directory of Open Access Journals (Sweden)

Jorge Marques do Vale

2014-10-01

Full Text Available The Chiari malformation type I (CM-I has been associated with sleep-disordered breathing, especially central sleep apnea syndrome. We report the case of a 44-year-old female with CM-I who was referred to our sleep laboratory for suspected sleep apnea. The patient had undergone decompressive surgery 3 years prior. An arterial blood gas analysis showed hypercapnia. Polysomnography showed a respiratory disturbance index of 108 events/h, and all were central apnea events. Treatment with adaptive servo-ventilation was initiated, and central apnea was resolved. This report demonstrates the efficacy of servo-ventilation in the treatment of central sleep apnea syndrome associated with alveolar hypoventilation in a CM-I patient with a history of decompressive surgery.

Multiple Concurrent Visual-Motor Mappings: Implications for Models of Adaptation

Science.gov (United States)

Cunningham, H. A.; Welch, Robert B.

1994-01-01

Previous research on adaptation to visual-motor rearrangement suggests that the central nervous system represents accurately only 1 visual-motor mapping at a time. This idea was examined in 3 experiments where subjects tracked a moving target under repeated alternations between 2 initially interfering mappings (the 'normal' mapping characteristic of computer input devices and a 108' rotation of the normal mapping). Alternation between the 2 mappings led to significant reduction in error under the rotated mapping and significant reduction in the adaptation aftereffect ordinarily caused by switching between mappings. Color as a discriminative cue, interference versus decay in adaptation aftereffect, and intermanual transfer were also examined. The results reveal a capacity for multiple concurrent visual-motor mappings, possibly controlled by a parametric process near the motor output stage of processing.

Remittances for Adaptation : An ‘Alternative Source’ of International Climate Finance?

NARCIS (Netherlands)

Bendandi, Barbara; Pauw, W.P.

2016-01-01

Climate finance is a key issue at the UN climate negotiations, but explicit international funding possibilities for adaptation in developing countries remain limited. According to the recent Paris Agreement, climate finance will come from a ‘wide variety of sources, instruments and channels’. To the

[Health economic consequences of the choice of follicle stimulating hormone alternatives in IVF treatment].

Science.gov (United States)

Poulsen, Peter Bo; Højgaard, Astrid; Quartarolo, Jens Piero

2007-04-02

There is a choice between two types of hormones for stimulation of the follicles in IVF treatment - recombinant FSH and the urine-derived menotrophin. A literature review by NICE (2004) in the United Kingdom documented that the two types of hormones were equally effective and safe, which is why it was recommended to use the cheaper urine-derived hormone. Based on the EISG study (European and Israeli Study Group), the aim was to analyse the health economic consequences of the choice between the two types of hormone in IVF treatment in Denmark. In a prospective cost-effectiveness analysis (health care sector perspective), menotrophin and recombinant FSH (Gonal-F) were compared. Differences in costs were compared with differences in effects of the two alternatives. The total costs for the average patient are lower when using menotrophin compared with recombinant FSH. Furthermore, the cost per clinical pregnancy was lower with menotrophin compared with recombinant FSH hormone. Menotrophin is therefore less expensive both for the patient as well as for the health care sector. The use of menotrophin instead of recombinant FSH can result in savings of up to DKK 16 million on the drug budget--savings that could finance 1,400 additional IVF cycles. The analysis shows that urine-derived menotrophin is a cost-effective alternative to recombinant FSH with a potential for considerable savings for patients as well as the public drug budget.

Alternative Therapy of Animals – Homeopathy and Other Alternative Methods of Therapy

Directory of Open Access Journals (Sweden)

Løken Torleiv

2002-03-01

Full Text Available Alternative therapy of animals is described, in the meaning of alternatives to veterinary therapy traditionally accepted by veterinary faculties and schools and included in their curricula. Alternative therapy composes of different disciplines, of which homeopathy is emphasised in this presentation. Information is given on the use and interest of such therapy among veterinarians and animal owners. Homeopathy as other alternative therapies, may offer great advances, if they induce any effect. Some of the disciplines are based on a scientifically accepted documentation. Others, and homeopathy in particular, are missing such a documentation of effect. The justification of including alternative therapy in treating animals is discussed. Research in alternative therapy of animals is greatly needed, in particular to evaluate therapeutic methods which are in extensive use without any documented effect. An ongoing research project in Norway on the effect of homeopathic treatment of mastitis in cows is shortly presented.

Effect of Metformin on Potassium-adapted and Non- adapted ...

African Journals Online (AJOL)

determined. Results: The blood glucose of the potassium-adapted diabetic group was not significantly reduced on treatment ... whom dietary carbohydrate restriction has not controlled .... significantly different from the metformin-treated group.

Constructed wetland: an alternative for wastewater treatment; Humedales construidos: una alternativa a considerar para el tratamiento de aguas residuales

Energy Technology Data Exchange (ETDEWEB)

Plaza de los Reyes del Rio, C.; Vidal Saez, G.

2007-07-01

Research and trends dealing with sewage and industrial wastewaters treated by constructed wetlands are shown in this paper. Plant and constructed wetlands configurations are also described. Sewage domestic wastewaters from individual houses or villages have used constructed wetlands as wastewater treatment. On the other hand, constructed wetlands as finally treatment working together with conventional technologies could be a good alternative for improving the treated quality wastewater. (Author) 56 refs.

Ethical Considerations in Designing Adaptive Persuasive Games

DEFF Research Database (Denmark)

Pedersen, Christoffer Holmgård; Khaled, Rilla; Yannakakis, Georgios N.

In this poster, we describe an ongoing project concerning the development of an Adaptive Treatment Game (ATG) for treating Post Traumatic Stress Disorder. The ATG uses biofeedback and computer game technology to enable multiple treatment techniques and goals. We examine how a multidisciplinary ap...... approach shaped the prototype and we discuss the ethical implications of creating a self-adaptive, semiautonomous treatment game....

Determination of Flood Reduction Alternatives for Climate Change Adaptation in Gyeongancheon basin

Science.gov (United States)

Han, D.; Joo, H. J.; Jung, J.; Kim, H. S.

2017-12-01

Recently, the frequency of extreme rainfall event has increased due to the climate change and the impermeable area in an urban watershed has also increased due to the rapid urbanization. Therefore, the flood risk is increasing and we ought to prepare countermeasures for flood damage reduction. For the determination of appropriate measures or alternatives, firstly, this study estimated the frequency based rainfall considering the climate change according to the each target period(reference : 1971˜2010, Target period Ⅰ : 2011˜2040, Target period Ⅱ : 2041˜2070, Target period Ⅲ : 2071˜2100). Then the future flood discharge was computed by using HEC-HMS model. We set 5 sizes of drainage pumps and detention ponds respectively as the flood reduction alternatives and the flood level in the river was obtained by each alternative through HEC-RAS model. The flood inundation map was constructed using topographical data and flood water level in the river and the economic analysis was conducted for the flood damage reduction studies using Multi Dimensional Flood Damage Analysis (MD-FDA) tool. As a result of the effectiveness analysis of the flood reduction alternatives, the flood level by drainage pump was reduced by 0.06m up to 0.44m while it was reduced by 0.01m up to 1.86m in the case of the detention pond. The flooded area was shrunk by up to 32.64% from 0.3% and inundation depth was also dropped. As a result of a comparison of the Benefit/Cost ratio estimated by the economic analysis, a detention pond E in the target period Ⅰ and the pump D in the periods Ⅱ and Ⅲ were considered as the appropriate alternatives for the flood damage reduction under the climate change. AcknowledgementsThis research was supported by Basic Science Research Program through the National Research Foundation of Korea(NRF) funded by the Ministry of Science, ICT & Future Planning(2017R1A2B3005695)

Chinese Adaptation of the Bad Sobernheim Stress Questionnaire for Patients With Adolescent Idiopathic Scoliosis Under Brace Treatment.

Science.gov (United States)

Xu, Ximing; Wang, Fei; Yang, Mingyuan; Huang, Qikai; Chang, Yifan; Wei, Xianzhao; Bai, Yushu; Li, Ming

2015-08-01

Bad Sobernheim Stress Questionnaire (BSSQ)-Deformity and BSSQ-Brace are the most widely used instruments for evaluating stress levels in adolescent idiopathic scoliosis (AIS) patients under brace treatment, and good reliability and validity have been demonstrated across different cultures. Great stress has been found among many adolescents, becoming a major concern for professionals. However, no previous research has addressed the cultural adaptations and psychometric testing of BSSQ-Deformity and BSSQ-Brace in China or the stress levels in AIS patients. The purposes of our study were to evaluate the cross-cultural adaptation and validation of the BSSQ-Deformity and BSSQ-Brace and to investigate stress levels in Chinese (AIS) patients under brace treatment.The original (German) versions of BSSQ-Deformity and BSSQ-Brace were cross-culturally translated according to international guidelines. Psychometric properties such as reliability and construct validity were tested. Eighty-six AIS patients were included in our study, and 50 patients paid a second visit 3 to 7 days later to test reproducibility. Cronbach α and the intraclass coefficient were determined to assess internal consistency and reproducibility. Scoliosis Research Society patient questionnaire-22 (SRS-22) was applied to evaluate construct validity.The mean BSSQ-Deformity and BSSQ-Brace scores were 15.3 and 13.4 points, respectively. Severe stress was observed in 12% of patients due to brace treatment. Item analysis demonstrated that each item was scored under a normal distribution with no redundancy. Psychometric analysis revealed excellent internal consistency (Cronbach α = 0.85 and 0.80, respectively) and reproducibility (intraclass correlation coefficient = 0.85 and 0.90, respectively) for BSSQ-Deformity and BSSQ-Brace. The correlation coefficients of BSSQ-Deformity, BSSQ-Brace and SRS-22 were 0.48 and 0.63, respectively.In conclusion, BSSQ-Deformity and BSSQ-Brace have been successfully

The life cycles of six multi-center adaptive clinical trials focused on neurological emergencies developed for the Advancing Regulatory Science initiative of the National Institutes of Health and US Food and Drug Administration: Case studies from the Adaptive Designs Accelerating Promising Treatments Into Trials Project.

Science.gov (United States)

Guetterman, Timothy C; Fetters, Michael D; Mawocha, Samkeliso; Legocki, Laurie J; Barsan, William G; Lewis, Roger J; Berry, Donald A; Meurer, William J

2017-01-01

Clinical trials are complicated, expensive, time-consuming, and frequently do not lead to discoveries that improve the health of patients with disease. Adaptive clinical trials have emerged as a methodology to provide more flexibility in design elements to better answer scientific questions regarding whether new treatments are efficacious. Limited observational data exist that describe the complex process of designing adaptive clinical trials. To address these issues, the Adaptive Designs Accelerating Promising Treatments Into Trials project developed six, tailored, flexible, adaptive, phase-III clinical trials for neurological emergencies, and investigators prospectively monitored and observed the processes. The objective of this work is to describe the adaptive design development process, the final design, and the current status of the adaptive trial designs that were developed. To observe and reflect upon the trial development process, we employed a rich, mixed methods evaluation that combined quantitative data from visual analog scale to assess attitudes about adaptive trials, along with in-depth qualitative data about the development process gathered from observations. The Adaptive Designs Accelerating Promising Treatments Into Trials team developed six adaptive clinical trial designs. Across the six designs, 53 attitude surveys were completed at baseline and after the trial planning process completed. Compared to baseline, the participants believed significantly more strongly that the adaptive designs would be accepted by National Institutes of Health review panels and non-researcher clinicians. In addition, after the trial planning process, the participants more strongly believed that the adaptive design would meet the scientific and medical goals of the studies. Introducing the adaptive design at early conceptualization proved critical to successful adoption and implementation of that trial. Involving key stakeholders from several scientific domains early

Regenerative medicine provides alternative strategies for the treatment of anal incontinence.

Science.gov (United States)

Gräs, Søren; Tolstrup, Cæcilie Krogsgaard; Lose, Gunnar

2017-03-01

Anal incontinence is a common disorder but current treatment modalities are not ideal and the development of new treatments is needed. The aim of this review was to identify the existing knowledge of regenerative medicine strategies in the form of cellular therapies or bioengineering as a treatment for anal incontinence caused by anal sphincter defects. PubMed was searched for preclinical and clinical studies in English published from January 2005 to January 2016. Animal studies have demonstrated that cellular therapy in the form of local injections of culture-expanded skeletal myogenic cells stimulates repair of both acute and 2 - 4-week-old anal sphincter injuries. The results from a small clinical trial with ten patients and a case report support the preclinical findings. Animal studies have also demonstrated that local injections of mesenchymal stem cells stimulate repair of sphincter injuries, and a complex bioengineering strategy for creation and implantation of an intrinsically innervated internal anal sphincter construct has been successfully developed in a series of animal studies. Cellular therapies with myogenic cells and mesenchymal stem cells and the use of bioengineering technology to create an anal sphincter are new potential strategies to treat anal incontinence caused by anal sphincter defects, but the clinical evidence is extremely limited. The use of culture-expanded autologous skeletal myogenic cells has been most intensively investigated and several clinical trials were ongoing at the time of this report. The cost-effectiveness of such a therapy is an issue and muscle fragmentation is suggested as a simple alternative.

SU-C-202-05: Pilot Study of Online Treatment Evaluation and Adaptive Re-Planning for Laryngeal SBRT

Energy Technology Data Exchange (ETDEWEB)

Mao, W [The University of Texas Southwestern Medical Ctr, Dallas, TX (United States); Henry Ford Health System, Detroit, MI (United States); Liu, C; Zhong, H [Henry Ford Health System, Detroit, MI (United States); Rozario, T; Lu, W; Gu, X; Yan, Y; Jia, X; Sumer, B; Schwartz, D [The University of Texas Southwestern Medical Ctr, Dallas, TX (United States)

2016-06-15

Purpose: We have instigated a phase I trial of 5-fraction stereotactic body radiotherapy (SBRT) for advanced-stage laryngeal cancer. We conducted this pilot dosimetric study to confirm the potential utility of online adaptive re-planning to preserve treatment quality. Methods: Ten cases of larynx cancer were evaluated. Baseline and daily SBRT treatment plans were generated per trial protocol. Daily volumetric images were acquired prior to every fraction of treatment. Reference simulation CT images were deformably registered to daily volumetric images using Eclipse. Planning contours were then deformably propagated to daily images. Reference SBRT plans were directly copied to calculate delivered dose distributions on deformed reference CT images. In-house software platform has been developed to calculate cumulative dose over a course of treatment in four steps: 1) deforming delivered dose grid to reference CT images using deformation information exported from Eclipse; 2) generating tetrahedrons using deformed dose grid as vertices; 3) resampling dose to a high resolution within every tetrahedron; 4) calculating dose-volume histograms. Our inhouse software was benchmarked with a commercial software, Mirada. Results: In all ten cases including 49 fractions of treatments, delivered daily doses were completely evaluated and treatment could be re-planned within 10 minutes. Prescription dose coverage of PTV was less than intended in 53% of fractions of treatment (mean: 94%, range: 84%–98%) while minimum coverage of CTV and GTV was 94% and 97%, respectively. Maximum bystander point dose limits to arytenoids, parotids, and spinal cord remained respected in all cases, although variances in carotid artery doses were observed in a minority of cases. Conclusion: Although GTV and CTV coverage is preserved by in-room 3D image guidance of larynx SBRT, PTV coverage can vary significantly from intended plans. Online adaptive treatment evaluation and re-planning is potentially

The many shades of prion strain adaptation.

Science.gov (United States)

Baskakov, Ilia V

2014-01-01

In several recent studies transmissible prion disease was induced in animals by inoculation with recombinant prion protein amyloid fibrils produced in vitro. Serial transmission of amyloid fibrils gave rise to a new class of prion strains of synthetic origin. Gradual transformation of disease phenotypes and PrP(Sc) properties was observed during serial transmission of synthetic prions, a process that resembled the phenomenon of prion strain adaptation. The current article discusses the remarkable parallels between phenomena of prion strain adaptation that accompanies cross-species transmission and the evolution of synthetic prions occurring within the same host. Two alternative mechanisms underlying prion strain adaptation and synthetic strain evolution are discussed. The current article highlights the complexity of the prion transmission barrier and strain adaptation and proposes that the phenomenon of prion adaptation is more common than previously thought.

Hazardous waste inventory, characteristics, generation, and facility assessment for treatment, storage, and disposal alternatives considered in the U.S. Department of Energy Waste Management Programmatic Environmental Impact Statement

International Nuclear Information System (INIS)

Lazaro, M.A.; Antonopoulos, A.A.; Policastro, A.J.

1995-04-01

This report focuses on the generation of hazardous waste (HW) and the treatment, storage, and disposal (TSD) of HW being generated by routine US Department of Energy (DOE) facility operations. The wastes to be considered are managed by the DOE Waste Management (WM) Division (WM HW). The waste streams are to be sent to WM operations throughout the DOE complex under four management alternatives: No Action, Decentralization, Regionalized 1, and Regionalized 2. On-site and off-site capabilities for TSD are examined for each alternative. This report (1) summarizes the HW inventories and generated amounts resulting from WM activities, focusing on the largest DOE HW generators; (2) presents estimates of the annual amounts shipped off-site, as well as the amounts treated by various treatment technology groups; (3) describes the existing and planned treatment and storage capabilities of the largest HW-generating DOE installations, as well as the use of commercial TSD facilities by DOE sites; (4) presents applicable technologies (destruction of organics, deactivation/neutralization of waste, removal/recovery of organics, and aqueous liquid treatment); and (5) describes the four alternatives for consideration for future HW management, and for each alternative provides the HW loads and the approach used to estimate the source term for routine TSD operations. In addition, potential air emissions, liquid effluents, and solid residuals associated with each alternative are presented. Furthermore, this report is supplemented with an addendum that includes detailed information related to HW inventory, characteristics, generation, and facility assessment for the TSD alternatives. The addendum also presents source terms, emission rates, and throughput totals by alternative and treatment installation

Haemophilus ducreyi Seeks Alternative Carbon Sources and Adapts to Nutrient Stress and Anaerobiosis during Experimental Infection of Human Volunteers.

Science.gov (United States)

Gangaiah, Dharanesh; Zhang, Xinjun; Baker, Beth; Fortney, Kate R; Gao, Hongyu; Holley, Concerta L; Munson, Robert S; Liu, Yunlong; Spinola, Stanley M

2016-05-01

Haemophilus ducreyi causes the sexually transmitted disease chancroid in adults and cutaneous ulcers in children. In humans, H. ducreyi resides in an abscess and must adapt to a variety of stresses. Previous studies (D. Gangaiah, M. Labandeira-Rey, X. Zhang, K. R. Fortney, S. Ellinger, B. Zwickl, B. Baker, Y. Liu, D. M. Janowicz, B. P. Katz, C. A. Brautigam, R. S. Munson, Jr., E. J. Hansen, and S. M. Spinola, mBio 5:e01081-13, 2014, http://dx.doi.org/10.1128/mBio.01081-13) suggested that H. ducreyi encounters growth conditions in human lesions resembling those found in stationary phase. However, how H. ducreyi transcriptionally responds to stress during human infection is unknown. Here, we determined the H. ducreyi transcriptome in biopsy specimens of human lesions and compared it to the transcriptomes of bacteria grown to mid-log, transition, and stationary phases. Multidimensional scaling showed that the in vivo transcriptome is distinct from those of in vitro growth. Compared to the inoculum (mid-log-phase bacteria), H. ducreyi harvested from pustules differentially expressed ∼93 genes, of which 62 were upregulated. The upregulated genes encode homologs of proteins involved in nutrient transport, alternative carbon pathways (l-ascorbate utilization and metabolism), growth arrest response, heat shock response, DNA recombination, and anaerobiosis. H. ducreyi upregulated few genes (hgbA, flp-tad, and lspB-lspA2) encoding virulence determinants required for human infection. Most genes regulated by CpxRA, RpoE, Hfq, (p)ppGpp, and DksA, which control the expression of virulence determinants and adaptation to a variety of stresses, were not differentially expressed in vivo, suggesting that these systems are cycling on and off during infection. Taken together, these data suggest that the in vivo transcriptome is distinct from those of in vitro growth and that adaptation to nutrient stress and anaerobiosis is crucial for H. ducreyi survival in humans. Copyright © 2016

Integration of alternative feedstreams for biomass treatment and utilization

Science.gov (United States)

Hennessey, Susan Marie [Avondale, PA; Friend, Julie [Claymont, DE; Dunson, Jr., James B.; Tucker, III, Melvin P.; Elander, Richard T [Evergreen, CO; Hames, Bonnie [Westminster, CO

2011-03-22

The present invention provides a method for treating biomass composed of integrated feedstocks to produce fermentable sugars. One aspect of the methods described herein includes a pretreatment step wherein biomass is integrated with an alternative feedstream and the resulting integrated feedstock, at relatively high concentrations, is treated with a low concentration of ammonia relative to the dry weight of biomass. In another aspect, a high solids concentration of pretreated biomass is integrated with an alternative feedstream for saccharifiaction.

Radiation Synovectomy: an effective alternative treatment for inflamed small joints.

Science.gov (United States)

Karavida, N; Notopoulos, A

2010-01-01

An inflamed painful joint is one of the most common indications for the patient to be referred to a rheumatologist or an orthopedician. In relation to the aetiology, the therapeutic approach might be systemic, local or a combination of them in some cases, always with the thought of balancing risk with benefit for the patient. In all cases, independently of the cause, the goal of therapy is to improve the quality of life through the reduction of pain, improvement of mobility and preservation of function. Nuclear Medicine has to offer Radiosynoviorthesis, an effective alternative procedure for treating inflamed small joints. Various radionuclides are available for radiosynoviorthesis. Their selection depends on the size of the joint to be treated. Small joints are mainly treated with [169Er] erbium under a fluoroscopic or sonographic guidance, usually with a simultaneous instillation of a corticoid. Candidates for radiosynoviorthesis should have been under a six-month systemic treatment without encouraging results or should have undergone at least one unsuccessful intra-articular injection of a long acting glucocorticoid. Since 1973, when [169Er] erbium was firstly suggested as a therapeutic agent for radiosynoviorthesis of the finger joints, there has been quite enough experience in its' application. It has been found to be cost effective in providing long term relief of pain and deformity of the inflamed joints in comparison to other therapeutic approaches. Additionally, there is no radiation risk and can be performed on an out patient basis. Therefore it can stand as an effective alternative procedure for treating early stages of chronic synovitis in RA (rheumatoid arthritis) patients, with minor damage of the cartilage and the adjacent bones, and for synovitis secondary to inflammatory arthropathies.

Use of Ursodeoxycholic Acid on Post-menopausal Obesity, Hepatic steatosis and Plasma Profile as an Alternative Treatment for Hormone Replacement Therapy

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Angelo Christiano Franzoni

2015-12-01

Full Text Available ABSTRACT The aim of this study was to evaluate the efficacy of the ursodeoxycholic acid (UDCA as an alternative treatment for menopause pathologies. For this, female Swiss-CD-1 mice were ovariectomized (OVX; SHAM operated mice served as controls. Ten weeks after operation, each group of mice was treated during four weeks with either UDCA, or 17(-estradiol+progesterone. The blood and tissues (liver and periuterine adipose tissue - PUAT were harvested. The OVX mice had increase body weight, accompanied by liver lipid accumulation. UDCA and HRT treatments reduced these parameters. PUAT was also increased in OVX group and UDCA and HRT treatments reduced this. Histology confirmed the results in the liver and PUAT. The plasma glucose levels were elevated in the OVX mice, as well as total cholesterol, LDL cholesterol and VLDL cholesterol levels and reduced in OVX-UDCA and OVX-HRT. These results suggest that UDCA could reduce weight gain and fat liver deposition caused by ovariectomy, such as HRT, showing a possible alternative treatment for post-menopausal metabolic dysfunctions with UDCA.

Use of Augmentative and Alternative Communication Systems in Preschool: teacher perceptions

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Munique Massaro

2013-06-01

Full Text Available Augmentative and Alternative Communication Resources have proven to be helpful in the insertion of students with disabilities and complex communication needs into a variety of pedagogical activities and expand the skills and competencies of the teacher in the teaching-learning. The objective of this research was to identify the perception of teachers regarding the use of augmentative and alternative communication during an intervention program in Preschool. Participants were a special class of Preschool students with disabilities and severe communication complexity, along with their teacher and the researcher. For the development of this research, a Alternative Communication Program was applied. The teacher was provided with systematic guidance concerning language and communication. In a collaborative process, three children’s songs were selected according to the teacher’s pedagogical planning and adapted resources through Augmentative and Alternative Communication Systems. During the intervention program, assisted evaluations also took place immediately after the activities with the music. The data were collected in audio recordings. For data analysis, content analysis was carried out resulting in the outlining of themes and sub-themes. Results indicated that the teacher identified that Augmentative and Alternative Communication Systems can to facilitate expression abilities of students with disabilities; that Augmentative and Alternative Communication Systems can be used by children in Preschool; and that resources adapted through augmentative and alternative communication systems should be in accordance with the specificities of students.

Curricular adaptation: alternatives of pedagogical support in the inclusive education

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Lucia Pereira Leite

2010-12-01

Full Text Available The organization of the inclusive education is a slow and complex process, which has the necessity of investments in supports for all the scholar team. Aiming at spreading one of the actions carried out for the promotion of the inclusive educational practices in a municipal education system in a western city in the state of São Paulo, this paperwork has the objective of presenting an elaborated manual of orientations for the implementation of the individual curricular adaptations (ACIs for students who demand special educational necessities.(NEEs. The material was constituted on the basis of three data sets: 1 tabulation of the evaluations of the curricular adaptations already made; 2 the literature review; 3 analysis of the themes which have emerged during case discussion meetings mediated by the researchers with teachers from the Specialized Pedagogical Support Service (SAPE, with teachers and administrators from the common education system and the technical-pedagogical team. The final version of the manual contemplates the theoretical-operational aspects about the themes: flexibility and curricular adequation, inclusive education, definitions of NEEs, how SAPE works; and it finishes with a model proposal of ACI. It is expected that the spreading of this material can subside new curricular propositions for students with deficiency that are very distant from the academic level expected for the current scholar year.

Head and Neck Margin Reduction With Adaptive Radiation Therapy: Robustness of Treatment Plans Against Anatomy Changes

International Nuclear Information System (INIS)

Kranen, Simon van; Hamming-Vrieze, Olga; Wolf, Annelisa; Damen, Eugène; Herk, Marcel van; Sonke, Jan-Jakob

2016-01-01

Purpose: We set out to investigate loss of target coverage from anatomy changes in head and neck cancer patients as a function of applied safety margins and to verify a cone beam computed tomography (CBCT)–based adaptive strategy with an average patient anatomy to overcome possible target underdosage. Methods and Materials: For 19 oropharyngeal cancer patients, volumetric modulated arc therapy treatment plans (2 arcs; simultaneous integrated boost, 70 and 54.25 Gy; 35 fractions) were automatically optimized with uniform clinical target volume (CTV)–to–planning target volume margins of 5, 3, and 0 mm. We applied b-spline CBCT–to–computed tomography (CT) deformable registration to allow recalculation of the dose on modified CT scans (planning CT deformed to daily CBCT following online positioning) and dose accumulation in the planning CT scan. Patients with deviations in primary or elective CTV coverage >2 Gy were identified as candidates for adaptive replanning. For these patients, a single adaptive intervention was simulated with an average anatomy from the first 10 fractions. Results: Margin reduction from 5 mm to 3 mm to 0 mm generally led to an organ-at-risk (OAR) mean dose (D_m_e_a_n) sparing of approximately 1 Gy/mm. CTV shrinkage was mainly seen in the elective volumes (up to 10%), likely related to weight loss. Despite online repositioning, substantial systematic errors were present (>3 mm) in lymph node CTV, the parotid glands, and the larynx. Nevertheless, the average increase in OAR dose was small: maximum of 1.2 Gy (parotid glands, D_m_e_a_n) for all applied margins. Loss of CTV coverage >2 Gy was found in 1, 3, and 7 of 73 CTVs, respectively. Adaptive intervention in 0-mm plans substantially improved coverage: in 5 of 7 CTVs (in 6 patients) to 2 Gy in 0-mm plans may be identified early in treatment using dose accumulation. A single intervention with an average anatomy derived from CBCT effectively mitigates discrepancies.

Adaptive Motion Compensation in Radiotherapy

CERN Document Server

Murphy, Martin J

2011-01-01

External-beam radiotherapy has long been challenged by the simple fact that patients can (and do) move during the delivery of radiation. Recent advances in imaging and beam delivery technologies have made the solution--adapting delivery to natural movement--a practical reality. Adaptive Motion Compensation in Radiotherapy provides the first detailed treatment of online interventional techniques for motion compensation radiotherapy. This authoritative book discusses: Each of the contributing elements of a motion-adaptive system, including target detection and tracking, beam adaptation, and pati

Transcriptomic insights into the alternative splicing-mediated adaptation of the entomopathogenic fungus Beauveria bassiana to host niches: autophagy-related gene 8 as an example.

Science.gov (United States)

Dong, Wei-Xia; Ding, Jin-Li; Gao, Yang; Peng, Yue-Jin; Feng, Ming-Guang; Ying, Sheng-Hua

2017-10-01

Alternative splicing (AS) regulates various biological processes in fungi by extending the cellular proteome. However, comprehensive studies investigating AS in entomopathogenic fungi are lacking. Based on transcriptome data obtained via dual RNA-seq, the first overview of AS events was developed for Beauveria bassiana growing in an insect haemocoel. The AS was demonstrated for 556 of 8840 expressed genes, accounting for 5.4% of the total genes in B. bassiana. Intron retention was the most abundant type of AS, accounting for 87.1% of all splicing events and exon skipping events were rare, only accounting for 2.0% of all events. Functional distribution analysis indicated an association between alternatively spliced genes and several physiological processes. Notably, B. bassiana autophagy-related gene 8 (BbATG8), an indispensable gene for autophagy, was spliced at an alternative 5' splice site to generate two transcripts (BbATG8-α and BbATG8-β). The BbATG8-α transcript was necessary for fungal autophagy and oxidation tolerance, while the BbATG8-β transcript was not. These two transcripts differentially contributed to the formation of conidia or blastospores as well as fungal virulence. Thus, AS acts as a powerful post-transcriptional regulatory strategy in insect mycopathogens and significantly mediates fungal transcriptional adaption to host niches. © 2017 Society for Applied Microbiology and John Wiley & Sons Ltd.

Treatment Sequencing for Childhood ADHD: A Multiple-Randomization Study of Adaptive Medication and Behavioral Interventions.

Science.gov (United States)

Pelham, William E; Fabiano, Gregory A; Waxmonsky, James G; Greiner, Andrew R; Gnagy, Elizabeth M; Pelham, William E; Coxe, Stefany; Verley, Jessica; Bhatia, Ira; Hart, Katie; Karch, Kathryn; Konijnendijk, Evelien; Tresco, Katy; Nahum-Shani, Inbal; Murphy, Susan A

2016-01-01

Behavioral and pharmacological treatments for children with attention deficit/hyperactivity disorder (ADHD) were evaluated to address whether endpoint outcomes are better depending on which treatment is initiated first and, in case of insufficient response to initial treatment, whether increasing dose of initial treatment or adding the other treatment modality is superior. Children with ADHD (ages 5-12, N = 146, 76% male) were treated for 1 school year. Children were randomized to initiate treatment with low doses of either (a) behavioral parent training (8 group sessions) and brief teacher consultation to establish a Daily Report Card or (b) extended-release methylphenidate (equivalent to .15 mg/kg/dose bid). After 8 weeks or at later monthly intervals as necessary, insufficient responders were rerandomized to secondary interventions that either increased the dose/intensity of the initial treatment or added the other treatment modality, with adaptive adjustments monthly as needed to these secondary treatments. The group beginning with behavioral treatment displayed significantly lower rates of observed classroom rule violations (the primary outcome) at study endpoint and tended to have fewer out-of-class disciplinary events. Further, adding medication secondary to initial behavior modification resulted in better outcomes on the primary outcomes and parent/teacher ratings of oppositional behavior than adding behavior modification to initial medication. Normalization rates on teacher and parent ratings were generally high. Parents who began treatment with behavioral parent training had substantially better attendance than those assigned to receive training following medication. Beginning treatment with behavioral intervention produced better outcomes overall than beginning treatment with medication.

The applicability of chemical alternatives assessment for engineered nanomaterials

DEFF Research Database (Denmark)

Hjorth, Rune; Hansen, Steffen Foss; Jacobs, Molly

2017-01-01

The use of alternatives assessment to substitute hazardous chemicals with inherently safer options is gaining momentum worldwide as a legislative and corporate strategy to minimize consumer, occupational, and environmental risks. Engineered nanomaterials represent an interesting case......, such as the use of mechanistic toxicity screens and control banding tools, alternatives assessment can be adapted to evaluate engineered nanomaterials both as potential substitutes for chemicals of concern and to ensure safer nanomaterials are incorporated in the design of new products. This article is protected...... for alternatives assessment approaches as they can be considered both emerging “chemicals” of concern, as well as potentially safer alternatives to hazardous chemicals. However, comparing the hazards of nanomaterials to traditional chemicals or to other nanomaterials is challenging and critical elements...

Review: The Necessity of Producing/Normalizing Adaptive Behavior Scales in Diagnosing Training Treatment Rehabilitation of Peop e and Assessment of the Programs

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Seyyed Jalal Sadrosadat

2000-10-01

Full Text Available Adaptive behavior is defined as the manner in which people cope with the natural and social demands of their environments. Impairments in adaptive behavior are described as significant limitations in an individual's effectiveness in meeting the standards of maturation, learning, personal independence, and/or social responsibility that are expected for one's age level and cultural group, as determined by clinical assessment, and usually, standardized scales. The definitions of adaptive deficiencies imply an individual's ability to cope with demands of his or her environment. Some scholars support this notion when describing adaptive behavior's relationship to mental retardation. Despite the fact that adaptive behavior scales are the necessary tools in diagnosing training: treatment. Rehabilitation of people (Particularly with developmental disorders and the assessment of programs, those are not available to professionals. This article tries to explain the necessity of producing/normalizing such scales, and introduces one of the most famous scales named as "Adaptive Behavior Scale-Residential and Community".

Unilateral mastectomy as an alternative treatment for gangrenous mastitis in a Saanen goat

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Ahmet Sabuncu

2015-06-01

Full Text Available A four-year-old Saanen goat, weighing 52 kg, was referred to the Department of Obstetrics and Gynaecology clinic with black discoloration of the left mammary gland. The goat’s general condition was not good upon initial examination. The goat was anorexic, lethargic, and febrile (rectal temperature of 40 °C with a palpably cold left mammary gland on which there was an accumulation of pus. Somatic cell count (SCC was measured as 820,000/ml in the milk sample collected from the infected gland, and Staphylococcus aureus was isolated. Gangrenous mastitis was diagnosed on the left mammary gland of the goat based on the clinical findings. To treat the condition, a unilateral mastectomy was performed successfully. The goat was fully recovered a week after surgery. This case aimed to establish a surgical approach of unilateral mastectomy as a treatment option for goats with gangrenous mastitis while allowing the other mammary gland to continue lactation. Thus, it can be concluded that unilateral mastectomy is a viable alternative treatment of goats with gangrenous mastitis.

An alternative technique in the treatment of anterior cross bite in a case of Nickel allergy: a case report.

Science.gov (United States)

Giancotti, A; Mozzicato, P; Mampieri, G

2011-03-01

The objective of this paper is to show an alternative use of an Essix based appliance in the treatment of anterior single-tooth crossbite malocclusion in a patient with Nickel allergy. Anterior crossbite malocclusion of one or more teeth, without posterior crossbite association, is a relatively frequent condition both in the mixed and the permanent dentition. This kind of malocclusion is usually treated with either fixed or removable appliances. The use of preformed Essix appliances could be an alternative to traditional removable and fixed orthodontic devices in patients with Nickel allergy as well as in every patient. The treatment was successfully completed in 12 weeks, the anterior single tooth crossbite was corrected using three full arch Essix-based appliances planned on the set-up casting, providing a gradual vestibular movement. Patient compliance was requested in order to provide the planned dental movement. The Essix appliance can be successfully used to correct a single-tooth crossbite even in allergic subjects in a short time with patient cooperation.

Evolution of Alternative Adaptive Immune Systems in Vertebrates.

Science.gov (United States)

Boehm, Thomas; Hirano, Masayuki; Holland, Stephen J; Das, Sabyasachi; Schorpp, Michael; Cooper, Max D

2018-04-26

Adaptive immunity in jawless fishes is based on antigen recognition by three types of variable lymphocyte receptors (VLRs) composed of variable leucine-rich repeats, which are differentially expressed by two T-like lymphocyte lineages and one B-like lymphocyte lineage. The T-like cells express either VLRAs or VLRCs of yet undefined antigen specificity, whereas the VLRB antibodies secreted by B-like cells bind proteinaceous and carbohydrate antigens. The incomplete VLR germline genes are assembled into functional units by a gene conversion-like mechanism that employs flanking variable leucine-rich repeat sequences as templates in association with lineage-specific expression of cytidine deaminases. B-like cells develop in the hematopoietic typhlosole and kidneys, whereas T-like cells develop in the thymoid, a thymus-equivalent region at the gill fold tips. Thus, the dichotomy between T-like and B-like cells and the presence of dedicated lymphopoietic tissues emerge as ancestral vertebrate features, whereas the somatic diversification of structurally distinct antigen receptor genes evolved independently in jawless and jawed vertebrates.

Declining conventional cancer treatment and using complementary and alternative medicine: a problem or a challenge?

Science.gov (United States)

Verhoef, M J; Rose, M S; White, M; Balneaves, L G

2008-08-01

Several studies have shown that a small but significant percentage of cancer patients decline one or more conventional cancer treatments and use complementary and alternative medicine (CAM) instead. Here, drawing on the literature and on our own ongoing research, we describe why cancer patients decide to decline conventional cancer treatments, who those patients are, and the response by physicians to patients who make such decisions. Poor doctor-patient communication, the emotional impact of the cancer diagnosis, perceived severity of conventional treatment side effects, a high need for decision-making control, and strong beliefs in holistic healing appear to affect the decision by patients to decline some or all conventional cancer treatments. Many patients indicate that they value ongoing follow-up care from their oncologists provided that the oncologists respect their beliefs. Patients declining conventional treatments have a strong sense of internal control and prefer to make the final treatment decisions after considering the opinions of their doctors. Few studies have looked at the response by physicians to patients making such a decision. Where research has been done, it found that a tendency by doctors to dichotomize patient decisions as rational or irrational may interfere with the ability of the doctors to respond with sensitivity and understanding. Declining conventional treatment is not necessarily an indicator of distrust of the medical system, but rather a reflection of many personal factors. Accepting and respecting such decisions may be instrumental in "keeping the door open."

Investigation of alternative phosphating treatments for nickel and hexavalent chromium elimination

International Nuclear Information System (INIS)

Jazbinsek, Luiz Antonio Rossi

2014-01-01

obtained with passivation treatment in niobium containing solution could be considered as a promising alternative to replace passivation with hexavalent chromium ions. Despite of the promising results, adjustments in the baths to obtain stability are still needed and should guide the next steps of the subject of this research. (author)

Decision-level adaptation in motion perception.

Science.gov (United States)

Mather, George; Sharman, Rebecca J

2015-12-01

Prolonged exposure to visual stimuli causes a bias in observers' responses to subsequent stimuli. Such adaptation-induced biases are usually explained in terms of changes in the relative activity of sensory neurons in the visual system which respond selectively to the properties of visual stimuli. However, the bias could also be due to a shift in the observer's criterion for selecting one response rather than the alternative; adaptation at the decision level of processing rather than the sensory level. We investigated whether adaptation to implied motion is best attributed to sensory-level or decision-level bias. Three experiments sought to isolate decision factors by changing the nature of the participants' task while keeping the sensory stimulus unchanged. Results showed that adaptation-induced bias in reported stimulus direction only occurred when the participants' task involved a directional judgement, and disappeared when adaptation was measured using a non-directional task (reporting where motion was present in the display, regardless of its direction). We conclude that adaptation to implied motion is due to decision-level bias, and that a propensity towards such biases may be widespread in sensory decision-making.

Chemotherapy induces alternative transcription and splicing: Facts and hopes for cancer treatment.

Science.gov (United States)

Lambert, Charles A; Garbacki, Nancy; Colige, Alain C

2017-10-01

Alternative promoter usage, alternative splicing and alternative cleavage/polyadenylation (referred here as to alternative transcription and splicing) are main instruments to diversify the transcriptome from a limited set of genes. There is a good deal of evidence that chemotherapeutic drugs affect these processes, but the therapeutic incidence of these effects is poorly documented. The scope of this study is to review the impact of chemotherapy on alternative transcription and splicing and to discuss potential implications in cancer therapy. A literature survey identified >2200 events induced by chemotherapeutic drugs. The molecular pathways involved in these regulations are briefly discussed. The GO terms associated with the alternative transcripts are mainly related to cell cycle/division, mRNA processing, DNA repair, macromolecules catabolism and chromatin. A large fraction (43%) of transcripts are also related to the new hallmarks of cancer, mostly genetic instability and replicative immortality. Finally, we ask the question of the impact of alternative transcription and splicing on drug efficacy and of the possible curative benefit of combining chemotherapy and pharmaceutical regulation of this process. Copyright © 2017 Elsevier Ltd. All rights reserved.

Evaluating the cost-effectiveness of ecosystem-based adaptation: Kamiesberg wetlands case study

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David Black

2016-12-01

Full Text Available Ecosystem-based adaptation (EbA is increasingly being promoted as a cost-effective means of adaptation to climate change. However, in spite of considerable international press, there is still little evidence to substantiate this claim. This study proposes a method through which the cost-effectiveness of EbA strategies can be evaluated against alternative adaptation options, and contributes to South African literature on the subject. The potential cost-effectiveness of wetland restoration is assessed as a means of securing the carrying capacity of land for pastoralist communities of the Kamiesberg communal area in South Africa under projected future climate conditions. The conventional alternatives would be to respond to increasingly dry conditions by drilling boreholes and using supplemental feed for livestock. It was assumed that the EbA interventions would occur upfront, whereas the alternatives are more likely to be implemented in reaction to droughts over a longer time period. The study found the implementation of conventional alternatives to be more cost-effective than EbA as a means to sustaining livestock stocking rates, with EbA being twice as costly. However, this is framed from the perspective of those directly affected (the landowners, and does not include the benefits to broader society.

Adaptive filtering and change detection

CERN Document Server

Gustafsson, Fredrik

2003-01-01

Adaptive filtering is a classical branch of digital signal processing (DSP). Industrial interest in adaptive filtering grows continuously with the increase in computer performance that allows ever more conplex algorithms to be run in real-time. Change detection is a type of adaptive filtering for non-stationary signals and is also the basic tool in fault detection and diagnosis. Often considered as separate subjects Adaptive Filtering and Change Detection bridges a gap in the literature with a unified treatment of these areas, emphasizing that change detection is a natural extensi

Complementary and Alternative Medicine use: Influence of Patients’ Satisfaction with Medical Treatment among Breast Cancer Patients at Uganda Cancer Institute

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Frank Kiwanuka

2018-02-01

Full Text Available Introduction: Use of Complementary and alternative medicine (CAM is high among cancer patients especially breast cancer patients. This study sought to evaluate Complementary and alternative medicine use in breast cancer patients and how its use is influencedby patient’s satisfaction with conventional medical treatment among breast cancer patients attending Uganda Cancer Institute. Patients and Methods: A cross-sectional study design was used in this study. Participants who were diagnosed histologically with breast cancer at Uganda Cancer Institute took part in the study. A questionnaire was developed and used to interview the participants and medical records of the respondents were also reviewed. Results: A total of 235 participants completed the study. The prevalence of CAM use was 77%. CAM therapies used included herbal medicines, prayer for health, vitamins/minerals, native healers, Chinese medicines, massage, yoga, Ayurvedic medicine, Acupuncture, reflexolog, Support group attendance, meditation, Magnetic and Bio-fieldmanipulation. Satisfaction with medical treatment was significantlyassociated with CAM use. Patients who are not satisfiedwith medical treatment were more likely to use CAM. Conclusion: There is a high number of breast cancer patients using CAM, various categories of therapies are being used and patients’ satisfaction with medical treatment triggers off a patients decision to use CAM therapies.

Alternating ibuprofen and acetaminophen in the treatment of febrile children: a pilot study [ISRCTN30487061

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Sabra Ramzi

2006-03-01

Full Text Available Abstract Background Alternating ibuprofen and acetaminophen for the treatment of febrile children is a prevalent practice among physicians and parents, despite the lack of evidence on effectiveness or safety. This randomized, double-blind and placebo-controlled clinical trial aims at comparing the antipyretic effectiveness and safety of a single administration of alternating ibuprofen and acetaminophen doses to that of ibuprofen mono-therapy in febrile children. Methods Seventy febrile children were randomly allocated to receive either a single oral dose of 10 mg/kg ibuprofen and 15 mg/kg oral acetaminophen after 4 hours, or a similar dose of ibuprofen and placebo at 4 hours. Rectal temperature was measured at baseline, 4, 5, 6, 7 and 8 hours later. Endpoints included proportions of afebrile children at 6, 7 and 8 hours, maximum decline in temperature, time to recurrence of fever, and change in temperature from baseline at each time point. Intent-to-treat analysis was planned with statistical significance set at P Results A higher proportion of subjects in the intervention group (83.3% became afebrile at 6 hours than in the control group (57.6%; P = 0.018. This difference was accentuated at 7 and 8 hours (P Conclusion A single dose of alternating ibuprofen and acetaminophen appears to be a superior antipyretic regimen than ibuprofen mono-therapy. Further studies are needed to confirm these findings.

An alternative methodology for the mathematical treatment of GPS positioning

Directory of Open Access Journals (Sweden)

Aly M. El-naggar

2011-12-01

In this paper a simple alternative method is developed to solve the GPS navigation equations directly without linearization and iteration. A practical study was done to evaluate the new model. Performance analysis was conducted using data collected by Trimble 4000SSE dual frequency receiver. The results indicated that the alternative methodology is simple, fast, and accurate as compared to Taylor method.

Role of Alternative Therapies for Chronic Pain Syndromes.

Science.gov (United States)

Thomas, Donna-Ann; Maslin, Benjamin; Legler, Aron; Springer, Erin; Asgerally, Abbas; Vadivelu, Nalini

2016-05-01

There is increasing interest in the use of complimentary and alternative medicine (CAM) for the treatment of chronic pain. This review examines alternative and complimentary therapies, which can be incorporated as part of a biopsychosocial approach in the treatment of chronic pain syndromes. In the present investigation, literature from articles indexed on PubMed was evaluated including topics of alternative therapies, complimentary therapies, pain psychology, biofeedback therapy, physical exercise therapies, acupuncture, natural and herbal supplements, whole-body cryotherapy, and smartphone technologies in the treatment of chronic pain syndromes. This review highlights the key role of psychology in the treatment of chronic pain. Cognitive behavior therapy appears to be the most impactful while biofeedback therapy has also been shown to be effective for chronic pain. Exercise therapy has been shown to be effective in short-, intermediate-, and long-term pain states. When compared to that in sham controls, acupuncture has shown some benefit for neck pain immediately after the procedure and in the short term and improvement has also been demonstrated in the treatment of headaches. The role of smartphones and whole-body cryotherapy are new modalities and further studies are needed. Recent literature suggests that several alternate therapies could play a role in the treatment of chronic pain, supporting the biopsychosocial model in the treatment of pain states.

[HER2 gene amplification assay: is CISH an alternative to FISH?].

Science.gov (United States)

Denoux, Yves; Arnould, Laurent; Fiche, Maryse; Lannes, B; Couturier, Jérôme; Vincent-Salomon, Anne; Penault-Llorca, Frédérique; Antoine, M; Balaton, A; Baranzelli, M C; Becette, V; Bellocq, J P; Bibeau, F; Ettore, F; Fridman, V; Gnassia, J P; Jacquemier, J; MacGrogan, G; Mathieu, M C; Migeon, C; Rigaud, C; Roger, P; Sigal-Zafrani, B; Simony-Lafontaine, J; Trassard, M; Treilleux, I; Verriele, V; Voigt, J J

2003-12-01

The HER2 proto-oncogene encodes a transmembrane protein, which is considered to function as a growth factor receptor. Overexpression of this protein found by immunohistochemistry in about 20% of infiltrating breast carcinomas, has a predictive value of response to treatment by trastuzumab, an anti-HER2 humanized monoclonal antibody. Search for HER2 gene amplification is necessary to adapt the immunohistochemical technique quality and also in the cases of delicate analysis or weak overexpression. It is usually carried out by Fluorescence In Situ Hybridization (FISH). A more recent hybridization technique, named CISH because of its chromogenic revelation is an alternative method, which gives highly correlated results with FISH. We present details of this technique, which may be more familiar for the pathologists than FISH, because reading analysis is similar to that of immunohistochemical staining.

Augmentative and alternative communication in adolescents with severe intellectual disability: a clinical experience.

Science.gov (United States)

Uliano, D; Falciglia, G; Del Viscio, C; Picelli, A; Gandolfi, M; Passarella, A

2010-06-01

Augmentative and alternative communication devices proved to be effective in patients with severe intellectual disability to overcome their communication impairments. In order to give a contribution for design of augmentative and alternative communication systems that better meet the needs of beginning communicators we decided to report our clinical experience about using augmentative and alternative communication in adolescents with severe intellectual disability. Five patients who underwent a long time traditional speech rehabilitation program (at least 5 years) with scant improvements in linguistic function were recruited and evaluated by means of the Vineland Adaptive Behaviour Scale before and after a three years augmentative and alternative communication intervention carried out by a multidisciplinary team. After the rehabilitative intervention patients showed an improvement in communication, daily living skills and socialization as measured by the Vineland Adaptive Behaviour Scale. Augmentative and alternative communication is an effective rehabilitation approach to people with severe intellectual disability and impairments in linguistic expression. Moreover augmentative and alternative communication is a useful tool allowing these patients to increase their social participation also enhancing their self-esteem. Our clinical experience confirmed these topics also in adolescents who underwent a long time traditional speech rehabilitation program with scant improvements, providing practical information to clinicians.

A randomized controlled trial of culturally adapted motivational interviewing for Hispanic heavy drinkers: Theory of Adaptation and Study Protocol

Science.gov (United States)

Lee, Christina S.; Colby, Suzanne M.; Magill, Molly; Almeida, Joanna; Tavares, Tonya; Rohsenow, Damaris J.

2016-01-01

Background The NIH Strategic Plan prioritizes health disparities research for socially disadvantaged Hispanics, to reduce the disproportionate burden of alcohol-related negative consequences compared to other racial/ethnic groups. Cultural adaptation of evidence-based treatments, such as motivational interviewing (MI), can improve access and response to alcohol treatment. However, the lack of rigorous clinical trials designed to test the efficacy and theoretical underpinnings of cultural adaptation has made proof of concept difficult. Objective The CAMI2 (Culturally Adapted Motivational Interviewing) study design and its theoretical model, is described to illustrate how MI adapted to social and cultural factors (CAMI) can be discriminated against non-adapted MI. Methods and Design CAMI2, a large, 12 month randomized prospective trial, examines the efficacy of CAMI and MI among heavy drinking Hispanics recruited from the community (n=257). Outcomes are reductions in heavy drinking days (Time Line Follow-Back) and negative consequences of drinking among Hispanics (Drinkers Inventory of Consequences). A second aim examines perceived acculturation stress as a moderator of treatment outcomes in the CAMI condition. Summary The CAMI2 study design protocol is presented and the theory of adaptation is presented. Findings from the trial described may yield important recommendations on the science of cultural adaptation and improve MI dissemination to Hispanics with alcohol risk. PMID:27565832

[Adaptive optics for ophthalmology].

Science.gov (United States)

Saleh, M

2016-04-01

Adaptive optics is a technology enhancing the visual performance of an optical system by correcting its optical aberrations. Adaptive optics have already enabled several breakthroughs in the field of visual sciences, such as improvement of visual acuity in normal and diseased eyes beyond physiologic limits, and the correction of presbyopia. Adaptive optics technology also provides high-resolution, in vivo imaging of the retina that may eventually help to detect the onset of retinal conditions at an early stage and provide better assessment of treatment efficacy. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Applications of adaptive filters in active noise control

Science.gov (United States)

Darlington, Paul

The active reduction of acoustic noise is achieved by the addition of a cancelling acoustic signal to the unwanted sound. Successful definition of the cancelling signal amounts to a system identification problem. Recent advances in adaptive signal processing have allowed this problem to be tackled using adaptive filters, which offer significant advantages over conventional solutions. The extension of adaptive noise cancelling techniques, which were developed in the electrical signal conditioning context, to the control of acoustic systems is studied. An analysis is presented of the behavior of the Widrow-Hoff LMS adaptive noise canceller with a linear filter in its control loop. The active control of plane waves propagating axially in a hardwalled duct is used as a motivating model problem. The model problem also motivates the study of the effects of feedback around an LMS adaptive filter. An alternative stochastic gradient algorithm for controlling adaptive filters in the presence of feedback is presented.

Alternative Argets Within the Endocannabinoid System for Future Treatment of Gastrointestinal Diseases

Directory of Open Access Journals (Sweden)

Rudolf Schicho

2011-01-01

Full Text Available Many beneficial effects of herbal and synthetic cannabinoids on gut motility and inflammation have been demonstrated, suggesting a vast potential for these compounds in the treatment of gastrointestinal disorders. These effects are based on the so-called ‘endocannabinoid system’ (ECS, a cooperating network of molecules that regulate the metabolism of the body’s own and of exogenously administered cannabinoids. The ECS in the gastrointestinal tract quickly responds to homeostatic disturbances by de novo synthesis of its components to maintain homeostasis, thereby offering many potential targets for pharmacological intervention. Of major therapeutic interest are nonpsychoactive cannabinoids or compounds that do not directly target cannabinoid receptors but still possess cannabinoid-like properties. Drugs that inhibit endocannabinoid degradation and raise the level of endocannabinoids are becoming increasingly promising alternative therapeutic tools to manipulate the ECS.

Environmental impacts of climate change adaptation

Energy Technology Data Exchange (ETDEWEB)

Enríquez-de-Salamanca, Álvaro, E-mail: aenriquez@draba.org [Universidad Nacional de Educación a Distancia (UNED)/Draba Ingeniería y Consultoría Medioambiental, Cañada Nueva, 13, 28200 San Lorenzo de El Escorial (Spain); Díaz-Sierra, Rubén, E-mail: sierra@dfmf.uned.es [Departamento de Física Matemática y de Fluidos, Facultad de Ciencias, Universidad Nacional de Educación a Distancia (UNED), Paseo Senda del Rey, 9, 28040 Madrid (Spain); Martín-Aranda, Rosa M., E-mail: rmartin@ccia.uned.es [Departamento de Química Inorgánica y Química Técnica, Facultad de Ciencias, Universidad Nacional de Educación a Distancia (UNED), Paseo Senda del Rey, 9, 28040 Madrid (Spain); Santos, Maria J., E-mail: M.J.FerreiraDosSantos@uu.nl [Department of Innovation, Environmental and Energy Sciences, Utrecht University, Heidelberglaan 2, 3572 TC Utrecht (Netherlands)

2017-05-15

Climate change adaptation reduces adverse effects of climate change but may also have undesirable environmental impacts. However, these impacts are yet poorly defined and analysed in the existing literature. To complement this knowledge-gap, we reviewed the literature to unveil the relationship between climate change adaptation and environmental impact assessment, and the degree to which environmental impacts are included in climate change adaptation theory and practice. Our literature review showed that technical, social and economic perspectives on climate change adaptation receive much more attention than the environmental perspective. The scarce interest on the environmental impacts of adaptation may be attributed to (1) an excessive sectoral approach, with dominance of non-environmental perspectives, (2) greater interest in mitigation and direct climate change impacts rather than in adaptation impacts, (3) a tendency to consider adaptation as inherently good, and (4) subjective/preconceived notions on which measures are good or bad, without a comprehensive assessment. Environmental Assessment (EA) has a long established history as an effective tool to include environment into decision-making, although it does not yet guarantee a proper assessment of adaptation, because it is still possible to postpone or even circumvent the processes of assessing the impacts of climate adaptation. Our results suggest that there is a need to address adaptation proactively by including it in EA, to update current policy frameworks, and to demand robust and reliable evaluation of alternatives. Only through the full EA of adaptation measures can we improve our understanding of the primary and secondary impacts of adaptation to global environmental change. - Highlights: • Climate change adaptation may have undesirable environmental impacts. • The impacts of adaptation are yet poorly analysed in the literature. • There is an excessive sectoral approach to adaptation, mainly

Environmental impacts of climate change adaptation

International Nuclear Information System (INIS)

Enríquez-de-Salamanca, Álvaro; Díaz-Sierra, Rubén; Martín-Aranda, Rosa M.; Santos, Maria J.

2017-01-01

Climate change adaptation reduces adverse effects of climate change but may also have undesirable environmental impacts. However, these impacts are yet poorly defined and analysed in the existing literature. To complement this knowledge-gap, we reviewed the literature to unveil the relationship between climate change adaptation and environmental impact assessment, and the degree to which environmental impacts are included in climate change adaptation theory and practice. Our literature review showed that technical, social and economic perspectives on climate change adaptation receive much more attention than the environmental perspective. The scarce interest on the environmental impacts of adaptation may be attributed to (1) an excessive sectoral approach, with dominance of non-environmental perspectives, (2) greater interest in mitigation and direct climate change impacts rather than in adaptation impacts, (3) a tendency to consider adaptation as inherently good, and (4) subjective/preconceived notions on which measures are good or bad, without a comprehensive assessment. Environmental Assessment (EA) has a long established history as an effective tool to include environment into decision-making, although it does not yet guarantee a proper assessment of adaptation, because it is still possible to postpone or even circumvent the processes of assessing the impacts of climate adaptation. Our results suggest that there is a need to address adaptation proactively by including it in EA, to update current policy frameworks, and to demand robust and reliable evaluation of alternatives. Only through the full EA of adaptation measures can we improve our understanding of the primary and secondary impacts of adaptation to global environmental change. - Highlights: • Climate change adaptation may have undesirable environmental impacts. • The impacts of adaptation are yet poorly analysed in the literature. • There is an excessive sectoral approach to adaptation, mainly

Adapting CBT for traumatized refugees and ethnic minority patients: examples from culturally adapted CBT (CA-CBT).

Science.gov (United States)

Hinton, Devon E; Rivera, Edwin I; Hofmann, Stefan G; Barlow, David H; Otto, Michael W

2012-04-01

In this article, we illustrate how cognitive behavioral therapy (CBT) can be adapted for the treatment of PTSD among traumatized refugees and ethnic minority populations, providing examples from our treatment, culturally adapted CBT, or CA-CBT. CA-CBT has a unique approach to exposure (typical exposure is poorly tolerated in these groups), emphasizes the treatment of somatic sensations (a particularly salient part of the presentation of PTSD in these groups), and addresses comorbid anxiety disorders and anger. To accomplish these treatment goals, CA-CBT emphasizes emotion exposure and emotion regulation techniques such as meditation and aims to promote emotional and psychological flexibility. We describe 12 key aspects of adapting CA-CBT that make it a culturally sensitive treatment of traumatized refugee and ethnic minority populations. We discuss three models that guide our treatment and that can be used to design culturally sensitive treatments: (a) the panic attack-PTSD model to illustrate the many processes that generate PTSD in these populations, highlighting the role of arousal and somatic symptoms; (b) the arousal triad to demonstrate how somatic symptoms are produced and the importance of targeting comorbid anxiety conditions and psychopathological processes; and (c) the multisystem network (MSN) model of emotional state to reveal how some of our therapeutic techniques (e.g., body-focused techniques: bodily stretching paired with self-statements) bring about psychological flexibility and improvement.

Adaptation of oral medication in people institutionalized in nursing homes for whom medication is crushed: The ADECUA Study

Directory of Open Access Journals (Sweden)

Francisco Apolo Carvajal

2016-12-01

Full Text Available Purpose: To evaluate the effect of pharmacist interventions in the adaptation of pharmaceutical forms in elders institutionalized in nursing homes whose medicines are crushed, which may have a clinical relevance. Methods: Quasi-experimental, multicenter, transversal and prospective study carried out in 10 nursing homes. Subjects for whom drugs were being crushed were identified. Their treatments were reviewed in order to identify drugs that should not be crushed. In these cases, we proposed an alternative to the physician and we evaluated the degree of acceptance, its association to other variables and the pre-post adaptation index (tablets that can be crushed and capsules that can be opened/ total number of tablets and capsules before and after the intervention. Moreover, health professionals received a training course. Results: Medication was being crushed for 33% (618/1875 of residents (mean: 5 drugs susceptible of crushing. 220 pharmaceutical interventions were performed, mostly in extended release or gastro-resistant drugs (48% were accepted. Switch was the type of intervention more frequent (79%, mainly to Purpose: To evaluate the effect of pharmacist interventions in the adaptation of pharmaceutical forms in elders institutionalized in nursing homes whose medicines are crushed, which may have a clinical relevance. Methods: Quasi-experimental, multicenter, transversal and prospective study carried out in 10 nursing homes. Subjects for whom drugs were being crushed were identified. Their treatments were reviewed in order to identify drugs that should not be crushed. In these cases, we proposed an alternative to the physician and we evaluated the degree of acceptance, its association to other variables and the pre-post adaptation index (tablets that can be crushed and capsules that can be opened/ total number of tablets and capsules before and after the intervention. Moreover, health professionals received a training course. Results

Treatment Outcomes of Full Pulpotomy as an Alternative to Tooth Extraction in Molars with Hyperplastic/Irreversible Pulpitis: A Case Report

Science.gov (United States)

Asgary, Saeed; Verma, Prashant; Nosrat, Ali

2017-01-01

Root canal therapy (RCT) is a common and successful treatment for irreversible pulpitis due to carious pulp exposure in mature permanent teeth. However, it is often an expensive procedure, may require multiple appointments, and requires a high level of training and clinical skill, specifically in molars. Uninsured patients, low-income patients, and patients with limited access to specialist care often elect for extraction of restorable teeth with irreversible pulpitis. There is a need for an alternative affordable treatment option to preserve their teeth and maintain chewing function. A case of pulpotomy using calcium-enriched mixture (CEM) cement in two maxillary molars (#14 and 15) in a healthy 36-year-old patient is presented. Both teeth were diagnosed with symptomatic hyperplastic/irreversible pulpitis. Patient did not have dental insurance, was unable to afford RCT, and refused to extract the teeth. CEM pulpotomy and amalgam build-ups were done as an alternative to extraction. At 2-year recall, both teeth were functional with no signs/symptoms of inflammation/infection. Periapical radiographs and 3D images showed normal PDL around all roots. Pulpotomy with CEM biomaterial might be a viable alternative to tooth extraction for mature permanent teeth with hyperplastic/irreversible pulpitis, and can result in long-term tooth retention and improved oral health. PMID:28512498

Alternative additives; Alternative additiver

Energy Technology Data Exchange (ETDEWEB)

2007-08-15

In this project a number of industrial and agricultural waste products have been characterised and evaluated in terms of alkali-getter performance. The intended use is for biomass-fired power stations aiming at reducing corrosion or slagging related problems. The following products have been obtained, characterised and evaluated: 1) Brewery draff 2) Danish de-gassed manure 3) Paper sludge 4) Moulding sand 5) Spent bleaching earth 6) Anorthosite 7) Sand 8) Clay-sludge. Most of the above alternative additive candidates are deemed unsuitable due to insufficient chemical effect and/or expensive requirements for pre-treatment (such as drying and transportation). 3 products were selected for full-scale testing: de-gassed manure, spent bleaching earth and clay slugde. The full scale tests were undertaken at the biomass-fired power stations in Koege, Slagelse and Ensted. Spent bleaching earth (SBE) and clay sludge were the only tested additive candidates that had a proven ability to react with KCl, to thereby reduce Cl-concentrations in deposits, and reduce the deposit flux to superheater tubes. Their performance was shown to nearly as good as commercial additives. De-gassed manure, however, did not evaluate positively due to inhibiting effects of Ca in the manure. Furthermore, de-gassed manure has a high concentration of heavy metals, which imposes a financial burden with regard to proper disposal of the ash by-products. Clay-sludge is a wet clay slurring, and drying and transportation of this product entails substantial costs. Spent bleaching does not require much pre-treatment and is therefore the most promising alternative additive. On the other hand, bleaching earth contains residual plant oil which means that a range of legislation relating to waste combustion comes into play. Not least a waste combustion fee of 330 DKK/tonne. For all alternative (and commercial) additives disposal costs of the increase ash by-products represents a significant cost. This is

Alternating phase focussing including space charge

International Nuclear Information System (INIS)

Cheng, W.H.; Gluckstern, R.L.

1992-01-01

Longitudinal stability can be obtained in a non-relativistic drift tube accelerator by traversing each gap as the rf accelerating field rises. However, the rising accelerating field leads to a transverse defocusing force which is usually overcome by magnetic focussing inside the drift tubes. The radio frequency quadrupole is one way of providing simultaneous longitudinal and transverse focusing without the use of magnets. One can also avoid the use of magnets by traversing alternate gaps between drift tubes as the field is rising and falling, thus providing an alternation of focussing and defocusing forces in both the longitudinal and transverse directions. The stable longitudinal phase space area is quite small, but recent efforts suggest that alternating phase focussing (APF) may permit low velocity acceleration of currents in the 100-300 ma range. This paper presents a study of the parameter space and a test of crude analytic predictions by adapting the code PARMILA, which includes space charge, to APF. 6 refs., 3 figs

Host plant adaptation in Drosophila mettleri populations.

Directory of Open Access Journals (Sweden)

Sergio Castrezana

Full Text Available The process of local adaptation creates diversity among allopatric populations, and may eventually lead to speciation. Plant-feeding insect populations that specialize on different host species provide an excellent opportunity to evaluate the causes of ecological specialization and the subsequent consequences for diversity. In this study, we used geographically separated Drosophila mettleri populations that specialize on different host cacti to examine oviposition preference for and larval performance on an array of natural and non-natural hosts (eight total. We found evidence of local adaptation in performance on saguaro cactus (Carnegiea gigantea for populations that are typically associated with this host, and to chemically divergent prickly pear species (Opuntia spp. in a genetically isolated population on Santa Catalina Island. Moreover, each population exhibited reduced performance on the alternative host. This finding is consistent with trade-offs associated with adaptation to these chemically divergent hosts, although we also discuss alternative explanations for this pattern. For oviposition preference, Santa Catalina Island flies were more likely to oviposit on some prickly pear species, but all populations readily laid eggs on saguaro. Experiments with non-natural hosts suggest that factors such as ecological opportunity may play a more important role than host plant chemistry in explaining the lack of natural associations with some hosts.

The UASB reactor as an alternative for the septic tank for on-site sewage treatment.

Science.gov (United States)

Coelho, A L S S; do Nascimento, M B H; Cavalcanti, P F F; van Haandel, A C

2003-01-01

Although septic tanks are amply used for on site sewage treatment, these units have serious drawbacks: the removal efficiency of organic material and suspended solids is low, the units are costly and occupy a large area and operational cost is high due to the need for periodic desludging. In this paper an innovative variant of the UASB reactor is proposed as an alternative for the septic tank. This alternative has several important advantages in comparison with the conventional septic tank: (1) Although the volume of the UASB reactor was about 4 times smaller than the septic tank, its effluent quality was superior, even though small sludge particles were present, (2) desludging of the UASB reactor is unnecessary and even counterproductive, as the sludge mass guarantees proper performance, (3) the UASB reactor is easily transportable (compact and light) and therefore can be produced in series, strongly reducing construction costs and (4) since the concentration of colloids in the UASB effluent is much smaller than in the ST effluent, it is expected that the infiltration of the effluent will be much less problematic.

Mental disorders frequency alternative and complementary ...

African Journals Online (AJOL)

Objectives: Diabetes mellitus (DM) and hypertension (HT) are chronic disorders with which mental disorders may coexist and for which patients may resort to alternative medicine use. Alternative and complementary medicine is a treatment option that patients tend to use. This study is to determine the prevalence of mental ...

Automatic treatment plan re-optimization for adaptive radiotherapy guided with the initial plan DVHs

International Nuclear Information System (INIS)

Li, Nan; Zarepisheh, Masoud; Uribe-Sanchez, Andres; Moore, Kevin; Tian, Zhen; Zhen, Xin; Graves, Yan Jiang; Gautier, Quentin; Mell, Loren; Jia, Xun; Jiang, Steve; Zhou, Linghong

2013-01-01

Adaptive radiation therapy (ART) can reduce normal tissue toxicity and/or improve tumor control through treatment adaptations based on the current patient anatomy. Developing an efficient and effective re-planning algorithm is an important step toward the clinical realization of ART. For the re-planning process, manual trial-and-error approach to fine-tune planning parameters is time-consuming and is usually considered unpractical, especially for online ART. It is desirable to automate this step to yield a plan of acceptable quality with minimal interventions. In ART, prior information in the original plan is available, such as dose–volume histogram (DVH), which can be employed to facilitate the automatic re-planning process. The goal of this work is to develop an automatic re-planning algorithm to generate a plan with similar, or possibly better, DVH curves compared with the clinically delivered original plan. Specifically, our algorithm iterates the following two loops. An inner loop is the traditional fluence map optimization, in which we optimize a quadratic objective function penalizing the deviation of the dose received by each voxel from its prescribed or threshold dose with a set of fixed voxel weighting factors. In outer loop, the voxel weighting factors in the objective function are adjusted according to the deviation of the current DVH curves from those in the original plan. The process is repeated until the DVH curves are acceptable or maximum iteration step is reached. The whole algorithm is implemented on GPU for high efficiency. The feasibility of our algorithm has been demonstrated with three head-and-neck cancer IMRT cases, each having an initial planning CT scan and another treatment CT scan acquired in the middle of treatment course. Compared with the DVH curves in the original plan, the DVH curves in the resulting plan using our algorithm with 30 iterations are better for almost all structures. The re-optimization process takes about 30�

The Morphing Waldo: An Adaptive User Interface.

Science.gov (United States)

Howell, Colby Chambers

2001-01-01

Performance Centered Design (PCD) offers an alternative to the old methodology of software development. The author suggests one design possibility that could be used to create a more universally satisfying interface for existing applications, an adaptive mini-program that "sits" between the larger application and the user. Potential…

Degradation alternatives for a commercial fungicide in water: biological, photo-Fenton, and coupled biological photo-Fenton processes.

Science.gov (United States)

López-Loveira, Elsa; Ariganello, Federico; Medina, María Sara; Centrón, Daniela; Candal, Roberto; Curutchet, Gustavo

2017-11-01

Imazalil (IMZ) is a widely used fungicide for the post-harvest treatment of citrus, classified as "likely to be carcinogenic in humans" for EPA, that can be only partially removed by conventional biological treatment. Consequently, specific or combined processes should be applied to prevent its release to the environment. Biological treatment with adapted microorganism consortium, photo-Fenton, and coupled biological photo-Fenton processes were tested as alternatives for the purification of water containing high concentration of the fungicide and the coadjutants present in the commercial formulation. IMZ-resistant consortium with the capacity to degrade IMZ in the presence of a C-rich co-substrate was isolated from sludge coming from a fruit packaging company wastewater treatment plant. This consortium was adapted to resist and degrade the organics present in photo-Fenton-oxidized IMZ water solution. Bacteria colonies from the consortia were isolated and identified. The effect of H 2 O 2 initial concentration and dosage on IMZ degradation rate, average oxidation state (AOS), organic acid concentration, oxidation, and mineralization percentage after photo-Fenton process was determined. The application of biological treatment to the oxidized solutions notably decreased the total organic carbon (TOC) in solution. The effect of the oxidation degree, limited by H 2 O 2 concentration and dosage, on the percentage of mineralization obtained after the biological treatment was determined and explained in terms of changes in AOS. The concentration of H 2 O 2 necessary to eliminate IMZ by photo-Fenton and to reduce TOC and chemical oxygen demand (COD) by biological treatment, in order to allow the release of the effluents to rivers with different flows, was estimated.

Treatment of PVC using an alternative low energy ion bombardment procedure

Science.gov (United States)

Rangel, Elidiane C.; dos Santos, Nazir M.; Bortoleto, José Roberto R.; Durrant, Steven F.; Schreiner, Wido H.; Honda, Roberto Y.; Rangel, Rita de Cássia C.; Cruz, Nilson C.

2011-12-01

In many applications, polymers have progressively substituted traditional materials such as ceramics, glasses, and metals. Nevertheless, the use of polymeric materials is still limited by their surface properties. Frequently, selective modifications are necessary to suit the surface to a given application. Amongst the most common treatments, plasma immersion ion implantation (PIII) has attracted the attention of many researchers owing to its versatility and practicality. This method, however, requires a power supply to provide high voltage (tens of kV) negative pulses, with a controlled duty cycle, width and frequency. Owing to this, the implementation of PIII on the industrial scale can become economically inviable. In this work, an alternative plasma treatment that enables low energy ion bombardment without the need of a high voltage pulse generator is presented. To evaluate the efficiency of the treatment of polymers, polyvinylchloride, PVC, specimens were exposed to 5 Pa argon plasmas for 3600 s, at excitation powers, P, of between 10 and 125 W. Through contact angle and atomic force microscopy data, the influence of P on the wettability, surface free energy and roughness of the samples was studied. Surface chemical composition was measured by X-ray photoelectron spectroscopy, XPS. To evaluate the effect of aging under atmospheric conditions, contact angle and XPS measurements were performed one and 1334 days after the treatment. The plasma potential and ion density around the driven electrode were determined from Langmuir probe measurements while the self-bias potential was derived with the aid of an oscilloscope. From these data it was possible to estimate the mean energy of ions bombarding the PVC surface. Chlorine, carbon and oxygen contamination were detected on the surface of the as-received PVC. Upon exposure to the plasma, the proportion of chlorine was observed to decrease while that of oxygen increased. Consequently, the wettability and surface energy

Treatment of PVC using an alternative low energy ion bombardment procedure

International Nuclear Information System (INIS)

Rangel, Elidiane C.; Santos, Nazir M. dos; Bortoleto, José Roberto R.; Durrant, Steven F.; Schreiner, Wido H.; Honda, Roberto Y.; Cássia C Rangel, Rita de; Cruz, Nilson C.

2011-01-01

In many applications, polymers have progressively substituted traditional materials such as ceramics, glasses, and metals. Nevertheless, the use of polymeric materials is still limited by their surface properties. Frequently, selective modifications are necessary to suit the surface to a given application. Amongst the most common treatments, plasma immersion ion implantation (PIII) has attracted the attention of many researchers owing to its versatility and practicality. This method, however, requires a power supply to provide high voltage (tens of kV) negative pulses, with a controlled duty cycle, width and frequency. Owing to this, the implementation of PIII on the industrial scale can become economically inviable. In this work, an alternative plasma treatment that enables low energy ion bombardment without the need of a high voltage pulse generator is presented. To evaluate the efficiency of the treatment of polymers, polyvinylchloride, PVC, specimens were exposed to 5 Pa argon plasmas for 3600 s, at excitation powers, P, of between 10 and 125 W. Through contact angle and atomic force microscopy data, the influence of P on the wettability, surface free energy and roughness of the samples was studied. Surface chemical composition was measured by X-ray photoelectron spectroscopy, XPS. To evaluate the effect of aging under atmospheric conditions, contact angle and XPS measurements were performed one and 1334 days after the treatment. The plasma potential and ion density around the driven electrode were determined from Langmuir probe measurements while the self-bias potential was derived with the aid of an oscilloscope. From these data it was possible to estimate the mean energy of ions bombarding the PVC surface. Chlorine, carbon and oxygen contamination were detected on the surface of the as-received PVC. Upon exposure to the plasma, the proportion of chlorine was observed to decrease while that of oxygen increased. Consequently, the wettability and surface energy

Comparison of alternative flue gas dry treatment technologies in waste-to-energy processes.

Science.gov (United States)

Dal Pozzo, Alessandro; Antonioni, Giacomo; Guglielmi, Daniele; Stramigioli, Carlo; Cozzani, Valerio

2016-05-01

Acid gases such as HCl and SO2 are harmful both for human health and ecosystem integrity, hence their removal is a key step of the flue gas treatment of Waste-to-Energy (WtE) plants. Methods based on the injection of dry sorbents are among the Best Available Techniques for acid gas removal. In particular, systems based on double reaction and filtration stages represent nowadays an effective technology for emission control. The aim of the present study is the simulation of a reference two-stage (2S) dry treatment system performance and its comparison to three benchmarking alternatives based on single stage sodium bicarbonate injection. A modelling procedure was applied in order to identify the optimal operating configuration of the 2S system for different reference waste compositions, and to determine the total annual cost of operation. Taking into account both operating and capital costs, the 2S system appears the most cost-effective solution for medium to high chlorine content wastes. A Monte Carlo sensitivity analysis was carried out to assess the robustness of the results. Copyright © 2016. Published by Elsevier Ltd.

Treatment of Palm Oil Mill Effluent (POME) by Using Electrocoagulation as an Alternative Method

International Nuclear Information System (INIS)

Suzana Che Sayuti; Abdul Aziz Mohd Azoddein

2015-01-01

The treatment of palm oil mill effluent (POME) is a crucial stage to prevent from environmental pollution. An alternative method should be implemented to replace the conventional wastewater treatment method. Concentration required by the Department of Environment (DOE) is 200 mg/L for chemical oxygen demand (COD) and 100 mg/L for total suspended solid (TSS). Electrocoagulation was used to reduce the amount of COD and TSS in POME. The performance of COD and TSS removal using electrocoagulation was scrutinized. Electrocoagulation reactor was used and the optimum operating parameters were determined. The voltage parameter was manipulated in order to identify the effect on the removal efficiency of COD and TSS. The highest removal efficiency obtained were 95.71 % for COD and 99.25 % for TSS in which COD reduced from 4900 mg/L to 210 mg/L meanwhile TSS from 4000 mg/L to 30 mg/L. The final COD almost meets the requirement of DOE of 200 mg/L while TSS fulfil the requirement of 100 mg/L for standard B. The highest efficiency obtained at optimum pH 7.44, electrocoagulation time 25 min and voltage of 100 V by using aluminium electrodes. This method was found to be efficient and capable to reduce time of treatment compared to standard conventional method. (author)

The Chinese approach to complementary and alternative medicine treatment for interstitial cystitis/bladder pain syndrome.

Science.gov (United States)

Pang, Ran; Ali, Abdullah

2015-12-01

Management of interstitial cystitis/bladder pain syndrome (IC/BPS) remains a challenge due to poor understanding on its etiology. Complementary and alternative medicine (CAM), as an optional treatment, has been widely used, because no definitive conventional therapy is available. The different domain of CAM provides miscellaneous treatments for IC/BPS, which mainly include dietary modification, nutraceuticals, bladder training, biofeedback, yoga, massage, physical therapy, Qigong, traditional Chinese medicine and acupuncture. Clinical evidence has shown that each therapy can certainly benefit a portion of IC/BPS patients. However, the target patient group of each therapy has not been well studied and randomized, controlled trials are needed to further confirm the efficacy and reliability of CAM on managing IC/BPS. Despite these limitations, CAM therapeutic characteristics including non-invasive and effectiveness for specific patients allow clinicians and patients to realize multimodal and individualized therapy for IC/BPS.

Adaptation Decision Support: An Application of System Dynamics Modeling in Coastal Communities

Institute of Scientific and Technical Information of China (English)

Daniel Lane; Shima Beigzadeh; Richard Moll

2017-01-01

This research develops and applies a system dynamics (SD) model for the strategic evaluation of environmental adaptation options for coastal communities.The article defines and estimates asset-based measures for community vulnerability,resilience,and adaptive capacity with respect to the environmental,economic,social,and cultural pillars of the coastal community under threat.The SD model simulates the annual multidimensional dynamic impacts of severe coastal storms and storm surges on the community pillars under alternative adaptation strategies.The calculation of the quantitative measures provides valuable information for decision makers for evaluating the alternative strategies.The adaptation strategies are designed model results illustrated for the specific context of the coastal community of Charlottetown,Prince Edward Island,Canada.The dynamic trend of the measures and model sensitivity analyses for Charlottetown-facing increased frequency of severe storms,storm surges,and sea-level rise-provide impetus for enhanced community strategic planning for the changing coastal environment.This research is presented as part of the International Community-University Research Alliance C-Change project "Managing Adaptation to Environmental Change in Coastal Communities:Canada and the Caribbean" sponsored by the Social Science and Humanities Research Council of Canada and the International Development Resource Centre.

Adaptive ultrasound temperature imaging for monitoring radiofrequency ablation.

Directory of Open Access Journals (Sweden)

Yi-Da Liu

Full Text Available Radiofrequency ablation (RFA has been widely used as an alternative treatment modality for liver tumors. Monitoring the temperature distribution in the tissue during RFA is required to assess the thermal dosage. Ultrasound temperature imaging based on the detection of echo time shifts has received the most attention in the past decade. The coefficient k, connecting the temperature change and the echo time shift, is a medium-dependent parameter used to describe the confounding effects of changes in the speed of sound and thermal expansion as temperature increases. The current algorithm of temperature estimate based on echo time shift detection typically uses a constant k, resulting in estimation errors when ablation temperatures are higher than 50°C. This study proposes an adaptive-k algorithm that enables the automatic adjustment of the coefficient k during ultrasound temperature monitoring of RFA. To verify the proposed algorithm, RFA experiments on in vitro porcine liver samples (total n = 15 were performed using ablation powers of 10, 15, and 20 W. During RFA, a clinical ultrasound system equipped with a 7.5-MHz linear transducer was used to collect backscattered signals for ultrasound temperature imaging using the constant- and adaptive-k algorithms. Concurrently, an infrared imaging system and thermocouples were used to measure surface temperature distribution of the sample and internal ablation temperatures for comparisons with ultrasound estimates. Experimental results demonstrated that the proposed adaptive-k method improved the performance in visualizing the temperature distribution. In particular, the estimation errors were also reduced even when the temperature of the tissue is higher than 50°C. The proposed adaptive-k ultrasound temperature imaging strategy has potential to serve as a thermal dosage evaluation tool for monitoring high-temperature RFA.

Urinary phthalate and phthalate alternative metabolites and isoprostane among couples undergoing fertility treatment.

Science.gov (United States)

Wu, Haotian; Olmsted, Alexandra; Cantonwine, David E; Shahsavari, Shahin; Rahil, Tayyab; Sites, Cynthia; Pilsner, J Richard

2017-02-01

Epidemiological data suggest associations between phthalate exposures to a variety of adverse reproductive outcomes including reduced sperm quality and reproductive success. While mechanisms of these associations are not fully elucidated, oxidative stress has been implicated as a potential mediator. We examined associations of urinary metabolites of phthalates and phthalate alternative plasticizers with oxidative stress among couples seeking fertility treatment. Seventeen urinary plasticizer metabolites and 15-F2t isoprostane, a biomarker of oxidative stress, were quantified in spot samples from 50 couples seeking fertility treatment who enrolled in the Sperm Environmental Epigenetics and Development Study during 2014-2015. In multivariable analyses, percent change in isoprostane was positively associated with interquartile range increases for the oxidative metabolites of di-2-ethylhexyl phthalate, [mono-2-ethyl-5-hydroxyhexyl phthalate (MEHHP; 20.0%, p=0.02), mono-2-ethyl-5-oxohexyl phthalate (MEOHP; 24.1%, p=0.01), and mono-2-ethyl-5-carboxypentyl phthalate (MECPP; 24.1%, p=0.004)], mono-isobutyl phthalate (MiBP; 17.8%, p=0.02), mono-hydroxyisobutyl phthalate (MHiBP; 27.5%, p=0.003), and cyclohexane-1,2-dicarboxylic acid mono-hydroxy-isononyl ester (MHINCH; 32.3%, p=0.002). Stratification of participants by sex revealed that isoprostane was positively associated with MHiBP (41.4%, p=0.01) and monocarboxy-isononyl phthalate (MCNP; 26.0%, p=0.02) among females and MEOHP (35.8%, p=0.03), MiBP (29.2%, p=0.01), MHiBP (34.7%, p=0.007) and MHINCH (49.0%, p=0.002) among males. Our results suggest that exposure to phthalates and phthalate replacements are associated with higher levels of oxidative stress in a sex-specific manner. Additional studies are needed to replicate our findings and to examine the potential health implications of the use of phthalates and alternative phthalates in consumer end products. Copyright © 2016 Elsevier Inc. All rights reserved.

Alternative solutions for inhibiting Legionella in domestic hot water systems based on low-temperature district heating

DEFF Research Database (Denmark)

Yang, Xiaochen; Li, Hongwei; Svendsen, Svend

2015-01-01

Abstract District heating is a cost-effective way of providing heat to high heat density areas. Low-temperature district heating (LTDH) is a promising way to make district heating more energy-efficient and adaptable to well-insulated buildings with low heating demand in the future. However, one c...... systems. They have the additional benefit of reducing the heat loss of the hot water system. The alternative design solutions both enrich our options for water sanitation and improve the energy efficiency of our energy systems....... concern is the multiplication of Legionella due to insufficient temperature elevation with low-temperature supply. The aim of this study was to find optimal solutions to this dilemma for specific situations. The solutions were of two types: alternative system designs and various methods of sterilization...... methods, thermal treatment, ionization, chlorine, chlorine dioxide, ultraviolet light, photocatalysis and filtration are discussed as the most frequently used methods in hot water systems. The characteristics, efficacy and operation methods of LTDH using the solutions investigated are documented...

Engineering economics of alternative energy sources

International Nuclear Information System (INIS)

Denno, K.

1990-01-01

This textbook presents a comprehensive picture of the economic aspects, feasibility and adaptability of alternative energy sources and their interconnections. The author intends for this treatment of energy sources to be total and complete. It therefore includes such topics as low temperature and high temperature fuel cells, rechargeable storage batteries (including lead acid, nickel-cadmium, lithium, and sodium-sulfur), Redox flows cells energy system in compatibility with fuel cells and storage batteries, MHD energy systems using non-fossil renewable fuels, solar energy system using direct thermal units and photovoltaic generators, wind energy conversion systems, tidal ocean wave energy converters, geothermal energy, and ocean thermal energy conversion systems. The book is structured so that each major energy source is given one chapter. Each chapter begins with a discussion of the basic structural components of the energy source, as well as operational and fuel characteristics. This is followed by an economic analysis, which includes incremental energy cost curves and economic coordination equations for each possible system of operation. Where appropriate, economic scheduling of generation is applied to several modes of system consumption (e.g., localized dispersed systems, interconnected load centers, and central systems)

The population ecology of contemporary adaptations: what empirical studies reveal about the conditions that promote adaptive evolution.

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Reznick, D N; Ghalambor, C K

2001-01-01

Under what conditions might organisms be capable of rapid adaptive evolution? We reviewed published studies documenting contemporary adaptations in natural populations and looked for general patterns in the population ecological causes. We found that studies of contemporary adaptation fall into two general settings: (1) colonization of new environments that established newly adapted populations, and (2) local adaptations within the context of a heterogeneous environments and metapopulation structure. Local ecological processes associated with colonizations and introductions included exposure to: (1) a novel host or food resource; (2) a new biophysical environment; (3) a new predator community; and (4) a new coexisting competitor. The new environments that were colonized often had depauperate communities, sometimes because of anthropogenic disturbance. Local adaptation in heterogeneous environments was also often associated with recent anthropogenic changes, such as insecticide and herbicide resistance, or industrial melanism. A common feature of many examples is the combination of directional selection with at least a short-term opportunity for population growth. We suggest that such opportunities for population growth may be a key factor that promotes rapid evolution, since directional selection might otherwise be expected to cause population decline and create the potential for local extinction, which is an ever-present alternative to local adaptation. We also address the large discrepancy between the rate of evolution observed in contemporary studies and the apparent rate of evolution seen in the fossil record.

Alternative thermodynamic cycle for the Stirling machine

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Romanelli, Alejandro

2017-12-01

We develop an alternative thermodynamic cycle for the Stirling machine, where the polytropic process plays a central role. Analytical expressions for pressure and temperatures of the working gas are obtained as a function of the volume and the parameter that characterizes the polytropic process. This approach achieves closer agreement with the experimental pressure-volume diagram and can be adapted to any type of Stirling engine.

EFSA Panel on Biological Hazards (BIOHAZ); Scientific Opinion on the „Biomation‟ application for an alternative method for the treatment of animal-by-products

DEFF Research Database (Denmark)

Hald, Tine

A method alternative to the ones already approved in the current legislation, called ‘Biomation’ process, for the treatment of Category (Cat.) 2 and 3 Animal By-Products (ABP) was assessed. The process consists of an alkaline treatment. The target parameters are: particle size ≤ 5mm, temperature 70...

Complementary and alternative medicine for the treatment of bronchiolitis in infants: A systematic review.

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Kua, Kok Pim; Lee, Shaun Wen Huey

2017-01-01

Bronchiolitis is a common cause of hospitalization among infants. The limited effectiveness of conventional medication has prompted the use of complementary and alternative medicine (CAM) as alternative or adjunctive therapy for the management of bronchiolitis. To determine the effectiveness and safety of CAM for the treatment of bronchiolitis in infants aged less than 2 years. A systematic electronic search was performed in Medline, Embase, CINAHL, AMED, and Cochrane Central Register of Controlled Trials (CENTRAL) from their respective inception to June 30, 2016 for studies evaluating CAM as an intervention to treat bronchiolitis in infants (1 month to 2 years of age). The CAM could be any form of treatment defined by the National Center for Complementary and Integrative Health (NCCIH) and was utilized either as a single agent or adjunctive therapy. The predefined primary outcome was length of hospital stay. Secondary outcomes were time to resolution of bronchiolitis symptoms, adverse events, and all other clinical outcomes reported by the included studies. The review identified 11 studies (8 randomized controlled trials and 3 cohort studies) examining four herbal preparations and four supplements used either as adjunctive or alternative therapy for bronchiolitis in 904 infants. Most studies were of moderate quality. Among six studies reporting on length of stay, a significant benefit was found for Chinese herbal medicine compared to ribavirin in one cohort study (n = 66) and vitamin D compared to placebo in one randomized controlled trial (n = 89). Studies of Chinese herbal medicine (4 studies, n = 365), vitamin D (1 study, n = 89), N-acetylcysteine (1 study, n = 100), and magnesium (2 studies, n = 176) showed some benefits with respect to clinical severity scores, oxygen saturation, and other symptoms, although data were sparse for any single intervention and the outcomes assessed and reported varied across studies. Only five studies reported on adverse events

Optimal region of latching activity in an adaptive Potts model for networks of neurons

International Nuclear Information System (INIS)

Abdollah-nia, Mohammad-Farshad; Saeedghalati, Mohammadkarim; Abbassian, Abdolhossein

2012-01-01

In statistical mechanics, the Potts model is a model for interacting spins with more than two discrete states. Neural networks which exhibit features of learning and associative memory can also be modeled by a system of Potts spins. A spontaneous behavior of hopping from one discrete attractor state to another (referred to as latching) has been proposed to be associated with higher cognitive functions. Here we propose a model in which both the stochastic dynamics of Potts models and an adaptive potential function are present. A latching dynamics is observed in a limited region of the noise(temperature)–adaptation parameter space. We hence suggest noise as a fundamental factor in such alternations alongside adaptation. From a dynamical systems point of view, the noise–adaptation alternations may be the underlying mechanism for multi-stability in attractor-based models. An optimality criterion for realistic models is finally inferred

Group adaptation, formal darwinism and contextual analysis.

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Okasha, S; Paternotte, C

2012-06-01

We consider the question: under what circumstances can the concept of adaptation be applied to groups, rather than individuals? Gardner and Grafen (2009, J. Evol. Biol.22: 659-671) develop a novel approach to this question, building on Grafen's 'formal Darwinism' project, which defines adaptation in terms of links between evolutionary dynamics and optimization. They conclude that only clonal groups, and to a lesser extent groups in which reproductive competition is repressed, can be considered as adaptive units. We re-examine the conditions under which the selection-optimization links hold at the group level. We focus on an important distinction between two ways of understanding the links, which have different implications regarding group adaptationism. We show how the formal Darwinism approach can be reconciled with G.C. Williams' famous analysis of group adaptation, and we consider the relationships between group adaptation, the Price equation approach to multi-level selection, and the alternative approach based on contextual analysis. © 2012 The Authors. Journal of Evolutionary Biology © 2012 European Society For Evolutionary Biology.

Acid Water Neutralization Using Microbial Fuel Cells: An Alternative for Acid Mine Drainage Treatment

Directory of Open Access Journals (Sweden)

Eduardo Leiva

2016-11-01

Full Text Available Acid mine drainage (AMD is a complex environmental problem, which has adverse effects on surface and ground waters due to low pH, high toxic metals, and dissolved salts. New bioremediation approach based on microbial fuel cells (MFC can be a novel and sustainable alternative for AMD treatment. We studied the potential of MFC for acidic synthetic water treatment through pH neutralization in batch-mode and continuous-flow operation. We observed a marked pH increase, from ~3.7 to ~7.9 under batch conditions and to ~5.8 under continuous-flow operation. Likewise, batch reactors (non-MFC inoculated with different MFC-enriched biofilms showed a very similar pH increase, suggesting that the neutralization observed for batch operation was due to a synergistic influence of these communities. These preliminary results support the idea of using MFC technologies for AMD remediation, which could help to reduce costs associated with conventional technologies. Advances in this configuration could even be extrapolated to the recovery of heavy metals by precipitation or adsorption processes due to the acid neutralization.

Adaptive Noise Canceling Menggunakan Algoritma Least Mean Square (Lms)

OpenAIRE

Nardiana, Anita; Sumaryono, Sari Sujoko

2011-01-01

Noise is inevitable in communication system. In some cases, noise can disturb signal. It is veryannoying as the received signal is jumbled with the noise itself. To reduce or remove noise, filter lowpass,highpass or bandpass can solve the problems, but this method cannot reach a maximum standard. One ofthe alternatives to solve the problem is by using adaptive filter. Adaptive algorithm frequently used is LeastMean Square (LMS) Algorithm which is compatible to Finite Impulse Response (FIR). T...

Procedures for Selecting Items for Computerized Adaptive Tests.

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Kingsbury, G. Gage; Zara, Anthony R.

1989-01-01

Several classical approaches and alternative approaches to item selection for computerized adaptive testing (CAT) are reviewed and compared. The study also describes procedures for constrained CAT that may be added to classical item selection approaches to allow them to be used for applied testing. (TJH)

Provider and patient perspectives on opioids and alternative treatments for managing chronic pain: a qualitative study.

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Penney, Lauren S; Ritenbaugh, Cheryl; DeBar, Lynn L; Elder, Charles; Deyo, Richard A

2017-03-24

Current literature describes the limits and pitfalls of using opioid pharmacotherapy for chronic pain and the importance of identifying alternatives. The objective of this study was to identify the practical issues patients and providers face when accessing alternatives to opioids, and how multiple parties view these issues. Qualitative data were gathered to evaluate the outcomes of acupuncture and chiropractic (A/C) services for chronic musculoskeletal pain (CMP) using structured interview guides among patients with CMP (n = 90) and primary care providers (PCPs) (n = 25) purposively sampled from a managed care health care system as well as from contracted community A/C providers (n = 14). Focus groups and interviews were conducted patients with CMP with varying histories of A/C use. Plan PCPs and contracted A/C providers took part in individual interviews. All participants were asked about their experiences managing chronic pain and experience with and/or attitudes about A/C treatment. Audio recordings were transcribed and thematically coded. A summarized version of the focus group/interview guides is included in the Additional file 1. We identified four themes around opioid use: (1) attitudes toward use of opioids to manage chronic pain; (2) the limited alternative options for chronic pain management; (3) the potential of A/C care as a tool to help manage pain; and (4) the complex system around chronic pain management. Despite widespread dissatisfaction with opioid medications for pain management, many practical barriers challenged access to other options. Most of the participants' perceived A/C care as helpful for short term pain relief. We identified that problems with timing, expectations, and plan coverage limited A/C care potential for pain relief treatment. These results suggest that education about realistic expectations for chronic pain management and therapy options, as well as making A/C care more easily accessible, might lead to more

Economic analysis of alternative LLW disposal methods

International Nuclear Information System (INIS)

Foutes, C.E.

1987-01-01

The Environmental Protection Agency (EPA) has evaluated the costs and benefits of alternative disposal technologies as part of its program to develop generally applicable environmental standards for the land disposal of low-level radioactive waste (LLW). Costs, population health effects and Critical Population Group (CPG) exposures resulting from alternative waste treatment and disposal methods were developed and input into the analysis. The cost-effectiveness analysis took into account a number of waste streams, hydrogeologic and climatic region settings, and waste treatment and disposal methods. Total costs of each level of a standard included costs for packaging, processing, transportation, and burial of waste. Benefits are defined in terms of reductions in the general population health risk (expected fatal cancers and genetic effects) evaluated over 10,000 years. A cost-effectiveness ratio, was calculated for each alternative standard. This paper describes the alternatives considered and preliminary results of the cost-effectiveness analysis

Adaptive responses to cefotaxime treatment in ESBL-producing Escherichia coli and the possible use of significantly regulated pathways as novel secondary targets

DEFF Research Database (Denmark)

Møller, Thea S. B.; Rau, Martin Holm; Bonde, Charlotte S

2016-01-01

The aim of the study was to determine how ESBL-producing Escherichia coli change the expression of metabolic and biosynthesis genes when adapting to inhibitory concentrations of cefotaxime. Secondly, it was investigated whether significantly regulated pathways constitute putative secondary targets......-fold). Inhibition and/or mutations in other genes that were significantly regulated, belonging to energy synthesis, purine synthesis, proline uptake or potassium uptake, also rendered the resistant bacteria more susceptible to cefotaxime. The results show that ESBL-producing E. coli adapt to treatment...

Alternative futures for societal change: The Shared Socio-Economic Pathways (SSPs) (Invited)

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O'Neill, B. C.

2013-12-01

Deciding how best to respond to the challenge of climate change requires anticipating not only how climate might change in the future, but how society might change as well. Changes in population and economic growth, innovation, technological development, governance, culture, and lifestyle all will affect the energy use and land use that drive climate change, as well as society's capacity to reduce emissions or adapt to climate change impacts. Developing a set of alternative scenarios for societal development is one way to capture and explore the uncertainty in future conditions. The climate change research community has produced a new set of five such scenarios, called Shared Socio-Economic Pathways (SSPs), that is intended to underpin scientific studies, assessments, and policy dialogues for the next decade or more. The SSPs include both qualitative narratives and quantitative projections of key elements such as population, economic growth, urbanization, and educational attainment. They are designed to span a wide range of future conditions in terms of the challenges they present to both adaptation and mitigation. The SSPs are one component of a larger scenario framework which also includes a set of radiative forcing pathways and climate model simulations based on them. Alternative climate futures will be integrated with the alternative societal futures represented by the SSPs to investigate climate change impacts as well as mitigation and adaptation response options.

Adaptive Treatment Strategies in Youth Mental Health: A Commentary on Advantages, Challenges, and Potential Directions.

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Sherrill, Joel T

2016-01-01

This commentary underscores the importance and potential of the research approaches and intervention strategies described in the JCCAP special issue on the Science of Adaptive Treatment Strategies in Child and Adolescent Mental Health for addressing the widely observed heterogeneity in response to even our most promising research-informed interventions. First, the commentary briefly summarizes the advantages of these approaches and highlights how these programs of research are responsive to widely agreed-upon calls for more personalized, prescriptive interventions. Next, the commentary briefly discusses key common challenges and gaps in our knowledge that might be addressed to advance the development, testing, and implementation of adaptive intervention strategies. For example, research to identify robust moderators that might serve as potential tailoring variables for initial assignment and sequencing of interventions, efforts to operationalize surrogate endpoints for early identification of individuals who are unlikely to respond to first-line interventions, and research that helps define what constitutes an adequate exposure (i.e., dose) or response threshold (e.g., response that suggests the need to intensify, switch, or augment interventions) would inform decision rules for adaptive algorithms. The commentary concludes with a discussion of potential strategies and current initiatives that might ultimately help facilitate research on more targeted, prescriptive approaches to intervening, including efforts to encourage investigators to use common data elements, to share and integrate data across trials, and to employ a more mechanism-based approach to intervention development and testing.

Treatment of fibromyalgia syndrome: recommendations of recent evidence-based interdisciplinary guidelines with special emphasis on complementary and alternative therapies.

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Ablin, Jacob; Fitzcharles, Mary-Ann; Buskila, Dan; Shir, Yoram; Sommer, Claudia; Häuser, Winfried

2013-01-01

Objective. Current evidence indicates that there is no single ideal treatment for fibromyalgia syndrome (FMS). First choice treatment options remain debatable, especially concerning the importance of complementary and alternative medicine (CAM) treatments. Methods. Three evidence-based interdisciplinary guidelines on FMS in Canada, Germany, and Israel were compared for their first choice and CAM-recommendations. Results. All three guidelines emphasized a patient-tailored approach according to the key symptoms. Aerobic exercise, cognitive behavioral therapy, and multicomponent therapy were first choice treatments. The guidelines differed in the grade of recommendation for drug treatment. Anticonvulsants (gabapentin, pregabalin) and serotonin noradrenaline reuptake inhibitors (duloxetine, milnacipran) were strongly recommended by the Canadian and the Israeli guidelines. These drugs received only a weak recommendation by the German guideline. In consideration of CAM-treatments, acupuncture, hypnosis/guided imagery, and Tai Chi were recommended by the German and Israeli guidelines. The Canadian guidelines did not recommend any CAM therapy. Discussion. Recent evidence-based interdisciplinary guidelines concur on the importance of treatment tailored to the individual patient and further emphasize the need of self-management strategies (exercise, and psychological techniques).

Doctor-patient communication and cancer patients' choice of alternative therapies as supplement or alternative to conventional care.

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Salamonsen, Anita

2013-03-01

Cancer patients' use of complementary and alternative medicine (CAM) is widespread, despite the fact that clinical studies validating the efficacy of CAM remain sparse in the Nordic countries. The purpose of this study was to explore possible connections between cancer patients' communication experiences with doctors and the decision to use CAM as either supplement or alternative to conventional treatment (CT). The Regional Committee for Medical and Health Research Ethics and the Norwegian Data Inspectorate approved the study. From a group of 52 cancer patients with self-reported positive experiences from use of CAM, 13 were selected for qualitative interviews. Six used CAM as supplement, and seven as alternative to CT, periodically or permanently. Communication experiences with 46 doctors were described. The analysis revealed three connections between doctor-patient communication and patients' treatment decisions: (i) negative communication experiences because of the use of CAM; (ii) negative communication experiences resulted in the decision to use CAM, and in some cases to decline CT; and (iii) positive communication experiences led to the decision to use CAM as supplement, not alternative to CT. The patients, including the decliners of CT, wanted to discuss treatment decisions in well-functioning interpersonal processes with supportive doctors. In doctors' practices and education of doctors, a greater awareness of potential positive and negative outcomes of doctor-patient communication that concern CAM issues could be of importance. More research is needed to safeguard CAM users' treatment decisions and their relationship to conventional health care. © 2012 The Author. Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.

Direct restorative treatment of anterior weared teeth after re-establishment of occlusal vertical dimension: a case report.

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Humel, Maria M C; Takahashi, Jessica M F K; Paulillo, Luis A M S; Mesquita, Marcelo F; Martins, Luis R M

2012-12-01

The loss of posterior teeth resulting in a lack of stability may lead to excessive mandibular load on some points of occlusion of the remaining teeth, causing wear. The rehabilitation of these cases must be carefully planned and the treatment requires a period of adaptation with a new vertical dimension. This case report describes the treatment of a patient with a loss of almost all posterior inferior teeth and a consequential loss of occlusal vertical dimension and accentuated wear of anterior elements.   Provisional removable partial dentures were manufactured and the patient used them for a period of adaptation prior to restoration of the anterior teeth. After the patient's adaptation with the new occlusal dimension, anterior restorations were made using a mycrohibrid resin composite with different color aspects for an optimal stratification. The restorations achieved an aesthetic configuration with ideal function as the final result and the occlusion showed a satisfactory stability for a provisional removable partial dentures. This article presents an anterior direct rehabilitation approach not only as an alternative option, but also as viable and less expensive treatment option with an optimally aesthetic and functional result. © 2012 The Gerodontology Society and John Wiley & Sons A/S.

Development and Validation of the EXPECT Questionnaire: Assessing Patient Expectations of Outcomes of Complementary and Alternative Medicine Treatments for Chronic Pain.

Science.gov (United States)

Jones, Salene M W; Lange, Jane; Turner, Judith; Cherkin, Dan; Ritenbaugh, Cheryl; Hsu, Clarissa; Berthoud, Heidi; Sherman, Karen

2016-11-01

Patient expectations may be associated with outcomes of complementary and alternative medicine (CAM) treatments for chronic pain. However, a psychometrically sound measure of such expectations is needed. The purpose of this study was to develop and evaluate a questionnaire to assess individuals' expectations regarding outcomes of CAM treatments for chronic low back pain (CLBP), as well as a short form of the questionnaire. An 18-item draft questionnaire was developed through literature review, cognitive interviews with individuals with CLBP, CAM practitioners, and expert consultation. Two samples completed the questionnaire: (1) a community sample (n = 141) completed it via an online survey before or soon after starting a CAM treatment for CLBP, and (2) participants (n = 181) in randomized clinical trials evaluating CAM treatments for CLBP or fibromyalgia completed it prior to or shortly after starting treatment. Factor structure, internal consistency, test-retest reliability, and criterion validity were examined. Based on factor analyses, 10 items reflecting expectations (used to create a total score) and three items reflecting hopes (not scored) were selected for the questionnaire. The questionnaire had high internal consistency, moderate test-retest reliability, and moderate correlations with other measures of expectations. A three-item short form also had adequate reliability and validity. The Expectations for Complementary and Alternative Medicine Treatments (EXPECT) questionnaire can be used in research to assess individuals' expectations of treatments for chronic pain. It is recommended that the three hope questions are included (but not scored) to help respondents distinguish between hopes and expectations. The short form may be appropriate for clinical settings and when expectation measurement is not a primary focus.

Alternated prone and supine whole-breast irradiation using IMRT: setup precision, respiratory movement and treatment time.

Science.gov (United States)

Veldeman, Liv; De Gersem, Werner; Speleers, Bruno; Truyens, Bart; Van Greveling, Annick; Van den Broecke, Rudy; De Neve, Wilfried

2012-04-01

The objective of this study was to compare setup precision, respiration-related breast movement and treatment time between prone and supine positions for whole-breast irradiation. Ten patients with early-stage breast carcinoma after breast-conserving surgery were treated with prone and supine whole breast-irradiation in a daily alternating schedule. Setup precision was monitored using cone-beam computed tomography (CBCT) imaging. Respiration-related breast movement in the vertical direction was assessed by magnetic sensors. The time needed for patient setup and for the CBCT procedure, the beam time, and the length of the whole treatment slot were also recorded. Random and systematic errors were not significantly different between positions in individual patients for each of the three axes (left-right, longitudinal, and vertical). Respiration-related movement was smaller in prone position, but about 80% of observations showed amplitudes movement was smaller in prone position. The longer treatment slots in prone position can probably be attributed to the higher repositioning need. Copyright © 2012 Elsevier Inc. All rights reserved.

The rationality of intuition: Studying adaptive heuristics in project decision-making

DEFF Research Database (Denmark)

Stingl, Verena; Geraldi, Joana

This paper presents a research agenda for studying adaptive heuristics in project decision making. Project decisions are a potentially fruitful research field for adaptive heuristics. These decisions typically take place under time and information constraints, with high complexity and ambiguity...... - environments in which adaptive heuristics typically strive as effective decision tools. Yet, project decisions as a research topic introduce challenges that are currently not considered in the main body of adaptive heuristics research: the issue of group decision making, and the element of an unpredictable...... the limitations of these methods for project decision-making, and suggests alternative methodologies, suitable to cope with group decision-making and irreducible uncertainty....

Systematic review of complementary and alternative medicine treatments in inflammatory bowel diseases.

Science.gov (United States)

Langhorst, J; Wulfert, H; Lauche, R; Klose, P; Cramer, H; Dobos, G J; Korzenik, J

2015-01-01

We performed a systematic review for Complementary and Alternative Medicine [CAM] as defined by the National Institute of Health in Inflammatory Bowel Disease [IBD], ie Crohn's disease [CD] and ulcerative colitis [UC], with the exception of dietary and nutritional supplements, and manipulative therapies. A computerized search of databases [Cochrane Library, Pubmed/Medline, PsychINFO, and Scopus] through March 2014 was performed. We screened the reference sections of original studies and systematic reviews in English language for CAM in IBD, CD and UC. Randomized controlled trials [RCT] and controlled trials [CT] were referred and assessed using the Cochrane risk of bias tool. A total of: 26 RCT and 3 CT for herbal medicine, eg aloe-vera gel, andrographis paniculata, artemisia absinthium, barley foodstuff, boswellia serrata, cannabis, curcumin, evening primrose oil, Myrrhinil intest®, plantago ovata, silymarin, sophora, tormentil, wheatgrass-juice and wormwood; 1 RCT for trichuris suis ovata; 7 RCT for mind/body interventions such as lifestyle modification, hypnotherapy, relaxation training and mindfulness; and 2 RCT in acupuncture; were found. Risk of bias was quite heterogeneous. Best evidence was found for herbal therapy, ie plantago ovata and curcumin in UC maintenance therapy, wormwood in CD, mind/body therapy and self-intervention in UC, and acupuncture in UC and CD. Complementary and alternative therapies might be effective for the treatment of inflammatory bowel diseases; however, given the low number of trials and the heterogeneous methodological quality of trials, further in-depth research is necessary. Copyright © 2014 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Cortical microcircuit dynamics mediating Binocular Rivalry: The role of adaptation in inhibition

Directory of Open Access Journals (Sweden)

Panagiota eTheodoni

2011-11-01

Full Text Available Perceptual bistability arises when two conflicting interpretations of an ambiguous stimulus or images in binocular rivalry (BR compete for perceptual dominance. From a computational point of view competition models based on cross-inhibition and adaptation have shown that noise is a crucial force for rivalry and operates in balance with adaptation in order to explain the observed alternations in perception. In particular, noise-driven transitions and adaptation-driven oscillations define two dynamical regimes and the system operates near its boundary. In order to gain insights into the microcircuit dynamics mediating spontaneous perceptual alternations we used a reduced recurrent attractor-based biophysically realistic spiking network well known for working memory, attention and decision-making, where a spike-frequency adaptation mechanism is implemented to account for perceptual bistability. We, thus, derived a consistently reduced four-variable population rate model using mean-field techniques and tested it on BR data collected from human subjects. Our model accounts for experimental data parameters such as time dominance, coefficient of variation and gamma distribution. In addition, we show that our model also operates on the boundary between noise and adaptation and agrees with Levelt’s second revised and fourth propositions. These results show for the first time that a consistent reduction of a biophysically realistic spiking network of integrate and fire neurons with spike frequency adaptation could account for BR. Moreover, we demonstrate that BR can be explained only through the dynamics of the competing neuronal pools, without taking into account the adaptation of inhibitory interneurons..However, adaptation of interneurons affects the optimal parametric space of the system, by decreasing the overall adaptation necessary for the bifurcation to occur.

Erbium: alternative poison? stabilisation additive? what future?

International Nuclear Information System (INIS)

Porta, J.; Asou, M.

2001-01-01

Erbium was proposed as alternative poison to gadolinium at a very early stage. The potential interest of this poison compared to gadolinium is that it presents a relatively low ( 167 Er) absorption cross section in the thermal range and a non-negligible resonance integral that lead to a relatively slow consumption kinetic rather adapted to long or even very long cycles. The poisoning mode adapted to this poison, homogeneous in low concentration (< 3 %), does not downgrade the power distribution, on the one hand, as the absorption is low and spatially homogeneous, and the thermal conductivity, on the other hand, as the addition in the fuel oxide is in low quantity. A review of knowledge acquired as regards Er, from the 1960's to now, is presented. (authors)

Adaptive Subband Filtering Method for MEMS Accelerometer Noise Reduction

Directory of Open Access Journals (Sweden)

Piotr PIETRZAK

2008-12-01

Full Text Available Silicon microaccelerometers can be considered as an alternative to high-priced piezoelectric sensors. Unfortunately, relatively high noise floor of commercially available MEMS (Micro-Electro-Mechanical Systems sensors limits the possibility of their usage in condition monitoring systems of rotating machines. The solution of this problem is the method of signal filtering described in the paper. It is based on adaptive subband filtering employing Adaptive Line Enhancer. For filter weights adaptation, two novel algorithms have been developed. They are based on the NLMS algorithm. Both of them significantly simplify its software and hardware implementation and accelerate the adaptation process. The paper also presents the software (Matlab and hardware (FPGA implementation of the proposed noise filter. In addition, the results of the performed tests are reported. They confirm high efficiency of the solution.

Direct aperture optimization for online adaptive radiation therapy

International Nuclear Information System (INIS)

Mestrovic, Ante; Milette, Marie-Pierre; Nichol, Alan; Clark, Brenda G.; Otto, Karl

2007-01-01

This paper is the first investigation of using direct aperture optimization (DAO) for online adaptive radiation therapy (ART). A geometrical model representing the anatomy of a typical prostate case was created. To simulate interfractional deformations, four different anatomical deformations were created by systematically deforming the original anatomy by various amounts (0.25, 0.50, 0.75, and 1.00 cm). We describe a series of techniques where the original treatment plan was adapted in order to correct for the deterioration of dose distribution quality caused by the anatomical deformations. We found that the average time needed to adapt the original plan to arrive at a clinically acceptable plan is roughly half of the time needed for a complete plan regeneration, for all four anatomical deformations. Furthermore, through modification of the DAO algorithm the optimization search space was reduced and the plan adaptation was significantly accelerated. For the first anatomical deformation (0.25 cm), the plan adaptation was six times more efficient than the complete plan regeneration. For the 0.50 and 0.75 cm deformations, the optimization efficiency was increased by a factor of roughly 3 compared to the complete plan regeneration. However, for the anatomical deformation of 1.00 cm, the reduction of the optimization search space during plan adaptation did not result in any efficiency improvement over the original (nonmodified) plan adaptation. The anatomical deformation of 1.00 cm demonstrates the limit of this approach. We propose an innovative approach to online ART in which the plan adaptation and radiation delivery are merged together and performed concurrently--adaptive radiation delivery (ARD). A fundamental advantage of ARD is the fact that radiation delivery can start almost immediately after image acquisition and evaluation. Most of the original plan adaptation is done during the radiation delivery, so the time spent adapting the original plan does not

PSYCHOSOCIAL INTERVENTION EFFECTS ON ADAPTATION, DISEASE COURSE AND BIOBEHAVIORAL PROCESSES IN CANCER

OpenAIRE

Antoni, Michael H.

2012-01-01

A diagnosis of cancer and subsequent treatments place demands on psychological adaptation. Behavioral research suggests the importance of cognitive, behavioral, and social factors in facilitating adaptation during active treatment and throughout cancer survivorship, which forms the rationale for the use of many psychosocial interventions in cancer patients. This cancer experience may also affect physiological adaptation systems (e.g., neuroendocrine) in parallel with psychological adaptation ...

Designing adaptive intensive interventions using methods from engineering.

Science.gov (United States)

Lagoa, Constantino M; Bekiroglu, Korkut; Lanza, Stephanie T; Murphy, Susan A

2014-10-01

Adaptive intensive interventions are introduced, and new methods from the field of control engineering for use in their design are illustrated. A detailed step-by-step explanation of how control engineering methods can be used with intensive longitudinal data to design an adaptive intensive intervention is provided. The methods are evaluated via simulation. Simulation results illustrate how the designed adaptive intensive intervention can result in improved outcomes with less treatment by providing treatment only when it is needed. Furthermore, the methods are robust to model misspecification as well as the influence of unobserved causes. These new methods can be used to design adaptive interventions that are effective yet reduce participant burden. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Alternative pavement designs : Randolph park and ride.

Science.gov (United States)

2013-05-01

Previous research on alternative pavement type bidding has proven that various treatments : are unique in terms of constructability, material characteristics, and associated performance. : While some treatments may have higher initial costs, it is im...

Modeling economic implications of alternative treatment strategies for acute bacterial skin and skin structure infections.

Science.gov (United States)

Revankar, Nikhil; Ward, Alexandra J; Pelligra, Christopher G; Kongnakorn, Thitima; Fan, Weihong; LaPensee, Kenneth T

2014-10-01

The economic implications from the US Medicare perspective of adopting alternative treatment strategies for acute bacterial skin and skin structure infections (ABSSSIs) are substantial. The objective of this study is to describe a modeling framework that explores the impact of decisions related to both the location of care and switching to different antibiotics at discharge. A discrete event simulation (DES) was developed to model the treatment pathway of each patient through various locations (emergency department [ED], inpatient, and outpatient) and the treatments prescribed (empiric antibiotic, switching to a different antibiotic at discharge, or a second antibiotic). Costs are reported in 2012 USD. The mean number of days on antibiotic in a cohort assigned to a full course of vancomycin was 11.2 days, with 64% of the treatment course being administered in the outpatient setting. Mean total costs per patient were $8671, with inpatient care accounting for 58% of the costs accrued. The majority of outpatient costs were associated with parenteral administration rather than drug acquisition or monitoring. Scenarios modifying the treatment pathway to increase the proportion of patients receiving the first dose in the ED, and then managing them in the outpatient setting or prescribing an oral antibiotic at discharge to avoid the cost associated with administering parenteral therapy, therefore have a major impact and lower the typical cost per patient by 11-20%. Since vancomycin is commonly used as empiric therapy in clinical practice, based on these analyses, a shift in treatment practice could result in substantial savings from the Medicare perspective. The choice of antibiotic and location of care influence the costs and resource use associated with the management of ABSSSIs. The DES framework presented here can provide insight into the potential economic implications of decisions that modify the treatment pathway.

TU-H-CAMPUS-JeP3-01: Towards Robust Adaptive Radiation Therapy Strategies

International Nuclear Information System (INIS)

Boeck, M; Eriksson, K; Hardemark, B; Forsgren, A

2016-01-01

Purpose: To set up a framework combining robust treatment planning with adaptive reoptimization in order to maintain high treatment quality, to respond to interfractional variations and to identify those patients who will benefit the most from an adaptive fractionation schedule. Methods: We propose adaptive strategies based on stochastic minimax optimization for a series of simulated treatments on a one-dimensional patient phantom. The plan should be able to handle anticipated systematic and random errors and is applied during the first fractions. Information on the individual geometric variations is gathered at each fraction. At scheduled fractions, the impact of the measured errors on the delivered dose distribution is evaluated. For a patient that receives a dose that does not satisfy specified plan quality criteria, the plan is reoptimized based on these individual measurements using one of three different adaptive strategies. The reoptimized plan is then applied during future fractions until a new scheduled adaptation becomes necessary. In the first adaptive strategy the measured systematic and random error scenarios and their assigned probabilities are updated to guide the robust reoptimization. The focus of the second strategy lies on variation of the fraction of the worst scenarios taken into account during robust reoptimization. In the third strategy the uncertainty margins around the target are recalculated with the measured errors. Results: By studying the effect of the three adaptive strategies combined with various adaptation schedules on the same patient population, the group which benefits from adaptation is identified together with the most suitable strategy and schedule. Preliminary computational results indicate when and how best to adapt for the three different strategies. Conclusion: A workflow is presented that provides robust adaptation of the treatment plan throughout the course of treatment and useful measures to identify patients in need

An environmental LCA of alternative scenarios of urban sewage sludge treatment and disposal

Directory of Open Access Journals (Sweden)

Tarantini Mario

2007-01-01

Full Text Available The majority of pollutants that affect wastewater are concentrated by treatment processes in sludge; it is therefore critical to have a suitable evaluation methodology of sludge management options to analyze if pollution is redirected from water to other media, such as air and soil. Life cycle assessment is one of the most widely known and internationally accepted methodologies to compare environmental impacts of processes and systems and to evaluate their sustainability in the entire life cycle. In this study the methodology was applied to assess and compare three scenarios of urban sewage sludge treatment and disposal: sludge anaerobic digestion followed by dedicated incineration, sludge incineration without previous digestion, and sludge anaerobic digestion followed by composting. The potential benefits of spreading the compost to soil were not included in the system boundaries even if, due to its nutrients contents and soil improving features, compost could partially replace the use of commercial products. The study was aimed at finding out the environmental critical points of the treatment alternatives selected and at providing a technical and scientific contribution for further debates with national and local authorities on the environmental optimization of sewage sludge management. Life cycle assessment results confirmed the major contribution of electricity and methane consumption on several environmental impact categories. Incineration contributes more than sludge composting to almost all categories, although the heavy metals content of urban wastewater sludge raises substantial concerns when composted sludge is spread to soil. In this paper the models adopted, the hypotheses assumed and the main findings of the study are presented and discussed. .

SU-F-J-105: Towards a Novel Treatment Planning Pipeline Delivering Pareto- Optimal Plans While Enabling Inter- and Intrafraction Plan Adaptation

Energy Technology Data Exchange (ETDEWEB)

Kontaxis, C; Bol, G; Lagendijk, J; Raaymakers, B [University Medical Center Utrecht, Utrecht (Netherlands); Breedveld, S; Sharfo, A; Heijmen, B [Erasmus University Medical Center Rotterdam, Rotterdam (Netherlands)

2016-06-15

Purpose: To develop a new IMRT treatment planning methodology suitable for the new generation of MR-linear accelerator machines. The pipeline is able to deliver Pareto-optimal plans and can be utilized for conventional treatments as well as for inter- and intrafraction plan adaptation based on real-time MR-data. Methods: A Pareto-optimal plan is generated using the automated multicriterial optimization approach Erasmus-iCycle. The resulting dose distribution is used as input to the second part of the pipeline, an iterative process which generates deliverable segments that target the latest anatomical state and gradually converges to the prescribed dose. This process continues until a certain percentage of the dose has been delivered. Under a conventional treatment, a Segment Weight Optimization (SWO) is then performed to ensure convergence to the prescribed dose. In the case of inter- and intrafraction adaptation, post-processing steps like SWO cannot be employed due to the changing anatomy. This is instead addressed by transferring the missing/excess dose to the input of the subsequent fraction. In this work, the resulting plans were delivered on a Delta4 phantom as a final Quality Assurance test. Results: A conventional static SWO IMRT plan was generated for two prostate cases. The sequencer faithfully reproduced the input dose for all volumes of interest. For the two cases the mean relative dose difference of the PTV between the ideal input and sequenced dose was 0.1% and −0.02% respectively. Both plans were delivered on a Delta4 phantom and passed the clinical Quality Assurance procedures by achieving 100% pass rate at a 3%/3mm gamma analysis. Conclusion: We have developed a new sequencing methodology capable of online plan adaptation. In this work, we extended the pipeline to support Pareto-optimal input and clinically validated that it can accurately achieve these ideal distributions, while its flexible design enables inter- and intrafraction plan

SU-F-J-105: Towards a Novel Treatment Planning Pipeline Delivering Pareto- Optimal Plans While Enabling Inter- and Intrafraction Plan Adaptation

International Nuclear Information System (INIS)

Kontaxis, C; Bol, G; Lagendijk, J; Raaymakers, B; Breedveld, S; Sharfo, A; Heijmen, B

2016-01-01

Purpose: To develop a new IMRT treatment planning methodology suitable for the new generation of MR-linear accelerator machines. The pipeline is able to deliver Pareto-optimal plans and can be utilized for conventional treatments as well as for inter- and intrafraction plan adaptation based on real-time MR-data. Methods: A Pareto-optimal plan is generated using the automated multicriterial optimization approach Erasmus-iCycle. The resulting dose distribution is used as input to the second part of the pipeline, an iterative process which generates deliverable segments that target the latest anatomical state and gradually converges to the prescribed dose. This process continues until a certain percentage of the dose has been delivered. Under a conventional treatment, a Segment Weight Optimization (SWO) is then performed to ensure convergence to the prescribed dose. In the case of inter- and intrafraction adaptation, post-processing steps like SWO cannot be employed due to the changing anatomy. This is instead addressed by transferring the missing/excess dose to the input of the subsequent fraction. In this work, the resulting plans were delivered on a Delta4 phantom as a final Quality Assurance test. Results: A conventional static SWO IMRT plan was generated for two prostate cases. The sequencer faithfully reproduced the input dose for all volumes of interest. For the two cases the mean relative dose difference of the PTV between the ideal input and sequenced dose was 0.1% and −0.02% respectively. Both plans were delivered on a Delta4 phantom and passed the clinical Quality Assurance procedures by achieving 100% pass rate at a 3%/3mm gamma analysis. Conclusion: We have developed a new sequencing methodology capable of online plan adaptation. In this work, we extended the pipeline to support Pareto-optimal input and clinically validated that it can accurately achieve these ideal distributions, while its flexible design enables inter- and intrafraction plan

Use of complementary and alternative medicine by patients with arthritis.

Science.gov (United States)

Unsal, Ayla; Gözüm, Sebahat

2010-04-01

The aims of this study were to determine the prevalence of complementary and alternative medicine use in patients with arthritis, the types of complementary and alternative medicine used, pertinent socio-demographic factors associated with complementary and alternative medicine use and its perceived efficacy. Arthritis is a major health issue, and the use of complementary and alternative medicine among patients with arthritis is common. This is a descriptive cross-sectional study. Data were obtained from 250 patients with arthritis at the physiotherapy and immunology clinics Atatürk University Hospital in eastern Turkey between May-July 2005 using a questionnaire developed specifically for this study. The instrument included questions on socio-demographic information, disease specifics and complementary and alternative medicine usage. Seventy-six per cent of participants reported use of at least one form of complementary and alternative medicine in the previous year. Complementary and alternative medicine users and non-users were not significantly different in most socio-demographic characteristics including age, gender, marital status and education level with the exception of economic status. We categorised treatment into six complementary and alternative medicine categories: 62.6% of patients used thermal therapies; 41.5% used oral herbal therapies; 40.5% used hot therapies; 32.6% used externally applied (skin) therapies; 28.4% used massage and 12.6% used cold therapies. All forms of complementary and alternative medicine except thermal and oral herbal therapies were perceived as very effective by more than half of study participants. Complementary and alternative medicine therapy is widely used by patients with arthritis and has perceived beneficial effects. It is important for nurses and other health care professionals to be knowledgeable about the use of complementary and alternative medicine therapies when providing care to patients with arthritis because of

Pharmacological Alternatives for the Treatment of Neurodegenerative Disorders: Wasp and Bee Venoms and Their Components as New Neuroactive Tools

OpenAIRE

Silva, Juliana; Monge-Fuentes, Victoria; Gomes, Fl?via; Lopes, Kamila; dos Anjos, Lilian; Campos, Gabriel; Arenas, Claudia; Biolchi, Andr?ia; Gon?alves, Jacqueline; Galante, Priscilla; Campos, Leandro; Mortari, M?rcia

2015-01-01

Neurodegenerative diseases are relentlessly progressive, severely impacting affected patients, families and society as a whole. Increased life expectancy has made these diseases more common worldwide. Unfortunately, available drugs have insufficient therapeutic effects on many subtypes of these intractable diseases, and adverse effects hamper continued treatment. Wasp and bee venoms and their components are potential means of managing or reducing these effects and provide new alternatives for...

Prism adaptation for spatial neglect after stroke: translational practice gaps.

Science.gov (United States)

Barrett, A M; Goedert, Kelly M; Basso, Julia C

2012-10-01

Spatial neglect increases hospital morbidity and costs in around 50% of the 795,000 people per year in the USA who survive stroke, and an urgent need exists to reduce the care burden of this condition. However, effective acute treatment for neglect has been elusive. In this article, we review 48 studies of a treatment of intense neuroscience interest: prism adaptation training. Due to its effects on spatial motor 'aiming', prism adaptation training may act to reduce neglect-related disability. However, research failed, first, to suggest methods to identify the 50-75% of patients who respond to treatment; second, to measure short-term and long-term outcomes in both mechanism-specific and functionally valid ways; third, to confirm treatment utility during the critical first 8 weeks poststroke; and last, to base treatment protocols on systematic dose-response data. Thus, considerable investment in prism adaptation research has not yet touched the fundamentals needed for clinical implementation. We suggest improved standards and better spatial motor models for further research, so as to clarify when, how and for whom prism adaptation should be applied.

Adaptive aspirations : Performance consequences of risk preferences at extremes and alternative reference groups

NARCIS (Netherlands)

Hu, S.; Blettner, D.P.; Bettis, R.

2011-01-01

Goals or aspirations and their relationships to risk taking and performance are important issues in both psychology and strategic management. The concept of adaptive aspirations, as discussed in Cyert and March's Behavioral Theory of the Firm, has long been a topic of interest in both fields.

Efficacy of a multidisciplinary fibromyalgia treatment adapted for women with low educational levels: a randomized controlled trial.

Science.gov (United States)

Castel, Antoni; Fontova, Ramon; Montull, Salvador; Periñán, Rocío; Poveda, Maria José; Miralles, Iris; Cascón-Pereira, Rosalia; Hernández, Pilar; Aragonés, Natalia; Salvat, Isabel; Castro, Sonia; Monterde, Sonia; Padrol, Anna; Sala, José; Añez, Cristóbal; Rull, Maria

2013-03-01

Multidisciplinary treatments of fibromyalgia (FM) have demonstrated efficacy. Nevertheless, they have been criticized for not maintaining their benefits and for not being studied for specific populations. Our objectives were to determine the efficacy of a multidisciplinary treatment for FM adapted for patients with low educational levels and to determine the maintenance of its therapeutic benefits during a long-term followup period. Inclusion criteria consisted of female sex, a diagnosis of FM (using American College of Rheumatology criteria), age between 18 and 60 years, and between 3 and 8 years of schooling. Patients were randomly assigned to 1 of the 2 treatment conditions: conventional pharmacologic treatment or multidisciplinary treatment. Outcome measures were functionality, sleep disturbances, pain intensity, catastrophizing, and psychological distress. Analysis was by intent-to-treat and missing data were replaced following the baseline observation carried forward method. One hundred fifty-five participants were recruited. No statistically significant differences regarding pretreatment measures were found between the 2 experimental groups. Overall statistics comparison showed a significant difference between the 2 groups in all of the variables studied (P educational levels is effective in reducing key symptoms of FM. Some improvements were maintained 1 year after completing the multidisciplinary treatment. Copyright © 2013 by the American College of Rheumatology.

Feasibility, Safety, and Efficacy of an Alternative Schedule of Sunitinib for the Treatment of Patients with Metastatic Renal Cell Carcinoma: A Retrospective Study.

Science.gov (United States)

Buti, Sebastiano; Donini, Maddalena; Bersanelli, Melissa; Gattara, Alessia; Leonardi, Francesco; Passalacqua, Rodolfo

2017-12-01

Standard treatment with sunitinib for patients with metastatic renal cancer provides an 'on-off' schedule (daily administration of a 50-mg capsule for 4 weeks, followed by a 2-week break; consecutive 6-week cycles). We developed an alternative intermittent schedule to reduce the toxicity and symptoms of tumor regrowth during the rest period and to allow prolonged continuation of therapy, maintaining dose intensity. The objective of this study was to provide a retrospective evaluation of the feasibility, safety, and efficacy of an alternative schedule of sunitinib in patients who did not tolerate classical treatment. Patients treated with the classical schedule with at least grade 2 toxicity or recurrence of symptoms during the rest period were switched to an alternative schedule (the same daily dose 5 consecutive days per week for 5 weeks and then the same daily dose on days 1, 3, and 5 in the sixth week; consecutive 6-week cycles). Twenty-five patients were enrolled. The median time from sunitinib initiation to schedule switch was 2.9 months. After the switch, the median therapy duration was 9.2 months. Rate of delay, corrected by cycle number, was 10% for both schedules. After the switch, 48.7% of patients obtained a toxicity reduction (hypertension -82%, stomatitis -71%, cutaneous toxicity -69%). A reduction in 'on-off symptoms' (-86%) was achieved. Overall response rate was 40% and the disease control rate was 80%. Median progression-free survival was 16.4 months and median overall survival was 41.3 months. Despite the small sample size and retrospective nature, we demonstrated the feasibility, safety, and efficacy of the alternative schedule, allowing prolonged treatment and better quality of life.

Treatment of Fibromyalgia Syndrome: Recommendations of Recent Evidence-Based Interdisciplinary Guidelines with Special Emphasis on Complementary and Alternative Therapies

Directory of Open Access Journals (Sweden)

Jacob Ablin

2013-01-01

Full Text Available Objective. Current evidence indicates that there is no single ideal treatment for fibromyalgia syndrome (FMS. First choice treatment options remain debatable, especially concerning the importance of complementary and alternative medicine (CAM treatments. Methods. Three evidence-based interdisciplinary guidelines on FMS in Canada, Germany, and Israel were compared for their first choice and CAM-recommendations. Results. All three guidelines emphasized a patient-tailored approach according to the key symptoms. Aerobic exercise, cognitive behavioral therapy, and multicomponent therapy were first choice treatments. The guidelines differed in the grade of recommendation for drug treatment. Anticonvulsants (gabapentin, pregabalin and serotonin noradrenaline reuptake inhibitors (duloxetine, milnacipran were strongly recommended by the Canadian and the Israeli guidelines. These drugs received only a weak recommendation by the German guideline. In consideration of CAM-treatments, acupuncture, hypnosis/guided imagery, and Tai Chi were recommended by the German and Israeli guidelines. The Canadian guidelines did not recommend any CAM therapy. Discussion. Recent evidence-based interdisciplinary guidelines concur on the importance of treatment tailored to the individual patient and further emphasize the need of self-management strategies (exercise, and psychological techniques.

Adaptation to climate change in agriculture: evaluation of options

International Nuclear Information System (INIS)

Dolan, A.H.; Smit, B.; Skinner, M.W.; Bradshaw, B.; Bryant, C.R.

2001-01-01

Adaptation was defined as the responses by stakeholders to actual or expected climatic stimuli or their effects to reduce vulnerability to adverse impacts or damage potential, or to realize opportunities associated with climate change. Planned policy initiatives representing change in the agricultural system were discussed in this report. An evaluation of adaptation options needed to be carried out before one could determine which adaptations should be promoted or implemented. The overall merit, suitability, utility or appropriateness of potential adaptation strategies or measures were examined. One interesting methodology was the Multiple Criteria Evaluation (MCE), which is designed to assess alternatives using more than one criterion. The criteria selected for this evaluation were: effectiveness, economic efficiency, flexibility, institutional compatibility, farmer implementation, and independent benefits. A selection of three adaptation options was made to better illustrate the utility of the evaluation framework., as follows: crop diversification, adoption of irrigation, and increase use of crop insurance. 122 refs., 6 tabs., 6 figs

[Adaptation of the picture exchange communication system in a school context].

Science.gov (United States)

Almeida, Maria Amélia; Piza, Maria Helena Machado; Lamônica, Dionísa Aparecida Cusin

2005-01-01

Alternative communication. To evaluate the efficacy of the adapted Pecs and Picture Communication Symbols (PCS) in the communication of a child with cerebral palsy. The participant of this study was a 9 year and 10 months old girl, with athetoid quadriplegia. All stages of the adapted Pecs were applied (Walter, 2000), using the PCS pictures (Johnson, 1998), associated with the functional curriculum proposed by LeBlanc (1991). An experimental AB Design was used in order to test the procedures. The subject was able to pass through all of the adapted Pecs phases and to use her communication board in school activities. The adapted Pecs proved to be effective in improving the subject's communication abilities.

[COCONUT OIL: NON-ALTERNATIVE DRUG TREATMENT AGAINST ALZHEIMER´S DISEASE].

Science.gov (United States)

Hu Yang, Iván; De la Rubia Ortí, Jose Enrique; Selvi Sabater, Pablo; Sancho Castillo, Sandra; Rochina, Mariano Julián; Manresa Ramón, Noemí; Montoya-Castilla, Inmaculada

2015-12-01

Alzheimer's dementia is the most prevalent nowadays. As for treatment, there is no definitive cure drug, thus new therapies are needed. In this regard the medium chain triglycerides are a direct source of cellular energy and can be a nonpharmacological alternative to the neuronal death for lack of it, that occurs in Alzheimer patients. to evaluate the impact of coconut oil in the development of Alzheimer's dementia, in any degree of dementia. Also determine whether this improvement influences within variables such as sex and suffering or not Type II Diabetes Mellitus. a prospective study was conducted in patients with Alzheimer's dementia, with a control and an intervention group which was administered 40 ml/day of extra virgin coconut oil. The parameters evaluated were the mini test scores Lobo cognitive test, pre and post intervention in both groups. it was observed in subjects taking the product, a statistically significant increase in test score MECWOLF and therefore an improvement in cognitive status, improving especially women's, those without diabetes mellitus type II, and severe patients. this study, although preliminary, demonstrated the positive influence of coconut oil at the cognitive level of patients with Alzheimer's, this improvement being dependent on sex, presence or absence of diabetes and degree of dementia. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

[Bariatric and plastic surgery in obese adolescents: an alternative treatment].

Science.gov (United States)

Dubern, Béatrice; Tounian, Patrice

2014-06-01

The increased frequency of extreme forms of obesity in adolescents and the disappointing results of conventional treatments are now leading pediatricians to consider bariatric or cosmetic surgery as the only real long-term effective therapeutic alternative. The two main techniques currently used for bariatric surgery in adolescents are gastric bypass and adjustable gastric banding. Whatever the technique, weight loss is significant with improvement of comorbidities and quality of life. In addition, the complications are identical to those in adults and equally frequent. However, because of the particularities of this age, caution is still required. Adolescence is indeed characterized by specific nutritional needs, but also changes in body image in which surgery could have a negative effect. Currently, all obese teenagers making a request for bariatric surgery should have a comprehensive assessment with global care for at least 6 months. The indication is then discussed on a case-by-case basis by multidisciplinary teams and experts. To date, the type of surgery (gastric banding, gastric sleeve, or bypass) is still widely discussed. Based on experience with adults, we believe that gastric sleeve and bypass should be preferred. In addition, obesity in adolescents almost always involves psychosocial consequences, while somatic complications are rare. Thus, the care of adipo- or gynecomastia, abdominal fat excess, and concealed penis is essential and therefore justifies cosmetic surgery. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

New trends in the treatment of meat industry waste waters; Depuracion de aguas residuales de la industria carnica. Nueva tendencias

Energy Technology Data Exchange (ETDEWEB)

Diez, V.; Pozo, R. del [Universidad de Burgos. Burgos (Spain)

2000-07-01

In this work, several alternatives for the meat industry wastewater treatment are examined. It is also presented the way in which the new technologies are being applied to this sector, as well as the future tendencies in the development of treatment processes specially adapted for the meat industry. Authors expose which are the guidelines that, in their opinion, must rule the development of treatment systems based on the particular characteristics of this sector and the different troubles and limitations that came up when the new technologies have been applied to this kind of wastewater. (Author) 17 refs.

Treatment for chronic daily headache by using auxiliary and alternative methods

Directory of Open Access Journals (Sweden)

V. A. Golovacheva

2015-01-01

Full Text Available Chronic daily headache (CDH is one of the top 10 causes of adult disability and one of the 5 most common causes of female disability. To treat patients with CDH is one of the most difficult tasks in neurological practice. Difficulties in managing patients with CHD are associated with the high prevalence of comorbid mental disorders, analgesic abuse, pain syndromes at another site, and misconceptions of a patient about his/her disease. A combination of drug and non-drug therapies is the mainstay of the current approach to treating patients with CDH. Standard, alternative, and auxiliary therapies are identified. The paper describes different types of current auxiliary and alternative therapy used in the world’s leading headache centers and clinics. It describes experience with cerebrolysin used as auxiliary and alternative pharmacotherapies for CDH.

Soft systems thinking and social learning for adaptive management.

Science.gov (United States)

Cundill, G; Cumming, G S; Biggs, D; Fabricius, C

2012-02-01

The success of adaptive management in conservation has been questioned and the objective-based management paradigm on which it is based has been heavily criticized. Soft systems thinking and social-learning theory expose errors in the assumption that complex systems can be dispassionately managed by objective observers and highlight the fact that conservation is a social process in which objectives are contested and learning is context dependent. We used these insights to rethink adaptive management in a way that focuses on the social processes involved in management and decision making. Our approach to adaptive management is based on the following assumptions: action toward a common goal is an emergent property of complex social relationships; the introduction of new knowledge, alternative values, and new ways of understanding the world can become a stimulating force for learning, creativity, and change; learning is contextual and is fundamentally about practice; and defining the goal to be addressed is continuous and in principle never ends. We believe five key activities are crucial to defining the goal that is to be addressed in an adaptive-management context and to determining the objectives that are desirable and feasible to the participants: situate the problem in its social and ecological context; raise awareness about alternative views of a problem and encourage enquiry and deconstruction of frames of reference; undertake collaborative actions; and reflect on learning. ©2011 Society for Conservation Biology.

Adaptive fractionated stereotactic Gamma Knife radiotherapy of meningioma using integrated stereotactic cone-beam-CT and adaptive re-planning (a-gkFSRT)

International Nuclear Information System (INIS)

Stieler, F.; Wenz, F.; Abo-Madyan, Y.; Schweizer, B.; Polednik, M.; Herskind, C.; Giordano, F.A.; Mai, S.

2016-01-01

The Gamma Knife Icon (Elekta AB, Stockholm, Sweden) allows frameless stereotactic treatment using a combination of cone beam computer tomography (CBCT), a thermoplastic mask system, and an infrared-based high-definition motion management (HDMM) camera system for patient tracking during treatment. We report on the first patient with meningioma at the left petrous bone treated with adaptive fractionated stereotactic radiotherapy (a-gkFSRT). The first patient treated with Gamma Knife Icon at our institute received MR imaging for preplanning before treatment. For each treatment fraction, a daily CBCT was performed to verify the actual scull/tumor position. The system automatically adapted the planned shot positions to the daily position and recalculated the dose distribution (online adaptive planning). During treatment, the HDMM system recorded the intrafractional patient motion. Furthermore, the required times were recorded to define a clinical treatment slot. Total treatment time was around 20 min. Patient positioning needed 0.8 min, CBCT positioning plus acquisition 1.65 min, CT data processing and adaptive planning 2.66 min, and treatment 15.6 min. The differences for the five daily CBCTs compared to the reference are for rotation: -0.59 ± 0.49 /0.18 ± 0.20 /0.05 ± 0.36 and for translation: 0.94 ± 0.52 mm/-0.08 ± 0.08 mm/-1.13 ± 0.89 mm. Over all fractions, an intrafractional movement of 0.13 ± 0.04 mm was observed. The Gamma Knife Icon allows combining the accuracy of the stereotactic Gamma Knife system with the flexibility of fractionated treatment with the mask system and CBCT. Furthermore, the Icon system introduces a new online patient tracking system to the clinical routine. The interfractional accuracy of patient positioning was controlled with a thermoplastic mask and CBCT. (orig.) [de

An alternative surgical approach for the combined treatment of pectus excavatum and acute aortic dissection type-A in Marfan syndrome.

Science.gov (United States)

Schwill, Simon; Kallenbach, Klaus; Beller, Carsten J; Karck, Matthias

2011-04-01

Acute aortic dissection type-A (AADA) is a life-threatening condition especially in patients with Marfan syndrome (MFS) simultaneously suffering from severe pectus excavatum (PE). We report on emergency surgery for combined treatment of PE and AADA in a patient with MFS using an alternative approach. It leads to excellent exposure of the dislocated heart and great vessels enabling Bentall procedure followed by funnel chest repair with modified technique of Adkins and Blades. We achieved favorable functional and cosmetic results. Therefore, we conclude the surgical approach presented is feasible for standard treatment of AADA and consecutive repair of PE.

Methods used in adaptation of health-related guidelines: A systematic survey.

Science.gov (United States)

Abdul-Khalek, Rima A; Darzi, Andrea J; Godah, Mohammad W; Kilzar, Lama; Lakis, Chantal; Agarwal, Arnav; Abou-Jaoude, Elias; Meerpohl, Joerg J; Wiercioch, Wojtek; Santesso, Nancy; Brax, Hneine; Schünemann, Holger; Akl, Elie A

2017-12-01

Adaptation refers to the systematic approach for considering the endorsement or modification of recommendations produced in one setting for application in another as an alternative to de novo development. To describe and assess the methods used for adapting health-related guidelines published in peer-reviewed journals, and to assess the quality of the resulting adapted guidelines. We searched Medline and Embase up to June 2015. We assessed the method of adaptation, and the quality of included guidelines. Seventy-two papers were eligible. Most adapted guidelines and their source guidelines were published by professional societies (71% and 68% respectively), and in high-income countries (83% and 85% respectively). Of the 57 adapted guidelines that reported any detail about adaptation method, 34 (60%) did not use a published adaptation method. The number (and percentage) of adapted guidelines fulfilling each of the ADAPTE steps ranged between 2 (4%) and 57 (100%). The quality of adapted guidelines was highest for the "scope and purpose" domain and lowest for the "editorial independence" domain (respective mean percentages of the maximum possible scores were 93% and 43%). The mean score for "rigor of development" was 57%. Most adapted guidelines published in peer-reviewed journals do not report using a published adaptation method, and their adaptation quality was variable.

The effect of solution heat treatments on the microstructure and hardness of ZK60 magnesium alloys prepared under low-frequency alternating magnetic fields

International Nuclear Information System (INIS)

Li, Caixia; Yu, Yan Dong

2013-01-01

The solidified structure of ZK60 magnesium alloys in the presence and absence of electromagnetic stirring during the solidification process was compared, and the precipitates of ZK60 magnesium alloys were analyzed after a solution heat treatment using optical microscopy, micro-hardness analysis, X-ray diffraction and scanning electron microscopy. The results showed that the microstructure of cast alloys under a low-frequency alternating magnetic field (LFAMF) was mainly composed of a primary crystalline Mg matrix and a non-equilibrium eutectic structure (Mg+MgZn+MgZn 2 ). In comparison with the microstructure observed in the absence of the electromagnetic field, the eutectic network structure on the grain boundary under low-frequency alternating magnetic field was finer and exhibited a more uniform grain distribution. The grains under the LFAMF were refined in comparison with those under no electromagnetic field before the solution heat treatment, and the former grain distribution was more uniform than the latter after the solution heat treatment. The more uniform grain distribution is because the solution heat treatment is conducive to the dissolution of the second phase particles. The hardness exhibited a downward trend with increasing solution heat treatment time. Under the same solution heat treatment, the hardness value of the samples prepared under the LFAMF was lower than those prepared in the absence of the electromagnetic field. In contrast, the mechanical properties of alloys prepared under the LFAMF were better than those prepared in the absence of the electromagnetic field.

Parent-Child Relationships and Family Functioning of Children and Youth Discharged from Residential Mental Health Treatment or a Home-Based Alternative

Science.gov (United States)

Preyde, Michele; Cameron, Gary; Frensch, Karen; Adams, Gerald

2011-01-01

This report stems from a larger study on the outcomes of children and youth who accessed residential treatment or a home-based alternative. In this report an analysis of family descriptive information, the nature of family relationships, and indicators of family functioning for children and youth who have participated in children's mental health…

TiO{sub 2} nanotubes as alternative cathode in microbial fuel cells: Effect of annealing treatment on its performance

Energy Technology Data Exchange (ETDEWEB)

Yahia, S. Ait Ali, E-mail: aay-soraya@yahoo.fr [Department of Chemical and Environmental Engineering, Regional Campus of International Excellence of “Campus Mare Nostrum”, Polytechnic University of Cartagena, Campus La Muralla, E-30202 Cartagena, Murcia (Spain); Laboratory of Physics and Chemical Materials (L.P.C.M.), University Mouloud MAMMERI, Tizi-Ouzou 1500 (Algeria); Hamadou, L., E-mail: lamhama@yahoo.fr [Laboratory of Physics and Chemical Materials (L.P.C.M.), University Mouloud MAMMERI, Tizi-Ouzou 1500 (Algeria); Salar-García, M.J. [Department of Chemical and Environmental Engineering, Regional Campus of International Excellence of “Campus Mare Nostrum”, Polytechnic University of Cartagena, Campus La Muralla, E-30202 Cartagena, Murcia (Spain); Kadri, A. [Laboratory of Physics and Chemical Materials (L.P.C.M.), University Mouloud MAMMERI, Tizi-Ouzou 1500 (Algeria); Ortiz-Martínez, V.M.; Hernández-Fernández, F.J. [Department of Chemical and Environmental Engineering, Regional Campus of International Excellence of “Campus Mare Nostrum”, Polytechnic University of Cartagena, Campus La Muralla, E-30202 Cartagena, Murcia (Spain); Pérez de los Rios, A. [Chemical Engineering Department, University of Murcia, Campus de Espinardo, E-30071 Murcia (Spain); Benbrahim, N. [Laboratory of Physics and Chemical Materials (L.P.C.M.), University Mouloud MAMMERI, Tizi-Ouzou 1500 (Algeria)

2016-11-30

Highlights: • An alternative cathode using TiO{sub 2} nanotubes. • Determination of the structural, morphological and electronic characteristics of the cathode. • Effect of crystalline structure on MFCs performances. - Abstract: In the present work, amorphous and crystalline TiO{sub 2} nanotubes (TiNT) were fabricated via anodization and characterized as an alternative cathode for Microbial Fuel Cells (MFCs). The morphology of TiNT is characterized by scanning electron microscopy (SEM). The crystalline structure and chemical composition are examined by X-ray diffraction (XRD) and Energy dispersive X-ray spectroscopy (EDX). The electrical conductivity characteristics were examined by electrochemical impedance spectroscopy (EIS). MFCs based on the alternative cathodes were evaluated in terms of energy generation and wastewater treatment. The performances of the as-anodized nanotubes and TiNT annealed at 450 °C and at 550 °C were investigated in double-chamber MFCs with carbon rod and graphite granules as anode and polymer inclusion membrane based on ionic liquid as separator. Industrial wastewater was the source of carbon and inoculum for the experiments. The as grown amorphous nanotubes exhibited the best output power density of 15.16 mWm{sup −2}. The results reported here indicate that the specific surface area and the oxygen vacancies of the TiNT cathode can influence the MFCs performance together, because both factors play crucial role in the oxygen reduction reaction (ORR). As-anodized TiNT, due to its higher specific surface provide more active sites for electrode reactions. The final oxygen demand (COD) for all systems achieved a COD removal within the interval 54–71% after 10 days. This approved the suitability of MFCs for wastewater treatment.

Alternatives to lithium and divalproex in the maintenance treatment of bipolar disorder.

Science.gov (United States)

Gnanadesikan, Mukund; Freeman, Marlene P; Gelenberg, Alan J

2003-06-01

The role of lithium carbonate in the maintenance treatment of bipolar disorder is well established. Unfortunately, many patients fail to respond adequately to this agent or are unable to tolerate its adverse effects. Divalproex has become a commonly used alternative to lithium, but it also is ineffective or poorly tolerated in many patients. This article attempts to review the available data on maintenance therapy in bipolar disorder with a variety of anticonvulsants and antipsychotics (both conventional and novel), with reference to relevant studies in acute mania and bipolar depression as well. Evidence on maintenance therapy and relevant acute-phase data were collected using MEDLINE database searches. Data on maintenance therapy with agents other than lithium and divalproex are sparse, and often derived from open, uncontrolled studies. Implications and flaws of available data are discussed. Other than lithium, there are few robust double-blind data to support the use of a variety of agents in the maintenance phase. However, uncontrolled data suggest that a number of agents merit further study.

Economic analysis of alternative LLW disposal methods

International Nuclear Information System (INIS)

Foutes, C.E.; Queenan, C.J. III

1987-01-01

The Environmental Protection Agency (EPA) has evaluated the costs and benefits of alternative disposal technologies as part of its program to develop generally applicable environmental standards for the land disposal of low-level radioactive waste (LLW). Costs, population health effects and Critical Population Group (CPG) exposures resulting from alternative waste treatment and disposal methods were evaluated both in absolute terms and also relative to a base case (current practice). Incremental costs of the standard included costs for packaging, processing, transportation, and burial of waste. Benefits are defined in terms of reductions in the general population health risk (expected fatal cancers and genetic effects) evaluated over 10,000 years. A cost-effectiveness ratio, defined as the incremental cost per avoided health effect, was calculated for each alternative standard. The cost-effectiveness analysis took into account a number of waste streams, hydrogeologic and climatic region settings, and waste treatment and disposal methods. This paper describes the alternatives considered and preliminary results of the cost-effectiveness analysis. 15 references, 7 figures, 3 tables

Cultural adaptation and validation of a peninsular Spanish version of the MSTCQ© (Multiple Sclerosis Treatment Concerns Questionnaire).

Science.gov (United States)

Muntéis Olivas, E; Navarro Mascarell, G; Meca Lallana, J; Maestre Martínez, A; Pérez Sempere, Á; Gracia Gil, J; Pato Pato, A

Although subcutaneous treatments for multiple sclerosis (MS) have been shown to be effective, adverse reactions and pain may adversely affect treatment satisfaction and adherence. This study presents an adapted and validated Spanish version of the Multiple Sclerosis Treatment Concerns Questionnaire © (MSTCQ), which evaluates satisfaction with the injection device (ID) across 4 domains: injection system (A), side effects (B) (flu-like symptoms, reactions, and satisfaction), experience with treatment (C) and benefits (D). Two study phases: 1) Cultural adaptation process with input from experts (n=6) and patients (n=30). 2) Validation obtained by means of an observational, cross-sectional, multi-centre study evaluating 143 adult MS patients using an ID. Tools employed: MSTCQ © , Patient-Reported Indices for Multiple Sclerosis (PRIMUS © ), and Treatment Satisfaction Questionnaire for Medication (TSQM © ). Psychometric properties: Feasibility (percentage of valid cases and floor/ceiling effects); Reliability (Cronbach α) and test-retest correlation (n=41, intraclass correlation coefficient, ICC); and construct validity (factor analysis of domains A and B) and convergent validity (Spearman rank-order correlation for MSTCQ © vs TSQM © ). Mean age (SD) was 41.94 (10.47) years, 63% of the group were women, and 88.11% presented relapsing-remitting MS. Mean (SD) EDSS score was 2.68 (1.82) points. MSTCQ © completion was high (0%-2.80% missing data). Internal consistency was high at α=0.89 for the total score (A+B) and α=0.76, 0.89, and 0.92 for domains A, B, and C, respectively. The version demonstrated excellent test-retest reliability for the total (ICC=0.98) and for domains A, B, and C: ICC=0.82, 0.97, and 0.89, respectively. Factor analysis corroborated the internal structure of the original questionnaire. The association between total and domain scores on both the MSTCQ © and the TSQM © was moderately strong (Rho=0.42-0.74) and significant (P<.05 and P<.01

CMOS continuous-time adaptive equalizers for high-speed serial links

CERN Document Server

Gimeno Gasca, Cecilia; Aldea Chagoyen, Concepción

2015-01-01

This book introduces readers to the design of adaptive equalization solutions integrated in standard CMOS technology for high-speed serial links. Since continuous-time equalizers offer various advantages as an alternative to discrete-time equalizers at multi-gigabit rates, this book provides a detailed description of continuous-time adaptive equalizers design - both at transistor and system levels-, their main characteristics and performances. The authors begin with a complete review and analysis of the state of the art of equalizers for wireline applications, describing why they are necessary, their types, and their main applications. Next, theoretical fundamentals of continuous-time adaptive equalizers are explored. Then, new structures are proposed to implement the different building blocks of the adaptive equalizer: line equalizer, loop-filters, power comparator, etc.  The authors demonstrate the design of a complete low-power, low-voltage, high-speed, continuous-time adaptive equalizer. Finally, a cost-...

Critical concepts in adaptive clinical trials

Directory of Open Access Journals (Sweden)

Park JJH

2018-03-01

Full Text Available Jay JH Park,1 Kristian Thorlund,2,3 Edward J Mills2,3 1Department of Medicine, University of British Columbia, Vancouver, BC, Canada; 2Department of Health Research Methods, Evidence, and Impact (HEI, McMaster University, Hamilton, ON, Canada; 3The Bill and Melinda Gates Foundation, Seattle, WA, USA Abstract: Adaptive clinical trials are an innovative trial design aimed at reducing resources, decreasing time to completion and number of patients exposed to inferior interventions, and improving the likelihood of detecting treatment effects. The last decade has seen an increasing use of adaptive designs, particularly in drug development. They frequently differ importantly from conventional clinical trials as they allow modifications to key trial design components during the trial, as data is being collected, using preplanned decision rules. Adaptive designs have increased likelihood of complexity and also potential bias, so it is important to understand the common types of adaptive designs. Many clinicians and investigators may be unfamiliar with the design considerations for adaptive designs. Given their complexities, adaptive trials require an understanding of design features and sources of bias. Herein, we introduce some common adaptive design elements and biases and specifically address response adaptive randomization, sample size reassessment, Bayesian methods for adaptive trials, seamless trials, and adaptive enrichment using real examples. Keywords: adaptive designs, response adaptive randomization, sample size reassessment, Bayesian adaptive trials, seamless trials, adaptive enrichment

Very-long-term and short-term chromatic adaptation: are their influences cumulative?

Science.gov (United States)

Belmore, Suzanne C; Shevell, Steven K

2011-02-09

Very-long-term (VLT) chromatic adaptation results from exposure to an altered chromatic environment for days or weeks. Color shifts from VLT adaptation are observed hours or days after leaving the altered environment. Short-term chromatic adaptation, on the other hand, results from exposure for a few minutes or less, with color shifts measured within seconds or a few minutes after the adapting light is extinguished; recovery to the pre-adapted state is complete in less than an hour. Here, both types of adaptation were combined. All adaptation was to reddish-appearing long-wavelength light. Shifts in unique yellow were measured following adaptation. Previous studies demonstrate shifts in unique yellow due to VLT chromatic adaptation, but shifts from short-term chromatic adaptation to comparable adapting light can be far greater than from VLT adaptation. The question considered here is whether the color shifts from VLT adaptation are cumulative with large shifts from short-term adaptation or, alternatively, does simultaneous short-term adaptation eliminate color shifts caused by VLT adaptation. The results show the color shifts from VLT and short-term adaptation together are cumulative, which indicates that both short-term and very-long-term chromatic adaptation affect color perception during natural viewing. Copyright © 2010 Elsevier Ltd. All rights reserved.

The use of a Leksell-BRW adapter for linac radiosurgery as an adjunct to Gamma Knife treatment

International Nuclear Information System (INIS)

Ekstrand, Kenneth E; Hinson, William H; Bourland, J Daniel; Guzman, Allan F de; Stieber, Volker W; Tatter, Steven B; Ellis, Thomas L

2003-01-01

We have investigated the use of an adapter that permits the use of a Leksell coordinate frame with a linear accelerator stereotactic radiosurgery system based on the Brown-Robert-Wells (BRW) design. This device is useful when lesions that are planned for treatment on a Leksell Gamma Knife system are found to be inaccessible to the Gamma Knife. We have found that with this device objects within a head phantom can be targeted by the linear accelerator within an accuracy of approximately 1 mm

Radiation treatment for the right naris in a pediatric anesthesia patient using an adaptive oral airway technique

Energy Technology Data Exchange (ETDEWEB)

Sponseller, Patricia, E-mail: sponselp@uw.edu; Pelly, Nicole; Trister, Andrew; Ford, Eric; Ermoian, Ralph

2015-10-01

Radiation therapy for pediatric patients often includes the use of intravenous anesthesia with supplemental oxygen delivered via the nasal cannula. Here, we describe the use of an adaptive anesthesia technique for electron irradiation of the right naris in a preschool-aged patient treated under anesthesia. The need for an intranasal bolus plug precluded the use of standard oxygen supplementation. This novel technique required the multidisciplinary expertise of anesthesiologists, radiation therapists, medical dosimetrists, medical physicists, and radiation oncologists to ensure a safe and reproducible treatment course.

The use of a Leksell-BRW adapter for linac radiosurgery as an adjunct to Gamma Knife treatment

Energy Technology Data Exchange (ETDEWEB)

Ekstrand, Kenneth E [Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC (United States); Hinson, William H [Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC (United States); Bourland, J Daniel [Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC (United States); Guzman, Allan F de [Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC (United States); Stieber, Volker W [Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC (United States); Tatter, Steven B [Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, NC (United States); Ellis, Thomas L [Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, NC (United States)

2003-12-21

We have investigated the use of an adapter that permits the use of a Leksell coordinate frame with a linear accelerator stereotactic radiosurgery system based on the Brown-Robert-Wells (BRW) design. This device is useful when lesions that are planned for treatment on a Leksell Gamma Knife system are found to be inaccessible to the Gamma Knife. We have found that with this device objects within a head phantom can be targeted by the linear accelerator within an accuracy of approximately 1 mm.

Radiation treatment for the right naris in a pediatric anesthesia patient using an adaptive oral airway technique

International Nuclear Information System (INIS)

Sponseller, Patricia; Pelly, Nicole; Trister, Andrew; Ford, Eric; Ermoian, Ralph

2015-01-01

Radiation therapy for pediatric patients often includes the use of intravenous anesthesia with supplemental oxygen delivered via the nasal cannula. Here, we describe the use of an adaptive anesthesia technique for electron irradiation of the right naris in a preschool-aged patient treated under anesthesia. The need for an intranasal bolus plug precluded the use of standard oxygen supplementation. This novel technique required the multidisciplinary expertise of anesthesiologists, radiation therapists, medical dosimetrists, medical physicists, and radiation oncologists to ensure a safe and reproducible treatment course

Small Water System Alternatives: Media and Membrane Filtration Alternatives for Small Communities and Households

Science.gov (United States)

This webinar presentation will highlight research case studies on innovative drinking water treatment alternatives for small community water systems. Emphasis will be placed on media and membrane filtration technologies capable of meeting the requirements of the Long-Term 2 Enha...

Adaptability of the Immature Ocular Motor Control System: Unilateral IGF-1 Medial Rectus Treatment.

Science.gov (United States)

Willoughby, Christy L; Fleuriet, Jérome; Walton, Mark M; Mustari, Michael J; McLoon, Linda K

2015-06-01

Unilateral treatment with sustained release IGF-1 to one medial rectus muscle in infant monkeys was performed to test the hypothesis that strabismus would develop as a result of changes in extraocular muscles during the critical period of development of binocularity. Sustained release IGF-1 pellets were implanted unilaterally on one medial rectus muscle in normal infant monkeys during the first 2 weeks of life. Eye position was monitored using standard photographic methods. After 3 months of treatment, myofiber and neuromuscular size, myosin composition, and innervation density were quantified in all rectus muscles and compared to those in age-matched controls. Sustained unilateral IGF-1 treatments resulted in strabismus for all treated subjects; 3 of the 4 subjects had a clinically significant strabismus of more than 10°. Both the treated medial rectus and the untreated ipsilateral antagonist lateral rectus muscles had significantly larger myofibers. No adaptation in myofiber size occurred in the contralateral functionally yoked lateral rectus or in myosin composition, neuromuscular junction size, or nerve density. Sustained unilateral IGF-1 treatment to extraocular muscles during the sensitive period of development of orthotropic eye alignment and binocularity was sufficient to disturb ocular motor development, resulting in strabismus in infant monkeys. This could be due to altering fusion of gaze during the early sensitive period. Serial measurements of eye alignment suggested the IGF-1-treated infants received insufficient coordinated binocular experience, preventing the establishment of normal eye alignment. Our results uniquely suggest that abnormal signaling by the extraocular muscles may be a cause of strabismus.

Alternated Prone and Supine Whole-Breast Irradiation Using IMRT: Setup Precision, Respiratory Movement and Treatment Time

International Nuclear Information System (INIS)

Veldeman, Liv; De Gersem, Werner; Speleers, Bruno; Truyens, Bart; Van Greveling, Annick; Van den Broecke, Rudy; De Neve, Wilfried

2012-01-01

Purpose: The objective of this study was to compare setup precision, respiration-related breast movement and treatment time between prone and supine positions for whole-breast irradiation. Methods and Materials: Ten patients with early-stage breast carcinoma after breast-conserving surgery were treated with prone and supine whole breast-irradiation in a daily alternating schedule. Setup precision was monitored using cone-beam computed tomography (CBCT) imaging. Respiration-related breast movement in the vertical direction was assessed by magnetic sensors. The time needed for patient setup and for the CBCT procedure, the beam time, and the length of the whole treatment slot were also recorded. Results: Random and systematic errors were not significantly different between positions in individual patients for each of the three axes (left-right, longitudinal, and vertical). Respiration-related movement was smaller in prone position, but about 80% of observations showed amplitudes <1 mm in both positions. Treatment slots were longer in prone position (21.2 ± 2.5 min) than in supine position (19.4 ± 0.8 min; p = 0.044). Conclusion: Comparison of setup precision between prone and supine position in the same patient showed no significant differences in random and systematic errors. Respiratory movement was smaller in prone position. The longer treatment slots in prone position can probably be attributed to the higher repositioning need.

TWTF design alternates

International Nuclear Information System (INIS)

Ayers, A.L. Sr.

1982-03-01

The Transuranic Waste Treatment Facility (TWTF) will process transuranic (TRU) waste in retrievable storage at the Idaho National Engineering Laboratory (INEL). The costs for a TWTF concept using a slagging pyrolysis incinerator were excessive. Alternate concepts using a slow speed shredder, a rotary kiln incinerator, and concrete immobilization should result in significant cost reductions. These will be included in future TWTF considerations

Unorthodox alternative therapies marketed to treat Lyme disease.

Science.gov (United States)

Lantos, Paul M; Shapiro, Eugene D; Auwaerter, Paul G; Baker, Phillip J; Halperin, John J; McSweegan, Edward; Wormser, Gary P

2015-06-15

Some patients with medically unexplained symptoms or alternative medical diagnoses suspect that they chronically suffer from the tick-borne infection Lyme disease. These patients are commonly targeted by providers of alternative therapies. This study was designed to identify and characterize the range of unorthodox alternative therapies advertised to patients with a diagnosis of Lyme disease. Internet searches using the Google search engine were performed to identify the websites of clinics and services that marketed nonantimicrobial therapies for Lyme disease. We subsequently used the PubMed search engine to identify any scientific studies evaluating such treatments for Lyme disease. Websites were included in our review so long as they advertised a commercial, nonantimicrobial product or service that specifically mentioned utility for Lyme disease. Websites with patient testimonials (such as discussion groups) were excluded unless the testimonial appeared as marketing on a commercial site. More than 30 alternative treatments were identified, which fell into several broad categories: these included oxygen and reactive oxygen therapy; energy and radiation-based therapies; nutritional therapy; chelation and heavy metal therapy; and biological and pharmacological therapies ranging from certain medications without recognized therapeutic effects on Borrelia burgdorgeri to stem cell transplantation. Review of the medical literature did not substantiate efficacy or, in most cases, any rationale for the advertised treatments. Providers of alternative therapies commonly target patients who believe they have Lyme disease. The efficacy of these unconventional treatments for Lyme disease is not supported by scientific evidence, and in many cases they are potentially harmful. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Evaluation of the effectiveness and feasibility of the Waste Isolation Pilot Plant engineered alternatives: Final report of the Engineered Alternatives Task Force

International Nuclear Information System (INIS)

1991-07-01

The Engineered Alternatives Task Force (EATF) was established by the United States Department of Energy (DOE) WIPP Project Office (WPO) in September 1989 (Hunt, A., 1990), to evaluate the relative effectiveness and feasibility of implementation of selected design enhancements (referred to as ''engineered alternatives'') for the Waste Isolation Pilot Plant (WIPP). These enhancements consist of modifications of existing waste forms and/or the WIPP facility, and other design variations such as passive marker systems. The purpose of this report is to summarize the methodologies and results of evaluation of the effectiveness of selected engineered alternatives relative to the existing repository design, and to discuss the feasibility of implementing these alternatives with respect to availability of technology, cost, schedule, and regulatory concerns. The EATF has concluded that a number of engineered alternatives could be implemented to improve repository performance if WIPP performance assessment determines that either gas generation or human intrusion presents a problem in demonstrating compliance. Within waste treatment, Level 3 treatments are the most effective in addressing multiple performance parameters, but tend to be the most expensive, the most difficult and time-consuming to implement, and have the greatest regulatory requirements. Level 2 treatments are less expensive, faster, require less extensive permitting, and utilize off- the-shelf technology, but are less effective in addressing multiple performance parameters. Depending upon the performance parameter, Level 1 alternatives such as alternative backfills, alternative waste containers, or modified repository design should be thoroughly evaluated and eliminated before any decision is made to treat the waste. The present uncertainty in the degree to which the baseline WIPP design complies with 40 CFR Part 191 and 40 CFR Part 268 precludes specific recommendations at this time. 130 refs., 21 figs., 37 tabs

Sleep dysfunction and psychosocial adaptation among women undergoing treatment for non-metastatic breast cancer.

Science.gov (United States)

Vargas, Sara; Wohlgemuth, William K; Antoni, Michael H; Lechner, Suzanne C; Holley, Heather A; Carver, Charles S

2010-06-01

The current study aimed to determine the frequency of sleep disturbances in women prior to adjuvant therapy for breast cancer (BCa), and whether greater sleep dysfunction uniquely predicts poorer functional outcomes. We assessed subjective sleep reports and associated them with multiple indicators of psychosocial adaptation in 240 women with Stage I-III BCa before they had begun adjuvant treatment. The average global score on the Pittsburgh Sleep Quality Index (PSQI) was 8.49 (SD=4.16); 54% scoring above the suggested adjusted cutoff for cancer populations of 8.0. Controlling for various medical, sociodemographic, and psychosocial covariates, multiple regression analyses revealed that higher global PSQI score was significantly associated with poorer functional well-being, greater fatigue intensity, greater disruptions in social interactions, and lower positive states of mind. Specifically, a poorer 'sleep efficiency' PSQI component was associated with poorer functional quality of life and the SIP-Social Interactions subscale, while a poorer 'sleep quality' (SQ) PSQI component was associated with all of the outcomes except for the SIP-Recreations and Pastimes subscale. Results indicate consistent associations between a clinical indicator of sleep dysfunction, particularly those subscales of the PSQI comprising the 'SQ' component, and multiple indicators of psychosocial adaptation among women treated for BCa, independent of anxiety and depression, and suggest the value of comprehensive psychosocial interventions that consider sleep problems. (c) 2009 John Wiley & Sons, Ltd.

Effect of storage temperature and osmotic pre-treatment with alternative solutes on the shelf-life of gilthead seabream (Sparus aurata fillets

Directory of Open Access Journals (Sweden)

Theofania N. Tsironi

2017-01-01

Osmotic pre-treatment led to significant shelf-life extension of fillets, in terms of microbial growth, chemical changes and organoleptic deterioration. The pre-treatment with the alternative solutes led to depression of the freezing point (−1.8, −2.6, −3.2 and −3.5 °C for the untreated samples and the osmotically pre-treated with HDM, HDM + treh and HDM + gluc, respectively. TVB-N values were higher in untreated samples, followed by osmotically treated fillets, mainly at higher storage temperatures (i.e. 10 and 15 °C. Based on the mathematical models for sensory evaluation scoring, the shelf-life was 12, 19, 22 and 22 days at 0 °C for untreated and osmotically pre-treated with HDM, HDM + treh and HDM + gluc fish slices, respectively, while the respective values at −3 °C were 21, 35, 38 and 38 days. The alternative solutes had no significant effect on the quality and shelf-life of pre-treated fish fillet during storage at refrigerated conditions.

Brain Activity Stimulated by Prism Adaptation Tasks Utilized for the Treatment of Unilateral Spatial Neglect: A Study with fNIRS

Directory of Open Access Journals (Sweden)

Hiroshi Taniguchi

2012-01-01

Full Text Available We investigated the neurological basis for efficacy of prism adaptation therapy, which is used for the treatment of poststroke unilateral spatial neglect (USN. Study subjects were 6 USN-positive (+, 6 USN-negative patients, and 6 healthy volunteer control subjects. USN was identified by the Behavioural Inattention Test (BIT. During the tasks, brain activity was assessed with fNIRS via changes in oxyHb concentration per unit length. There was no significant difference in the number of errors in the task between the 3 groups. However, in the USN(+ group there was a significantly greater reduction in oxyHb levels in the right parietal association cortex during the prism adaptation task than in the other 2 groups (<0.05. There was an immediate improvement in USN symptoms as well as a significant increase in oxyHb levels during the prism adaptation in the channels covering the right frontal and parietal lobes in 2 patients in the USN(+ group (<0.05. This result suggested that decreased activity in the right parietal association cortex, which is related to spatial perception, during the prism adaptation task and task-induced reorganization of the right frontal and parietal areas were involved in improvement in USN symptoms.

Calculation of projected waste loads for transuranic waste management alternatives

International Nuclear Information System (INIS)

Hong, K.; Kotek, T.; Koebnick, B.; Wang, Y.; Kaicher, C.

1995-01-01

The level of treatment and the treatment and interim storage site configurations (decentralized, regional, or centralized) impact transuranic (TRU) waste loads at and en route to sites in the US Department of Energy (DOE) complex. Other elements that impact waste loads are the volume and characteristics of the waste and the unit operation parameters of the technologies used to treat it. Projected annual complexwide TRU waste loads under various TRU waste management alternatives were calculated using the WASTEunderscoreMGMT computational model. WASTEunderscoreMGMT accepts as input three types of data: (1) the waste stream inventory volume, mass, and contaminant characteristics by generating site and waste stream category; (2) unit operation parameters of treatment technologies; and (3) waste management alternative definitions. Results indicate that the designed capacity of the Waste Isolation Pilot Plant, identified under all waste management alternatives as the permanent disposal facility for DOE-generated TRU waste, is sufficient for the projected complexwide TRU waste load under any of the alternatives

Justice and Equity Implications of Climate Change Adaptation: A Theoretical Evaluation Framework

Science.gov (United States)

Boeckmann, Melanie; Zeeb, Hajo

2016-01-01

Climate change affects human health, and climate change adaptation aims to reduce these risks through infrastructural, behavioral, and technological measures. However, attributing direct human health effects to climate change adaptation is difficult, causing an ethical dilemma between the need for evidence of strategies and their precautionary implementation before such evidence has been generated. In the absence of conclusive evidence for individual adaptation strategies, alternative approaches to the measurement of adaptation effectiveness need to be developed. This article proposes a theoretical framework and a set of guiding questions to assess effects of adaptation strategies on seven domains of health determinants, including social, economic, infrastructure, institutional, community, environmental, and cultural determinants of health. Its focus on advancing gender equity and environmental justice concurrently with the implementation of health-related adaptation could serve as a template for policymakers and researchers. PMID:27618121

Justice and Equity Implications of Climate Change Adaptation: A Theoretical Evaluation Framework

Directory of Open Access Journals (Sweden)

Melanie Boeckmann

2016-09-01

Full Text Available Climate change affects human health, and climate change adaptation aims to reduce these risks through infrastructural, behavioral, and technological measures. However, attributing direct human health effects to climate change adaptation is difficult, causing an ethical dilemma between the need for evidence of strategies and their precautionary implementation before such evidence has been generated. In the absence of conclusive evidence for individual adaptation strategies, alternative approaches to the measurement of adaptation effectiveness need to be developed. This article proposes a theoretical framework and a set of guiding questions to assess effects of adaptation strategies on seven domains of health determinants, including social, economic, infrastructure, institutional, community, environmental, and cultural determinants of health. Its focus on advancing gender equity and environmental justice concurrently with the implementation of health-related adaptation could serve as a template for policymakers and researchers.

Nonpharmacological treatment of epilepsy

Directory of Open Access Journals (Sweden)

V S Saxena

2011-01-01

Full Text Available Nonpharmacological treatment of epilepsy includes surgery, vagal nerve stimulation, ketogenic diet, and other alternative/complementary therapies, e.g., yoga, Ayurveda, electroencephalography (EEG biofeedback technique, aerobic exercise, music therapy, transcranial magnetic stimulation, acupuncture, and herbal remedies (traditional Chinese medicine. Alternative therapies, despite the term, should not be considered as an alternative to antiepileptic medication; they complement accepted drug treatment. Alternative therapies like yoga, through techniques that relax the body and mind, reduce stress, improve seizure control, and also improve quality of life. Ketogenic diet is a safe and effective treatment for intractable epilepsies; it has been recommended since 1921. The diet induces ketosis, which may control seizures. The most successful treatment of epilepsy is with modern antiepileptic drugs, which can achieve control of seizures in 70-80% cases. Patients opt for alternative therapies because they may be dissatisfied with antiepileptic drugs due to their unpleasant side effects, the long duration of treatment, failure to achieve control of seizures, cultural beliefs and, in the case of women, because they wish to get pregnant Surgical treatment may lead to physical and psychological sequelae and is an option only for a minority of patients. This article presents supportive evidence from randomized controlled trials done to assess the benefit of non-pharmacological treatment.

Adaptive radiotherapy based on contrast enhanced cone beam CT imaging

International Nuclear Information System (INIS)

Soevik, Aaste; Skogmo, Hege K.; Roedal, Jan; Lervaag, Christoffer; Eilertsen, Karsten; Malinen, Eirik

2010-01-01

Cone beam CT (CBCT) imaging has become an integral part of radiation therapy, with images typically used for offline or online patient setup corrections based on bony anatomy co-registration. Ideally, the co-registration should be based on tumor localization. However, soft tissue contrast in CBCT images may be limited. In the present work, contrast enhanced CBCT (CECBCT) images were used for tumor visualization and treatment adaptation. Material and methods. A spontaneous canine maxillary tumor was subjected to repeated cone beam CT imaging during fractionated radiotherapy (10 fractions in total). At five of the treatment fractions, CECBCT images, employing an iodinated contrast agent, were acquired, as well as pre-contrast CBCT images. The tumor was clearly visible in post-contrast minus pre-contrast subtraction images, and these contrast images were used to delineate gross tumor volumes. IMRT dose plans were subsequently generated. Four different strategies were explored: 1) fully adapted planning based on each CECBCT image series, 2) planning based on images acquired at the first treatment fraction and patient repositioning following bony anatomy co-registration, 3) as for 2), but with patient repositioning based on co-registering contrast images, and 4) a strategy with no patient repositioning or treatment adaptation. The equivalent uniform dose (EUD) and tumor control probability (TCP) calculations to estimate treatment outcome for each strategy. Results. Similar translation vectors were found when bony anatomy and contrast enhancement co-registration were compared. Strategy 1 gave EUDs closest to the prescription dose and the highest TCP. Strategies 2 and 3 gave EUDs and TCPs close to that of strategy 1, with strategy 3 being slightly better than strategy 2. Even greater benefits from strategies 1 and 3 are expected with increasing tumor movement or deformation during treatment. The non-adaptive strategy 4 was clearly inferior to all three adaptive strategies

Organ preservation in invasive bladder cancer: Brachytherapy, an alternative to cystectomy and combined modality treatment?

International Nuclear Information System (INIS)

Pos, Floris; Horenblas, Simon; Dom, Paul; Moonen, Luc; Bartelink, Harry

2005-01-01

Purpose: To evaluate our long-term results of bladder preservation with brachytherapy in the treatment of bladder cancer. Methods and materials: Between 1987 and 2000, 108 patients with T1-G3 and T2-T3a stages of bladder cancer were treated with a transurethral resection (TUR) and a course of external beam radiotherapy (30 Gy in 15 fractions) followed by brachytherapy (40 Gy). All tumors were solitary lesions with a diameter ≤5 cm. Median follow-up was 54 months (range, 1-178 months). Results: The 5-year and 10-year overall survival rates were 62% and 50%, respectively. The 5-year and 10-year disease-specific survival rates were 73% and 67%, respectively. The actuarial local control rate was 73% at 5 and 73% at 10 years, respectively. The 5-year and 10-year disease-specific survival rates for patients with a preserved bladder were 68% and 59%, respectively. Of all long-term surviving patients, 90% preserved their native bladders. The treatment was well tolerated. Acute toxicity was mild. Two patients experienced serious late toxicity: 1 patient developed a persisting vesicocutaneous fistula and the other a stricture of the urethra and ureters. Conclusion: For patients with solitary, organ confined invasive bladder cancer ≤5 cm, bladder preservation with brachytherapy is an excellent alternative to radical cystectomy and combined modality treatment

[Head and neck adaptive radiotherapy].

Science.gov (United States)

Graff, P; Huger, S; Kirby, N; Pouliot, J

2013-10-01

Onboard volumetric imaging systems can provide accurate data of the patient's anatomy during a course of head and neck radiotherapy making it possible to assess the actual delivered dose and to evaluate the dosimetric impact of complex daily positioning variations and gradual anatomic changes such as geometric variations of tumors and normal tissues or shrinkage of external contours. Adaptive radiotherapy is defined as the correction of a patient's treatment planning to adapt for individual variations observed during treatment. Strategies are developed to selectively identify patients that require replanning because of an intolerable dosimetric drift. Automated tools are designed to limit time consumption. Deformable image registration algorithms are the cornerstones of these strategies, but a better understanding of their limits of validity is required before adaptive radiotherapy can be safely introduced to daily practice. Moreover, strict evaluation of the clinical benefits is yet to be proven. Copyright © 2013 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

Irradiation as an alternative treatment to methyl bromide for insect control

International Nuclear Information System (INIS)

Akinbingol, B.

2001-01-01

Turkey is the leading country in the world, in production and exports of dried fig, apricot, raisin and hazelnut. One of main problem in the export trade is infestation by stored product insects. Using MB is very effective for controlling stored product insects in Turkey. MB has also listed as an ozone depleting substance and worldwide production will be phased out in the near future, than Turkey will be faced very serious problem for export dry fruits and hazelnut. Use of irradiation to disinfest agricultural products has obvius advantages, most of which are influenced by environmental, cultural, economic, commercial and govermental factors. The first two factors, effectiveness and economy, are adressed principally. Research conducted world-wide in the past four decades have shown that radiation processing is an effective and safe method for controlling insect pests of stored products. Irradiation offers an effective alternative quarantine treatment which is more environmentally friendly and sustainable as compared to fumigants. In view of the phasing out of the currently used post harvest chemical fumigants, irradiation either alone or in conjuction with other post-harvest procedures can contribute towards the goals of achieving food security in developing and less developed countries by effectively reducing post-harvest losses

[Test your decision-making. When to do endodontic retreatment? Some therapeutic alternatives].

Science.gov (United States)

Aryanpour, S; D'Hoore, W; Van Nieuwenhuysen, J P

2000-01-01

The aim of the present article was to propose examples of treatment alternatives for the management of 14 clinical cases. All these cases involved endodontically treated teeth and have been managed by the same practitioner. In this paper, the authors tried to show the variety of treatment alternatives as well as the complexity of the decision-making process and, not to consider that proposed alternatives were the most adequate.

The science of adaptation. A framework for assessment

International Nuclear Information System (INIS)

Smit, B.; Burton, I.; Street, R.; Klein, R.J.T.; Maciver, D.C.

1999-01-01

This paper outlines what is meant by 'adaptation' to climate change, and how it might be addressed in the IPCC Assessments. Two roles of adaptation in the climate change field are identified: adaptation as part of impact assessment (where the key question is: what adaptations are likely?), and adaptation as part of the policy response (where the central question is: what adaptations are recommended?). The concept of adaptation has been adopted in several fields including climate impact assessment and policy development, risk management, and natural hazards research. A framework for systematically defining adaptations is based on three questions: (1) adaptation to what? (2) who or what adapts? and (3) how does adaptation occur? The paper demonstrates that, for adaptation purposes, climate extremes and variability are integral parts of climate change, along with shifts in mean conditions. Attributes for differentiating adaptations include purposefulness, timing, temporal and spatial scope, effects, form and performance. The framework provides a guide for the treatment of adaptation in the IPCC assessments, both in the assessment of impacts and in the evaluation of adaptive policy options. 64 refs

Individual differences in implicit motor learning: task specificity in sensorimotor adaptation and sequence learning.

Science.gov (United States)

Stark-Inbar, Alit; Raza, Meher; Taylor, Jordan A; Ivry, Richard B

2017-01-01

In standard taxonomies, motor skills are typically treated as representative of implicit or procedural memory. We examined two emblematic tasks of implicit motor learning, sensorimotor adaptation and sequence learning, asking whether individual differences in learning are correlated between these tasks, as well as how individual differences within each task are related to different performance variables. As a prerequisite, it was essential to establish the reliability of learning measures for each task. Participants were tested twice on a visuomotor adaptation task and on a sequence learning task, either the serial reaction time task or the alternating reaction time task. Learning was evident in all tasks at the group level and reliable at the individual level in visuomotor adaptation and the alternating reaction time task but not in the serial reaction time task. Performance variability was predictive of learning in both domains, yet the relationship was in the opposite direction for adaptation and sequence learning. For the former, faster learning was associated with lower variability, consistent with models of sensorimotor adaptation in which learning rates are sensitive to noise. For the latter, greater learning was associated with higher variability and slower reaction times, factors that may facilitate the spread of activation required to form predictive, sequential associations. Interestingly, learning measures of the different tasks were not correlated. Together, these results oppose a shared process for implicit learning in sensorimotor adaptation and sequence learning and provide insight into the factors that account for individual differences in learning within each task domain. We investigated individual differences in the ability to implicitly learn motor skills. As a prerequisite, we assessed whether individual differences were reliable across test sessions. We found that two commonly used tasks of implicit learning, visuomotor adaptation and the

Irradiation as an alternative post harvest treatment

Energy Technology Data Exchange (ETDEWEB)

Satin, M. [Agricultural Industries and Post-harvest Management Service, FAO, Rome (Italy); Loaharanu, P. [Head, Food Preservation Section, Joint FAO/ IAEA Division of Nuclear Techniques in Food and Agriculture, Wagramerstr. 5, A-1400, Vienna (Austria)

1997-12-31

This current world population has significantly added to the pressures placed upon our finite resources and our resulting ability to feed ourselves. In order to cope with current and future demands, the two established lines of action, that is, reduced population growth and expansion of agricultural production, must be supplemented with the parallel activity of reducing food losses during and after harvest. For developing countries in particular, enormous post-harvest losses result from spillage, contamination, pests and physiological deterioration during storage. Studies in these countries indicate that post-harvest losses are enormous and amount to tens of millions of tons per year valued at billions of dollars. Programs to reduce post-harvest losses, if applied properly, can result in realistic yield increases between 10 and 30%, which can be directly converted into increased consumption for humans. Post-harvest losses vary greatly and are a function of the crop variety, pest combinations in the environment, climate, the system of harvesting, storage, handling, marketing, and even the social and cultural environment. Pests are among the most criticals of these factors. Because of the disastrous potential consequences of such pests, quarantine regulations prohibit the entrance of plants or products which might hide the unwanted pest from countries where it is known to exist. Quarantine treatments are can be chemical, physical or ionizing radiation treatment. Numerous investigations on the use of ionizing radiation for the disinfestation of fresh plant materials indicate that rather low dosages will control fruit-fly problems, thus making it well suited for quarantine treatment. The effectiveness of the irradiation as a broad spectrum quarantine treatment of fresh fruits and vegetables was recognized by the several plant protection organizations around the world. Currently, some 40 countries have approved one or more irradiated food items or groups of food

Irradiation as an alternative post harvest treatment

International Nuclear Information System (INIS)

Satin, M.; Loaharanu, P.

1997-01-01

This current world population has significantly added to the pressures placed upon our finite resources and our resulting ability to feed ourselves. In order to cope with current and future demands, the two established lines of action, that is, reduced population growth and expansion of agricultural production, must be supplemented with the parallel activity of reducing food losses during and after harvest. For developing countries in particular, enormous post-harvest losses result from spillage, contamination, pests and physiological deterioration during storage. Studies in these countries indicate that post-harvest losses are enormous and amount to tens of millions of tons per year valued at billions of dollars. Programs to reduce post-harvest losses, if applied properly, can result in realistic yield increases between 10 and 30%, which can be directly converted into increased consumption for humans. Post-harvest losses vary greatly and are a function of the crop variety, pest combinations in the environment, climate, the system of harvesting, storage, handling, marketing, and even the social and cultural environment. Pests are among the most criticals of these factors. Because of the disastrous potential consequences of such pests, quarantine regulations prohibit the entrance of plants or products which might hide the unwanted pest from countries where it is known to exist. Quarantine treatments are can be chemical, physical or ionizing radiation treatment. Numerous investigations on the use of ionizing radiation for the disinfestation of fresh plant materials indicate that rather low dosages will control fruit-fly problems, thus making it well suited for quarantine treatment. The effectiveness of the irradiation as a broad spectrum quarantine treatment of fresh fruits and vegetables was recognized by the several plant protection organizations around the world. Currently, some 40 countries have approved one or more irradiated food items or groups of food

Irradiation as an alternative post harvest treatment

Energy Technology Data Exchange (ETDEWEB)

Satin, M [Agricultural Industries and Post-harvest Management Service, FAO, Rome (Italy); Loaharanu, P [Head, Food Preservation Section, Joint FAO/ IAEA Division of Nuclear Techniques in Food and Agriculture, Wagramerstr. 5, A-1400, Vienna (Austria)

1998-12-31

This current world population has significantly added to the pressures placed upon our finite resources and our resulting ability to feed ourselves. In order to cope with current and future demands, the two established lines of action, that is, reduced population growth and expansion of agricultural production, must be supplemented with the parallel activity of reducing food losses during and after harvest. For developing countries in particular, enormous post-harvest losses result from spillage, contamination, pests and physiological deterioration during storage. Studies in these countries indicate that post-harvest losses are enormous and amount to tens of millions of tons per year valued at billions of dollars. Programs to reduce post-harvest losses, if applied properly, can result in realistic yield increases between 10 and 30%, which can be directly converted into increased consumption for humans. Post-harvest losses vary greatly and are a function of the crop variety, pest combinations in the environment, climate, the system of harvesting, storage, handling, marketing, and even the social and cultural environment. Pests are among the most criticals of these factors. Because of the disastrous potential consequences of such pests, quarantine regulations prohibit the entrance of plants or products which might hide the unwanted pest from countries where it is known to exist. Quarantine treatments are can be chemical, physical or ionizing radiation treatment. Numerous investigations on the use of ionizing radiation for the disinfestation of fresh plant materials indicate that rather low dosages will control fruit-fly problems, thus making it well suited for quarantine treatment. The effectiveness of the irradiation as a broad spectrum quarantine treatment of fresh fruits and vegetables was recognized by the several plant protection organizations around the world. Currently, some 40 countries have approved one or more irradiated food items or groups of food

Urban drainage design and climate change adaptation decision making

Energy Technology Data Exchange (ETDEWEB)

Qianqian Zhou

2012-10-15

The emphasis of this PhD thesis is flood protection in the context of pluvial flooding by investigating new principles and approaches for assessment of urban drainage adaptation measures under climate change impacts. The thesis describes a new framework for design and analysis of urban drainage that accurately assesses hazards and vulnerabilities of urban areas and quantifies the present and future risks based on projections of climate change and city development. Furthermore, this framework can be utilized to identify cost-effective measures that can reduce the overall flood risk to an acceptable level considering both costs and benefits of adaptation. The framework is mainly based on a utilitarian approach that studies urban drainage adaptation solutions from a socio-economic point of view. The methodologies involve the state-of-the-art flood inundation modelling, risk assessment tools, socio-economic analysis tools, city planning, and uncertainty analysis. The thesis has explored several limitations of the current design practice of urban drainage. To further supplement and develop the common practice, a systemic and integrated framework is proposed by incorporating three research areas: (i) risk-based economic approaches for assessment of climate adaptation design, (ii) uncertainty analysis of climate adaptation assessment and (iii) reframing the assessment approaches by incorporating additional benefits and costs of adaptation alternatives. To strategically provide a functional performance of urban drainage systems, a risk-based economic approach is developed to take into account the impacts of all probable floods in terms of their probabilities and consequences (e.g. extents of floods, costing of damage). It is found that this approach contributes to a better understanding of the contributions of different return periods/flood events to the overall risk under both current and future climatic conditions and therefore can be used as guidance for further

Adaptive management for a turbulent future

Science.gov (United States)

Allen, Craig R.; Fontaine, J.J.; Pope, K.L.; Garmestani, A.S.

2011-01-01

The challenges that face humanity today differ from the past because as the scale of human influence has increased, our biggest challenges have become global in nature, and formerly local problems that could be addressed by shifting populations or switching resources, now aggregate (i.e., "scale up") limiting potential management options. Adaptive management is an approach to natural resource management that emphasizes learning through management based on the philosophy that knowledge is incomplete and much of what we think we know is actually wrong. Adaptive management has explicit structure, including careful elucidation of goals, identification of alternative management objectives and hypotheses of causation, and procedures for the collection of data followed by evaluation and reiteration. It is evident that adaptive management has matured, but it has also reached a crossroads. Practitioners and scientists have developed adaptive management and structured decision making techniques, and mathematicians have developed methods to reduce the uncertainties encountered in resource management, yet there continues to be misapplication of the method and misunderstanding of its purpose. Ironically, the confusion over the term "adaptive management" may stem from the flexibility inherent in the approach, which has resulted in multiple interpretations of "adaptive management" that fall along a continuum of complexity and a priori design. Adaptive management is not a panacea for the navigation of 'wicked problems' as it does not produce easy answers, and is only appropriate in a subset of natural resource management problems where both uncertainty and controllability are high. Nonetheless, the conceptual underpinnings of adaptive management are simple; there will always be inherent uncertainty and unpredictability in the dynamics and behavior of complex social-ecological systems, but management decisions must still be made, and whenever possible, we should incorporate

Evaluating the Appropriateness of a New Computer-Administered Measure of Adaptive Function for Children and Youth with Autism Spectrum Disorders

Science.gov (United States)

Coster, Wendy J.; Kramer, Jessica M.; Tian, Feng; Dooley, Meghan; Liljenquist, Kendra; Kao, Ying-Chia; Ni, Pengsheng

2016-01-01

The Pediatric Evaluation of Disability Inventory-Computer Adaptive Test is an alternative method for describing the adaptive function of children and youth with disabilities using a computer-administered assessment. This study evaluated the performance of the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test with a national…

Adaptation to Temporally Fluctuating Environments by the Evolution of Maternal Effects.

Directory of Open Access Journals (Sweden)

Snigdhadip Dey

2016-02-01

Full Text Available All organisms live in temporally fluctuating environments. Theory predicts that the evolution of deterministic maternal effects (i.e., anticipatory maternal effects or transgenerational phenotypic plasticity underlies adaptation to environments that fluctuate in a predictably alternating fashion over maternal-offspring generations. In contrast, randomizing maternal effects (i.e., diversifying and conservative bet-hedging, are expected to evolve in response to unpredictably fluctuating environments. Although maternal effects are common, evidence for their adaptive significance is equivocal since they can easily evolve as a correlated response to maternal selection and may or may not increase the future fitness of offspring. Using the hermaphroditic nematode Caenorhabditis elegans, we here show that the experimental evolution of maternal glycogen provisioning underlies adaptation to a fluctuating normoxia-anoxia hatching environment by increasing embryo survival under anoxia. In strictly alternating environments, we found that hermaphrodites evolved the ability to increase embryo glycogen provisioning when they experienced normoxia and to decrease embryo glycogen provisioning when they experienced anoxia. At odds with existing theory, however, populations facing irregularly fluctuating normoxia-anoxia hatching environments failed to evolve randomizing maternal effects. Instead, adaptation in these populations may have occurred through the evolution of fitness effects that percolate over multiple generations, as they maintained considerably high expected growth rates during experimental evolution despite evolving reduced fecundity and reduced embryo survival under one or two generations of anoxia. We develop theoretical models that explain why adaptation to a wide range of patterns of environmental fluctuations hinges on the existence of deterministic maternal effects, and that such deterministic maternal effects are more likely to contribute to

Adaptable history biases in human perceptual decisions.

Science.gov (United States)

Abrahamyan, Arman; Silva, Laura Luz; Dakin, Steven C; Carandini, Matteo; Gardner, Justin L

2016-06-21

When making choices under conditions of perceptual uncertainty, past experience can play a vital role. However, it can also lead to biases that worsen decisions. Consistent with previous observations, we found that human choices are influenced by the success or failure of past choices even in a standard two-alternative detection task, where choice history is irrelevant. The typical bias was one that made the subject switch choices after a failure. These choice history biases led to poorer performance and were similar for observers in different countries. They were well captured by a simple logistic regression model that had been previously applied to describe psychophysical performance in mice. Such irrational biases seem at odds with the principles of reinforcement learning, which would predict exquisite adaptability to choice history. We therefore asked whether subjects could adapt their irrational biases following changes in trial order statistics. Adaptability was strong in the direction that confirmed a subject's default biases, but weaker in the opposite direction, so that existing biases could not be eradicated. We conclude that humans can adapt choice history biases, but cannot easily overcome existing biases even if irrational in the current context: adaptation is more sensitive to confirmatory than contradictory statistics.

Integrated ultrasonic/microbiological treatment of toxic and refractory pollutants

Energy Technology Data Exchange (ETDEWEB)

Tiehm, A. [Water Technology Center, Karlsruhe (Germany)

2002-07-01

The elimination of environmental pollutants by biodegradation in many cases represents an efficient and reliable method, e.g. in waste waster treatment, treatment of solid wastes, and in the remediation of contaminated soil. Nevertheless, there are situations where biological treatment alone does not result in a successful elimination of the target pollutants. For example, the presence of toxic compounds, an insufficient period of adaptation or a low bioavailability of the pollutants hinder a rapid biodegradation. Physico-chemical techniques, e.g. sonochemical degradation, provide an alternative to eliminate pollutants that are poorly biodegradable. It is the aim of this paper to demonstrate the potential of integrated ultrasound/biodegradation processes in the light of the underlying mechanisms. Optimisation of sonication is discussed with respect to ultrasound frequency and pH of the aqueous phase. Examplarily, two successful combinations of the integrated process are presented: (i) Application of ultrasound to reduce the toxicity of chlorophenols and (ii) ultrasonic irradiation to increase mass transfer and biodegradation of polyaromatic hydrocarbons. (orig.)

A Comparison of Alternative Distributed Dynamic Cluster Formation Techniques for Industrial Wireless Sensor Networks.

Science.gov (United States)

Gholami, Mohammad; Brennan, Robert W

2016-01-06

In this paper, we investigate alternative distributed clustering techniques for wireless sensor node tracking in an industrial environment. The research builds on extant work on wireless sensor node clustering by reporting on: (1) the development of a novel distributed management approach for tracking mobile nodes in an industrial wireless sensor network; and (2) an objective comparison of alternative cluster management approaches for wireless sensor networks. To perform this comparison, we focus on two main clustering approaches proposed in the literature: pre-defined clusters and ad hoc clusters. These approaches are compared in the context of their reconfigurability: more specifically, we investigate the trade-off between the cost and the effectiveness of competing strategies aimed at adapting to changes in the sensing environment. To support this work, we introduce three new metrics: a cost/efficiency measure, a performance measure, and a resource consumption measure. The results of our experiments show that ad hoc clusters adapt more readily to changes in the sensing environment, but this higher level of adaptability is at the cost of overall efficiency.

Online Magnetic Resonance Image Guided Adaptive Radiation Therapy: First Clinical Applications

International Nuclear Information System (INIS)

Acharya, Sahaja; Fischer-Valuck, Benjamin W.; Kashani, Rojano; Parikh, Parag; Yang, Deshan; Zhao, Tianyu; Green, Olga; Wooten, Omar; Li, H. Harold; Hu, Yanle; Rodriguez, Vivian; Olsen, Lindsey; Robinson, Clifford; Michalski, Jeff; Mutic, Sasa; Olsen, Jeffrey

2016-01-01

Purpose: To demonstrate the feasibility of online adaptive magnetic resonance (MR) image guided radiation therapy (MR-IGRT) through reporting of our initial clinical experience and workflow considerations. Methods and Materials: The first clinically deployed online adaptive MR-IGRT system consisted of a split 0.35T MR scanner straddling a ring gantry with 3 multileaf collimator-equipped "6"0Co heads. The unit is supported by a Monte Carlo–based treatment planning system that allows real-time adaptive planning with the patient on the table. All patients undergo computed tomography and MR imaging (MRI) simulation for initial treatment planning. A volumetric MRI scan is acquired for each patient at the daily treatment setup. Deformable registration is performed using the planning computed tomography data set, which allows for the transfer of the initial contours and the electron density map to the daily MRI scan. The deformed electron density map is then used to recalculate the original plan on the daily MRI scan for physician evaluation. Recontouring and plan reoptimization are performed when required, and patient-specific quality assurance (QA) is performed using an independent in-house software system. Results: The first online adaptive MR-IGRT treatments consisted of 5 patients with abdominopelvic malignancies. The clinical setting included neoadjuvant colorectal (n=3), unresectable gastric (n=1), and unresectable pheochromocytoma (n=1). Recontouring and reoptimization were deemed necessary for 3 of 5 patients, and the initial plan was deemed sufficient for 2 of the 5 patients. The reasons for plan adaptation included tumor progression or regression and a change in small bowel anatomy. In a subsequently expanded cohort of 170 fractions (20 patients), 52 fractions (30.6%) were reoptimized online, and 92 fractions (54.1%) were treated with an online-adapted or previously adapted plan. The median time for recontouring, reoptimization, and QA was 26�

Online Magnetic Resonance Image Guided Adaptive Radiation Therapy: First Clinical Applications

Energy Technology Data Exchange (ETDEWEB)

Acharya, Sahaja; Fischer-Valuck, Benjamin W.; Kashani, Rojano; Parikh, Parag; Yang, Deshan; Zhao, Tianyu; Green, Olga; Wooten, Omar; Li, H. Harold; Hu, Yanle; Rodriguez, Vivian; Olsen, Lindsey; Robinson, Clifford; Michalski, Jeff; Mutic, Sasa; Olsen, Jeffrey, E-mail: jolsen@radonc.wustl.edu

2016-02-01

Purpose: To demonstrate the feasibility of online adaptive magnetic resonance (MR) image guided radiation therapy (MR-IGRT) through reporting of our initial clinical experience and workflow considerations. Methods and Materials: The first clinically deployed online adaptive MR-IGRT system consisted of a split 0.35T MR scanner straddling a ring gantry with 3 multileaf collimator-equipped {sup 60}Co heads. The unit is supported by a Monte Carlo–based treatment planning system that allows real-time adaptive planning with the patient on the table. All patients undergo computed tomography and MR imaging (MRI) simulation for initial treatment planning. A volumetric MRI scan is acquired for each patient at the daily treatment setup. Deformable registration is performed using the planning computed tomography data set, which allows for the transfer of the initial contours and the electron density map to the daily MRI scan. The deformed electron density map is then used to recalculate the original plan on the daily MRI scan for physician evaluation. Recontouring and plan reoptimization are performed when required, and patient-specific quality assurance (QA) is performed using an independent in-house software system. Results: The first online adaptive MR-IGRT treatments consisted of 5 patients with abdominopelvic malignancies. The clinical setting included neoadjuvant colorectal (n=3), unresectable gastric (n=1), and unresectable pheochromocytoma (n=1). Recontouring and reoptimization were deemed necessary for 3 of 5 patients, and the initial plan was deemed sufficient for 2 of the 5 patients. The reasons for plan adaptation included tumor progression or regression and a change in small bowel anatomy. In a subsequently expanded cohort of 170 fractions (20 patients), 52 fractions (30.6%) were reoptimized online, and 92 fractions (54.1%) were treated with an online-adapted or previously adapted plan. The median time for recontouring, reoptimization, and QA was 26�

Preimplantation genetic screening as an alternative to prenatal testing for Down syndrome : preferences of women undergoing in vitro fertilization/intracytoplasmic sperm injection treatment

NARCIS (Netherlands)

Twisk, Moniek; Haadsma, Maaike L.; van der Veen, Fulco; Repping, Sjoerd; Mastenbroek, Sebastiaan; Heineman, Maas-Jan; Bossuyt, Patrick M. M.; Korevaar, Johanna C.

2007-01-01

Objective: Although the primary goal of preimplantation genetic screening (PGS) is to increase pregnancy rates in women undergoing IVF/intracytoplasmic sperm injection treatment, it has been suggested that it may also be used as an alternative to prenatal testing for Down syndrome. Design: Trade-off

Preimplantation genetic screening as an alternative to prenatal testing for Down syndrome: preferences of women undergoing in vitro fertilization/intracytoplasmic sperm injection treatment

NARCIS (Netherlands)

Twisk, Moniek; Haadsma, Maaike L.; van der Veen, Fulco; Repping, Sjoerd; Mastenbroek, Sebastiaan; Heineman, Maas-Jan; Bossuyt, Patrick M. M.; Korevaar, Johanna C.

2007-01-01

Objective: Although the primary goal of preimplantation genetic screening (PGS) is to increase pregnancy rates in women undergoing IVF/intracytoplasmic sperm injection treatment, it has been suggested that it may also be used as an alternative to prenatal testing for Down syndrome. Design: Trade-off

Anti-inflammatory salicylate treatment alters the metabolic adaptations to lactation in dairy cattle

OpenAIRE

Farney, Jaymelynn K.; Mamedova, Laman K.; Coetzee, Johann F.; KuKanich, Butch; Sordillo, Lorraine M.; Stoakes, Sara K.; Minton, J. Ernest; Hollis, Larry C.; Bradford, Barry J.

2013-01-01

Adapting to the lactating state requires metabolic adjustments in multiple tissues, especially in the dairy cow, which must meet glucose demands that can exceed 5 kg/day in the face of negligible gastrointestinal glucose absorption. These challenges are met through the process of homeorhesis, the alteration of metabolic setpoints to adapt to a shift in physiological state. To investigate the role of inflammation-associated pathways in these homeorhetic adaptations, we treated cows with the no...

Physician and patient use of and attitudes toward complementary and alternative medicine in the treatment of infertility.

Science.gov (United States)

Clark, Natalie A; Will, Matthew A; Moravek, Molly B; Xu, Xiao; Fisseha, Senait

2013-09-01

To determine use of and attitudes toward complementary and alternative medicine (CAM) among infertility patients and subspecialty physicians. Infertility patients were asked to complete anonymous written surveys at an academic infertility practice; members of the Society for Reproductive Endocrinology and Infertility were electronically surveyed. Both groups were assessed regarding their use of and attitudes toward CAM. The response rate was 32.1% (115/358) among patients and 22.6% (225/995) among physicians (Pinfertility patients requires greater physician attention and justifies further study on the risks and benefits of integrating CAM into the biomedical treatment of infertility. Published by Elsevier Ireland Ltd.

Salivary Gland Cancer Treatment

Science.gov (United States)

... A to Z List of Cancer Drugs Complementary & Alternative Medicine (CAM) Questions to Ask about Your Treatment Research ... Treatment Side Effects Clinical Trials Cancer Drugs Complementary & Alternative Medicine Coping Feelings & Cancer Adjusting to Cancer Self Image & ...

[Dissertations 25 year after date 41. Older people's adaptability].

Science.gov (United States)

de Baat, C; Gerritsen, A E; van der Putten, G J; van der Maarel-Wierink, C D

2015-09-01

In 1990, the thesis 'Removable complete dentures in older people, an issue dealing with adaptability?' was published. Among other things, this thesis aimed at finding a method of measuring older people's adaptability to removable complete dentures. Its conclusion was that a subscale of the "Beoordelingsschaal voor Oudere Patiënten" (Rating scale for older patients) had predictive value. Subsequently, only a few research projects on this topic have been carried out. They dealt with demonstrated adaptation achieved after treatment, the realised adaptation. The results were disappointing. Ever since the availability of endosseous oral implants, research into adaptability to conventional removable complete dentures seems less relevant. During the last decades, inquiries into a method of measuring treatment effectiveness has focused on older people's quality of life and general health condition. However, to assess with respect to oral health care an older person's general health condition and load-taking capacity adequately, some experience is indispensable.

Epigenetic Mechanisms Regulating Adaptive Responses to Targeted Kinase Inhibitors in Cancer.

Science.gov (United States)

Angus, Steven P; Zawistowski, Jon S; Johnson, Gary L

2018-01-06

Although targeted inhibition of oncogenic kinase drivers has achieved remarkable patient responses in many cancers, the development of resistance has remained a significant challenge. Numerous mechanisms have been identified, including the acquisition of gatekeeper mutations, activating pathway mutations, and copy number loss or gain of the driver or alternate nodes. These changes have prompted the development of kinase inhibitors with increased selectivity, use of second-line therapeutics to overcome primary resistance, and combination treatment to forestall resistance. In addition to genomic resistance mechanisms, adaptive transcriptional and signaling responses seen in tumors are gaining appreciation as alterations that lead to a phenotypic state change-often observed as an epithelial-to-mesenchymal shift or reversion to a cancer stem cell-like phenotype underpinned by remodeling of the epigenetic landscape. This epigenomic modulation driving cell state change is multifaceted and includes modulation of repressive and activating histone modifications, DNA methylation, enhancer remodeling, and noncoding RNA species. Consequently, the combination of kinase inhibitors with drugs targeting components of the transcriptional machinery and histone-modifying enzymes has shown promise in preclinical and clinical studies. Here, we review mechanisms of resistance to kinase inhibition in cancer, with special emphasis on the rewired kinome and transcriptional signaling networks and the potential vulnerabilities that may be exploited to overcome these adaptive signaling changes.

Adaptive fractionated stereotactic Gamma Knife radiotherapy of meningioma using integrated stereotactic cone-beam-CT and adaptive re-planning (a-gkFSRT).

Science.gov (United States)

Stieler, F; Wenz, F; Abo-Madyan, Y; Schweizer, B; Polednik, M; Herskind, C; Giordano, F A; Mai, S

2016-11-01

The Gamma Knife Icon (Elekta AB, Stockholm, Sweden) allows frameless stereotactic treatment using a combination of cone beam computer tomography (CBCT), a thermoplastic mask system, and an infrared-based high-definition motion management (HDMM) camera system for patient tracking during treatment. We report on the first patient with meningioma at the left petrous bone treated with adaptive fractionated stereotactic radiotherapy (a-gkFSRT). The first patient treated with Gamma Knife Icon at our institute received MR imaging for preplanning before treatment. For each treatment fraction, a daily CBCT was performed to verify the actual scull/tumor position. The system automatically adapted the planned shot positions to the daily position and recalculated the dose distribution (online adaptive planning). During treatment, the HDMM system recorded the intrafractional patient motion. Furthermore, the required times were recorded to define a clinical treatment slot. Total treatment time was around 20 min. Patient positioning needed 0.8 min, CBCT positioning plus acquisition 1.65 min, CT data processing and adaptive planning 2.66 min, and treatment 15.6 min. The differences for the five daily CBCTs compared to the reference are for rotation: -0.59 ± 0.49°/0.18 ± 0.20°/0.05 ± 0.36° and for translation: 0.94 ± 0.52 mm/-0.08 ± 0.08 mm/-1.13 ± 0.89 mm. Over all fractions, an intrafractional movement of 0.13 ± 0.04 mm was observed. The Gamma Knife Icon allows combining the accuracy of the stereotactic Gamma Knife system with the flexibility of fractionated treatment with the mask system and CBCT. Furthermore, the Icon system introduces a new online patient tracking system to the clinical routine. The interfractional accuracy of patient positioning was controlled with a thermoplastic mask and CBCT.

Role of Peritoneal Ultrafiltration in Heart Failure Treatment

Directory of Open Access Journals (Sweden)

Tuba Elif Şenel

2017-09-01

Full Text Available Cardiorenal syndrome (CRS is a general term that can reflect different clinical conditions in which cardiac and renal dysfunctions coexist. The main pathogenetic mechanisms playing a role in heart failure (HF and CRS are neurohumoral adaptation, right ventricular dilatation and dysfunction and systemic inflammation. Persistence of these factors cause focal and segmental glomerulosclerosis, and tubulointerstitial fibrosis in the renal parenchyma. Diuretics, beta blockers, renin-angiotensin-aldosterone system inhibitors, and vasodilators are the main medical treatments besides conventional approach, such as salt and water restriction and quitting smoking, in HF treatment. Diuretic resistance is the main problem emerging during diuretic treatments. Two renal replacement treatments have become prominent for removal of excess fluids via ultrafiltration in HF patients with diuretic resistance extracorporeal ultrafiltration with hemodialysis and peritoneal dialysis (PD. Herein, the role of these two ultrafiltration modalities, especially peritoneal ultrafiltration (PUF in the treatment of HF is discussed. The main studies and advantages of PUF in HF treatment were discussed. Moreover, effects of PD on glomerular filtration rate, hospitalization and mortality were investigated. In conclusion, PD is an alternative cheap, practical and convenient therapy in reducing cardiac volume burden in HF patients who do not respond well to standard treatments and/or require frequent hospitalization.

The Molecular Immunology of Mucositis: Implications for Evidence-Based Research in Alternative and Complementary Palliative Treatments

Directory of Open Access Journals (Sweden)

Francesco Chiappelli

2005-01-01

Full Text Available The terms ‘mucositis’ and ‘stomatitis’ are often used interchangeably. Mucositis, however, pertains to pharyngeal-esophago-gastrointestinal inflammation that manifests as red, burn-like sores or ulcerations throughout the mouth. Stomatitis is an inflammation of the oral tissues proper, which can present with or without sores, and is made worse by poor dental hygiene. Mucositis is observed in a variety of immunosuppressed patients, but is most often consequential to cancer therapy. It appears as early as the third day of intervention, and is usually established by Day 7 of treatment. Mucositis increases mortality and morbidity and contributes to rising health care costs. The precise immune components involved in the etiology of mucositis are unclear, but evidence-based research (EBR data has shown that applications of granulocyte–macrophage-colony stimulating factor prevent the onset or the exacerbation of oropharyngeal mucositis. The molecular implications of this observation are discussed from the perspective of future developments of complementary and alternative treatments for this condition. It must be emphasized that this article is meant to be neither a review on mucositis and the various treatments for it, nor a discussion paper on its underlying molecular immunology. It is a statement of the implications of EBR for CAM-based interventions for mucositis. It explores and discusses the specific domain of molecular immunology in the context of mucositis and its direct implications for EBR research in CAM-based treatments for mucositis.

Organic Farming as a Strategy for Climate Change Adaptation and ...

African Journals Online (AJOL)

For climate change adaptation, OF systems have a strong potential for building resilient food systems through farm diversification and building soil fertility with organic matter. In developing countries, OF offers alternatives to energy-intensive production inputs such as synthetic fertilizers which are limited for poor rural ...

Pregnancy- and lactation-associated osteoporosis with severe vertebral deformities: can strontium ranelate be a new alternative for the treatment?

Science.gov (United States)

Tanriover, Mine Durusu; Oz, S Gul; Sozen, Tumay; Kilicarslan, Alpaslan; Guven, Gulay Sain

2009-04-01

Pregnancy- and lactation-associated osteoporosis is an uncommon condition that may be a consequence of preexisting low bone density, loss of bone mineral content during pregnancy, and increased bone turnover. To present a case of severe osteoporosis associated with pregnancy and lactation and its treatment protocol. A tertiary care hospital. A young female after twin pregnancy presenting with severe osteoporosis. The diagnosis was done on the basis of bone mineral density (BMD) measurement. The patient was treated with first alendronate and then strontium ranelate. She was considered as a candidate for kyphoplasty. A dramatic increase in the BMD and palliation of back pain were observed. Strontium ranelate may be a new alternative in the treatment of pregnancy- and lactation-associated osteoporosis.

[A magnetic therapy apparatus with an adaptable electromagnetic spectrum for the treatment of prostatitis and gynecopathies].

Science.gov (United States)

Kuz'min, A A; Meshkovskiĭ, D V; Filist, S A

2008-01-01

Problems of engineering and algorithm development of magnetic therapy apparatuses with pseudo-random radiation spectrum within the audio range for treatment of prostatitis and gynecopathies are considered. A typical design based on a PIC 16F microcontroller is suggested. It includes a keyboard, LCD indicator, audio amplifier, inducer, and software units. The problem of pseudo-random signal generation within the audio range is considered. A series of rectangular pulses is generated on a random-length interval on the basis of a three-component random vector. This series provides the required spectral characteristics of the therapeutic magnetic field and their adaptation to the therapeutic conditions and individual features of the patient.

Perception of chloroquine efficacy and alternative treatments for uncomplicated malaria in children in a holoendemic area of Tanzania: implications for the change of treatment policy

DEFF Research Database (Denmark)

Tarimo, D S; Minjas, J N; Bygbjerg, I C

2001-01-01

Prior to policy change from chloroquine (CQ) to sulphadoxine/pyrimethamine (S/P; Fansidar) we assessed the perception of CQ efficacy and the alternative treatment options for malaria in children among parents/guardians (N=527) of under-fives attending first level health facilities on account...... of fever. It was hypothesized that the long experience with CQ and its antipyretic effect (lacking in S/P) might impede acceptance of S/P for wider use as first-line drug. Malarial fevers in children were most commonly treated with CQ (92.8%), followed by quinine (60.7%) and S/P (28.7%). A 63.2% knew...

Alternative Work Schedules Increase Employee Satisfaction.

Science.gov (United States)

Turney, John R.; Cohen, Stanley L.

1983-01-01

Facets of alternative work schedules (AWS) are discussed: importance of employee control, possible negative consequences, AWS handbook, time monitoring systems, and treatment of exceptions. AWS' effect on productivity and motivation is examined. (SK)

The irradiation as alternative treatment for laboratory wastes; A irradiacao como alternativa de tratamento para residuos de laboratorio

Energy Technology Data Exchange (ETDEWEB)

Borrely, Sueli Ivone; Romanelli, Maria Fernanda; Silva, Giovana Pasqualini da; Castro, Daniela Marques [Instituto de Pesquisas Energeticas e Nucleares (IPEN), Sao Paulo, SP (Brazil)]. E-mail: sborrely@ipen.br

2005-07-01

The irradiation of effluents may be done by electron accelerator or gamma radiation source (cobalt-60). This technology has been developed as an alternative for several contaminants from different processes and sources. This paper shows the results of electron beam applied to liquid laboratories residues (effluents and standard solutions). Radiation doses were determined for the improvement of laboratories residues measured by detoxification of them. New technologies for residues treatment as well as decreasing contaminants generation is essential part of laboratories activities for environmental management for industry, universities and research institutions. (author)

Genetic basis of growth adaptation of Escherichia coli after deletion of pgi, a major metabolic gene.

Directory of Open Access Journals (Sweden)

Pep Charusanti

2010-11-01

Full Text Available Bacterial survival requires adaptation to different environmental perturbations such as exposure to antibiotics, changes in temperature or oxygen levels, DNA damage, and alternative nutrient sources. During adaptation, bacteria often develop beneficial mutations that confer increased fitness in the new environment. Adaptation to the loss of a major non-essential gene product that cripples growth, however, has not been studied at the whole-genome level. We investigated the ability of Escherichia coli K-12 MG1655 to overcome the loss of phosphoglucose isomerase (pgi by adaptively evolving ten replicates of E. coli lacking pgi for 50 days in glucose M9 minimal medium and by characterizing endpoint clones through whole-genome re-sequencing and phenotype profiling. We found that 1 the growth rates for all ten endpoint clones increased approximately 3-fold over the 50-day period; 2 two to five mutations arose during adaptation, most frequently in the NADH/NADPH transhydrogenases udhA and pntAB and in the stress-associated sigma factor rpoS; and 3 despite similar growth rates, at least three distinct endpoint phenotypes developed as defined by different rates of acetate and formate secretion. These results demonstrate that E. coli can adapt to the loss of a major metabolic gene product with only a handful of mutations and that adaptation can result in multiple, alternative phenotypes.

[Transcultural adaptation of scales for treatment adherence in hemodialysis: Renal Adherence Behaviour Questionnaire(RABQ) and Renal Adherence Attitudes Questionnaire(RAAQ)].

Science.gov (United States)

Machado, Inês Maria de Jesus; Bandeira, Marina Bittencourt; Pinheiro, Hélady Sanders; Dutra, Nathália Dos Santos

2015-10-01

Treatment adherence in hemodialysis is important for guaranteeing better results for patients, but Brazil still lacks validated assessment tools for this purpose. The current study aimed to perform a cross-cultural adaptation of the Renal Adherence Behaviour Questionnaire (RABQ) and the Renal Adherence Attitudes Questionnaire (RAAQ). The two questionnaires were submitted to the following cross-cultural adaptation procedures: translation, back-translation, expert panel review, and pilot study. Changes were made in the items' wording and application, which requires a face-to-face interview. It was not necessary to change the choices of answers. The Brazilian versions of the RABQ and RAAQ showed semantic and cultural equivalence to the original versions and are easy for the target population to understand. The two scales still require validity and reliability studies before use in the field.

Preliminary matrix model for quantifying and balancing the socio-economic impact of alternative cooling system technologies for nuclear power plants

International Nuclear Information System (INIS)

Cleary, D.P.; Salomon, S.N.; Pollnow, L.A.; Spangler, M.B.

1976-01-01

Assessment of environmental, including socio-economic, impacts of alternative technologies or courses of action is made difficult by the inability to adequately quantify the impacts. Matrix methods offer a set of techniques which allows the analyst to compare the relative impacts of alternative technologies or actions. Work is underway to develop and adapt these techniques to be used in assessing the environmental impacts of alternative cooling systems, and other alternative technological and siting options

Adaptation in integrated assessment modeling: where do we stand?

OpenAIRE

Patt, A.; van Vuuren, D.P.; Berkhout, F.G.H.; Aaheim, A.; Hof, A.F.; Isaac, M.; Mechler, R.

2010-01-01

Adaptation is an important element on the climate change policy agenda. Integrated assessment models, which are key tools to assess climate change policies, have begun to address adaptation, either by including it implicitly in damage cost estimates, or by making it an explicit control variable. We analyze how modelers have chosen to describe adaptation within an integrated framework, and suggest many ways they could improve the treatment of adaptation by considering more of its bottom-up cha...

Adaptation of slow myofibers: the effect of sustained BDNF treatment of extraocular muscles in infant nonhuman primates.

Science.gov (United States)

Willoughby, Christy L; Fleuriet, Jérome; Walton, Mark M; Mustari, Michael J; McLoon, Linda K

2015-06-01

We evaluated promising new treatment options for strabismus. Neurotrophic factors have emerged as a potential treatment for oculomotor disorders because of diverse roles in signaling to muscles and motor neurons. Unilateral treatment with sustained release brain-derived neurotrophic factor (BDNF) to a single lateral rectus muscle in infant monkeys was performed to test the hypothesis that strabismus would develop in correlation with extraocular muscle (EOM) changes during the critical period for development of binocularity. The lateral rectus muscles of one eye in two infant macaques were treated with sustained delivery of BDNF for 3 months. Eye alignment was assessed using standard photographic methods. Muscle specimens were analyzed to examine the effects of BDNF on the density, morphology, and size of neuromuscular junctions, as well as myofiber size. Counts were compared to age-matched controls. No change in eye alignment occurred with BDNF treatment. Compared to control muscle, neuromuscular junctions on myofibers expressing slow myosins had a larger area. Myofibers expressing slow myosin had larger diameters, and the percentage of myofibers expressing slow myosins increased in the proximal end of the muscle. Expression of BDNF was examined in control EOM, and observed to have strongest immunoreactivity outside the endplate zone. We hypothesize that the oculomotor system adapted to sustained BDNF treatment to preserve normal alignment. Our results suggest that BDNF treatment preferentially altered myofibers expressing slow myosins. This implicates BDNF signaling as influencing the slow twitch properties of EOM.

Beyond conventional antibiotics for the future treatment of methicillin-resistant Staphylococcus aureus infections: two novel alternatives.

LENUS (Irish Health Repository)

Fitzgerald-Hughes, Deirdre

2012-08-01

The majority of antibiotics currently used to treat methicillin-resistant Staphylococus aureus (MRSA) infections target bacterial cell wall synthesis or protein synthesis. Only daptomycin has a novel mode of action. Reliance on limited targets for MRSA chemotherapy, has contributed to antimicrobial resistance. Two alternative approaches to the treatment of S. aureus infection, particularly those caused by MRSA, that have alternative mechanisms of action and that address the challenge of antimicrobial resistance are cationic host defence peptides and agents that target S. aureus virulence. Cationic host defence peptides have multiple mechanisms of action and are less likely than conventional agents to select resistant mutants. They are amenable to modifications that improve their stability, effectiveness and selectivity. Some cationic defence peptides such as bactenecin, mucroporin and imcroporin have potent in vitro bactericidal activity against MRSA. Antipathogenic agents also have potential to limit the pathogenesis of S aureus. These are generally small molecules that inhibit virulence targets in S. aureus without killing the bacterium and therefore have limited capacity to promote resistance development. Potential antipathogenic targets include the sortase enzyme system, the accessory gene regulator (agr) and the carotenoid biosynthetic pathway. Inhibitors of these targets have been identified and these may have potential for further development.