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Sample records for adjusted clinical group

  1. Quantifying morbidities by Adjusted Clinical Group system for a Taiwan population: A nationwide analysis

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    Lee Wui-Chiang

    2008-07-01

    Full Text Available Abstract Background The Adjusted Clinical Group (ACG system has been used in measuring an individual's and a population's morbidities. Although all required inputs for running the ACG system are readily available, patients' morbidities and their associations to health care utilizations have been rarely studied in Taiwan. Therefore, the objective of this study was using the ACG system to quantify morbidities for Taiwanese population and to examine their relationship to ambulatory utilizations and costs. Methods This secondary analysis examined claims data for ambulatory services provided to 2.71 million representative Taiwanese in 2002 and 2003. People were grouped by the ACG system according to age, gender, and all ambulatory diagnosis codes in a given year. The software collapses the full set of ACGs into six morbidity categories (Non-users, Healthy, Low-morbidity, Moderate-, High- and Very-high termed Resource Utilization Bands (RUBs. Each ACG was assigned a relative weight (RW, which was calculated as the ratio of mean ambulatory cost for each ACG to that for the overall. The distribution of morbidities was compared between years 2002 and 2003. The consistency of the distributions of visits, costs, and RWs of each ACG were examined for a two-year period. The relationship between people's morbidities and their ambulatory utilizations and costs was assessed. Results Ninety-eight percent of the subjects were correctly assigned to ACGs. Except for non-users (7.9 ~ 8.3%, most subjects were assigned to ACGs of acute and minor diseases and ACGs of moderate-to-high-morbid chronic diseases. The distributions of ACG-based morbidities were highly consistent (r = 0.949, p between 2002 and 2003. The ACG-specific visits (r = 0.955, p , costs (r = 0.966, p and RWs (r = 0.991, p were correlated across two years. People grouped to the high-morbid ACGs had more visits and costs than those grouped to the low-morbid ACGs. Forty-six percent of the total

  2. Los adjusted clinicals groups: Un sistema de clasificación de pacientes por ajuste de riesgos

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    Antonio Sicras-Mainar

    2013-06-01

    Full Text Available Los Adjusted Clinical Groups (ACG son un sistema de ajuste de riesgos que clasifica a las personas según su edad y sexo y las condiciones médicas que presentan, y estas personas tienen un consumo similar de recursos sanitarios durante un periodo. Fueron desarrollados por Starfield y Weiner (Universidad Johns Hopkins, EE. UU. 1991, y su objetivo es medir el grado de enfermedad en poblaciones de pacientes basándose en sus niveles de comorbilidad. Entre sus principales aplicaciones destacan: a evaluar la eficiencia en la utilización de los servicios sanitarios, b medir la comorbilidad de la población, y c programar la financiación o pago capitativo para grupos de proveedores. Entre las ventajas del sistema ACG destaca la necesidad de un número limitado de variables para cada paciente (edad, sexo y diagnósticos y que la unidad de medida es el paciente. Se comentan algunas características de este sistema de ajuste de riesgos poblacionales.

  3. Medida de los pesos relativos del coste de la asistencia como efecto de la aplicación retrospectiva de los adjusted clinical groups en atención primaria Measurement of relative cost weights as an effect of the retrospective application of adjusted clinical groups in primary care

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    Antoni Sicras-Mainar

    2006-03-01

    Full Text Available Objetivo: El objeto del estudio es obtener los pesos relativos medios de los costes de la asistencia con la aplicación retrospectiva de los adjusted clinical groups (ACG en población atendida por equipos de atención primaria en situación de práctica clínica habitual. Métodos: Estudio descriptivo de carácter retrospectivo. Fueron incluidos en el estudio todos los pacientes atendidos por 4 equipos de atención primaria durante el año 2003. Las principales mediciones fueron: variables universales (edad y sexo, dependientes (visitas y costes y de casuística o comorbilidad. El modelo de costes para cada paciente se estableció diferenciando los costes fijos y los variables. Se efectuó un análisis de regresión lineal múltiple para la predicción de los modelos. El coste relativo de cada ACG se obtuvo dividiendo el coste medio de cada categoría entre el coste medio de toda la población de referencia. Resultados: El número total de pacientes estudiados fue de 62.311 (intensidad de uso del 76,7%, con una media de 4,8 ± 3,2 episodios y 7,8 ± 7,5 visitas/paciente/año. La distribución de los costes fue de 24.135.236,41 €, el 28,9% fijos. El coste unitario total por visita/año fue de 49,62 ± 24,71 € y el promedio paciente/año de 387,34 ± 145,87 € (pesos relativos de referencia. El poder explicativo de la clasificación ACG fue del 50,1% en las visitas y del 54,9% para los costes totales. Conclusiones: Los ACG se muestran como un aceptable sistema de clasificación de pacientes en situación de práctica clínica habitual. De confirmarse los resultados posibilitarían una mejora en la aplicación práctica de los ACG como una posible herramienta para la gestión clínica en los centros de atención primaria.Objective: The objective of the study is to obtain the cost's relative average weights of the assistance with the retrospective application of the Adjusted Clinical Groups (ACG's in four teams of Primary Care with an attended

  4. Variability in prescription drug expenditures explained by adjusted clinical groups (ACG case-mix: A cross-sectional study of patient electronic records in primary care

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    Serrat Josep

    2008-03-01

    Full Text Available Abstract Background In view of rapidly increasing prescription costs, case-mix adjustment should be considered for effective control of costs. We have estimated the variability in pharmacy costs explained by ACG in centers using patient electronic records, profiled centers and physicians and analyzed the correlation between cost and quality of prescription. Methods We analyzed 65,630 patient records attending five primary care centers in Spain during 2005. Variables explored were age, gender, registered diagnosed episodes of care during 2005, total cost of prescriptions, physician and center. One ACG was assigned to each patient with ACG case-mix software version 7.1. In a two-part model, logistic regression was used to explain the incurrence of drug expenditure at the first stage and a linear mixed model that considered the multilevel structure of data modeled the cost, conditional upon incurring any expense. Risk and efficiency indexes in pharmacy cost adjusted for ACG were obtained for centers and physicians. Spearman rank correlation between physician expenditure, adjusted for ACG, and a prescription quality index was also obtained. Pediatric and adult data were analyzed separately. Results No prescription was recorded for 13% of adults and 39.6% of children. The proportion of variance of the incurrence of expenditure explained by ACGs was 0.29 in adults and 0.21 in children. For adults with prescriptions, the variance of cost explained by ACGs was 35.4%, by physician-center was 1.8% and age 10.5% (residual 52.3%. For children, ACGs explained 22.4% of cost and physician-center 10.9% (residual 66.7%. Center efficiency index for adults ranged 0.58 to 1.22 and for children 0.32 to 2.36. Spearman correlation between expenditure and prescription quality index was -0.36 in family physicians (p = 0.019, N = 41 and -0.52 in pediatricians (p = 0.08, N = 12. Conclusion In our setting, ACG is the variable studied that explains more variability in

  5. Effects of Divorce Counseling Groups on Adjustment and Self Concept.

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    Salts, Connie J.; Zongker, Calvin E.

    1983-01-01

    Tested whether self-concept and adjustment of separated or divorced individuals (N=64) could be enhanced by group counseling. Data showed individuals in either a structured or unstructured group had greater improvement in adjustment than individuals who dropped out. No significant differences in improvement in self-concept were noted. (JAC)

  6. Nonverbal Interventions in Clinical Groups.

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    Shadish, William R., Jr.

    1980-01-01

    A comparison of nonverbal with verbal clinical group interventions suggested that some traditional self-report devices show less differentiation between these two interventions than do measures of group cohesion. A strong, replicable manipulation tested these findings, which were consistent with previous research. (Author/BEF)

  7. Predicting Eating Disorder Continuum Groups: Hardiness and College Adjustment.

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    Simon-Boyd, Gail D.; Bieschke, Kathleen J.

    This study examined relationships between hardiness, college adjustment (academic adjustment, social adjustment, personal-emotional adjustment, institutional attachment) and eating disorder (ED) continuum categories in 122 female and 20 male college students. Students who exhibited a higher level of personal-emotional adjustment (PEA) to college…

  8. Banding together: an investigation of post-surgery support groups for laparoscopic adjustable gastric banding patients

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    Melissa Opolski

    2014-09-01

    Full Text Available Though advocated as useful for patients, there is little in the literature regarding the use and effectiveness of bariatric support groups. This study investigated characteristics and experiences of bariatric patients who did and did not attend offered groups. Seventy-eight postoperative laparoscopic adjustable gastric banding patients from a private bariatric clinic completed mailed self-report questionnaires. Almost 60% reported having attended the clinic groups, with most wanting to meet other patients and obtain information rather than access psychological assistance. Participants reported generally positive experiences of attending. Nonattendance was often attributed to practical barriers. Satisfaction with support from others was not related to past or predicted future attendance, but higher psychological distress was related to and predictive of greater intention to attend future groups. Likely future attenders also held more positive beliefs about the groups than those who were unlikely to attend. Further research is required into potential positive and negative consequences of attendance, and characteristics of those who are likely to benefit or be harmed by attending. Interventions addressing stereotypes about support groups may help patients make informed decisions about whether to attend a bariatric support group.

  9. Group size adjustment to ecological demand in a cooperative breeder

    OpenAIRE

    Zöttl, Markus; Frommen, Joachim G.; Taborsky, Michael

    2013-01-01

    Environmental factors can determine which group size will maximize the fitness of group members. This is particularly important in cooperative breeders, where group members often serve different purposes. Experimental studies are yet lacking to check whether ecologically mediated need for help will change the propensity of dominant group members to accept immigrants. Here, we manipulated the perceived risk of predation for dominant breeders of the cooperatively breeding cichlid fish Neolampro...

  10. Adjusting to living with multiple sclerosis: The role of social groups.

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    Tabuteau-Harrison, Sophie L; Haslam, Catherine; Mewse, Avril J

    2016-01-01

    Multiple sclerosis (MS) is typically associated with life-long adjustment to wide-ranging, changeable symptoms and psychosocial disruption as all relationships are changed or lost. Despite accumulating evidence, the therapeutic impact of harnessing social group factors in MS management and rehabilitation remains largely unexplored. We investigated their role specific to adjusting to MS. A qualitative approach was used with thematic analysis to induce a rich and developing account of the impact of social groups on adjustment for 15 individuals with MS. An adjustment questionnaire was used to provide a framework for its organisation and discussion. The analysis revealed three themes associated with loss, change and social processes that influenced adjustment. These features distinguished between those who were more or less able to adjust, and resonated well with processes previously identified as central to identity loss and change. Social factors enhanced adjustment through easing transition between pre- and post-MS diagnosis lives. Notably, maintenance of pre-existing social roles and relationships was critical in providing a meaningful basis for integrating the old with new senses of self. The capacity to join new social groups was as key in adjustment as was awareness of having access to multiple social groups to avoid being solely defined by MS. These concepts provided a more stable grounding upon which to nurture value systems and employ collective support to counter the negative consequences of living with MS.

  11. Evaluation of a Group Counseling Program Designed to Enhance Social Adjustment of Mentally Retarded Adults

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    Lee, Dong Yul

    1977-01-01

    Moderately retarded institutionalized residents received 10 weeks of structured group counseling focused on five areas of social and personal adjustment. Results showed that in each of the above variables, the experimental group showed a greater mean score than that of the control group. (Author)

  12. Assessing clinical competency: reports from discussion groups.

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    Turnwald, Grant; Stone, Elizabeth; Bristol, David; Fuentealba, Carmen; Hardie, Lizette; Hellyer, Peter; Jaeger, Laurie; Kerwin, Sharon; Kochevar, Deborah; Lissemore, Kerry; Olsen, Christopher; Rogers, Kenita; Sabin, Beth; Swanson, Cliff; Warner, Angeline

    2008-01-01

    This report describes proposed new models for assessment of eight of the nine clinical competencies the American Veterinary Medical Association Council on Education requires for accreditation. The models were developed by discussion groups at the Association of American Veterinary Medical Colleges' Clinical Competency Symposium. Clinical competencies and proposed models (in parentheses) are described. Competency 1: comprehensive patient diagnosis (neurologic examination on a dog, clinical reasoning skills); Competency 2: comprehensive treatment planning (concept mapping, computerized case studies); Competency 3: anesthesia, pain management (student portfolio); Competency 4: surgery skills (objective structured clinical examination, cased-based examination, "super dog" model); Competency 5: medicine skills (clinical reasoning and case management, skills checklist); Competency 6: emergency and intensive care case management (computerized case study or scenario); Competency 7: health promotion, disease prevention/biosecurity (360 degrees evaluation, case-based computer simulation); Competency 8: client communications and ethical conduct (Web-based evaluation forms, client survey, communicating with stakeholders, telephone conversation, written scenario-based cases). The report also describes faculty recognition for participating in clinical competency assessments.

  13. Neurally adjusted ventilatory assist : from animal studies to clinical practice

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    Campoccia Jalde, Francesca

    2016-01-01

    Patients in the Intensive Care Unit (ICU) undergoing ventilator treatment may experience asynchrony with the ventilator, which has been associated with increased need of sedation, sleep disruption, prolonged mechanical ventilation and unsuccessful weaning from the ventilator. The search for new strategies to improve patient-ventilator interaction is ongoing. Neurally Adjusted Ventilatory Assist (NAVA) is a recently developed ventilator support that uses the Electrical Activity of the diaphrag...

  14. Effect of Internet peer-support groups on psychosocial adjustment to cancer

    DEFF Research Database (Denmark)

    Høybye, Mette Terp; Dalton, S O; Deltour, I;

    2010-01-01

    BACKGROUND: We conducted a randomised study to investigate whether providing a self-guided Internet support group to cancer patients affected mood disturbance and adjustment to cancer. METHODS: Baseline and 1-, 6- and 12-month assessments were conducted from 2004 to 2006 at a national rehabilitat...

  15. Asian College Students’ Perceived Peer Group Cohesion, Cultural Identity, and College Adjustment

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    Zhao, Xin

    2012-01-01

    Despite the increase in Asian college student population, this group remains one of the most understudied, due to the myth of “model minority.” Many Asian students adjust well academically but often experience high levels of stress, anxiety, or depression due to factors such as acculturation to Western culture, pressure from parents to succeed, ethnic identity issues, intergenerational conflict, immigration status, racism, and discrimination. This study examined the role of five dimensions of...

  16. Adjustment to cancer: exploring patients' experiences of participating in a psychodramatic group intervention.

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    Menichetti, J; Giusti, L; Fossati, I; Vegni, E

    2016-09-01

    The main purpose of the present study was to understand the subjective experience of patients adjusting to cancer by focusing on how that experience might be affected by participating in a psychodramatic group intervention. In-depth interviews using an interpretative-phenomenological approach were conducted with eight cancer patients involved in a psychodrama group. Four key themes were identified: (1) outside and inside relationships; (2) identities: nurturing other selves; (3) a feelings' gym: performing the internal world; and (4) many ends: mourning death and dying. Participation in cancer group using a psychodramatic approach provided positive results. In detail, the group setting: (1) favoured relationships in which it was possible to freely express oneself and (2) empowered patients in their feelings of being able to give and receive help; the psychodramatic approach: (1) supported the physical mobilisation of sense of agency and (2) permitted to deal with the grieving process. Cancer healthcare pathways would benefit from psychotherapeutic programmes using a similar approach, since psychodrama by actively involving body seems to works on areas that are often underwhelmed by other approaches, such as (i.e., physical mobilisation, body engagement, grieving adjustment). Psychodrama supports patients to achieve insights into their own possibilities to actively participate in their own life situations despite having cancer and undergoing treatment for it.

  17. Adjustment to cancer: exploring patients' experiences of participating in a psychodramatic group intervention.

    Science.gov (United States)

    Menichetti, J; Giusti, L; Fossati, I; Vegni, E

    2016-09-01

    The main purpose of the present study was to understand the subjective experience of patients adjusting to cancer by focusing on how that experience might be affected by participating in a psychodramatic group intervention. In-depth interviews using an interpretative-phenomenological approach were conducted with eight cancer patients involved in a psychodrama group. Four key themes were identified: (1) outside and inside relationships; (2) identities: nurturing other selves; (3) a feelings' gym: performing the internal world; and (4) many ends: mourning death and dying. Participation in cancer group using a psychodramatic approach provided positive results. In detail, the group setting: (1) favoured relationships in which it was possible to freely express oneself and (2) empowered patients in their feelings of being able to give and receive help; the psychodramatic approach: (1) supported the physical mobilisation of sense of agency and (2) permitted to deal with the grieving process. Cancer healthcare pathways would benefit from psychotherapeutic programmes using a similar approach, since psychodrama by actively involving body seems to works on areas that are often underwhelmed by other approaches, such as (i.e., physical mobilisation, body engagement, grieving adjustment). Psychodrama supports patients to achieve insights into their own possibilities to actively participate in their own life situations despite having cancer and undergoing treatment for it. PMID:26515989

  18. New approach to the adjustment of group cross-sections fitting integral measurements

    International Nuclear Information System (INIS)

    The adjustment of group cross-sections fitting integral measurements is viewed as a process of uncovering theoretical and/or experimental negligence errors to bring statistical consistency to the integral and differential data so that they can be combined to form an enlarged ensemble, on which an improved estimation of the physical constants can be based. An approach with three steps is suggested, and its formalism of general validity is developed. In step one, the data of negligence error are extracted from the given integral and differential data. The method of extraction is based on the concepts of prior probability and information entropy. It automatically leads to vanishing negligence error as the two sets of data are statistically consistent. The second step is to identify the sources of negligence error and adjust the data by an amount compensating the extracted negligence discrepancy. In the last step the two data sets, already adjusted to mutual consistency, are combined as a single unified ensemble. Standard methods of statistics can then be applied to re-estimate the physical constants. A simple example is shown as a demonstration of the method. 1 figure

  19. Nurses' experiences of clinical commissioning group boards.

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    Allan, Helen; O'Driscoll, Mike; Savage, Jan; Lee, Gay; Dixon, Roz

    2016-06-15

    Aim To explore the experience of governing body nurses appointed to clinical commissioning group (CCG) boards; how they perform their responsibilities; and their perceived effectiveness in ensuring safe, patient-centred care and the factors that influence their effectiveness. Method This was a small pilot study using a mixed methods approach. There were four phases of the study: literature review, qualitative data collection (interviews), quantitative data collection (survey), and final data analysis. Findings In the early stages of the formation of CCGs, few governing body nurses had relevant experience to meet the needs of a strategic role, and many of these nurses had no proper job description, too little time to carry out their responsibilities, little management support, and unequal access to training, development, formal support or supervision compared to GP colleagues. Two working patterns or models of work of governing body nurses emerged: the full-time integrated executive statutory role and the part-time non-executive statutory role. Quality and quality assurance were the most frequently cited roles or responsibilities of governing body nurses in CCGs, and their highest priority was to improve the population's health. Conclusion The role of governing body nurse has emerged at a time of organisational change, and following extensive criticism of nursing and nurses in the media. Nurses' roles and experiences are affected by these contextual events and by the emerging structures and diversity of CCGs. Further research is required into the leadership role of governing body nurses, succession planning, and the effectiveness of their relationships with other senior nurses. PMID:27305258

  20. Drug Dose Adjustment in Dialysis Patients Admitted in Clinics Other Than Internal Medicine.

    Science.gov (United States)

    Solak, Yalcin; Biyik, Zeynep; Gaipov, Abduzhappar; Kayrak, Mehmet; Ciray, Hilal; Cizmecioglu, Ahmet; Tonbul, Halil Zeki; Turk, Suleyman

    2016-01-01

    Many drugs that are administered during hospitalization are metabolized or excreted through kidneys, consequently require dosage adjustment. We aimed to investigate inappropriate prescription of drugs requiring renal dose adjustment (RDA) in various surgical and medical inpatient clinics. We retrospectively determined dialysis patients hospitalized between January 2007 and December 2010. Inpatient clinics, including cardiology, pulmonary medicine, neurology, infectious diseases (medical clinics) and cardiovascular surgery, orthopedics, general surgery, obstetrics and gynecology, and neurosurgery (surgical clinics), were screened via electronic database. Total and RDA medications were determined. RDA drugs correctly adjusted to creatinine clearance were labeled as RDA-A (appropriate), otherwise as RDA-I (inappropriate). Renal doses of RDA medications were based on the "American College of Physicians Drug Prescribing in Renal Failure, fifth Edition." Two hundred seventeen hospitalization records of 172 dialysis patients (92 men and 80 women) were included in the analysis. Mean age of patients was 59.4 ± 14.6 years, and the mean hospitalization duration was 8.5 ± 7.8 days. In total, 247 (84.3%, percentage in drugs requiring dose adjustment) and 175 (46.2%) drugs have been inadequately dosed in surgical and medical clinics, respectively. The percentage of patients to whom at least 1 RDA-I drug was ordered was 92% and 91.4% for surgical and medical clinics, respectively (P > 0.05). Nephrology consultation numbers were 8 (7.1%) in surgical and 32 (30.4%) in medical clinics. The most common RDA-I drugs were aspirin and famotidine. A significant portion of RDA drugs was ordered inappropriately both in surgical and medical clinics. Nephrology consultation rate was very low. Measures to increase physician awareness are required to improve results.

  1. Psychosocial adjustment among patients with ostomy: a survey in stoma clinics, Nepal

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    Gautam S

    2016-08-01

    Full Text Available Sital Gautam,1 Surya Koirala,2 Anju Poudel,1 Dipak Paudel,3 1Department of Nursing, Nepal Medical College, 2Department of Nursing, Institute of Medicine, Tribhuvan University, Nursing Campus Maharajgunj, 3Department of Medicine, People’s Medical College, Kathmandu, Nepal Background: Ostomy changes the overall lifestyle of a person, and ostomates have been identified as a chronic illness population frequently experiencing adjustment problems. Purpose: The aim of this study was to determine the psychosocial adjustment and its predictors among patients with ostomy in Nepal. Patients and methods: A descriptive cross-sectional study was conducted in two stoma clinics of Nepal. Patients who had a colostomy, ileostomy, or urostomy, visited the selected stoma clinics during the data collection period, and who had ostomy for at least 6 months before data collection were included in the study. A total of 130 patients were included in this study. Data on sociodemographic and clinical variables were collected. Psychosocial adjustment score was measured using Ostomy Adjustment Inventory-23. Results: A total of 130 patients (80 males and 50 females were included in the study. The mean age of the patients was 51 years, ranging from 23 to 78 years. The study findings revealed that mean ±SD adjustment score was 41.49±13.57, indicating moderate impairment in the psychosocial adjustment among ostomates, and the mean ±SD scores of acceptance, anxious preoccupation, social engagement, and anger were 22.01±6.99, 8.75±3.89, 5.38±3.41, 5.35±1.62, respectively. Four variables contributed significantly to the final model, explaining 46.8% of variance in the psychosocial adjustment score (R2 =0.468, F(4, 125 =27.53, P<0.001. Perceived lack of family support (β=−0.367, P<0.001, total dependence on others to care for ostomy (ß=−0.357, P<0.001, and unemployment (ß=−0.144, P=0.032 significantly predicted lower psychosocial adjustment scores. However

  2. Evaluation and Comparison of Individual and Group Sports in the Social Adjustment of Students

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    Seyed Hossein Mousavi

    2012-01-01

    Full Text Available Due to the role of sports in youth social adjustment and social skills in their interpersonal relationships and social skills associated with academic achievement and their role in reducing mental and psychological problems ,we conducted this study to examine the role of physical activity in different sport fields. In order to compare the social skills of male students participating in the team and individual sports in Islamic Azad University of Zanjan, we chose 30 randomly as the sample size. In order to gather information, two questionnaires-i-e-demographic questionnaire and social skills questionnaire (social adjustment section Albert J. Petitpas F (2004 with a reliability of 0.90 were used. For data analysis, descriptive statistics and T-test were used. Results showed significant differences between team and individual sports athletes with the soccer ranking higher than the rest of the field. Gymnastics athletes would have better social adjustment than the rest of athletes and the rowing athletes had less social adjustment, but this difference was not statistically significant and the results showed no significant relationship between age and marital status with the Social Adjustment. The results of this study confirm a considerable effect of team sports on levels of social adjustment compared with individual sports.

  3. Towards individualized dose constraints: Adjusting the QUANTEC radiation pneumonitis model for clinical risk factors

    DEFF Research Database (Denmark)

    Appelt, Ane L; Vogelius, Ivan R.; Farr, Katherina P.;

    2014-01-01

    factors, in order to enable individual risk prediction. The approach is validated in an independent dataset. Material and methods. The prevalence of risk factors in the patient populations underlying the QUANTEC analysis was estimated, and a previously published method to adjust dose......-response relationships for clinical risk factors was employed. Effect size estimates (odds ratios) for risk factors were drawn from a recently published meta-analysis. Baseline values for D50 and γ50 were found. The method was tested in an independent dataset (103 patients), comparing the predictive power of the dose......Background. Understanding the dose-response of the lung in order to minimize the risk of radiation pneumonitis (RP) is critical for optimization of lung cancer radiotherapy. We propose a method to combine the dose-response relationship for RP in the landmark QUANTEC paper with known clinical risk...

  4. Attachment disorganization in different clinical groups: What underpins unresolved attachment?

    OpenAIRE

    Juen Florian; Arnold Lisa; Meissner Dominik; Nolte Tobias; Buchheim Anna

    2013-01-01

    This paper summarizes findings and clinical implications of research on attachment disorganization in diverse clinical groups. Disorganized/unresolved attachment is overrepresented in these groups compared to healthy control participants, but disorder specific characteristics of this attachment pattern are still poorly understood. The focus of this study was to explore defensive processes in participants whose narratives were classified as disorganized/unresolved using the Adult Attach...

  5. Rejection, Feeling Bad, and Being Hurt: Using Multilevel Modeling to Clarify the Link between Peer Group Aggression and Adjustment

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    Rulison, Kelly L.; Gest, Scott D.; Loken, Eric; Welsh, Janet A.

    2010-01-01

    The association between affiliating with aggressive peers and behavioral, social and psychological adjustment was examined. Students initially in 3rd, 4th, and 5th grade (N = 427) were followed biannually through 7th grade. Students' peer-nominated groups were identified. Multilevel modeling was used to examine the independent contributions of…

  6. When Parents Divorce: Assisting Teens to Adjust through a Group Approach.

    Science.gov (United States)

    Studer, Jeannine R.; Allton, Judith A.

    1996-01-01

    Addresses factors that contribute to the adjustment difficulties of children and adolescents when their parents divorce. Gender issues, custody, age, parenting style, visitation patterns, socioeconomic considerations, the support system, family size, and the reconstituted family are all discussed. Describes a model for an effective support group…

  7. Evaluation and Comparison of Individual and Group Sports in the Social Adjustment of Students

    OpenAIRE

    Seyed Hossein Mousavi

    2012-01-01

    Due to the role of sports in youth social adjustment and social skills in their interpersonal relationships and social skills associated with academic achievement and their role in reducing mental and psychological problems ,we conducted this study to examine the role of physical activity in different sport fields. In order to compare the social skills of male students participating in the team and individual sports in Islamic Azad University of Zanjan, we chose 30 randomly as the sample size...

  8. The application of the Ten Group classification system (TGCS in caesarean delivery case mix adjustment. A multicenter prospective study.

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    Gianpaolo Maso

    Full Text Available BACKGROUND: Caesarean delivery (CD rates are commonly used as an indicator of quality in obstetric care and risk adjustment evaluation is recommended to assess inter-institutional variations. The aim of this study was to evaluate whether the Ten Group classification system (TGCS can be used in case-mix adjustment. METHODS: Standardized data on 15,255 deliveries from 11 different regional centers were prospectively collected. Crude Risk Ratios of CDs were calculated for each center. Two multiple logistic regression models were herein considered by using: Model 1- maternal (age, Body Mass Index, obstetric variables (gestational age, fetal presentation, single or multiple, previous scar, parity, neonatal birth weight and presence of risk factors; Model 2- TGCS either with or without maternal characteristics and presence of risk factors. Receiver Operating Characteristic (ROC curves of the multivariate logistic regression analyses were used to assess the diagnostic accuracy of each model. The null hypothesis that Areas under ROC Curve (AUC were not different from each other was verified with a Chi Square test and post hoc pairwise comparisons by using a Bonferroni correction. RESULTS: Crude evaluation of CD rates showed all centers had significantly higher Risk Ratios than the referent. Both multiple logistic regression models reduced these variations. However the two methods ranked institutions differently: model 1 and model 2 (adjusted for TGCS identified respectively nine and eight centers with significantly higher CD rates than the referent with slightly different AUCs (0.8758 and 0.8929 respectively. In the adjusted model for TGCS and maternal characteristics/presence of risk factors, three centers had CD rates similar to the referent with the best AUC (0.9024. CONCLUSIONS: The TGCS might be considered as a reliable variable to adjust CD rates. The addition of maternal characteristics and risk factors to TGCS substantially increase the

  9. Demographic variables, clinical aspects, and medicolegal implications in a population of patients with adjustment disorder

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    Anastasia A

    2016-04-01

    Full Text Available Annalisa Anastasia,1 Chiara Colletti,1 Valentina Cuoco,1 Adele Quartini,1 Stefania Urso,2 Raffaella Rinaldi,2 Giuseppe Bersani1 1Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 2Department of Anatomical, Istological, Forensic and Locomotor System Sciences, Sapienza University of Rome, Rome, Italy Introduction: Although adjustment disorder (AD is considered as residual diagnosis and receives little attention in research, it plays an important role in clinical practice and also assumes an increasingly important role in the field of legal medicine, where the majority of diagnostic frameworks (eg, mobbing often refer to AD. Our study aimed to look for specific stressor differences among demographic and clinical variables in a naturalistic setting of patients with AD.Methods: A restrospective statistical analysis of the data of patients diagnosed with AD from November 2009 to September 2012, identified via manual search from the archive of the outpatient setting at the University Unit of Psychiatry “A. Fiorini” Hospital, Terracina (Latina, Italy, was performed.Results: The sample consisted of 93 patients (46 males and 47 females, aged between 26 and 85, with medium–high educational level who were mainly employed. In most cases (54.80%, a diagnosis of AD with mixed anxiety and depressed mood was made. In all, 72% of the sample reported a negative family history for psychiatric disorders. In 22.60%, a previous history of psychopathology, especially mood disorders (76.19%, was reported. The main stressors linked to the development of AD were represented by working problems (32.30%, family problems (23.70%, and/or somatic disease (22.60% with significant differences with respect to age and sex. Half of the patients were subjected to a single first examination; 24.47% requested a copy of medical records.Conclusion: Confirming previous data from previous reports, our results

  10. The clinical application and nursing experience of adjustable shunt valve in treatment for patients with normal pressure hydrocephalus

    Directory of Open Access Journals (Sweden)

    YANG Li-rong

    2012-02-01

    Full Text Available Objective To introduce the application of adjustable shunt valve in treatment for patients with normal pressure hydrocephalus. Methods Twenty-four patients with normal pressure hydrocephalus implanted adjustable shunt valve underwent ventriculo-peritoneal shunt surgery and nursing care. Results After operation, cerebrospinal pressure was regulated for 0-6 (1.88 ± 1.52 times. Clinical symptoms were improved, especially in gait disturbance. Conclusion Treatment of normal pressure hydrocephalus with adjustable shunt valve can alleviate symptoms of hydrocephalus. It is especially suitable for patients with short course and secondary normal hydrocephalus patients.

  11. Improvement of psychosocial adjustment to HIV-1 infection through a cognitive-behavioral oriented group psychotherapy program: a pilot study.

    Science.gov (United States)

    Rousaud, Araceli; Blanch, Jordi; Hautzinger, Martin; De Lazzari, Elisa; Peri, Josep Maria; Puig, Olga; Martinez, Esteban; Masana, Guillem; De Pablo, Joan; Gatell, Josep Maria

    2007-03-01

    The present study evaluated the efficacy of a group therapy program in improving psychosocial adjustment to HIV infection, and tried to identify variables predictive of greater improvement. The outcome of 47 completing patients was analyzed, comparing the measures between T1 (1 month before therapy), and T2 (first session), and between T2 and T3 (last session) using the Wilcoxon matched-pairs signed-ranks test for each dimension of the Psychosocial Adjustment to Illness Scale (PAIS). The therapy consisted of 16 weekly 2-hour sessions following a structured time-limited cognitive-behavioral group psychotherapy program. During the intervention (between T2 and T3) a significant improvement was observed in health care orientation, vocational environment, domestic environment, sexual relation, extended family relationships, social environment, and total PAIS. There were no changes during baseline (between T1 and T2) in any of the PAIS subscales, or in the total PAIS score. Sexual route of transmission was independently associated with an improvement in health care orientation (beta = 2.525). Time since HIV diagnosis (beta = 0.022) and being employed (beta = 2.548) were independently associated with an improvement in adjustment to vocational environment. Men who have sex with men showed a poorer improvement in adjusting to family relations after the intervention (beta = -2.548). Finally, a lower CD4 count (beta = -0.005) and being employed (beta = 3.054) were independently associated with an improvement in adjustment to social environment. Our psychotherapy program improved psychosocial functioning in a heterogeneous sample of HIV-1-infected patients referred to a consultation-liaison psychiatry unit. PMID:17428189

  12. Attachment disorganization in different clinical groups: What underpins unresolved attachment?

    Directory of Open Access Journals (Sweden)

    Juen Florian

    2013-01-01

    Full Text Available This paper summarizes findings and clinical implications of research on attachment disorganization in diverse clinical groups. Disorganized/unresolved attachment is overrepresented in these groups compared to healthy control participants, but disorder specific characteristics of this attachment pattern are still poorly understood. The focus of this study was to explore defensive processes in participants whose narratives were classified as disorganized/unresolved using the Adult Attachment Projective Picture System (AAP. Besides the predominance of disorganized attachment, clinical participants demonstrated more “segregated system material” especially in stories representing aloneness and more “Personal Experience material” compared to healthy individuals. Within the disorganized/ unresolved clinical individuals, BPD and PTSD patients showed the highest proportion of attachment disorganization and were less able to use other attachment-related defenses to maintain organized. Furthermore, PTSD patients were emotionally overwhelmed by the projective attachment scenes compared to the other clinical groups as indexed by an incapacity to complete sections of the AAP. BPD and addicted patients were characterized by a high degree of self-other boundary confusion. Depressive and schizophrenic patients showed a high overall defensive intensity to remain organized.

  13. Group-sequential clinical trials with multiple co-objectives

    CERN Document Server

    Hamasaki, Toshimitsu; Evans, Scott R; Ochiai, Toshimitsu

    2016-01-01

    This book focuses on group sequential methods for clinical trials with co-primary endpoints based on the decision-making frameworks for: (1) rejecting the null hypothesis (stopping for efficacy), (2) rejecting the alternative hypothesis (stopping for futility), and (3) rejecting the null or alternative hypothesis (stopping for either futility or efficacy), where the trial is designed to evaluate whether the intervention is superior to the control on all endpoints. For assessing futility, there are two fundamental approaches, i.e., the decision to stop for futility based on the conditional probability of rejecting the null hypothesis, and the other based on stopping boundaries using group sequential methods. In this book, the latter approach is discussed. The book also briefly deals with the group sequential methods for clinical trials designed to evaluate whether the intervention is superior to the control on at least one endpoint. In addition, the book describes sample size recalculation and the resulting ef...

  14. BMI, Overweight Status and Obesity Adjusted by Various Factors in All Age Groups in the Population of a City in Northeastern Brazil

    Directory of Open Access Journals (Sweden)

    Raquel Patrícia Ataíde Lima

    2015-04-01

    Full Text Available Objective: In Brazil, demographic, socioeconomic and epidemiological changes over time have led to a transition in nutritional standards, resulting in a gradual reduction of malnutrition and an increased prevalence of overweight and obese individuals, similar to the situation in developed countries in previous decades. This study assessed the body mass index (BMI and the prevalence of an overweight status and obesity, adjusted for various factors, in a population in northeastern Brazil including all age groups. Methods: This is a cross-sectional population-based epidemiological study using single sampling procedure composed of levels. Given the heterogeneity of the variable “income” and the relationship between income, prevalence of diseases and nutrition, a stratified sampling on blocks in the first level was used. In this, city districts were classified by income into 10 strata, according to information obtained from IBGE. A systematic sampling was applied on randomly selected blocks in order to choose the residences that would be part of the sample (second level, including 1165 participants from all age groups. Results and Discussion: The prevalence of an overweight status or obesity was adjusted for demographic, socioeconomic and lifestyle variables. When the Chi-square test was applied, a relationship was observed between the prevalence of an overweight status or obesity and the age group, gender, educational level and income of the participants. Regarding lifestyle parameters, only smoking was associated with the prevalence of an overweight status or obesity, in both adults and in the total sample. The results for the following groups were significant (p < 0.05: the age group from 20 to 59 years, when the individual presented an educational level greater than or equal to high school; and the age group ≥ 60 years, when the individual was female. It is noteworthy that educational level and being female were significant in adjusting for

  15. Characteristics of CDC group 1 and group 1-like coryneform bacteria isolated from clinical specimens.

    OpenAIRE

    Funke, G; Lucchini, G M; Pfyffer, G E; Marchiani, M; von Graevenitz, A

    1993-01-01

    Fifteen strains of CDC group 1 coryneform and biochemically similar bacteria were isolated from clinical specimens. Of the 15 strains isolated, 11 were derived from abscesses and purulent lesions, mostly from the upper part of the body, and 3 were grown from blood cultures. Nine strains were associated with mixed anaerobic but no other aerobic flora. Seven strains exhibited the classical biochemical profile of CDC coryneform group 1; however, eight strains were unable to reduce nitrate and we...

  16. Neonatal Nasopharyngeal Colonization with Group B Streptococcus and its Association with Clinical Sepsis.

    Science.gov (United States)

    Malik, Anuj; Kothari, Chetna; Paulose, Ammukutty; Fogel, Joshua; Boxer, Harriet; Doraiswamy, Brinda

    2016-07-01

    Objective This study aims to determine whether nasopharyngeal (NP) colonization with group B streptococcus (GBS) is associated with early-onset clinical sepsis within 72 hours of birth, prolonged antibiotic duration, longer neonatal intensive care unit (NICU) stay, and delay in tolerating full feeds among neonates ≥ 35 weeks gestation. Study Design A retrospective cohort study of 192 NICU neonates admitted for sepsis evaluation. Based on their GBS colonization status, the mother-neonate pairs were divided into four groups of mother-negative neonate (baby)-positive (MNBP), mother-positive neonate-positive (MPBP), mother-positive neonate-negative (MPBN), and a reference group of mother-negative neonate-negative (MNBN). Neonates with GBS-positive blood cultures were excluded. Results The colonized neonate groups of MNBP (odds ratio [OR]: 21.8, 95% confidence interval [CI]: 7.99, 59.44) and MPBP (OR: 35.5, 95% CI: 9.57, 131.70) were each associated with increased odds for clinical sepsis (p NICU stay (adjusted β: 0.1, standard error = 0.05, p < 0.01). None of the GBS groups were associated with increased days to full feeds. Conclusion Neonatal NP GBS colonization was found among a substantial proportion of GBS-negative mothers and was associated with an increased diagnosis of clinical sepsis. PMID:26906181

  17. Clinical and no-clinical setting specificities in first session short-term psychotherapy psychodrama group.

    Science.gov (United States)

    Drakulić, Aleksandra Mindoljević

    2011-03-01

    Modern history of short-term group psychotherapy dates back to the late 1950-ies. From then to present day, this psychotherapeutic method has been used in various forms, from dynamic-oriented to cognitive behavioural psychotherapies. Although it has always been considered rather controversial, due its cost-effectiveness, it has been capturing more and more popularity. This paper presents the specificities of first session short-term psychotherapy psychodrama group through session work with two examined groups: a group of 20 adult women who suffer from mild or moderate forms of unipolar depression and a group of 20 students of the School of Medicine in Zagreb without any psychiatric symptomatology. The results indicate the high importance of having structure in first psychodrama session, of relating it with the previously thoroughly conducted, initial, clinical, interviews, and of the clarity and focus in terms of determining the goals of therapy, especially in a clinical context. This study also confirmed assumptions regarding the need for different approaches of warming-up in psychodrama, both in the clinical and in non-clinical samples. A psychodrama psychotherapist should have good time managing skills and capability to convert the time available into an opportunity for directly boosting the group energy and work on therapeutic alliance. PMID:21661367

  18. Clinical and no-clinical setting specificities in first session short-term psychotherapy psychodrama group.

    Science.gov (United States)

    Drakulić, Aleksandra Mindoljević

    2011-03-01

    Modern history of short-term group psychotherapy dates back to the late 1950-ies. From then to present day, this psychotherapeutic method has been used in various forms, from dynamic-oriented to cognitive behavioural psychotherapies. Although it has always been considered rather controversial, due its cost-effectiveness, it has been capturing more and more popularity. This paper presents the specificities of first session short-term psychotherapy psychodrama group through session work with two examined groups: a group of 20 adult women who suffer from mild or moderate forms of unipolar depression and a group of 20 students of the School of Medicine in Zagreb without any psychiatric symptomatology. The results indicate the high importance of having structure in first psychodrama session, of relating it with the previously thoroughly conducted, initial, clinical, interviews, and of the clarity and focus in terms of determining the goals of therapy, especially in a clinical context. This study also confirmed assumptions regarding the need for different approaches of warming-up in psychodrama, both in the clinical and in non-clinical samples. A psychodrama psychotherapist should have good time managing skills and capability to convert the time available into an opportunity for directly boosting the group energy and work on therapeutic alliance.

  19. Efficient adaptive designs with mid-course sample size adjustment in clinical trials

    CERN Document Server

    Bartroff, Jay

    2011-01-01

    Adaptive designs have been proposed for clinical trials in which the nuisance parameters or alternative of interest are unknown or likely to be misspecified before the trial. Whereas most previous works on adaptive designs and mid-course sample size re-estimation have focused on two-stage or group sequential designs in the normal case, we consider here a new approach that involves at most three stages and is developed in the general framework of multiparameter exponential families. Not only does this approach maintain the prescribed type I error probability, but it also provides a simple but asymptotically efficient sequential test whose finite-sample performance, measured in terms of the expected sample size and power functions, is shown to be comparable to the optimal sequential design, determined by dynamic programming, in the simplified normal mean case with known variance and prespecified alternative, and superior to the existing two-stage designs and also to adaptive group sequential designs when the al...

  20. Adjusting the Proportion of Electron-Withdrawing Groups in a Graft Functional Polymer for Multilevel Memory Performance.

    Science.gov (United States)

    Wu, Linxin; Wang, Peng; Zhang, Chunyu; He, Jinghui; Chen, Dongyun; Jun, Jiang; Xu, Qingfeng; Lu, Jianmei

    2016-01-01

    A polymer containing aldehyde active groups (PVB) was synthesized by atom transfer radical polymerization (ATRP), acting as a polymer precursor to graft a functional moiety via nucleophilic addition reaction. DHI (2-(1,5-dimethyl-hexyl)-6-hydrazino-benzo[de]isoquinoline-1,3-dione) and NPH (nitrophenyl hydrazine) groups, which contain naphthalimides that act as narrow traps and nitro groups that act as deep traps, were anchored onto the PVB at different ratios. A series of graft polymers were obtained and named PVB-DHI, PVB-DHI4 -NPH, PVB-DHI-NPH4 , and PVB-NPH. The chemical composition of the polymers was analyzed by (1) H-NMR spectroscopy and X-ray photoelectron spectroscopy (XPS). Memory devices were prepared from the polymers, and I-V characteristics were measured to determine the performance. By adjusting the ratio of different electron acceptors (DHI and NPH) to 4:1, ternary memory behavior was achieved. The relationship between memory behavior of PVB-DHIx NPHy and acceptor groups as well as their conduction mechanism were studied in detail.

  1. Adjustable Gastric Band Surgery or Medical Management in Patients With Type 2 Diabetes: A Randomized Clinical Trial

    Science.gov (United States)

    Ding, Su-Ann; Simonson, Donald C.; Wewalka, Marlene; Halperin, Florencia; Foster, Kathleen; Goebel-Fabbri, Ann; Hamdy, Osama; Clancy, Kerri; Lautz, David; Vernon, Ashley

    2015-01-01

    Context: Recommendations for surgical, compared with lifestyle and pharmacologically based, approaches for type 2 diabetes (T2D) management remain controversial. Objective: The objective was to compare laparoscopic adjustable gastric band (LAGB) to an intensive medical diabetes and weight management (IMWM) program for T2D. Design: This was designed as a prospective, randomized clinical trial. Setting: The setting was two Harvard Medical School-affiliated academic institutions. Interventions and Participants: A 12-month randomized trial comparing LAGB (n = 23) vs IMWM (n = 22) in persons aged 21–65 years with body mass index of 30–45 kg/m2, T2D diagnosed more than 1 year earlier, and glycated hemoglobin (HbA1c) ≥ 6.5% on antihyperglycemic medication(s). Main Outcome Measure: The proportion meeting the prespecified primary glycemic endpoint, defined as HbA1c < 6.5% and fasting glucose < 7.0 mmol/L at 12 months, on or off medication. Results: After randomization, five participants did not undergo the surgical intervention. Of the 40 initiating intervention (22 males/18 females; age, 51 ± 10 y; body mass index, 36.5 ± 3.7 kg/m2; diabetes duration, 9 ± 5 y; HbA1c, 8.2 ± 1.2%; 40% on insulin), the proportion meeting the primary glycemic endpoint was achieved in 33% of the LAGB patients and 23% of the IMWM patients (P = .457). HbA1c reduction was similar between groups at both 3 and 12 months (−1.2 ± 0.3 vs −1.0 ± 0.3%; P = .496). Weight loss was similar at 3 months but greater 12 months after LAGB (−13.5 ± 1.7 vs −8.5 ± 1.6 kg; P = .027). Systolic blood pressure reduction was greater after IMWM than LAGB, whereas changes in diastolic blood pressure, lipids, fitness, and cardiovascular risk scores were similar between groups. Patient-reported health status, assessed using the Short Form-36, Impact of Weight on Quality of Life, and Problem Areas in Diabetes, all improved similarly between groups. Conclusions: LAGB and a multidisciplinary IMWM program

  2. Views on clinically suspect arthralgia: a focus group study.

    Science.gov (United States)

    Newsum, Elize C; van der Helm-van Mil, Annette H M; Kaptein, Adrian A

    2016-05-01

    The rheumatology field is moving towards identifying individuals with an increased risk for rheumatoid arthritis (RA) at a stage when arthritis is still absent but persons having clinically suspect arthralgia (CSA). Incorporating patients' views in rheumatologic care is pivotal; however, the views of persons with CSA on their condition are unknown. We aimed to help fill this gap by exploring illness perceptions of persons with CSA and their views on hypothetical prognoses for developing RA. Persons with CSA were invited to participate in a semi-structured focus group discussion. Illness perceptions according to the Common Sense Model (CSM) and four a priori formulated themes were explored in detail during the group discussion. The discussion was audio-taped and transcribed verbatim. Transcripts were analysed in an interpretative phenomenological approach manner, on the basis of the dimensions of the CSM by three researchers independently. The views of four participants with CSA were explored during one focus group discussion. Four dimensions of the CSM were mainly observed: Identity, Consequences, Personal Control and Concern. None of the patients identified themselves as being a patient. They did experience pain and impairments in daily functioning and were concerned that their symptoms would progress. In the absence of physician-initiated treatment, some patients changed lifestyle in order to reduce pain and to promote health. Patients unanimously said that they could not interpret prognostic information on RA development expressed in hypothetical chances. Persons with CSA do not consider themselves patients. Prognostic information related to the development of RA based on risk percentages was considered as not useful by persons with CSA. Understanding of the illness perceptions of persons with CSA by health care professionals might improve medical management and facilitate shared decision-making.

  3. Development and clinical application of a length-adjustable water phantom for total body irradiation.

    Science.gov (United States)

    Chen, Zhi-Wei; Yao, Sheng-Yu; Zhang, Tie-Ning; Zhu, Zhen-Hua; Hu, Zhe-Kai; Lu, Xun

    2012-08-01

    A new type of water phantom which would be specialised for the absorbed dose measurement in total body irradiation (TBI) treatment is developed. Ten millimetres of thick Plexiglas plates were arranged to form a square cube with 300 mm of edge length. An appropriate sleeve-type piston was installed on the side wall, and a tabular Plexiglas piston was positioned inside the sleeve. By pushing and pulling the piston, the length of the self-made water phantom could be varied to meet the required patients' physical sizes. To compare the international standard water phantom with the length-adjustable and the Plexiglas phantoms, absorbed dose for 6-MV X ray was measured by an ionisation chamber at different depths in three kinds of phantoms. In 70 cases with TBI, midplane doses were metered using the length-adjustable and the Plexiglas phantoms for simulating human dimensions, and dose validation was synchronously carried out. There were no significant statistical differences, p > 0.05, through statistical processing of data from the international standard water phantom and the self-designed one. There were significant statistical differences, p body width. Obviously, the difference had a positive correlation with the body width. The results proved that the new length-adjustable water phantom is more accurate for simulating human dimensions than Plexiglas phantom.

  4. Effectiveness of Group Positive Parenting Program (Triple P) in Changing Child Behavior, Parenting Style, and Parental Adjustment: An Intervention Study in Japan

    Science.gov (United States)

    Fujiwara, Takeo; Kato, Noriko; Sanders, Matthew R.

    2011-01-01

    The purpose of this study is to investigate the effectiveness of a group-based family intervention program known as the Group Positive Parenting Program (Triple P), with families in Japan. Reductions in children's behavioral problems, changes in dysfunctional parenting practices, and affects on parenting adjustment were examined. Participants of…

  5. Generalized Likelihood Ratio Statistics and Uncertainty Adjustments in Efficient Adaptive Design of Clinical Trials

    CERN Document Server

    Bartroff, Jay

    2011-01-01

    A new approach to adaptive design of clinical trials is proposed in a general multiparameter exponential family setting, based on generalized likelihood ratio statistics and optimal sequential testing theory. These designs are easy to implement, maintain the prescribed Type I error probability, and are asymptotically efficient. Practical issues involved in clinical trials allowing mid-course adaptation and the large literature on this subject are discussed, and comparisons between the proposed and existing designs are presented in extensive simulation studies of their finite-sample performance, measured in terms of the expected sample size and power functions.

  6. A novel method to adjust efficacy estimates for uptake of other active treatments in long-term clinical trials.

    Directory of Open Access Journals (Sweden)

    John Simes

    Full Text Available BACKGROUND: When rates of uptake of other drugs differ between treatment arms in long-term trials, the true benefit or harm of the treatment may be underestimated. Methods to allow for such contamination have often been limited by failing to preserve the randomization comparisons. In the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD study, patients were randomized to fenofibrate or placebo, but during the trial many started additional drugs, particularly statins, more so in the placebo group. The effects of fenofibrate estimated by intention-to-treat were likely to have been attenuated. We aimed to quantify this effect and to develop a method for use in other long-term trials. METHODOLOGY/PRINCIPAL FINDINGS: We applied efficacies of statins and other cardiovascular drugs from meta-analyses of randomized trials to adjust the effect of fenofibrate in a penalized Cox model. We assumed that future cardiovascular disease events were reduced by an average of 24% by statins, and 20% by a first other major cardiovascular drug. We applied these estimates to each patient who took these drugs for the period they were on them. We also adjusted the analysis by the rate of discontinuing fenofibrate. Among 4,900 placebo patients, average statin use was 16% over five years. Among 4,895 assigned fenofibrate, statin use was 8% and nonuse of fenofibrate was 10%. In placebo patients, use of cardiovascular drugs was 1% to 3% higher. Before adjustment, fenofibrate was associated with an 11% reduction in coronary events (coronary heart disease death or myocardial infarction (P = 0.16 and an 11% reduction in cardiovascular disease events (P = 0.04. After adjustment, the effects of fenofibrate on coronary events and cardiovascular disease events were 16% (P = 0.06 and 15% (P = 0.008, respectively. CONCLUSIONS/SIGNIFICANCE: This novel application of a penalized Cox model for adjustment of a trial estimate of treatment efficacy incorporates evidence

  7. AN UNUSUAL CLINICAL PRESENTATION OF GROUP A STREPTOCOCCAL INFECTION

    OpenAIRE

    H.V., Prashanth; R.M, Saldanha Dominic; Shenoy, Shalini; Baliga, Shrikala

    2011-01-01

    After two decades of decline of Group A streptococcal infections, the recent years are witnessing a resurgence in the incidence and severity of infections caused by Group A Streptococcus including necrotizing fasciitis and streptococcal toxic shock syndrome sometimes with fatal outcomes. We present an unusual case of Group A streptococcal infection in a 4-year-old boy who did not have any predisposing factors for Group A streptococcal infection.

  8. Performance of first-trimester combined test for Down syndrome in different maternal age groups: reason for adjustments in screening policy?

    NARCIS (Netherlands)

    Engels, Martin; Heijboer, A.C.; Blankenstein, M.A.; Vugt, J.M.G. van

    2011-01-01

    OBJECTIVE: To evaluate the performance of the first-trimester combined test (FCT) in different maternal age groups and to discuss whether adjustments in screening policies should be made. METHODS: In this retrospective study data (n = 26 274) from a fetal medicine center on FCT (maternal age, fetal

  9. A Comparison of Clinical and Non-Clinical Samples Using the Concepts of: Individual Personality, Family Structure, Family of Origin Perception, Sexuality, and Adjustment/Adaptability To Determine Family Risk for Father Daughter Incest.

    Science.gov (United States)

    Utesch, William E.

    Father-daughter incest is more traumatic than any other type of child-sexual molestation. This study examines some of the factors which may lead to father-daughter incest. The author divided 40 Caucasian couples into three groups: (1) clinical incest group; (2) clinical non-incest group (to control for clinical status); and (3) non-clinical group.…

  10. 集团成员企业与资本结构动态调整%Group-affiliations and Capital Structure Dynamics Adjustment

    Institute of Scientific and Technical Information of China (English)

    王嘉歆; 黄国良

    2015-01-01

    我国中小企业经济环境瞬息万变,企业如要保持良好的绩效和竞争力就必须对企业的内外部环境做出正确的判断以及适当的决策。企业通过有效的战略规划,确立自身在市场上的发展方向并配合监督、控制从而达到企业预期的经营绩效。然而在中小企业中,决策质量的高低直接受到了企业家素质的影响。因此文章以我国中小企业为样本,运用实证分析方法,探讨企业家异质性与企业绩效的关联。实证结果显示:企业绩效与企业家年龄、经营企业前后是否参加相关的管理或技术训练呈显著正相关关系;而企业家的教育程度与企业绩效间关系不显著,与预期假设不符。%Based on the special institution background in China, this paper empirically examines the effects of groups on their affiliations' leverage adjustment speed toward target. The study shows that group-affiliations have a faster leverage adjustment speed than stand-alone companies and groups has more obvious effect on the enhancement of their affiliations' adjustment speed in areas where the level of capital marketization is low. Through further research, it is found that the affiliations of state-owned groups have a faster adjustment speed than affiliations of private-owned groups, and group-affiliations with larger divergence between control right and cash flow right have a slower speed of capital structure adjustment. From the perspective of capital structure adjustment, the paper confirms that groups reduce the cost of capital, which provides a favorable empirical evidence for our economic policies of developing groups.

  11. [Clinical features and genetics of the ichthyosis vulgaris group].

    Science.gov (United States)

    Traupe, H; Happle, R

    1980-12-11

    Combined application of clinical, genetic and histological criteria in general allows a definite diagnosis of autosomal dominant ichthyosis vulgaris and of X-linked recessive ichthyosis. For differential diagnosis, the following rare syndromes should be considered: ichthyosis bullosa: Refsum syndrome; Jung-Vogel syndrome; ichthyosis with corneal opacity, pili torti and alopecia; ichthyosis with deafness, pili torti and dental anomalies; and ichthyosis with hepatosplenomegaly and cerebellar degeneration.

  12. The implications of different developmental patterns of disruptive behavior problems for school adjustment. Conduct Problems Prevention Research Group.

    Science.gov (United States)

    Stormshak, E A; Bierman, K L

    1998-01-01

    Based upon developmental models of disruptive behavior problems, this study examined the hypothesis that the nature of a child's externalizing problems at home may be important in predicting the probability of and nature of school adjustment problems at school entry. Parent ratings were collected for a sample of 631 behaviorally disruptive children using the Child Behavior Checklist. Confirmatory factor analyses revealed differentiated ratings of oppositional, aggressive, and hyperactive/inattentive behaviors at home. Teacher and peer nominations assessed school adjustment at the end of first grade. As expected from a developmental perspective, aggressive behaviors indicated more severe dysfunction and were more likely to generalize to the school setting than were oppositional behaviors. Hyperactive/inattentive behaviors at home led to more classroom disruption than did aggressive or oppositional behaviors. Co-occurring patterns of oppositional/aggressive and hyperactive/inattentive behaviors were more common than were single-problem patterns, and were associated with broad dysfunction in the social and classroom contexts. The results were interpreted within a developmental framework, in which oppositional, aggressive, and hyperactive/inattentive behaviors may reflect distinct (as well as shared) developmental processes that have implications for the home-to-school generalization of behavior problems and subsequent school adjustment.

  13. The Adjustment of Offspring of Within-Group and Interracial/Intercultural Marriages: A Comparison of Personality Factor Scores.

    Science.gov (United States)

    Johnson, Ronald C.; Nagoshi, Craig T.

    1986-01-01

    Results indicated offspring of within-group versus across-racial/ethnic marriages did not differ in personality test scores. As compared with offspring of within-group marriages, male offspring of across-group marriages scored higher on a factor measuring socially desirable traits and lower on a factor measuring intraception, while female…

  14. Group sequential and confirmatory adaptive designs in clinical trials

    CERN Document Server

    Wassmer, Gernot

    2016-01-01

    This book provides an up-to-date review of the general principles of and techniques for confirmatory adaptive designs. Confirmatory adaptive designs are a generalization of group sequential designs. With these designs, interim analyses are performed in order to stop the trial prematurely under control of the Type I error rate. In adaptive designs, it is also permissible to perform a data-driven change of relevant aspects of the study design at interim stages. This includes, for example, a sample-size reassessment, a treatment-arm selection or a selection of a pre-specified sub-population. Essentially, this adaptive methodology was introduced in the 1990s. Since then, it has become popular and the object of intense discussion and still represents a rapidly growing field of statistical research. This book describes adaptive design methodology at an elementary level, while also considering designing and planning issues as well as methods for analyzing an adaptively planned trial. This includes estimation methods...

  15. The age-adjusted D-dimer safely excludes a high number of pulmonary embolisms in combination with four different clinical decision rules

    NARCIS (Netherlands)

    van Es, J.; Mos, I.C.M.; Douma, R.A.; Nizet, T.A.C.; Durian, M.; van Houten, A.A.; Hofstee, H.M.A.; ten Cate, H.; Ullmann, E.F.; Buller, H.R.; Huisman, M.V.; Kamphuisen, P.W.

    2011-01-01

    Background: Four different clinical decision rules (CDRs) (Wells score, Revised Geneva score (RGS), simplified Wells score and simplified RGS) safely exclude pulmonary embolism (PE), when combined with a normal D-dimer test. Recently, an age adjusted cut-off of the D-dimer (patient's age x 10 ig/L)

  16. Scale Development of a Measure to Assess Community-Based and Clinical Intervention Group Environments

    Science.gov (United States)

    Wilson, Patrick A.; Hansen, Nathan B.; Tarakeshwar, Nalini; Neufeld, Sharon; Kochman, Arlene; Sikkema, Kathleen J.

    2008-01-01

    Though group interventions are widely used in community-based and clinical settings, there are few brief instruments for assessing the group environment. Two studies on the development of a brief measure to assess intervention group environments are described, and psychometric properties of the new scale are presented. The new measure is based on…

  17. Developmental Model Using Gestalt-Play versus Cognitive-Verbal Group with Chinese Adolescents: Effects on Strengths and Adjustment Enhancement

    Science.gov (United States)

    Shen, Yih-Jiun

    2007-01-01

    This study compared the effectiveness of short-term developmental group counseling applying Gestalt-play versus cognitive-verbal approaches with Taiwanese adolescents. On a measure of behavioral and emotional strengths, teachers reported significant changes in students' overall behavioral and emotional strengths measured via total scores. Specific…

  18. The European Register for Clinical Chemists. (European Communities Confederation of Clinical Chemistry, Working Group on Registration).

    Science.gov (United States)

    Sanders, G T; Kelly, A M; Breuer, J; Kohse, K P; Mocarelli, P; Sachs, C

    1997-10-01

    To ensure freedom of movement in the European Union, a limited number of professions is regulated by a so-called Sectorial Directive; all other disciplines, including clinical chemistry, fall under a General Directive. However, clinical chemists in the EU wish their specialty to be more specifically regulated; this means that common standards of education, training, experience and compliance with continuing professional developments must be guaranteed. Therefore, the European Communities Confederation of Clinical Chemistry (EC4) is about to implement the European Register for clinical chemists, and has composed a guide to this Register. The document describes the conditions for entry to specialty training, the minimum standards for registration (university education and postgraduate vocational training with a minimum total of eight years), the competencies of those qualifying for registration, and the operation of the register. Registration guarantees professional and managerial competencies; the title conferred is "European Clinical Chemist". EC4 recognises the existing national registers as far as they are based on the minimal requirements as indicated. An EC4 Register Commission (EC4RC) will maintain and control the European Register, supported by National Clinical Chemistry Registration Committees (NCCRC). An NCCRC controls the quality of the education in each country and assesses candidates. An individual (EU citizen or non-EU citizen trained in an EU country) applies privately for the European Register to EC4RC and, where applicable, the application is accompanied by a document from the NCCRC of the country of registration, stating that the applicant has the necessary qualifications. For EU citizens trained outside the EU the final decision is with EC4RC; non-EU citizens not trained in an EU country are not eligible for registration. Registration is renewed once every five years. PMID:9368800

  19. A randomized clinical trial of neurally adjusted ventilatory assist versus conventional weaning mode in patients with COPD and prolonged mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Kuo NY

    2016-05-01

    Full Text Available Nai-Ying Kuo,1,2 Mei-Lien Tu,1,3 Tsai-Yi Hung,1 Shih-Feng Liu,4 Yu-Hsiu Chung,4 Meng-Chih Lin,4 Chao-Chien Wu41Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital; 2Kaohsiung Medical University; 3Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan; 4Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, TaiwanBackground: Patient-ventilator asynchrony is a common problem in mechanically ventilated patients; the problem is especially obvious in COPD. Neutrally adjusted ventilatory assist (NAVA can improve patient-ventilator asynchrony; however, the effect in COPD patients with prolonged mechanical ventilation is still unknown. The goals of this study are to evaluate the effect of NAVA and conventional weaning mode in patients with COPD during prolonged mechanical ventilation.Methods: The study enrolled a total of 33 COPD patients with ventilator dependency for more than 21 days in the weaning center. A diaphragm electrical activity (Edi catheter was inserted in patients within 24 hours after admission to the respiratory care center, and patients were randomly allocated to NAVA or conventional group. A spontaneous breathing trial was performed every 24 hours. The results correlated with the clinical parameters.Results: There were significantly higher asynchrony incidence rates in the whole group after using Edi catheter (before vs post-Edi catheter insertion =60.6% vs 87.9%, P<0.001. Asynchrony index: before vs post-Edi catheter insertion =7.4%±8.5% vs 13.2%±13.5%, P<0.01. Asynchrony incidence: NAVA vs conventional =0% vs 84.2%, P<0.001. Asynchrony index: NAVA vs conventional =0 vs 11.9±11.2 (breath %, P<0.001. The most common asynchrony events were ineffective trigger and delayed trigger. Conclusion: Compared to conventional mode, NAVA mode can significantly enhance

  20. Clinical and No-Clinical Setting Specificities in First Session Short-Term Psychotherapy Psychodrama Group

    OpenAIRE

    Mindoljević Drakulić, Aleksandra

    2011-01-01

    Modern history of short-term group psychotherapy dates back to the late 1950-ies. From then to present day, this psychotherapeutic method has been used in various forms, from dynamic-oriented to cognitive behavioural psychotherapies. Although it has always been considered rather controversial, due its cost-effectiveness, it has been capturing more and more popularity. This paper presents the specificities of first session short-term psychotherapy psychodrama group through session ...

  1. ADJUSTMENT FACTORS AND ADJUSTMENT STRUCTURE

    Institute of Scientific and Technical Information of China (English)

    Tao Benzao

    2003-01-01

    In this paper, adjustment factors J and R put forward by professor Zhou Jiangwen are introduced and the nature of the adjustment factors and their role in evaluating adjustment structure is discussed and proved.

  2. Clinical presentation of infective endocarditis caused by different groups of non-beta haemolytic streptococci.

    Science.gov (United States)

    Nilson, B; Olaison, L; Rasmussen, M

    2016-02-01

    Streptococci are common causes of infective endocarditis (IE) and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has provided a practical tool for their species determination. We aimed to investigate if particular groups of non-beta heamolytic streptococci were associated with IE or to specific presentations thereof. The Swedish Registry of Infective Endocarditis was used to identify cases of IE caused by streptococci and a local database to identify cases of streptococcal bacteremia. The bacteria were grouped using MALDI-TOF MS and the clinical characteristics of IE caused by different groups were compared. We identified a group of 201 streptococcal IE isolates: 18 isolates belonged to the anginosus, 19 to the bovis, 140 to the mitis, 17 to the mutans, and seven to the salivarius groups. The mitis and mutans groups were significantly more common and the anginosus group less common among IE cases as compared to all cause bacteremia. Patients infected with the bovis group isolates were older, had more cardiac devices, and had more commonly prosthetic valve IE compared to IE caused by streptococci of the other groups. Twenty-one percent of patients needed surgery, and in-hospital mortality was 8% with no significant differences between the groups. Grouping of non-beta haemolytic streptococci using MALDI-TOF MS can provide a basis for decision-making in streptococcal bacteremia. IE caused by bovis group isolates have clinical characteristics distinguishing them from IE caused by other groups of Streptococcus. PMID:26610338

  3. An Empirical Investigation of Group Treatment for a Clinical Population of Adult Female Incest Survivors.

    Science.gov (United States)

    Saxe, Brenda J.; Johnson, Susan M.

    1999-01-01

    Empirically assesses the effectiveness of a group treatment program on intrapersonal symptomatology and interpersonal difficulties in a clinical population of women with a history of incest. Results indicate that a time-limited group, which focuses on the original trauma, is effective in reducing intrapersonal symptomatology for women with a…

  4. Factors Influencing Electronic Clinical Information Exchange in Small Medical Group Practices

    Science.gov (United States)

    Kralewski, John E.; Zink, Therese; Boyle, Raymond

    2012-01-01

    Purpose: The purpose of this study was to identify the organizational factors that influence electronic health information exchange (HIE) by medical group practices in rural areas. Methods: A purposive sample of 8 small medical group practices in 3 experimental HIE regions were interviewed to determine the extent of clinical information exchange…

  5. Recommendations for Collection and Handling of Specimens From Group Breast Cancer Clinical Trials

    OpenAIRE

    Leyland-Jones, Brian R.; Ambrosone, Christine B.; Bartlett, John; Ellis, Matthew J. C.; Enos, Rebecca A.; Raji, Adekunle; Pins, Michael R.; Zujewski, Jo Anne; Hewitt, Stephen M.; Forbes, John F.; Abramovitz, Mark; Braga, Sofia; Cardoso, Fatima; Harbeck, Nadia; Denkert, Carsten

    2008-01-01

    Recommendations for specimen collection and handling have been developed for adoption across breast cancer clinical trials conducted by the Breast International Group (BIG)-sponsored Groups and the National Cancer Institute (NCI)-sponsored North American Cooperative Groups. These recommendations are meant to promote identifiable standards for specimen collection and handling within and across breast cancer trials, such that the variability in collection/handling practices that currently exist...

  6. Clinical Trial Adaptation by Matching Evidence in Complementary Patient Sub-groups of Auxiliary Blinding Questionnaire Responses.

    Directory of Open Access Journals (Sweden)

    Ognjen Arandjelović

    Full Text Available Clinical trial adaptation refers to any adjustment of the trial protocol after the onset of the trial. Such adjustment may take on various forms, including the change in the dose of administered medicines, the frequency of administering an intervention, the number of trial participants, or the duration of the trial, to name just some possibilities. The main goal is to make the process of introducing new medical interventions to patients more efficient, either by reducing the cost or the time associated with evaluating their safety and efficacy. The principal challenge, which is an outstanding research problem, is to be found in the question of how adaptation should be performed so as to minimize the chance of distorting the outcome of the trial. In this paper we propose a novel method for achieving this. Unlike most of the previously published work, our approach focuses on trial adaptation by sample size adjustment i.e. by reducing the number of trial participants in a statistically informed manner. We adopt a stratification framework recently proposed for the analysis of trial outcomes in the presence of imperfect blinding and based on the administration of a generic auxiliary questionnaire that allows the participants to express their belief concerning the assigned intervention (treatment or control. We show that this data, together with the primary measured variables, can be used to make the probabilistically optimal choice of the particular sub-group a participant should be removed from if trial size reduction is desired. Extensive experiments on a series of simulated trials are used to illustrate the effectiveness of our method.

  7. 米多君联合低温可调钠对改善透析低血压的临床研究%Clinical Efficacy of Midodrine Combined Low Temperature Adjustable Sodi-um in Improving Dialysis Hypotension

    Institute of Scientific and Technical Information of China (English)

    张丽阳; 高弼虎

    2015-01-01

    目的 探讨透析低血压的相关症状和米多君联合低温可调钠对透析相关性低血压的治疗作用. 方法 整群选取2013年3月-2014年6月在该院治疗的120例反复发生透析相关性低血压的患者,采用自身分组对照的方法随机分为常温普通钠透析组(对照组),普通钠常温+米多君组(米多君透析组),低温可调钠组(低温可调钠透析组),低温可调钠+米多君组(联合治疗透析组),每组30例,每种治疗方法应用5次透析,比较四组方法透析中平均动脉压和低血压的发生次数. 结果 米多君透析组、低温可调钠透析组、联合治疗透析组平均动脉压分别为13.3%、15.3%、6.7%显著高于对照组21.3%(P<0.05). 结论 使用低温可调钠透析联合米多君对透析相关性低血压临床疗效显著.%Objective To discuss the complication of dialysis hypotension and the clinical curative effect of midodrine com-bined low temperature adjustable sodium for dialysis hypotension. Methods 120 patients experiencing repeated occurrence of dialysis hypotension and treated in our department from March 2013 and June 2014 were randomized to undergoing nor-mal-temperature sodium dialysis (the control group, n=30), dialysis using normal-temperature sodium combined with mido-drine (midodrine dialysis group, n=30), dialysis using low temperature adjustable sodium (dialysis using low temperature ad-justable sodium group, n=30), and dialysis using midodrine combined low temperature adjustable sodium (combined dialysis group, n=30), according to self-grouping and controlled method. Each dialysis regimen was performed five times for the pa-tients. The mean arterial blood pressure and the frequency of low blood pressure were compared between the patients in the four groups. Results The mean arterial blood pressure of the midodrine dialysis group, dialysis using low temperature ad-justable sodium group, and combined dialysis group was 13.3%, 15.3%, 6.7% respectively

  8. Similar barriers and facilitators to physical activity across different clinical groups experiencing lower limb spasticity.

    Science.gov (United States)

    Hundza, Sandra; Quartly, Caroline; Kim, Jasmine M; Dunnett, James; Dobrinsky, Jill; Loots, Iris; Choy, Kim; Chow, Brayley; Hampshire, Alexis; Temple, Viviene A

    2016-07-01

    Purpose Given the importance of physical activity in maintaining health and wellness, an improved understanding of physical activity patterns across different clinical populations is required. This study examines the facilitators for, and barriers to, participation in physical activity across multiple contexts for three clinical groups with chronic lower limb spasticity (individuals with stroke, multiple sclerosis and incomplete spinal cord injury). Method This cross-sectional study employed quantitative measures for spasticity, ankle range of motion, pain, falls, cognition, mobility, and physical activity as well as qualitative semi-structured interviews. Results There were similar impairments in body functions and structures and limitations in activities across the clinical groups. These impairments and limitations negatively impacted participation in physical activity, which was low. Environmental and personal factors exacerbated or mitigated the limiting effects of body functions and structures and activities on physical activity in many areas of life. Conclusions In this population, participation in physical activity includes activities such as housework which are different than what is typically considered as physical activity. Further, the presence of similar barriers and facilitators across the groups suggests that support and services to promote valued forms of physical activity could be organised and delivered based on limitations in mobility and functioning rather than clinical diagnosis. Implications for rehabilitation Physical activity is of utmost importance in maintaining health and wellness in clinical populations. This research highlights the desired and actual physical activity for these populations can look different than what may traditionally be considered as physical activity (e.g. housework is not typically considered participation physical activity). Therefore, rehabilitation interventions need to be directly designed to enhance clients

  9. Ethical Challenges and Lessons Learned During the Clinical Development of a Group A Meningococcal Conjugate Vaccine

    OpenAIRE

    Martellet, Lionel; Sow, Samba O.; Diallo, Aldiouma; Hodgson, Abraham; Kampmann, Beate; Hirve, Siddhivinayak; Tapia, Milagritos; Haidara, Fadima Cheick; Ndiaye, Assane; Diarra, Bou; Ansah, Patrick Odum; Akinsola, Adebayo; Idoko, Olubukola T.; Adegbola, Richard A.; Bavdekar, Ashish

    2015-01-01

    Background.  The group A meningococcal vaccine (PsA-TT) clinical development plan included clinical trials in India and in the West African region between 2005 and 2013. During this period, the Meningitis Vaccine Project (MVP) accumulated substantial experience in the ethical conduct of research to the highest standards. Methods.  Because of the public–private nature of the sponsorship of these trials and the extensive international collaboration with partners from a diverse setting of countr...

  10. Moving the Self-Esteem of People with Epilepsy by Supportive Group: A Clinical Trial

    Directory of Open Access Journals (Sweden)

    Kritaya Sawangchareon

    2013-11-01

    Full Text Available Introduction: People with epilepsy (PWE face physical and mental illness, and social stigma, which affect their self-esteem and quality of life. The purpose of this study was to examine the effects of a support group on the self-esteem of PWE. Methods: A Quasi-experimental study was performed on 120 PWE in the Epilepsy Clinic at Srinagarind Hospital. The experimental group (N=60 attended the support group before receiving regular health care services. The control group (N=60 received only regular healthcare services. Data was collected by using the Rosenberg self-esteem scale scoring before and after the experiment. The score was analyzed by using a paired t-test and an independent t-test. Results: The study showed that before the experiment, the self–esteem score of the control group was significantly higher than the experimental group. After the experiment, the scores of the control group and the experimental group showed a significant statistical difference. The score in the control group was significantly lower than the experimental group, while the score in the experimental group was significantly higher than before the experiment. Conclusion: The support group improves the self-esteem of PWE. Medical personnel should set up a support group for PWE to enhance their self-esteem.

  11. The first 10,000 Adult Attachment Interviews: distributions of adult attachment representations in clinical and non-clinical groups.

    Science.gov (United States)

    Bakermans-Kranenburg, Marian J; van IJzendoorn, Marinus H

    2009-05-01

    More than 200 adult attachment representation studies, presenting more than 10,500 Adult Attachment Interview (AAI; George, Kaplan, & Main, 1985) classifications, have been conducted in the past 25 years. In a series of analyses on the distributions of the AAI classifications in various cultural and age groups, fathers, and high-risk and clinical samples, we used the distribution of the combined samples of North American non-clinical mothers (23% dismissing, 58% secure, 19% preoccupied attachment representations, and 18% additionally coded for unresolved loss or other trauma) to examine deviations from this normative pattern, through multinomial tests and analyses of correspondence. The analyses were restricted to AAI classifications coded according to the Main, Goldwyn, and Hesse (2003) system. We did not find gender differences in the use of dismissing versus preoccupied attachment strategies, and the AAI distributions were largely independent of language and country of origin. Clinical subjects showed more insecure and unresolved attachment representations than the norm groups. Disorders with an internalizing dimension (e.g., borderline personality disorders) were associated with more preoccupied and unresolved attachments, whereas disorders with an externalizing dimension (e.g., antisocial personality disorders) displayed more dismissing as well as preoccupied attachments. Depressive symptomatology was associated with insecurity but not with unresolved loss or trauma, whereas adults with abuse experiences or PTSD were mostly unresolved. In order to find more reliable associations with clinical symptoms and disorders, future AAI studies may make more fruitful use of continuous AAI scales in addition to the conventionally used categorical classifications.

  12. Using computer simulations and focus groups for planned change in prenatal clinics.

    Science.gov (United States)

    Lowry, L W; Callahan, A L; Philippe, T

    2001-01-01

    The Colleges of Nursing and Engineering in a southwest Florida university combined efforts to design a project to use time/motion techniques and focus groups to assess patent flow and effective and efficient use of human resources in public health clinics. Data for 877 observations were entered into a computer simulation program that displayed alternative configurations for health resource management. Information from focus groups was used to plan for ways to use clinic wait time more effectively. This article describes data collection and findings. PMID:11898674

  13. Relationship between ABO blood groups and malaria with clinical outcome in rural area of South India

    Directory of Open Access Journals (Sweden)

    Gayathri B.N.

    2013-05-01

    Full Text Available Background A number of studies have shown that susceptibility to several infectious diseases is related to the patient’s blood group. Although the relationship between blood group and susceptibility to malaria has been studied by several researchers, the results have been contradictory. Since malaria has re-emerged as a major problem in India during the past few years, it would be useful to know whether there is any relationship between blood group and infection. Objectives The study will be undertaken to correlate the blood groups and clinical presentations in malaria patients and to understand the differential host susceptibility in malaria. Method Over a period of 4 years malaria positive samples identified by peripheral smear (thin and thick smears will be evaluated in this study. Haemoglobin, total leucocyte count, differential leucocyte count and platelet count of each patient done on an automated cell counter will be retrieved from the data. Blood group was determined by forward and reverse method. The demographic details of the patients and clinical details were obtained from case records of the patients. Malarial species and the severity of clinical course were correlated with blood groups Results A total of 205 patients were included in the study, of which 123 cases were positive for plasmodium falciparum and 78 cases were positive for P. vivax infection and 4 patients had mixed infection. The results of blood groups showed 33 -‘A’ group, 84 -‘B’ group, 70 -‘O’ group and 18 were ‘AB’ group. When the clinical courses between different groups were compared using the following parameters for severe infection- a parasitic load of > 10/1000 RBCs, severe anemia with haemoglobin 101o F and the other organ involvement, it was observed that there was no significant relationship between ABO blood group and malaria in our population, this could be due to various demographic reasons. Conclusions The present study indicate that

  14. Convexity Adjustments

    DEFF Research Database (Denmark)

    M. Gaspar, Raquel; Murgoci, Agatha

    2010-01-01

    A convexity adjustment (or convexity correction) in fixed income markets arises when one uses prices of standard (plain vanilla) products plus an adjustment to price nonstandard products. We explain the basic and appealing idea behind the use of convexity adjustments and focus on the situations...

  15. Tidal volume (TV) post-process obtained with electrical impedance tomography on a group of chronic obstructive pulmonary disease (COPD) patients. Use of adjust equations

    Science.gov (United States)

    Balleza, Marco; Anton, Daniel; Casan, Pere; Riu, Pere

    2010-04-01

    Equations used to estimate ventilation out of EIT images, validated on healthy volunteers show a significant bias and a larger variance when were applied on a COPD patients group. The differences in estimation values were found to be highly correlated with anthropometric parameters. Two groups of 13 and 4 COPD male patients (FEV1/FVC= 80%) were used in this study. We have measured different anthropometric parameters like age, weight, height and skinfolds. The EIT system (TIE4sys) and a pneumotach were simultaneously connected to monitor tidal volume. The main anthropometric parameters values of 13 COPD patients were: age: 67±9 years, height: 1.65±0.05 m, weight: 72±11 kg, BMI: 26.4±3.3 and the subscapular skinfold thickness was 23±9mm. The mean tidal volume estimated with TIE4sys and the pneumotach were: 0.580±0.212 L and 0.774±0.173 L r = 0.861 (p<0.01). The mean difference was 0.196±0.096 L (p0.01). On this group we have found out an adjust equation and we have validated it on an independent group of 4 COPD patients. The equation was Diff=-1478+15.6(weight). The mean tidal volume values obtained with pneumotach and TIE4sys on the second group of COPD patients (M:4) were: 0.798±0.395 L and 0.732±0.327 L. The mean of the differences was 0.066±0.114L. The differences of determinations estimated with pneumotach and TIE4sys can be attributed to changes of anthropometric characteristics like subscapular skinfold.

  16. Sample size and power for comparing two or more treatment groups in clinical trials.

    OpenAIRE

    Day, S. J.; Graham, D F

    1989-01-01

    Methods for determining sample size and power when comparing two groups in clinical trials are widely available. Studies comparing three or more treatments are not uncommon but are more difficult to analyse. A linear nomogram was devised to help calculate the sample size required when comparing up to five parallel groups. It may also be used retrospectively to determine the power of a study of given sample size. In two worked examples the nomogram was efficient. Although the nomogram offers o...

  17. Group Cognitive-Behavioral Therapy for Insomnia in a VA Mental Health Clinic

    Science.gov (United States)

    Perlman, Lawrence M.; Arnedt, J. Todd; Earnheart, Kristie L.; Gorman, Ashley A.; Shirley, Katherine G.

    2008-01-01

    Effective cognitive-behavioral therapies for insomnia have been developed over the past 2 decades, but they have not been systematically evaluated in some clinical settings. While insomnia is common among veterans with mental health problems, the availability of effective treatments is limited. We report on the group application of a…

  18. Change in quality management in diabetes care groups and outpatient clinics after feedback and tailored support

    NARCIS (Netherlands)

    Campmans-Kuijpers, Marjo J.; Baan, Caroline A.; Lemmens, Lidwien C.; Rutten, Guy E.

    2015-01-01

    OBJECTIVE: To assess the change in level of diabetes quality management in primary care groups and outpatient clinics after feedback and tailored support. RESEARCH DESIGN AND METHODS: This before-and-after study with a 1-year follow-up surveyed qualitymanagers on six domains of quality management. Q

  19. Mutual assumptions and facts about nondisclosure among clinical supervisors and students in group supervision

    DEFF Research Database (Denmark)

    Nielsen, Geir Høstmark; Skjerve, Jan; Jacobsen, Claus Haugaard;

    2009-01-01

    In the two preceding papers of this issue of Nordic Psychology the authors report findings from a study of nondisclosure among student therapists and clinical supervisors. The findings were reported separately for each group. In this article, the two sets of findings are held together and compared......, so as to draw a picture of mutual assumptions and facts about nondisclosure among students and supervisors....

  20. Dreams of Deceased Children and Countertransference in the Group Psychotherapy of Bereaved Mothers: Clinical Illustration

    Science.gov (United States)

    Begovac, Branka; Begovac, Ivan

    2012-01-01

    This article presents, in the form of a clinical illustration, a therapeutic group of bereaved mothers with special reference to their dreams about their deceased children. The article presents descriptions of the emotions of these mothers and countertransference feelings, a topic that, to our knowledge, has not been frequently studied. The group…

  1. Differences in Clinical and Laboratory Findings between Group D and Non-Group D Non-Typhoidal Salmonella Gastroenteritis in Children

    OpenAIRE

    Park, Heung Keun; Rhie, Kyuyol; Yeom, Jung Sook; Park, Ji Sook; Park, Eun Sil; Seo, Ji-Hyun; Lim, Jae Young; Park, Chan-Hoo; Woo, Hyang-Ok; Youn, Hee-Shang; Kang, Ki Ryeon; Park, Jung Je

    2015-01-01

    Purpose To investigate the differences in clinical features and laboratory findings between group D and non-group D non-typhoidal Salmonella (NTS) gastroenteritis in children. Methods A retrospective chart review of children diagnosed with NTS confirmed by culture study was performed. The clinical features and laboratory findings of group D and non-group D NTS were compared. Results From 2003 to 2012, 75 cases were diagnosed as NTS at our center. The number of group D and non-group D patients...

  2. A group-mediated psychotherapy with children: Clinical observation and assessment

    Directory of Open Access Journals (Sweden)

    Sara Cuticchio

    2014-09-01

    Full Text Available The study is based on clinical evaluation of a psychotherapy group for children, employing Sicilian puppets, objects as mediators, to reflect on significant moments and the dynamic processes of change during the therapy. TCM (Therapeutic Cycle Model, 1996, designed by Mergenthaler, is used to identify whether and how the assessment corresponds to the changes detected by observation of each subject and the group. During the 8 sessions of therapy, verbal productions of children and therapists were analyzed and compared. Keywords:Evaluation; Group therapy; Mediating object; Children 

  3. 群决策专家权重自适应算法研究%Research on serf-adjusting algorithm of group decision-making experts' weight

    Institute of Scientific and Technical Information of China (English)

    王俊英; 李德华

    2011-01-01

    为获得科学合理的群体决策结果,并在综合集成研讨厅中维护一个动态的专家权重信息库,提出了一种基于TOPSIS法和灰色关联度的专家权重自适应调整算法,算法综合考虑了专家个体与群体在方案重要属性以及方案序的判定上的相似度,并根据决策问题的不同,对算法的参数进行相应选取,算例表明算法是有效的,收敛速度也比较快.%In order to obtain scientific rational group decision-making results and maintain a dynamic experts' weight information base in HWME ( hall for workshop of meta synthesis engineering), this paper proposed an experts' weight self-adaptive adjustment algorithm based on TOPSIS method and grey correlation degree.This algorithm took into account the similarity between the individuals and groups of experts in the judge on the important attributes and order of the alternatives.Meanwhile,according to different decision-making problems, this algorithm could select corresponding parameter.Numerical example shows that the algorithm is effective and its convergence rate is relatively fast.

  4. THE CLINICAL EFFECT OF CHEMONUCLEOLYSIS BY ADJUSTING THE CONTRAST AGENT OMNIPAQUE IN THE TREATMENT OF LUMBAR DISC HERNINATION%胶原酶溶解术中调整造影剂分布对疗效的影响

    Institute of Scientific and Technical Information of China (English)

    王志力; 吴云松; 张俊辉; 陈松; 李明

    2011-01-01

    目的:通过调整造影剂在腰椎间盘和突出物内分布,探讨提高胶原酶溶解术治疗椎间盘突出症临床疗效的方法.方法:将83例经腰椎CT或MRI确诊为腰椎间盘突出症的患者随机分成对照组和造影组,两组均在CT直视下经椎板间孔入路穿刺成功,针尖(靶点)位于突出椎间盘突出物内.对照组直接注射胶原酶;造影组注射碘海醇0.5ml,突出物显影完整后注射胶原酶;术后1周、3月、6月对两组患者进行随访.结果:造影组术后3个月、6个月有效率达90.48%、97.62%,造影组术后6月疗效优于对照组,有统计学意义.结论:胶原酶溶解术中调整造影剂分布可提高远期临床疗效.%Objective: Chemonucleolysis by adjusting the contrast agent omnipaque in an attempt to improve the long term clinical effect. Methods: 83 patients of lumbar disc herniation were divided randomly into two groups. The operations were carried out under CT guidance, and the target point was the disc prominence. The control group were not injected with contrast agent. In the contrast group, 0.5ml Omnipaque contrast were injected in order to observe the contrast agent distribution in prominence. Adjusting the needle position until a full prominence is developed. After 1 week, 3 months, 6 months, patients is developed followed-up. Results: The efficacy rate in the angiography group after three and six months were 90.5% and 97.6%, respectively. The effects of angiography group were significantly better than the control group after six months. Conclusion: chemonucleolysis with adjustment of the distribution of contrast agents can improve clinical efficacy.

  5. [Group psychotherapy with an analytical orientation at the Tlatelolco clinic of neuropsychiatry].

    Science.gov (United States)

    1977-01-01

    Since most of the patients who attend for psychiatric consultation at a clinic are little motivated for psychotherapy, analytic group therapy was attempted, with basis on studies on psychological genetics, on groups management, and on the theories of Freud, Klein and Bion. Several open groups were handled, with the following achievements: 1. A decrease in anxiety, and increase in the objective vision of reality and in increase in the ability to see past and present conflicts. 2. A greater tolerance to agressive and sexual instincts and to frustration. 3. A greater personal acceptance, ability to sublimate productively and elimination of clinical symptoms. Varying degrees of improvement, and lesser need for psychiatric medication and hospitalization were obtained. Several problems were encountered: a) Desertion of 30% of patients from the sessions, due to the disapearance of symptoms buth with no character changes (resistances). b) Temporary absence or habit of arriving late to the sessions (resistances). c) Overwhelming passivity. The groups were handled in cotherapy and the work was supervised with experienced therapists. To attempt solving the above mentioned problems a better selection of patients was made, complete clinical histories were elaborated, a battery of psychological tests was made, and diagnosis, dynamics and prognosis of each case were outlined; this allowed the evaluation of middle and long term treatment. It was suggested to change the technique to that of operative groups.

  6. ABO blood groups and oral premalignancies: A clinical study in selected Indian population.

    Science.gov (United States)

    Bhateja, S; Arora, G

    2014-01-01

    Background: The ABO blood group antigens are present on the surface of red blood cells and various epithelial cells. As the majority of human cancers are derived from epithelial cells, changes in blood group antigens constitute an important aspect of human cancers. The aim of the study was to establish clinical usefulness of ABO blood group as a predisposing factor in early diagnosis and management of patients with oral precancerous lesions/conditions. Materials and Methods: The study sample consisted of 50 control and 50 oral precancer (25 leukoplakia and 25 Oral Submucous Fibrosis) confirmed by histopathologic examination. All samples were subjected to blood group testing and their prevalence was compared by Z-test using STATA version 8. Results: The "A" blood group was prevalent among the precancerous group. Significant differences on prevalences of blood groups were found (P blood group. Conclusion: Blood group type should be considered along with other risk factors to understand the individual patient's risk and further studies in larger samples with inclusion of Rh factor is needed to elucidate the relationship with ABO blood group types.

  7. Prescription Writing in Small Groups as a Clinical Pharmacology Educational Intervention: Perceptions of Preclerkship Medical Students.

    Science.gov (United States)

    James, Henry; Tayem, Yasin I Y; Al Khaja, K A J; Veeramuthu, Sindhan; Sequeira, Reginald P

    2016-08-01

    Medical students do not perform well in writing prescriptions, and the 3 variables-learner, teacher, and instructional method-are held responsible to various degrees. The objective of this clinical pharmacology educational intervention was to improve medical students' perceptions, motivation, and participation in prescription-writing sessions. The study participants were second-year medical students of the College of Medicine and Medical Sciences of the Arabian Gulf University, Bahrain. Two prescription-writing sessions were conducted using clinical case scenarios based on problems the students had studied as part of the problem-based learning curriculum. At the end of the respiratory system subunit, the training was conducted in small groups, each facilitated by a tutor. At the end of the cardiovascular system subunit, the training was conducted in a traditional large-group classroom setting. Data were collected with the help of a questionnaire at the end of each session and a focus group discussion. A majority of the students (95.3% ± 2.4%) perceived the small-group method better for teaching and learning of all aspects of prescription writing: analyzing the clinical case scenario, applying clinical pharmacology knowledge for therapeutic reasoning, using a formulary for searching relevant prescribing information, and in writing a complete prescription. Students also endorsed the small-group method for better interaction among themselves and with the tutor and for the ease of asking questions and clarifying doubts. In view of the principles of adult learning, where motivation and interaction are important, teaching and learning prescription writing in small groups deserve a serious consideration in medical curricula. PMID:26677798

  8. Ethical Challenges and Lessons Learned During the Clinical Development of a Group A Meningococcal Conjugate Vaccine

    Science.gov (United States)

    Martellet, Lionel; Sow, Samba O.; Diallo, Aldiouma; Hodgson, Abraham; Kampmann, Beate; Hirve, Siddhivinayak; Tapia, Milagritos; Haidara, Fadima Cheick; Ndiaye, Assane; Diarra, Bou; Ansah, Patrick Odum; Akinsola, Adebayo; Idoko, Olubukola T.; Adegbola, Richard A.; Bavdekar, Ashish; Juvekar, Sanjay; Viviani, Simonetta; Enwere, Godwin C.; Marchetti, Elisa; Chaumont, Julie; Makadi, Marie-Francoise; Pallardy, Flore; Kulkarni, Prasad S.; Preziosi, Marie-Pierre; LaForce, F. Marc

    2015-01-01

    Background. The group A meningococcal vaccine (PsA-TT) clinical development plan included clinical trials in India and in the West African region between 2005 and 2013. During this period, the Meningitis Vaccine Project (MVP) accumulated substantial experience in the ethical conduct of research to the highest standards. Methods. Because of the public–private nature of the sponsorship of these trials and the extensive international collaboration with partners from a diverse setting of countries, the ethical review process was complex and required strategic, timely, and attentive communication to ensure the smooth review and approval for the clinical studies. Investigators and their site teams fostered strong community relationships prior to, during, and after the studies to ensure the involvement and the ownership of the research by the participating populations. As the clinical work proceeded, investigators and sponsors responded to specific questions of informed consent, pregnancy testing, healthcare, disease prevention, and posttrial access. Results. Key factors that led to success included (1) constant dialogue between partners to explore and answer all ethical questions; (2) alertness and preparedness for emerging ethical questions during the research and in the context of evolving international ethics standards; and (3) care to assure that approaches were acceptable in the diverse community contexts. Conclusions. Many of the ethical issues encountered during the PsA-TT clinical development are familiar to groups conducting field trials in different cultural settings. The successful approaches used by the MVP clinical team offer useful examples of how these problems were resolved. Clinical Trials Registration. ISRCTN17662153 (PsA-TT-001); ISRTCN78147026 (PsA-TT-002); ISRCTN87739946 (PsA-TT-003); ISRCTN46335400 (PsA-TT-003a); ISRCTN82484612 (PsA-TT-004); CTRI/2009/091/000368 (PsA-TT-005); PACTR ATMR2010030001913177 (PsA-TT-006); PACTR201110000328305

  9. Experimenting clinical pathways in general practice: a focus group investigation with Italian general practitioners

    Directory of Open Access Journals (Sweden)

    Lucia Zannini

    2012-07-01

    Full Text Available Background. Clinical governance is considered crucial in primary care. Since 2005, clinical pathways have been experimentally implemented at the Local Health Authority of Monza Brianza (ASLMB, Italy, to develop general practitioners’ (GPs care of patients affected by some chronic diseases. The experimentation was aimed at introducing clinical governance in primary care, increasing GPs’ involvement in the care of their patients, and improving both patients’ and professionals’ satisfaction. In the period 2005-2006, 12% of the 763 employed GPs in the ASLMB were involved in the experiment, while this percentage increased to 15-20% in 2007-2008. Design and Methods. Twenty-four GPs were purposively sampled, randomly divided into two groups and asked to participate in focus groups (FGs held in 2008, aimed at evaluating their perception of the experiment. The FGs were audio-recorded, dialogues were typed out and undergone to a thematic analysis, according to the Interpretative Phenomenological Approach. Results. Four major themes emerged: i clinical pathways can result in GPs working in a more efficient and effective fashion; ii they can assure higher levels of both patient and professional satisfaction, since they sustain a caring approach and strengthen the GPs’ role; iii nevertheless, clinical pathways increase the bureaucratic workload and problems can arise in relationships among GPs and the LHA; iv the implementation of clinical pathways can be improved, especially by reducing bureaucracy and by assuring their continuity. Conclusions. Managerial aspects should be considered with care in order to experimentally introduce clinical pathways in general practice, and continuity of the experimentation should be guaranteed to improve GPs’ adherence and commitment.

  10. Application of (13)C ramp CPMAS NMR with phase-adjusted spinning sidebands (PASS) for the quantitative estimation of carbon functional groups in natural organic matter.

    Science.gov (United States)

    Ikeya, Kosuke; Watanabe, Akira

    2016-01-01

    The composition of carbon (C) functional groups in natural organic matter (NOM), such as dissolved organic matter, soil organic matter, and humic substances, is frequently estimated using solid-state (13)C NMR techniques. A problem associated with quantitative analysis using general cross polarization/magic angle spinning (CPMAS) spectra is the appearance of spinning side bands (SSBs) split from the original center peaks of sp (2) hybridized C species (i.e., aromatic and carbonyl C). Ramp CP/phase-adjusted side band suppressing (PASS) is a pulse sequence that integrates SSBs separately and quantitatively recovers them into their inherent center peaks. In the present study, the applicability of ramp CP/PASS to NOM analysis was compared with direct polarization (DPMAS), another quantitative method but one that requires a long operation time, and/or a ramp CP/total suppression side band (ramp CP/TOSS) technique, a popular but non-quantitative method for deleting SSBs. The test materials were six soil humic acid samples with various known degrees of aromaticity and two fulvic acids. There were no significant differences in the relative abundance of alkyl C, O-alkyl C, and aromatic C between the ramp CP/PASS and DPMAS methods, while the signal intensities corresponding to aromatic C in the ramp CP/TOSS spectra were consistently less than the values obtained in the ramp CP/PASS spectra. These results indicate that ramp CP/PASS can be used to accurately estimate the C composition of NOM samples.

  11. Clinically Significant Minor Blood Group Antigens amongst North Indian Donor Population

    Directory of Open Access Journals (Sweden)

    Divjot Singh Lamba

    2013-01-01

    Full Text Available Background. Racial differences in blood group antigen distribution are common and may result in striking and interesting findings. These differences in blood group antigen distribution are important due to their influence on the clinical practice of transfusion medicine. Study Design and Methods. This is a prospective study, involving 1000 healthy regular repeat voluntary blood donors associated with the department. The clinically significant minor blood group antigens of these donors were studied. Results. Out of 1000 healthy regular repeat voluntary blood donors, 93% were D positive and 2.8% were K positive. Amongst the Rh antigens, e was the most common (99%, followed by D (93%, C (85.1%, c (62.3%, and E (21.5%. Within the MNS blood group system, antigen frequency was M (88%, N (57.5%, S (57.8%, and s (87.5%. Within the Duffy blood group system, antigen frequency was Fya (87.3% and Fyb (58.3%. Conclusions. This data base will help us to prevent alloimmunisation in young females, pregnant women, and patients who are expected to require repeated transfusions in life by providing them with antigen matched blood. Antigen negative blood can also be made available without delay to already alloimmunized multitransfused patients.

  12. Levels of the Staff's Exposure to Violence at Locked Psychiatric Clinics: A Comparison by Occupational Groups.

    Science.gov (United States)

    Bilici, Rabia; Sercan, Mustafa; Izci, Filiz

    2016-07-01

    This study explored the rates of exposure to violence among physicians, nurses, and other health care staff members working at the locked psychiatric clinics, to examine the quantity and types of violence exposed, and to compare occupational groups by the level of exposure to violence. In parallel with the existing literature, the present study supports the proposition that physicians and nurses working at psychiatric units represent a risky group in terms of exposure to violence. The survey found that 87.6% of staff members viewed security measures insufficient. It is considered by the authors that preventive actions should be taken to reduce the risk of exposure to violence against the staff members working at the locked psychiatric clinics. PMID:27104294

  13. Return of individual research results and incidental findings in the clinical trials cooperative group setting.

    Science.gov (United States)

    Ferriere, Michael; Van Ness, Brian

    2012-04-01

    The National Cancer Institute (NCI)-funded cooperative group cancer clinical trial system develops experimental therapies and often collects samples from patients for correlative research. The cooperative group bank (CGB) system maintains biobanks with a current policy not to return research results to individuals. An online survey was created, and 10 directors of CGBs completed the surveys asking about understanding and attitudes in changing policies to consider return of incidental findings (IFs) and individual research results (IRRs) of health significance. The potential impact of the 10 consensus recommendations of Wolf et al. presented in this issue are examined. Reidentification of samples is often not problematic; however, changes to the current banking and clinical trial systems would require significant effort to fulfill an obligation of recontact of subjects. Additional resources, as well as a national advisory board would be required to standardize implementation.

  14. Biomarkers of sarcopenia in clinical trials—recommendations from the International Working Group on Sarcopenia

    OpenAIRE

    Cesari, Matteo; Pahor, Marco; Goodpaster, Bret; Hellerstein, Marc; Van Kan, Gabor A.; Anker, Stefan D.; Vrijbloed, J. Willem; Isaac, Maria; Rolland, Yves; M’Rini, Christine; Aubertin-Leheudre, Mylène; Cedarbaum, Jesse M.; Zamboni, Mauro; Sieber, Cornell C.; Laurent, Didier

    2012-01-01

    Sarcopenia, the age-related skeletal muscle decline, is associated with relevant clinical and socioeconomic negative outcomes in older persons. The study of this phenomenon and the development of preventive/therapeutic strategies represent public health priorities. The present document reports the results of a recent meeting of the International Working Group on Sarcopenia (a task force consisting of geriatricians and scientists from academia and industry) held on June 7–8, 2011 in Toulouse (...

  15. [Activity and Future Perspective of Local Independent Clinical Trial Group (OGSG)].

    Science.gov (United States)

    Tsujinaka, Toshimasa

    2016-04-01

    Osaka Gastrointestinal Cancer Chemotherapy Study Group (OGSG) was established in 2000 and has been conducting investigator initiated multi-institutional collaboration trials regarding the treatment of gastrointestinal cancer, especially using chemotherapeutic agents. Although organization of OGSG has been renovated to perform post-marketing clinical trials with high quality, OGSG is now facing severe financial crisis because of shortage of donation from pharmaceutical companies. Here, present problems and future perspectives are discussed. PMID:27220796

  16. Developing a clinical research network : the Northern Region Endoscopy Group experience.

    OpenAIRE

    Rajasekhar, P.; Rees, C. van; Rutter, M; Hungin, P

    2014-01-01

    Research is central to the National Health Service. Clinical trial recruitment has been aided by the National Institute for Health Research's Comprehensive Research Network but these networks do not support development of research. The Northern Region Endoscopy Group (NREG) was founded in 2007, encompasses 17 endoscopy units and has become a highly successful collaborative research network. The network is now a major contributor to UK trials, has published over 20 papers (>60 abstracts) and h...

  17. Leadership of healthcare commissioning networks in England: a mixed-methods study on clinical commissioning groups

    OpenAIRE

    Zachariadis, Markos; Oborn, Eivor; Barrett, Michael; Zollinger-Read, Paul

    2013-01-01

    Objective To explore the relational challenges for general practitioner (GP) leaders setting up new network-centric commissioning organisations in the recent health policy reform in England, we use innovation network theory to identify key network leadership practices that facilitate healthcare innovation. Design Mixed-method, multisite and case study research. Setting Six clinical commissioning groups and local clusters in the East of England area, covering in total 208 GPs and 1 662 000 pop...

  18. Carbapenem Breakpoints for Acinetobacter baumannii Group: Supporting Clinical Outcome Data from Patients with Bacteremia.

    Science.gov (United States)

    Lee, Yi-Tzu; Chiang, Mei-Chun; Kuo, Shu-Chen; Wang, Yung-Chih; Lee, I-Hsin; Chen, Te-Li; Yang, Ya-Sung

    2016-01-01

    The carbapenem breakpoints set by different organizations for Acinetobacter are discordant, but supporting clinical data are lacking. This study aimed to provide the first clinical outcome data to support the carbapenem breakpoints for Acinetobacter baumannii (Ab) group in patients with bacteremia. This study included 117 adults who received carbapenems for treatment of Ab group bacteremia in Taipei Veterans General Hospital over an 8-year period. We analyzed 30-day mortality rates among patient groups acquiring isolates with different carbapenem minimal inhibitory concentrations (MICs). The carbapenem MIC breakpoint derived from classification and regression tree (CART) analysis to delineate the risk of 30-day mortality was between MICs of ≤ 4 mg/L and ≥ 8 mg/L. Mortality rate was higher in patients acquiring isolates with carbapenem MIC ≥ 8 mg/L than ≤ 4 mg/L, by bivariate (54.9% [28/51] vs 25.8% [17/66]; P = 0.003) and survival analysis (P = 0.001 by log-rank test). Multivariate analysis using logistic regression and Cox regression models including severity of illness indices demonstrated that treating patients with Ab group bacteremia caused by isolates with a carbapenem MIC ≥ 8 mg/L with carbapenem was an independent predictor of 30-day mortality (odds ratio, 5.125; 95% confidence interval [CI], 1.946-13.498; P = 0.001, and hazard ratio, 2.630; 95% CI, 1.431-4.834; P = 0.002, respectively). The clinical outcome data confirmed that isolates with MIC ≤ 4 mg/L were susceptible to carbapenem, and those with MIC ≥ 8 mg/L were resistant in patients with Ab group bacteremia. PMID:27644087

  19. Clinical use of electronic portal imaging: Report of AAPM Radiation Therapy Committee Task Group 58

    International Nuclear Information System (INIS)

    AAPM Task Group 58 was created to provide materials to help the medical physicist and colleagues succeed in the clinical implementation of electronic portal imaging devices (EPIDs) in radiation oncology. This complex technology has matured over the past decade and is capable of being integrated into routine practice. However, the difficulties encountered during the specification, installation, and implementation process can be overwhelming. TG58 was charged with providing sufficient information to allow the users to overcome these difficulties and put EPIDs into routine clinical practice. In answering the charge, this report provides; comprehensive information about the physics and technology of currently available EPID systems; a detailed discussion of the steps required for successful clinical implementation, based on accumulated experience; a review of software tools available and clinical use protocols to enhance EPID utilization; and specific quality assurance requirements for initial and continuing clinical use of the systems. Specific recommendations are summarized to assist the reader with successful implementation and continuing use of an EPID

  20. The genesis of 'the Neophytes': a writing support group for clinical nurses.

    Science.gov (United States)

    Stone, Teresa; Levett-Jones, Tracy; Harris, Margaret; Sinclair, Peter M

    2010-10-01

    This paper profiles the establishment and evaluation of the Neophyte Writers' Group, run by nurse academics in collaboration with clinical nurses. The growing demand for nurses to write, publish and present their work had inspired the introduction of a series of workshops designed to develop and improve writing and presentation skills, which eventuated in formation of the Neophytes. The group was founded on the basis of Bandura's theory of self-efficacy (1997), a concept which has been discussed extensively in social psychology literature to explain motivation and learning theory. People with high assurance in their capabilities regard difficult tasks as challenges to be mastered rather than as threats to be avoided (Bandura, 1994). The Neophytes' group employs a collaborative approach intended to increase and reinforce members' self-confidence; the underlying philosophy is to promote and enhance writers' motivation, capacity and self-efficacy in order to achieve future publication goals confidently and independently. Support which engenders these strengths through a program relevant to participants' needs is likely, as this group found, to increase publication productivity. Additional unexpected outcomes resulted, such as engagement by clinical nurses' in academic work, and an increase in research higher degree enrolments. PMID:20096487

  1. Implementation of a severity-adjusted diagnosis-related groups payment system in a large health plan: implications for pay for performance.

    Science.gov (United States)

    Fay, Michael D; Jackson, David A; Vogel, Barbara B

    2007-01-01

    This article describes the implementation of the All Patient Refined Diagnosis Related Group (APR-DRG) inpatient payment system in a large regional commercial payer. The APR-DRG system replaced the Plan's current All-Payer DRG (AP-DRG) payment methodology on December 1, 2006, and is part of a strategic hospital payment redesign that will enable the Plan to control costs, increase pricing transparency for customers and providers, and reward hospital quality and efficiency. On the basis of modeled results using 2005 data, we found that the APR-DRG payment system using cost-based weights will do a better job of linking inpatient severity and use of resources to payments. The transition to the cost-based APR-DRG methodology with enhanced clinical specificity will also support measurement of hospital quality and efficiency in the Plan's performance improvement programs. PMID:17581433

  2. Adjustment disorder

    Science.gov (United States)

    American Psychiatric Association. Diagnostic and statistical manual of mental disorders . 5th ed. Arlington, VA: American Psychiatric Publishing. 2013. Powell AD. Grief, bereavement, and adjustment disorders. In: Stern TA, Fava ...

  3. Veteran satisfaction and treatment preferences in response to a posttraumatic stress disorder specialty clinic orientation group.

    Science.gov (United States)

    Schumm, Jeremiah A; Walter, Kristen H; Bartone, Anne S; Chard, Kathleen M

    2015-06-01

    To maximize accessibility to evidence-based treatments for posttraumatic stress disorder (PTSD), the United States Department of Veterans Affairs (VA) has widely disseminated cognitive processing therapy (CPT) and prolonged exposure (PE) therapy to VA clinicians. However, there is a lack of research on veteran preferences when presented with a range of psychotherapy and medication options. This study uses a mixed-method approach to explore veteran satisfaction with a VA PTSD specialty clinic pre-treatment orientation group, which provides education about available PTSD treatment options. This study also tested differences in treatment preference in response to the group. Participants were 183 US veterans. Most were White, male, and referred to the clinic by a VA provider. Results indicated high satisfaction with the group in providing an overview of services and helping to inform treatment choice. Most preferred psychotherapy plus medications (63.4%) or psychotherapy only (30.1%). Participants endorsed a significantly stronger preference for CPT versus other psychotherapies. PE was significantly preferred over nightmare resolution therapy and present-centered therapy, and both PE and cognitive-behavioral conjoint therapy were preferred over virtual reality exposure therapy. Results suggest that by informing consumers about evidence-based treatments for PTSD, pre-treatment educational approaches may increase consumer demand for these treatment options.

  4. Postgraduate Training in Clinical Oncology. Report on a WHO Working Group (The Hague, The Netherlands, December 6-8, 1978).

    Science.gov (United States)

    World Health Organization, Copenhagen (Denmark). Regional Office for Europe.

    The 1978 report of the Working Group of Postgraduate Training in Clinical Oncology, convened by the World Health Organization (WHO) Regional Office for Europe in collaboration with the government of The Netherlands, is presented. The groups analyzed models of postgraduate training in clinical oncology and evaluated their suitability in relation to…

  5. Hepato-biliary clinical trials and their inclusion in the Cochrane Hepato-Biliary Group register and reviews

    DEFF Research Database (Denmark)

    Klingenberg, Sarah Louise; Nikolova, Dimitrinka; Alexakis, Nicholas;

    2011-01-01

    The Cochrane Hepato-Biliary Group (CHBG) is one of the 52 collaborative review groups within The Cochrane Collaboration. The activities of the CHBG focus on collecting hepato-biliary randomized clinical trials (RCT) and controlled clinical trials (CCT), and including them in systematic reviews...

  6. The involvement of the thalamus in semantic retrieval: a clinical group study.

    Science.gov (United States)

    Pergola, Giulio; Bellebaum, Christian; Gehlhaar, Britta; Koch, Benno; Schwarz, Michael; Daum, Irene; Suchan, Boris

    2013-06-01

    There is increasing attention about the role of the thalamus in high cognitive functions, including memory. Although the bulk of the evidence refers to episodic memory, it was recently proposed that the mediodorsal (MD) and the centromedian-parafascicular (CM-Pf) nuclei of the thalamus may process general operations supporting memory performance, not only episodic memory. This perspective agrees with other recent fMRI findings on semantic retrieval in healthy participants. It can therefore be hypothesized that lesions to the MD and the CM-Pf impair semantic retrieval. In this study, 10 patients with focal ischemic lesions in the medial thalamus and 10 healthy controls matched for age, education, and verbal IQ performed a verbal semantic retrieval task. Patients were assigned to a target clinical group and a control clinical group based on lesion localization. Patients did not suffer from aphasia and performed in the range of controls in a categorization and a semantic association task. However, target patients performed poorer than healthy controls on semantic retrieval. The deficit was not because of higher distractibility but of an increased rate of false recall and, in some patients, of a considerably increased rate of misses. The latter deficit yielded a striking difference between the target and the control clinical groups and is consistent with anomia. Follow-up high-resolution structural scanning session in a subsample of patients revealed that lesions in the CM-Pf and MD were primarily associated with semantic retrieval deficits. We conclude that integrity of the MD and the CM-Pf is required for semantic retrieval, possibly because of their role in the activation of phonological representations.

  7. Meant to make a difference, the clinical experience of minimally invasive endodontics with the self-adjusting file system in India.

    Science.gov (United States)

    Pawar, Ajinkya M; Pawar, Mansing G; Kokate, Sharad R

    2014-01-01

    The vital steps in any endodontic treatment are thorough mechanical shaping and chemical cleaning followed by obtaining a fluid tight impervious seal by an inert obturating material. For the past two decades, introduction and use of rotary nickel-titanium (Ni-Ti) files have changed our concepts of endodontic treatment from conventional to contemporary. They have reported good success rates, but still have many drawbacks. The Self-Adjusting File (SAF) introduces a new era in endodontics by performing the vital steps of shaping and cleaning simultaneously. The SAF is a hollow file in design that adapts itself three-dimensionally to the root canal and is a single file system, made up of Ni-Ti lattice. The case series presented in the paper report the clinical experience, while treating primary endodontic cases with the SAF system in India.

  8. Meant to make a difference, the clinical experience of minimally invasive endodontics with the self-adjusting file system in India

    Directory of Open Access Journals (Sweden)

    Ajinkya M Pawar

    2014-01-01

    Full Text Available The vital steps in any endodontic treatment are thorough mechanical shaping and chemical cleaning followed by obtaining a fluid tight impervious seal by an inert obturating material. For the past two decades, introduction and use of rotary nickel-titanium (Ni-Ti files have changed our concepts of endodontic treatment from conventional to contemporary. They have reported good success rates, but still have many drawbacks. The Self-Adjusting File (SAF introduces a new era in endodontics by performing the vital steps of shaping and cleaning simultaneously. The SAF is a hollow file in design that adapts itself three-dimensionally to the root canal and is a single file system, made up of Ni-Ti lattice. The case series presented in the paper report the clinical experience, while treating primary endodontic cases with the SAF system in India.

  9. The effectiveness of a health promotion with group intervention by clinical trial. Study protocol

    Directory of Open Access Journals (Sweden)

    Campo Osaba Maria-Antonia

    2012-03-01

    Full Text Available Abstract Background The promotion of health and the interventions in community health continue to be one of the pending subjects of our health system. The most prevalent health problems (cardiovascular diseases, cancer, diabetes... are for the most part related to life habits. We propose a holistic and integral approach as the best option for tackling behavior and its determinants. The research team has elaborated the necessary educational material to realize group teaching, which we call "Health Workshops". The goal of the present study is to evaluate the effectiveness of these Health Workshops in the following terms: Health Related Quality of Life (HRQOL, incorporate and maintain a balanced diet, do physical activity regularly, maintain risk factors such as tension, weight, cholesterol within normal limits and diminish cardiovascular risk. Methods/Design Controlled and random clinical testing, comparing a group of persons who have participated in the Health Workshops with a control group of similar characteristics who have not participated in the Health Workshops. Field of study: the research is being done in Health Centers of the city of Barcelona, Spain. Population studied: The group is composed of 108 persons that are actually doing the Health Workshops, and 108 that are not and form the control group. They are assigned at random to one group or the other. Data Analysis: With Student's t-distribution test to compare the differences between numerical variables or their non parametric equivalent if the variable does not comply with the criteria of normality. (Kolmogorov-Smirnof test. Chi-square test to compare the differences between categorical variables and the Logistic Regression Model to analyze different meaningful variables by dichotomous analysis related to the intervention. Discussion The Health Workshop proposed in the present study constitutes an innovative approach in health promotion, placing the emphasis on the person's self

  10. Occupational Adjustment of Immigrants

    OpenAIRE

    Zorlu, Aslan

    2011-01-01

    This paper examines the speed of the occupational adjustment of immigrants using Labour Force Surveys 2004 and 2005 from Statistics Netherlands. The analysis provides new evidence that immigrants start with jobs at the lower levels of skill distribution. Their occupational achievement improves significantly with the duration of residence. The extent of this initial disadvantage and the rate of adjustment vary across immigrant groups according to the transferability of skills associated with t...

  11. Cognitive-behavioral group therapy in obsessive-compulsive disorder: a clinical trial

    Directory of Open Access Journals (Sweden)

    Cordioli Aristides V

    2002-01-01

    Full Text Available Objective: To develop a cognitive-behavioral group therapy protocol and to verify its efficacy to reduce obsessive-compulsive symptoms. Methods: An open clinical trial with 32 obsessive-compulsive patients was performed, in which a cognitive-behavioral group therapy protocol of 12 weekly sessions of two hours, in 5 consecutive groups, was applied. The severity of symptoms was rated with the Yale-Brown Obsessive-Compulsive (Y-BOCS, Hamilton Anxiety (HAM A and Hamilton Depression (HAM D scales. The patients were followed up for 3 months after the end of the treatment. Results: There was a significant reduction in the scores of Y-BOCS, HAM A and HAM D scales with the treatment regardless the use of anti-obsessive medications. The rate of improved patients (decrease of > or = 35% in Y-BOCS was 78.1%. Two patients (6.25% dropped out from the study. The effect size calculated for the Y-BOCS scale was 1.75. Conclusions: This study suggests that cognitive-behavioral group therapy reduces obsessive-compulsive symptoms. In addition, patients presented good compliance.

  12. Analysis of a group of clinical and social processing to caregivers of patients with dementia

    Directory of Open Access Journals (Sweden)

    Antonino Giorgi

    2014-09-01

    Full Text Available In Italy, according to recent data, the over 65 are about 20% of the population, while those over 80 are as many as 3 million (Istat, 2011. Over 600 thousand people are affected by Alzheimer's disease, the most common of the dementias. This pandemic is concerned, more or less directly, the majority of Italian families. A territorial service which wants to approach to families in difficulty must be organized on professional performances of experts and operators, whose diversity of competence is warranty for taking charge and for overcoming of the detected uneasiness. In this sense, the elaboration group for family members (caregivers that we present, offers the chance to receive and give sense to the effort due to the emotional implications that the disease of the elderly person involves. The work, presented here, has been designed and built by a perspective groupanalityc subjectual (Lo Verso, Di Blasi, 2011. It has set itself the goal of helping families to cope with the implications emotional / affective related to the topics of death and loss. The group device well it is combined with these clinical needs because it provided support and processing of emotional and cognitive experiences, has put in network information, has enabled the sharing of specific experiences. Through rigorous qualitative methodology, are therefore presented the outcomes of the group experience. Keywords:dementia, caregivers, group

  13. Aggression in children with autism spectrum disorders and a clinic-referred comparison group.

    Science.gov (United States)

    Farmer, Cristan; Butter, Eric; Mazurek, Micah O; Cowan, Charles; Lainhart, Janet; Cook, Edwin H; DeWitt, Mary Beth; Aman, Michael

    2015-04-01

    A gap exists in the literature regarding aggression in autism spectrum disorders and how this behavior compares to other groups. In this multisite study, the Children's Scale for Hostility and Aggression: Reactive/Proactive and the Aggression subscale of the Child Behavior Checklist were rated for 414 children with autism spectrum disorder (autistic disorder, 69%; pervasive developmental disorder not otherwise specified, 24%; Asperger's disorder, 7%) and 243 clinic-referred children without autism spectrum disorder, aged 1-21 years (mean age about 7 years). Participants were not selected for aggressive behavior. Relative to the comparison group, children with autism spectrum disorder were reported to have less aggression and were more likely to be rated as reactive rather than proactive. Among all subjects, sex was not associated with aggression; higher IQ/adaptive behavior and older age were associated with more sophisticated types of aggression, while lower scores on IQ, adaptive behavior, and communication measures were associated with more physical aggression. The interaction between demographic variables and diagnosis was significant only for age: younger but not older children with autism spectrum disorder showed less aggression than clinic-referred controls.

  14. Adjusting the DNA Interaction and Anticancer Activity of Pt(II) N-Heterocyclic Carbene Complexes by Steric Shielding of the Trans Leaving Group.

    Science.gov (United States)

    Muenzner, Julienne K; Rehm, Tobias; Biersack, Bernhard; Casini, Angela; de Graaf, Inge A M; Worawutputtapong, Pawida; Noor, Awal; Kempe, Rhett; Brabec, Viktor; Kasparkova, Jana; Schobert, Rainer

    2015-08-13

    Five platinum(II) complexes bearing a (1,3-dibenzyl)imidazol-2-ylidene ligand but different leaving groups trans to it were examined for cytotoxicity, DNA and cell cycle interference, vascular disrupting properties, and nephrotoxicity. The cytotoxicity of complexes 3a-c increased with the steric shielding of their leaving chloride ligand, and complex 3c, featuring two triphenylphosphanes, was the most efficacious, with submicromolar IC50 concentrations. Complexes 3a-c interacted with DNA in electrophoretic mobility shift and ethidium bromide binding assays. The cationic complex 3c did not bind coordinatively to DNA but led to its aggregation, damage that is not amenable to the usual repair mechanisms. Accordingly, it arrested the cell cycle of melanoma cells in G1 phase, whereas cis-dichlorido[(1,3-dibenzyl)imidazol-2-ylidene](dimethyl sulfoxide) platinum(II) 3a induced G2/M phase arrest. Complex 3c also disrupted the blood vessels in the chorioallantoic membrane of fertilized chicken eggs. Ex vivo studies using precision-cut tissue slices suggested the nephrotoxicities of 3a-c to be clinically manageable. PMID:26182125

  15. Developing clinical practice guidelines for epilepsy: A report from the ILAE Epilepsy Guidelines Working Group.

    Science.gov (United States)

    Sauro, Khara M; Wiebe, Samuel; Perucca, Emilio; French, Jacqueline; Dunkley, Colin; de Marinis, Alejandro; Kirkpatrick, Martin; Jetté, Nathalie

    2015-12-01

    Clinical practice guidelines (CPGs) contain evidence-based recommendations to guide clinical care, policy development, and quality of care improvement. A recent systematic review of epilepsy guidelines identified considerable variability in the quality of available guidelines. Although excellent frameworks for CPG development exist, processes are not followed uniformly internationally, and resources to develop CPGs may be limited in certain settings. An International League Against Epilepsy (ILAE) working group was charged with proposing methodology to guide the development of future epilepsy-specific CPGs. A comprehensive literature search (1985-2014) identified articles related to CPG development and handbooks. Guideline handbooks were included if they were publicly available, and if their methodology had been used to develop CPGs. The working group's expertise also informed the creation of methodologies and processes to develop future CPGs for the ILAE. Five handbooks from North America (American Academy of Neurology), Europe (Scottish Intercollegiate Guidelines Network & National Institute for Health and Care Excellence), Australia (National Health and Medical Research Council), World Health Organization (WHO), and additional references were identified to produce evidence-based, consensus-driven methodology for development of epilepsy-specific CPGs. Key components of CPG development include the following: identifying the topic and defining the scope; establishing a working group; identifying and evaluating the evidence; formulating recommendations and determining strength of recommendations; obtaining peer reviews; dissemination, implementation, and auditing; and updating and retiring the CPG. A practical handbook and toolkit was developed. The resulting CPG development toolkit should facilitate the development of high-quality ILAE CPGs to improve the care of persons with epilepsy.

  16. Maternal Sensitivity and Effortful Control in Early Childhood as Predictors of Adolescents' Adjustment: The Mediating Roles of Peer Group Affiliation and Social Behaviors

    Science.gov (United States)

    Laible, Deborah; Carlo, Gustavo; Davis, Alexandra N.; Karahuta, Erin

    2016-01-01

    Longitudinal links between early childhood temperament, maternal sensitivity, and adolescents' adjustment have been proposed and found in several longitudinal studies, but the mechanisms of influence have not been explored. The authors examined the paths from maternal sensitivity and temperament in early childhood to adolescents' prosocial,…

  17. High cost pool or high cost groups-How to handle high(est) cost cases in a risk adjustment mechanism?

    Science.gov (United States)

    Schillo, Sonja; Lux, Gerald; Wasem, Juergen; Buchner, Florian

    2016-02-01

    Competitive social health insurance systems (at least) in Western Europe have implemented systems of morbidity based risk adjustment to set a level playing field for insurers. However, many high cost insured still are heavily underfunded despite risk adjustment, leaving incentives for risk selection. In most of these health care systems, there is an ongoing debate about how to deal with such underpaid high cost cases. This study develops four distinct concepts by adding variables to risk adjustment or by setting up a high cost pool for underpaid insured besides the risk adjustment system. Their features, incentives and distributional effects are discussed. With a data set of 6 million insured, performance is demonstrated for Germany. All models achieve a substantial improvement in model fit, measured in terms of R(2) as well as CPM. As the results of the various models are different in different dimensions, the trade-offs that have to be dealt with and should be addressed, when implementing a model to reduce underfunding of high cost cases. PMID:26806676

  18. Cohesion and alliance between clinic and research, in a time-limited group for young adults in a mental health center: A study of clinical efficacy

    OpenAIRE

    Maria Teresa Gargano; Vittorio Lenzo; Giuseppa Salanitro; Savio Camizzi; Girolamo Lo Verso

    2014-01-01

    Currently, the clinical efficacy of psychodynamic group psychotherapy, is still poorly studied. Also some process variables, such as cohesion and alliance, are poorly investigated, despite the group-setting is widely used in italian public health system. Hence a progressive separation between the scientific work of empirical research and clinical practice conducted in the italian public health system. Starting from these premises, a single-case research was realized, whose results are describ...

  19. Clinical Implications for Muscle Strength Differences in Women of Different Age and Racial Groups: The WIN Study

    Science.gov (United States)

    Trudelle-Jackson, Elaine; Ferro, Emerenciana; Morrow, James R.

    2011-01-01

    Background Reduction in muscle strength is strongly associated with functional decline in women, and women with lower quadriceps strength adjusted for body weight are more likely to develop knee osteoarthritis. Objective To compare body weight--adjusted strength among women of different age/racial groups. Study Design Cross-sectional study of muscle strength in 918 women aged 20--83 (M ± SD = 52 ± 13). Methods An orthopedic examination was conducted including measurement of handgrip and lower extremity strength (hip abductors/external rotators, knee flexors/extensors). Data were grouped into young (20--39 years, n = 139), middle (40--54 years, n = 300), and older (55+ years, n = 424) ages for white (n = 699) and African American (AA) (n = 164) women. Means and standard deviations for strength adjusted for body weight were calculated for each age and racial group and compared using 2-way multivariate analysis of variance and post hoc tests. Results No significant age-by-race interaction (P = .092) but significant main effects for age and race (P < .001). Pairwise comparisons revealed significant differences in knee extensor and flexor strength between all age groups. For grip and hip external rotator strength, significant differences were found between the middle and older groups. Differences in hip abductor strength were found between the young and middle-aged groups. AA women had lower strength than white women in all muscle groups (P < .05) except hip external rotators. Conclusions Strength decreased with age in all muscle groups but magnitude of decrease varied by muscle. Strengthening programs should target different muscles, depending on a woman's age and race. PMID:21666779

  20. Effect of group psychotherapy on remission of adjustment disorder in college freshmen%团体心理疗法缓解大学新生适应障碍

    Institute of Scientific and Technical Information of China (English)

    邓旭阳; 郭晋林; 王小玲; 何壮湘; 李卉; 李辉; 姜婷娜

    2004-01-01

    of group psychotherapy on adjustment disorder in mass sample is still very few.OBJECTIVE: To explore the efficacy of group psychotherapy for eliminating adjustment disorder symptoms of college freshmen.DESIGN: A retrospective control study.SETTING, PARTICIPANTS and INTERVENTIONS: Symptom Check(SGL-90) and psychological clinic interview were used in the study. Totally 1 126 freshmen from either 1999 or 2000 grades of Nanjing Medical College were adopted for screening adjustment disorder, which were randomly divided into two groups with 30 patients in each group. Basic techniques of group therapy, such as group discussion, psychodrama and relaxation were applied, and selfassessing scale and SCL-90 were combined for self-comparison after treatment.MAIN OUTCOME MEASURES: Ghanges of mental health and self-worth of freshman were identified after treatment.served in participant(7.10 ± 1.40, 7.23 ± 1.48), self-confidence(5.87 ±2.14,7.48±1.70) andothers (t=2.01, P <0.05, t=3.37, P <0.01);While 2000 grade freshmen showed obvious improvements in sharing experience with others after treatment( t = 2.41, P < 0.05), particularly in participation with higher significance(t = 3.05, P < 0.01), as well as in caring Post-treatment sonatization, interpersonal communication, depression, obsessive-compulsion, anxiety, phobia and psychoticism were significantly higher than those of pretreatment in 1999 grade freshmen( t = 2.26-2.50, P <0.05; t = 2.88-3.15, P < 0.01), the same as somatization, phobia and depression of 2000 grade freshmen( t = 2.67, 2.10, P < 0.05; t = 2. 94, P <groups, revealing higher significant difference in caring about others, responsibility and understanding others before treatment( t = 2.09, P < 0.05; t =2.80, P < 0.01; t = 3.82, P < 0. 001), and obviously difference in four items including caring about others, self-confidence and so on( t = 2.47,2.17, P < 0.01); post-treatment mental health was compared with that of pretreatment in both

  1. Salary adjustments

    CERN Document Server

    HR Department

    2008-01-01

    In accordance with decisions taken by the Finance Committee and Council in December 2007, salaries are adjusted with effect from 1 January 2008. Scale of basic salaries and scale of stipends paid to fellows (Annex R A 5 and R A 6 respectively): increased by 0.71% with effect from 1 January 2008. As a result of the stability of the Geneva consumer price index, the following elements do not increase: a)\tFamily Allowance, Child Allowance and Infant Allowance (Annex R A 3); b)\tReimbursement of education fees: maximum amounts of reimbursement (Annex R A 4.01) for the academic year 2007/2008. Related adjustments will be applied, wherever applicable, to Paid Associates and Students. As in the past, the actual percentage increase of each salary position may vary, due to the application of a constant step value and rounding effects. Human Resources Department Tel. 73566

  2. Salary adjustments

    CERN Document Server

    HR Department

    2008-01-01

    In accordance with decisions taken by the Finance Committee and Council in December 2007, salaries are adjusted with effect from 1 January 2008. Scale of basic salaries and scale of stipends paid to fellows (Annex R A 5 and R A 6 respectively): increased by 0.71% with effect from 1 January 2008. As a result of the stability of the Geneva consumer price index, following elements do not increase: a) Family Allowance, Child Allowance and Infant Allowance (Annex R A 3). b) Reimbursement of education fees: maximum amounts of reimbursement (Annex R A 4.01) for the academic year 2007/2008. Related adjustments will be implemented, wherever applicable, to Paid Associates and Students. As in the past, the actual percentage increase of each salary position may vary, due to the application of a constant step value and the rounding effects. Human Resources Department Tel. 73566

  3. Disability and countertransference in group psychotherapy: connecting social oppression with the clinical frame.

    Science.gov (United States)

    Watermeyer, Brian

    2012-07-01

    Psychoanalysis has paid limited attention to disability, and at times the approach has lacked political awareness. Over recent decades the international disability rights movement has argued that disabled people constitute an oppressed, systemically disadvantaged minority. Lately, a critical psychoanalytic view has connected disablist discrimination to universal unconscious conflicts evoked by impairment. Corresponding evocations emerge in the therapeutic frame, producing countertransference responses to the impaired body. Drawing on psychoanalytically oriented group psychotherapy with severely physically impaired adults, countertransference phenomena were studied in developing discussion on disability-related clinical work. The complex, uncertain role of psychoanalytic practice in combating oppression was also examined. Key issues include challenges to the traditional frame, the crossing of psychic boundaries, anxieties relating to not knowing, and the role of unconscious factors in marginalizing disabled experience. PMID:22676787

  4. Clinical trials update of the European Organization for Research and Treatment of Cancer Breast Cancer Group

    International Nuclear Information System (INIS)

    The present clinical trial update consists of a review of two of eight current studies (the 10981-22023 AMAROS trial and the 10994 p53 trial) of the European Organization for Research and Treatment of Cancer Breast Cancer Group, as well as a preview of the MIND-ACT trial. The AMAROS trial is designed to prove equivalent local/regional control for patients with proven axillary lymph node metastasis by sentinel node biopsy if treated with axillary radiotherapy instead of axillary lymph node dissection, with reduced morbidity. The p53 trial started to assess the potential predictive value of p53 using a functional assay in yeast in patients with locally advanced/inflammatory or large operable breast cancer prospectively randomised to a taxane regimen versus a nontaxane regimen

  5. Clinical characteristics of a group of adults with nodular lymphoid hyperplasia: A single center experience

    Institute of Scientific and Technical Information of China (English)

    Alberto Rubio-Tapia; Jorge Hernéndez-Calleros; Sagrario Trinidad-Hernández; Luis Uscanga

    2006-01-01

    AIM: To describe the clinical and histological characteristics of a group of adults with small-bowel nodular lymphoid hyperplasia (NLH).METHODS: Patients were searched for five years in pathology records of our institution. The biopsy material was reassessed using strict histopathological criteria.Clinical data were obtained from medical records.RESULTS: Small-bowel NLH was diagnosed in 18 cases.The female: male ratio was 2: 1. The most frequent symptoms were diarrhea (72%), involuntary weight loss (72%) and abdominal pain (61%). Nine patients (50%)had immunodeficiency. Small-bowel bacterial overgrowth was found in three (17%) cases. At small-bowel NLH diagnosis, three (17%) had associated lymphoma: two intestinal and one extra-intestinal lymphomas. In two patients with villous atrophy and anti-endomysial antibodies the diagnosis of celiac disease was established.Giardia lamblia infection was found in only one patientwith hypogammaglobulinemia (Herman's syndrome).CONCLUSIONS; NLH is uncommon in adult patients.Associated diseases are immunodeficiency and lymphoid tissue malignancies.

  6. Integration of noninvasive prenatal prediction of fetal blood group into clinical prenatal care.

    Science.gov (United States)

    Clausen, Frederik Banch

    2014-05-01

    Incompatibility of red blood cell blood group antigens between a pregnant woman and her fetus can cause maternal immunization and, consequently, hemolytic disease of the fetus and newborn. Noninvasive prenatal testing of cell-free fetal DNA can be used to assess the risk of hemolytic disease of the fetus and newborn to fetuses of immunized women. Prediction of the fetal RhD type has been very successful and is now integrated into clinical practice to assist in the management of the pregnancies of RhD immunized women. In addition, noninvasive prediction of the fetal RhD type can be applied to guide targeted prenatal prophylaxis, thus avoiding unnecessary exposure to anti-D in pregnant women. The analytical aspect of noninvasive fetal RHD typing is very robust and accurate, and its routine utilization has demonstrated high sensitivities for fetal RHD detection. A high compliance with administering anti-D is essential for obtaining a clinical effect. Noninvasive fetal typing of RHC/c, RHE/e, and KEL may become more widely used in the future. PMID:24431264

  7. Group sequential control of overall toxicity incidents in clinical trials - non-Bayesian and Bayesian approaches.

    Science.gov (United States)

    Yu, Jihnhee; Hutson, Alan D; Siddiqui, Adnan H; Kedron, Mary A

    2016-02-01

    In some small clinical trials, toxicity is not a primary endpoint; however, it often has dire effects on patients' quality of life and is even life-threatening. For such clinical trials, rigorous control of the overall incidence of adverse events is desirable, while simultaneously collecting safety information. In this article, we propose group sequential toxicity monitoring strategies to control overall toxicity incidents below a certain level as opposed to performing hypothesis testing, which can be incorporated into an existing study design based on the primary endpoint. We consider two sequential methods: a non-Bayesian approach in which stopping rules are obtained based on the 'future' probability of an excessive toxicity rate; and a Bayesian adaptation modifying the proposed non-Bayesian approach, which can use the information obtained at interim analyses. Through an extensive Monte Carlo study, we show that the Bayesian approach often provides better control of the overall toxicity rate than the non-Bayesian approach. We also investigate adequate toxicity estimation after the studies. We demonstrate the applicability of our proposed methods in controlling the symptomatic intracranial hemorrhage rate for treating acute ischemic stroke patients.

  8. Sociodemographic analysis of patients in radiation therapy oncology group clinical trials

    International Nuclear Information System (INIS)

    Purpose: To assess the degree to which the sociodemographic characteristics of patients enrolled in Radiation Therapy Oncology Group (RTOG) clinical trails are representative of the general population. Methods and Materials: Sociodemographic data were collected on 4016 patients entered in 33 open RTOG studies between July 1991 and June 1994. The data analyzed included educational attainment, age, gender, and race. For comparison, we obtained similar data from the U.S. Department of Census. We also compared our RTOG data with Surveillance Epidemiology and End Results (SEER) data for patients who received radiation therapy, to determine how RTOG patients compared with cancer patients in general, and with patients with cancers at sites typically treated with radiotherapy. Results: Overall, the sociodemographic characteristics of patients entered in RTOG trials were similar to those of the Census data. We found that, in every age group of African-American men and at nearly every level of educational attainment, the proportion of RTOG trial participants mirrored the proportion in the census data. Significant differences were noted only in the youngest category of African-American men, where the RTOG accrues more in the lower educational categories and fewer with college experience. For African-American women, we found a similar pattern in every age group and at each level of educational attainment. As with men, RTOG trials accrued a considerably larger proportion of younger, less educated African-American women than the census reported. Using SEER for comparison, the RTOG enrolled proportionately more African-American men to trials all cancer sites combined, and for prostate and head and neck cancer. In head and neck trials, the RTOG enrolled nearly twice as many African-American men than would be predicted by SEER data. In lung cancer trials, RTOG underrepresented African-American men significantly; however, there was no difference for brain cancer trials. There were

  9. Hepato-biliary clinical trials and their inclusion in the Cochrane Hepato-Biliary Group register and reviews

    DEFF Research Database (Denmark)

    Klingenberg, Sarah Louise; Nikolova, Dimitrinka; Alexakis, Nicholas;

    2011-01-01

    The Cochrane Hepato-Biliary Group (CHBG) is one of the 52 collaborative review groups within The Cochrane Collaboration. The activities of the CHBG focus on collecting hepato-biliary randomized clinical trials (RCT) and controlled clinical trials (CCT), and including them in systematic reviews with...... meta-analyses of the trials. In this overview, we present the growth of The CHBG Controlled Trials Register, as well as the systematic reviews that have been produced since March 1996....

  10. The Effectiveness of Peer Taught Group Sessions of Physiotherapy Students within the Clinical Setting: A Quasi-Experimental Study

    Science.gov (United States)

    Scott, Dee; Jelsma, Jennifer

    2014-01-01

    The study aimed to investigate whether learning from peers, learning from a clinical educator, or being the peer teacher during clinical group sessions was more effective at enhancing student learning outcomes for different health conditions. A secondary aim was to determine which method students found more satisfactory. Physiotherapy students at…

  11. Accountable Care Organizations and Clinical Commissioning Groups face an uncertain challenge for improving public health

    Directory of Open Access Journals (Sweden)

    Douglas J. Noble

    2012-04-01

    Full Text Available Accountable Care Organizations (ACO in the United States of America (USA and Clinical Commissioning Groups (CCG in the United Kingdom (UK are new proposed organizations in health services both tasked with a role which includes improving public health.  Although there are very significant differences between the UK and USA health systems there appears to be a similar confusion as to how ACO and CCG will regard and address public or population health.  The role of ACO in improving population health and evaluating the health needs of their registered and insured patients remains ill-defined and poorly explored.  Likewise, in the current UK National Health Service (NHS reorganisation, control and commissioning of appropriate local health services are passing from Primary Care Trusts (PCT to new cross-organizational structures (CCG.  CCG groups aim to be, like ACO, physician led.  They will also assume a role for public or population health, but this role, like that of the newly-forming ACO, is currently unclear.  Lessons learned from the USA and UK experience of new organizations tasked with a role in improving public health may inform mechanisms for physician led organizations in the UK and the USA to assess health needs, monitor population health information and improve population health outcomes.

  12. A pilot evaluation of group-based programming offered at a Canadian outpatient adult eating disorders clinic.

    Science.gov (United States)

    Mac Neil, Brad A; Leung, Pauline; Nadkarni, Pallavi; Stubbs, Laura; Singh, Manya

    2016-10-01

    Eating disorder clinics across Canada place heavy reliance on group-based programming. However, little work has examined whether this modality of treatment is well-received by patients and results in clinical improvements. The purpose of this pilot study was to evaluate patient satisfaction and outcomes for group-based programming offered through an adult eating disorders clinic. Participants were 81 adults who met DSM-5 criteria for an eating disorder and participated in the study as part of the clinic's program evaluation. Participants received medical monitoring, psychiatric follow-up, adjunct nutrition and pre-psychological treatment, and participated in the clinic's core cognitive behavioural therapy (CBT) group. Demographic information and weight were collected at intake. Participants also completed pre- and post-group programming measures of life satisfaction, depressive and anxiety symptoms, psychological symptoms of the eating disorder, and satisfaction with the programming. Participants' experienced a significant increase in satisfaction with life, and decreases in depressive symptoms and psychological symptoms of the eating disorder post-group. Adults endorsed feeling fairly satisfied with the group-based services provided. Results draw attention to the importance of program evaluation as an integral component of an adult outpatient eating disorder clinic by providing a voice for patients' views of the services received and program outcomes. PMID:27288960

  13. A pilot evaluation of group-based programming offered at a Canadian outpatient adult eating disorders clinic.

    Science.gov (United States)

    Mac Neil, Brad A; Leung, Pauline; Nadkarni, Pallavi; Stubbs, Laura; Singh, Manya

    2016-10-01

    Eating disorder clinics across Canada place heavy reliance on group-based programming. However, little work has examined whether this modality of treatment is well-received by patients and results in clinical improvements. The purpose of this pilot study was to evaluate patient satisfaction and outcomes for group-based programming offered through an adult eating disorders clinic. Participants were 81 adults who met DSM-5 criteria for an eating disorder and participated in the study as part of the clinic's program evaluation. Participants received medical monitoring, psychiatric follow-up, adjunct nutrition and pre-psychological treatment, and participated in the clinic's core cognitive behavioural therapy (CBT) group. Demographic information and weight were collected at intake. Participants also completed pre- and post-group programming measures of life satisfaction, depressive and anxiety symptoms, psychological symptoms of the eating disorder, and satisfaction with the programming. Participants' experienced a significant increase in satisfaction with life, and decreases in depressive symptoms and psychological symptoms of the eating disorder post-group. Adults endorsed feeling fairly satisfied with the group-based services provided. Results draw attention to the importance of program evaluation as an integral component of an adult outpatient eating disorder clinic by providing a voice for patients' views of the services received and program outcomes.

  14. Effects of Group Training on Depression and Anxiety among Patients with Type I Diabetes: a Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Shanaz Rostami

    2016-05-01

    Full Text Available Background Depression and anxiety can have a significant impact on prognosis in diabetic patients. In this study we evaluate how the effect of group learning on anxiety and depression in adolescents with type 1 diabetes at clinics of Ahvaz Jundishapur University of Medical Science. Materials and Methods  This study was carried out via a pretest- posttest design on the adolescent 11-21 ages with type I diabetes. 74 patients were randomized in education group (n=37 either to the control group (n=37. Data collection tools included demographic and clinical status questionnaires, and the Beck anxiety and depression inventory. Group training intervention was done for intervention group and three months after study two groups filled questionnaires and inventories. Data analyzed using chi-square test and t-test using SPSS- 22 software. Results  Findings showed that there was a significant difference between patients mean of depression in intervention group before and after intervention (P

  15. Group differences in physician responses to handheld presentation of clinical evidence: a verbal protocol analysis

    Directory of Open Access Journals (Sweden)

    Pavlovic Nada J

    2007-07-01

    Full Text Available Abstract Background To identify individual differences in physicians' needs for the presentation of evidence resources and preferences for mobile devices. Methods Within-groups analysis of responses to semi-structured interviews. Interviews consisted of using prototypes in response to task-based scenarios. The prototypes were implemented on two different form factors: a tablet style PC and a pocketPC. Participants were from three user groups: general internists, family physicians and medicine residents, and from two different settings: urban and semi-urban. Verbal protocol analysis, which consists of coding utterances, was conducted on the transcripts of the testing sessions. Statistical relationships were investigated between staff physicians' and residents' background variables, self-reported experiences with the interfaces, and verbal code frequencies. Results 47 physicians were recruited from general internal medicine, family practice clinics and a residency training program. The mean age of participants was 42.6 years. Physician specialty had a greater effect on device and information-presentation preferences than gender, age, setting or previous technical experience. Family physicians preferred the screen size of the tablet computer and were less concerned about its portability. Residents liked the screen size of the tablet, but preferred the portability of the pocketPC. Internists liked the portability of the pocketPC, but saw less advantage to the large screen of the tablet computer (F[2,44] = 4.94, p = .012. Conclusion Different types of physicians have different needs and preferences for evidence-based resources and handheld devices. This study shows how user testing can be incorporated into the process of design to inform group-based customization.

  16. A Comparative Study of Deep Neck Abscess with Regards to Anatomical Location and Age Groups Using CT and Clinical Data

    Energy Technology Data Exchange (ETDEWEB)

    Park, Chan Ho; Han, Jong Kyu; Kim, Young Tong; Shin, Hyeong Cheol; Kim, Hyung Hwan; Jou, Sung Shick [Dept. of Radiology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan (Korea, Republic of)

    2012-04-15

    To evaluate differences anatomical location and age groups on CT and clinical data in deep neck abscess. This study included 200 patients who underwent CT and were diagnosed with a deep neck abscess, from December 2005 to July 2010. Patients were divided into four groups by age (children, adolescent, adult, elderly). Next, the anatomic location, location multiplicity and clinical data regarding the deep neck abscesses were analyzed retrospectively. The deep neck abscesses observed were defined as superficial or deep and partitioned into sub-groups, with further analysis of their clinical data. The incidence of the parapharyngeal abscess was more frequent in children and elderly groups (p < 0.05). The masticator abscess was only observed among patients in the elderly group (p < 0.05). Multiple locations were observed with increased frequency in children and elderly groups (p < 0.05). Swelling in the neck was more frequently observed in children and elderly groups (p < 0.05), cervical lymphadenitis was frequently seen in children and adolescent groups (p < 0.05), and the incidence of symptoms including sore throat were significantly increased in adolescent and adult groups (p < 0.05). Location multiplicity was significantly higher in parapharyngeal, retropharyngeal, submandibular, danger, visceral and masticator spaces than other spaces (p < 0.05). With regards to anatomic location, neck swelling was more frequent in superficial group and sore throat was more frequent in deep group (p < 0.05). Deep neck abscess would show significant differences with regards to the abscess location, location multiplicity, and clinical symptoms according to age. The clinical symptoms observed are dependent on the anatomic location as defined by a superficial or deep abscess.

  17. A simplified surveillance case definition of AIDS derived from empirical clinical data. The Clinical AIDS Study Group, and the Working Group on AIDS case definition.

    Science.gov (United States)

    Weniger, B G; Quinhões, E P; Sereno, A B; de Perez, M A; Krebs, J W; Ismael, C; Sion, F S; Ramos-Filho, C F; de Sá, C A; Byers, R H

    1992-12-01

    A clinical AIDS case definition is needed for surveillance in countries where the CDC case definition is not practical. To derive such a definition, we compared 110 HIV-seropositive and 135 randomly selected HIV-seronegative adult medical-ward inpatients in Brazil. Multivariate analysis of clinical signs and symptoms and simple diagnoses resulted in a discriminant function with sensitivity of 89% and specificity of 96% in predicting for AIDS. These data were the empirical basis for a clinical definition of AIDS in adults drafted in a Caracas, Venezuela, workshop sponsored by the Pan American Health Organization. The revised "Caracas" definition presented here requires a positive HIV serology, the absence of cancer or other cause of immunosuppression, plus > or = 10 cumulative points, as follows: Kaposi's sarcoma (10 points); extrapulmonary/noncavitary pulmonary tuberculosis (10); oral candidiasis or hairy leukoplakia (5); cavitary pulmonary/unspecified tuberculosis (5); herpes zoster or = 1 month (2); fever > or = 1 month (2); cachexia or > 10% weight loss (2); asthenia > or = 1 month (2); persistent dermatitis (2); anemia, lymphopenia, or thrombocytopenia (2); persistent cough or any pneumonia except TB (2); and lymphadenopathy > or = 1 cm at > or = 2 noninguinal sites for > or = 1 month (2). This definition has a sensitivity of 95% and a specificity of 100% (91% without HIV serology) when applied to the Brazilian patients in this study. The Caracas definition has been adopted by Brazil, Honduras, and Surinam, and is in validation elsewhere. The use of a reasonably sensitive and specific case definition commensurate with available diagnostic resources should facilitate AIDS surveillance in developing countries. PMID:1453332

  18. Cognitive behavioral therapy for depression among adults in Japanese clinical settings: a single-group study

    Directory of Open Access Journals (Sweden)

    Kikuchi Toshiaki

    2010-06-01

    Full Text Available Abstract Background Empirical support for cognitive behavioral therapy (CBT for treating Japanese patients with major depression is lacking, therefore, a feasibility study of CBT for depression in Japanese clinical settings is urgently required. Findings A culturally adapted, 16-week manualized individual CBT program for Japanese patients with major depressive disorder was developed. A total of 27 patients with major depression were enrolled in a single-group study with the purpose of testing the feasibility of the program. Twenty six patients (96% completed the study. The mean total score on the Beck Depression Inventory-II (BDI-II for all patients (Intention-to-treat sample improved from 32.6 to 11.7, with a mean change of 20.8 (95% confidence interval: 17.0 to 24.8. Within-group effect size at the endpoint assessment was 2.64 (Cohen's d. Twenty-one patients (77.7% showed treatment response and 17 patients (63.0% achieved remission at the end of the program. Significant improvement was observed in measurement of subjective and objective depression severity (assessed by BDI-II, Quick Inventory of Depressive Symptomatology-Self Rated, and Hamilton Depression Rating Scale, dysfunctional attitude (assessed by Dysfunctional Attitude Scale, global functioning (assessed by Global Assessment of Functioning of DSM-IV and subjective well-being (assessed by WHO Subjective Well-being Inventory (all p values Conclusions Our manualized treatment comprised of a 16-week individual CBT program for major depression appears feasible and may achieve favorable treatment outcomes among Japanese patients with major depression. Further research involving a larger sample in a randomized, controlled trial design is warranted. Trial registration UMIN-CTR UMIN000002542.

  19. Patient Engagement Practices in Clinical Research among Patient Groups, Industry, and Academia in the United States: A Survey.

    Directory of Open Access Journals (Sweden)

    Sophia K Smith

    Full Text Available Patient-centered clinical trial design and execution is becoming increasingly important. No best practice guidelines exist despite a key stakeholder declaration to create more effective engagement models. This study aims to gain a better understanding of attitudes and practices for engaging patient groups so that actionable recommendations may be developed.Individuals from industry, academic institutions, and patient groups were identified through Clinical Trials Transformation Initiative and Drug Information Association rosters and mailing lists. Objectives, practices, and perceived barriers related to engaging patient groups in the planning, conduct, and interpretation of clinical trials were reported in an online survey. Descriptive and inferential statistical analysis of survey data followed a literature review to inform survey questions.Survey respondents (n = 179 valued the importance of involving patient groups in research; however, patient group respondents valued their contributions to research protocol development, funding acquisition, and interpretation of study results more highly than those contributions were valued by industry and academic respondents (all p < .001. Patient group respondents placed higher value in open communications, clear expectations, and detailed contract execution than did non-patient group respondents (all p < .05. Industry and academic respondents more often cited internal bureaucratic processes and reluctance to share information as engagement barriers than did patient group respondents (all p < .01. Patient groups reported that a lack of transparency and understanding of the benefits of collaboration on the part of industry and academia were greater barriers than did non-patient group respondents (all p< .01.Despite reported similarities among approaches to engagement by the three stakeholder groups, key differences exist in perceived barriers and benefits to partnering with patient groups among the

  20. Veal calves’ clinical/health status in large groups fed with automatic feeding devices

    Directory of Open Access Journals (Sweden)

    Giulio Cozzi

    2010-01-01

    Full Text Available Aim of the current study was to evaluate the clinical/health status of veal calves in 3 farms that adopt large group housing and automatic feeding stations in Italy. Visits were scheduled in three phases of the rearing cycle (early, middle, and end. Results showed a high incidence of coughing, skin infection and bloated rumen particularly in the middle phase while cross-sucking signs were present at the early stage when calves’ nibbling proclivity is still high. Throughout the rearing cycle, the frequency of bursitis increased reaching 53% of calves at the end. The percentage of calves with a poorer body condition than the mid-range of the batch raised gradually as well, likely due to the non-proportioned teat/calves ratio that increases competition for feed and reduces milk intake of the low ranking animals. The remarked growth differences among pen-mates and the mortality rate close to 7% showed by the use of automatic feeding devices for milk delivery seem not compensating the lower labour demand, therefore its sustainability at the present status is doubtful both for the veal calves’ welfare and the farm incomes.

  1. Relationship of femorodistal bypass patency to clinical outcome. Iloprost Bypass International Study Group

    DEFF Research Database (Denmark)

    Watson, H R; Schroeder, T V; Simms, M H;

    1999-01-01

    To investigate the relationship between bypass patency, limb survival and clinical symptoms after femorodistal bypass procedures.......To investigate the relationship between bypass patency, limb survival and clinical symptoms after femorodistal bypass procedures....

  2. Psychiatric nursing menbers' reflections on participating in group-based clinical supervision

    DEFF Research Database (Denmark)

    Buus, Niels; Angel, Sanne; Traynor, Michael;

    2011-01-01

    This paper is a report of an interview study exploring psychiatric hospital nursing staff members' reflections on participating in supervision. Clinical supervision is a pedagogical process designed to direct, develop, and support clinical nurses. Participation rates in clinical supervision in ps...

  3. Central review of cytogenetics is necessary for cooperative group correlative and clinical studies of adult acute leukemia: The Cancer and Leukemia Group B experience

    OpenAIRE

    Mrózek, Krzysztof; Carroll, Andrew J.; Maharry, Kati; Rao, Kathleen W.; Patil, Shivanand R.; Pettenati, Mark J.; Watson, Michael S.; Arthur, Diane C.; Tantravahi, Ramana; Heerema, Nyla A.; Koduru, Prasad R. K.; Block, AnneMarie W; Qumsiyeh, Mazin B.; Edwards, Colin G.; Sterling, Lisa J.

    2008-01-01

    The Cancer and Leukemia Group B has performed central review of karyotypes submitted by institutional cytogenetics laboratories from patients with acute myeloid (AML) and acute lymphoblastic (ALL) leukemia since 1986. We assessed the role of central karyotype review in maintaining accurate, high quality cytogenetic data for clinical and translational studies using two criteria: the proportion of karyotypes rejected (i.e. inadequate), and, among accepted (i.e. adequate) cases, the proportion o...

  4. Confronting diversity in the production of clinical evidence goes beyond merely including under-represented groups in clinical trials

    NARCIS (Netherlands)

    Stronks, Karien; Wieringa, Nicolien F.; Hardon, Anita

    2013-01-01

    There is increasing evidence that outcomes of health care differ by patient characteristics, such as gender and ethnicity. If evidence-based medicine is to improve quality of care for all patients, it is essential to take this diversity into account when designing clinical studies. So far, this noti

  5. Gait analysis in clinically healthy sheep from three different age groups using a pressure-sensitive walkway

    OpenAIRE

    Agostinho Felipe S; Rahal Sheila C; Araújo Fábio A P; Conceição Renato T; Hussni Carlos A; El-Warrak Alexander O; Monteiro Frederico O B

    2012-01-01

    Abstract Background Understanding normal gait requires allowing for variations in normal patterns by the sex, age, and species in question. Therefore, the aim of this study was to evaluate kinetic and temporospatial parameters in clinically healthy sheep from three different age groups with a pressure-sensing walkway. The sheep were judged to be healthy based on the results of complete physical and orthopaedic examinations and had no history of lameness. Twenty-one clinically healthy female S...

  6. Moving the Self-Esteem of People with Epilepsy by Supportive Group: A Clinical Trial

    OpenAIRE

    Kritaya Sawangchareon; Sineenard Pranboon; Somsak Tiamkao; Kittisak Sawanyawisuth

    2013-01-01

    Introduction: People with epilepsy (PWE) face physical and mental illness, and social stigma, which affect their self-esteem and quality of life. The purpose of this study was to examine the effects of a support group on the self-esteem of PWE. Methods: A Quasi-experimental study was performed on 120 PWE in the Epilepsy Clinic at Srinagarind Hospital. The experimental group (N=60) attended the support group before receiving regular health care services. The control group (N=60) received only...

  7. Anti-choice group seeks Supreme Court review of federal clinic access law; Congress holds hearings.

    Science.gov (United States)

    1995-05-19

    The Freedom of Access to Clinic Entrances Act (FACE) is a federal statute which was signed into law May 1994 prohibiting the use of force, threat of force, or physical obstruction to intentionally injure, intimidate, or interfere with anyone providing reproductive health services. Since FACE was enacted, seven federal district courts and one federal appellate court have found the measure constitutional, although one federal district court in Wisconsin did rule against FACE. Anti-choice activists have argued that neither the Commerce Clause nor the Fourteenth Amendment to the US Constitution empower Congress to enact FACE. Congress relied upon both constitutional provisions when it enacted the statute, recognizing that illegal, violent acts against abortion providers and their patients threaten to disrupt medical care nationwide and eliminate the right to choose abortion. The US Court of Appeals for the Fourth Circuit on February 13, 1995, however, unanimously upheld a lower court's dismissal of the case, finding that FACE does not violate the US Constitution. Relying upon an April 26 Supreme Court decision in United States vs. Lopez, which held that Congress did not have the power under the Commerce Clause to enact a federal statute prohibiting the possession of a firearm within 100 feet of a school zone, an anti-choice group and several individuals petitioned the US Supreme Court in a May 12 filing to review the appellate court ruling in American Life League vs. Reno. The petitioners also challenge the broad powers of Congress under the Fourteenth Amendment to remedy infringements upon constitutional rights and assert FACE violates the First Amendment and the Religious Freedom Restoration Act. PMID:12346170

  8. Anti-choice group seeks Supreme Court review of federal clinic access law; Congress holds hearings.

    Science.gov (United States)

    1995-05-19

    The Freedom of Access to Clinic Entrances Act (FACE) is a federal statute which was signed into law May 1994 prohibiting the use of force, threat of force, or physical obstruction to intentionally injure, intimidate, or interfere with anyone providing reproductive health services. Since FACE was enacted, seven federal district courts and one federal appellate court have found the measure constitutional, although one federal district court in Wisconsin did rule against FACE. Anti-choice activists have argued that neither the Commerce Clause nor the Fourteenth Amendment to the US Constitution empower Congress to enact FACE. Congress relied upon both constitutional provisions when it enacted the statute, recognizing that illegal, violent acts against abortion providers and their patients threaten to disrupt medical care nationwide and eliminate the right to choose abortion. The US Court of Appeals for the Fourth Circuit on February 13, 1995, however, unanimously upheld a lower court's dismissal of the case, finding that FACE does not violate the US Constitution. Relying upon an April 26 Supreme Court decision in United States vs. Lopez, which held that Congress did not have the power under the Commerce Clause to enact a federal statute prohibiting the possession of a firearm within 100 feet of a school zone, an anti-choice group and several individuals petitioned the US Supreme Court in a May 12 filing to review the appellate court ruling in American Life League vs. Reno. The petitioners also challenge the broad powers of Congress under the Fourteenth Amendment to remedy infringements upon constitutional rights and assert FACE violates the First Amendment and the Religious Freedom Restoration Act.

  9. Mood Adjustment via Mass Communication.

    Science.gov (United States)

    Knobloch, Silvia

    2003-01-01

    Proposes and experimentally tests mood adjustment approach, complementing mood management theory. Discusses how results regarding self-exposure across time show that patterns of popular music listening among a group of undergraduate students differ with initial mood and anticipation, lending support to mood adjustment hypotheses. Describes how…

  10. The interrelationships between clinical signs and their effect on involuntary culling among pregnant sows in group-housing systems

    DEFF Research Database (Denmark)

    Jensen, Tina Birk; Bonde, Marianne Kjær; Kongsted, Anne Grete;

    2010-01-01

    Sows suffering from clinical signs of disease (e.g. lameness, wounds and shoulder ulcers) are often involuntarily culled, affecting the farmer's economy and the welfare of the animals. In order to investigate the interrelationships between clinical signs of individual pregnant group-housed sows, we...... the explanatory factor analysis, we identified three factors describing the underlying structure of the 16 clinical variables. We interpreted the factors as ‘pressure marks', ‘wounds' and ‘lameness' Logistic analyses were performed to investigate the effect of the three factors and the parity number of each sow...

  11. The articulation of integration of clinical and basic sciences in concept maps: differences between experienced and resident groups.

    Science.gov (United States)

    Vink, Sylvia; van Tartwijk, Jan; Verloop, Nico; Gosselink, Manon; Driessen, Erik; Bolk, Jan

    2016-08-01

    To determine the content of integrated curricula, clinical concepts and the underlying basic science concepts need to be made explicit. Preconstructed concept maps are recommended for this purpose. They are mainly constructed by experts. However, concept maps constructed by residents are hypothesized to be less complex, to reveal more tacit basic science concepts and these basic science concepts are expected to be used for the organization of the maps. These hypotheses are derived from studies about knowledge development of individuals. However, integrated curricula require a high degree of cooperation between clinicians and basic scientists. This study examined whether there are consistent variations regarding the articulation of integration when groups of experienced clinicians and basic scientists and groups of residents and basic scientists-in-training construct concept maps. Seven groups of three clinicians and basic scientists on experienced level and seven such groups on resident level constructed concept maps illuminating clinical problems. They were guided by instructions that focused them on articulation of integration. The concept maps were analysed by features that described integration. Descriptive statistics showed consistent variations between the two expertise levels. The concept maps of the resident groups exceeded those of the experienced groups in articulated integration. First, they used significantly more links between clinical and basic science concepts. Second, these links connected basic science concepts with a greater variety of clinical concepts than the experienced groups. Third, although residents did not use significantly more basic science concepts, they used them significantly more frequent to organize the clinical concepts. The conclusion was drawn that not all hypotheses could be confirmed and that the resident concept maps were more elaborate than expected. This article discusses the implications for the role that residents and

  12. Different Effect of the Additional Electron-Withdrawing Cyano Group in Different Conjugation Bridge: The Adjusted Molecular Energy Levels and Largely Improved Photovoltaic Performance.

    Science.gov (United States)

    Li, Huiyang; Fang, Manman; Hou, Yingqin; Tang, Runli; Yang, Yizhou; Zhong, Cheng; Li, Qianqian; Li, Zhen

    2016-05-18

    Four organic sensitizers (LI-68-LI-71) bearing various conjugated bridges were designed and synthesized, in which the only difference between LI-68 and LI-69 (or LI-70 and LI-71) was the absence/presence of the CN group as the auxiliary electron acceptor. Interestingly, compared to the reference dye of LI-68, LI-69 bearing the additional CN group exhibited the bad performance with the decreased Jsc and Voc values. However, once one thiophene moiety near the anchor group was replaced by pyrrole with the electron-rich property, the resultant LI-71 exhibited a photoelectric conversion efficiency increase by about 3 folds from 2.75% (LI-69) to 7.95% (LI-71), displaying the synergistic effect of the two moieties (CN and pyrrole). Computational analysis disclosed that pyrrole as the auxiliary electron donor (D') in the conjugated bridge can compensate for the lower negative charge in the electron acceptor, which was caused by the CN group as the electron trap, leading to the more efficient electron injection and better photovoltaic performance.

  13. Adjusting the DNA Interaction and Anticancer Activity of Pt(II) N-Heterocyclic Carbene Complexes by Steric Shielding of the Trans Leaving Group

    NARCIS (Netherlands)

    Muenzner, Julienne K.; Rehm, Tobias; Biersack, Bernhard; Casini, Angela; de Graaf, Inge A. M.; Worawutputtapong, Pawida; Noor, Awal; Kempe, Rhett; Brabec, Viktor; Kasparkova, Jana; Schobert, Rainer

    2015-01-01

    Five platinum(LI) complexes bearing a (1,3-dibenzyl)imidazol-2-ylidene ligand but different leaving groups trans to it were examined for cytotomicity, DNA and cell cycle interference, vascular disrupting properties, and nephrotoxicity. The cytotoxicity of complexes 3a-c increased with the steric shi

  14. Differentiation in Data Analysis & Probability, PreK-Grade 2: A Content Companion for Ongoing Assessment, Grouping Students, Targeting Instruction, and Adjusting Levels of Cognitive Demand

    Science.gov (United States)

    Taylor-Cox, Jennifer

    2008-01-01

    This book applies the author's easy but effective differentiation strategies to the data analysis and probability content standard. Taking the foundational elements of differentiation in this book, it helps you: (1) assess students' math abilities quickly and efficiently; (2) group children by need; (3) target instruction to meet every student's…

  15. Maternal evaluations of young children’s developmental status: A comparison of clinic- and non-clinic-groups

    Directory of Open Access Journals (Sweden)

    Pia Deimann

    2011-06-01

    Full Text Available The question whether parents’ reports on their children’s development provide reliable information is a subject of controversial debate. While parental rating scales and parental interviews are widely used in clinical practice, empirical findings have shown that parents cannot assess their children well. Previous research has illustrated that most parents tend to overestimate the developmental status and cognitive performance of their children. If the child displays behavior problems, the accuracy of mothers’ appraisals decreases substantially. The aim of this study was (1 to examine whether mothers who are concerned about their children’s development still overestimate the developmental status and (2 whether maternal beliefs about developmental norms influence the accuracy of evaluation. The sample consisted of 14 mother-child-dyads who were clients of two outpatient clinics in Vienna and had concerns about the child’s development, 16 mother-child-dyads without concerns who sought advice because of their children’s potential high abilities, and 30 mother-child-dyads without concerns and no clinic referral. While the children were tested using the Wiener Entwicklungstest (Viennese Developmental Test, WET, Kastner-Koller & Deimann, 2002, a developmental test for children 3 to 6 years old, mothers were asked to estimate which items of the WET (1 their own child and (2 a normal peer would be able to solve. Mothers with concerns had limited knowledge of what a child of a certain age can achieve and they expected too much. Though they realized that their own developmentally delayed child did not fulfill these high expectations, they were not able to appraise his/her performance accurately. Mothers whose children were normally developed or even above average were able to evaluate their own children much more precisely. Moreover, these mothers estimated developmental norms more accurately. Both mothers of gifted children and of

  16. Clinical intuition in mental health care: A discussion and focus groups

    NARCIS (Netherlands)

    Witteman, C.L.M.; Spaanjaars, N.L.; Aarts, A.A.

    2012-01-01

    Clinical intuition in mental health care has been written off as a mysterious kind of ability to ‘see through’ clients, something that clinicians who favour evidence-based practice should have nothing to do with. We propose another understanding of clinical intuition. Similar to other types of profe

  17. [Development of clinical trial education program for pharmaceutical science students through small group discussion and role-playing using protocol].

    Science.gov (United States)

    Imakyure, Osamu; Shuto, Hideki; Nishikawa, Fumi; Hagiwara, Yoshifuka; Inoue, Sachiko; Koyanagi, Taeko; Hirakawa, Masaaki; Kataoka, Yasufumi

    2010-08-01

    The acquirement of basic knowledge of clinical trials and professional attitude in their practices is a general instructional objective in the Model Core Curriculum for Pharmaceutical Education. Unfortunately, the previous program of clinical trial education was not effective in the acquirement of a professional attitude in their practices. Then, we developed the new clinical trial education program using protocol through small group discussion (SGD) and roll-playing. Our program consists of 7 steps of practical training. In step 1, the students find some problems after presentation of the protocol including case and prescription. In step 2, they analyse the extracted problems and share the information obtained in SGD. In steps 3 and 5, five clinical case scenarios are presented to the students and they discuss which case is suitable for entry to the clinical trial or which case corresponds to the discontinuance criteria in the present designed protocol. In steps 4 and 6, the roll-playing is performed by teachers and students as doctors and clinical research coordinators (CRC) respectively. Further, we conducted a trial practice based on this program for the students. In the student's self-evaluation into five grades, the average score of the skill acquisition level in each step was 3.8-4.7 grade. Our clinical trial education program could be effective in educating the candidates for CRC or clinical pharmacists.

  18. Adjusting Population Risk for Functional Health Status.

    Science.gov (United States)

    Fuller, Richard L; Hughes, John S; Goldfield, Norbert I

    2016-04-01

    Risk adjustment accounts for differences in population mix by reducing the likelihood of enrollee selection by managed care plans and providing a correction to otherwise biased reporting of provider or plan performance. Functional health status is not routinely included within risk-adjustment methods, but is believed by many to be a significant enhancement to risk adjustment for complex enrollees and patients. In this analysis a standardized measure of functional health was created using 3 different source functional assessment instruments submitted to the Medicare program on condition of payment. The authors use a 5% development sample of Medicare claims from 2006 and 2007, including functional health assessments, and develop a model of functional health classification comprising 9 groups defined by the interaction of self-care, mobility, incontinence, and cognitive impairment. The 9 functional groups were used to augment Clinical Risk Groups, a diagnosis-based patient classification system, and when using a validation set of 100% of Medicare data for 2010 and 2011, this study found the use of the functional health module to improve the fit of observed enrollee cost, measured by the R(2) statistic, by 5% across all Medicare enrollees. The authors observed complex nonlinear interactions across functional health domains when constructing the model and caution that functional health status needs careful handling when used for risk adjustment. The addition of functional health status within existing risk-adjustment models has the potential to improve equitable resource allocation in the financing of care costs for more complex enrollees if handled appropriately. (Population Health Management 2016;19:136-144). PMID:26348621

  19. RADIATION THERAPY ONCOLOGY GROUP TRANSLATIONAL RESEARCH PROGRAM STEM CELL SYMPOSIUM : INCORPORATING STEM CELL HYPOTHESES INTO CLINICAL TRIALS

    NARCIS (Netherlands)

    Woodward, Wendy A.; Bristow, Robert G.; Clarke, Michael F.; Coppes, Robert P.; Cristofanilli, Massimo; Duda, Dan G.; Fike, John R.; Hambardzumyan, Dolores; Hill, Richard P.; Jordan, Craig T.; Milas, Luka; Pajonk, Frank; Curran, Walter J.; Dicker, Adam P.; Chen, Yuhchyau

    2009-01-01

    At a meeting of the Translation Research Program of the Radiation Therapy Oncology Group held in early 2008, attendees focused on updating the current state of knowledge in cancer stem cell research and discussing ways in which this knowledge can be translated into clinical use across all disease si

  20. Role modelling of clinical tutors: a focus group study among medical students

    OpenAIRE

    Burgess, Annette; Goulston, Kerry; Oates, Kim

    2015-01-01

    Background Role modelling by clinicians assists in development of medical students’ professional competencies, values and attitudes. Three core characteristics of a positive role model include 1) clinical attributes, 2) teaching skills, and 3) personal qualities. This study was designed to explore medical students’ perceptions of their bedside clinical tutors as role models during the first year of a medical program. Methods The study was conducted with one cohort (n = 301) of students who ha...

  1. A Novel Religious/Spiritual Group Psychotherapy Reduces Depressive Symptoms in a Randomized Clinical Trial.

    Science.gov (United States)

    Chida, Yoichi; Schrempft, Stephanie; Steptoe, Andrew

    2016-10-01

    This randomized controlled trial aimed to examine the effect of the Happy Science doctrine-based group psychotherapy on depressive symptoms in 118 Japanese mental disorder outpatients. The treatment group (n = 58) took part in five 90-min sessions at one-week intervals, while the control group (n = 60) received standard care including medication. Depressive symptoms were assessed before the intervention, 5 weeks after the intervention, and at 3-month follow-up. Compared to the control group, the treatment group showed a significant reduction in depressive symptoms both at post-intervention and at 3-month follow-up. In conclusion, this group psychotherapy might be of benefit in treating depressive symptoms. PMID:26320001

  2. An Australasian perspective on sarcoma research, translational biology and clinical trials: the Australasian Sarcoma Study Group (ASSG).

    Science.gov (United States)

    Bae, Susie; Caruso, Denise; Desai, Jayesh

    2014-02-01

    Each year approximately 800 Australians are diagnosed with sarcoma, accounting for less than 1% of cancer diagnoses overall. A significant proportion of these sarcoma cases are in children and adolescents. The rarity and heterogeneity of this group of tumours, coupled with Australasia's relative geographical isolation, pose significant challenges in developing locoregional basic, translational and clinical research. The Australasian Sarcoma Study Group (ASSG) was established in 2008 as a Cooperative Cancer Clinical Research Group and is now the peak body for sarcoma research in Australasia, providing a mechanism to drive and coordinate collaborative research, promote education and assist with advocating for sarcoma within the region. This paper describes the development of ASSG and examines the current state of play with regard to sarcoma research in Australasia. PMID:24378392

  3. Relationship between ABO blood groups and malaria with clinical outcome in rural area of South India

    OpenAIRE

    Gayathri B.N.; Harendra Kumar M.L.; Gomathi. N.; Jeevan Shetty; Reethesh R. P.

    2013-01-01

    Background A number of studies have shown that susceptibility to several infectious diseases is related to the patient’s blood group. Although the relationship between blood group and susceptibility to malaria has been studied by several researchers, the results have been contradictory. Since malaria has re-emerged as a major problem in India during the past few years, it would be useful to know whether there is any relationship between blood group and infection. Objectives The study will be...

  4. Effectiveness of group cognitive–behavioral treatment for childhood anxiety disorders in community clinics: benchmarking against an efficacy trial at a university clinic

    DEFF Research Database (Denmark)

    Jónsson, Hjalti; Arendt, Kristian Bech; Jørgensen, Lisbeth;

    Background: The efficacy of a group cognitive behavioural therapy program (Cool Kids) of childhood anxiety has been demonstrated in a university-clinic setting in Australia (Hudson et al., 2009) and findings from a randomized controlled trial (RCT) at a University-clinic supports its efficacy...... in Denmark (Arendt & Thastum, 2013). Objective: To evaluate the outcomes of evidence based, manualized group cognitive-behavioural treatment (CBT) for children and adolescent with anxiety disorders, when delivered in an outpatient Child and Adolescent Psychiatry or in a community based School Counselling...... with the children and their parents at pre- and post-treatment and at 3-month follow-up (ADIS-C/P: Silverman & Nelles, 1988), as well as by self-report child and parent scales pre- and post-treatment, and at 3- and 12 month follow-ups. Parents’ symptoms of anxiety and depression are also measured. Results...

  5. Clinical patch test data evaluated by multivariate analysis. Danish Contact Dermatitis Group

    DEFF Research Database (Denmark)

    Christophersen, J; Menné, T; Tanghøj, P;

    1989-01-01

    patch tested with the standard series of the International Contact Dermatitis Research Group (ICDRG) by members of the Danish Contact Dermatitis Group (DCDG) over a period of 6 months. For the 8 test allergens most often found positive (nickel, fragrance-mix, cobalt, chromate, balsam of Peru, carba...

  6. Group Therapy with Patients in the Waiting Room of an Oncology Clinic.

    Science.gov (United States)

    Arnowitz, Edward; And Others

    1983-01-01

    Describes a therapy group for cancer patients, conducted by cotherapists in an oncology waiting room. Group members provided mutual support and shared concerns and coping methods. Medical staff members became more involved and were more able to address the affective needs of the patients and their families. (JAC)

  7. Dynamic schedule of steel making-continuous casting based on group adjustment orienting restrict%基于约束联动的炼钢-连铸动态调度

    Institute of Scientific and Technical Information of China (English)

    赵宁; 丁文英; 董绍华; 冯爱兰

    2011-01-01

    为了解决炼钢-连铸生产动态调度中调度约束繁杂、多变的问题,分析了炼钢-连铸动态调度约束集,提出了约束联动的方法来实现快速的人机交互动态调度,并在此基础上建立了约束联动的动态调度数学模型和调度算法,最后结合实例说明了约束联动动态调度方法的有效性.%In order to solve dynamic disturbance in steel making-continuous casting, the restrict muster of steel making-continuous casting was analyzed firstly. Group adjustment orienting restrict was built to ensure schedule result timely and correctness in interactive schedule. Dynamic schedule model and schedule algorithm were built orienting this method. Finally, an example was showed to prove the efficiency of group adjustment orienting restrict.

  8. Clinical education and training: Using the nominal group technique in research with radiographers to identify factors affecting quality and capacity

    International Nuclear Information System (INIS)

    There are a number of group-based research techniques available to determine the views or perceptions of individuals in relation to specific topics. This paper reports on one method, the nominal group technique (NGT) which was used to collect the views of important stakeholders on the factors affecting the quality of, and capacity to provide clinical education and training in diagnostic imaging and radiotherapy and oncology departments in the UK. Inclusion criteria were devised to recruit learners, educators, practitioners and service managers to the nominal groups. Eight regional groups comprising a total of 92 individuals were enrolled; the numbers in each group varied between 9 and 13. A total of 131 items (factors) were generated across the groups (mean = 16.4). Each group was then asked to select the top three factors from their original list. Consensus on the important factors amongst groups found that all eight groups agreed on one item: staff attitude, motivation and commitment to learners. The 131 items were organised into themes using content analysis. Five main categories and a number of subcategories emerged. The study concluded that the NGT provided data which were congruent with the issues faced by practitioners and learners in their daily work; this was of vital importance if the findings are to be regarded with credibility. Further advantages and limitations of the method are discussed, however it is argued that the NGT is a useful technique to gather relevant opinion; to select priorities and to reach consensus on a wide range of issues

  9. Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya.

    Directory of Open Access Journals (Sweden)

    D James Nokes

    2008-07-01

    Full Text Available BACKGROUND: Rotavirus, predominantly of group A, is a major cause of severe diarrhoea worldwide, with the greatest burden falling on young children living in less-developed countries. Vaccines directed against this virus have shown promise in recent trials, and are undergoing effectiveness evaluation in sub-Saharan Africa. In this region limited childhood data are available on the incidence and clinical characteristics of severe group A rotavirus disease. Advocacy for vaccine intervention and interpretation of effectiveness following implementation will benefit from accurate base-line estimates of the incidence and severity of rotavirus paediatric admissions in relevant populations. The study objective was to accurately define the incidence and severity of group A rotavirus disease in a resource-poor setting necessary to make informed decisions on the need for vaccine prevention. METHODS AND FINDINGS: Between 2002 and 2004 we conducted prospective surveillance for group A rotavirus infection at Kilifi District Hospital in coastal Kenya. Children 2% of children are admitted to hospital with group A rotavirus diarrhoea in the first 5 y of life. This translates into over 28,000 vaccine-preventable hospitalisations per year across Kenya, and is likely to be a considerable underestimate. Group A rotavirus diarrhoea is associated with acute life-threatening metabolic derangement in otherwise healthy children. Although mortality is low in this clinical research setting this may not be generally true in African hospitals lacking rapid and appropriate management.

  10. Radiation Therapy Oncology Group Translational Research Program Stem Cell Symposium: Incorporating Stem Cell Hypotheses into Clinical Trials

    International Nuclear Information System (INIS)

    At a meeting of the Translation Research Program of the Radiation Therapy Oncology Group held in early 2008, attendees focused on updating the current state of knowledge in cancer stem cell research and discussing ways in which this knowledge can be translated into clinical use across all disease sites. This report summarizes the major topics discussed and the future directions that research should take. Major conclusions of the symposium were that the flow cytometry of multiple markers in fresh tissue would remain the standard technique of evaluating cancer-initiating cells and that surrogates need to be developed for both experimental and clinical use.

  11. The use of hirudin as universal anticoagulant in haematology, clinical chemistry and blood grouping.

    Science.gov (United States)

    Menssen, H D; Melber, K; Brandt, N; Thiel, E

    2001-12-01

    Undesirable interactions between anticoagulants and diagnostic test kit procedures so far have prevented the development of a single uniform blood sampling tube. Contrary to K2-EDTA, heparin and other anticoagulants, hirudin only minimally alters blood cells and dissolved blood constituents, thus qualifying as a universal anticoagulant for diagnostic purposes. Automated complete blood counts, automated analyses of clinical chemistry analytes and immunohaematology were performed from hirudinised and routinely processed blood obtained from healthy volunteers (n=35) and hospitalised patients (n=45). Hirudin (400 ATU/ml blood) sufficiently anticoagulated blood for diagnostic purposes. The measurements of automated complete blood counts obtained from K2-EDTA-anticoagulated and hirudinised blood correlated significantly as did the measurements of 24 clinical chemistry analytes from hirudinised plasma and serum. Regression analysis revealed that the results of complete blood counts and clinical chemistry tests were predictable from the respective measurements from hirudinised blood (p=0.001). Immunohaematological tests and cross-matching from hirudinised and native blood of the same donors gave identical results. Single clotting factors, but not global coagulation analytes, could be measured from hirudinised blood. Therefore, a universal hirudin-containing blood sampling tube could be designed for automated analysis of haematological, serological and clinical chemistry analytes. PMID:11798089

  12. Psychiatric hospital nursing staff's experiences of participating in group-based clinical supervision:

    DEFF Research Database (Denmark)

    Buus, Niels; Angel, Sanne; Traynor, Michael;

    2010-01-01

    reasons for their ambivalence. Semi-structured interviews were conducted with 22 psychiatric nurses at a Danish university hospital. The results indicated that participation in clinical supervision was difficult for the nurses because of an uncomfortable exposure to the professional community. The sense...

  13. Clinical research on peri-implant diseases: consensus report of Working Group 4.

    LENUS (Irish Health Repository)

    Sanz, Mariano

    2012-02-01

    Two systematic reviews have evaluated the quality of research and reporting of observational studies investigating the prevalence of, the incidence of and the risk factors for peri-implant diseases and of experimental clinical studies evaluating the efficacy of preventive and therapeutic interventions.

  14. Post-Polio Directory 2014: Post-Polio Clinics, Health Professionals, Support Groups

    Science.gov (United States)

    ... Orthopedics & Sports Medicine 12499 University Ave, Ste 210 Clive, IA 50325 515-440-2676 IOWA–Support Group ... Health Professionals TMR Orthotic Prosthetic Service Ethel Mieles Robert Martinez 2418 Ditmars Blvd Astoria, NY 11105 718- ...

  15. The validity of clinical findings for diagnosing temporomandibular disorders in patients from different age and gender groups

    International Nuclear Information System (INIS)

    This study was to clarify the diagnostic accuracy of clinical findings for internal derangement of the temporomandibular joint (TMJ) compared with that of magnetic resonance imaging. A series of 4559 patients (879 male and 3680 female, mean age 32.7 years; range 8-85 years;) with temporomandibular disorders were clinically examined by un unspecified number of dentists. All patients underwent magnetic resonance imaging (MRI). The clinical findings that characterize disc displacement, anterior disc displacement with reduction (ADDwR) and anterior disc displacement without reduction (ADDwoR) are pain, clicking sound and limitation of maximum mouth opening. These clinical findings were compared to the MRI interpretation, which was used as the gold standard for diagnosis of temporomandibular disorders to define the diagnostic accuracy, specificity, sensitivity, positive predictive value and negative predictive value of clinical findings. The prevalence of clinical finding was 3990 joints (43%) with pain, 2775 joints (30%) with clicking sound and 1731 patients (38%) with limitation of opening. Three thousands forty seven joints were diagnosed as having a normal disc position, 510 joints with sideways disc displacement, 2312 joints with ADDwR, 3239 joints with ADDwoR on MR image. The sensitivity of clinical findings was considerably low: sensitivity was 0.48 for pain versus internal derangement, 0.51 for clicking sound versus ADDwR, 0.62 for limitation of opening versus ADDwoR. The sensitivity was higher in the younger group for clicking sound versus ADDwR, but sensitivity was higher in the older group for limitation of opening versus ADDwoR. The diagnostic accuracy based on clinical findings of internal derangement of TMJ was found to be correlated with age. This study has been that the overall diagnostic accuracy of the clinical findings to determine the status of the joint is about 50-60%. The status of the joint could not be accurately determined by clinical findings

  16. The interrelationships between clinical signs and their effect on involuntary culling among pregnant sows in group-housing systems.

    Science.gov (United States)

    Jensen, T B; Bonde, M K; Kongsted, A G; Toft, N; Sørensen, J T

    2010-11-01

    Sows suffering from clinical signs of disease (e.g. lameness, wounds and shoulder ulcers) are often involuntarily culled, affecting the farmer's economy and the welfare of the animals. In order to investigate the interrelationships between clinical signs of individual pregnant group-housed sows, we performed an explanatory factor analysis to identify factors describing the patterns of variation of clinical signs. Moreover, we investigated how these emerging factors affected the probability of a sow to be either (i) euthanized, (ii) suddenly dead, (iii) sent to slaughter due to clinical signs of disease such as claw lesions or wounds or (iv) involuntarily culled (representing a pool of sows that were either euthanized, dead or sent to slaughter due to disease). Data from 2.989 pregnant sows in group-housing systems from 33 sow herds were included in the study. A thorough clinical examination was performed for each sow by using a protocol including 16 different clinical signs. Farmers recorded all cullings and deaths and the reasons for these actions in a 3-month period after the clinical examination. Among the observed sows, 4.2% were involuntarily culled during the 3-month period. From the explanatory factor analysis, we identified three factors describing the underlying structure of the 16 clinical variables. We interpreted the factors as 'pressure marks', 'wounds' and 'lameness' Logistic analyses were performed to investigate the effect of the three factors and the parity number of each sow on the four outcomes: (i) euthanized, (ii) suddenly dead, (iii) sent to slaughter due to clinical signs of disease and (iv) involuntarily culled. The analyses showed that 'lameness' significantly increased the risk of sows to be involuntarily culled (P = 0.016) or sent to slaughter due to clinical signs of disease (P = 0.026). Lameness is generally considered to be an important welfare problem in sows, which could explain the increased risk seen in this study. By contrast

  17. The interrelationships between clinical signs and their effect on involuntary culling among pregnant sows in group-housing systems.

    Science.gov (United States)

    Jensen, T B; Bonde, M K; Kongsted, A G; Toft, N; Sørensen, J T

    2010-11-01

    Sows suffering from clinical signs of disease (e.g. lameness, wounds and shoulder ulcers) are often involuntarily culled, affecting the farmer's economy and the welfare of the animals. In order to investigate the interrelationships between clinical signs of individual pregnant group-housed sows, we performed an explanatory factor analysis to identify factors describing the patterns of variation of clinical signs. Moreover, we investigated how these emerging factors affected the probability of a sow to be either (i) euthanized, (ii) suddenly dead, (iii) sent to slaughter due to clinical signs of disease such as claw lesions or wounds or (iv) involuntarily culled (representing a pool of sows that were either euthanized, dead or sent to slaughter due to disease). Data from 2.989 pregnant sows in group-housing systems from 33 sow herds were included in the study. A thorough clinical examination was performed for each sow by using a protocol including 16 different clinical signs. Farmers recorded all cullings and deaths and the reasons for these actions in a 3-month period after the clinical examination. Among the observed sows, 4.2% were involuntarily culled during the 3-month period. From the explanatory factor analysis, we identified three factors describing the underlying structure of the 16 clinical variables. We interpreted the factors as 'pressure marks', 'wounds' and 'lameness' Logistic analyses were performed to investigate the effect of the three factors and the parity number of each sow on the four outcomes: (i) euthanized, (ii) suddenly dead, (iii) sent to slaughter due to clinical signs of disease and (iv) involuntarily culled. The analyses showed that 'lameness' significantly increased the risk of sows to be involuntarily culled (P = 0.016) or sent to slaughter due to clinical signs of disease (P = 0.026). Lameness is generally considered to be an important welfare problem in sows, which could explain the increased risk seen in this study. By contrast

  18. Benefits of Group Singing for People with Eating Disorders: Preliminary Findings from a Non-Clinical Study

    Directory of Open Access Journals (Sweden)

    Metaxia Pavlakou

    2009-01-01

    Full Text Available The purpose of this study is to examine the possible benefits of participation in group singing for people with eating disorders in a non-clinical context. The creation of a group singing workshop for women that exhibited disordered eating provided the opportunity to explore the participants’ experiences as perceived by them. A qualitative approach utilizing a semi-structured interview was employed to explore in depth the women’s perceptions regarding the group singing workshop. A thematic analysis of the data identified four main categories concerning the benefits of group singing for the population under study. The theoretical model of Sears (1968 of the processes in music therapy and its application on anorexic clients (Parente 1989 informed the discussion of the empirical findings.

  19. Under-representation of women on governing bodies: women general practitioners on Clinical Commissioning Groups in England.

    Science.gov (United States)

    Segar, Julia

    2015-10-01

    Recently formed Clinical Commissioning Groups in the English National Health Service have important responsibility for commissioning local health and care services. Women are under-represented on the governing bodies of these significant primary care based organizations despite the fact that they constitute almost half of the general practitioner workforce in England. This essay examines some of the reasons for this under-representation including the predominance of women in the salaried and part-time sector of general practice and gendered management styles within the National Health Service. It is argued that the under-representation of women on Clinical Commissioning Group governing bodies matters in terms of social justice, representation of the broader community and role models. PMID:25589088

  20. Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest.

    Science.gov (United States)

    Eccles, Martin P; Grimshaw, Jeremy M; Shekelle, Paul; Schünemann, Holger J; Woolf, Steven

    2012-07-04

    Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearing houses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this first paper we discuss: the target audience(s) for guidelines and their use of guidelines; identifying topics for guidelines; guideline group composition (including consumer involvement) and the processes by which guideline groups function and the important procedural issue of managing conflicts of interest in guideline development.

  1. Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest

    Directory of Open Access Journals (Sweden)

    Eccles Martin P

    2012-07-01

    Full Text Available Abstract Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearing houses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence. It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this first paper we discuss: the target audience(s for guidelines and their use of guidelines; identifying topics for guidelines; guideline group composition (including consumer involvement and the processes by which guideline groups function and the important procedural issue of managing conflicts of interest in guideline development.

  2. The dyadic adjustment of female-to-male transsexuals.

    Science.gov (United States)

    Fleming, M; MacGowan, B; Costos, D

    1985-02-01

    Dyadic adjustment, sexual activities, and marital stability in the relationships of female-to-male transsexuals and their spouses were examined. Participants were 22 female-to-male transsexuals who had undergone some form of surgery to alter their anatomical sex, their spouses, and a control group of married or cohabitating nontranssexual men and women. Participants were administered the Dyadic Adjustment Scale and additional items to assess quantitatively their marital relationships. The transsexuals and their spouses were also asked open-ended interview questions concerning marital and life adjustments. Generally, the transsexuals and their spouses reported good and mutually satisfying interpersonal relationships that are in many ways comparable to those of the matched control group. These findings lend support to the previous clinical interview studies that have reported that female-to-male transsexuals form stable and enduring intimate relationships.

  3. Assessment of the Need to Integrate Academic Electronic Medical Records Into the Undergraduate Clinical Practicum: A Focus Group Interview.

    Science.gov (United States)

    Choi, Mona; Park, Joon Ho; Lee, Hyeong Suk

    2016-06-01

    As healthcare systems demand that nurses be competent in using electronic medical records for patient care, the integration of electronic medical records into nursing curricula has become necessary. The purpose of this study was to explore how students, new nurses, clinical instructors, and faculty perceive the integration of academic electronic medical records into the undergraduate clinical practicum. From January to February 2014, four focus group interviews with 18 participants were conducted based on purposive sampling. Content analysis was used on the unabridged transcripts to extract themes and develop meaningful categories. Three major themes and eight subthemes were revealed from the focus group interviews. The major themes were "electronic medical record as a learning tool for clinical practicum," "essential functions of academic electronic medical records," and "expected outcomes of academic electronic medical record." Participants expected academic electronic medical records to enhance students' nursing informatics competencies. The findings of this study can inform the process of developing academic electronic medical records for clinical practicum, which will then augment students' informatics competencies. PMID:27081757

  4. Social and behavioral research in genomic sequencing: approaches from the Clinical Sequencing Exploratory Research Consortium Outcomes and Measures Working Group.

    Science.gov (United States)

    Gray, Stacy W; Martins, Yolanda; Feuerman, Lindsay Z; Bernhardt, Barbara A; Biesecker, Barbara B; Christensen, Kurt D; Joffe, Steven; Rini, Christine; Veenstra, David; McGuire, Amy L

    2014-10-01

    The routine use of genomic sequencing in clinical medicine has the potential to dramatically alter patient care and medical outcomes. To fully understand the psychosocial and behavioral impact of sequencing integration into clinical practice, it is imperative that we identify the factors that influence sequencing-related decision making and patient outcomes. In an effort to develop a collaborative and conceptually grounded approach to studying sequencing adoption, members of the National Human Genome Research Institute's Clinical Sequencing Exploratory Research Consortium formed the Outcomes and Measures Working Group. Here we highlight the priority areas of investigation and psychosocial and behavioral outcomes identified by the Working Group. We also review some of the anticipated challenges to measurement in social and behavioral research related to genomic sequencing; opportunities for instrument development; and the importance of qualitative, quantitative, and mixed-method approaches. This work represents the early, shared efforts of multiple research teams as we strive to understand individuals' experiences with genomic sequencing. The resulting body of knowledge will guide recommendations for the optimal use of sequencing in clinical practice.

  5. Viridans Group Streptococci clinical isolates: MALDI-TOF mass spectrometry versus gene sequence-based identification.

    Directory of Open Access Journals (Sweden)

    Silvia Angeletti

    Full Text Available Viridans Group Streptococci (VGS species-level identification is fundamental for patients management. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS has been used for VGS identification but discrimination within the Mitis group resulted difficult. In this study, VGS identifications with two MALDI-TOF instruments, the Biotyper (Bruker and the VITEK MS (bioMérieux have been compared to those derived from tuf, soda and rpoB genes sequencing. VGS isolates were clustered and a dendrogram constructed using the Biotyper 3.0 software (Bruker. RpoB gene sequencing resulted the most sensitive and specific molecular method for S. pneumonia identification and was used as reference method. The sensitivity and the specificity of the VITEK MS in S. pneumonia identification were 100%, while the Biotyper resulted less specific (92.4%. In non pneumococcal VGS strains, the group-level correlation between rpoB and the Biotyper was 100%, while the species-level correlation was 61% after database upgrading (than 37% before upgrading. The group-level correlation between rpoB and the VITEK MS was 100%, while the species-level correlation was 36% and increases at 69% if isolates identified as S. mitis/S. oralis are included. The less accurate performance of the VITEK MS in VGS identification within the Mitis group was due to the inability to discriminate between S. mitis and S. oralis. Conversely, the Biotyper, after the release of the upgraded database, was able to discriminate between the two species. In the dendrogram, VGS strains from the same group were grouped into the same cluster and had a good correspondence with the gene-based clustering reported by other authors, thus confirming the validity of the upgraded version of the database. Data from this study demonstrated that MALDI-TOF technique can represent a rapid and cost saving method for VGS identification even within the Mitis group but improvements of spectra

  6. Characterization, in vitro susceptibility, and clinical significance of CDC group HB-5 from Rwanda.

    OpenAIRE

    Bogaerts, J.; Verhaegen, J.; Martinez Tello, W.; Allen, S.; Verbist, L; Van Dyck, E; Piot, P.

    1990-01-01

    From June 1984 until July 1988, CDC group HB-5 isolates were recovered from the exudates of genital ulcers in 25 of 675 (3.6%) patients (204 women, 471 men) in Kigali, Rwanda. Among a group of 145 men presenting with urethritis but without genital ulcers, a positive culture for HB-5 of a specimen from the coronal groove of the penis of only 1 man (0.7%) was found. During the same period, the organism was not obtained in cultures of vaginal specimens from 838 women without genital ulcer diseas...

  7. The Effect of Spiritual and Religious Group Psychotherapy on Suicidal Ideation in Depressed Patients: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Hossein Ebrahimi

    2014-06-01

    Full Text Available Introduction: Suicide is a great economical, social and public health problem. It is prevalent worldwide and has a lot of negative effects on individuals, families and society. Depression is often prelude to Suicide. An important part of the treatment of the mentally ill patients is spiritual-religious psychotherapy which should be done after physical treatment. The aim of this study was to determine the effect of spiritual and religious group psychotherapy on suicidal ideation in depressed patients. Methods: 51 depressed patients with suicidal ideation from Razi hospital (Tabriz, Iran participated in this clinical trial. To collect Data questionnaire was used which included demographic and Beck Suicide Scale Ideation. Experimental group participated in 10 sessions of group psychotherapy. Each section lasted 1 hour. Two weeks after the last section post test was done. Statistical software SPSS ver 13 was used for data analysis. Results: Results of independent t-test revealed no difference between two groups in terms of suicidal ideation before intervention but after study there is a statistical difference. Also the results of ANCOVA test showed a significant relationship between spiritual group therapy and decrease in suicidal ideation, so that this intervention can make 57% of variance in suicidal ideation of experimental group.Conclusion: Regarding positive effect of spiritual and religious group psychotherapy on decreasing suicidal ideation of depressed patients, we suggest this intervention to be held in Psychiatric Wards and also more study on depression and other psychiatric patients with greater sample size would be helpful.

  8. Self-Compassion among College Counseling Center Clients: An Examination of Clinical Norms and Group Differences

    Science.gov (United States)

    Lockard, Allison J.; Hayes, Jeffrey A.; Neff, Kristin; Locke, Benjamin D.

    2014-01-01

    There has been growing interest in the mental health benefits of self-compassion. This study was designed to establish norms on the Self-Compassion Scale-Short Form, a popular measure of self-compassion for individuals seeking counseling, and to examine group differences in self-compassion based on gender, race/ethnicity, sexual orientation,…

  9. Integration of noninvasive prenatal prediction of fetal blood group into clinical prenatal care

    DEFF Research Database (Denmark)

    Clausen, Frederik Banch

    2014-01-01

    Incompatibility of red blood cell blood group antigens between a pregnant woman and her fetus can cause maternal immunization and, consequently, hemolytic disease of the fetus and newborn. Noninvasive prenatal testing of cell-free fetal DNA can be used to assess the risk of hemolytic disease...

  10. Can Group Interventions Facilitate Forgiveness of an Ex-Spouse?: A Randomized Clinical Trial

    Science.gov (United States)

    Rye, Mark S.; Pargament, Kenneth I.; Pan, Wei; Yingling, David W.; Shogren, Karrie A.; Ito, Masako

    2005-01-01

    This study evaluated the effectiveness of 2 versions of an 8-session forgiveness group intervention for divorced individuals. Participants (randomized, n = 192; analyzed, n = 149) were randomly assigned to a secular forgiveness condition, a religious forgiveness condition, or a no-intervention comparison condition. Measures of forgiveness and…

  11. Prize Reinforcement Contingency Management for Cocaine Dependence: Integration with Group Therapy in a Methadone Clinic

    Science.gov (United States)

    Petry, Nancy M.; Martin, Bonnie; Simcic, Francis

    2005-01-01

    In this study, the authors evaluated a low-cost contingency management (CM) procedure for reducing cocaine use and enhancing group therapy attendance in 77 cocaine-dependent methadone patients. Patients were randomly assigned to 12 weeks of standard treatment or standard treatment with CM, in which patients earned the opportunity to win prizes…

  12. Aggression in Children with Autism Spectrum Disorders and a Clinic-Referred Comparison Group

    Science.gov (United States)

    Farmer, Cristan; Butter, Eric; Mazurek, Micah O.; Cowan, Charles; Lainhart, Janet; Cook, Edwin H.; DeWitt, Mary Beth; Aman, Michael

    2015-01-01

    A gap exists in the literature regarding aggression in autism spectrum disorders and how this behavior compares to other groups. In this multisite study, the "Children's Scale for Hostility and Aggression: Reactive/Proactive" and the Aggression subscale of the "Child Behavior Checklist" were rated for 414 children with autism…

  13. Exploratory study of the characteristics of feedback in the reflective dialogue group given to medical students in a clinical clerkship

    Directory of Open Access Journals (Sweden)

    Chin-Chen Wen

    2015-02-01

    Full Text Available Purpose: Structured narrative reflective writing combined with guided feedback is an efficient teaching method for enhancing medical students’ reflective capacity. However, what kinds of feedback offered and reflection presented in a reflective group remain unclear. The aim of this study was to investigate the characteristics of feedback in a reflective dialogue group. Methods: Fifth-year medical students on a monthly interval rotation at the pediatric department of a medical center in eastern Taiwan during the 2012 academic year completed their reflective writing regarding patient and family psychosocial issues, and were subsequently debriefed in a 2-h group discussion session to receive feedback from a clinical tutor and peers. Content analysis was conducted to explore the characteristics of feedback and reflection presented in the reflective dialogue. The evaluative questionnaire regarding the benefits of reflection with others was administrated following the group session. Results: Forty students participated in five reflective groups and 108 psychosocial issues were discussed and identified. The tutor played an initiating role in the group discussion by providing six equal feedback types involving exploring new knowledge, initiating advanced discussion, highlighting the issues, and encouraging the students. The students provided eight types of feedback that involved a substantial deep discussion on psychosocial issues and action plans based on the complex interactive ecological network of clinical encounters. Each student attained 1.25 times the depth or breadth of reflection after receiving feedback and experienced the benefits of reflection with others. Conclusion: Through structured narrative reflective writing combined with pluralistic group discussion with a tutor and peers, the medical students had time to think deeply and broadly about psychosocial issues among patients and their family members. Facilitative feedback providing new

  14. Design and Clinical Application of an Adjustable Spine Prone Frame%可调式脊柱俯卧架的设计及临床应用

    Institute of Scientific and Technical Information of China (English)

    赵军; 吴锦秋; 邓强; 裴生太; 谢兴文; 杨波

    2013-01-01

      介绍一种可调式脊柱俯卧架的设计原理及应用。该俯卧架应用于腰椎后路手术,术中X拍摄方便、快捷,内固定植入准确,悬空腹部保证呼吸、循环功能正常,腰椎曲度调节方便,有效满足了手术体位和护理的要求,预防并发症的发生。%The design principle and application of an adjustable spine prone frame are introduced. Adjustable spine prone frame is used in posterior lumbar surgery, during operation, X-ray can shoot fast and internal fixation implants can fix accurately, the vacant abdominal ensure normal respiratory and circulatory function, and the lumbar curvature can adjust conveniently. It meets the surgical position and care requirements, can prevent the complications effectively.

  15. Abandon the coat Experiential group about clinical psychologist’s identity

    Directory of Open Access Journals (Sweden)

    Maria Caterina Branca

    2014-12-01

    Full Text Available This research was driven by the fundamental idea that one of the main methodological competencies of a psychologist is to be able to think one’s emotions (especially those formed within a relationship and to use them to build theories on the relationship itself. In this context, the project aims to explore the role identity of the trainee psychologist, that is to say the mental representations (fantasies, subconscious associations, myths of those who have just finished their university journey and are about to embark upon the world of work in the field of applied clinical psychology.

  16. Adjustments and Depression

    Medline Plus

    Full Text Available ... to my SCI? How do I deal with depression and adjustment to my SCI? ☷ ▾ Page contents The ... the moment you are injured. Understanding adjustment and depression Adjustment to paralysis is a process of changing ...

  17. Teamwork for clinical emergencies: interprofessional focus group analysis and triangulation with simulation.

    Science.gov (United States)

    Bristowe, Katherine; Siassakos, Dimitrios; Hambly, Helen; Angouri, Jo; Yelland, Andrew; Draycott, Timothy J; Fox, Robert

    2012-10-01

    Our purpose was to investigate health care professionals' beliefs about effective teamwork in medical emergencies based on their experiences. We used framework analysis of interprofessional focus groups in four secondary and tertiary maternity units. The participants were randomly selected senior and junior doctors, senior and junior midwives, and health care assistants, in five groups of 5 to 7 participants each. We found that optimal teamwork was perceived to be dependent on good leadership and availability of experienced staff. The participants described a good leader as one who verbally declares being the leader, communicates clear objectives, and allocates critical tasks, including communication with patients or their family, to suitable individual members. We triangulated the results with evidence from simulation to identify convergent findings and issues requiring further research. The findings will inform the development of teaching programs for medical teams who manage emergencies to improve patient safety and experience.

  18. The effectiveness of a health promotion with group intervention by clinical trial. Study protocol

    OpenAIRE

    Campo Osaba Maria-Antonia; Del Val José-Luis; Lapena Carolina; Laguna Vicencia; García Araceli; Lozano Olga; Martín Ziortza; Rodriguez Rómulo; Borrás Enriqueta; Orfila Francesc; Tierno María Teresa

    2012-01-01

    Abstract Background The promotion of health and the interventions in community health continue to be one of the pending subjects of our health system. The most prevalent health problems (cardiovascular diseases, cancer, diabetes...) are for the most part related to life habits. We propose a holistic and integral approach as the best option for tackling behavior and its determinants. The research team has elaborated the necessary educational material to realize group teaching, which we call "H...

  19. Surfactant treatment in neonatal group B streptococcal pneumonia : experimental and clinical studies

    OpenAIRE

    Herting, Egbert

    1999-01-01

    Surfactant dysfunction is probably involved in the pathophysiology of neonatal group B streptococcal (GBS) pneumonia. Aim of the present studies was to evaluate efficacy and safety of surfactant replacement therapy for term and preterm neonates with severe respiratory failure due to GBS infection. We investigated the effects of surfactant on growth of GBS and on oxidative metabolism of polymorphonuclear neutrophilic granulocytes (PMN) stimulated with GBS, and developed an an...

  20. Clinical Feature And Pathogeny Analysis Of Brain Hemorrhage In Young Adult Group

    Institute of Scientific and Technical Information of China (English)

    Wang Jianming; Zeng Xiaoyun

    2000-01-01

    Objection: The trend of brain hemorrhage cases of young adults have increased recently. In this article, We studied brain hemorrhage clinical feature and pathogenic causes of 72 young adults, Whose ages are all beneath 45Y. We found That the major pathogen reasons of young adult brain hemorrhage are blood system diseases、 arteriovenous malformation of cerebral blood vessel、 hypertension arteriosclerosis、 arteritis and rheumatic heart disease et. We also found that the trend can be related to hard work、 tense life、 drinking too much alcohol and eating high lipid food, and cercbral vascular disease family history. So in order to reduce the incidence of young adult brain hemorrhage, Young adults should not drink and smoke heavily, should not eat too much high lipid food. Young adults who have hypertension and brain vessel disease family history should be regularly measured blood pressure and blood lipid. If they had hypertension, should be treated regularly.

  1. Demographics features, clinical findings and functional status in a group of subjects with cervical myofascial pain syndrome.

    Science.gov (United States)

    Sahin, Nilay; Karataş, Omer; Ozkaya, Murat; Cakmak, Ayşegül; Berker, Ender

    2008-07-01

    Subjects with myofascial pain of muscles of the neck region may present with various clinical symptoms. The aim of this study was to explore the demographics features, clinical findings and functional status in a group of patients presenting with myofascial pain of the cervical muscles. 94 cervical myofascial pain syndrome patients were recruited from the out-patient clinic. Evaluated of patient short form health survey (SF-36), pain, depression, patient demographics and physical examinations. Outcome measures; SF-36 Health Survey, visual analog scale, Beck Depression Inventory, history, physical examination. A total of 82 patients with a diagnosis of cervical myofascial syndrome were included in the study. All patients were in the young age group 37.4+/-9, and 87.8% were females. 53.1% had trigger points in the trapezius muscle with high percentage of autonomic phenomena like skin reddening, lacrimation, tinnitus and vertigo. 58.5% of the series had suffered from former cervical trauma and 40.2% also had fibromyalgia syndrome and 18.5% had benign Joint hypermobility syndrome. Younger female patients presenting with autonomic phenomena and early onset cervical injury should be examined for cervical myofascial pain syndrome and also for fibromyalgia syndrome since this study demonstrated a high percentage of fibromyalgia syndrome in these patients.

  2. Fostering integrated learning and clinical professionalism using contextualized simulation in a small-group role-play.

    Science.gov (United States)

    Baillie, Sarah; Pierce, Stephanie E; May, Stephen A

    2010-01-01

    Teaching and learning in a clinical setting is important in veterinary and medical training but presents many challenges, including providing enough hands-on experience while not putting patients (animal or human) at risk. Some of the issues have been addressed with the introduction of clinical skills laboratories and communication skills training using role play. However, in both instances skills are learned in isolation, whereas the real task requires the integration of many skills including technical competencies, effective communication, decision making, and professionalism. In our study, we trialed "contextualized simulation" by combining role play with a simulator, the haptic cow, in a small-group tutorial, the Simulated Fertility Visit. Students took turns as the veterinarian; they had to establish the cow's history from the farmer (a role player), palpate the simulation, make a diagnosis, and decide on treatment, if appropriate. We included scenarios varying from common cases to challenging situations. The tutorial was introduced in the farm-animal clinical rotation, and feedback was gathered from students by means of a questionnaire. The tutorial was attended by 178 students (98% of that year's students), and 151 questionnaires were returned (85% response rate). Students reported that the tutorial was a positive learning experience and recognized that it presented an opportunity to integrate the skills needed for clinical work. Student feedback suggests that contextualized simulation provides a valuable complement to clinical cases, and we recommend extending this teaching method to other clinical scenarios and species, particularly because it provides a safe environment in which to experience, and learn from, mistakes.

  3. Identity--lost and found: patterns of migration and psychological and psychosocial adjustment of migrants.

    Science.gov (United States)

    Hertz, D G

    1988-01-01

    This paper focuses on patterns of integration in migrant individuals and families. The level of adjustment in traditional and Westernized families has been examined. Different factors affecting adjustment are pointed out. Migration process is interpreted as a transient and necessary crisis situation. Risk factors in the acculturation crisis are reported and predictive and preventive measures are suggested. Characteristics of migrant and remigrant groups are compared. The role of "homesickness" in clinical symptom formation is discussed.

  4. Clinical study on magnetic resonance imaging of lacunar infarcts and cerebrovascular high-risk group

    Energy Technology Data Exchange (ETDEWEB)

    Hironaka, Masatoshi (Hiroshima Univ. (Japan). School of Medicine)

    1990-04-01

    Magnetic resonance imaging (MRI) study was performed in 32 patients with recent lacunar stroke. T2-weighted images showed ischemic lesions more clearly than T1-weighted images. Sixty-six percent of 32 patients had periventricular lesions. Eighty-four percent had subcortical white matter lesions. Sixty-nine percent had lesions in basal ganglia. Twenty-eight percent had lesions in brainstem. Periventricular lesions were revealed symmetrically. On the other hand, lesions in other areas were not detected symmetrically. Severe periventricular lesions on MRI were similar to those of Binswanger's disease. Patients with severe periventricular lesions had often hypertension. Moreover, two of them had dementia. Twenty-three patients with transient ischemic attack had less remarkable lesions than patients with lacunar stroke. Thirty-seven patients with a history of cerebrovascular risk factors (hypertension, diabetes mellitus) had severer lesions compared with normal controls. Sixty-one percent of controls, who had no cerebrovascular symptoms and signs, had MRI lesions. These results suggest that MRI is useful for detection of cerebral ischemic lesions with no associated clinical symptoms or signs. (author).

  5. Clinical study on magnetic resonance imaging of lacunar infarcts and cerebrovascular high-risk group

    International Nuclear Information System (INIS)

    Magnetic resonance imaging (MRI) study was performed in 32 patients with recent lacunar stroke. T2-weighted images showed ischemic lesions more clearly than T1-weighted images. Sixty-six percent of 32 patients had periventricular lesions. Eighty-four percent had subcortical white matter lesions. Sixty-nine percent had lesions in basal ganglia. Twenty-eight percent had lesions in brainstem. Periventricular lesions were revealed symmetrically. On the other hand, lesions in other areas were not detected symmetrically. Severe periventricular lesions on MRI were similar to those of Binswanger's disease. Patients with severe periventricular lesions had often hypertension. Moreover, two of them had dementia. Twenty-three patients with transient ischemic attack had less remarkable lesions than patients with lacunar stroke. Thirty-seven patients with a history of cerebrovascular risk factors (hypertension, diabetes mellitus) had severer lesions compared with normal controls. Sixty-one percent of controls, who had no cerebrovascular symptoms and signs, had MRI lesions. These results suggest that MRI is useful for detection of cerebral ischemic lesions with no associated clinical symptoms or signs. (author)

  6. Changes in quality of life following group CBT for anxiety and depression in a psychiatric outpatient clinic.

    Science.gov (United States)

    Oei, Tian Po; McAlinden, Niamh May

    2014-12-30

    The present study examined the relationship between quality of life and symptom change following group CBT treatment for anxiety or depression in a psychiatric hospital outpatient setting. One hundred seventy seven outpatients undergoing eight sessions of group CBT for anxiety (n=124) or mood disorders (n=53) participated. The Beck Anxiety Inventory (BAI), Zung Self-Rating Depression Scale (Zung-SRDS), Quality of Life Inventory (QOLI), and Satisfaction with Life Scale (SWLS) were administered at baseline and post-treatment. Additionally, the QOLI and SWLS scores of those who achieved reliable improvement or clinically significant symptom change were compared to those who experienced no reliable symptom improvement. There were significant changes across the QOLI, SWLS, BAI and Zung-SRDS outcome measures between baseline and post-treatment, with moderate to very large effect sizes observed. Patients with reliable or clinically significant change in their symptoms experienced significant increases in QOLI and SWLS scores when compared to those whose symptoms did not change reliably. Overall, in a psychiatric hospital outpatient setting, group CBT appeared to be successful in increasing quality of life and satisfaction with life in addition to reducing anxiety and depression symptoms.

  7. Whole genome sequencing as a tool for phylogenetic analysis of clinical strains of Mitis group streptococci.

    Science.gov (United States)

    Rasmussen, L H; Dargis, R; Højholt, K; Christensen, J J; Skovgaard, O; Justesen, U S; Rosenvinge, F S; Moser, C; Lukjancenko, O; Rasmussen, S; Nielsen, X C

    2016-10-01

    Identification of Mitis group streptococci (MGS) to the species level is challenging for routine microbiology laboratories. Correct identification is crucial for the diagnosis of infective endocarditis, identification of treatment failure, and/or infection relapse. Eighty MGS from Danish patients with infective endocarditis were whole genome sequenced. We compared the phylogenetic analyses based on single genes (recA, sodA, gdh), multigene (MLSA), SNPs, and core-genome sequences. The six phylogenetic analyses generally showed a similar pattern of six monophyletic clusters, though a few differences were observed in single gene analyses. Species identification based on single gene analysis showed their limitations when more strains were included. In contrast, analyses incorporating more sequence data, like MLSA, SNPs and core-genome analyses, provided more distinct clustering. The core-genome tree showed the most distinct clustering.

  8. Propensity scores as a basis for equating groups: basic principles and application in clinical treatment outcome research.

    Science.gov (United States)

    West, Stephen G; Cham, Heining; Thoemmes, Felix; Renneberg, Babette; Schulze, Julian; Weiler, Matthias

    2014-10-01

    A propensity score is the probability that a participant is assigned to the treatment group based on a set of baseline covariates. Propensity scores provide an excellent basis for equating treatment groups on a large set of covariates when randomization is not possible. This article provides a nontechnical introduction to propensity scores for clinical researchers. If all important covariates are measured, then methods that equate on propensity scores can achieve balance on a large set of covariates that mimics that achieved by a randomized experiment. We present an illustration of the steps in the construction and checking of propensity scores in a study of the effectiveness of a health coach versus treatment as usual on the well-being of seriously ill individuals. We then consider alternative methods of equating groups on propensity scores and estimating treatment effects including matching, stratification, weighting, and analysis of covariance. We illustrate a sensitivity analysis that can probe for the potential effects of omitted covariates on the estimate of the causal effect. Finally, we briefly consider several practical and theoretical issues in the use of propensity scores in applied settings. Propensity score methods have advantages over alternative approaches to equating groups particularly when the treatment and control groups do not fully overlap, and there are nonlinear relationships between covariates and the outcome.

  9. Reexamining the validity and reliability of the clinical version of the Iowa gambling task: Evidence from a normal subject group

    Directory of Open Access Journals (Sweden)

    Ching-Hung eLin

    2013-05-01

    Full Text Available Over past decade, the Iowa gambling task (IGT has been utilized to test various decision deficits induced by neurological damage or psychiatric disorders. The IGT has recently been standardized for identifying 13 different neuropsychological disorders. Neuropsychological patients choose bad decks frequently, and normal subjects prefer good EV decks. However, the IGT has several validity and reliability problems. Some research groups have pointed out that the validity of IGT is influenced by the personality and emotional state of subjects. Additionally, several other studies have proposed that the prominent deck B phenomenon (PDB phenomenon – that is, normal subjects preferring bad deck B – may be the most serious problem confronting IGT validity. Specifically, deck B offers a high frequency of gains but negative EV. In the standard IGT administration, choice behavior can be understood with reference to gain-loss frequency (GLF rather than inferred future consequences (EV, the basic assumption of IGT. Furthermore, using two different criteria (basic assumption vs. professional norm results in significantly different classification results. Therefore, we recruited 72 normal subjects to test the validity and reliability of IGT. Each subject performed three runs of the computer-based clinical IGT version. The PDB phenomenon has been observed to a significant degree in the first and second stages of the clinical IGT version. Obviously, validity, reliability and the practice effect were unstable between two given stages. The present form of the clinical IGT version has only one stage, so its use should be reconsidered for examining normal decision makers; results from patient groups must also be interpreted with great care. GLF could be the main factor to be considered in establishing the constructional validity and reliability of the clinical IGT version.

  10. Establishment of age- and sex-adjusted reference data for hand bone mass and investigation of hand bone loss in patients with rheumatoid arthritis treated in clinical practice

    DEFF Research Database (Denmark)

    Ørnbjerg, Lykke Midtbøll; Østergaard, Mikkel; Jensen, Trine;

    2016-01-01

    BACKGROUND: Rheumatoid arthritis is characterised by progressive joint destruction and loss of periarticular bone mass. Hand bone loss (HBL) has therefore been proposed as an outcome measure for treatment efficacy. A definition of increased HBL adjusted for age- and sex-related bone loss is lacking......: DXR-BMD was measured from hand x-rays in a reference cohort (1485 men/2541 women) without arthritis randomly selected from an urban Danish population. Sex- and age-related HBL/year was estimated. DXR-BMD was measured in rheumatoid arthritis patients (n = 350: at start of TNFI, and ~2 years after TNFI...... increased HBL during TNFI treatment. In the 350 patients, increased HBL during TNFI was associated with time-averaged 28-joint disease activity score (odds ratio 1.69 (95 % Confidence Interval 1.34-2.15)/unit increase, p 

  11. Clinical-anthropometric characteristics of COPD outpatients belonging to the different groups and having different severity of airway obstruction

    Directory of Open Access Journals (Sweden)

    Gashynova K.Y.

    2015-06-01

    Full Text Available The aim of the study was to compare the clinical and anthropometric characteristics of patients with COPD, which differ in the degree of airways obstruction and belong to groups A, B, C, D in accordance with GOLD, 2011 classification. A total of 112 ambulatory COPD patients in remission made the study sample. Anthropometric data, body mass index, medical history, dyspnea by mMRC scale, and spirometry was performed for all patients. There was confirmed that outpatients with COPD is a heterogeneous group, in which the majority are those with moderate (48.22 % and severe (30.36 %, airway obstruction. Despite the vast majority of men among outpatients, the percentage of women among patients with mild to moderate obstruction (22.58±5.31 % was significantly higher (p=0.002 as compared with those with severe or very severe limitation of airflow (6.00±3.36 %. Patients with severe and very severe obstruction were of significantly older age (p = 0.024. At the same time, the distribution of patients according to the GOLD, 2011 classification, demonstrate that all groups did not differ on any of the anthropometric indicators, including gender and age (p > 0.050. Distribution of patients by groups with different risk for future exacerbations is not a mirror image of gradation in accordance with the degree of airway obstruction. Every second (50.00±4.43 % of cases patient is included in group C and every tenth (10.20±4.32 % belongs to the group D not due to degree of bronchial obstruction, but due to the number of exa­cerbations in the past year. Therefore, in future studies it is advisable to use both principles of patients’ classification.

  12. CLINICAL PROFILE OF CHILDREN IN THE AGE GROUP 6 MONTHS TO 60 MONTHS WITH LOWER RESPIRATORY TRACT INFECTION

    Directory of Open Access Journals (Sweden)

    Bharath Kumar

    2015-05-01

    Full Text Available CONTEXT : Infections of the respiratory tract are perhaps the most common human ailments. Acute Respiratory Infections (ARI has quite a high morbidity and mortality in children in developing countries 1 ARI is responsible for about 30 - 50 percent of visits to health facilities and for about 20 - 40 percent of hospital admissions. Pneumonia is a leading cause of mortality in children worldwide. Because mortality due to pneumonia in developing countries is attributable mainly to bacterial etiology , IM NCI strategy recommends the use of antibiotics when a child presented with tachypnea as defined previously . AIMS : To re - define or refine tachypnea as a specific indicator of bacterial pneumonia. To identify other clinical predictors for identifying bacteri al pneumonia. DESIGNS : The study was designed to be done in two phases . In the first phase it is to be carried out as a descriptive study of children presenting with fever and respiratory distress in the OPD to identify the specific markers for bacterial p neumonia. In the second phase presenting clinical features in children with radiological pneumonia will be analysed to validate the findings from Phase I. MATERIALS AND METHODS : This was a hospital based study and was conducted in Sri Manakula V inayagar Me dical College and Hospital , Puducherry . The study included 100 Children in the age group 6 months to 5 years presenting in the out patients department with fever and respiratory distress Children attending the out - patient department on a fixed day of the w eek (Monday and who come under this study population during the study period were admitted and recruited in the study and informed verbal consent for participation was taken from the parents. Their clinical profiles were recorded as in phase I. All childr en coming under this study population were given antibiotics and supportive treatment. The cases were monitored for any worsening or improvement every 6 th hourly on day 1 and

  13. Group Patient Education: Effectiveness of a Brief Intervention in People with Type 2 Diabetes Mellitus in Primary Health Care in Greece: A Clinically Controlled Trial

    Science.gov (United States)

    Merakou, K.; Knithaki, A.; Karageorgos, G.; Theodoridis, D.; Barbouni, A.

    2015-01-01

    This study aims to assess the impact of a brief patient group education intervention in people with type 2 diabetes mellitus. The sample, 193 people with type 2 diabetes mellitus who were patients at the diabetic clinic of a primary health care setting in Attica, was assigned to two groups, intervention (138 individuals) and control group (55…

  14. Serum high mobility group box-1 (HMGB1 is closely associated with the clinical and pathologic features of gastric cancer

    Directory of Open Access Journals (Sweden)

    Chung Jae

    2009-05-01

    Full Text Available Abstract Background High mobility group box-1 (HMGB1 is a newly recognized factor regulating cancer cell tumorigenesis, expansion and invasion. We investigated the correlation between the serum HMGB1 levels and the clinical and pathologic features of gastric cancer and evaluated the validity of HMGB1 as a potential biomarker for the early diagnosis of gastric cancer. Methods A total of 227 subjects were classified into 5 disease groups according to the 'gastritis-dysplasia-carcinoma' sequence of gastric carcinogenesis and their serum levels of HMGB1 were analyzed by an enzyme-linked immunosorbent assay (ELISA method. Clinical parameters, International Union Against Cancer (UICC TNM stage, cancer size, differentiation or lymphatic invasion, vascular or perineural invasion and prognosis were used as analysis variables. Results The serum HMGB1 levels were significantly different among disease groups (ANOVA, p and HMGB1 levels tended to increase according to the progression of gastric carcinogenesis. Serum HMGB1 levels were significantly associated with depth of invasion, lymph node metastasis, tumor size, and poor prognosis (p . However, HMGB1 levels were not associated with patient gender or age, differentiation of tumor cells, or lymphatic, vascular and perineural invasion, or the existence of distant metastasis in advanced cancer (p > 0.05. The sensitivity and specificity of serum HMGB1 was 71% and 67% (cut-off value of 5 ng/ml for the diagnosis of early gastric cancer, and 70% and 64% (cut-off value of 4 ng/ml for the diagnosis of high-risk lesions, respectively. These values were greater than those for carcinoembryonic antigen (CEA (30–40% of sensitivity. Conclusion HMGB1 appears to be a useful serological biomarker for early diagnosis as well as evaluating the tumorigenesis, stage, and prognosis of gastric cancer.

  15. 可调压式分流管治疗成年人脑积水20例临床分析%Clinical analysis of the adjustable shunt valve in the treatment of adult hydrocephalus in 20 cases

    Institute of Scientific and Technical Information of China (English)

    徐德才; 张少军; 姜之全; 韩易

    2014-01-01

    Objective: To explore the clinical effects of the adjustable ventriculo-peritoneal shunt valve in treating adult hydrocephalus. Methods:Twenty cases with hydrocephalus were treated with the adjustable ventriculo-peritoneal shunt valve. The valve pressure was adjusted according to the intracranial pressure of patients during the operation and the ventricular size in CT and the clinical symptoms after operation. The valve increased or decreased 1 level every month according to the brain CT. Results:All patients were followed up for 3 to 19 months. The high-pressure hydrocephalus symptoms were improved in 5 cases,the valve in 1 case with less ventricle was adjusted to high 1 level. Among 15 cases with normal-pressure hydrocephalus,the improvement in 8 cases and no obvious improvement in 7 cases were found. Among 8 cases treated with adjustment,the improvement of symptom and imaging in 7 cases and no obvious improvement in 1 case were found. Conclusions:The clinical effects of the adjustable ventriculo-peritoneal shunt valve are good,which can prevent complications.%目的:探讨可调压式分流管行脑室-腹腔分流术治疗成年人脑积水的临床效果。方法:采用可调压式分流管行脑室-腹腔分流术治疗成年人脑积水20例。术中测量颅内压并根据所测压力调整阀门压力。术后根据头颅CT显示的脑室大小和临床症状的改善调节分流泵的压力。每月复查头颅CT 1次,每次调低或调高1个档次,每月调节1次。结果:出院后随访3~19个月,5例高压性脑积水术后症状均有不同程度的改善,1例出现脑室过小,调高1个档次,共调节1次;15例正常压力脑积水术后1个月内8例症状改善,7例症状改善不明显,进行压力调节;共8例调节,7例症状和影像学改善,1例无改善。结论:使用可调压式分流管行脑室-腹腔分流术,可在术后调整阀门压力,防止并发症,分流效果显著。

  16. Adjustment problems and residential care environment

    Directory of Open Access Journals (Sweden)

    Jan Sebastian Novotný

    2015-01-01

    Full Text Available Problem: Residential care environment represents a specific social space that is associated with a number of negative consequences, covering most aspects of children and youth functioning. The paper analyzes of the presence of adjustment problems among adolescents from institutional care environment and compares this results with a population of adolescents who grew up in a family. Methods: The sample consisted of two groups of adolescents. The first group included 285 adolescents currently growing up in an residential care environment, aged 13 to 21 (M = 16.23, SD = 1.643. The second group consisted of 214 adolescents growing up in a family, aged 15 to 20 (M = 17.07, SD = 1.070. We used a questionnaire Youth Self Report. Data were analyzed using descriptive statistics and MANOVA. Results: Results showed that adolescents in residential care exhibit higher average values in all adjustment problems. Also, in the context of diagnostic categories are the residential care adolescents more frequently in non-normal range (borderline and clinical, primarily in the border range. The greatest differences were reflected in the Thought problems and Rule-breaking behavior. MANOVA showed a significant multivariate effect between groups of adolescents, Hotelling's T = .803, F(8, 490 = 49.202, p <.001, d = .445 (large effect. Univariate analysis further showed a significant effect for Withdrawn/depressed (p = .044, d = .089, small effect, Somatic complaints (p = .002, d = .139, medium effect, Social problems (p = 004, d = .127, a small effect, Thought problems (p <.001, d = .633, strong effect, Attention problems (p <.001, d = .320,strong effect, Rule-breaking behavior (p <.001 , d = .383, strong effect, and Aggressive behavior (p = 015, d = .110, small effect. Results for the dimension of Anxious/depressed were not significant (p = .159. Discussion: The results didn’t confirmed the assumption that more than 30% of residential care adolescents have adjustment

  17. TU-C-BRE-07: Quantifying the Clinical Impact of VMAT Delivery Errors Relative to Prior Patients’ Plans and Adjusted for Anatomical Differences

    International Nuclear Information System (INIS)

    Purpose: There is increased interest in the Radiation Oncology Physics community regarding sensitivity of pre-treatment IMRT/VMAT QA to delivery errors. Consequently, tools mapping pre-treatment QA to the patient DVH have been developed. However, the quantity of plan degradation that is acceptable remains uncertain. Using DVHs adapted from prior patients’ plans, we developed a technique to determine the magnitude of various delivery errors required to degrade a treatment plan to outside the clinically accepted range. Methods: DVHs for relevant organs at risk were adapted from a population of prior patients’ plans using a machine learning algorithm to establish the clinically acceptable DVH range specific to the patient’s anatomy. We applied this technique to six low-risk prostate cancer patients treated with single-arc VMAT and compared error-induced DVH changes to the adapted DVHs to determine the magnitude of error required to push the plan outside of the acceptable range. The procedure follows: (1) Errors (systematic ' random shift of MLCs, gantry-MLC desynchronization, dose rate fluctuations, etc.) were simulated and degraded DVHs calculated using the Varian Eclipse TPS. (2) Adapted DVHs and acceptable ranges for DVHs were established. (3) Relevant dosimetric indices and corresponding acceptable ranges were calculated from the DVHs. Key indices included NTCP (Lyman-Kutcher-Burman Model) and QUANTEC’s dose-volume Objectives: s of V75Gy≤0.15 for the rectum and V75Gy≤0.25 for the bladder. Results: Degradations to the clinical plan became “unacceptable” for 19±29mm and 1.9±2.0mm systematic outward shifts of a single leaf and leaf bank, respectively. All other simulated errors fell within the acceptable range. Conclusion: Utilizing machine learning and prior patients’ plans one can predict a clinically acceptable range of DVH degradation for a specific patient. Comparing error-induced DVH degradations to this range, it is shown that single

  18. Annual Adjustment Factors

    Data.gov (United States)

    Department of Housing and Urban Development — The Department of Housing and Urban Development establishes the rent adjustment factors - called Annual Adjustment Factors (AAFs) - on the basis of Consumer Price...

  19. Adjustments and Depression

    Medline Plus

    Full Text Available ... depression and adjustment to my SCI? How do I deal with depression and adjustment to my SCI? ☷ ▾ ... following an SCI? What are the secondary conditions? I have no health insurance, what are my options? ...

  20. Adjustments and Depression

    Medline Plus

    Full Text Available ... course an adjustment period as you navigate your new normal. The most important point to remember is ... to rebuild one's identity and to find a new balance in relationships. The stages of adjustment can ...

  1. Comparison of the clinical features and outcomes in two age-groups of elderly patients with atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Shao XH

    2014-08-01

    Full Text Available Xing-Hui Shao,1 Yan-Min Yang,1 Jun Zhu,1 Han Zhang,1 Yao Liu,1 Xin Gao,1 Li-Tian Yu,1 Li-Sheng Liu,1 Li Zhao,2 Peng-Fei Yu,3 Hua Zhang,4 Qing He,5 Xiao-Dan Gu6 1Emergency and Intensive Care Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 2Department of Emergency, Fu Xing Hospital, Capital Medical University, Beijing, 3Department of Cardiology, Pingdu People’s Hospital, Pingdu, 4Department of Emergency, Qingdao Municipal Hospital, Qingdao, 5Department of Emergency, West China Hospital, Sichuan University, Chengdu, 6Department of Emergency, Sixth People’s Hospital of Chengdu, Chengdu, People’s Republic of China Background: Atrial fibrillation (AF disproportionately affects older adults. However, direct comparison of clinical features, medical therapy, and outcomes in AF patients aged 65–74 and ≥75 years is rare. The objective of the present study was to evaluate the differences in clinical characteristics and prognosis in these two age-groups of geriatric patients with AF.Materials and methods: A total of 1,336 individuals aged ≥65 years from a Chinese AF registry were assessed in the present study: 570 were in the 65- to 74-year group, and 766 were in the ≥75-year group. Multivariable Cox hazards regression was performed to analyze the major adverse cardiac events (MACEs between groups.Results: In our population, the older group were more likely to have coronary artery disease, hypertension, previous stroke, cognitive disorder, or chronic obstructive pulmonary disease, and the 65- to 74-year group were more likely to have valvular heart disease, left ventricular systolic dysfunction, or sleep apnea. The older patients had 1.2-fold higher mean CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes, stroke scores, but less ­probability of being prescribed drugs. Compared with those aged 65–74 years, the older group had a higher risk of death (hazard ratio 2

  2. The role of ADME pharmacogenomics in early clinical trials: perspective of the Industry Pharmacogenomics Working Group (I-PWG).

    Science.gov (United States)

    Tremaine, Larry; Brian, William; DelMonte, Terrye; Francke, Stephan; Groenen, Peter; Johnson, Keith; Li, Lei; Pearson, Kimberly; Marshall, Jean-Claude

    2015-12-01

    Genetic polymorphisms in metabolizing enzymes and drug transporters have been shown to significantly impact the exposure of drugs having a high dependence on a single mechanism for their absorption, distribution or clearance, such that genotyping can lead to actionable steps in disease treatment. Recently, global regulatory agencies have provided guidance for assessment of pharmacogenomics during early stages of drug development, both in the form of formal guidance and perspectives published in scientific journals. The Industry Pharmacogenomics Working Group (I-PWG), conducted a survey among member companies to assess the practices relating to absorption, distribution, metabolism, excretion pharmacogenomics) during early stages of clinical development, to assess the impact of the recent Regulatory Guidance issued by the US FDA and EMA on Industry practices.

  3. Effects of an adapted physical activity program in a group of elderly subjects with flexed posture: clinical and instrumental assessment

    Directory of Open Access Journals (Sweden)

    Frizziero Antonio

    2008-11-01

    Full Text Available Abstract Background Flexed posture commonly increases with age and is related to musculoskeletal impairment and reduced physical performance. The purpose of this clinical study was to systematically compare the effects of a physical activity program that specifically address the flexed posture that marks a certain percentage of elderly individuals with a non specific exercise program for 3 months. Methods Participants were randomly divided into two groups: one followed an Adapted Physical Activity program for flexed posture and the other one completed a non-specific physical activity protocol for the elderly. A multidimensional clinical assessment was performed at baseline and at 3 months including anthropometric data, clinical profile, measures of musculoskeletal impairment and disability. The instrumental assessment of posture was realized using a stereophotogrammetric system and a specific biomechanical model designed to describe the reciprocal position of the body segments on the sagittal plane in a upright posture. Results The Adapted Physical Activity program determined a significant improvement in several key parameters of the multidimensional assessment in comparison to the non-specific protocol: decreased occiput-to-wall distance, greater lower limb range of motion, better flexibility of pectoralis, hamstrings and hip flexor muscles, increased spine extensor muscles strength. Stereophotogrammetric analysis confirmed a reduced protrusion of the head and revealed a reduction in compensative postural adaptations to flexed posture characterized by knee flexion and ankle dorsiflexion in the participants of the specific program. Conclusion The Adapted Physical Activity program for flexed posture significantly improved postural alignment and musculoskeletal impairment of the elderly. The stereophotogrammetric evaluation of posture was useful to measure the global postural alignment and especially to analyse the possible compensatory strategies

  4. Increasing antimicrobial resistance in clinical isolates of Staphylococcus intermedius group bacteria and emergence of MRSP in the UK.

    Science.gov (United States)

    Beever, L; Bond, R; Graham, P A; Jackson, B; Lloyd, D H; Loeffler, A

    2015-02-14

    Frequencies of antimicrobial resistance were determined amongst 14,555 clinical Staphylococcus intermedius group (SIG) isolates from UK dogs and cats to estimate resistance trends and quantify the occurrence of meticillin-resistant Staphylococcus pseudintermedius (MRSP). Reports from two diagnostic laboratories (13,313 general submissions, 1242 referral centre only submissions) were analysed retrospectively (2003/2006-2012). MRSP were defined by phenotypic resistance to meticillin and concurrent broad β-lactam resistance; a subset was confirmed genetically (SIG-specific nuc and mecA). Trends were analysed by Cochran-Armitage test. Resistance remained below 10 per cent for cefalexin, amoxicillin-clavulanic acid and the fluoroquinolones. Increasing resistance trends were seen in both laboratories for ampicillin/amoxicillin (both P<0.001), cefovecin (both P<0.046) and enrofloxacin (both P<0.02). Resistance to cefalexin increased over time in referral hospital isolates (P<0.001) to clindamycin (P=0.01) and trimethoprim-sulfamethoxazole (P=0.001) amongst general laboratory submissions. Overall, 106 MRSP were isolated (0.7 per cent of submissions) including 32 (2.6 per cent of submissions, all genetically confirmed) from the referral centre population (inter-laboratory difference P<0.001). Against a background of widely susceptible SIG isolates, a new trend of increasing resistance to important antimicrobials was identified overtime and the emergence of MRSP from UK clinical cases was confirmed. Attention to responsible use of antibacterial therapy in small animal practice is urgently needed.

  5. Notes from the Field: Group A Streptococcal Pharyngitis Misdiagnoses at a Rural Urgent-Care Clinic--Wyoming, March 2015.

    Science.gov (United States)

    Harrist, Alexia; Van Houten, Clayton; Shulman, Stanford T; Van Beneden, Chris; Murphy, Tracy

    2016-01-01

    Group A Streptococcus (GAS) is the most common bacterial cause of pharyngitis, implicated in 20%-30% of pediatric and 5%-15% of adult health care visits for sore throat (1). Along with the sudden onset of throat pain, GAS pharyngitis symptoms include fever, headache, and bilateral tender cervical lymphadenopathy (1,2). Accurate diagnosis and management of GAS pharyngitis is critical for limiting antibiotic overuse and preventing rheumatic fever (2), but distinguishing between GAS and viral pharyngitis clinically is challenging (1). Guidelines for diagnosis and management of GAS pharyngitis have been published by the Infectious Diseases Society of America (IDSA)* (1). IDSA recommends that patients with sore throat be tested for GAS to distinguish between GAS and viral pharyngitis; however, IDSA emphasizes the use of selective testing based on clinical symptoms and signs to avoid identifying GAS carriers rather than acute GAS infections (1). Therefore, testing for GAS usually is not recommended for the following: patients with sore throat and accompanying symptoms (e.g., cough, rhinorrhea) that strongly suggest a viral etiology; children aged pharyngitis (1). IDSA recommends penicillin or amoxicillin as the treatment of choice based on effectiveness and narrow spectrum of activity. To date, penicillin-resistant GAS has never been documented (1). PMID:26719990

  6. Looking for the new preparations for antibacterial therapy III. New antimicrobial agents from the quinolones group in clinical trials.

    Science.gov (United States)

    Karpiuk, Izabela; Tyski, Stefan

    2013-01-01

    There is an essential need for searching for the new compounds effective in the treatment of infections caused by multidrug-resistant bacteria. This paper is the third part of a series associated with the exploration of new antibacterial agents and it discusses the compounds belonging to the group of quinolones and substances possessing a hybrid structure composed of the quinolone molecule and other compounds. Eleven new substances at the stage of clinical trials are presented. Three of them belong to the group of non-fluorinated quinolone (nemonoxacin, ozenoxacin and KRP-AM 1977X), while six are the quinolones containing fluorine atom at 6 position of the carbon atom in the quinoline ring (zabofloxacin, finafloxacin, delafloxacin, JNJ-Q2, WCK771 and KPI-10). The remaining two compounds possess a hybrid construction composed of the quinolone structure and other molecules (cadazolid and CBR-2092). There is a chance in the near future, that the presented compounds can extend the range of existing antibacterial drugs and provide an alternative to currently available medicinal products.

  7. Gait analysis in clinically healthy sheep from three different age groups using a pressure-sensitive walkway

    Directory of Open Access Journals (Sweden)

    Agostinho Felipe S

    2012-06-01

    Full Text Available Abstract Background Understanding normal gait requires allowing for variations in normal patterns by the sex, age, and species in question. Therefore, the aim of this study was to evaluate kinetic and temporospatial parameters in clinically healthy sheep from three different age groups with a pressure-sensing walkway. The sheep were judged to be healthy based on the results of complete physical and orthopaedic examinations and had no history of lameness. Twenty-one clinically healthy female Santa Ines sheep were divided into three groups: G1 – seven animals, aged from 8 to 12 months and weighing 19.5-33 kg; G2 - seven individuals, aged from 2 to 4 years and weighing 26.5-42 kg; and G3 - seven sheep, aged more than 5 years and weighing 37.3-45 kg. The animals were examined from two directions: first on the left side and then on the right side of the handler. The data from the first five valid trials in each direction were collected for each sheep and analysed using the designated software. A trial was considered valid if the sheep walked within the correct velocity (1.1-1.3 m/s and acceleration (from −0.15 to 0.15 m/s2 ranges. The peak vertical force (PVF, vertical impulse (VI, gait cycle time, stance time, swing time, stride length, and the percentage body weight distribution among the four limbs were determined. Results No significant differences were observed, in either the forelimbs or the hind limbs, between the left and right sides or between the two directions for any of the variables. No significant temporospatial differences were found among the groups. Significant PVF (%BW differences were observed in the forelimbs (G1 > G3 and hind limbs (G1 > G3, and significant VI differences were observed in the forelimbs (G1 > G3. Conclusions Young healthy sheep differ from older sheep in the vertical forces they create when walking at the same velocity on a pressure-sensing walkway.

  8. Implementation of Risk Adjustment for Medicare

    OpenAIRE

    Ingber, Melvin J.

    2000-01-01

    The Health Care Financing Administration (HCFA) implemented risk adjustment for Medicare capitated organizations January 2000. The risk adjustment system used, the Principal Inpatient Diagnostic Cost Group (PIPDCG) method, had to be incorporated into the payment structure mandated by the Balanced Budget Act of 1997 (BBA). This article describes how risk adjustment was integrated into the payment system within the rules of the BBA, and how fee-for-service (FFS) and health maintenance organizat...

  9. Consensus on the detection and management of prediabetes. Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society.

    Science.gov (United States)

    Mata-Cases, M; Artola, S; Escalada, J; Ezkurra-Loyola, P; Ferrer-García, J C; Fornos, J A; Girbés, J; Rica, I

    2015-03-01

    In Spain, according to the Di@bet.es study, 13.8% of the adult population suffers from diabetes and 14.8% from some form of prediabetes (impaired glucose tolerance, impaired fasting glucose or both). Since early detection of prediabetes can facilitate the implementation of therapeutic measures to prevent its progression to diabetes, we believe that preventive strategies in primary care and specialized clinical settings should be agreed. Screening for diabetes and prediabetes using a specific questionnaire (FINDRISC) and/or the measurement of fasting plasma glucose in high risk patients leads to detecting patients at risk of developing diabetes and it is necessary to consider how they should be managed. The intervention in lifestyle can reduce the progression to diabetes and reverse a prediabetic state to normal and is a cost-effective intervention. Some drugs, such as metformin, have also been shown effective in reducing the progression to diabetes but are not superior to non-pharmacological interventions. Finally, an improvement in some cardiovascular risk factors has been observed although there is no strong evidence supporting the effectiveness of screening in terms of morbility and mortality. The Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society has issued some recommendations that have been agreed by the Sociedad Española de Endocrinología y Nutrición, Sociedad Española de Endocrinología Pediátrica, Sociedad Española de Farmacia Comunitaria, Sociedad Española de Medicina Familiar y Comunitaria, Sociedad Española de Médicos Generales, Sociedad Española de Médicos de Atención Primaria, Sociedad Española de Medicina Interna, Asociación de Enfermería Comunitaria and Red de Grupos de Estudio de la Diabetes en Atención Primaria.

  10. [Consensus on the detection and management of prediabetes. Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society].

    Science.gov (United States)

    Mata-Cases, M; Artola, S; Escalada, J; Ezkurra-Loyola, P; Ferrer-García, J C; Fornos, J A; Girbés, J; Rica, I

    2015-01-01

    In Spain, according to the Di@bet.es study, 13.8% of the adult population suffers from diabetes and 14.8% from some form of prediabetes (impaired glucose tolerance, impaired fasting glucose or both). Since early detection of prediabetes can facilitate the implementation of therapeutic measures to prevent its progression to diabetes, we believe that preventive strategies in primary care and specialized clinical settings should be agreed. Screening for diabetes and prediabetes using a specific questionnaire (FINDRISC) and/or the measurement of fasting plasma glucose in high risk patients leads to detecting patients at risk of developing diabetes and it is necessary to consider how they should be managed. The intervention in lifestyle can reduce the progression to diabetes and reverse a prediabetic state to normal and is a cost-effective intervention. Some drugs, such as metformin, have also been shown effective in reducing the progression to diabetes but are not superior to non-pharmacological interventions. Finally, an improvement in some cardiovascular risk factors has been observed although there is no strong evidence supporting the effectiveness of screening in terms of morbility and mortality. The Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society has issued some recommendations that have been agreed by the Sociedad Española de Endocrinología y Nutrición, Sociedad Española de Endocrinología Pediátrica, Sociedad Española de Farmacia Comunitaria, Sociedad Española de Medicina Familiar y Comunitaria, Sociedad Española de Médicos Generales, Sociedad Española de Médicos de Atención Primaria, Sociedad Española de Medicina Interna, Asociación de Enfermería Comunitaria and Red de Grupos de Estudio de la Diabetes en Atención Primaria.

  11. [Consensus on the detection and management of prediabetes. Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society].

    Science.gov (United States)

    Mata-Cases, M; Artola, S; Escalada, J; Ezkurra-Loyola, P; Ferrer-García, J C; Fornos, J A; Girbés, J; Rica, I

    2015-03-01

    In Spain, according to the Di@bet.es study, 13.8% of the adult population suffers from diabetes and 14.8% from some form of prediabetes (impaired glucose tolerance, impaired fasting glucose or both). Since early detection of prediabetes can facilitate the implementation of therapeutic measures to prevent its progression to diabetes, we believe that preventive strategies in primary care and specialized clinical settings should be agreed. Screening for diabetes and prediabetes using a specific questionnaire (FINDRISC) and/or the measurement of fasting plasma glucose in high risk patients leads to detecting patients at risk of developing diabetes and it is necessary to consider how they should be managed. The intervention in lifestyle can reduce the progression to diabetes and reverse a prediabetic state to normal and is a cost-effective intervention. Some drugs, such as metformin, have also been shown effective in reducing the progression to diabetes but are not superior to non-pharmacological interventions. Finally, an improvement in some cardiovascular risk factors has been observed although there is no strong evidence supporting the effectiveness of screening in terms of morbility and mortality. The Consensus and Clinical Guidelines Working Group of the Spanish Diabetes Society has issued some recommendations that have been agreed by the Sociedad Española de Endocrinología y Nutrición, Sociedad Española de Endocrinología Pediátrica, Sociedad Española de Farmacia Comunitaria, Sociedad Española de Medicina Familiar y Comunitaria, Sociedad Española de Médicos Generales, Sociedad Española de Médicos de Atención Primaria, Sociedad Española de Medicina Interna, Asociación de Enfermería Comunitaria and Red de Grupos de Estudio de la Diabetes en Atención Primaria.

  12. Implementation of Remote 3-Dimensional Image Guided Radiation Therapy Quality Assurance for Radiation Therapy Oncology Group Clinical Trials

    International Nuclear Information System (INIS)

    Purpose: To report the process and initial experience of remote credentialing of three-dimensional (3D) image guided radiation therapy (IGRT) as part of the quality assurance (QA) of submitted data for Radiation Therapy Oncology Group (RTOG) clinical trials; and to identify major issues resulting from this process and analyze the review results on patient positioning shifts. Methods and Materials: Image guided radiation therapy datasets including in-room positioning CT scans and daily shifts applied were submitted through the Image Guided Therapy QA Center from institutions for the IGRT credentialing process, as required by various RTOG trials. A centralized virtual environment is established at the RTOG Core Laboratory, containing analysis tools and database infrastructure for remote review by the Physics Principal Investigators of each protocol. The appropriateness of IGRT technique and volumetric image registration accuracy were evaluated. Registration accuracy was verified by repeat registration with a third-party registration software system. With the accumulated review results, registration differences between those obtained by the Physics Principal Investigators and from the institutions were analyzed for different imaging sites, shift directions, and imaging modalities. Results: The remote review process was successfully carried out for 87 3D cases (out of 137 total cases, including 2-dimensional and 3D) during 2010. Frequent errors in submitted IGRT data and challenges in the review of image registration for some special cases were identified. Workarounds for these issues were developed. The average differences of registration results between reviewers and institutions ranged between 2 mm and 3 mm. Large discrepancies in the superior-inferior direction were found for megavoltage CT cases, owing to low spatial resolution in this direction for most megavoltage CT cases. Conclusion: This first experience indicated that remote review for 3D IGRT as part of QA

  13. The clinical application of adjusted inferior petrosal sinus sampling in Cushing′s disease%改良岩下窦静脉采血在库欣病诊断中的应用

    Institute of Scientific and Technical Information of China (English)

    周薇薇; 苏颋为; 姜蕾; 蒋怡然; 张华; 吴志远; 武鲁铭; 宁光; 王卫庆

    2016-01-01

    目的:岩下窦静脉采血( inferior petrosal sinus sampling, IPSS)有助于确认ACTH依赖性库欣综合征患者中ACTH肿瘤的分泌来源,但存在一定的假阴性。本研究拟通过催乳素校正来改良IPSS技术,探讨其在库欣病诊断中的临床意义。方法纳入93例ACTH依赖性库欣综合征患者,包括87例库欣病和6例异位ACTH综合征患者。所有患者均进行了催乳素校正的IPSS检查。结果库欣病患者ACTH岩下窦/外周( inferior petrosal sinus to peripheral gradient, IPS/P)比值和催乳素校正IPS/P比值均显著高于异位ACTH综合征患者[11.3(5.0~22.4)对1.4(1.2~2.0),3.3(1.9~4.8)对0.5(0.2~1.0),均P<0.01]。非改良IPSS的假阴性率为10.3%;经催乳素校正后,IPSS诊断准确性从89.2%提高到96.8%。与其它定位诊断试验比较,催乳素校正IPSS的敏感性和特异性最高。结论 IPSS对鉴别ACTH肿瘤来源而言是一种可信度很高的检查,采用催乳素校正能减少IPSS假阴性结果,有效提高诊断准确性。%Objective Inferior petrosal sinus sampling ( IPSS) is helpful in confirming the source of ACTH secreting tumor in ACTH-dependent Cushing′s syndrome. However, false-negative results have been reported. Prolactin level adjustment may reduce false-negative results of IPSS. This study was to investigate the utility of prolactin measurement during IPSS in patients with Cushing′s disease. Methods This study included 93 patients with a pathological diagnosis of Cushing′s disease(n=87) or ectopic Cushing′s syndrome(n=6). Clinical, biochemical, and radiological records were reviewed and all cases underwent IPSS with prolactin adjustment. Results Baseline and prolactin adjusted inferior petrosal sinus to peripheral gradient ( IPS/P) ratio were significantly higher in patients with Cushing′s disease than those with ectopic Cushing′s syndrome[11. 3(5. 0-22. 4)vs 1. 4(1. 2-2. 0),3. 3(1. 9-4. 8)vs 0. 5(0. 2-1. 0), both P<0. 01]. False-negative rate of

  14. Toward comprehensive management tailored to prognostic factors of patients with clinical stages I and II in Hodgkin's disease. The EORTC Lymphoma Group controlled clinical trials: 1964-1987.

    Science.gov (United States)

    Tubiana, M; Henry-Amar, M; Carde, P; Burgers, J M; Hayat, M; Van der Schueren, E; Noordijk, E M; Tanguy, A; Meerwaldt, J H; Thomas, J

    1989-01-01

    From 1964 to 1987, the EORTC Lymphoma Group conducted four consecutive controlled clinical trials on clinical stages I and II Hodgkin's disease in which 1,579 patients were entered. From the onset the main aim of these trials was to identify the subsets of patients who could be treated safely by regional radiotherapy (RT). Therefore, several prognostic indicators were prospectively registered and progressively used in the trial protocols for the delineation of the favorable and unfavorable subgroups as soon as they were recognized of high predictive value. In the H2 trial (1972 to 1976), the histologic subtype was the only variable taken into account for the therapeutic strategy and the staging laparotomy findings were found to be of prognostic value only in patients with favorable prognostic indicators. In the H5 trial (1977 to 1982), patients were subdivided into two subgroups according to six prognostic indicators. Patients with favorable features were submitted to a staging laparotomy (lap); lap negative patients were randomized between mantle field RT and mantle field plus paraaortic RT. Disease free survival (DFS) and total survival (S) were similar in the two arms. Among patients with unfavorable features, DFS and S were significantly higher in the arm treated by combination of mechlorethamine, vincristine, procarbazine, prednisone (MOPP) chemotherapy (CT) and RT than in the arm treated by total nodal irradiation. Nevertheless, in patients below the age of 40, the overall survival rates were equivalent in the two arms. In the H6 trial, the delineation of the favorable subgroup was based on (a) absence of systemic symptoms and elevated ESR, (b) no more than one or two lymph node areas involved. The aim of the study was to assess the impact on survival of a therapeutic strategy including staging laparotomy. At a 4-year follow-up, no difference in survival was evidenced. In patients with unfavorable prognostic indicators, 3 MOPP-RT-3 MOPP were compared with 3

  15. Clinical Usefulness of Oral Supplementation with Alpha-Lipoic Acid, Curcumin Phytosome, and B-Group Vitamins in Patients with Carpal Tunnel Syndrome Undergoing Surgical Treatment

    OpenAIRE

    Giorgio Pajardi; Paola Bortot; Veronica Ponti; Chiara Novelli

    2014-01-01

    We investigated the clinical usefulness of oral supplementation with a combination product containing alpha-lipoic acid, curcumin phytosome, and B-group vitamins in 180 patients with carpal tunnel syndrome (CTS), scheduled to undergo surgical decompression of the median nerve. Patients in Group A (n = 60) served as controls and did not receive any treatment either before or after surgery. Patients in Group B (n = 60) received oral supplementation twice a day for 3 months both before and after...

  16. Repatriation Adjustment: Literature Review

    Directory of Open Access Journals (Sweden)

    Gamze Arman

    2009-12-01

    Full Text Available Expatriation is a widely studied area of research in work and organizational psychology. After expatriates accomplish their missions in host countries, they return to their countries and this process is called repatriation. Adjustment constitutes a crucial part in repatriation research. In the present literature review, research about repatriation adjustment was reviewed with the aim of defining the whole picture in this phenomenon. Present research was classified on the basis of a theoretical model of repatriation adjustment. Basic frame consisted of antecedents, adjustment, outcomes as main variables and personal characteristics/coping strategies and organizational strategies as moderating variables.

  17. Establishing clinically significant change : increment of precision and the distinction between individual and group level of analysis

    NARCIS (Netherlands)

    Hageman, WJJM; Arrindell, WA

    1999-01-01

    Some essential adaptations to the method for determining clinically significant change originally introduced by Jacobson, Follette and Revenstorf [Jacobson, N. S., Follette, W. C. & Revenstorf, D. (1984a). Psychotherapy outcome research: methods for reporting variability and evaluating clinical sign

  18. Novel Three-Day, Community-Based, Nonpharmacological Group Intervention for Chronic Musculoskeletal Pain (COPERS): A Randomised Clinical Trial

    Science.gov (United States)

    Taylor, Stephanie J. C.; Carnes, Dawn; Homer, Kate; Kahan, Brennan C.; Hounsome, Natalia; Eldridge, Sandra; Spencer, Anne; Pincus, Tamar; Underwood, Martin

    2016-01-01

    , accounted for clustering by course in the intervention arm, and used multiple imputation for missing or incomplete primary outcome data. The mean age of participants was 59.9 y, with 81% white, 67% female, 23% employed, 85% with pain for at least 3 y, and 23% on strong opioids. Symptoms of depression and anxiety were common (baseline mean HADS scores 7.4 [standard deviation 4.1] and 9.2 [4.6], respectively). Overall, 282 (70%) intervention participants met the predefined intervention adherence criterion. Primary outcome data were obtained from 88% of participants. There was no significant difference between groups in pain-related disability at 6 or 12 mo (12 mo: difference −1.0, intervention versus control, 95% CI −4.9 to 3.0), pain intensity, or the census global health question. Anxiety, depression, pain-related self-efficacy, pain acceptance, and social integration were better in the intervention group at 6 mo; at 12 mo, these differences remained statistically significant only for depression (−0.7, 95% CI −1.2 to −0.2) and social integration (0.8, 95% CI 0.4 to 1.2). Intervention participants received more analgesics than the controls across the 12 mo. The total cost of the course per person was £145 (US$214). The cost–utility analysis showed there to be a small benefit in terms of quality-adjusted life years (QALYs) (0.0325, 95% CI −0.0074 to 0.0724), and on the cost side the intervention was a little more expensive than usual care (i.e., £188 [US$277], 95% CI −£125 [−US$184] to £501 [US$738]), resulting in an incremental cost-effectiveness ratio of £5,786 (US$8,521) per QALY. Limitations include the fact that the intervention was relatively brief and did not include any physical activity components. Conclusions While the COPERS intervention was brief, safe, and inexpensive, with a low attrition rate, it was not effective for reducing pain-related disability over 12 mo (primary outcome). For secondary outcomes, we found sustained benefits on

  19. Risk adjustment for inter-hospital comparison of caesarean delivery rates in low-risk deliveries.

    Directory of Open Access Journals (Sweden)

    Elisa Stivanello

    Full Text Available BACKGROUND: Caesarean delivery (CD rates have been frequently used as quality measures for maternity service comparisons. More recently, primary CD rates (CD in women without previous CD or CD rates within selected categories such as nulliparous, term, cephalic singleton deliveries (NTCS have been used. The objective of this study is to determine the extent to which risk adjustment for clinical and socio-demographic variables is needed for inter-hospital comparisons of CD rates in women without previous CD and in NTCS deliveries. METHODS: Hospital discharge records of women who delivered in Emilia-Romagna Region (Italy from January, 2007 to June 2009 and in Tuscany Region for year 2009 were linked with birth certificates. Adjusted RRs of CD in women without a previous Caesarean and NTCS were estimated using Poisson regression. Percentage differences in RR before and after adjustment were calculated and hospital rankings, based on crude and adjusted RRs, were examined. RESULTS: Adjusted RR differed substantially from crude RR in women without a previous Caesarean and only marginally in NTCS group. Hospital ranking was markedly affected by adjustment in women without a previous CD, but less in NTCS. CONCLUSION: Risk adjustment is warranted for inter-hospital comparisons of primary CD rates but not for NTCS CD rates. Crude NTCS CD rates are a reliable estimate of adjusted NTCS CD.

  20. A Clinical Research on the Effect of Chaihu Shugan Powder Combined with Adjusted Ganmai Dazao Decoction in Treating Mammary Hyperplasia%柴胡疏肝散合甘麦大枣汤加减治疗乳腺增生症的临床疗效研究

    Institute of Scientific and Technical Information of China (English)

    吴越; 吴永强; 高秀飞; 王蓓; 郑红斌; 张硕

    2016-01-01

    Objective] To study the clinical efficacy of using Chaihu Shugan powder combined with Ganmai Dazao decoction(with adjustments) in treating"Stagnation of Liver-Qi" type of mammary hyperplasia and its effects on emotional interventions. To study the effectiveness of using Chinese traditional medicine to improve treatment efficacy of mammary hyperplasia by relieving mental stress, tranquilizing the mind on the basis of soothing the liver and regulating Qi. [Method] 215 cases of"Stagnation of Liver-Qi"type of mammary hyperplasia are divided into two groups according to the random number table. The treatment group(N=106) is treated with Chaihu Shugan powder combined with Ganmai Dazao decoction(with adjustments). The control group(N=109) is treated with Chaihu Shugan powder alone. For both groups, the clinical efficacy and mood changes after treatments are compared and analyzed. [Results] Better results of breast pain relief are achieved for both groups. The improvement of pain relief is better in treatment group than in control group. The differences are statistically significant(P<0.01).The breast lump size is reduced in both groups, but it reduces more in treatment group with a statistical significance(P<0.01). The total effective rates in the treatment group and the control group are 95.1%and 86.8%respectively. The difference has statistical significance(P<0.01). For both groups, Hamilton Depression Rating Scale(HAMD) and Hamilton Anxiety Rating Scale(HAMA) score become much lower after treatment. HAMA score and HAMD score of treatment group are even lower than control group. The difference has statistical significance( P<0.01). [Conclusion] Chaihu Shugan powder combined with Ganmai Dazao decoction(with adjustments) is effective in treating "Stagnation of Liver-Qi" type of mammary gland hyperplasia. It significantly relieves clinical symptoms and improves emotional state. Emotion regulations by relieving mental stress, tranquilizing the mind on the basis of soothing

  1. Benchmarking judgmentally adjusted forecasts

    NARCIS (Netherlands)

    Ph.H.B.F. Franses (Philip Hans); L.P. de Bruijn (Bert)

    2015-01-01

    markdownabstractMany publicly available macroeconomic forecasts are judgmentally-adjusted model-based forecasts. In practice usually only a single final forecast is available, and not the underlying econometric model, nor are the size and reason for adjustment known. Hence, the relative weights give

  2. ADJUSTABLE CHIP HOLDER

    DEFF Research Database (Denmark)

    2009-01-01

    An adjustable microchip holder for holding a microchip is provided having a plurality of displaceable interconnection pads for connecting the connection holes of a microchip with one or more external devices or equipment. The adjustable microchip holder can fit different sizes of microchips...

  3. A snapshot of the predominant single nucleotide polymorphism cluster groups of Mycobacterium tuberculosis clinical isolates in Delhi, India.

    Science.gov (United States)

    Varma-Basil, Mandira; Narang, Anshika; Chakravorty, Soumitesh; Garima, Kushal; Gupta, Shraddha; Kumar Sharma, Naresh; Giri, Astha; Zozio, Thierry; Couvin, David; Hanif, Mahmud; Bhatnagar, Anuj; Menon, Balakrishnan; Niemann, Stefan; Rastogi, Nalin; Alland, David; Bose, Mridula

    2016-09-01

    Several attempts have been made to associate phylogenetic differences among Mycobacterium tuberculosis strains to variations in the clinical outcome of the disease and to drug resistance. We genotyped 139 clinical isolates of M. tuberculosis obtained from patients of pulmonary tuberculosis in North Delhi region. The isolates were analyzed using nine Single nucleotide polymorphism (SNP) markers, spoligotyping and MIRU-VNTRs; and the results were correlated with their drug susceptibility profile. Results of SNP cluster group (SCG) analysis (available for 138 isolates) showed that the most predominant cluster was SCG 3a, observed in 58.7% (81/138) of the isolates with 44.4% (36/81) of these being drug susceptible, while 16% (13/81) were multidrug resistant (MDR). Of the ancestral cluster SCG 1 observed in 19.5% (27/138) of the isolates, 14.8% (4/27) were MDR while 44.4% (12/27) were drug susceptible. SCG 2 formed 5.79% (8/138) of the isolates and 50% (4/8) of these were multidrug resistant (MDR). Spoligotyping subdivided the strains into 45 shared types (n = 125) and 14 orphan strains. The orphan strains were mostly associated with SCG 3a or SCG 1, reflecting the principal SCGs found in the Indian population. SCG 1 and SCG 2 genotypes were concordant with the East African Indian (EAI) and Beijing families respectively. Central Asian (CAS) clade and its sublineages were predominantly associated with SCG 3a. No consistent association was seen between the SCGs and Harlem, T or X clades. The 15 loci MIRU-VNTR typing revealed 123/136 isolates to be unclustered, while 13 isolates were present in 6 clusters of 2-3 isolates each. However, correlating the cluster analysis with patient details did not suggest any evidence of recent transmission. In conclusion, though our study revealed the preponderance of SCG 1 and 3a in the M. tuberculosis population circulating in the region, the diversity of strains highlights the changes occurring within lineages and reemphasizes the

  4. Prevention of cisplatin nephrotoxicity: state of the art and recommendations from the European Society of Clinical Pharmacy Special Interest Group on Cancer Care.

    Science.gov (United States)

    Launay-Vacher, Vincent; Rey, Jean-Baptiste; Isnard-Bagnis, Corinne; Deray, Gilbert; Daouphars, Mikael

    2008-05-01

    Antineoplastic drugs used in the treatment of cancers present with variable renal tolerance profiles. Among drugs with a potential for renal toxicity, platinum salts, and especially cisplatin is a well-known agent that may induce acute and chronic renal failure. The mechanisms of its renal toxicity and the means of its prevention are presented in this article which represent the Clinical Recommendation from the Special Interest Group on Cancer Care of the European Society of Clinical Pharmacy (ESCP).

  5. Feedback versus no feedback in improving patient outcome in group psychotherapy for eating disorders (F-EAT): protocol for a randomized clinical trial

    OpenAIRE

    Davidsen, Annika Helgadóttir; Poulsen, Stig; Waaddegaard, Mette; Lindschou, Jane; Lau, Marianne

    2014-01-01

    Background Continuous feedback on patient improvement and the therapeutic alliance may reduce the number of dropouts and increase patient outcome. There are, however, only three published randomized trials on the effect of feedback on the treatment of eating disorders, showing inconclusive results, and there are no randomized trials on the effect of feedback in group therapy. Accordingly the current randomized clinical trial, initiated in September 2012 at the outpatient clinic for eating dis...

  6. Large-scale STI services in Avahan improve utilization and treatment seeking behaviour amongst high-risk groups in India: an analysis of clinical records from six states

    Directory of Open Access Journals (Sweden)

    Gurung Anup

    2011-12-01

    Full Text Available Abstract Background Avahan, the India AIDS Initiative, implemented a large HIV prevention programme across six high HIV prevalence states amongst high risk groups consisting of female sex workers, high risk men who have sex with men, transgenders and injecting drug users in India. Utilization of the clinical services, health seeking behaviour and trends in syndromic diagnosis of sexually transmitted infections amongst these populations were measured using the individual tracking data. Methods The Avahan clinical monitoring system included individual tracking data pertaining to clinical services amongst high risk groups. All clinic visits were recorded in the routine clinical monitoring system using unique identification numbers at the NGO-level. Visits by individual clinic attendees were tracked from January 2005 to December 2009. An analysis examining the limited variables over time, stratified by risk group, was performed. Results A total of 431,434 individuals including 331,533 female sex workers, 10,280 injecting drug users, 82,293 men who have sex with men, and 7,328 transgenders visited the clinics with a total of 2,700,192 visits. Individuals made an average of 6.2 visits to the clinics during the study period. The number of visits per person increased annually from 1.2 in 2005 to 8.3 in 2009. The proportion of attendees visiting clinics more than four times a year increased from 4% in 2005 to 26% in 2009 (p Conclusions The programme demonstrated that acceptable and accessible services with marginalised and often difficult–to-reach populations can be brought to a very large scale using standardized approaches. Utilization of these services can dramatically improve health seeking behaviour and reduce STI prevalence.

  7. Overpaying morbidity adjusters in risk equalization models.

    Science.gov (United States)

    van Kleef, R C; van Vliet, R C J A; van de Ven, W P M M

    2016-09-01

    Most competitive social health insurance markets include risk equalization to compensate insurers for predictable variation in healthcare expenses. Empirical literature shows that even the most sophisticated risk equalization models-with advanced morbidity adjusters-substantially undercompensate insurers for selected groups of high-risk individuals. In the presence of premium regulation, these undercompensations confront consumers and insurers with incentives for risk selection. An important reason for the undercompensations is that not all information with predictive value regarding healthcare expenses is appropriate for use as a morbidity adjuster. To reduce incentives for selection regarding specific groups we propose overpaying morbidity adjusters that are already included in the risk equalization model. This paper illustrates the idea of overpaying by merging data on morbidity adjusters and healthcare expenses with health survey information, and derives three preconditions for meaningful application. Given these preconditions, we think overpaying may be particularly useful for pharmacy-based cost groups. PMID:26420555

  8. Development and Preliminary Validation of a Measure for Assessing Staff Perspectives on the Quality of Clinical Group Supervision

    Science.gov (United States)

    Horton, Simon; de Lourdes Drachler, Maria; Fuller, Alison; de Carvalho Leite, Jose Carlos

    2008-01-01

    Background: In the UK clinical supervision is regarded as an essential process supporting quality improvement within the clinical governance framework, and the Royal College of Speech and Language Therapists regards it as a tool for promoting critical reflective practice. There is limited evidence of the impact on practice or improvements in…

  9. Low clinical relevance of risky alcohol consumption in a selected group of high adherent HIV-infected patients attended in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Alicia Gonzalez Baeza

    2014-11-01

    Full Text Available Introduction: The prevalence of risky alcohol consumption, associated factors and its impact on the brain is not well established in clinically stable HIV patients. Materials and Methods: Within the PIVOT neurocognitive sub-study, effectively suppressed HIV-infected adults on either standard cART or ritonavir-boosted PI monotherapy completed the Alcohol Use Disorders Identification Test (AUDIT designed to detect risky alcohol consumption. They also completed a brief neuropsychological assessment (NPZ 5 composed by five measures. For this cross-sectional analysis, we calculated rates of hazardous (AUDIT=8–15 or harmful (AUDIT=16–19 consumption and likely dependence (AUDIT>20. We explored the association between risky alcohol intakes (AUDIT>8 and clinical/demographical variables, conducting logistic regressions when significant association was found (p<.05. Also, the association between cognitive performance and alcohol consumption was calculated and adjusted by potential confounders. Results: Of the 146 included participants, the majority were male (86.3%, white (81.5% and educated (mean years on formal education=15, SD=3.9. Average age was 47.6 years (SD=8.7, and 36.3% had risky consumption (29.5% hazardous, 6.2% harmful, 0.7% likely dependence. White ethnicity and male sex were positively associated with risky consumption (Table 1. After adjustments, white ethnicity remained significantly associated with risky consumption (1.64 [95% CI 0.34–2.95]; p=0.013. Better cognitive performance was associated with risky alcohol consumption in the univariate analysis (p<.001. After adjustment by ethnicity, sex and years of education, cognitive performance and risky alcohol consumption maintained significant association (0.45 [95% CI 0.19–0.70] p=0.001. Conclusions: Despite the substantially high prevalence of risky alcohol consumption, it was not associated with worse adherence, immunological or quality of life measures in this cohort of

  10. Belonging to a peer support group enhance the quality of life and adherence rate in patients affected by breast cancer: A non-randomized controlled clinical trial*

    OpenAIRE

    Tehrani, Afsaneh Malekpour; Farajzadegan, Ziba; Rajabi, Fariborz Mokarian; Zamani, Ahmad Reza

    2011-01-01

    BACKGROUND: Breast cancer is the most common cancer in women. It seems that breast cancer patients benefit from meeting someone who had a similar experience. This study evaluated the effect of two kinds of interventions (peer support and educational program) on quality of life in breast cancer patients. METHODS: This study was a controlled clinical trial on women with non-metastatic breast cancer. The patients studied in two experimental and control groups. Experimental group took part in pee...

  11. EGFR testing and clinical management of advanced NSCLC: a Galician Lung Cancer Group study (GGCP 048-10

    Directory of Open Access Journals (Sweden)

    Vázquez S

    2016-02-01

    Full Text Available Sergio Vázquez,1 Joaquín Casal,2 Francisco Javier Afonso Afonso,3 José Luis Fírvida,4 Lucía Santomé,5 Francisco Barón,6 Martín Lázaro,7 Carolina Pena,7 Margarita Amenedo,8 Ihab Abdulkader,9 Carmen González-Arenas,10 Laura Fachal,11 Ana Vega11 On behalf of the Galician Lung Cancer Group (GGCP1Medical Oncology Department, Lucus Augusti University Hospital, Lugo, 2Medical Oncology Department, University Hospital Complex of Vigo, Pontevedra, 3Medical Oncology Department, University Hospital Complex of Ferrol, Ferrol, 4Medical Oncology Department, University Hospital Complex of Ourense, Ourense, 5Medical Oncology Department Povisa Hospital, Vigo, 6Medical Oncology Department, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, 7Medical Oncology Department, Hospital Complex of Pontevedra, Pontevedra, 8Medical Oncology Department, Oncology Center of Galicia, A Coruña, 9Anatomical Pathology Department, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, 10AstraZeneca, Madrid, 11Galician Public Foundation of Genomic Medicine-SERGAS, Santiago de Compostela Clinic Hospital, Santiago de Compostela, Spain Purpose: This study aimed to assess the incidence of mutations in the epidermal growth factor receptor (EGFR gene in non-small-cell lung cancer (NSCLC patients in the Galician region of Spain and the clinical management and outcome of patients carrying EGFR mutations. Patients and methods: All newly diagnosed advanced or metastatic NSCLC patients were screened for EGFR mutations in matched tumor samples (tissue or cytology specimens and serum samples. Results: Of 198 patients screened for EGFR mutations in tumor samples, 184 had evaluable data and, of these, 25 (13.6% had EGFR mutations (84% sensitizing mutations. EGFR mutation was found in serum in 14 (8.1% patients (of 174 evaluable. Compared to matched tumor tissue, serum EGFR mutation testing specificity and sensitivity were 99% and 52

  12. Adjustment of macroeconomic imbalances

    Directory of Open Access Journals (Sweden)

    Georgeta Barbulescu

    2013-03-01

    Full Text Available The global financial and economic crisis was the factor that triggered the adjustment of macroeconomic imbalances accumulated in Romania. The current account deficit and budget deficit were two major structural imbalances that have created a high vulnerability for the economy and explained the extent of economic contraction in Romania during the economic crisis. This article identifies the main causes that lead to the need for fiscal adjustment both in the EU and in Romania, as well as main effects of adjustments in respect of their experience in recent years. The article deals with this topic, because the current topical debate in the field of fiscal adjustments implemented both in the EU and our country, and their need for economic activity aimed at economic recovery.

  13. Adjustments and Depression

    Medline Plus

    Full Text Available ... thoughts and feelings and is something that takes time. The goal of adjusting is to rebuild one's ... updates about our impact > Get the Reeve newsletter International support > Pages in other languages Made with ♡ in ...

  14. Adjustments and Depression

    Medline Plus

    Full Text Available ... identity and to find a new balance in relationships. The stages of adjustment can include grieving, taking ... treatment options. Related pages What is a complete vs incomplete injury? What emergency procedures occur following an ...

  15. Adjustments and Depression

    Medline Plus

    Full Text Available ... rebuild one's identity and to find a new balance in relationships. The stages of adjustment can include ... a peer mentor Advocate for change Fundraise with Team Reeve Champions Committee Volunteering About Us Our story ...

  16. Family Adjustment to Aphasia

    Science.gov (United States)

    ... Public / Speech, Language and Swallowing / Disorders and Diseases Family Adjustment to Aphasia Richard S. was a senior manager ... It also presents a great challenge to the family. There may be tension among family members and ...

  17. KVA: Capital Valuation Adjustment

    OpenAIRE

    Andrew Green; Chris Kenyon

    2014-01-01

    Credit (CVA), Debit (DVA) and Funding Valuation Adjustments (FVA) are now familiar valuation adjustments made to the value of a portfolio of derivatives to account for credit risks and funding costs. However, recent changes in the regulatory regime and the increases in regulatory capital requirements has led many banks to include the cost of capital in derivative pricing. This paper formalises the addition of cost of capital by extending the Burgard-Kjaer (2013) semi-replication approach to C...

  18. Weighted triangulation adjustment

    Science.gov (United States)

    Anderson, Walter L.

    1969-01-01

    The variation of coordinates method is employed to perform a weighted least squares adjustment of horizontal survey networks. Geodetic coordinates are required for each fixed and adjustable station. A preliminary inverse geodetic position computation is made for each observed line. Weights associated with each observed equation for direction, azimuth, and distance are applied in the formation of the normal equations in-the least squares adjustment. The number of normal equations that may be solved is twice the number of new stations and less than 150. When the normal equations are solved, shifts are produced at adjustable stations. Previously computed correction factors are applied to the shifts and a most probable geodetic position is found for each adjustable station. Pinal azimuths and distances are computed. These may be written onto magnetic tape for subsequent computation of state plane or grid coordinates. Input consists of punch cards containing project identification, program options, and position and observation information. Results listed include preliminary and final positions, residuals, observation equations, solution of the normal equations showing magnitudes of shifts, and a plot of each adjusted and fixed station. During processing, data sets containing irrecoverable errors are rejected and the type of error is listed. The computer resumes processing of additional data sets.. Other conditions cause warning-errors to be issued, and processing continues with the current data set.

  19. Implementing a system of structured clinical supervision with a group of DipHE(nursing) RMN students.

    Science.gov (United States)

    Markham, V; Turner, P

    1998-01-01

    Clinical supervision is to become an integral part of mental health nursing, and the United Kingdom Central Council for Nursing, Midwifery & Health Visiting has recommended that it be incorporated in pre-registration education. This paper describes teachers' experiences of delivering a programme of clinical supervision education within the mental health branch of a diploma in nursing course. It outlines the implementation and evaluation of the programme, including discussion of the process and difficulties encountered. The programme appears to have provided a positive first experience for the students and to have given them the enthusiasm to adopt clinical supervision as part of their future roles as qualified practitioners.

  20. 中周部加光镜片联合调节训练治疗儿童近视的疗效观察%Clinical effect of the midperipherv additional designed lenses combined adjustment training on myopia in childhood

    Institute of Scientific and Technical Information of China (English)

    卢毓敏; 马胜生; 罗铭; 梁纳

    2015-01-01

    目的::观察中周部加光镜片联合调节训练治疗儿童近视的临床效果。方法:选取我院2014-01/2015-07门诊就诊的儿童近视患者80例160眼,随机分为治疗组和对照组,每组各40例80眼。治疗组采用中周部加光镜片联合调节训练治疗近视,对照组则采用配戴普通单光框架眼镜的常规方法治疗近视,两组患者戴镜后每3 mo复查,1 a后观察各组近视进展指标、调节功能指标,比较分析两组的治疗效果。结果:戴镜1a后治疗组病例裸眼视力、屈光度数、眼轴长度较戴镜前变化不大趋于稳定,与戴镜前比较差异无统计学意义(P>0.05);对照组病例裸眼视力较戴镜前下降,屈光度数增加,眼轴增长,与戴镜前比较差异有统计学意义(P0.05)。两组间比较差异有统计学意义(P 0. 05 ). The visual acuity decreased, refraction and axial length increased in comparison group, the differences were statistically significant (P0. 05). The difference between the two groups was statistically significant ( P<0. 01).•CONCLUSlON:Midperipherv additional designed lenses and adjustment training treatment of juvenile myopia is effective, which can delay the diopters development of myopic children, improve the regulatory function, control the development of myopia, improve the adjustment function.

  1. Are senior nurses on Clinical Commissioning Groups in England inadvertently supporting the devaluation of their profession?: A critical integrative review of the literature.

    Science.gov (United States)

    Allan, Helen Therese; Dixon, Roz; Lee, Gay; O'Driscoll, Michael; Savage, Jan; Tapson, Christine

    2016-06-01

    In this study, we discuss the role of senior nurses who sit on clinical commissioning groups that now plan and procure most health services in England. These nurses are expected to bring a nursing view to all aspects of clinical commissioning group business. The role is a senior level appointment and requires experience of strategic commissioning. However, little is known about how nurses function in these roles. Following Barrientos' methodology, published policy and literature were analysed to investigate these roles and National Health Service England's claim that nursing can influence and advance a nursing perspective in clinical commissioning groups. Drawing on work by Berg, Barry and Chandler on 'new public management', we discuss how nurses on clinical commissioning groups work at the alignment of the interests of biomedicine and managerialism. We propose that the way this nursing role is being implemented might paradoxically offer further evidence of the devaluing of nursing rather than the emergence of a strong professional nursing voice at the level of strategic commissioning. PMID:27187276

  2. The clinical database and the treatment guidelines of the Danish Breast Cancer Cooperative Group (DBCG); its 30-years experience and future promise

    DEFF Research Database (Denmark)

    Moller, S.; Jensen, M.B.; Ejlertsen, B.;

    2008-01-01

    Introduction. Since 30 years, DBCG (Danish Breast Cancer Cooperative Group) has maintained a clinical database allowing the conduct of quality control studies, of randomised trials, examination of the epidemiology of breast cancer and of prognostic and predictive factors. Material and methods. The...

  3. Challenges relating to solid tumour brain metastases in clinical trials, part 1: patient population, response, and progression. A report from the RANO group.

    Science.gov (United States)

    Lin, Nancy U; Lee, Eudocia Q; Aoyama, Hidefumi; Barani, Igor J; Baumert, Brigitta G; Brown, Paul D; Camidge, D Ross; Chang, Susan M; Dancey, Janet; Gaspar, Laurie E; Harris, Gordon J; Hodi, F Stephen; Kalkanis, Steven N; Lamborn, Kathleen R; Linskey, Mark E; Macdonald, David R; Margolin, Kim; Mehta, Minesh P; Schiff, David; Soffietti, Riccardo; Suh, John H; van den Bent, Martin J; Vogelbaum, Michael A; Wefel, Jeffrey S; Wen, Patrick Y

    2013-09-01

    Therapeutic outcomes for patients with brain metastases need to improve. A critical review of trials specifically addressing brain metastases shows key issues that could prevent acceptance of results by regulatory agencies, including enrolment of heterogeneous groups of patients and varying definitions of clinical endpoints. Considerations specific to disease, modality, and treatment are not consistently addressed. Additionally, the schedule of CNS imaging and consequences of detection of new or progressive brain metastases in trials mainly exploring the extra-CNS activity of systemic drugs are highly variable. The Response Assessment in Neuro-Oncology (RANO) working group is an independent, international, collaborative effort to improve the design of trials in patients with brain tumours. In this two-part series, we review the state of clinical trials of brain metastases and suggest a consensus recommendation for the development of criteria for future clinical trials.

  4. [Group psychotherapy. Experience with a changing process at a clinic of the Instituto del Servicio de Seguridad Social de los Trabajadores del Estado (ISSSTE)].

    Science.gov (United States)

    Velasco de Ongay, M E

    1977-01-01

    The problems of an ISSSTE clinic were approached within the general systems theory and it was observed that within the group there existed forces to maintain the status-quo and forces towards change; to produce the latter the group was handled during 20 hours with a slightly directive technique. The goals were to improve interpersonal relationships, to increase communication, to make known to individuals their attitudes within a group and make them sensitive to problems they shared with others. The results were good, the status-quo was broken and change started occurring.

  5. Effects of Group-Based Exercise on Range of Motion, Muscle Strength, Functional Ability, and Pain During the Acute Phase After Total Knee Arthroplasty: A Controlled Clinical Trial.

    Science.gov (United States)

    Hiyama, Yoshinori; Kamitani, Tsukasa; Wada, Osamu; Mizuno, Kiyonori; Yamada, Minoru

    2016-09-01

    Study Design Prospective observational study including a historical control group. Background The extent to which group-based exercise (G-EXE) improves knee range of motion (ROM), quadriceps strength, and gait ability is similar to that of individualized exercise (I-EXE) at 6 weeks and 8 months after total knee arthroplasty (TKA). However, the benefits of G-EXE for patients during the acute recovery phase after TKA remain unclear. Objective To determine the effects of G-EXE during the acute recovery phase after TKA on knee ROM, quadriceps strength, functional ability, and knee pain. Methods Two hundred thirty-one patients participated in G-EXE in addition to regular ambulation and activities-of-daily-living exercises twice daily during the hospital stay. Outcomes were compared to those of a retrospectively identified, historical control group (I-EXE group [n = 206]) that included patients who performed exercises identical to those performed by the G-EXE group. The outcomes included knee ROM, quadriceps strength, pain intensity, and timed up-and-go test score at 1 month before surgery and at discharge. Analyses were adjusted for age, body mass index, sex, length of hospital stay, and preoperative values. Results Changes in ROM of knee flexion and extension (PSports Phys Ther 2016;46(9):742-748. Epub 5 Aug 2016. doi:10.2519/jospt.2016.6409. PMID:27494052

  6. Social Support and Parental Adjustment to Pediatric Cancer.

    Science.gov (United States)

    Morrow, Gary R.; And Others

    1981-01-01

    Assessed the psychosocial adjustment of (N=107) parents whose children had cancer. Different patterns of association between 11 sources of social support and adjustment were found among groups of parents. Psychosocial adjustment of parents with a child in treatment was correlated more frequently with perceived social support. (Author)

  7. Clinical and genetic features of International Collaborative Group-hereditary nonpolyposis colorectal cancer families and suspected hereditary nonpolyposis colorectal cancer families

    Institute of Scientific and Technical Information of China (English)

    袁瑛; 叶俊; 郑树

    2004-01-01

    Background Hereditary nonpolyposis colorectal cancer (HNPPC) is one of the most common genetic syndrome related with mutation of human mismatch repair genes. This study was to evaluate the clinical significance of suspected hereditary nonpolyposis colorectal cancer (sHNPCC) criteria I and the clinical and genetic features of International Collaborative Group-HNPCC (ICG-HNPCC) and sHNPCC families.Methods Twenty-nine ICG-HNPCC families fulfilling the Amsterdam criteria and 34 sHNPCC families fulfilling the sHNPCC criteria I were collected. PCR-SSCP and DNA sequencing analysis were employed to screen the germline mutations of the hMLH1 and hMSH2 genes in these families.Results The ICG group had more colorectal cancer (CRC) patients per family than did the suspected group (P0.05), mutation type, and mutation distribution. Comparison of the families with and without mutation showed no significant difference in CRC patients per family, Lynch classification, and tumor spectrum.Conclusions ICG-HNPCC and sHNPCC families that have similar clinical manifestations and genetic basis indicate a similar nature for cancer development. The application of sHNPCC criteria I will facilitate clinical diagnosis and treatment of small families.

  8. Clinical usefulness of oral supplementation with alpha-lipoic Acid, curcumin phytosome, and B-group vitamins in patients with carpal tunnel syndrome undergoing surgical treatment.

    Science.gov (United States)

    Pajardi, Giorgio; Bortot, Paola; Ponti, Veronica; Novelli, Chiara

    2014-01-01

    We investigated the clinical usefulness of oral supplementation with a combination product containing alpha-lipoic acid, curcumin phytosome, and B-group vitamins in 180 patients with carpal tunnel syndrome (CTS), scheduled to undergo surgical decompression of the median nerve. Patients in Group A (n = 60) served as controls and did not receive any treatment either before or after surgery. Patients in Group B (n = 60) received oral supplementation twice a day for 3 months both before and after surgery (totaling 6 months of supplementation). Patients in Group C (n = 60) received oral supplementation twice a day for 3 months before surgery only. Patients in Group B showed significantly lower nocturnal symptoms scores compared with Group A subjects at both 40 days and 3 months after surgery (both P values <0.05). Moreover, patients in Group B had a significantly lower number of positive Phalen's tests at 3 months compared with the other study groups (P < 0.05). We conclude that oral supplementation with alpha-lipoic acid, curcumin phytosome, and B-group vitamins twice a day both before and after surgery is safe and effective in CTS patients scheduled to undergo surgical decompression of the median nerve. PMID:24563654

  9. Clinical Usefulness of Oral Supplementation with Alpha-Lipoic Acid, Curcumin Phytosome, and B-Group Vitamins in Patients with Carpal Tunnel Syndrome Undergoing Surgical Treatment

    Directory of Open Access Journals (Sweden)

    Giorgio Pajardi

    2014-01-01

    Full Text Available We investigated the clinical usefulness of oral supplementation with a combination product containing alpha-lipoic acid, curcumin phytosome, and B-group vitamins in 180 patients with carpal tunnel syndrome (CTS, scheduled to undergo surgical decompression of the median nerve. Patients in Group A (n=60 served as controls and did not receive any treatment either before or after surgery. Patients in Group B (n=60 received oral supplementation twice a day for 3 months both before and after surgery (totaling 6 months of supplementation. Patients in Group C (n=60 received oral supplementation twice a day for 3 months before surgery only. Patients in Group B showed significantly lower nocturnal symptoms scores compared with Group A subjects at both 40 days and 3 months after surgery (both P values <0.05. Moreover, patients in Group B had a significantly lower number of positive Phalen’s tests at 3 months compared with the other study groups (P<0.05. We conclude that oral supplementation with alpha-lipoic acid, curcumin phytosome, and B-group vitamins twice a day both before and after surgery is safe and effective in CTS patients scheduled to undergo surgical decompression of the median nerve.

  10. Application of Clinical Pathway on Group Health Examination%临床路径在团体人群健康体检中的应用

    Institute of Scientific and Technical Information of China (English)

    管丽红; 谭洁; 黄郁; 王占科

    2012-01-01

    Objective To investigate the application effect of clinical pathway on group health examination, and to standardize nursing behaviors during group health examination. Methods People undergoing group health examination were divided into conventional management group to receive the routine management and method of health examination and clinical pathway management group to receive the management and method of clinical pathway. Comparisons were conducted in the differences of satisfaction, physical examination defect incidence (missing probability, untimely collection of examination results, late reporting, etc. ) and physical examination process indicators. Results The satisfaction rate was significantly higher,the examination defect rate was significantly lower and the examination process was significantly faster in clinical pathway management group than those in the conventional group(P<0. 01). Conclusion Clinical pathway management in group health examination can elevate the medical work efficiency, reduce the incidence of physical examination defects and improve the satisfaction of health examination.%目的 探讨临床路径在团体人群健康体检中的应用效果,规范团体健康体检中的护理行为.方法 依据团体体检者来院体检时间分成常规管理组和临床路径管理组,常规管理组采用传统组织及实施方法,临床路径管理组采用临床路径组织及实施方法,比较两组体检者的满意度、体检缺陷发生率(漏检、体检结果未及时收集、报告延迟发放等)及体检进程速度等指标的差异.结果 临床路径管理组体检者满意度测评结果高于常规管理组、体检缺陷发生率低于常规管理组、体检进程快于常规组,差异均有统计学意义(均P<0.01).结论 在团体人群健康体检中实施临床路径管理,可提高体检工作效率,降低体检缺陷发生率,提高体检者满意度.

  11. Sustainable urban regime adjustments

    DEFF Research Database (Denmark)

    Quitzau, Maj-Britt; Jensen, Jens Stissing; Elle, Morten;

    2013-01-01

    The endogenous agency that urban governments increasingly portray by making conscious and planned efforts to adjust the regimes they operate within is currently not well captured in transition studies. There is a need to acknowledge the ambiguity of regime enactment at the urban scale. This directs......, inspired by Actor-Network Theory to demonstrate that regime incumbent actors can induce gradual regime adjustments at the urban scale. This is done through a case study of an urban development project, where the Municipality of Egedal in Denmark has successfully promoted energy efficient buildings through...

  12. Xingsu San Adjustment Treatment of Pediatric Acute Bronchitis 60 cases of Clinical Observation%杏苏散加减治疗小儿急性支气管炎60例临床观察

    Institute of Scientific and Technical Information of China (English)

    崔松涛

    2015-01-01

    目的:探讨杏苏散加减治疗小儿急性支气管炎的效果。方法:把我院收治的小儿支气管炎患儿60例平均分成两组,治疗组用杏苏散加减,对照组应用头孢曲松、地塞米松、病毒性静脉滴注,比较疗效。结果:治疗组痊愈率为95%,对照组为60%,差异明显。结论:杏苏散加减治疗小儿急性支气管炎,疗效满意,且无不良反应,较之西药治疗可以有效缩短治疗时间,避免患儿病情加重,减轻患儿痛苦,值得临床工作者推广使用。%Objective:To investigate the Xingsu San Decoction for the treatment of children with Acute Bronchitis effect. Methods: Our Hospital pediatric bronchiolitis were 60 patients divided into two groups, treatment group with apricot Su powder the addition and subtraction, control group used cephalosporin ceftriaxone, dexamethasone,virus of intravenous injection,the curative effect was compared. Results:The cure rate of treatment group was 95%,60% in the control group, the difference is obvious.Conclusion:Xingsu San Decoction for the treatment of acute bronchitis in children, the curative effect is satisfied, and no adverse reactions,compared to western medicine treatment can effectively shorten the treatment time, avoid exacerbations in children, reduce the pain of patients, it is worth to promote the use of clinical workers.

  13. Expert Consensus Group report on the use of apomorphine in the treatment of Parkinson's disease - Clinical practice recommendations

    NARCIS (Netherlands)

    Trenkwalder, Claudia; Chaudhuri, K. Ray; Garcia Ruiz, Pedro J.; LeWitt, Peter; Katzenschlager, Regina; Sixel-Doering, Friederike; Henriksen, Tove; Sesar, Angel; Poewe, Werner; Baker, Mary; Ceballos-Baumann, Andres; Deuschl, Guenther; Drapier, Sophie; Ebersbach, Georg; Evans, Andrew; Fernandez, Hubert; Isaacson, Stuart; van Laar, Teus; Lees, Andrew; Lewis, Simon; Martinez Castrillo, Juan Carlos; Martinez-Martin, Pablo; Odin, Per; O'Sullivan, John; Tagaris, Georgios; Wenzel, Karoline

    2015-01-01

    Extensive published evidence supports the use of subcutaneously-administered apomorphine as an effective therapy for Parkinson's disease (PD) but to date no consensus recommendations have been available to guide healthcare professionals in the optimal application of apomorphine therapy in clinical p

  14. The Articulation of Integration of Clinical and Basic Sciences in Concept Maps: Differences between Experienced and Resident Groups

    Science.gov (United States)

    Vink, Sylvia; van Tartwijk, Jan; Verloop, Nico; Gosselink, Manon; Driessen, Erik; Bolk, Jan

    2016-01-01

    To determine the content of integrated curricula, clinical concepts and the underlying basic science concepts need to be made explicit. Preconstructed concept maps are recommended for this purpose. They are mainly constructed by experts. However, concept maps constructed by residents are hypothesized to be less complex, to reveal more tacit basic…

  15. Pregnancy-Related Group A Streptococcal Infections: Temporal Relationships Between Bacterial Acquisition, Infection Onset, Clinical Findings, and Outcome

    OpenAIRE

    Stephanie M Hamilton; Stevens, Dennis L.; Bryant, Amy E.

    2013-01-01

    The development and outcome of pregnancy-related group A streptococcal infections are dependent upon the stage of pregnancy or puerperium, epidemiologic factors of the patient's home and hospital environments, and virulence of the prevalent pathogens.

  16. Auto Adjusting Astronomical Telescope

    Directory of Open Access Journals (Sweden)

    Rohit R. Ghalsasi

    2014-04-01

    Full Text Available Astronomical telescope is powerful and basic tool for star or celestial observation. Here we proposed integrated system using Raspberry Pi for auto adjusting astronomical telescope. This integrated circuit helps to control stellar monitoring, stellar targeting, and tracking functions of telescope. Astro compass gives the direction of the celestial objects.

  17. Consequences of overutilization and underutilization of thrombolytic therapy in clinical practice. TRACE Study Group. TRAndolapril Cardiac Evaluation

    DEFF Research Database (Denmark)

    Ottesen, M M; Køber, L; Jørgensen, S;

    2001-01-01

    OBJECTIVES: The aim of this study was to evaluate the consequences, measured as mortality and in-hospital stroke, of the use of thrombolytic therapy among patients with acute myocardial infarction (AMI), who do not fulfill accepted criteria or who have contraindications to thrombolytic therapy (i.......e., overutilization) and among patients who are withheld thrombolytic treatment despite fulfilling indications and having no contraindications (i.e., underutilization). BACKGROUND: The implementation of treatment with thrombolysis in clinical practice is not in accordance with the accepted criteria from randomized...... studies. The consequence has been over- and underutilization of thrombolytic therapy among patients with AMI in clinical practice. The outcome of overutilization of thrombolytic therapy has not been described previously. METHODS: We examined 6,676 consecutive patients admitted to the hospital with an AMI...

  18. A phase II clinical trial of endoscopic submucosal dissection for early gastric cancer of undifferentiated type: Japan Clinical Oncology Group study JCOG1009/1010.

    Science.gov (United States)

    Takizawa, Kohei; Takashima, Atsuo; Kimura, Aya; Mizusawa, Junki; Hasuike, Noriaki; Ono, Hiroyuki; Terashima, Masanori; Muto, Manabu; Boku, Narikazu; Sasako, Mitsuru; Fukuda, Haruhiko

    2013-01-01

    A Phase II clinical trial has been initiated to evaluate the efficacy and safety of endoscopic submucosal dissection for intramucosal (cT1a) gastric cancer of undifferentiated type. Patients with cT1a gastric cancer with undifferentiated-type adenocarcinoma are eligible for the study. The tumor size should be 2 cm or less without ulceration. The study will enroll a total of 325 patients from 51 institutions over a 4-year period. The primary endpoint is proportion of 5-year overall survival (% 5-year overall survival) in patients with undifferentiated dominant type. The secondary endpoints are overall survival, relapse-free survival, distant metastasis-free survival, % 5-year overall survival without either recurrence or gastrectomy, % en-bloc resection with endoscopic submucosal dissection, % pathological curative resection with endoscopic submucosal dissection, % 5-year overall survival in patients with differentiated dominant type, % 5-year overall survival in patients with pathologically curative resection with endoscopic submucosal dissection and adverse events.

  19. A dance movement therapy group for depressed adult patients in a psychiatric outpatient clinic: effects of the treatment

    OpenAIRE

    Pylvänäinen, Päivi M.; Muotka, Joona S.; Lappalainen, Raimo

    2015-01-01

    We were interested in investigating the effects of dance movement therapy (DMT) in a psychiatric outpatient clinic with patients diagnosed with depression. DMT aims to engage the patients in physical and verbal exploration of their experiences generated in movement based interaction. The assumption was that DMT, which includes both physical engagement as well as emotional and social exploration, would alleviate the mood and psychiatric symptoms. All adult patients (n = 33) incl...

  20. International neurocognitive normative study: neurocognitive comparison data in diverse resource-limited settings: AIDS Clinical Trials Group A5271.

    Science.gov (United States)

    Robertson, K; Jiang, H; Evans, S R; Marra, C M; Berzins, B; Hakim, J; Sacktor, N; Silva, M Tulius; Campbell, T B; Nair, A; Schouten, J; Kumwenda, J; Supparatpinyo, K; Tripathy, S; Kumarasamy, N; la Rosa, A; Montano, S; Mwafongo, A; Firnhaber, C; Sanne, I; Naini, L; Amod, F; Walawander, A

    2016-08-01

    Infrastructure for conducting neurological research in resource-limited settings (RLS) is limited. The lack of neurological and neuropsychological (NP) assessment and normative data needed for clinical interpretation impedes research and clinical care. Here, we report on ACTG 5271, which provided neurological training of clinical site personnel and collected neurocognitive normative comparison data in diverse settings. At ten sites in seven RLS countries, we provided training for NP assessments. We collected normative comparison data on HIV- participants from Brazil (n = 240), India (n = 480), Malawi (n = 481), Peru (n = 239), South Africa (480), Thailand (n = 240), and Zimbabwe (n = 240). Participants had a negative HIV test within 30 days before standardized NP exams were administered at baseline and 770 at 6 months. Participants were enrolled in eight strata, gender (female and male), education (memory and speed of processing tests, while men performed better on motor tests. This study provides the necessary neurocognitive normative data needed to build infrastructure for future neurological and neurocognitive studies in diverse RLS. These normative data are a much-needed resource for both clinicians and researchers. PMID:26733457

  1. Investigation of class 1 integrons in Klebsiella pneumoniae clinical and microbiota isolates belonging to different phylogenetic groups in Recife, State of Pernambuco

    Directory of Open Access Journals (Sweden)

    Alexsandra Maria Silva Lima

    2014-04-01

    Full Text Available Introduction The high prevalence of Klebsiella pneumoniae infections is related to the ability of K. pneumoniae to acquire and disseminate exogenous genes associated with mobile elements, such as R plasmids, transposons and integrons. This study investigated the presence of class 1 integrons in clinical and microbiota isolates of K. pneumoniae belonging to different phylogenetic groups and correlated these results with the antimicrobial resistance profiles of the studied isolates. Methods Of the 51 isolates of K. pneumoniae selected for this study, 29 were from multidrug-resistant clinical isolates, and 22 were from children's microbiota. The susceptibility profile was determined using the disk diffusion method, and class 1 integrons were detected through polymerase chain reaction (PCR. Results The results showed that none of the 22 microbiota isolates carried class 1 integrons. Among the 29 clinical isolates, 19 (65.5% contained class 1 integrons, and resistance to sulfamethoxazole/trimethoprim was identified in 18 of these isolates (94.7%. Among the K. pneumoniae isolates with class 1 integrons, 47% belonged to the KpI phylogenetic group, and one isolate (14.3% carrying these genetic elements belonged to the KpIII group. Conclusions The wide variety of detected class 1 integrons supports the presence of high rates of antimicrobial resistance, genetic variability, and rapid dissemination of beta-lactamase genes among K. pneumoniae clinical isolates in recent years in hospitals in Recife-PE, Brazil. The findings of this study indicate that the surveillance of K. pneumoniae integrons in clinical isolates could be useful for monitoring the spread of antibiotic resistance genes in the hospital environment.

  2. A computerized adjustable brain atlas

    International Nuclear Information System (INIS)

    A computerized brain atlas, adjustable to the patients anatomy, has been developed. It is primarily intended for use in positron emission tomography, but may also be employed in other fields utilizing neuro imaging, such as sterotactic surgery, transmission computerized tomography (CT) and magnetic resonance imaging (MRI). The atlas is based on anatomical information obtained from digitized cryosectioned brains. It can be adjusted to fit a wide range of images from individual brains with normal anatomy. The corresponding transformation is chosen so that the modified atlas agrees with a set of CT or NMR images of the patient. The computerized atlas can be used to improve the quantification and evaluation of PET data by: Aiding and improving the selection of regions of interests. Facilitating comparisons of functional image data from different individuals or groups of individuals. Facilitating the comparison of different examinations of the same patient, thus reducing the need of reproducible fixation systems. Providing external a priori anatomical information to be used in the image reconstruction. Improving the attenuation and scatter corrections. Aiding in selecting a suitable patient orientation during the PET study. By applying the inverse atlas transformation to PET data set it is possible to relate the PET information to the anatomy of the reference atlas. Reformatted PET data from different patients can thus be averaged, and averages from different categories of patients can be compared. The method will facilitate the identification of statistically significant differences in the PET information from different groups of patients. (orig.)

  3. Does accountability for reasonableness work? A protocol for a mixed methods study using an audit tool to evaluate the decision-making of clinical commissioning groups in England

    OpenAIRE

    Kieslich, Katharina; Littlejohns, Peter

    2015-01-01

    Introduction Clinical commissioning groups (CCGs) in England are tasked with making difficult decisions on which healthcare services to provide against the background of limited budgets. The question is how to ensure that these decisions are fair and legitimate. Accounts of what constitutes fair and legitimate priority setting in healthcare include Daniels’ and Sabin's accountability for reasonableness (A4R) and Clark's and Weale's framework for the identification of social values. This study...

  4. Comparative analysis of agr groups and virulence genes among subclinical and clinical mastitis Staphylococcus aureus isolates from sheep flocks of the Northeast of Brazil

    OpenAIRE

    de Almeida, Lara M.; de Almeida, Mayra Zilta P.R.B.; Carla L. Mendonça; Mamizuka, Elsa M.

    2013-01-01

    Staphylococcus aureus is one of the most frequent mastitis causative agents in small ruminants. The expression of most virulence genes of S. aureus is controlled by an accessory gene regulator (agr) locus. This study aimed to ascertain the prevalence of the different agr groups and to evaluate the occurrence of encoding genes for cytotoxin, adhesins and toxins with superantigen activity in S. aureus isolates from milk of ewes with clinical and subclinical mastitis in sheep flocks raised for m...

  5. Parsing the recognition memory components of the WMS-III face memory subtest: normative data and clinical findings in dementia groups.

    Science.gov (United States)

    Holdnack, James A; Delis, Dean C

    2004-06-01

    The WMS-III face memory subtest was developed as a quick, reliable, measure of non-verbal recognition memory. While the face memory subtest has demonstrated clinical sensitivity, the test has been criticized for low correlation with other WMS-III visual memory subtests and for failing to differentiate performance between clinical groups. One possible reason for these findings may be due to the impact of response bias associated with recognition memory tests. Four studies were conducted to evaluate the utility of applying signal detection measures to the face memory subtests. The first two studies used the WMS-III standardization data set to determine age and education effects and to present normative and reliability data for hits, false positives, discriminability and response bias. The third study tested the hypothesis that using response components and signal detection measures would enhance the correlation between face memory and the other WMS-III visual memory subtests. The fourth study compared performance of patients with Alzheimer's disease, Huntington's disease, Korsakoff's syndrome and demographically matched controls on the new face memory scores. The new measures did not have higher correlation with other WMS-III visual memory measures than the standard scoring of the test. Analysis of the clinical samples indicated that the discriminability index best differentiated patients from controls. The response components, particularly delayed false positives, differentiated performance among the clinical groups. Normative and reliability data are presented.

  6. Transforming Clinical Documentation in EHRs for 2020: Recommendations from University of Minnesota's Big Data Conference Working Group.

    Science.gov (United States)

    Weaver, Charlotte; O'Brien, Ann

    2016-01-01

    In 2014, a group of diverse informatics leaders from practice, academia, and the software industry formed to address how best to transform electronic documentation to provide knowledge at the point of care and to deliver value to front line nurses and nurse leaders. This presentation reports the recommendations from this Working Group geared towards a 2020 framework. The recommendations propose redesign to optimize nurses' documentation efficiency while contributing to knowledge generation and attaining a balance that ensures the capture of nursing's impact on safety, quality, yet minimizes "death by data entry."

  7. Transforming Clinical Documentation in EHRs for 2020: Recommendations from University of Minnesota's Big Data Conference Working Group.

    Science.gov (United States)

    Weaver, Charlotte; O'Brien, Ann

    2016-01-01

    In 2014, a group of diverse informatics leaders from practice, academia, and the software industry formed to address how best to transform electronic documentation to provide knowledge at the point of care and to deliver value to front line nurses and nurse leaders. This presentation reports the recommendations from this Working Group geared towards a 2020 framework. The recommendations propose redesign to optimize nurses' documentation efficiency while contributing to knowledge generation and attaining a balance that ensures the capture of nursing's impact on safety, quality, yet minimizes "death by data entry." PMID:27332154

  8. Comparative analysis of agr groups and virulence genes among subclinical and clinical mastitis Staphylococcus aureus isolates from sheep flocks of the Northeast of Brazil

    Directory of Open Access Journals (Sweden)

    Lara M. de Almeida

    2013-01-01

    Full Text Available Staphylococcus aureus is one of the most frequent mastitis causative agents in small ruminants. The expression of most virulence genes of S. aureus is controlled by an accessory gene regulator (agrlocus. This study aimed to ascertain the prevalence of the different agr groups and to evaluate the occurrence of encoding genes for cytotoxin, adhesins and toxins with superantigen activity in S. aureus isolates from milk of ewes with clinical and subclinical mastitis in sheep flocks raised for meat production The agr groups I and II were identified in both cases of clinical and subclinical mastitis. Neither the arg groups III and IV nor negative agr were found. The presence of cflA gene was identified in 100% of the isolates. The frequency of hla and lukE-D genes was high -77.3 and 82.8%, respectively and all isolates from clinical mastitis presented these genes. The sec gene, either associated to tst gene or not, was identified only in isolates from subclinical mastitis. None of the following genes were identified: bbp, ebpS, cna, fnbB, icaA, icaD, bap, hlg, lukM-lukF-PV and se-a-b-d-e.

  9. Clinical, physical and lifestyle indicators and relationship with cognition and mood in aging: a cross-sectional analysis of distinct educational groups

    Directory of Open Access Journals (Sweden)

    Nadine Correia Santos

    2014-02-01

    Full Text Available It is relevant to unravel the factors that may mediate the cognitive decline observed during aging. Previous reports indicate that education has a positive influence on cognitive performance, while age, female gender and, especially, depressed mood were associated with poorer performances across multiple cognitive dimensions (memory and general executive function. Herein, the present study aimed to characterize the cognitive performance of community-dwelling individuals within distinct educational groups categorized by the number of completed formal school years: less than 4, 4, completed primary education, and more than 4. Participants (n = 1051 were randomly selected from local health registries and representative of the Portuguese population for age and gender. Neurocognitive and clinical assessments were conducted in local health care centers. Structural equation modeling was used to derive a cognitive score, and hierarchical linear regressions were conducted for each educational group. Education, age and depressed mood were significant variables in directly explaining the obtained cognitive score, while gender was found to be an indirect variable. In all educational groups, mood was the most significant factor with effect on cognitive performance. Specifically, a depressed mood led to lower cognitive performance. The clinical disease indices cardiac and stroke associated with a more negative mood, while moderate increases in BMI, alcohol consumption and physical activity associated positively with improved mood and thus benefitted cognitive performance. Results warrant further research on the cause-effect (longitudinal relationship between clinical indices of disease and risk factors and mood and cognition throughout aging.

  10. Comparative analysis of agr groups and virulence genes among subclinical and clinical mastitis Staphylococcus aureus isolates from sheep flocks of the Northeast of Brazil.

    Science.gov (United States)

    de Almeida, Lara M; de Almeida, Mayra Zilta P R B; de Mendonça, Carla L; Mamizuka, Elsa M

    2013-01-01

    Staphylococcus aureus is one of the most frequent mastitis causative agents in small ruminants. The expression of most virulence genes of S. aureus is controlled by an accessory gene regulator (agr) locus. This study aimed to ascertain the prevalence of the different agr groups and to evaluate the occurrence of encoding genes for cytotoxin, adhesins and toxins with superantigen activity in S. aureus isolates from milk of ewes with clinical and subclinical mastitis in sheep flocks raised for meat production The agr groups I and II were identified in both cases of clinical and subclinical mastitis. Neither the arg groups III and IV nor negative agr were found. The presence of cflA gene was identified in 100% of the isolates. The frequency of hla and lukE-D genes was high - 77.3 and 82.8%, respectively and all isolates from clinical mastitis presented these genes. The sec gene, either associated to tst gene or not, was identified only in isolates from subclinical mastitis. None of the following genes were identified: bbp, ebpS, cna, fnbB, icaA, icaD, bap, hlg, lukM-lukF-PV and se-a-b-d-e.

  11. Comparative analysis of agr groups and virulence genes among subclinical and clinical mastitis Staphylococcus aureus isolates from sheep flocks of the Northeast of Brazil.

    Science.gov (United States)

    de Almeida, Lara M; de Almeida, Mayra Zilta P R B; de Mendonça, Carla L; Mamizuka, Elsa M

    2013-01-01

    Staphylococcus aureus is one of the most frequent mastitis causative agents in small ruminants. The expression of most virulence genes of S. aureus is controlled by an accessory gene regulator (agr) locus. This study aimed to ascertain the prevalence of the different agr groups and to evaluate the occurrence of encoding genes for cytotoxin, adhesins and toxins with superantigen activity in S. aureus isolates from milk of ewes with clinical and subclinical mastitis in sheep flocks raised for meat production The agr groups I and II were identified in both cases of clinical and subclinical mastitis. Neither the arg groups III and IV nor negative agr were found. The presence of cflA gene was identified in 100% of the isolates. The frequency of hla and lukE-D genes was high - 77.3 and 82.8%, respectively and all isolates from clinical mastitis presented these genes. The sec gene, either associated to tst gene or not, was identified only in isolates from subclinical mastitis. None of the following genes were identified: bbp, ebpS, cna, fnbB, icaA, icaD, bap, hlg, lukM-lukF-PV and se-a-b-d-e. PMID:24294245

  12. A Model of Small-Group Problem-Based Learning in Pharmacy Education: Teaching in the Clinical Environment

    Science.gov (United States)

    Khumsikiew, Jeerisuda; Donsamak, Sisira; Saeteaw, Manit

    2015-01-01

    Problem-based Learning (PBL) is an alternate method of instruction that incorporates basic elements of cognitive learning theory. Colleges of pharmacy use PBL to aid anticipated learning outcomes and practice competencies for pharmacy student. The purpose of this study were to implement and evaluate a model of small group PBL for 5th year pharmacy…

  13. Clinical use of cancer biomarkers in epithelial ovarian cancer: updated guidelines from the European Group on Tumor Markers

    NARCIS (Netherlands)

    Sölétormos, G.; Duffy, M.J.; Othman Abu Hassan, S.; Verheijen, RHM; Tholander, B.; Bast jr., R.C.; Gaarenstroom, K.N.; Sturgeon, C.M.; Bonfrer, J.M.G.; Petersen, P.H.; Troonen, H.; Carlo Torre, G.; Kanty Kulpa, J.; Tuxen, M.K.; Molina, R.

    2016-01-01

    OBJECTIVE: To present an update of the European Group on Tumor Markers guidelines for serum markers in epithelial ovarian cancer. METHODS: Systematic literature survey from 2008 to 2013. The articles were evaluated by level of evidence and strength of recommendation. RESULTS: Because of its low sens

  14. International neurocognitive normative study: neurocognitive comparison data in diverse resource-limited settings: AIDS Clinical Trials Group A5271.

    Science.gov (United States)

    Robertson, K; Jiang, H; Evans, S R; Marra, C M; Berzins, B; Hakim, J; Sacktor, N; Silva, M Tulius; Campbell, T B; Nair, A; Schouten, J; Kumwenda, J; Supparatpinyo, K; Tripathy, S; Kumarasamy, N; la Rosa, A; Montano, S; Mwafongo, A; Firnhaber, C; Sanne, I; Naini, L; Amod, F; Walawander, A

    2016-08-01

    Infrastructure for conducting neurological research in resource-limited settings (RLS) is limited. The lack of neurological and neuropsychological (NP) assessment and normative data needed for clinical interpretation impedes research and clinical care. Here, we report on ACTG 5271, which provided neurological training of clinical site personnel and collected neurocognitive normative comparison data in diverse settings. At ten sites in seven RLS countries, we provided training for NP assessments. We collected normative comparison data on HIV- participants from Brazil (n = 240), India (n = 480), Malawi (n = 481), Peru (n = 239), South Africa (480), Thailand (n = 240), and Zimbabwe (n = 240). Participants had a negative HIV test within 30 days before standardized NP exams were administered at baseline and 770 at 6 months. Participants were enrolled in eight strata, gender (female and male), education (country differences were evident in all the neurocognitive test scores (p < 0.0001). There was variation between the age, gender, and education strata on the neurocognitive tests. Age and education were important variables for all tests; older participants had poorer performance, and those with higher education had better performance. Women had better performance on verbal learning/memory and speed of processing tests, while men performed better on motor tests. This study provides the necessary neurocognitive normative data needed to build infrastructure for future neurological and neurocognitive studies in diverse RLS. These normative data are a much-needed resource for both clinicians and researchers.

  15. Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups

    DEFF Research Database (Denmark)

    Madsen, Matias Vested; Gøtzsche, Peter C; Hróbjartsson, Asbjørn

    2009-01-01

    OBJECTIVES: To study the analgesic effect of acupuncture and placebo acupuncture and to explore whether the type of the placebo acupuncture is associated with the estimated effect of acupuncture. DESIGN: Systematic review and meta-analysis of three armed randomised clinical trials. DATA SOURCES.......26 to -0.08), corresponding to 4 mm (2 mm to 6 mm) on a 100 mm visual analogue scale. No statistically significant heterogeneity was present (P=0.10, I(2)=36%). A moderate difference was found between placebo acupuncture and no acupuncture: standardised mean difference -0.42 (-0.60 to -0.23). However...

  16. Credit Valuation Adjustment

    OpenAIRE

    Hoffman, Frederick

    2011-01-01

    Credit risk has become a topical issue since the 2007 Credit Crisis, particularly for its impact on the valuation of OTC derivatives. This becomes critical when the credit risk of entities involved in a contract either as underlying or counterparty become highly correlated as is the case during macroeconomic shocks. It impacts the valuation of such contracts through an additional term, the credit valuation adjustment (CVA). This can become large with such correlation. This thesis outlines the...

  17. Fiscal adjustment in Brazil

    Directory of Open Access Journals (Sweden)

    Fabiana Rocha

    2003-03-01

    Full Text Available Two questions are addressed in this paper. The first one is the determination of periods of fiscal consolidation and fiscal stimulus. The second one is the importance of the composition of fiscal adjustments for their success, defined as a declining debt to GDP ratio. We, characterize 1994 and 1999 as points of fiscal consolidation. The 1994 consolidation can not be considered successful since after that period the debt to GDP ratio has grown continuously. The adjustment can be characterized as a type 2 adjustment (Alesina and Perotti (1997 in the sense that cuts were made mainly in public investment, while government wages and transfers remained almost unchanged. This type of adjustment usually has a low likelihood of being a success.Duas questões são tratadas neste artigo. A primeira é a determinação dos períodos de consolidação fiscal e estímulo fiscal. A segunda questão é a importância da composição dos ajustamentos fiscais para o seu sucesso, definido como um declínio na razo dívida/PIB. Nós, caracterizamos 1994 e 1999 como pontos de consolidação fiscal. A consolidação de 1994 não pode ser considerada um sucesso pois nos anos seguintes a razão dívida/PIB cresceu continuamente. O ajustamento pode ser considerado como um ajustamento do tipo 2 (Alesina and Perotti, 1997 no sentido de que foram feitos cortes principalmente no investimento público, enquanto os salários e transferências permaneceram praticamente inalterados. Este tipo de ajustamento geralmente tem uma baixa probabilidade de sucesso.

  18. Regional differences in clinical care among patients with type 1 diabetes in Brazil: Brazilian Type 1 Diabetes Study Group

    Directory of Open Access Journals (Sweden)

    Gomes Marília B

    2012-10-01

    Full Text Available Abstract Background To determine the characteristics of clinical care offered to type 1 diabetic patients across the four distinct regions of Brazil, with geographic and contrasting socioeconomic differences. Glycemic control, prevalence of cardiovascular risk factors, screening for chronic complications and the frequency that the recommended treatment goals were met using the American Diabetes Association guidelines were evaluated. Methods This was a cross-sectional, multicenter study conducted from December 2008 to December 2010 in 28 secondary and tertiary care public clinics in 20 Brazilian cities in north/northeast, mid-west, southeast and south regions. The data were obtained from 3,591 patients (56.0% females and 57.1% Caucasians aged 21.2 ± 11.7 years with a disease duration of 9.6 ± 8.1 years ( Results Overall, 18.4% patients had HbA1c levels Conclusions A majority of patients, mainly in the north/northeast and mid-west regions, did not meet metabolic control goals and were not screened for diabetes-related chronic complications. These results should guide governmental health policy decisions, specific to each geographic region, to improve diabetes care and decrease the negative impact diabetes has on the public health system.

  19. Clinical information system services and capabilities desired for scalable, standards-based, service-oriented decision support: consensus assessment of the Health Level 7 clinical decision support Work Group.

    Science.gov (United States)

    Kawamoto, Kensaku; Jacobs, Jason; Welch, Brandon M; Huser, Vojtech; Paterno, Marilyn D; Del Fiol, Guilherme; Shields, David; Strasberg, Howard R; Haug, Peter J; Liu, Zhijing; Jenders, Robert A; Rowed, David W; Chertcoff, Daryl; Fehre, Karsten; Adlassnig, Klaus-Peter; Curtis, A Clayton

    2012-01-01

    A standards-based, service-oriented architecture for clinical decision support (CDS) has the potential to significantly enhance CDS scalability and robustness. To enable such a CDS architecture, the Health Level 7 CDS Work Group reviewed the literature, hosted multi-stakeholder discussions, and consulted domain experts to identify and prioritize the services and capabilities required from clinical information systems (CISs) to enable service-oriented CDS. In addition, relevant available standards were identified. Through this process, ten CIS services and eight CIS capabilities were identified as being important for enabling scalable, service-oriented CDS. In particular, through a survey of 46 domain experts, five services and capabilities were identified as being especially critical: 1) the use of standard information models and terminologies; 2) the ability to leverage a Decision Support Service (DSS); 3) support for a clinical data query service; 4) support for an event subscription and notification service; and 5) support for a user communication service. PMID:23304315

  20. Clinical Information System Services and Capabilities Desired for Scalable, Standards-Based, Service-oriented Decision Support: Consensus Assessment of the Health Level 7 Clinical Decision Support Work Group

    Science.gov (United States)

    Kawamoto, Kensaku; Jacobs, Jason; Welch, Brandon M.; Huser, Vojtech; Paterno, Marilyn D.; Del Fiol, Guilherme; Shields, David; Strasberg, Howard R.; Haug, Peter J.; Liu, Zhijing; Jenders, Robert A.; Rowed, David W.; Chertcoff, Daryl; Fehre, Karsten; Adlassnig, Klaus-Peter; Curtis, A. Clayton

    2012-01-01

    A standards-based, service-oriented architecture for clinical decision support (CDS) has the potential to significantly enhance CDS scalability and robustness. To enable such a CDS architecture, the Health Level 7 CDS Work Group reviewed the literature, hosted multi-stakeholder discussions, and consulted domain experts to identify and prioritize the services and capabilities required from clinical information systems (CISs) to enable service-oriented CDS. In addition, relevant available standards were identified. Through this process, ten CIS services and eight CIS capabilities were identified as being important for enabling scalable, service-oriented CDS. In particular, through a survey of 46 domain experts, five services and capabilities were identified as being especially critical: 1) the use of standard information models and terminologies; 2) the ability to leverage a Decision Support Service (DSS); 3) support for a clinical data query service; 4) support for an event subscription and notification service; and 5) support for a user communication service. PMID:23304315

  1. Clinical information system services and capabilities desired for scalable, standards-based, service-oriented decision support: consensus assessment of the Health Level 7 clinical decision support Work Group.

    Science.gov (United States)

    Kawamoto, Kensaku; Jacobs, Jason; Welch, Brandon M; Huser, Vojtech; Paterno, Marilyn D; Del Fiol, Guilherme; Shields, David; Strasberg, Howard R; Haug, Peter J; Liu, Zhijing; Jenders, Robert A; Rowed, David W; Chertcoff, Daryl; Fehre, Karsten; Adlassnig, Klaus-Peter; Curtis, A Clayton

    2012-01-01

    A standards-based, service-oriented architecture for clinical decision support (CDS) has the potential to significantly enhance CDS scalability and robustness. To enable such a CDS architecture, the Health Level 7 CDS Work Group reviewed the literature, hosted multi-stakeholder discussions, and consulted domain experts to identify and prioritize the services and capabilities required from clinical information systems (CISs) to enable service-oriented CDS. In addition, relevant available standards were identified. Through this process, ten CIS services and eight CIS capabilities were identified as being important for enabling scalable, service-oriented CDS. In particular, through a survey of 46 domain experts, five services and capabilities were identified as being especially critical: 1) the use of standard information models and terminologies; 2) the ability to leverage a Decision Support Service (DSS); 3) support for a clinical data query service; 4) support for an event subscription and notification service; and 5) support for a user communication service.

  2. Characteristics and evaluation of the clinical application of a self-adjusting file%自调节根管锉的特性和临床应用评价

    Institute of Scientific and Technical Information of China (English)

    吴幸晨(综述); 朱亚琴(审校)

    2013-01-01

    根管预备(根管清理和根管成形)是根管治疗的关键步骤。为了达到良好的根管预备目的,各种先进器械和新型材料不断涌现。从标准不锈钢根管锉到旋转镍钛锉系统的相继应用,根管预备的质量和效率得到了大幅的提高;然而这两种临床常用的器械并没有完全达到根管预备的目标,尤其在三维影像上仍存在着明显的缺陷。自调节根管锉(SAF)这种新型镍钛器械的诞生,为根管预备技术带来了突破。其全新的设计克服了传统根管锉在柔韧性和可塑性等方面的不足,其自带的冲洗装置实现了根管冲洗和成形的同步操作,根管清理更为完善。本文就SAF的特性、力学性能和临床应用等研究进展作一综述。%Root canal preparations, including the cleaning and shaping of the root canal, are a key step in the root canal treatment process. Advanced equipment and new materials have continuously emerged to better achieve this step. From standard stainless steel files to the use of nickel-titanium rotary file systems, the quality and efficiency of root canal preparation have greatly improved. However, while the resulting root canal filling radiographs are impressive, the third dimension of the root canal is commonly ignored. A new nickel-titanium instrument, the self-adjusting file(SAF), was recently developed. This tool is a breakthrough in root canal preparation technology because its unique design overcomes the lack of flexibility and plasticity of traditional files. As the file features its own washing device, the synchronous operation of root canal cleaning and shaping may be realized, thereby achieving more efficient root canal preparations. This study discusses research progress on the characteristics, mechanical properties, and clinical applications of SAF.

  3. Dengue: clinical forms and risk groups in a high incidence city in the southeastern region of Brazil

    OpenAIRE

    Ivana Macedo Cardoso; Aline de Souza Areias Cabidelle; Patrícia de Castro e Leão Borges; Carolina Ferreira Lang; Fabrício Greco Calenti; Larissa de Oliveira Nogueira; Aloisio Falqueto; Crispim Cerutti Junior

    2011-01-01

    INTRODUCTION: The article describes the epidemiologic profile of dengue cases in Vitória, the capital of Espírito Santo, Brazil, from 2000 to 2009, aimed at identifying risk groups regarding the incidence and severity of the disease. METHODS: Confirmed cases of dengue among city residents during ten years were classified as dengue fever, dengue hemorrhagic fever, dengue shock syndrome and dengue with complications, and analyzed according to sex, age, race-color and education. RESULTS: The pro...

  4. Feedback versus no feedback to improve patient outcome in group psychotherapy for eating disorders (F-EAT): A randomized clinical trial

    DEFF Research Database (Denmark)

    Davidsen, Annika Helgadóttir; Waaddegaard, Mette; Poulsen, Stig Bernt;

    Background: A high rate of dropout in the treatment of eating disorders calls for ways to improve treatment attendance. Research indicates that continuous feedback on patient improvement and the therapeutic alliance reduces the number of dropouts and increases patient outcome. There are, however......, only three published randomized trials on the effect of feedback on the treatment of eating disorders showing inconclusive results, and there are no randomized trials on the effect of feedback in group therapy. Objective: The current randomized clinical trial aims to investigate the impact...... of continuous feedback on adherence and outcome in group psychotherapy. Methods/design: The trial is set up in a randomized design for outpatients diagnosed with bulimia nervosa, binge eating disorder, or eating disorder not otherwise specified (DSM-IV). They are allocated 1:1 to the experimental group...

  5. Psychological Adjustment in Bullies and Victims of School Violence

    Science.gov (United States)

    Estevez, Estefania; Murgui, Sergio; Musitu, Gonzalo

    2009-01-01

    The present study examined psychosocial adjustment in the following four groups of students: victims, bullies, bully/victims and a control group of adolescents not involved in bullying or victimization problems. Psychosocial adjustment was measured considering as indicators: level of self-esteem, depressive symptomatology, perceived stress,…

  6. [Nutritional and Functional assessment of peritoneal dialysis patients in the clinical practice: Report from MITO-DP Group].

    Science.gov (United States)

    Cupisti, Adamasco; D'Alessandro, Claudia; Caselli, Gian Marco

    2016-01-01

    Nutritional abnormalities and physical inactivity are risk factors of increased morbidity and mortality in patients with ESRD. Identify and define malnutrition, in particular protein-energy depletion (PEW), is an important task in the management of renal patients. The aim of this multicenter observational study was to implement the assessment of nutritional status and functional capacity in patients on peritoneal dialysis, including tests and validated methods which are relatively easy to apply in daily clinical practice. The study includes all the 133 prevalent patients (80 m, 53 f, age 65 14 years), in peritoneal dialysis treatment (vintage 26 19 months) in 9 centers in Tuscany. We performed anthropometry, bioimpedance (BIA), clinical biochemistry, evaluation of habitual physical activity (RAPA tests) and performance (Sit-To-Stand test), appetite-evaluation questionnaire, and indices including the Malnutrition Inflammation Score (MIS), Geriatric Nutrition Risk Index (GNRI), Charlson comorbidity index, Barthel and Karnowsky index. The latter showed a condition of dependence in 7.2% and 19.7% of cases, respectively. Poor appetite was recorded in 48.2%. The majority of patients fell within the overweight / obesity range (51%) with waist circumference values associated with increased cardiovascular risk in 51% of males and 60% of females. At the BIA analysis, a BCMI 11, indicative of PEW, took place in 12.7% of cases. The values of the MIS correlated directly with age and the degree of comorbidity and inversely with the sit-to-stand test, RAPA tests and appetite level. The data in this study show that single tests indicative of malnutrition disorders are frequent to be found in our series of peritoneal dialysis patients. However, a diagnosis of PEW is quite infrequent. A large percentage of patients are overweight with increased abdominal adiposity, and reduced cell mass and protein intake below recommended levels; the level of habitual physical activity is low, and

  7. Adjustment Criterion and Algorithm in Adjustment Model with Uncertain

    Directory of Open Access Journals (Sweden)

    SONG Yingchun

    2015-02-01

    Full Text Available Uncertainty often exists in the process of obtaining measurement data, which affects the reliability of parameter estimation. This paper establishes a new adjustment model in which uncertainty is incorporated into the function model as a parameter. A new adjustment criterion and its iterative algorithm are given based on uncertainty propagation law in the residual error, in which the maximum possible uncertainty is minimized. This paper also analyzes, with examples, the different adjustment criteria and features of optimal solutions about the least-squares adjustment, the uncertainty adjustment and total least-squares adjustment. Existing error theory is extended with new observational data processing method about uncertainty.

  8. Ensuring Resident Competence: A Narrative Review of the Literature on Group Decision Making to Inform the Work of Clinical Competency Committees.

    Science.gov (United States)

    Hauer, Karen E; Cate, Olle Ten; Boscardin, Christy K; Iobst, William; Holmboe, Eric S; Chesluk, Benjamin; Baron, Robert B; O'Sullivan, Patricia S

    2016-05-01

    Background The expectation for graduate medical education programs to ensure that trainees are progressing toward competence for unsupervised practice prompted requirements for a committee to make decisions regarding residents' progress, termed a clinical competency committee (CCC). The literature on the composition of these committees and how they share information and render decisions can inform the work of CCCs by highlighting vulnerabilities and best practices. Objective We conducted a narrative review of the literature on group decision making that can help characterize the work of CCCs, including how they are populated and how they use information. Methods English language studies of group decision making in medical education, psychology, and organizational behavior were used. Results The results highlighted 2 major themes. Group member composition showcased the value placed on the complementarity of members' experience and lessons they had learned about performance review through their teaching and committee work. Group processes revealed strengths and limitations in groups' understanding of their work, leader role, and information-sharing procedures. Time pressure was a threat to the quality of group work. Conclusions Implications of the findings include the risks for committees that arise with homogeneous membership, limitations to available resident performance information, and processes that arise through experience rather than deriving from a well-articulated purpose of their work. Recommendations are presented to maximize the effectiveness of CCC processes, including their membership and access to, and interpretation of, information to yield evidence-based, well-reasoned judgments.

  9. Expert Consensus Group report on the use of apomorphine in the treatment of Parkinson's disease - Clinical practice recommendations

    DEFF Research Database (Denmark)

    Trenkwalder, Claudia; Chaudhuri, K Ray; García Ruiz, Pedro J;

    2015-01-01

    Extensive published evidence supports the use of subcutaneously-administered apomorphine as an effective therapy for Parkinson's disease (PD) but to date no consensus recommendations have been available to guide healthcare professionals in the optimal application of apomorphine therapy in clinical....... Apomorphine is a suitable therapeutic option for PD patients who experience troublesome 'off' periods despite optimized treatment with oral PD medications. Due to its speed of onset, apomorphine injection is particularly suited to those patients requiring rapid, reliable relief of both unpredictable and...... predictable 'off' periods, those who require reliable and fast relief when anticipating an 'off', those with levodopa absorption or gastric emptying problems resulting in delayed or failed 'on', or for rapid relief of early morning dystonia or akinesia. Apomorphine infusion(1) is suited for patients whose...

  10. [Use of reactions with Limulus amoebocyte lysate (LAL) to determine biological activity of lipopolysaccharides from reference and clinical strains of the Bacteroides fragilis group].

    Science.gov (United States)

    Rokosz, Alicja; Fiejka, Maria; Górska, Paulina; Aleksandrowicz, Janina; Meisel-Mikołajczyk, Felicja; Łuczak, MirosŁaw

    2002-01-01

    The aim of this study was to determine and compare a biological activity of lipopolysaccharides (LPS) from reference and clinical strains of strictly anaerobic bacteria belonging to the Bacteroides fragilis group (BFG) by means of quantitative, photometric BET (LAL) method with Limulus polyphemus amoebocyte lysate and chromogenic substrate S-2423. Lipopolysaccharides of five BFG species were extracted by Westphal and Jann method (1965) from eight reference and two clinical strains of B. fragilis group. Crude LPS preparations were purified according to the procedure described by Gmeiner (1975) with ultracentrifugation and nuclease treatment. Biological activities of bacterial endotoxins were determined by quantitative BET method with chromogenic substrate S-2423 (ENDOCHROME kit, Charles River Endosafe Ltd., USA). Tests were performed according to the producer's recommendations. E. coli O55:B5 LPS was applied to compare its activity in reaction with LAL reagent with activities of LPS preparations from rods of the Bacteroides genus. Among examined bacterial compounds the most active in BET method was E. coli O55:B5 LPS. Activities of lipopolysaccharides from five species of BFG rods in reaction with Limulus amoebocyte lysate were differentiated. Greater ability to activate LAL proenzyme revealed lipopolysaccharides of these species of the Bacteroides genus, which are important from the clinical point of view--B. fragilis and B. thetaiotaomicron.

  11. A Complex Multiherbal Regimen Based on Ayurveda Medicine for the Management of Hepatic Cirrhosis Complicated by Ascites: Nonrandomized, Uncontrolled, Single Group, Open-Label Observational Clinical Study

    Directory of Open Access Journals (Sweden)

    Manish V. Patel

    2015-01-01

    Full Text Available Hepatic cirrhosis is one of the leading causes of death worldwide, especially if complicated by ascites. This chronic condition can be related to the classical disease entity jalodara in Traditional Indian Medicine (Ayurveda. The present paper aims to evaluate the general potential of Ayurvedic therapy for overall clinical outcomes in hepatic cirrhosis complicated by ascites (HCcA. In form of a nonrandomized, uncontrolled, single group, open-label observational clinical study, 56 patients fulfilling standardized diagnostic criteria for HCcA were observed during their treatment at the P. D. Patel Ayurveda Hospital, Nadiad, India. Based on Ayurvedic tradition, a standardized treatment protocol was developed and implemented, consisting of oral administration of single and compound herbal preparations combined with purificatory measures as well as dietary and lifestyle regimens. The outcomes were assessed by measuring liver functions through specific clinical features and laboratory parameters and by evaluating the Child-Pugh prognostic grade score. After 6 weeks of treatment and a follow-up period of 18 weeks, the outcomes showed statistically significant and clinically relevant improvements. Further larger and randomized trials on effectiveness, safety, and quality of the Ayurvedic approach in the treatment of HCcA are warranted to support these preliminary findings.

  12. In vitro antibacterial activity of some antihistaminics belonging to different groups against multi-drug resistant clinical isolates

    Directory of Open Access Journals (Sweden)

    Moustafa A El-Nakeeb

    2011-09-01

    Full Text Available Antihistaminics are widely used for various indications during microbial infection. Hence, this paper investigates the antimicrobial activities of 10 antihistaminics belonging to both old and new generations using multiresistant Gram-positive and Gram-negative clinical isolates. The bacteriostatic activity of antihistaminics was investigated by determining their MIC both by broth and agar dilution techniques against 29 bacterial strains. Azelastine, cyproheptadine, mequitazine and promethazine were the most active among the tested drugs. Diphenhydramine and cetirizine possessed weaker activity whereas doxylamine, fexofenadine and loratadine were inactive even at the highest tested concentration (1 mg/ml. The MIC of meclozine could not be determined as it precipitated with the used culture media. The MBC values of antihistaminics were almost identical to the corresponding MIC values. The bactericidal activity of antihistaminics was also studied by the viable count technique in sterile saline solution. Evident killing effects were exerted by mequitazine, meclozine, azelastine and cyproheptadine. Moreover, the dynamics of bactericidal activity of azelastine were studied by the viable count technique in nutrient broth. This activity was found to be concentration-dependant. This effect was reduced on increasing the inoculum size while it was increased on raising the pH. The post-antimicrobial effect of 100 fg/ml azelastine was also determined and reached up to 3.36 h.

  13. Jordan Adjusted Human Development

    OpenAIRE

    Ababsa, Myriam

    2014-01-01

    Jordan Human Development Index (HDI) and Adjusted Human Development Index (IHDI) In 1990, the United Nations Development Programme designed a Human Development Index composed of life expectancy at birth, level of education and gross domestic product (GDP) per capita. In 2011, the UNDP ranked Jordan 95th out of 187 countries with a human development index of 0.698, up from 0.591 in 1990, making it the leading medium-range country for human development (fig. VIII.1). In 2010, the inequality adj...

  14. Development and Preliminary Validation of Diabetes Adjustment Assessment Scale (DAAS): a New Measure of Adjustment with Type 2 Diabetes

    OpenAIRE

    Ebrahimi, Hossein; Karimi Moonaghi, Hossein; Asghari Jafarabadi, Mohammad; Namdar Areshtanab, Hossein; Jouybari, Leila

    2016-01-01

    Introduction: Several adjustment scales are available for Diabetes, but, unfortunately most of them focused on the limited dimensions of diabetes and are not specific for type 2 diabetes. The aim of this study was to develop a multidimensional scale for Diabetes type 2 Adjustment Assessment and to test preliminary validity, reliability and clinical utility of the scale for this population. Methods: In this methodological design study, the Diabetes Adjustment Assessment Scale was developed and...

  15. Clinical predictors of reinfarction among men and women after a first myocardial infarction. SPRINT Study Group. Secondary Prevention Reinfarction Israeli Nifedipine Trial.

    Science.gov (United States)

    Kornowski, R; Goldbourt, U; Boyko, V; Behar, S

    1995-01-01

    Independent clinical factors predicting reinfarction in the 1st year following an initial myocardial infarction were identified among 900 women and 2,795 men. Women were older (65.8 vs. 59.3 years; p men (6.9 vs. 5.6%, p = 0.17). Cumulative 1-month, 1- and 5.5-year all-cause mortality following the first infarction was higher among women who sustained reinfarction (43, 52 and 74%, respectively) than among men (29, 30 and 51%, respectively, p women were (adjusted relative odds): peripheral vascular disease (3.2), postinfarction angina (2.3), diabetes mellitus (2.2), radiographic evidence of cardiomegaly (1.9), anterior location of the first infarction (2.0), congestive heart failure (1.8), prior angina (1.6) and age (10 years) increment (1.2). Predictive variables for men were: anterior infarct location (1.7), peripheral vascular disease (1.6, prior stroke (1.5), prior angina (1.4), systemic hypertension (1.3) and age (10 years) increment (1.1). Our data indicate (a) different cardiac risk factors for reinfarction among men and women after a first myocardial infarction, and (b) a prognostic advantage for men over women following reinfarction.

  16. Clinical outcomes after hepatitis C infection from contaminated anti-D immune globulin. Irish Hepatology Research Group.

    LENUS (Irish Health Repository)

    Kenny-Walsh, E

    2012-02-03

    BACKGROUND AND METHODS: In February 1994, batches of anti-D immune globulin used in Ireland during 1977 and 1978 to prevent Rh isoimmunization were found to be contaminated with hepatitis C virus (HCV) from a single infected donor. In March 1994, a national screening program was initiated for all women who had received anti-D immune globulin between 1970 and 1994. Of the 62,667 women who had been screened when this study began, 704 (1.1 percent) had evidence of past or current HCV infection, and 390 of those 704 (55 percent) had positive tests for serum HCV RNA on reverse-transcription-polymerase-chain-reaction analysis. All 390 were offered a referral for clinical assessment and therapy. We evaluated 376 of these 390 women (96 percent); the other 14 were not seen at one of the designated treatment centers. RESULTS: The mean (+\\/-SD) age of the 376 women was 45+\\/-6 years at the time of screening. They had been infected with hepatitis C for about 17 years. A total of 304 women (81 percent) reported symptoms, most commonly fatigue (248 [66 percent]). Serum alanine aminotransferase concentrations were slightly elevated (40 to 99 U per liter) in 176 of 371 women (47 percent), and the concentrations were 100 U per liter or higher in 31 (8 percent). Liver biopsies showed inflammation in 356 of 363 women (98 percent); in most cases the inflammation was slight (41 percent) or moderate (52 percent). Although the biopsy samples from 186 of the 363 women (51 percent) showed evidence of fibrosis, only 7 women (2 percent) had probable or definite cirrhosis. Two of the seven reported excessive alcohol consumption. CONCLUSIONS: Most of the women with HCV infection 17 years after receiving HCV-contaminated anti-D immune globulin had evidence of slight or moderate hepatic inflammation on liver biopsy, about half had fibrosis, and 2 percent had probable or definite cirrhosis.

  17. Immunocompromentation of persons from groups with high risk of parenteral contamination with hepatitis B and C viruses: mechanisms of development and clinical pathogenetical significance

    Directory of Open Access Journals (Sweden)

    M. K. Mamedov

    2012-01-01

    Full Text Available The paper contains data demonstrated that majority of persons belonged to groups with high risk of parenteral contamination with hepatitis B and C viruses yet before contamination with these viruses have complex of immunological disorders. In the article is presented the data reflecting main causes of these disorders development at different categories of such persons and main aspects of their pathogenetical and clinical significance are discussed.

  18. Analysis of NF-B Pathway Proteins in Pediatric Hodgkin Lymphoma: Correlations with EBV Status and Clinical Outcome—A Children's Oncology Group Study

    OpenAIRE

    Horton, Terzah M.; Sheehan, Andrea M.; Dolores López-Terrada; Hutchison, Robert E.; Sonia Narendra; Meng-Fen Wu; Hao Liu

    2012-01-01

    Constitutively active nuclear factor-κB (NF-κB) is integral to the survival of Hodgkin/Reed-Sternberg cells (H/RS) in Hodgkin lymphoma (HL). To investigate NF-κB pathway proteins in pediatric HL, we utilized a tissue microarray compiled from 102 children enrolled in the Children's Oncology Group intermediate-risk clinical trial AHOD0031 (56 male, 78 Caucasian, median age 15 years (range 1–20 years), 85 nodular sclerosing subtype, 23 Epstein-Barr virus (EBV) positive, and 24 refractory/relapse...

  19. Predictors of Marital Adjustment: Are There Any Differences Between Women and Men?

    Directory of Open Access Journals (Sweden)

    Antoaneta Andreea Muraru

    2013-08-01

    Full Text Available The purpose of this study was to explore if there are differences between women and men in relationships among family-of-origin, romantic attachment, and marital adjustment. Two hundred and forty-nine participants filled out four self-reported measures: The Differentiation in the Family System Scale, Family Adaptability and Cohesion Evaluation Scale, Experiences in Close Relationship Scale, and Revised Dyadic Adjustment Scale. In order to analyze the data, multiple-group analysis with AMOS 16.0 was used. There was no difference between women and men in all observed variables. Regardless of gender, only the romantic attachment was a significant predictor of marital adjustment. Only in women, family-of-origin significantly predicted their romantic attachment. Across gender groups, the configural model fitted satisfactorily the observed data. When measurement and structural weights, as well as residuals were constrained to be equal across gender groups, the invariance of the model was also supported. The results suggest women and men could be similar when it comes to the relationships among constructions they both have regarding family-of-origin experiences, romantic attachment patterns, and marital adjustment. Some implications for research and clinical practice with marital couples are briefly discussed.

  20. Dengue: clinical forms and risk groups in a high incidence city in the southeastern region of Brazil

    Directory of Open Access Journals (Sweden)

    Ivana Macedo Cardoso

    2011-08-01

    Full Text Available INTRODUCTION: The article describes the epidemiologic profile of dengue cases in Vitória, the capital of Espírito Santo, Brazil, from 2000 to 2009, aimed at identifying risk groups regarding the incidence and severity of the disease. METHODS: Confirmed cases of dengue among city residents during ten years were classified as dengue fever, dengue hemorrhagic fever, dengue shock syndrome and dengue with complications, and analyzed according to sex, age, race-color and education. RESULTS: The proportion of dengue cases was highest among women aged 20 to 29 years-old and similar between whites and blacks. A gradual decrease occurred in the percentage of dengue cases in the population aged 15 years-old or more, in the historical series of 10 years, and a growing increase in individuals less than 15 years-old, showing statistical significance. The fatality rate ranged from zero to 0.3% for all forms of dengue and from 0.2% to 18.2% for severe forms. CONCLUSIONS: The profile of those affected by the disease in the municipality is similar to those affected in Brazil. The increasing number of cases in individuals under 15 years-old corroborates the results of recent studies in other Brazilian municipalities.

  1. Dose Adjustment for Normal Eating: A Role for the Expert Patient?

    Directory of Open Access Journals (Sweden)

    Harold David McIntyre

    2014-04-01

    Full Text Available The Dose Adjustment for Normal Eating (DAFNE programme of intensive insulin therapy for type 1 diabetes provides a structured educational intervention to improve glycemic control, reduce hypoglycemia and improve quality of life. Enhancement of self-management skills is a key element of DAFNE and patients acquire detailed skills in insulin dose adjustment. Following DAFNE training, patients report improved confidence in their ability to manage their own insulin dosing, but generally still seek and require the assistance of health professionals when making substantial changes to their insulin regimens. Some DAFNE trained patients may be able to assist their peers in aspects of diabetes management within a group environment, but widespread introduction of the expert patient/peer educator role in the self-management of type 1 diabetes, in particular related to insulin dose management, would require formal and detailed evaluation, preferably in randomized controlled clinical trials, before being introduced into routine clinical practice.

  2. Barriers to a Career Focus in Cancer Prevention: A Report and Initial Recommendations From the American Society of Clinical Oncology Cancer Prevention Workforce Pipeline Work Group

    Science.gov (United States)

    Meyskens, Frank L.; Bajorin, Dean F.; George, Thomas J.; Jeter, Joanne M.; Khan, Shakila; Tyne, Courtney A.; William, William N.

    2016-01-01

    Purpose To assist in determining barriers to an oncology career incorporating cancer prevention, the American Society of Clinical Oncology (ASCO) Cancer Prevention Workforce Pipeline Work Group sponsored surveys of training program directors and oncology fellows. Methods Separate surveys with parallel questions were administered to training program directors at their fall 2013 retreat and to oncology fellows as part of their February 2014 in-training examination survey. Forty-seven (67%) of 70 training directors and 1,306 (80%) of 1,634 oncology fellows taking the in-training examination survey answered questions. Results Training directors estimated that ≤ 10% of fellows starting an academic career or entering private practice would have a career focus in cancer prevention. Only 15% of fellows indicated they would likely be interested in cancer prevention as a career focus, although only 12% thought prevention was unimportant relative to treatment. Top fellow-listed barriers to an academic career were difficulty in obtaining funding and lower compensation. Additional barriers to an academic career with a prevention focus included unclear career model, lack of clinical mentors, lack of clinical training opportunities, and concerns about reimbursement. Conclusion Reluctance to incorporate cancer prevention into an oncology career seems to stem from lack of mentors and exposure during training, unclear career path, and uncertainty regarding reimbursement. Suggested approaches to begin to remedy this problem include: 1) more ASCO-led and other prevention educational resources for fellows, training directors, and practicing oncologists; 2) an increase in funded training and clinical research opportunities, including reintroduction of the R25T award; 3) an increase in the prevention content of accrediting examinations for clinical oncologists; and 4) interaction with policymakers to broaden the scope and depth of reimbursement for prevention counseling and

  3. Adolescent Mothers' Adjustment to Parenting.

    Science.gov (United States)

    Samuels, Valerie Jarvis; And Others

    1994-01-01

    Examined adolescent mothers' adjustment to parenting, self-esteem, social support, and perceptions of baby. Subjects (n=52) responded to questionnaires at two time periods approximately six months apart. Mothers with higher self-esteem at Time 1 had better adjustment at Time 2. Adjustment was predicted by Time 2 variables; contact with baby's…

  4. Technical Document for Price Adjustment

    OpenAIRE

    Zheng Tian; Mulugeta Kahsai; Randall Jackson

    2014-01-01

    This document presents the basis for the price adjustment mechanisms in a time series IO model. The essentials of the price adjustment and price change propagation algorithms are presented, along with a matrix permutation algorithm that facilitates the implementation of the price adjustment mechanism. The Matlab function is provided.

  5. Oral fibrinogen-depleting agent lumbrokinase for secondary ischemic stroke prevention: results from a multicenter, randomized, parallel-group and controlled clinical trial

    Institute of Scientific and Technical Information of China (English)

    CAO Yong-jun; ZHANG Xia; WANG Wan-hua; ZHAI Wan-qing; QIAN Ju-fen; WANG Jian-sheng; CHEN Jun

    2013-01-01

    Background Elevated fibrinogen (Fg) level is a known risk factor for ischemic stroke.There are few clinical trials on oral fibrinogen-depleting therapies for secondary ischemic stroke prevention.We aimed to assess the effects of one-year therapy with oral lumbrokinase enteric-coated capsules on secondary ischemic stroke prevention.Methods This is a multicenter,randomized,parallel group and controlled study that began treatment in hospitalized patients with ischemic stroke and continued for 12 months.Patients were randomized to either the control group that received the standard stroke treatment or the fibrinogen-depleting group that received the standard stroke treatment plus enteric-coated lumbrokinase capsules.The NIH Stroke Scale scores (NIHSSs) and plasma Fg level were recorded.The carotid artery intima-media thickness (IMT) and status of plaques were examined through carotid ultrasound examination.Primary outcomes included all-cause mortality,any event of recurrent ischemic stroke/transient ischemic attack (TIA),hemorrhagic stroke,myocardial infarction and angina,and other noncerebral ischemia or hemorrhage.Kaplan-Meier survival analysis and the Long-rank test were used to compare total vascular end point incidence between the two groups.Comparison of median values between two groups was done by the Student t test,one-way analysis of variance (ANOVA),or non-parametric rank sum test.Results A total of 310 patients were enrolled,192 patients in the treatment group and 118 patients in the control group.Compared to the control group,the treatment group showed favorable outcomes in the Fg level,carotid IMT,the detection rate of vulnerable plaques,the volume of carotid plaques,NIHSS scores,and incidence of total vascular (6.78% and 2.08%,respectively) and cerebral vascular events (5.93% and 1.04%,respectively) (P <0.05).In the treatment group,the volume of carotid plaques was significantly related to the carotid IMT,the plaque diameter,width and number (P

  6. Premorbid Adjustment Profiles in Psychosis and the Role of Familial Factors

    NARCIS (Netherlands)

    Quee, Piotr J.; Meijer, Julia H.; Islam, Md Atiqul; Aleman, Andre; Alizadeh, Behrooz Z.; Meijer, Carin J.; van den Heuvel, Edwin R.

    2014-01-01

    Disease heterogeneity in patients with psychotic disorder may be explained by distinct profiles of premorbid adjustment. The current study explored premorbid adjustment profiles in patients with psychotic disorders, associations with cognitive and clinical characteristics after disease onset, and th

  7. Premorbid adjustment profiles in psychosis and the role of familial factors

    NARCIS (Netherlands)

    Quee, Piotr J; Meijer, Julia H; Islam, Md Atiqul; Aleman, André; Alizadeh, Behrooz Z; Meijer, Carin J; van den Heuvel, Edwin R

    2014-01-01

    Disease heterogeneity in patients with psychotic disorder may be explained by distinct profiles of premorbid adjustment. The current study explored premorbid adjustment profiles in patients with psychotic disorders, associations with cognitive and clinical characteristics after disease onset, and th

  8. Prognostic significance of clinical grading of patients envenomed by Bothrops lanceolatus in Martinique. Members of the Research Group on Snake Bite in Martinique.

    Science.gov (United States)

    Thomas, L; Tyburn, B; Ketterlé, J; Biao, T; Mehdaoui, H; Moravie, V; Rouvel, C; Plumelle, Y; Bucher, B; Canonge, D; Marie-Nelly, C A; Lang, J

    1998-01-01

    The correlation between clinical grading of patients bitten by Bothrops lanceolatus and the subsequent development of their envenoming was examined. Severity of envenoming was graded using a 1-4 scale (minor to major). Patients were classified into 2 groups according to the time elapsed between bite and treatment with a specific purified equine F(ab')2 antivenom. The late/no treatment group (n = 33) was characterized by a systemic thrombotic complication rate of 14/33 (42.4%) leading to 4 deaths, which increased with the maximum severity assessed on the first day following the bite (P = 0.003). However, infarctions could develop in patients who presented initially with signs of moderate envenoming, normal blood clotting and low serum levels of venom antigens. No such complication of fatality occurred in the early (0.5-6 h) treatment group (n = 70). Multiple regression analysis showed that duration of stay in hospital in this group increased with the length of the snake (P = 0.017), venom antigenaemia (P = 0.016), initial grading (P < 0.001), and with the need for surgical debridement (n = 10/70, P < 0.001). Outcome was correlated with initial severity of envenoming. However, the only factor with a positive prognostic significance for the individual envenomed patient was the early infusion of specific antivenom, which led to 100% recovery in our series. PMID:9861375

  9. Metric adjusted skew information

    DEFF Research Database (Denmark)

    Hansen, Frank

    2008-01-01

    We extend the concept of Wigner-Yanase-Dyson skew information to something we call "metric adjusted skew information" (of a state with respect to a conserved observable). This "skew information" is intended to be a non-negative quantity bounded by the variance (of an observable in a state......) that vanishes for observables commuting with the state. We show that the skew information is a convex function on the manifold of states. It also satisfies other requirements, proposed by Wigner and Yanase, for an effective measure-of-information content of a state relative to a conserved observable. We...... establish a connection between the geometrical formulation of quantum statistics as proposed by Chentsov and Morozova and measures of quantum information as introduced by Wigner and Yanase and extended in this article. We show that the set of normalized Morozova-Chentsov functions describing the possible...

  10. Adjusting to the Emergent

    DEFF Research Database (Denmark)

    Revsbæk, Line

    In her doctoral thesis Line Revsbaek explores newcomer innovation related to organizational entry processes in a changing organization. She introduces process philosophy and complexity theory to research on organizational socialization and newcomer innovation. The study challenges assumptions...... in standardized induction programs where newcomers are cast in roles as insecure novices needing to be “taught the ropes” of the organizational culture. Linked with this, it is suggested that the prevailing dichotomy of ‘newcomer assimilation’ versus ‘organizational accommodation’ is replaced with a notion...... of ‘adjusting to the emergent’. Newcomer innovation is portrayed as carrying a variety of possible significations, such as unintentional innovation effects of newcomer’s proactive self-socializing behavior; an inspirational basis for designing innovation-generating employee induction; ‘resonant instances...

  11. Study of Tripartite Game Model on Interest Adjustment of Group Conflict Management Engineering%群体性冲突中利益调节的三方博弈模型研究

    Institute of Scientific and Technical Information of China (English)

    熊国强; 余红梅; 史阿品; 刘西

    2013-01-01

      通过分析群体性冲突中各利益主体之间的博弈行为,运用演化博弈的方法建立了非政府组织与冲突双方的三方博弈模型,并寻求博弈均衡点。通过分析均衡解,认为冲突双方是否选择和解取决于非政府组织调解成功的概率、协调成本和冲突双方不愿意和解时所产生的损失。%In the group conflict, the biggest contradiction often is to fight for the ownership of interest, and the focus is on how to make the interest maximization. When the two parties in the game can’t properly resolve the contradiction and the game is stalemated, we introduce the third party non-governmental organizations to mediate contradiction and even resolve the contradiction between the two parties. Through analysis of the game behavior between main stakeholders in group conflict, this paper uses the evolutionary game method to establish the tripartite game model with the non-governmental organizations and the two parties in conflict, and pursuits equilibrium points of the game. Through the analysis of the equilibrium, the paper concludes whether the two parties choose mediation depends on the non-governmental organizations’ probability of success to mediation, the costs of mediation, and the loss generated by that conflict in which the two parties don’t compromise.

  12. Clinical characteristics and public health management of invasive meningococcal group W disease in the East Midlands region of England, United Kingdom, 2011 to 2013.

    Science.gov (United States)

    Bethea, Jane; Makki, Sophia; Gray, Steve; MacGregor, Vanessa; Ladhani, Shamez

    2016-06-16

    In England and Wales, meningococcal disease caused by group W has historically been associated with outbreaks of disease among travellers to high-risk countries. Following a large outbreak associated with travel to the Hajj in 2000, the number of cases declined and, in 2008, only 19 laboratory-confirmed cases were identified nationally. In 2013, in the East Midlands region of England, eight cases of meningococcal disease caused by this serogroup were recorded, compared with six from 2011 to 2012. To explore this further, data for all cases with a date of onset between 1 January 2011 and 31 December 2013 were collected. Data collected included geographical location, clinical presentation and outcome. Fourteen cases were identified; two died as a result of their illness and two developed long-term health problems. No commonality in terms of geographical location, shared space or activities was identified, suggesting that group W is circulating endemically with local transmission. Clinical presentation was variable. Half presented with symptoms not typical of a classical meningococcal disease, including two cases of cellulitis, which may have implications for clinicians, in terms of timely identification and treatment, and public health specialists, for offering timely antibiotic chemoprophylaxis to close contacts. PMID:27336327

  13. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: III. The 2014 Biomarker Working Group Report.

    Science.gov (United States)

    Paczesny, Sophie; Hakim, Frances T; Pidala, Joseph; Cooke, Kenneth R; Lathrop, Julia; Griffith, Linda M; Hansen, John; Jagasia, Madan; Miklos, David; Pavletic, Steven; Parkman, Robertson; Russek-Cohen, Estelle; Flowers, Mary E D; Lee, Stephanie; Martin, Paul; Vogelsang, Georgia; Walton, Marc; Schultz, Kirk R

    2015-05-01

    Biology-based markers to confirm or aid in the diagnosis or prognosis of chronic graft-versus-host disease (GVHD) after allogeneic hematopoietic cell transplantation or monitor its progression are critically needed to facilitate evaluation of new therapies. Biomarkers have been defined as any characteristic that is objectively measured and evaluated as an indicator of a normal biological or pathogenic process, or of a pharmacologic response to a therapeutic intervention. Applications of biomarkers in chronic GVHD clinical trials or patient management include the following: (1) diagnosis and assessment of chronic GVHD disease activity, including distinguishing irreversible damage from continued disease activity; (2) prognostic risk to develop chronic GVHD; and (3) prediction of response to therapy. Sample collection for chronic GVHD biomarkers studies should be well documented following established quality control guidelines for sample acquisition, processing, preservation, and testing, at intervals that are both calendar and event driven. The consistent therapeutic treatment of subjects and standardized documentation needed to support biomarker studies are most likely to be provided in prospective clinical trials. To date, no chronic GVHD biomarkers have been qualified for use in clinical applications. Since our previous chronic GVHD Biomarkers Working Group report in 2005, an increasing number of chronic GVHD candidate biomarkers are available for further investigation. This paper provides a 4-part framework for biomarker investigations: identification, verification, qualification, and application with terminology based on Food and Drug Administration and European Medicines Agency guidelines. PMID:25644957

  14. 通过临床小讲课培养学生临床思维能力%Development of clinical reasoning by small group session

    Institute of Scientific and Technical Information of China (English)

    朱蓓; 王艳霞

    2008-01-01

    Clinical small group session is one of the essential elements of medical training pro-grams, it is a great opportunity for the medical students to refresh what they learnt from the classroom and to enhance their abilities in analyzing and solving clinical problems, and it is also a valuable approach for the teachers to improve their lecturing skills. As a result, both the teachers and students benefit from this unique format of teaching-learning experience. The paper summarizes the evaluation on the effectiveness of a clinical small group session teaching case, which is a part of the 2007 undergraduate education survey conducted in Beijing University by the Ministry of Education of People's Republic of China.%临床小讲课是传授医学知识的重要方法,是医学生巩固课堂知识,提高分析问题、解决问题能力的重要环节,是带教教师提高授课水平的过程,是教学相长、师生共同受益的有效途径.本文从积累丰富的教学资料,精心选择教学内容,有的放失地设置问题,有效提高学生解决问题能力.适量开展双语教学,制作精致多媒体课件等方面,总结了临床小讲课的讲课技巧,以及教育部本科教学工作水平评估专家组对临床小讲课的评价.

  15. 可调压和固定压分流管治疗儿童交通性脑积水的临床比较%The clinical comparison of treatment with Adjustable shunt valve and Standard shunt valve for children with Communicating hydrocephalus

    Institute of Scientific and Technical Information of China (English)

    刘洛同; 霍坤良; 明扬; 周杰; 陈礼刚

    2014-01-01

    目的:通过对比研究,探讨可调压分流管治疗儿童交通性脑积水的优势及临床使用经验。方法回顾我科自2006年1月至2011年7月通过脑室-腹腔分流术(VPS)治疗的儿童交通性脑积水共86例,50例采用可调压分流管,36采用固定压分流管。对两组的成功率和并发症进行分析比较。结果可调压组首次手术成功率84.00%,固定压组首次手术成功率63.89%,两组间比较差异有统计学意义(χ2=4.587, P<0.05)。可调压组并发症发生率16.00%,固定压组并发症发生率36.11%,两组间比较差异有统计学意义(χ2=4.587, P<0.05)。分流不足和过度分流病例占固定压组并发症总数的69.23%,可调压组无分流不足和过度分流病例。结论可调压分流管的个体化调节功能符合儿童生长发育特点,能有效降低并发症发生率、提高治疗效果,在儿童交通性脑积水VPS治疗中较固定压分流管有明显优势。%Objective To explore the advantages and application of adjustable shunt valve in treatment of chil-dren with Communicating hydrocephalus. Methods Eighty six consecutive children undergoing surgery treatment for Communicating hydrocephalus from January 2006 to July 2011 were included in this retrospective study. Fifty cases re-ceived adjustable shunt valve whereas the rest received standard shunt valve. Results The success rate was 84.00% in the adjustable shunt valve group and 63.89%in the standard shunt valve group. Complication rate was 16.00%in the ad-justable shunt valve group and 36.11% in the standard shunt valve group. Inadequate and excessive shunt rate was 69.23% in the standard shunt valve group and zero% in adjustable shunt valve group. Compared with standard shunt valve group, adjustable shunt valve group had significantly higher success rate and lower complication rate (All P<0.05). Conclusions Adjustable shunt valve effectively reduce the complication rate and improve

  16. A case-based, small-group cooperative learning course in preclinical veterinary science aimed at bridging basic science and clinical literacy.

    Science.gov (United States)

    Schoeman, J P; van Schoor, M; van der Merwe, L L; Meintjes, R A

    2009-03-01

    In 1999 a dedicated problem-based learning course was introduced into the lecture-based preclinical veterinary curriculum of the University of Pretoria. The Introduction to Clinical Studies Course combines traditional lectures, practical sessions, student self-learning and guided tutorials. The self-directed component of the course utilises case-based, small-group cooperative learning as an educational vehicle to link basic science with clinical medicine. The aim of this article is to describe the objectives and structure of the course and to report the results of the assessment of the students' perceptions on some aspects of the course. Students reacted very positively to the ability of the course to equip them with problem-solving skills. Students indicated positive perceptions about the workload of the course. There were, however, significantly lower scores for the clarity of the course objectives. Although the study guide for the course is very comprehensive, the practice regarding the objectives is still uncertain. It is imperative to set clear objectives in non-traditional, student-centred courses. The objectives have to be explained at the outset and reiterated throughout the course. Tutors should also communicate the rationale behind problem-based learning as a pedagogical method to the students. Further research is needed to verify the effectiveness of this course in bridging the gap between basic science and clinical literacy in veterinary science. Ongoing feedback and assessment of the management and content are important to refine this model for integrating basic science with clinical literacy. PMID:19653516

  17. Adjustments and Depression

    Medline Plus

    Full Text Available ... a specific question, our information specialists are available business weekdays, Monday through Friday, toll-free at 800- ... to cerebral palsy support groups and organizations, including: Model Systems Knowledge Translation Center (MSKTC) maintains factsheets on ...

  18. Adjustments and Depression

    Medline Plus

    Full Text Available ... reach out to cerebral palsy support groups and organizations, including: Model Systems Knowledge Translation Center (MSKTC) maintains ... is a registered 501(c)(3) tax-exempt organization

  19. High Accuracy of Common HIV-Related Oral Disease Diagnoses by Non-Oral Health Specialists in the AIDS Clinical Trial Group.

    Directory of Open Access Journals (Sweden)

    Caroline H Shiboski

    Full Text Available Many studies include oral HIV-related endpoints that may be diagnosed by non-oral-health specialists (non-OHS like nurses or physicians. Our objective was to assess the accuracy of clinical diagnoses of HIV-related oral lesions made by non-OHS compared to diagnoses made by OHS.A5254, a cross-sectional study conducted by the Oral HIV/AIDS Research Alliance within the AIDS Clinical Trial Group, enrolled HIV-1-infected adults participants from six clinical trial units (CTU in the US (San Francisco, New York, Chapel Hill, Cleveland, Atlanta and Haiti. CTU examiners (non-OHS received standardized training on how to perform an oral examination and make clinical diagnoses of specific oral disease endpoints. Diagnoses by calibrated non-OHS were compared to those made by calibrated OHS, and sensitivity and specificity computed.Among 324 participants, the majority were black (73%, men (66%, and the median CD4+ cell count 138 cells/mm(3. The overall frequency of oral mucosal disease diagnosed by OHS was 43% in US sites, and 90% in Haiti. Oral candidiasis (OC was detected in 153 (47% by OHS, with erythematous candidiasis (EC the most common type (39% followed by pseudomembranous candidiasis (PC; 26%. The highest prevalence of OC (79% was among participants in Haiti, and among those with CD4+ cell count ≤ 200 cells/mm(3 and HIV-1 RNA > 1000 copies/mL (71%. The sensitivity and specificity of OC diagnoses by non-OHS were 90% and 92% (for EC: 81% and 94%; PC: 82% and 95%. Sensitivity and specificity were also high for KS (87% and 94%, respectively, but sensitivity was < 60% for HL and oral warts in all sites combined. The Candida culture confirmation of OC clinical diagnoses (as defined by ≥ 1 colony forming unit per mL of oral/throat rinse was ≥ 93% for both PC and EC.Trained non-OHS showed high accuracy of clinical diagnoses of OC in comparison with OHS, suggesting their usefulness in studies in resource-poor settings, but detection of less common

  20. Exploration adjustment by ant colonies.

    Science.gov (United States)

    Doran, Carolina; Stumpe, Martin C; Sendova-Franks, Ana; Franks, Nigel R

    2016-01-01

    How do animals in groups organize their work? Division of labour, i.e. the process by which individuals within a group choose which tasks to perform, has been extensively studied in social insects. Variability among individuals within a colony seems to underpin both the decision over which tasks to perform and the amount of effort to invest in a task. Studies have focused mainly on discrete tasks, i.e. tasks with a recognizable end. Here, we study the distribution of effort in nest seeking, in the absence of new nest sites. Hence, this task is open-ended and individuals have to decide when to stop searching, even though the task has not been completed. We show that collective search effort declines when colonies inhabit better homes, as a consequence of a reduction in the number of bouts (exploratory events). Furthermore, we show an increase in bout exploration time and a decrease in bout instantaneous speed for colonies inhabiting better homes. The effect of treatment on bout effort is very small; however, we suggest that the organization of work performed within nest searching is achieved both by a process of self-selection of the most hard-working ants and individual effort adjustment. PMID:26909180

  1. New adjustable suture technique for trabeculectomy

    Directory of Open Access Journals (Sweden)

    Vespasiano Rebouças-Santos

    2013-06-01

    Full Text Available PURPOSE: To describe an adjustable suture (AS experimental model that allows for tightening, loosening and retightening of the suture tension in trabeculectomy. METHODS: Standard trabeculectomy was performed in fifteen pig eyeballs. All pig eyes were tested twice: one test with conventional suture in both flap's corners (conventional suture group and another test with a conventional suture at one corner and an adjustable suture in the other corner (AS group. The order in which each test was performed was defined by randomization. Intraocular pressure was measured at three time points: T1 when the knots were tightened; T2 when the AS was loosened or the conventional knot was removed; and T3 when the AS was retightened in the AS group or five minutes after the knot removal in the conventional suture group. RESULTS: The mean Intraocular pressure was similar between the two groups at time point 1 (p=0.97. However, significant Intraocular pressure differences were found between eyes in the conventional and adjustable suture groups at time points 2 (12.6 ± 4.2 vs 16.3 ± 2.3 cmH2O, respectively, p=0.006 and 3 (12.2 ± 4.0 vs 26.4 ± 1.7cmH2O, respectively; p=0.001. While the conventional technique allowed only Intraocular pressure reduction (following the knot removal; T2 and T3, the AS technique allowed both Intraocular pressure reduction (T2 and elevation (T3 through the management (loosening and retightening of the suture. CONCLUSION: This experimental model provides an effective noninvasive postoperative mechanism of suture tension adjustment.

  2. Do randomized clinical trials with inadequate blinding report enhanced placebo effects for intervention groups and nocebo effects for placebo groups? A protocol for a meta-epidemiological study of PDE-5 inhibitors

    Directory of Open Access Journals (Sweden)

    Feys Frederik

    2012-11-01

    Full Text Available Abstract Background Patients’ expectations of treatment effects may contribute to positive (placebo and negative (nocebo outcomes. The effect of patient expectations may be pronounced in subjectively assessed conditions, such as male erectile dysfunction. The aim of this project is to examine the magnitude of expectancy in trials of phosphodiesterase-5 inhibitors. We hypothesize that randomized controlled trials with inadequate blinding will report enhanced placebo effects for intervention groups and nocebo effects for placebo groups, compared with adequately blinded studies. Methods/design We will quantify the magnitude of expectancy by comparing the effect estimates of trials with inadequate and adequate blinding. Blinding will be assessed using four domains from the Cochrane ‘risk-of-bias’ tool: allocation concealment; blinding of patient; caregiver; and outcome assessor. Our secondary aim is to identify factors that can modify expectations, such as prior experience with the intervention and drug side effects. We will perform an electronic search using a combination of controlled vocabulary and free text words in the following databases: MEDLINE, EMBASE, CENTRAL, and a clinical trials register. We will include randomized controlled trials, with either parallel or crossover design, that compare one phosphodiesterase-5 inhibitor with a placebo. The study’s primary aim should be to investigate the efficacy of phosphodiesterase-5 inhibitors for treating male erectile dysfunction. Screening will take place at two levels: abstracts and titles, followed by full text reports. Two reviewers will independently extract data on the primary outcome and assess risk of bias. We will meta-analyze treatment effects, if appropriate, to assess the magnitude of enhanced placebo effects and nocebo effects in intervention and placebo groups, respectively. We will explore possible mediators of placebo and nocebo effects with subgroup and meta

  3. Klebsiella pneumoniae lipopolysaccharide O typing: revision of prototype strains and O-group distribution among clinical isolates from different sources and countries.

    Science.gov (United States)

    Hansen, D S; Mestre, F; Alberti, S; Hernández-Allés, S; Alvarez, D; Doménech-Sánchez, A; Gil, J; Merino, S; Tomás, J M; Benedí, V J

    1999-01-01

    We have previously described an inhibition enzyme-linked immunosorbent assay method for the O typing of O1 lipopolysaccharide from Klebsiella pneumoniae which overcomes the technical problems and limitations of the classical O-typing method. In this study, we have extended the method to all of the currently recognized O types. The method was validated by studying the prototype strains that have defined the O groups by the classical tube agglutinatination O-typing method. Based on these results, we confirmed the O types of 60 of 64 typeable strains, and we propose a revised O-antigenic scheme, with minor but necessary changes, consisting of serogroups or serotypes O1, O2, O2ac, O3, O4, O5, O7, O8, and O12. Application of this typing method to 638 K. pneumoniae clinical isolates from Denmark, Spain, and the United States from different sources (blood, urine, and others) showed that up to 80% of these isolates belong to serotypes or serogroups O1, O2, O3, and O5, independently of the source of isolation, and that a major group of nontypeable isolates, representing about 17% of the total, consists of half O+ and half O- strains. Differences were observed, however, in the prevalence of the lipopolysaccharide O types or groups, depending on the country and isolation source.

  4. Delay Adjusted Incidence Infographic

    Science.gov (United States)

    This Infographic shows the National Cancer Institute SEER Incidence Trends. The graphs show the Average Annual Percent Change (AAPC) 2002-2011. For Men, Thyroid: 5.3*,Liver & IBD: 3.6*, Melanoma: 2.3*, Kidney: 2.0*, Myeloma: 1.9*, Pancreas: 1.2*, Leukemia: 0.9*, Oral Cavity: 0.5, Non-Hodgkin Lymphoma: 0.3*, Esophagus: -0.1, Brain & ONS: -0.2*, Bladder: -0.6*, All Sites: -1.1*, Stomach: -1.7*, Larynx: -1.9*, Prostate: -2.1*, Lung & Bronchus: -2.4*, and Colon & Rectum: -3/0*. For Women, Thyroid: 5.8*, Liver & IBD: 2.9*, Myeloma: 1.8*, Kidney: 1.6*, Melanoma: 1.5, Corpus & Uterus: 1.3*, Pancreas: 1.1*, Leukemia: 0.6*, Brain & ONS: 0, Non-Hodgkin Lymphoma: -0.1, All Sites: -0.1, Breast: -0.3, Stomach: -0.7*, Oral Cavity: -0.7*, Bladder: -0.9*, Ovary: -0.9*, Lung & Bronchus: -1.0*, Cervix: -2.4*, and Colon & Rectum: -2.7*. * AAPC is significantly different from zero (p<.05). Rates were adjusted for reporting delay in the registry. www.cancer.gov Source: Special section of the Annual Report to the Nation on the Status of Cancer, 1975-2011.

  5. Cultural similarity and adjustment of expatriate academics

    DEFF Research Database (Denmark)

    Selmer, Jan; Lauring, Jakob

    2009-01-01

    results also are applicable to other groups of expatriates. To explore this eventuality, an electronic survey was directed towards expatriate academics in 34 universities in five European countries. For the purpose of this study, they were sorted into two groups, expatriate academics from EU countries and...... non-EU countries. Results showed that although the perceived cultural similarity between host and home country for the two groups of investigated respondents was different, there was neither any difference in their adjustment nor in the time it took for them to become proficient. Implications of these...

  6. Parental alcohol use and adolescent school adjustment in the general population: Results from the HUNT study

    Directory of Open Access Journals (Sweden)

    Røysamb Espen

    2011-09-01

    Full Text Available Abstract Background This study investigates the relationship between parental drinking and school adjustment in a total population sample of adolescents, with independent reports from mothers, fathers, and adolescents. As a group, children of alcohol abusers have previously been found to exhibit lowered academic achievement. However, few studies address which parts of school adjustment that may be impaired. Both a genetic approach and social strains predict elevated problem scores in these children. Previous research has had limitations such as only recruiting cases from clinics, relying on single responders for all measures, or incomplete control for comorbid psychopathology. The specific effects of maternal and paternal alcohol use are also understudied. Methods In a Norwegian county, 88% of the population aged 13-19 years participated in a health survey (N = 8984. Among other variables, adolescents reported on four dimensions of school adjustment, while mothers and fathers reported their own drinking behaviour. Mental distress and other control variables were adjusted for. Multivariate analysis including generalized estimation equations was applied to investigate associations. Results Compared to children of light drinkers, children of alcohol abusers had moderately elevated attention and conduct problem scores. Maternal alcohol abuse was particularly predictive of such problems. Children of abstainers did significantly better than children of light drinkers. Controlling for adolescent mental distress reduced the association between maternal abuse and attention problems. The associations between parental reported drinking and school adjustment were further reduced when controlling for the children's report of seeing their parents drunk, which itself predicted school adjustment. Controlling for parental mental distress did not reduce the associations. Conclusions Parental alcohol abuse is an independent risk factor for attention and conduct

  7. AIDS Clinical Trials Group Network

    Science.gov (United States)

    ... Search About Our Mission History of the ACTG Network Leadership Committees Organizational Matrix (PDF - 68 KB) State ... Guidelines Annual Progress Reports Leadership and Operations Center Network Coordinating Center Statistical and Data Management Center Performance ...

  8. Fixed combination of cinnarizine and dimenhydrinate versus betahistine dimesylate in the treatment of Ménière's disease: a randomized, double-blind, parallel group clinical study.

    Science.gov (United States)

    Novotný, Miroslav; Kostrica, Rom

    2002-01-01

    In a randomized, double-blind clinical study, we evaluated the efficacy and tolerability of the fixed combination of cinnarizine, 20 mg, and dimenhydrinate, 40 mg (Arlevert [ARL]) in comparison to betahistine dimesylate (12 mg) in 82 patients suffering from Ménière's disease for at least 3 months and showing the characteristic triad of symptoms (paroxysmal vertigo attacks, cochlear hearing loss, and tinnitus). The treatment (one tablet three times daily) extended to 12 weeks, with control visits at 1, 3, 6, and 12 weeks after drug intake. The study demonstrated for both the fixed-combination ARL and for betahistine a highly efficient reduction of vertigo symptoms in the course of the 12 weeks of treatment; however, no statistically significant difference between the two treatment groups could be established. Similar results were found for tinnitus (approximately 60% reduction) and for the associated vegetative symptoms (almost complete disappearance). Vestibulospinal reactions, recorded by means of craniocorpography, also improved distinctly, with a statistically significant superiority of ARL versus betahistine (p < .042) for the parameter of lateral sway (Unterberger's test). The caloric tests (electronystagmography) showed only minor changes for both treatment groups in the course of the study. A statistically significant improvement of hearing function of the affected ear (p = .042) was found for the combination preparation after 12 weeks of treatment. The tolerability was judged by the vast majority of patients (97.5%) in both groups to be very good. Only one patient (betahistine group) reported a nonserious adverse event, and two betahistine patients did not complete the study. In conclusion, the combination preparation proved to be a highly efficient and safe treatment option for Ménière's disease and may be used both in the management of acute episodes and in long-term treatment. Efficacy and safety were found to be similar to the widely used standard

  9. Changing the Ties That Bind? The Emerging Roles and Identities of General Practitioners and Managers in the New Clinical Commissioning Groups in the English NHS

    Directory of Open Access Journals (Sweden)

    Julia Segar

    2014-10-01

    Full Text Available The English National Health Service (NHS is undergoing significant reorganization following the 2012 Health and Social Care Act. Key to these changes is the shift of responsibility for commissioning services from Primary Care Trusts (PCTs to general practitioners (GPs working together in Clinical Commissioning Groups (CCGs. This article is based on an empirical study that examined the development of emerging CCGs in eight case studies across England between September 2011 and June 2012. The findings are based on interviews with GPs and managers, observations of meetings, and reading of related documents. Scott’s notion that institutions are constituted by three pillars—the regulative, normative, and cognitive–cultural—is explored here. This approach helps to understand the changing roles and identities of doctors and managers implicated by the present reforms. This article notes the far reaching changes in the regulative pillar and questions how these changes will affect the normative and cultural–cognitive pillars.

  10. The role of European Federation of Clinical Chemistry and Laboratory Medicine Working Group for Preanalytical Phase in standardization and harmonization of the preanalytical phase in Europe

    DEFF Research Database (Denmark)

    Cornes, Michael P; Church, Stephen; van Dongen-Lases, Edmée;

    2016-01-01

    and Laboratory Medicine Working Group for Preanalytical Phase (EFLM WG-PRE) was established to lead in standardization and harmonization of preanalytical policies and practices at a European level. One of the key activities of the WG-PRE is the organization of the biennial EFLM-BD conference on the preanalytical......Patient safety is a leading challenge in healthcare and from the laboratory perspective it is now well established that preanalytical errors are the major contributor to the overall rate of diagnostic and therapeutic errors. To address this, the European Federation of Clinical Chemistry...... summarises the work that has and will be done in these areas. The goal of this initiative is to ensure the EFLM WG-PRE produces work that meets the needs of the European laboratory medicine community. Progress made in the identified areas will be updated at the next preanalytical phase conference and show...

  11. Klebsiella pneumoniae lipopolysaccharide O typing: revision of prototype strains and O-group distribution among clinical isolates from different sources and countries

    DEFF Research Database (Denmark)

    Hansen, D S; Mestre, F; Alberti, S;

    1999-01-01

    We have previously described an inhibition enzyme-linked immunosorbent assay method for the O typing of O1 lipopolysaccharide from Klebsiella pneumoniae which overcomes the technical problems and limitations of the classical O-typing method. In this study, we have extended the method to all......, with minor but necessary changes, consisting of serogroups or serotypes O1, O2, O2ac, O3, O4, O5, O7, O8, and O12. Application of this typing method to 638 K. pneumoniae clinical isolates from Denmark, Spain, and the United States from different sources (blood, urine, and others) showed that up to 80......% of these isolates belong to serotypes or serogroups O1, O2, O3, and O5, independently of the source of isolation, and that a major group of nontypeable isolates, representing about 17% of the total, consists of half O+ and half O- strains. Differences were observed, however, in the prevalence...

  12. 'Schizoid' personality in childhood and adult life. II: Adult adjustment and the continuity with schizotypal personality disorder.

    Science.gov (United States)

    Wolff, S; Townshend, R; McGuire, R J; Weeks, D J

    1991-11-01

    In a controlled follow-up study into adulthood of 32 children diagnosed 'schizoid', three-quarters fulfilled DSM-III criteria for schizotypal personality disorder and two developed schizophrenia. Overall their psychosocial adjustment was somewhat, but not markedly, worse than that of other attenders at a child psychiatry clinic, although as a group they remained more solitary, lacking in empathy, oversensitive, with odd styles of communicating, and often with circumscribed interests.

  13. Introduction of online adaptive radiotherapy for bladder cancer through a multicentre clinical trial (Trans-Tasman Radiation Oncology Group 10.01): lessons learned

    International Nuclear Information System (INIS)

    Online adaptive radiotherapy for bladder cancer is a novel radiotherapy technique that was found feasible in a pilot study at a single academic institution. In September 2010 this technique was opened as a multicenter study through the Trans-Tasman Radiation Oncology Group (TROG 10.01 bladder online adaptive radiotherapy treatment). Twelve centers across Australia and New-Zealand registered interest into the trial. A multidisciplinary team of radiation oncologists, radiation therapists and medical physicists represented the trial credentialing and technical support team. To provide timely activation and proper implementation of the adaptive technique the following key areas were addressed at each site: Staff education/training; Practical image guided radiotherapy assessment; provision of help desk and feedback. The trial credentialing process involved face-to-face training and technical problem solving via full day site visits. A dedicated 'help-desk' team was developed to provide support for the clinical trial. 26% of the workload occurred at the credentialing period while the remaining 74% came post-center activation. The workload was made up of the following key areas; protocol clarification (36%), technical problems (46%) while staff training was less than 10%. Clinical trial credentialing is important to minimizing trial deviations. It should not only focus on site activation quality assurance but also provide ongoing education and technical support. (author)

  14. Introduction of online adaptive radiotherapy for bladder cancer through a multicentre clinical trial (Trans-Tasman Radiation Oncology Group 10.01: Lessons learned

    Directory of Open Access Journals (Sweden)

    Daniel Pham

    2013-01-01

    Full Text Available Online adaptive radiotherapy for bladder cancer is a novel radiotherapy technique that was found feasible in a pilot study at a single academic institution. In September 2010 this technique was opened as a multicenter study through the Trans-Tasman Radiation Oncology Group (TROG 10.01 bladder online adaptive radiotherapy treatment. Twelve centers across Australia and New-Zealand registered interest into the trial. A multidisciplinary team of radiation oncologists, radiation therapists and medical physicists represented the trial credentialing and technical support team. To provide timely activation and proper implementation of the adaptive technique the following key areas were addressed at each site: Staff education/training; Practical image guided radiotherapy assessment; provision of help desk and feedback. The trial credentialing process involved face-to-face training and technical problem solving via full day site visits. A dedicated "help-desk" team was developed to provide support for the clinical trial. 26% of the workload occurred at the credentialing period while the remaining 74% came post-center activation. The workload was made up of the following key areas; protocol clarification (36%, technical problems (46% while staff training was less than 10%. Clinical trial credentialing is important to minimizing trial deviations. It should not only focus on site activation quality assurance but also provide ongoing education and technical support.

  15. Metric-adjusted skew information

    DEFF Research Database (Denmark)

    Liang, Cai; Hansen, Frank

    2010-01-01

    We give a truly elementary proof of the convexity of metric-adjusted skew information following an idea of Effros. We extend earlier results of weak forms of superadditivity to general metric-adjusted skew information. Recently, Luo and Zhang introduced the notion of semi-quantum states...... on a bipartite system and proved superadditivity of the Wigner-Yanase-Dyson skew informations for such states. We extend this result to the general metric-adjusted skew information. We finally show that a recently introduced extension to parameter values 1 information is a special case...... of (unbounded) metric-adjusted skew information....

  16. Adjustment computations spatial data analysis

    CERN Document Server

    Ghilani, Charles D

    2011-01-01

    the complete guide to adjusting for measurement error-expanded and updated no measurement is ever exact. Adjustment Computations updates a classic, definitive text on surveying with the latest methodologies and tools for analyzing and adjusting errors with a focus on least squares adjustments, the most rigorous methodology available and the one on which accuracy standards for surveys are based. This extensively updated Fifth Edition shares new information on advances in modern software and GNSS-acquired data. Expanded sections offer a greater amount of computable problems and their worked solu

  17. Conduct problems, depressive symptomatology and their co-occurring presentation in childhood as predictors of adjustment in early adolescence.

    Science.gov (United States)

    Ingoldsby, Erin M; Kohl, Gwynne O; McMahon, Robert J; Lengua, Liliana

    2006-10-01

    The present study investigated patterns in the development of conduct problems (CP), depressive symptoms, and their co-occurrence, and relations to adjustment problems, over the transition from late childhood to early adolescence. Rates of depressive symptoms and CP during this developmental period vary by gender; yet, few studies involving non-clinical samples have examined co-occurring problems and adjustment outcomes across boys and girls. This study investigates the manifestation and change in CP and depressive symptom patterns in a large, multisite, gender-and ethnically-diverse sample of 431 youth from 5th to 7th grade. Indicators of CP, depressive symptoms, their co-occurrence, and adjustment outcomes were created from multiple reporters and measures. Hypotheses regarding gender differences were tested utilizing both categorical (i.e., elevated symptom groups) and continuous analyses (i.e., regressions predicting symptomatology and adjustment outcomes). Results were partially supportive of the dual failure model (Capaldi, 1991, 1992), with youth with co-occurring problems in 5th grade demonstrating significantly lower academic adjustment and social competence two years later. Both depressive symptoms and CP were risk factors for multiple negative adjustment outcomes. Co-occurring symptomatology and CP demonstrated more stability and was associated with more severe adjustment problems than depressive symptoms over time. Categorical analyses suggested that, in terms of adjustment problems, youth with co-occurring symptomatology were generally no worse off than those with CP-alone, and those with depressive symptoms-alone were similar over time to those showing no symptomatology at all. Few gender differences were noted in the relations among CP, depressive symptoms, and adjustment over time. PMID:16967336

  18. Padrões clínicos de acne em mulheres de diferentes faixas etárias Acne in women: clinical patterns in different age-groups

    Directory of Open Access Journals (Sweden)

    Juliano Vilaverde Schmitt

    2009-08-01

    Full Text Available FUNDAMENTOS: Acne é dermatose comum que acomete ambos os gêneros e todas as faixas etárias. Mulheres apresentam diferentes padrões clínicos da doença, além de frequente persistência da acne após a adolescência. OBJETIVO: Analisar características clínicas e epidemiológicas associadas às diferentes faixas etárias acometidas por acne feminina. MÉTODOS: Estudo transversal envolvendo mulheres com diagnóstico de acne, atendidas em ambulatório de dermatologia geral. Variáveis relacionadas à doença e às pacientes foram avaliadas com o emprego de questionário padronizado. RESULTADOS: Avaliaram-se 103 pacientes, cuja idade média na época da consulta foi 21,7 ± 7,3 anos. Definiram-se dois subgrupos com idade de corte de 21 anos e idades médias de 15,8 ± 2,3 e 28,0 ± 5,1 anos. Houve correlação entre a duração do quadro e a idade das pacientes na consulta (R = 0,7. Observaram-se diferenças entre os grupos nas frequências de uso de contraceptivo oral combinado (OR = 48,1, lesões no colo (OR = 11,6, lesões no dorso (OR = 0,2, predominância na topografia superior da face (OR = 0,1 e idade de início das lesões (OR = 1,8. No grupo de mulheres adultas, 80% relataram início do quadro antes dos 20 anos. CONCLUSÕES: Identificaram-se padrões clínicos cronológicos e topográficos que caracterizaram a acne feminina em diferentes faixas etárias, alertando para a importância da abordagem diagnóstica e terapêutica individualizada.BACKGROUND: Acne is a frequent skin disease that occurs in both sexes and all age-groups. Women present several clinical disease patterns; moreover, persistence after adolescence is common. OBJECTIVE: To analyze clinical and epidemiological characteristics associated with different age-groups affected by acne in women. METHODS: Cross-sectional study involving female patients diagnosed with acne, at a general dermatology outpatient clinic. Variables related to disease and patients were assessed

  19. Variance Adjusted Actor Critic Algorithms

    OpenAIRE

    Tamar, Aviv; Mannor, Shie

    2013-01-01

    We present an actor-critic framework for MDPs where the objective is the variance-adjusted expected return. Our critic uses linear function approximation, and we extend the concept of compatible features to the variance-adjusted setting. We present an episodic actor-critic algorithm and show that it converges almost surely to a locally optimal point of the objective function.

  20. Spousal Adjustment to Myocardial Infarction.

    Science.gov (United States)

    Ziglar, Elisa J.

    This paper reviews the literature on the stresses and coping strategies of spouses of patients with myocardial infarction (MI). It attempts to identify specific problem areas of adjustment for the spouse and to explore the effects of spousal adjustment on patient recovery. Chapter one provides an overview of the importance in examining the…

  1. A complete generalized adjustment criterion

    NARCIS (Netherlands)

    Perković, Emilija; Textor, Johannes; Kalisch, Markus; Maathuis, Marloes H.

    2015-01-01

    Covariate adjustment is a widely used approach to estimate total causal effects from observational data. Several graphical criteria have been developed in recent years to identify valid covariates for adjustment from graphical causal models. These criteria can handle multiple causes, latent confound

  2. 可调压式分流管治疗正常压力脑积水的临床应用及护理体会%The clinical application and nursing experience of adjustable shunt valve in treatment for patients with normal pressure hydrocephalus

    Institute of Scientific and Technical Information of China (English)

    杨利容; 索鹏; 王晶; 姚远; 李德珍

    2012-01-01

    Objective To introduce the application of adjustable shunt valve in treatment for patients with normal pressure hydrocephalus. Methods Twenty - four patients with normal pressure hydrocephalus implanted adjustable shunt valve underwent ventriculo-peritoneal shunt surgery and nursing care. Results After operation, cerebrospinal pressure was regulated for 0-6 (1.88 ± 1.52) times. Clinical symptoms were improved, especially in gait disturbance. Conclusion Treatment of normal pressure hydrocephalus with adjustable shunt valve can alleviate symptoms of hydrocephalus. It is especially suitable for patients with short course and secondary normal hydrocephalus patients.%采用可调压式分流管治疗24例正常压力脑积水患者,根据影像学检查结果 和临床症状.术后分别调压0~6次,平均(1.88±1.52)次,患者临床症状得到明显改善,尤以步态障碍为首发症状者效果最佳.证明可调压式分流管能够缓解正常压力脑积水患者临床症状,尤其适用于病程短之继发性正常压力脑积水.

  3. Bayes linear covariance matrix adjustment

    CERN Document Server

    Wilkinson, Darren J

    1995-01-01

    In this thesis, a Bayes linear methodology for the adjustment of covariance matrices is presented and discussed. A geometric framework for quantifying uncertainties about covariance matrices is set up, and an inner-product for spaces of random matrices is motivated and constructed. The inner-product on this space captures aspects of our beliefs about the relationship between covariance matrices of interest to us, providing a structure rich enough for us to adjust beliefs about unknown matrices in the light of data such as sample covariance matrices, exploiting second-order exchangeability and related specifications to obtain representations allowing analysis. Adjustment is associated with orthogonal projection, and illustrated with examples of adjustments for some common problems. The problem of adjusting the covariance matrices underlying exchangeable random vectors is tackled and discussed. Learning about the covariance matrices associated with multivariate time series dynamic linear models is shown to be a...

  4. Parental Divorce and Children's Adjustment.

    Science.gov (United States)

    Lansford, Jennifer E

    2009-03-01

    This article reviews the research literature on links between parental divorce and children's short-term and long-term adjustment. First, I consider evidence regarding how divorce relates to children's externalizing behaviors, internalizing problems, academic achievement, and social relationships. Second, I examine timing of the divorce, demographic characteristics, children's adjustment prior to the divorce, and stigmatization as moderators of the links between divorce and children's adjustment. Third, I examine income, interparental conflict, parenting, and parents well-being as mediators of relations between divorce and children's adjustment. Fourth, I note the caveats and limitations of the research literature. Finally, I consider notable policies related to grounds for divorce, child support, and child custody in light of how they might affect children s adjustment to their parents divorce.

  5. Adjustment Disorder: epidemiology, diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Murru Andrea

    2009-06-01

    Full Text Available Abstract Background Adjustment Disorder is a condition strongly tied to acute and chronic stress. Despite clinical suggestion of a large prevalence in the general population and the high frequency of its diagnosis in the clinical settings, there has been relatively little research reported and, consequently, very few hints about its treatments. Methods the authors gathered old and current information on the epidemiology, clinical features, comorbidity, treatment and outcome of adjustment disorder by a systematic review of essays published on PUBMED. Results After a first glance at its historical definition and its definition in the DSM and ICD systems, the problem of distinguishing AD from other mood and anxiety disorders, the difficulty in the definition of stress and the implied concept of 'vulnerability' are considered. Comorbidity of AD with other conditions, and outcome of AD are then analyzed. This review also highlights recent data about trends in the use of antidepressant drugs, evidence on their efficacy and the use of psychotherapies. Conclusion AD is a very common diagnosis in clinical practice, but we still lack data about its rightful clinical entity. This may be caused by a difficulty in facing, with a purely descriptive methods, a "pathogenic label", based on a stressful event, for which a subjective impact has to be considered. We lack efficacy surveys concerning treatment. The use of psychotropic drugs such as antidepressants, in AD with anxious or depressed mood is not properly supported and should be avoided, while the usefulness of psychotherapies is more solidly supported by clinical evidence. To better determine the correct course of therapy, randomized-controlled trials, even for the combined use of drugs and psychotherapies, are needed vitally, especially for the resistant forms of AD.

  6. Radiotherapy quality assurance review in a multi-center randomized trial of limited-disease small cell lung cancer: the Japan Clinical Oncology Group (JCOG) trial 0202

    International Nuclear Information System (INIS)

    The purpose of this study was to analyze the radiotherapy (RT) quality assurance (QA) assessment in Japan Clinical Oncology Group (JCOG) 0202, which was the first trial that required on-going RT QA review in the JCOG. JCOG 0202 was a multi-center phase III trial comparing two types of consolidation chemotherapy after concurrent chemoradiotherapy for limited-disease small cell lung cancer. RT requirements included a total dose of 45 Gy/30 fx (bis in die, BID/twice a day) without heterogeneity correction; elective nodal irradiation (ENI) of 30 Gy; at least 1 cm margin around the clinical target volume (CTV); and interfraction interval of 6 hours or longer. Dose constraints were defined in regards to the spinal cord and the lung. The QA assessment was classed as per protocol (PP), deviation acceptable (DA), violation unacceptable (VU), and incomplete/not evaluable (I/NE). A total of 283 cases were accrued, of which 204 were fully evaluable, excluding 79 I/NE cases. There were 18 VU in gross tumor volume (GTV) coverage (8% of 238 evaluated); 4 VU and 23 DA in elective nodal irradiation (ENI) (2% and 9% of 243 evaluated, respectively). Some VU were observed in organs at risk (1 VU in the lung and 5 VU in the spinal cord). Overall RT compliance (PP + DA) was 92% (187 of 204 fully evaluable). Comparison between the former and latter halves of the accrued cases revealed that the number of VU and DA had decreased. The results of the RT QA assessment in JCOG 0202 seemed to be acceptable, providing reliable results

  7. Vesicular monoamine transporter protein expression correlates with clinical features, tumor biology, and MIBG avidity in neuroblastoma: a report from the Children's Oncology Group

    Energy Technology Data Exchange (ETDEWEB)

    Temple, William; Mendelsohn, Lori; Nekritz, Erin; Gustafson, W.C.; Matthay, Katherine K. [UCSF School of Medicine, Department of Pediatrics, San Francisco, CA (United States); UCSF Benioff Children' s Hospital, San Francisco, CA (United States); Kim, Grace E. [UCSF School of Medicine, Department of Pathology, San Francisco, CA (United States); Lin, Lawrence; Giacomini, Kathy [UCSF School of Pharmacy, Department of Bioengineering and Therapeutic Sciences, San Francisco, CA (United States); Naranjo, Arlene; Van Ryn, Collin [University of Florida, Children' s Oncology Group Statistics and Data Center, Gainesville, FL (United States); Yanik, Gregory A. [University of Michigan, CS Mott Children' s Hospital, Ann Arbor, MI (United States); Kreissman, Susan G. [Duke University Medical Center, Durham, NC (United States); Hogarty, Michael [University of Pennsylvania, Children' s Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, PA (United States); DuBois, Steven G. [UCSF School of Medicine, Department of Pediatrics, San Francisco, CA (United States); UCSF Benioff Children' s Hospital, San Francisco, CA (United States); UCSF School of Medicine, San Francisco, CA (United States)

    2016-03-15

    Vesicular monoamine transporters 1 and 2 (VMAT1 and VMAT2) are thought to mediate MIBG uptake in adult neuroendocrine tumors. In neuroblastoma, the norepinephrine transporter (NET) has been investigated as the principal MIBG uptake protein, though some tumors without NET expression concentrate MIBG. We investigated VMAT expression in neuroblastoma and correlated expression with MIBG uptake and clinical features. We evaluated VMAT1 and VMAT2 expression by immunohistochemistry (IHC) in neuroblastoma tumors from 76 patients with high-risk metastatic disease treated in a uniform cooperative group trial (COG A3973). All patients had baseline MIBG diagnostic scans centrally reviewed. IHC results were scored as the product of intensity grading (0 - 3+) and percent of tumor cells expressing the protein of interest. The association between VMAT1 and VMAT2 scores and clinical and biological features was tested using Wilcoxon rank-sum tests. Patient characteristics were typical of high-risk neuroblastoma, though the cohort was intentionally enriched in patients with MIBG-nonavid tumors (n = 20). VMAT1 and VMAT2 were expressed in 62 % and 75 % of neuroblastoma tumors, respectively. VMAT1 and VMAT2 scores were both significantly lower in MYCN amplified tumors and in tumors with high mitotic karyorrhectic index. MIBG-avid tumors had significantly higher VMAT2 scores than MIBG-nonavid tumors (median 216 vs. 45; p = 0.04). VMAT1 expression did not correlate with MIBG avidity. VMAT1 and VMAT2 are expressed in the majority of neuroblastomas. Expression correlates with other biological features. The expression level of VMAT2 but not that of VMAT1 correlates with avidity for MIBG. (orig.)

  8. A Novel Biomarker Panel Examining Response to Gemcitabine with or without Erlotinib for Pancreatic Cancer Therapy in NCIC Clinical Trials Group PA.3.

    Directory of Open Access Journals (Sweden)

    David B Shultz

    Full Text Available NCIC Clinical Trials Group PA.3 was a randomized control trial that demonstrated improved overall survival (OS in patients receiving erlotinib in addition to gemcitabine for locally advanced or metastatic pancreatic cancer. Prior to therapy, patients had plasma samples drawn for future study. We sought to identify biomarkers within these samples.Using the proximity ligation assay (PLA, a probe panel was built from commercially available antibodies for 35 key proteins selected from a global genetic analysis of pancreatic cancers, and used to quantify protein levels in 20 uL of patient plasma. To determine if any of these proteins levels independently associated with OS, univariate and mulitbaraible Cox models were used. In addition, we examined the associations between biomarker expression and disease stage at diagnosis using Fisher's exact test. The correlation between Erlotinib sensitivity and each biomarkers was assessed using a test of interaction between treatment and biomarker.Of the 569 eligible patients, 480 had samples available for study. Samples were randomly allocated into training (251 and validation sets (229. Among all patients, elevated levels of interleukin-8 (IL-8, carcinoembryonic antigen (CEA, hypoxia-inducible factor 1-alpha (HIF-1 alpha, and interleukin-6 were independently associated with lower OS, while IL-8, CEA, platelet-derived growth factor receptor alpha and mucin-1 were associated with metastatic disease. Patients with elevated levels of receptor tyrosine-protein kinase erbB-2 (HER2 expression had improved OS when treated with erlotinib compared to placebo. In conclusion, PLA is a powerful tool for identifying biomarkers from archived, small volume serum samples. These data may be useful to stratify patient outcomes regardless of therapeutic intervention.ClinicalTrials.gov NCT00040183.

  9. Observational study of patients with gastroenteropancreatic and bronchial neuroendocrine tumors in Argentina: Results from the large database of a multidisciplinary group clinical multicenter study

    Science.gov (United States)

    O’CONNOR, JUAN MANUEL; MARMISSOLLE, FABIANA; BESTANI, CLAUDIA; PESCE, VERONICA; BELLI, SUSANA; DOMINICHINI, ENZO; MENDEZ, GUILLERMO; PRICE, PAOLA; GIACOMI, NORA; PAIROLA, ALEJANDRO; LORIA, FERNANDO SÁNCHEZ; HUERTAS, EDUARDO; MARTIN, CLAUDIO; PATANE, KARINA; POLERI, CLAUDIA; ROSENBERG, MOISES; CABANNE, ANA; KUJARUK, MIRTA; CAINO, ANALIA; ZAMORA, VICTOR; MARIANI, JAVIER; DIOCA, MARIANO; PARMA, PATRICIA; PODESTA, GUSTAVO; ANDRIANI, OSCAR; GONDOLESI, GABRIEL; ROCA, ENRIQUE

    2014-01-01

    Neuroendocrine tumors (NET) include a spectrum of malignancies arising from neuroendocrine cells throughout the body. The objective of this clinical investigation of retrospectively and prospectively collected data was to describe the prevalence, demographic data, clinical symptoms and methods of diagnosis of NET and the treatment and long-term follow-up of patients with NET. Data were provided by the participating centers and assessed for consistency by internal reviewers. All the cases were centrally evaluated (when necessary) by the pathologists in our group. The tissue samples were reviewed by hematoxylin and eosin and immunohistochemical staining techniques to confirm the diagnosis of NET. In total, 532 cases were documented: 461 gastroenteropancreatic-NET (GEP-NET) and 71 bronchial NET (BNET). All the tumors were immunohistochemically defined according to the World Health Organization (WHO) and European Neuroendocrine Tumor Society criteria. The most common initial symptoms in GEP-NET were abdominal pain, diarrhea, bowel obstruction, flushing, gastrointestinal bleeding and weight loss. The most common tumor types were carcinoid (58.0%), non-functional pancreatic tumor (23.0%), metastatic NET of unknown primary (16.0%) and functional pancreatic tumor (3.0%). Of the BNET, 89.0% were typical and 11.0% atypical carcinoids. Of the patients with GEP-NET, 59.2% had distant metastasis at diagnosis. The locations of the primary tumors in GEP-NET were the small bowel (26.9%), pancreas (25.2%), colon-rectum (12.4%), appendix (7.6%), stomach (6.9%), esophagus (2.8%), duodenum (2.0%) and unknown primary (16.3%). The histological subtypes based on the WHO classification were well-differentiated NET (20.1%), well-differentiated neuroendocrine carcinomas (66.5%) and poorly differentiated neuroendocrine carcinomas (10.3%). Overall, 67.3% of the patients underwent surgery, 41.2% with curative intent and 26.1% for palliative purposes. The 5-year survival rates were 65.1% (95

  10. Intraoperative maximal urethral closing pressure measurement: a new technique of tape tension adjustment in transobturator sling surgery?

    Directory of Open Access Journals (Sweden)

    Myung Beum Kang

    2011-12-01

    Full Text Available PURPOSE: Tape tension adjustment is an essential procedure in mid-urethral sling surgery. The goal of this study was to determine if intraoperative maximal urethral closing pressure (MUCP elevation could be used as a reference value for adequate tape tension adjustment and predict transobturator (TOT sling surgery outcome. MATERIALS AND METHODS: A prospective study was performed using MUCP measurements just before tape insertion and just after tension adjustment during surgery. Clinical data including preoperative urodynamic results were collected. The cure rate was determined by questionnaire. Patients were divided into two groups. The MUCP elevation group included patients with a MUCP elevation of more than 10 cmH2O before tape insertion; the others were regarded as the non-elevation group. The cure rate and pre- and postoperative clinical variables were compared between the two groups. RESULTS: A total of 48 patients had TOT surgery. The MUCP elevation group (n=19 and the non-elevation group (n=29 were similar with regard to patient characteristics and the preoperative parameters including age, mixed incontinence prevalence, Q-tip angle, peak flow rate, MUCP and the valsalva leak point pressure (VLPP. The mean follow-up period was nine months. The cure rate was significantly higher in the group with MUCP elevation than in the non-elevation group (84% vs. 52%, p=0.02. There was no significant difference in the mean postoperative peak flow rate between the two groups and there was no retention episode. CONCLUSIONS: MUCP elevation of more than 10 cmH2O just after tape insertion was a prognostic factor.

  11. The role of European Federation of Clinical Chemistry and Laboratory Medicine Working Group for Preanalytical Phase in standardization and harmonization of the preanalytical phase in Europe.

    Science.gov (United States)

    Cornes, Michael P; Church, Stephen; van Dongen-Lases, Edmée; Grankvist, Kjell; Guimarães, João T; Ibarz, Mercedes; Kovalevskaya, Svetlana; Kristensen, Gunn Bb; Lippi, Giuseppe; Nybo, Mads; Sprongl, Ludek; Sumarac, Zorica; Simundic, Ana-Maria

    2016-09-01

    Patient safety is a leading challenge in healthcare and from the laboratory perspective it is now well established that preanalytical errors are the major contributor to the overall rate of diagnostic and therapeutic errors. To address this, the European Federation of Clinical Chemistry and Laboratory Medicine Working Group for Preanalytical Phase (EFLM WG-PRE) was established to lead in standardization and harmonization of preanalytical policies and practices at a European level. One of the key activities of the WG-PRE is the organization of the biennial EFLM-BD conference on the preanalytical phase to provide a forum for National Societies (NS) to discuss their issues. Since 2012, a year after the first Preanalytical phase conference, there has been a rapid growth in the number of NS with a working group engaged in preanalytical phase activities and there are now at least 19 countries that have one. As a result of discussions with NS at the third conference held in March 2015 five key areas were identified as requiring harmonisation. These were test ordering, sample transport and storage, patient preparation, sampling procedures and management of unsuitable specimens. The article below summarises the work that has and will be done in these areas. The goal of this initiative is to ensure the EFLM WG-PRE produces work that meets the needs of the European laboratory medicine community. Progress made in the identified areas will be updated at the next preanalytical phase conference and show that we have produced guidance that has enhanced standardisation in the preanalytical phase and improved patient safety throughout Europe.

  12. Clinical observation about nursing intervention for primary insomnia treatment by the acupuncture method of adjustment and smoothing Ren and Du meridians%调任通督治疗失眠症实施护理干预的临床观察

    Institute of Scientific and Technical Information of China (English)

    丘凤贤; 皮敏; 缑燕华

    2012-01-01

    Objective To discuss the effect of the acupuncture method of adjustment and smoothing Ren and Du meridians on the patients with primary insomnia.Methods Fifty - seven patients with insomnia were randomly divided into control group (28 cases) and intervention group (29 cases).The patients in control group were treated with the acupuncture method of adjustment and smoothing Ren and Du meridians,and on basis of it,the patients in intervention group were treated with numing intervention additionally.The psychology health condition,sleep quality,curative effect,and compliance of two groups were observed and compared.Results The cure rate,psychology health condition,sleep quality,and compliance of intervention group were obviously superior to control group.Conclusions The acupuncture method of adjustment and smoothing Ren and Du meridians is an effective method of treating primary insomnia.%目的 探讨调任通督治疗并实施护理干预对失眠患者睡眠的影响.方法 将57例失眠患者随机分为对照组28例和干预组29例,对照组给予调任通督针剌治疗,干预组在调任通督治疗基础上实施护理干预,观察两组心理健康状况、睡眠质量、临床疗效及治疗依从性,并进行比较.结果 干预组治愈率明显高于对照组,心理健康状况、睡眠质量指标及对治疗的依从性亦明显优于对照组.结论 调任通督针刺并实施护理干预是治疗失眠症的有效方法.

  13. Radiation Therapy Oncology Group Consensus Panel Guidelines for the Delineation of the Clinical Target Volume in the Postoperative Treatment of Pancreatic Head Cancer

    International Nuclear Information System (INIS)

    Purpose: To develop contouring guidelines to be used in the Radiation Therapy Oncology Group protocol 0848, a Phase III randomized trial evaluating the benefit of adjuvant chemoradiation in patients with resected head of pancreas cancer. Methods and Materials: A consensus committee of six radiation oncologists with expertise in gastrointestinal radiotherapy developed stepwise contouring guidelines and an atlas for the delineation of the clinical target volume (CTV) in the postoperative treatment of pancreas cancer, based on identifiable regions of interest and margin expansions. Areas at risk for subclinical disease to be included in the CTV were defined, including nodal regions, anastomoses, and the preoperative primary tumor location. Regions of interest that could be reproducibly contoured on postoperative imaging after a pancreaticoduodenectomy were identified. Standardized expansion margins to encompass areas at risk were developed after multiple iterations to determine the optimal margin expansions. Results: New contouring recommendations based on CT anatomy were established. Written guidelines for the delineation of the postoperative CTV and normal tissues, as well as a Web-based atlas, were developed. Conclusions: The postoperative abdomen has been a difficult area for effective radiotherapy. These new guidelines will help physicians create fields that better encompass areas at risk and minimize dose to normal tissues.

  14. Radiation Therapy Oncology Group Consensus Panel Guidelines for the Delineation of the Clinical Target Volume in the Postoperative Treatment of Pancreatic Head Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Goodman, Karyn A., E-mail: goodmank@mskcc.org [Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Regine, William F. [University of Maryland School of Medicine, Baltimore, Maryland (United States); Dawson, Laura A. [Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); Ben-Josef, Edgar [University of Michigan Medical School, Ann Arbor, Michigan (United States); Haustermans, Karin [University Hospital Leuven, Leuven (Belgium); Bosch, Walter R. [Image-Guided Therapy QA Center, Washington University, St. Louis, Missouri (United States); Turian, Julius; Abrams, Ross A. [Rush University Medical College, Chicago, Illinois (United States)

    2012-07-01

    Purpose: To develop contouring guidelines to be used in the Radiation Therapy Oncology Group protocol 0848, a Phase III randomized trial evaluating the benefit of adjuvant chemoradiation in patients with resected head of pancreas cancer. Methods and Materials: A consensus committee of six radiation oncologists with expertise in gastrointestinal radiotherapy developed stepwise contouring guidelines and an atlas for the delineation of the clinical target volume (CTV) in the postoperative treatment of pancreas cancer, based on identifiable regions of interest and margin expansions. Areas at risk for subclinical disease to be included in the CTV were defined, including nodal regions, anastomoses, and the preoperative primary tumor location. Regions of interest that could be reproducibly contoured on postoperative imaging after a pancreaticoduodenectomy were identified. Standardized expansion margins to encompass areas at risk were developed after multiple iterations to determine the optimal margin expansions. Results: New contouring recommendations based on CT anatomy were established. Written guidelines for the delineation of the postoperative CTV and normal tissues, as well as a Web-based atlas, were developed. Conclusions: The postoperative abdomen has been a difficult area for effective radiotherapy. These new guidelines will help physicians create fields that better encompass areas at risk and minimize dose to normal tissues.

  15. Intravenous Autologous Bone Marrow Mononuclear Cell Transplantation for Stroke: Phase1/2a Clinical Trial in a Homogeneous Group of Stroke Patients.

    Science.gov (United States)

    Taguchi, Akihiko; Sakai, Chiaki; Soma, Toshihiro; Kasahara, Yukiko; Stern, David M; Kajimoto, Katsufumi; Ihara, Masafumi; Daimon, Takashi; Yamahara, Kenichi; Doi, Kaori; Kohara, Nobuo; Nishimura, Hiroyuki; Matsuyama, Tomohiro; Naritomi, Hiroaki; Sakai, Nobuyuki; Nagatsuka, Kazuyuki

    2015-10-01

    The goal of this clinical trial was to assess the feasibility and safety of transplanting autologous bone marrow mononuclear cells into patients suffering severe embolic stroke. Major inclusion criteria included patients with cerebral embolism, age 20-75 years, National Institute of Health Stroke Scale (NIHSS) score displaying improvement of ≤ 5 points during the first 7 days after stroke, and NIHSS score of ≥ 10 on day 7 after stroke. Bone marrow aspiration (25 or 50 mL; N = 6 patients in each case) was performed 7-10 days poststroke, and bone marrow mononuclear cells were administrated intravenously. Mean total transplanted cell numbers were 2.5 × 10(8) and 3.4 × 10(8) cells in the lower and higher dose groups, respectively. No apparent adverse effects of administering bone marrow cells were observed. Compared with the lower dose, patients receiving the higher dose of bone marrow cells displayed a trend toward improved neurologic outcomes. Compared with 1 month after treatment, patients receiving cell therapy displayed a trend toward improved cerebral blood flow and metabolic rate of oxygen consumption 6 months after treatment. In comparison with historical controls, patients receiving cell therapy had significantly better neurologic outcomes. Our results indicated that intravenous transplantation of autologous bone marrow mononuclear cells is safe and feasible. Positive results and trends favoring neurologic recovery and improvement in cerebral blood flow and metabolism by cell therapy underscore the relevance of larger scale randomized controlled trials using this approach.

  16. The Racial, Cultural and Social Makeup of Hispanics as a potential Profile Risk for Intensifying the Need for Including this Ethnic Group in Clinical Trials.

    Science.gov (United States)

    López-Candales, Angel; Aponte Rodríguez, Jaime; Harris, David

    2015-01-01

    Hypertension not only is the most frequently listed cause of death worldwide; but also a well-recognized major risk factor for cardiovascular disease and stroke. Based on the latest published statistics published by the American Heart Association, hypertension is very prevalent and found in one of every 3 US adults. Furthermore, data from NHANES 2007 to 2010 claims that almost 6% of US adults have undiagnosed hypertension. Despite this staggering statistic, previous US guidelines for the prevention, detection, and treatment of hypertension (The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 7 [JNC 7]), released in 2003, stated that; "unfortunately, sufficient numbers of Mexican Americans and other Hispanic Americans... have not been included in most of the major clinical trials to allow reaching strong conclusions about their responses to individual antihypertensive therapies." However, the recently published JNC 8 offers no comment regarding recommendations or guideline treatment suggestions on Hispanics. The purpose of this article not only is to raise awareness of the lack of epidemiological data and treatment options regarding high blood pressure in the US Hispanic population; but also to make a case of the racial, cultural and social makeup of this ethnic group that places them at risk of cardiovascular complications related to hypertension.

  17. The Social Appearance Anxiety Scale in Italian Adolescent Populations: Construct Validation and Group Discrimination in Community and Clinical Eating Disorders Samples.

    Science.gov (United States)

    Dakanalis, Antonios; Carrà, Giuseppe; Calogero, Rachel; Zanetti, M Assunta; Volpato, Chiara; Riva, Giuseppe; Clerici, Massimo; Cipresso, Pietro

    2016-02-01

    Anxiety in situations where one's overall appearance (including body shape) may be negatively evaluated is hypothesized to play a central role in Eating Disorders (EDs) and in their co-occurrence with Social Anxiety Disorder (SAD). Three studies were conducted among community (N = 1995) and clinical (N = 703) ED samples of 11- to 18-year-old Italian girls and boys to (a) evaluate the psychometric qualities and measurement equivalence/invariance (ME/I) of the Social Appearance Anxiety (SAA) Scale (SAAS) and (b) determine to what extent SAA or other situational domains of social anxiety related to EDs distinguish adolescents with an ED only from those with SAD. Results upheld the one-factor structure and ME/I of the SAAS across samples, gender, age categories, and diagnostic status (i.e., ED participants with and without comorbid SAD). The SAAS demonstrated high internal consistency and 3-week test-retest reliability. The strength of the inter-relationships between SAAS and measures of body image, teasing about appearance, ED symptoms, depression, social anxiety, avoidance, and distress, as well as the ability of SAAS to discriminate community adolescents with high and low levels of ED symptoms and community participants from ED participants provided construct validity evidence. Only SAA strongly differentiated adolescents with any ED from those with comorbid SAD (23.2 %). Latent mean comparisons across all study groups were performed and discussed.

  18. CLINICAL AND LABORATORY PROFILE OF CHILDREN OF AGE GROUP 6 MONTHS TO 5 YEARS WITH IRON DEFICIENCY ANEMIA ADMITTED IN A TERTIARY CARE CENTRE

    Directory of Open Access Journals (Sweden)

    Leela Kumari

    2015-11-01

    Full Text Available : Iron deficiency is the commonest micronutrient deficiency worldwide. It is preventable and treatable. Iron deficiency in a child can affect the physical growth as well as the cognitive functions since Iron is essential for growing brain. So early detection and correction of Iron deficiency is very essential. This descriptive study was conducted in 155 anemic children of age 6months to 5 years admitted in a tertiary care centre. Objective was to study the clinical and laboratory profile. This study showed high prevalence of anemia in male children compared to females. Higher grades of anaemiawas found in those taking diet deficient in Iron rich food and those not having periodic deworming. Mild anemia was noted in 34.2%, Moderate in 52.9% severe in 12.9%.47.5 % were in the age group 3-5 years. Significant association was found between Iron deficiency and Febrile seizures.18.7% of study participants had under nutrition and 11% had first degree stunting.

  19. The Social Appearance Anxiety Scale in Italian Adolescent Populations: Construct Validation and Group Discrimination in Community and Clinical Eating Disorders Samples.

    Science.gov (United States)

    Dakanalis, Antonios; Carrà, Giuseppe; Calogero, Rachel; Zanetti, M Assunta; Volpato, Chiara; Riva, Giuseppe; Clerici, Massimo; Cipresso, Pietro

    2016-02-01

    Anxiety in situations where one's overall appearance (including body shape) may be negatively evaluated is hypothesized to play a central role in Eating Disorders (EDs) and in their co-occurrence with Social Anxiety Disorder (SAD). Three studies were conducted among community (N = 1995) and clinical (N = 703) ED samples of 11- to 18-year-old Italian girls and boys to (a) evaluate the psychometric qualities and measurement equivalence/invariance (ME/I) of the Social Appearance Anxiety (SAA) Scale (SAAS) and (b) determine to what extent SAA or other situational domains of social anxiety related to EDs distinguish adolescents with an ED only from those with SAD. Results upheld the one-factor structure and ME/I of the SAAS across samples, gender, age categories, and diagnostic status (i.e., ED participants with and without comorbid SAD). The SAAS demonstrated high internal consistency and 3-week test-retest reliability. The strength of the inter-relationships between SAAS and measures of body image, teasing about appearance, ED symptoms, depression, social anxiety, avoidance, and distress, as well as the ability of SAAS to discriminate community adolescents with high and low levels of ED symptoms and community participants from ED participants provided construct validity evidence. Only SAA strongly differentiated adolescents with any ED from those with comorbid SAD (23.2 %). Latent mean comparisons across all study groups were performed and discussed. PMID:25976291

  20. Parental bonding in males with adjustment disorder and hyperventilation syndrome

    Directory of Open Access Journals (Sweden)

    Lung For-Wey

    2012-06-01

    Full Text Available Abstract Background The purpose of the study was to identify the style of parental bonding and the personality characteristics that might increase the risk of hyperventilation and adjustment disorder. Methods A total of 917 males were recruited, 156 with adjustment disorder and hyperventilation syndrome (AD + HY, 273 with adjustment disorder without hyperventilation syndrome (AD–HY, and 488 healthy controls. All participants completed the Parental Bonding Instrument, Eysenck Personality Questionnaire, and Chinese Health Questionnaire. Results Analysis using structural equation models identified a pathway relationship in which parental bonding affected personality characteristics, personality characteristics affected mental health condition, and mental health condition affected the development of hyperventilation or adjustment disorder. Males with AD–HY perceived less paternal care, and those with AD + HY perceived more maternal protection than those with adjustment disorder and those in the control group. Participants with AD–HY were more neurotic and less extroverted than those with AD + HY. Both groups showed poorer mental health than the controls. Conclusions Although some patients with hyperventilation syndrome demonstrated symptoms of adjustment disorder, there were different predisposing factors between the two groups in terms of parental bonding and personality characteristics. This finding is important for the early intervention and prevention of hyperventilation and adjustment disorder.

  1. Yuan Exchange Rate 'Properly Adjusted'

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

      The currency exchange rate was "properly adjusted" this year and takes into account effects on the country's neighbors and the world, Premier Wen Jiabao said at a regional meeting in Malaysia.……

  2. Adjustment to Spinal Cord Injury

    Science.gov (United States)

    ... may need to work to help with family finances. All of the changes that they face can ... 2000). Goal instability and adjustment to physical disability. Journal of Counseling Psychology, 47(2). 251-265. This ...

  3. Adjustable Induction-Heating Coil

    Science.gov (United States)

    Ellis, Rod; Bartolotta, Paul

    1990-01-01

    Improved design for induction-heating work coil facilitates optimization of heating in different metal specimens. Three segments adjusted independently to obtain desired distribution of temperature. Reduces time needed to achieve required temperature profiles.

  4. Adjustable Chain Trees for Proteins

    DEFF Research Database (Denmark)

    Winter, Pawel; Fonseca, Rasmus

    2012-01-01

    A chain tree is a data structure for changing protein conformations. It enables very fast detection of clashes and free energy potential calculations. A modified version of chain trees that adjust themselves to the changing conformations of folding proteins is introduced. This results in much...... tighter bounding volume hierarchies and therefore fewer intersection checks. Computational results indicate that the efficiency of the adjustable chain trees is significantly improved compared to the traditional chain trees....

  5. Adjustment techniques for experimental data

    International Nuclear Information System (INIS)

    To carry through numerically the different adjustment of experimental data planned by National Institute of Nuclear Research investigators. It is presented the different adjustment techniques of experimental data which are fundamentally for: linear least squares, non linear with restrictions. Methodology: Lineal least squares - Orthogonal decomposition via Householder reflections. No lineal - Method of general lowering and quasi Newton; Levenberg-Marquardt modified - More version. No lineal with restrictions - Quadratic sequential programming method (In process). (Author)

  6. Perception of quality of life and social adjustment of patients with recurrent depression

    Directory of Open Access Journals (Sweden)

    Stanković Žana

    2006-01-01

    Full Text Available Introduction: Depression is the most commonly present psychiatric entity in clinical practice, accompanied by significant impairment of both social and professional functioning. In addition, depression frequently develops as complication of other psychiatric disorders and various somatic diseases. Objective: To investigate subjective perception of quality of life and social adjustment, severity of depressive symptoms as well as level of correlation of severity of depressive symptoms and quality of life and social adjustment of patients with recurrent depression in comparison to the group of patients with diabetes and healthy subjects. Method: The study included 45 subjects of both sexes, ranging from 18 to 60 years of age, divided in three groups of 15 subjects each. The experimental group comprised the patients diagnosed with recurrent depression in remission (DSM-IV, one control group was consisted of patients diagnosed with Type 2 Diabetes mellitus and another one comprised healthy subjects. The instruments of assessment were: The Beck Depression Inventory- BDI, The Social Adaptation Self -evaluation scale - SASS, The Psychological General Well-Being Scale - WBQ. Results: Significant difference of both BDI and WBQ scales was found between the experimental and the control group of healthy subjects (ANOVA, Mann Whitney; p≤0.01, as well as between two control groups (p≤0.02. The level of inverse correlation of mean score values of BDI and SASS scales was significant in the control group of patients with diabetes while such levels of BDI and WBQ scales (Spearman correlation coefficient, p<0.01 were found in all groups of our study. Conclusion: In the group of patients with recurrent depression, significant decline of quality of life and significantly higher severity of depressive symptoms were present in comparison to the group of healthy subjects as well as significant level of inverse correlation of severity of depressive symptoms and

  7. 7 CFR 251.7 - Formula adjustments.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 4 2010-01-01 2010-01-01 false Formula adjustments. 251.7 Section 251.7 Agriculture... GENERAL REGULATIONS AND POLICIES-FOOD DISTRIBUTION THE EMERGENCY FOOD ASSISTANCE PROGRAM § 251.7 Formula adjustments. Formula adjustments. (a) Commodity adjustments. The Department will make annual adjustments...

  8. Identification and Clinical Infusion of B (A) Blood Group%B(A)血型的鉴定及临床输注探讨

    Institute of Scientific and Technical Information of China (English)

    郑望春; 骆宏; 叶有玩; 沈磁石; 黄华霖

    2013-01-01

    目的 对1例常规血清学为B(A)表现型的献血者进行血型鉴定,探讨B(A)血型在临床输注中的安全性和有效性.方法 采用血型血清学、ABO基因第6及第7外显子直接测序和克隆测序的方法,对该例标本的血清学表型和其ABO等位基因进行检测;同时回顾性调查该献血者前次已献血液输注给B型受血者的相关实验记录和病历.结果 被检血样的血型血清学结果初步定型为B(A);直接测序和克隆测序发现:被检者含有O01等位基因,B等位基因在第7外显子存在640A/G突变,证实其为B(A)04等位基因,其基因型为B(A)04/O01;该献血者血液输给B型受血者,Hb升高符合预期值,无输血不良反应发生.结论 发现该例B(A)表现型,其基因型为B(A)04/O01型;在配血相合的情况下,B(A)供血者血液输注给B型受血者是安全有效的.%Objective To explore the identification and clinical infusion of B(A) blood group. Methods B(A) blood groups and B(A) alleles of the samples were checked out by serology and direct sequencing and cloning sequencing of ABO gene exon 6 and 7. Retrospective experiment records were collected to analyze the clinical infusion. Results The serological results of the blood sample was shown as B(A). Result of the sequencing analysis showed the sample harbored an O01 allele.and had the nt640 A/G mutation in B gene,which was previously defined as B(A) 04. B(A) blood of donor was infused to type B receptor,whose Hb rising conformed to the expected value, no adverse reaction of blood transfusion occurred. Conclusion The sample is identified as B(A) phenotype in serological tests, whose genotype is rare B(A)04 / O01. Under the consistency of cross matching.it is safe and effective for the blood of B (A) blood donor infused to type B receptor.

  9. Proposal for a revised definition of dilated cardiomyopathy, hypokinetic non-dilated cardiomyopathy, and its implications for clinical practice: a position statement of the ESC working group on myocardial and pericardial diseases.

    Science.gov (United States)

    Pinto, Yigal M; Elliott, Perry M; Arbustini, Eloisa; Adler, Yehuda; Anastasakis, Aris; Böhm, Michael; Duboc, Denis; Gimeno, Juan; de Groote, Pascal; Imazio, Massimo; Heymans, Stephane; Klingel, Karin; Komajda, Michel; Limongelli, Giuseppe; Linhart, Ales; Mogensen, Jens; Moon, James; Pieper, Petronella G; Seferovic, Petar M; Schueler, Stephan; Zamorano, Jose L; Caforio, Alida L P; Charron, Philippe

    2016-06-14

    In this paper the Working Group on Myocardial and Pericardial Disease proposes a revised definition of dilated cardiomyopathy (DCM) in an attempt to bridge the gap between our recent understanding of the disease spectrum and its clinical presentation in relatives, which is key for early diagnosis and the institution of potential preventative measures. We also provide practical hints to identify subsets of the DCM syndrome where aetiology directed management has great clinical relevance. PMID:26792875

  10. The new final Clinical Skills examination in human medicine in Switzerland: Essential steps of exam development, implementation and evaluation, and central insights from the perspective of the national Working Group

    OpenAIRE

    Berendonk, Christoph; Schirlo, Christian; Balestra, Gianmarco; Bonvin, Raphael; Feller, Sabine; Huber, Philippe; Jünger, Ernst; Monti, Matteo; Schnabel, Kai; Beyeler, Christine; Guttormsen, Sissel; Huwendiek, Sören

    2015-01-01

    Objective: Since 2011, the new national final examination in human medicine has been implemented in Switzerland, with a structured clinical-practical part in the OSCE format. From the perspective of the national Working Group, the current article describes the essential steps in the development, implementation and evaluation of the Federal Licensing Examination Clinical Skills (FLE CS) as well as the applied quality assurance measures. Finally, central insights gained from the last years are ...

  11. Self-Concept and Psychological Adjustment Differences Between Self-Identified Male Transexuals and Male Homosexuals

    Science.gov (United States)

    Roback, Howard B.; And Others

    1977-01-01

    Self-concept and adjustment data from anatomical males seeking sexual reassignment surgery were compared with that from a male homosexual group. Findings indicated that the homosexual group had a better self-image and was better adjusted than the sex change group. (Author)

  12. Risk-Adjusted Control Charts for Health Care Monitoring

    Directory of Open Access Journals (Sweden)

    Willem Albers

    2011-01-01

    the distribution involved is negative binomial. However, in health care monitoring, (groups of patients will often belong to different risk categories. In the present paper, we will show how information about category membership can be used to adjust the basic negative binomial charts to the actual risk incurred. Attention is also devoted to comparing such conditional charts to their unconditional counterparts. The latter do take possible heterogeneity into account but refrain from risk-adjustment. Note that in the risk adjusted case several parameters are involved, which will all be typically unknown. Hence, the potentially considerable estimation effects of the new charts will be investigated as well.

  13. Determination of Axial Length Requiring Adjustment of Measured Circumpapillary Retinal Nerve Fiber Layer Thickness for Ocular Magnification

    Science.gov (United States)

    Hirasawa, Kazunori; Shoji, Nobuyuki; Yoshii, Yukako; Haraguchi, Shota

    2014-01-01

    Purpose To determine the axial length requiring adjustment of measured circumpapillary retinal nerve fiber layer (cpRNFL) thickness to account for ocular magnification during spectral-domain optical coherence tomography (SD-OCT). Methods In this prospective study, 148 eyes of 148 healthy student volunteers were imaged by two examiners using three-dimensional SD-OCT. In 54 randomly selected eyes, total cpRNFL thickness was measured with and without adjustment for ocular magnification to establish intra-examiner and inter-examiner measurement error. The 148 eyes were then divided into three groups according to the error values: control group (difference in the corrected and uncorrected total cpRNFL thickness was within the measurement error range), thinner group (the corrected total cpRNFL thickness was less than the uncorrected one), and thicker group (the corrected total cpRNFL thickness was more than the uncorrected one). The cutoff values of axial length between the control and the other groups were calculated by receiver operating characteristic analysis. Results Measurement error ranged from 4.2 to 5.3 µm; the threshold value was defined as 5.3 µm. The cutoff values of axial length between the thinner and the control groups and between the control and the thicker groups were 23.60 (area under the curve [AUC] = 0.959) and 25.55 (AUC = 0.944) mm, respectively. Conclusions Axial lengths shorter than 23.60 mm and longer than 25.55 mm require adjustment of measured cpRNFL thickness to account for ocular magnification during SD-OCT. Clinical Trial Registration UMIN Clinical Trials Registry (http://www.umin.ac.jp/) under unique trial number UMIN000013248 (date of registration: 02/24/2014) PMID:25215521

  14. Latest Adjustment of the Argentine Height System

    Science.gov (United States)

    Piñón, D. A.; Cimbaro, S. R.; Sanchez, R. E.

    2013-05-01

    For over 70 years the National Geographic Institute of Argentina (NGI) has conducted a systematic project to building benchmarks throughout the country, which have been measured with spirit leveling and gravimetry techniques. The measurements were undertaken on a total of approximately 18,000 benchmarks, which define the High Precision Leveling Network of Argentina. The first adjustment of this network took place in 1971. This assignment was given to the Defense Mapping Agency of the United States of America (DMA). Leveling lines that were built and measured after the year 1971 were adjusted to this original network. It was of great importance to perform a new adjustment calculation with modern techniques to update the entire network. Some modern tools worth mentioning are: gravity interpolation using prediction method and topographic correction calculation by the Hammer method using SRTM model. All historical field books were digitalized to retrieve the information corresponding to the spirit leveling, from which it was then possible to calculate geopotential difference between the nodes, using the gravity acceleration values over the benchmarks. Subsequently, by the method of least squares it was possible to calculate the geopotential numbers of the nodes, and then the orthometric height of all the benchmarks. The recommendations of the Working Group III of SIRGAS (Geodetic Reference System for the Americas) were taken into account in relation to this task. The development of this paper shows the results that have been obtained so far in the development of the New Height System for Argentina.

  15. 病案分组讨论教学法在临床心电图带教中的应用%Application of Medical Record Group Discussion Teaching Method in the Clinical Electrocardiogram Teaching

    Institute of Scientific and Technical Information of China (English)

    杨桂花

    2016-01-01

    Objective To study the application of medical record group discussion teaching method in the clinical electro-cardiogram teaching. Methods 200 cases of school students majoring in clinic in 2014 were selected as the research ob-jects, and divided into two groups with 100 cases in each according to the admission number, the traditional group adopted the teaching model mainly in analysis and explanation of class medical record, the discussion group adopted medical record group discussion teaching model, and the final grades and students' evaluation of teaching model of the two groups were observed. Results The operation ability and medical record analysis ability in the traditional group were lower than those in the discussion group and the comparison between groups had statistical significance, P0.05);100名学生对该病案讨论模式的平均肯定率为92.3%。结论在临床心电图教学中应用病案分组讨论方式可增加学生对该学科自主学习意识,提升对心电图的了解与掌握,减少该学科学生期末的挂科率,有效增加临床学生对心电图的全面掌握和对疾病判断思维的培养。

  16. MCCB warm adjustment testing concept

    Science.gov (United States)

    Erdei, Z.; Horgos, M.; Grib, A.; Preradović, D. M.; Rodic, V.

    2016-08-01

    This paper presents an experimental investigation in to operating of thermal protection device behavior from an MCCB (Molded Case Circuit Breaker). One of the main functions of the circuit breaker is to assure protection for the circuits where mounted in for possible overloads of the circuit. The tripping mechanism for the overload protection is based on a bimetal movement during a specific time frame. This movement needs to be controlled and as a solution to control this movement we choose the warm adjustment concept. This concept is meant to improve process capability control and final output. The warm adjustment device design will create a unique adjustment of the bimetal position for each individual breaker, determined when the testing current will flow thru a phase which needs to trip in a certain amount of time. This time is predetermined due to scientific calculation for all standard types of amperages and complies with the IEC 60497 standard requirements.

  17. A study on lifestyle adjustment and insulin sensitizing treatment in PCOS-IR women

    Institute of Scientific and Technical Information of China (English)

    Ma Liang-kun; Jin Li-na; Yu Qi; Xu Ling

    2008-01-01

    Objective:To compare the efficacy of lifestyle adjustment,metformin and rosiglitazone on women with polycystic ovary syndrome and insulin resistance(PCOS-IR)Methods:A randomized controlled trial(RCT)was carried out in Peking Union Medical College Hospital(PUMCH),One hundred and six women with PCOS were randomly allocated to three intervention groups:lifestyle adjustment,lifestyle adjustment plus metformin,lifestyle adjustment plus rosiglitazone group,patients were treated with lifestyle adjustment(diet and exercise),lifestyle adjustment plus metformin(500mg three times daily),lifestyle adjustment plus rosiglitazone(4mg once daily)for three months.Sixty patients completed treatments,basal body temperature(BBT),total testosterone as well as fasting serum insulin and lipid levels were measured and compared in all patients before and after lifestyle adjustment.Results:No significant differences were found in the baseline characteristics among three groups.In lifestyle adjustment group 51%(22/43)patients completed treatment,23%(5/22)patients resumed ovulation.In lifestyle adjustment plus metformin group 58%(21/36)patients completed treatment,43%(9/21)patients resumed ovulation.In lifestyle adjustment plus rosiglitazone group 63%(17/27)patients completed treatment,59%(10/17)patients resumed ovulation.Ovulation rate was significantly higher in lifestyle adjustment plus rosiglitazone group than that in weight loss group.There was no significant difference among three groups in body mass index(BMI),waist circumference,waist-hip ratio(WHR),sex hormone,serum fasting insulin and lipid levels after treatment.Conclusions:Lifestyle adjustment,metformin and rosiglitazone treatment can improve ovulation each.

  18. Tax Adjusted for Imported Equipment

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    @@ Ministry of Finance, Central Administration of Customs, and State Administration of Taxation of P.R. of China jointly issued a "Notice on the Lists Related to the Interim Provisions on the Adjustment of Import Tax Policy on Major Technical Equipment" (the Notice) on April 13rd to adjust the list of equipment catalog and merchandise attached to the "Interim Provisions on the Import Tax Policy on Major Technical Equipment", as well as the preferential scope and extent of the import tax on a number of major technical equipment.

  19. Functional recovery measures for spinal cord injury : An evidence-based review for clinical practice and research - Functional recovery outcome measures work group

    NARCIS (Netherlands)

    Anderson, Kim; Aito, Sergio; Atkins, Michal; Biering-Sorensen, Fin; Charlifue, Susan; Curt, Armin; Ditunno, John; Glass, Clive; Marino, Ralph; Marshall, Ruth; Mulcahey, Mary Jane; Post, Marcel; Savic, Gordana; Scivoletto, Giorgio; Catz, Amiram

    2008-01-01

    Background/Objective: The end goal of clinical care and clinical research involving spinal cord injury (SCI) is to improve the overall ability of persons living with SCI to function on a daily basis. Neurologic recovery does not always translate into functional recovery. Thus, sensitive outcome meas

  20. A randomized trial assessing the impact of written information on outpatients' knowledge about and attitude toward randomized clinical trials. The Info Trial Group

    DEFF Research Database (Denmark)

    Kruse, A Y; Kjaergard, L L; Krogsgaard, K;

    2000-01-01

    To improve the patient education process in clinical research, three information materials describing general aspects of design and conduct of randomized clinical trials were developed. The materials varied in length, reading ability level, and reader appeal. Their influence on knowledge about an...

  1. Belonging to a peer support group enhance the quality of life and adherence rate in patients affected by breast cancer: A non-randomized controlled clinical trialFNx01

    OpenAIRE

    Afsaneh Malekpour Tehrani; Ziba Farajzadegan; Fariborz Mokarian Rajabi; Ahmad Reza Zamani

    2011-01-01

    Background: Breast cancer is the most common cancer in women. It seems that breast cancer patients benefit from meeting someone who had a similar experience. This study evaluated the effect of two kinds of interventions (peer support and educational program) on quality of life in breast cancer patients. Methods: This study was a controlled clinical trial on women with non-metastatic breast cancer. The patients studied in two experimental and control groups. Experimental group took part i...

  2. The evaluation of the feasibility and clinical utility of liquid based cytology, human papillomavirus testing and high-resolution anoscopy to screen for anal intraepithelial neoplasia in high-risk groups

    OpenAIRE

    Schofield, Alice

    2016-01-01

    The evaluation of the feasibility and clinical utility of liquid based cytology, human papillomavirus testing and high-resolution anoscopy to screen for anal intraepithelial neoplasia in high-risk groups. Dr Alice Martha Schofield: The University of Manchester for the degree of Doctor of Medicine, January 2016. Background: The increased incidence and natural history of anal cancer in high-risk groups, provides a screening opportunity to detect precancerous lesions, anal intraepithelial neopla...

  3. Cardiovascular group

    Science.gov (United States)

    Blomqvist, Gunnar

    1989-01-01

    As a starting point, the group defined a primary goal of maintaining in flight a level of systemic oxygen transport capacity comparable to each individual's preflight upright baseline. The goal of maintaining capacity at preflight levels would seem to be a reasonable objective for several different reasons, including the maintenance of good health in general and the preservation of sufficient cardiovascular reserve capacity to meet operational demands. It is also important not to introduce confounding variables in whatever other physiological studies are being performed. A change in the level of fitness is likely to be a significant confounding variable in the study of many organ systems. The principal component of the in-flight cardiovascular exercise program should be large-muscle activity such as treadmill exercise. It is desirable that at least one session per week be monitored to assure maintenance of proper functional levels and to provide guidance for any adjustments of the exercise prescription. Appropriate measurements include evaluation of the heart-rate/workload or the heart-rate/oxygen-uptake relationship. Respiratory gas analysis is helpful by providing better opportunities to document relative workload levels from analysis of the interrelationships among VO2, VCO2, and ventilation. The committee felt that there is no clear evidence that any particular in-flight exercise regimen is protective against orthostatic hypotension during the early readaptation phase. Some group members suggested that maintenance of the lower body muscle mass and muscle tone may be helpful. There is also evidence that late in-flight interventions to reexpand blood volume to preflight levels are helpful in preventing or minimizing postflight orthostatic hypotension.

  4. 理筋手法联合颈椎关节调整手法治疗颈椎病30例临床观察%Clinical Observation on Manipulation of Regulating Jingjin and Adjusting Cervical Joints in the Treatment of 30 Patients with Cervical Spondylosis

    Institute of Scientific and Technical Information of China (English)

    朱清广; 房敏; 沈国权; 姜淑云; 程英武; 周楠

    2011-01-01

    目的 观察理筋手法联合颈椎关节调整手法对颈椎病颈部肌群疲劳程度的影响.方法 将60例颈椎病患者随机分为治疗组和对照组各30例,治疗组进行理筋手法和颈椎关节调整手法治疗,隔天1次,每周3次,疗程2周;对照组进行牵引治疗,每天1次,每周5次,疗程2周.治疗前后应用TeleMy0 2400T表面肌电图仪分别测试两组患者颈伸肌群疲劳程度,指标包括积分肌电(IEMG)、平均功率频率(MPF)、中位频率(MF).结果 治疗后两组患者颈部右侧肌群IEMG、MPF、MF及治疗组左侧肌群1EMG均较本组治疗前明显改善(P<0.05);治疗后治疗组颈部、左侧、右侧肌群IEMG、MPF、MF均较对照组改善更为显著(P<0.05).结论 理筋手法联合颈椎关节调整手法可以增加颈椎病患者颈伸肌群运动神经元募集数量和运动单位放电频率,从而缓解颈椎病患者颈部肌群的疲劳程度.%Objective To observe the influence of manipulation of regulating Jingjin-(soft tissue) and adjusting cervical joints on the fatigue severity of cervical muscles in cervical spondylosis patients. Methods Sixty patients with cervical spondylosis were randomized into treatment group and control group with 30 in each. The treatment group was treated with manipulation of regulating Jingjin and adjusting cervical joints, once every other day, three times a week, for 2 weeks. The control group was treated with traction, once everyday, five times a week, for 2 weeks. Before and after treatment, both groups were tested with TeleMyo 2400 T Surface EMG to measure the fatigue severity of cervical muscles, including integrated EMG (IEMG), and mean power frequency (MPF) and middle frequency (MF). Results After treatment, the IEMG, MPF, and MF of the right side cervical muscles of both groups and the left side cervical muscles of the treatment group were significantly improved (P<0. 05). The IEMG, MPF, and MF of the right side cervical muscles and the IEMG of

  5. Adjustment or updating of models

    Indian Academy of Sciences (India)

    D J Ewins

    2000-06-01

    In this paper, first a review of the terminology used in the model adjustment or updating is presented. This is followed by an outline of the major updating algorithms cuurently available, together with a discussion of the advantages and disadvantages of each, and the current state-of-the-art of this important application and part of optimum design technology.

  6. Self-Adjusting Stack Machines

    CERN Document Server

    Hammer, Matthew A; Chen, Yan; Acar, Umut A

    2011-01-01

    Self-adjusting computation offers a language-based approach to writing programs that automatically respond to dynamically changing data. Recent work made significant progress in developing sound semantics and associated implementations of self-adjusting computation for high-level, functional languages. These techniques, however, do not address issues that arise for low-level languages, i.e., stack-based imperative languages that lack strong type systems and automatic memory management. In this paper, we describe techniques for self-adjusting computation which are suitable for low-level languages. Necessarily, we take a different approach than previous work: instead of starting with a high-level language with additional primitives to support self-adjusting computation, we start with a low-level intermediate language, whose semantics is given by a stack-based abstract machine. We prove that this semantics is sound: it always updates computations in a way that is consistent with full reevaluation. We give a comp...

  7. An adjustable contracted CI method

    Institute of Scientific and Technical Information of China (English)

    王育彬; 甘正汀; 苏克和; 文振翼

    1999-01-01

    A new contracted CI scheme——adjustable contracted CI scheme——is presented and programed. The efficiency of this scheme is tested by some example calculations. The result shows that the application of the new scheme is flexible and the correlation energy loss is lower than that of the original externally contracted CI method.

  8. Development and Adjustment of Adopted Adolescents : Longitudinal and Concurrent Factors

    NARCIS (Netherlands)

    Jaffari-Bimmel, Nicole

    2005-01-01

    The first study of this thesis (Chapter 2) showed that the majority of the internationally adopted children are well adjusted, although a relatively large minority of adopted children had behavior problems of clinical significance or were referred to mental health services compared with non-adopted

  9. American Society of Blood and Marrow Transplantation, European Society of Blood and Marrow Transplantation, Blood and Marrow Transplant Clinical Trials Network, and International Myeloma Working Group Consensus Conference on Salvage Hematopoietic Cell Transplantation in Patients with Relapsed

    DEFF Research Database (Denmark)

    Giralt, Sergio; Garderet, Laurent; Durie, Brian;

    2015-01-01

    not been extensively studied in MM patients relapsing after primary therapy. The International Myeloma Working Group together with the Blood and Marrow Transplant Clinical Trials Network, the American Society of Blood and Marrow Transplantation, and the European Society of Blood and Marrow Transplantation...

  10. Adjusted drug treatment is superior to renal sympathetic denervation in patients with true treatment-resistant hypertension.

    Science.gov (United States)

    Fadl Elmula, Fadl Elmula M; Hoffmann, Pavel; Larstorp, Anne C; Fossum, Eigil; Brekke, Magne; Kjeldsen, Sverre E; Gjønnæss, Eyvind; Hjørnholm, Ulla; Kjaer, Vibeke N; Rostrup, Morten; Os, Ingrid; Stenehjem, Aud; Høieggen, Aud

    2014-05-01

    We aimed to investigate for the first time the blood pressure (BP)-lowering effect of renal sympathetic denervation (RDN) versus clinically adjusted drug treatment in true treatment-resistant hypertension (TRH) after excluding patients with confounding poor drug adherence. Patients with apparent TRH (n=65) were referred for RDN, and those with secondary and spurious hypertension (n=26) were excluded. TRH was defined as office systolic BP (SBP) >140 mm Hg, despite maximally tolerated doses of ≥3 antihypertensive drugs including a diuretic. In addition, ambulatory daytime SBP >135 mm Hg after witnessed intake of antihypertensive drugs was required, after which 20 patients had normalized BP and were excluded. Patients with true TRH were randomized and underwent RDN (n=9) performed with Symplicity Catheter System versus clinically adjusted drug treatment (n=10). The study was stopped early for ethical reasons because RDN had uncertain BP-lowering effect. Office SBP and diastolic BP in the drug-adjusted group changed from 160±14/88±13 mm Hg (±SD) at baseline to 132±10/77±8 mm Hg at 6 months (Ptreatment has superior BP lowering effects compared with RDN in patients with true TRH. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01673516.

  11. Antibacterial Agent Adjustment Performed by Clinical Pharmacists in the Treatment of One Case of Hospi-tal-acquired Pneumonia%临床药师参与1例医院获得性肺炎患者抗菌药物调整

    Institute of Scientific and Technical Information of China (English)

    张金莲; 李莉霞

    2014-01-01

    目的::小结临床药师在协同查房中调整抗菌药物治疗的工作。方法:临床药师参入1例医院获得性肺炎病例查房,与医生共同确定、抗菌药选择并实行药学服务。结果:临床药师协同查房,关注病程发展,病史,用药史,选用正确的抗菌药覆盖可疑病原菌及时控制感染。结论:临床药师参与药物治疗,主动提出抗菌药使用建议,为患者和医师提供药学服务提高药物治疗质量。%Objective:To summary the antibacterial agent therapy adjustment performed by clinical pharmacists in the collabora-tive rounds. Methods:Combined with physicians, clinical pharmacists participated in the ward round and antibacterial agent selection for one case of hospital-acquired pneumonia, meanwhile, pharmaceutical care was performed for the patient. Results:Clinical pharma-cists chose appropriate antibacterial agents for the patient to cover the suspected pathogens and control the infection in time through par-ticipating in the ward round and paying attention to the disease course progress, medical history and medication history. Conclusion:Clinical pharmacists can enhance the quality of drug therapy through participating in the drug therapy, providing the proposal for the antibacterial agent use and performing pharmaceutical service for physicians and patients.

  12. [Evidence-based medicine. 1. The transfer of research results to clinical practice. The Italian Group for Evidence-Based Medicine-GIMBE].

    Science.gov (United States)

    Cartabellotta, A

    1998-03-01

    Evidence-based Medicine, born officially in November 1992, during last five years is grown everywhere, showing its power to influence virtually all aspects of health care: clinical practice, medical education, patient information and health policy. Because of the raising interest also in Italy for the new paradigm of clinical practice, "Recently Progress in Medicina" launches a series of articles with the aim of giving to physicians tools and skills for searching, critically appraising and implementing in their own decisions the best results of clinical research. For a better explanation of practical aspects of Evidence-based Medicine, the first article discusses about several obstacles existing in transferring correctly and timely the results of research into clinical practice, and about the potential role of Evidence-based Medicine in the evolution of the medical art and the health systems of the third millennium.

  13. Profiles of acculturative adjustment patterns among Chinese international students.

    Science.gov (United States)

    Wang, Kenneth T; Heppner, Puncky Paul; Fu, Chu-Chun; Zhao, Ran; Li, Feihan; Chuang, Chih-Chun

    2012-07-01

    This is the first study to empirically identify distinct acculturative adjustment patterns of new international students over their first 3 semesters in the United States. The sample consisted of 507 Chinese international students studying in the United States. Using psychological distress as an indicator of acculturative adjustment, measured over 4 time points (prearrival, first semester, second semester, and third semester), 4 distinct groups of student adjustment trajectories emerged: (a) a group exhibiting high levels of psychological distress across each time point (consistently distressed; 10%), (b) a group with decreasing psychological distress scores from Time 1 to Time 2 (relieved; 14%), (c), those with a sharp peak in psychological distress at Time 2 and Time 3 (culture-shocked; 11%), and (d) a group with relatively consistent low psychological distress scores (well-adjusted; 65%). Moreover, significant predictors of a better acculturative adjustment pattern included having higher self-esteem, positive problem-solving appraisal, and lower maladaptive perfectionism prior to the acculturation process. In addition, during the first semester of studying in the United States, having a balanced array of social support and using acceptance, reframing, and striving as coping strategies were associated with a better cross-cultural transition. Practical implications and future directions were also discussed. PMID:22642268

  14. Adjustable wheelchair and method for adjusting said adjustable wheelchair, and wheelchair assembly

    NARCIS (Netherlands)

    Oosterhuis, D.S.

    2013-01-01

    The invention relates to an adjustable wheelchair comprising: -a carriage; -two rear wheels; -at least one front wheel; -at least one footrest; -a sub-frame; -a seat; and -a backrest; wherein the two rear wheels, the at least one front wheel and the at least one footrest are mounted to the carriage,

  15. Creative arts therapies in psychiatry : A clinical application of the Bonny method of guided imagery and music and creative arts groups

    OpenAIRE

    Körlin, Dag

    2005-01-01

    The Creative Arts Therapies (CATs) are characterized by imagery in altered states of consciousness, artistic expression (art, music, dance, drama) and metaphoric expression (as in poetry). The CATs implemented in this thesis consist of The Bonny Method of Guided Imagery and Music (BMGIM), and the Spektrum Creative arts group program. Spektrum is a four-week treatment program, where group applications of BMGIM and Art therapy are combined with psychodynamic verbal group and o...

  16. 12 CFR 19.240 - Inflation adjustments.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Inflation adjustments. 19.240 Section 19.240... PROCEDURE Civil Money Penalty Inflation Adjustments § 19.240 Inflation adjustments. (a) The maximum amount... Civil Penalties Inflation Adjustment Act of 1990 (28 U.S.C. 2461 note) as follows: ER10NO08.001 (b)...

  17. Shared clinical decision making

    Science.gov (United States)

    AlHaqwi, Ali I.; AlDrees, Turki M.; AlRumayyan, Ahmad; AlFarhan, Ali I.; Alotaibi, Sultan S.; AlKhashan, Hesham I.; Badri, Motasim

    2015-01-01

    Objectives: To determine preferences of patients regarding their involvement in the clinical decision making process and the related factors in Saudi Arabia. Methods: This cross-sectional study was conducted in a major family practice center in King Abdulaziz Medical City, Riyadh, Saudi Arabia, between March and May 2012. Multivariate multinomial regression models were fitted to identify factors associated with patients preferences. Results: The study included 236 participants. The most preferred decision-making style was shared decision-making (57%), followed by paternalistic (28%), and informed consumerism (14%). The preference for shared clinical decision making was significantly higher among male patients and those with higher level of education, whereas paternalism was significantly higher among older patients and those with chronic health conditions, and consumerism was significantly higher in younger age groups. In multivariate multinomial regression analysis, compared with the shared group, the consumerism group were more likely to be female [adjusted odds ratio (AOR) =2.87, 95% confidence interval [CI] 1.31-6.27, p=0.008] and non-dyslipidemic (AOR=2.90, 95% CI: 1.03-8.09, p=0.04), and the paternalism group were more likely to be older (AOR=1.03, 95% CI: 1.01-1.05, p=0.04), and female (AOR=2.47, 95% CI: 1.32-4.06, p=0.008). Conclusion: Preferences of patients for involvement in the clinical decision-making varied considerably. In our setting, underlying factors that influence these preferences identified in this study should be considered and tailored individually to achieve optimal treatment outcomes. PMID:26620990

  18. Multi-toning Image Adjustment

    Institute of Scientific and Technical Information of China (English)

    LIU Shi-guang; WANG Xiao-juan; PENG Qun-sheng

    2011-01-01

    Due to the different lighting environments or other reasons, the pixel colors may be quite different in one image which causes distinct visual discontinuities. It makes the analysis and processing of such an image more difficult and sometime impossible. In this paper, a unified multi-toning image adjustment method is proposed to solve this problem. First, a novel unsupervised clustering method was proposed to partition the source and the target image into a certain number of subsets with similar color statistics. By matching the texture characteristics and luminance distribution between the blocks, it can create optimized correspondence. Then, the color information was transferred from the matched pixels in the source blocks to the target ones. Graph cut method was used to optimize the seams between different subsets in the final step. This method can automatically perform color adjustment of a multi-toning image. It is simple and efficient. Various results show the validity of this method.

  19. Psychiatric Morbidity and Work and Social Adjustment Among Earthquake Survivors Extricated from under the Rubble

    Directory of Open Access Journals (Sweden)

    Shamaila Aziz

    2012-01-01

    Full Text Available Objectives: This cross-sectional study examined psychiatric co-morbidity and work and social adjustment after a natural disaster among survivors who were extricated from under the rubble. Materials and Methods: Individuals (N=40 belonging to district Muzaffarabad, a severely earthquake affected area on 8 th October 2005, were interviewed. The examination included the MINI International Neuropsychiatric Interview for DSM-IV Axis I disorders, Work and Social Adjustment Scale, and questions covering background characteristics and disaster exposure. Results: The most prevalent disorders were posttaumatic stress disorder (32.5%, major depressive disorder (17.5%, dysthymia (15.0%, agoraphobia (25.0%, and panic disorder (20.0%. Moreover, 77% of the respondents have been diagnosed with at least one psychiatric disorder. Work and soical adjustment was found to have an inverse relationship with the psychiatric co-morbidity. Conclusion: Small sample size and lack of comparison group from non-earthquake struck areas may limit the generalizability of the psychatric disorders. Psychiatric disorders other than PTSD, especially depressive and anxiety disorders, are of clinical importance when considering long-term mental health effect of disasters.

  20. Focal Adjustment for Star Tracker

    OpenAIRE

    Liu Hai-bo; Jian-kun Yang; Ji-chun Tan; De-zhi Su; Wen-liang Wang; Xiu-jian Li; Hui Jia

    2010-01-01

    Technique of measuring intensity distribution and size of spot image developed has been discussed, which is especially suitable for defocus adjustment in ground test of star tracker. A novel approach for choosing a proper defocusing position has been proposed based on collimator, Gaussian surface fitting method, and other ordinary instruments. It proves to be practical and adequate in the development of distant object tracking such as star tracker.Defence Science Journal, 2010, 60(6), pp.678-...

  1. Parenting Perfectionism and Parental Adjustment

    OpenAIRE

    Lee, Meghan A.; Schoppe-Sullivan, Sarah J.; Kamp Dush, Claire M.

    2012-01-01

    The parental role is expected to be one of the most gratifying and rewarding roles in life. As expectations of parenting become ever higher, the implications of parenting perfectionism for parental adjustment warrant investigation. Using longitudinal data from 182 couples, this study examined the associations between societal- and self-oriented parenting perfectionism and new mothers’ and fathers’ parenting self-efficacy, stress, and satisfaction. For mothers, societal-oriented parenting perf...

  2. Group Psychotherapy in Italy.

    Science.gov (United States)

    Giannone, Francesca; Giordano, Cecilia; Di Blasi, Maria

    2015-10-01

    This article describes the history and the prevailing orientations of group psychotherapy in Italy (psychoanalytically oriented, psychodrama, CBT groups) and particularly group analysis. Provided free of charge by the Italian health system, group psychotherapy is growing, but its expansion is patchy. The main pathways of Italian training in the different group psychotherapy orientations are also presented. Clinical-theoretical elaboration on self development, psychopathology related to group experiences, and the methodological attention paid to objectives and methods in different clinical groups are issues related to group therapy in Italy. Difficulties in the relationship between research and clinical practice are discussed, as well as the empirical research network that tries to bridge the gap between research and clinical work in group psychotherapy. The economic crisis in Italy has led to massive cuts in health care and to an increasing demand for some forms of psychological treatment. For these reasons, and because of its positive cost-benefit ratio, group psychotherapy is now considered an important tool in the national health care system to expand the clinical response to different forms of psychological distress. PMID:26401793

  3. Systematic review: glucocorticosteroids for alcoholic hepatitis - a Cochrane Hepato-Biliary Group systematic review with meta-analyses and trial sequential analyses of randomized clinical trials

    DEFF Research Database (Denmark)

    Rambaldi, A.; Saconato, H.H.; Christensen, E.;

    2008-01-01

    or hepatic encephalopathy and with low-bias risk. In all analyses, heterogeneity was significant and substantial. Trial sequential analyses using heterogeneity-adjusted information size demonstrated no significant effect of glucocorticosteroids on mortality. Weighted logistic regression analyses taking...... vs. placebo or no intervention for patients with alcoholic hepatitis. Methods We searched for randomized trials published before July 2007. The trials were assessed for risk of bias. Results We included 15 trials with a total of 721 randomized patients. The overall mortality rate was 39.5%. Twelve...... of the fifteen trials were at risk of bias. Glucocorticosteroids did not statistically reduce mortality compared with placebo or no intervention (relative risk 0.83, 95% CI 0.63-1.11). Glucocorticosteroids significantly reduced mortality in the subgroup of trials with patients with Maddrey's score of at least 32...

  4. Response Assessment in Neuro-Oncology working group and European Association for Neuro-Oncology recommendations for the clinical use of PET imaging in gliomas.

    Science.gov (United States)

    Albert, Nathalie L; Weller, Michael; Suchorska, Bogdana; Galldiks, Norbert; Soffietti, Riccardo; Kim, Michelle M; la Fougère, Christian; Pope, Whitney; Law, Ian; Arbizu, Javier; Chamberlain, Marc C; Vogelbaum, Michael; Ellingson, Ben M; Tonn, Joerg C

    2016-09-01

    This guideline provides recommendations for the use of PET imaging in gliomas. The review examines established clinical benefit in glioma patients of PET using glucose ((18)F-FDG) and amino acid tracers ((11)C-MET, (18)F-FET, and (18)F-FDOPA). An increasing number of studies have been published on PET imaging in the setting of diagnosis, biopsy, and resection as well radiotherapy planning, treatment monitoring, and response assessment. Recommendations are based on evidence generated from studies which validated PET findings by histology or clinical course. This guideline emphasizes the clinical value of PET imaging with superiority of amino acid PET over glucose PET and provides a framework for the use of PET to assist in the management of patients with gliomas.

  5. The DEMO trial: a randomized, parallel-group, observer-blinded clinical trial of strength versus aerobic versus relaxation training for patients with mild to moderate depression

    DEFF Research Database (Denmark)

    2009-01-01

    OBJECTIVE: To assess the benefit and harm of exercise training in adults with clinical depression. METHOD: The DEMO trial is a randomized pragmatic trial for patients with unipolar depression conducted from January 2005 through July 2007. Patients were referred from general practitioners or psych......OBJECTIVE: To assess the benefit and harm of exercise training in adults with clinical depression. METHOD: The DEMO trial is a randomized pragmatic trial for patients with unipolar depression conducted from January 2005 through July 2007. Patients were referred from general practitioners......: Our findings do not support a biologically mediated effect of exercise on symptom severity in depressed patients, but they do support a beneficial effect of strength training on work capacity. TRIAL REGISTRATION: (ClinicalTrials.gov) Identifier: NCT00103415....

  6. On variance estimate for covariate adjustment by propensity score analysis.

    Science.gov (United States)

    Zou, Baiming; Zou, Fei; Shuster, Jonathan J; Tighe, Patrick J; Koch, Gary G; Zhou, Haibo

    2016-09-10

    Propensity score (PS) methods have been used extensively to adjust for confounding factors in the statistical analysis of observational data in comparative effectiveness research. There are four major PS-based adjustment approaches: PS matching, PS stratification, covariate adjustment by PS, and PS-based inverse probability weighting. Though covariate adjustment by PS is one of the most frequently used PS-based methods in clinical research, the conventional variance estimation of the treatment effects estimate under covariate adjustment by PS is biased. As Stampf et al. have shown, this bias in variance estimation is likely to lead to invalid statistical inference and could result in erroneous public health conclusions (e.g., food and drug safety and adverse events surveillance). To address this issue, we propose a two-stage analytic procedure to develop a valid variance estimator for the covariate adjustment by PS analysis strategy. We also carry out a simple empirical bootstrap resampling scheme. Both proposed procedures are implemented in an R function for public use. Extensive simulation results demonstrate the bias in the conventional variance estimator and show that both proposed variance estimators offer valid estimates for the true variance, and they are robust to complex confounding structures. The proposed methods are illustrated for a post-surgery pain study. Copyright © 2016 John Wiley & Sons, Ltd. PMID:26999553

  7. Clinical experience and institutional in a Department of Mental Health: The multifamily groups for parents and children with psychiatric illness in the time of post-modernity

    Directory of Open Access Journals (Sweden)

    Luisella Ferraris

    2014-09-01

    Full Text Available The following work shows the beginning and development of a multifamily group, involving mental health professionals, parents and psychiatric patients, in a mental health center. The group goals and the main functions of this setting, will be described, observing also the social and community changes, occurring in recent years. Finally, starting from the analysis of the major psychoanalysis research findings, the concepts of inter-subjectivity, therapeutic alliance and institution's role regarding the psychiatric patients’ treatment, will be deepened. Keywords: Department of Mental Health; Multifamily group; Community changes; Therapeutic alliance; Psychiatric patients

  8. Genome-wide association study of virologic response with efavirenz-containing or abacavir-containing regimens in AIDS clinical trials group protocols

    NARCIS (Netherlands)

    Lehmann, David S; Ribaudo, Heather J; Daar, Eric S; Gulick, Roy M; Haubrich, Richard H; Robbins, Gregory K; de Bakker, Paul I W; Haas, David W; McLaren, Paul J

    2015-01-01

    BACKGROUND: Efavirenz and abacavir are components of recommended first-line regimens for HIV-1 infection. We used genome-wide genotyping and clinical data to explore genetic associations with virologic failure among patients randomized to efavirenz-containing or abacavir-containing regimens in AIDS

  9. Effects of video-feedback on the communication, clinical competence and motivational interviewing skills of practice nurses: a pre-test posttest control group study

    NARCIS (Netherlands)

    Noordman, J.; Weijden, T.T. van der; Dulmen, S. van

    2014-01-01

    AIMS: To examine the effects of individual video-feedback on the generic communication skills, clinical competence (i.e. adherence to practice guidelines) and motivational interviewing skills of experienced practice nurses working in primary care. BACKGROUND: Continuing professional education may be

  10. Effects of video-feedback on the communication, clinical competence and motivational interviewing skills of practice nurses: a pre-test posttest control group study.

    NARCIS (Netherlands)

    Noordman, J.; Weijden, T. van der; Dulmen, S. van

    2014-01-01

    Aims: To examine the effects of individual video-feedback on the generic communication skills, clinical competence (i.e. adherence to practice guidelines) and motivational interviewing skills of experienced practice nurses working in primary care. Background: Continuing professional education may be

  11. Clinical characteristics of very old patients hospitalized in internal medicine wards for heart failure: a sub-analysis of the FADOI-CONFINE Study Group

    Directory of Open Access Journals (Sweden)

    Paolo Biagi

    2014-03-01

    Full Text Available The incidence and prevalence of chronic heart failure are increasing worldwide, as is the number of very old patients (>85 years affected by this disease. The aim of this sub-analysis of the multicenter, observational CONFINE study was to detect clinical and therapeutic peculiarities in patients with chronic heart failure aged >85 years. We recruited patients admitted with a diagnosis of chronic heart failure and present in the hospital in five index days, in 91 Units of Internal Medicine. The patients’ clinical characteristics, functional and cognitive status, and the management of the heart failure were analyzed. A total of 1444 subjects were evaluated, of whom 329 (23.1% were over 85 years old. Signs and symptoms of chronic heart failure were more common in very old patients, as were severe renal insufficiency, anemia, disability and cognitive impairment. The present survey found important age-related differences (concomitant diseases, cognitive status among patients with chronic heart failure, as well as different therapeutic strategies and clinical outcome for patients over 85 years old. Since these patients are usually excluded from clinical trials and their management remains empirical, specific studies focused on the treatment of very old patients with chronic heart failure are needed.

  12. Clinical analysis of 670 cases in two trials of the European Organization for the Research and Treatment of Cancer Lymphoma Cooperative Group subtyped according to the Revised European-American Classification of Lymphoid Neoplasms: a comparison with the Working Formulation.

    Science.gov (United States)

    Pittaluga, S; Bijnens, L; Teodorovic, I; Hagenbeek, A; Meerwaldt, J H; Somers, R; Thomas, J; Noordijk, E M; De Wolf-Peeters, C

    1996-05-15

    In the Working Formulation (WF), non-Hodgkin's lymphomas (NHL) are grouped according to their clinical behavior. These disorders are listed as entities defined by morphology, phenotype, and cytogenetics in the proposed Revised European-American Classification of Lymphoid Neoplasms (REAL), the clinical relevance of which is still debated. We analyzed 670 NHL cases included in two randomized clinical trials (EORTC 20855 WF-intermediate/high-grade and 20856 WF-low-grade malignancy) with histologic material available for review. Based on hematoxylin-eosin-stained sections, 77% of cases could be subtyped. Immunophenotyping was considered to be mandatory only in diagnosing T-cell lymphoma and anaplastic large-cell lymphoma. Of 522 cases subtyped, 11% were mantle cell lymphoma (MCL), 5% were marginal zone B-cell lymphoma (MZBCL), 46% were follicle center lymphoma, and 32% were diffuse large B-cell lymphoma. Statistical analysis and comparisons between classifications were made only within each trial and treatment group. MCL and MZBCL were characterized by a shorter median survival (3.4 and 4.1 years, respectively) in comparison with low- and intermediate-grade WF groups (> 9.3 and 5.8 years, respectively). In terms of progression-free survival, MCL showed a behavior similar to the low-grade group, with frequent relapses. Follicle center cell lymphomas behaved as low-grade lymphomas as defined by the WF and diffuse large B-cell lymphomas as the WF-intermediate grade group. Because several NHL entities have a clinical behavior of their own, their recognition by the REAL classification offers clinicians additional information that is not obtained when the WF is used.

  13. Comparing telehealth-based and clinic-based group cognitive behavioral therapy for adults with depression and anxiety: a pilot study

    Directory of Open Access Journals (Sweden)

    Khatri N

    2014-05-01

    Full Text Available Nasreen Khatri, Elsa Marziali, Illia Tchernikov, Nancy ShepherdRotman Research Institute, Toronto, ON, CanadaBackground: The primary objective of this pilot study was to demonstrate reliable adherence to a group cognitive behavioral (CBT therapy protocol when delivered using on-line video conferencing as compared with face-to-face delivery of group CBT. A secondary aim was to show comparability of changes in subject depression inventory scores between on-line and face-to-face delivery of group CBT.Methods: We screened 31 individuals, 18 of whom met the criteria for a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition diagnosis of mood and/or anxiety disorder. All qualifying participants had the necessary equipment (computer, webcam, Internet for participation in the study, but could exercise their preference for either the on-line or face-to-face format. Eighteen completed the 13 weekly session intervention program (ten face-to-face; eight video conferencing. We coded adherence to protocol in both intervention formats and generated pre–post changes in scores on the Beck Depression Inventory Second Edition (BDI-II for each participant.Results: Application of the CBT protocol coding system showed reliable adherence to the group CBT intervention protocol in both delivery formats. Similarly, qualitative analysis of the themes in group discussion indicated that both groups addressed similar issues. Pre–post intervention scores for the BDI-II were comparable across the two delivery formats, with 60% of participants in each group showing a positive change in BDI-II severity classification (eg, from moderate to low symptoms.Conclusion: This pilot study demonstrates that group CBT could be delivered in a technology-supported environment (on-line video conferencing and can meet the same professional practice standards and outcomes as face-to-face delivery of the intervention program.Keywords: psychotherapy, gerontology, mood

  14. Nuclear data adjustment methodology utilizing resonance parameter sensitivities and uncertainties

    International Nuclear Information System (INIS)

    This work presents the development and demonstration of a Nuclear Data Adjustment Method that allows inclusion of both energy and spatial self-shielding into the adjustment procedure. The resulting adjustments are for the basic parameters (i.e., resonance parameters) in the resonance regions and for the group cross sections elsewhere. The majority of this development effort concerns the production of resonance parameter sensitivity information which allows the linkage between the responses of interest and the basic parameters. The resonance parameter sensitivity methodology developed herein usually provides accurate results when compared to direct recalculations using existing and well-known cross section processing codes. However, it has been shown in several cases that self-shielded cross sections can be very non-linear functions of the basic parameters. For this reason caution must be used in any study which assumes that a linear relationship exists between a given self-shielded group cross section and its corresponding basic data parameters

  15. Unwrapping the organizational entry process: disentangling multiple antecedents and their pathways to adjustment.

    Science.gov (United States)

    Kammeyer-Mueller, John D; Wanberg, Connie R

    2003-10-01

    This 4-wave longitudinal study of newcomers in 7 organizations examined preentry knowledge, proactive personality, and socialization influences as antecedents of both proximal (task mastery, role clarity, work group integration, and political knowledge) and distal (organizational commitment, work withdrawal, and turnover) indicators of newcomer adjustment. Results suggest that preentry knowledge, proactive personality, and socialization influences from the organization, supervisors, and coworkers are independently related to proximal adjustment outcomes, consistent with a theoretical framework highlighting distinct dimensions of organizational and work task adjustment. The proximal adjustment outcomes partially mediated most of the relationships between the antecedents of adjustment and organizational commitment, work withdrawal, and turnover. PMID:14516244

  16. Focal Adjustment for Star Tracker

    Directory of Open Access Journals (Sweden)

    Liu Hai-bo

    2010-10-01

    Full Text Available Technique of measuring intensity distribution and size of spot image developed has been discussed, which is especially suitable for defocus adjustment in ground test of star tracker. A novel approach for choosing a proper defocusing position has been proposed based on collimator, Gaussian surface fitting method, and other ordinary instruments. It proves to be practical and adequate in the development of distant object tracking such as star tracker.Defence Science Journal, 2010, 60(6, pp.678-682, DOI:http://dx.doi.org/10.14429/dsj.60.36

  17. Effects of video-feedback on the communication, clinical competence and motivational interviewing skills of practice nurses: a pre-test posttest control group study.

    OpenAIRE

    Noordman, J.; van der Weijden, T; Van Dulmen, S.

    2014-01-01

    Aims: To examine the effects of individual video-feedback on the generic communication skills, clinical competence (i.e. adherence to practice guidelines) and motivational interviewing skills of experienced practice nurses working in primary care. Background: Continuing professional education may be necessary to refresh and reflect on the communication and motivational interviewing skills of experienced primary care practice nurses. A video-feedback method was designed to improve these skills...

  18. Rasburicase in the prevention of laboratory/clinical tumour lysis syndrome in children with advanced mature B-NHL: A Children’s Oncology Group Report

    OpenAIRE

    Galardy, Paul; Hochberg, Jessica; Perkins, Sherrie L.; Harrison, Lauren; Goldman, Stanton; Cairo, Mitchell S

    2013-01-01

    Laboratory (LTLS) and clinical (CTLS) tumour lysis syndrome (TLS) are frequent complications in newly diagnosed children with advanced mature B cell non-Hodgkin lymphoma (B-NHL). Rasburicase, compared to allopurinol, results in more rapid reduction of uric acid in paediatric patients at risk for TLS. However, the safety and efficacy of rasburicase for the treatment or or prevention of TLS has not been prospectively evaluated. Children with newly diagnosed stage III–IV, bone marrow+ and/or cen...

  19. A comparative study of the clinical efficacy and safety of agomelatine with escitalopram in major depressive disorder patients: A randomized, parallel-group, phase IV study

    Directory of Open Access Journals (Sweden)

    Chetan S Urade

    2015-01-01

    Full Text Available Objective: To compare the efficacy of agomelatine with escitalopram in the treatment of major depressive disorder (MDD, improve sleep in MDD patients and study the adverse effects of agomelatine. Materials and Methods: Randomized, parallel-group, open-label study. The primary efficacy outcome was change from baseline to last post-baseline value in Hamilton depression rating scale and Leeds sleep evaluation questionnaire scale. Both parametric and nonparametric tests were applied for analysis. Results: Within-group and between-groups comparison of the mean HAMD17 scores showed statistically significant changes (P < 0.0001. Escitalopram showed early onset of response and remission compared to agomelatine at 10th week (P < 0.0001 and 14th week (P < 0.0001, respectively. In agomelatine, within-group and between-groups change of the mean LSEQ score was statistically significant at subsequent follow-up visits (P < 0.0001. Conclusion: Escitalopram is superior to agomelatine in efficacy, considering the early response, early remission, and better relief from symptoms of MDD in adults. Agomelatine may be preferred in MDD patients having insomnia as a predominant symptom. Liver function monitoring should be done in patients on long-term agomelatine therapy.

  20. Anxiety Disorders: Support Groups

    Science.gov (United States)

    ... Guidelines Scientific Council Special Interest Groups Child & Adolescent Anxiety SIG Peer Consultation OCD & Related Disorders SIG Peer ... Jobs and Fellowships Journal & Multimedia Announcements Depression and Anxiety Podcasts & Videos Resources Clinical Practice Reviews & Teaching Tools ...

  1. Design paper: The CapOpus trial: a randomized, parallel-group, observer-blinded clinical trial of specialized addiction treatment versus treatment as usual for young patients with cannabis abuse and psychosis

    DEFF Research Database (Denmark)

    Hjorthøj, Carsten; Fohlmann, Allan; Larsen, Anne-Mette;

    2008-01-01

    ) treatment as usual. The specialized addiction treatment is manualized and consists of both individual and group-based motivational interviewing and cognitive behavioral therapy, and incorporates both the family and the case manager of the patient.The primary outcome measure will be changes in amount...... of cannabis consumption over time. Other outcome measures will be psychosis symptoms, cognitive functioning, quality of life, social functioning, and cost-benefit analyses. TRIAL REGISTRATION: ClinicalTrials.gov NCT00484302....

  2. Evaluation of an Immunochromatographic Assay for Rapid Detection of Penicillin-Binding Protein 2a in Human and Animal Staphylococcus intermedius Group, Staphylococcus lugdunensis, and Staphylococcus schleiferi Clinical Isolates.

    Science.gov (United States)

    Arnold, A R; Burnham, C-A D; Ford, B A; Lawhon, S D; McAllister, S K; Lonsway, D; Albrecht, V; Jerris, R C; Rasheed, J K; Limbago, B; Burd, E M; Westblade, L F

    2016-03-01

    The performance of a rapid penicillin-binding protein 2a (PBP2a) detection assay, the Alere PBP2a culture colony test, was evaluated for identification of PBP2a-mediated beta-lactam resistance in human and animal clinical isolates of Staphylococcus intermedius group, Staphylococcus lugdunensis, and Staphylococcus schleiferi. The assay was sensitive and specific, with all PBP2a-negative and PBP2a-positive strains testing negative and positive, respectively.

  3. Evaluation of an Immunochromatographic Assay for Rapid Detection of Penicillin-Binding Protein 2a in Human and Animal Staphylococcus intermedius Group, Staphylococcus lugdunensis, and Staphylococcus schleiferi Clinical Isolates.

    Science.gov (United States)

    Arnold, A R; Burnham, C-A D; Ford, B A; Lawhon, S D; McAllister, S K; Lonsway, D; Albrecht, V; Jerris, R C; Rasheed, J K; Limbago, B; Burd, E M; Westblade, L F

    2016-03-01

    The performance of a rapid penicillin-binding protein 2a (PBP2a) detection assay, the Alere PBP2a culture colony test, was evaluated for identification of PBP2a-mediated beta-lactam resistance in human and animal clinical isolates of Staphylococcus intermedius group, Staphylococcus lugdunensis, and Staphylococcus schleiferi. The assay was sensitive and specific, with all PBP2a-negative and PBP2a-positive strains testing negative and positive, respectively. PMID:26677248

  4. Pathogen group specific risk factors for clinical mastitis, intramammary infection and blind quarters at the herd, cow and quarter level in smallholder dairy farms in Jimma, Ethiopia.

    Science.gov (United States)

    Tolosa, T; Verbeke, J; Ayana, Z; Piepers, S; Supré, K; De Vliegher, S

    2015-07-01

    A cross-sectional study on clinical mastitis, intramammary infection (IMI) and blind quarters was conducted on 50 smallholder dairy farms in Jimma, Ethiopia. A questionnaire was performed, and quarters of 211 cows were sampled and bacteriologically cultured. Risk factors at the herd, cow, and quarter level for clinical mastitis and (pathogen-specific) intramammary infection were studied using multilevel modeling. As well, factors associated with quarters being blind were studied. Eleven percent of the cows and 4% of the quarters had clinical mastitis whereas 85% of the cows and 51% of the quarters were infected. Eighteen percent of the cows had one or more blind quarter(s), whereas 6% of the quarters was blind. Non-aureus staphylococci were the most frequently isolated pathogens in both clinical mastitis cases and IMI. The odds of clinical mastitis was lower in herds where heifers were purchased in the last year [odds ratio (OR) with 95% confidence interval: 0.11 (0.01-0.90)], old cows (>4 years) [OR: 0.45 (0.18-1.14)], and quarters not showing teat injury [OR: 0.23 (0.07-0.77)]. The odds of IMI caused by any pathogen was higher in herds not practicing teat drying before milking (opposed to drying teats with 1 towel per cow) [OR: 1.68 (1.05-2.69)], cows in later lactation (>180 DIM opposed to ≤90 DIM) [OR: 1.81 (1.14-2.88)], cows with a high (>3) body condition score (BCS) [OR: 1.57 (1.06-2.31)], right quarters (opposed to a left quarter position) [OR: 1.47 (1.10-1.98)], and quarters showing teat injury [OR: 2.30 (0.97-5.43)]. Quarters of cows in herds practicing bucket-fed calf feeding (opposed to suckling) had higher odds of IMI caused by Staphylococcus aureus [OR: 6.05 (1.31-27.90)]. Except for BCS, IMI caused by non-aureus staphylococci was associated with the same risk factors as IMI caused by any pathogen. No access to feed and water immediately after milking [OR: 2.41 (1.26-4.60)], higher parity [OR: 3.60 (1.20-10.82)] and tick infestation [OR: 2.42 (1

  5. Pathogen group specific risk factors for clinical mastitis, intramammary infection and blind quarters at the herd, cow and quarter level in smallholder dairy farms in Jimma, Ethiopia.

    Science.gov (United States)

    Tolosa, T; Verbeke, J; Ayana, Z; Piepers, S; Supré, K; De Vliegher, S

    2015-07-01

    A cross-sectional study on clinical mastitis, intramammary infection (IMI) and blind quarters was conducted on 50 smallholder dairy farms in Jimma, Ethiopia. A questionnaire was performed, and quarters of 211 cows were sampled and bacteriologically cultured. Risk factors at the herd, cow, and quarter level for clinical mastitis and (pathogen-specific) intramammary infection were studied using multilevel modeling. As well, factors associated with quarters being blind were studied. Eleven percent of the cows and 4% of the quarters had clinical mastitis whereas 85% of the cows and 51% of the quarters were infected. Eighteen percent of the cows had one or more blind quarter(s), whereas 6% of the quarters was blind. Non-aureus staphylococci were the most frequently isolated pathogens in both clinical mastitis cases and IMI. The odds of clinical mastitis was lower in herds where heifers were purchased in the last year [odds ratio (OR) with 95% confidence interval: 0.11 (0.01-0.90)], old cows (>4 years) [OR: 0.45 (0.18-1.14)], and quarters not showing teat injury [OR: 0.23 (0.07-0.77)]. The odds of IMI caused by any pathogen was higher in herds not practicing teat drying before milking (opposed to drying teats with 1 towel per cow) [OR: 1.68 (1.05-2.69)], cows in later lactation (>180 DIM opposed to ≤90 DIM) [OR: 1.81 (1.14-2.88)], cows with a high (>3) body condition score (BCS) [OR: 1.57 (1.06-2.31)], right quarters (opposed to a left quarter position) [OR: 1.47 (1.10-1.98)], and quarters showing teat injury [OR: 2.30 (0.97-5.43)]. Quarters of cows in herds practicing bucket-fed calf feeding (opposed to suckling) had higher odds of IMI caused by Staphylococcus aureus [OR: 6.05 (1.31-27.90)]. Except for BCS, IMI caused by non-aureus staphylococci was associated with the same risk factors as IMI caused by any pathogen. No access to feed and water immediately after milking [OR: 2.41 (1.26-4.60)], higher parity [OR: 3.60 (1.20-10.82)] and tick infestation [OR: 2.42 (1

  6. Psychological adjustment among bereaved parents: individual and interpersonal predictors

    NARCIS (Netherlands)

    Wijngaards-de Meij, L.D.N.V.

    2007-01-01

    Bereaved parents are a highly vulnerable group. Nevertheless, considerable individual differences exist between parents who have lost their child. The aim of this thesis was to identify factors that can predict which parents will be at particularly elevated risk for problematic adjustment after the

  7. Effects of Domestic Violence on Children's Adjustment in School.

    Science.gov (United States)

    Dawud, Samia; And Others

    This study examined the relationship between children's experiences of domestic violence and their adjustment at school. Sixty-three children (28 girls), in Israel, their classmates and teachers took part in the study. Children were divided into four groups: (1) those who were victims of physical abuse; (2) those who witnessed abuse; (3) those who…

  8. Recent Stressful Life Events among Bahraini Adolescents with Adjustment Disorder.

    Science.gov (United States)

    Al-Ansari, Ahmed; Matar, Ali M.

    1993-01-01

    Retrospectively examined adolescents from two time periods, diagnosed with adjustment disorder (n=72), for type of life stressors that initiated referrals to child psychiatry unit and compared them to control group of 42 referred adolescents with no psychopathology. Disappointment in relationships with family member or friend of opposite sex was…

  9. Psychological Adjustment and Neuropsychological Performance in Diabetic Patients.

    Science.gov (United States)

    Skenazy, Judy A.; Bigler, Erin D.

    1985-01-01

    Compared diabetic (N=39) with nondiabetic chronic illness patients (N=20) and healthy controls (N=24). The chronic illness and the diabetic groups had significant elevations on the Hypochondriasis, Depression, and Hysteria scales of the Feschingbauer Abbreviated MMPI. For diabetics, results demonstrated a negligible effect of poor adjustment on…

  10. 77 FR 60047 - Adjustment of Civil Monetary Penalties for Inflation

    Science.gov (United States)

    2012-10-02

    ..., and inconsequential to the industry and to the public.'' Utility Solid Waste Activities Group v. EPA... most recent cost adjustment to each CMP in the Federal Register on January 4, 2005 (70 FR 297), and... increase in the Consumer Price Index for all urban consumers (CPI-U) published by the Department of...

  11. Risk-Adjusted Mortality: Problems and Possibilities

    Directory of Open Access Journals (Sweden)

    Daniel Shine

    2012-01-01

    Full Text Available The ratio of observed-to-expected deaths is considered a measure of hospital quality and for this reason will soon become a basis for payment. However, there are drivers of that metric more potent than quality: most important are medical documentation and patient acuity. If hositals underdocument and therefore do not capture the full “expected mortality” they may be tempted to lower their observed/expected ratio by reducing “observed mortality” through limiting access to the very ill. Underdocumentation occurs because hospitals do not recognize, and therefore cannot seek to confirm, specific comorbidities conferring high mortality risk. To help hospitals identify these comorbidities, this paper describes an easily implemented spread-sheet for evaluating comorbid conditions associated, in any particular hospital, with each discharge. This method identifies comorbidities that increase in frequency as mortality risk increases within each diagnostic grouping. The method is inductive and therefore independent of any particular risk-adjustment technique.

  12. Teaching clinical interviewing skills using role-playing: conveying empathy to performing a suicide assessment: a primer for individual role-playing and scripted group role-playing.

    Science.gov (United States)

    Shea, Shawn Christopher; Barney, Christine

    2015-03-01

    This article provides a useful introduction to the art of role-playing in both the individual format and the group format using scripted group role-playing (SGRP). Role-playing can provide powerful learning opportunities, but to do so it must be done well. This article imparts guidance toward this goal. SGRP may greatly enhance the acquisition of critical complex interviewing skills, such as suicide assessment and uncovering domestic violence, in health care providers across all disciplines, an educational goal that has not been achievable to date. Although research is at an early stage of development, the hope represented by SGRP is tangible.

  13. Parenting Perfectionism and Parental Adjustment.

    Science.gov (United States)

    Lee, Meghan A; Schoppe-Sullivan, Sarah J; Kamp Dush, Claire M

    2012-02-01

    The parental role is expected to be one of the most gratifying and rewarding roles in life. As expectations of parenting become ever higher, the implications of parenting perfectionism for parental adjustment warrant investigation. Using longitudinal data from 182 couples, this study examined the associations between societal- and self-oriented parenting perfectionism and new mothers' and fathers' parenting self-efficacy, stress, and satisfaction. For mothers, societal-oriented parenting perfectionism was associated with lower parenting self-efficacy, but self-oriented parenting perfectionism was associated with higher parenting satisfaction. For fathers, societal-oriented parenting perfectionism was associated with higher parenting stress, whereas higher levels of self-oriented parenting perfectionism were associated with higher parenting self-efficacy, lower parenting stress, and greater parenting satisfaction. These findings support the distinction between societal- and self-oriented perfectionism, extend research on perfectionism to interpersonal adjustment in the parenting domain, and provide the first evidence for the potential consequences of holding excessively high standards for parenting. PMID:22328797

  14. Cohesion to the Group and Its Association with Attendance and Early Treatment Response in an Adult Day-Hospital Program for Eating Disorders: A Preliminary Clinical Investigation

    Science.gov (United States)

    Crino, Natalie; Djokvucic, Ivana

    2010-01-01

    Treatment outcome studies demonstrate that day-hospital programs are effective in the treatment of eating disorders. Few descriptions are available on the specifics of treatment, particularly the process of therapy. The group therapy modality is thought to provide important therapeutic benefits. The present study aimed to examine the association…

  15. Comparison of the administration of progesterone versus progesterone and vitamin D in improvement of outcomes in patients with traumatic brain injury: A randomized clinical trial with placebo group

    Directory of Open Access Journals (Sweden)

    Bahram Aminmansour

    2012-01-01

    Full Text Available Background: Due to the heterogeneity of traumatic brain injury (TBI, many of single treatments have not been successful in prevention and cure of these kinds of injuries. The neuroprotective effect of progesterone drug on severe brain injuries has been identified, and recently, the neuroprotective effect of vitamin D has also been studied as the combination of these two drugs has shown better effects on animal samples in some studies. This study was conducted to examine the effect of vitamin D and progesterone on brain injury treatment after brain trauma. Materials and Methods: This study was performed on patients with severe brain trauma (Glasgow Coma Scale (GCS ≤ 8 from April to September, 2011. The patients were divided to 3 groups (placebo, progesterone, progesterone-vitamin D, each with 20 people. Upon the patients′ admission, their GCS and demographic information were recorded. After 3 months, they were reassessed, and their GCS and GOS (Glasgow outcome scale were recorded. The collected data were analyzed using SPSS 18 software (SPSS Inc., Chicago IL, USA. Results: Before intervention, GCS mean of the placebo, progesterone, and progesterone-vitamin D groups were 6.3 ± 0.88, 6.31 ± 0.87, and 6 ± 0.88, respectively. They increased to 9.16 ± 1.11, 10.25 ± 1.34, and 11.27 ± 2.27, respectively 3 months after intervention. There was a significant difference among GCS means of the 3 groups (P-value = 0.001. GOS was classified to 2 main categories of favorable and unfavorable recovery, of which, favorable recovery in placebo, progesterone, and progesterone-vitamin D was 25%, 45%, and 60%, respectively which showed a statistical significant difference among the groups (P-value = 0.03. Conclusion: The results showed that recovery rate in patients with severe brain trauma in the group receiving progesterone and vitamin D together was significantly higher than that of progesterone group, which was in turn higher than that of placebo group.

  16. Research Design in Marital Adjustment Studies.

    Science.gov (United States)

    Croake, James W.; Lyon, Rebecca S.

    1978-01-01

    The numerous marital adjustment studies which exist in the literature are confounded by basic design problems. Marital stability should be the baseline for data. It is then possible to discuss "happiness,""success,""adjustment," and "satisfaction." (Author)

  17. Belonging to a peer support group enhance the quality of life and adherence rate in patients affected by breast cancer: A non-randomized controlled clinical trialFNx01

    Directory of Open Access Journals (Sweden)

    Afsaneh Malekpour Tehrani

    2011-01-01

    Full Text Available Background: Breast cancer is the most common cancer in women. It seems that breast cancer patients benefit from meeting someone who had a similar experience. This study evaluated the effect of two kinds of interventions (peer support and educational program on quality of life in breast cancer patients. Methods: This study was a controlled clinical trial on women with non-metastatic breast cancer. The patients studied in two experimental and control groups. Experimental group took part in peer support program and control group passed a routine educational program during 3 months. The authors administered SF-36 for evaluating the quality of life pre-and post intervention. Also, patient′s adherence was assessed by means of a simple checklist. Results: Two groups were similar with respect of age, age of onset of the disease, duration of having breast cancer, marital status, type of the treatment receiving now, and type of the received surgery. In the control group, there were statistically significant improvements in body pain, role-physical, role-emotional and social functioning. In experimental group, role-physical, vitality, social functioning, role-emotional and mental health showed significant improvement. Vitality score and mental health score in experimental group was significantly higher than that of the control group, both with p < 0.001. Also, it was shown that adherence was in high levels in both groups and no significant difference was seen after the study was done. Conclusions: According to the results of this study, supporting the patients with breast cancer by forming peer groups or by means of educational sessions could improve their life qualities.

  18. The Social Appearance Anxiety Scale in Italian adolescent populations: Construct validation and group discrimination in community and clinical eating disorders samples

    OpenAIRE

    Dakanalis, Antonios; Carrà, Giuseppe; Calogero, Rachel M.; Zanetti, M. Assunta; Volpato, Chiara; Riva, Giuseppe; Clerici, Massimo; Cipresso, Pietro

    2015-01-01

    Anxiety in situations where one’s overall appearance (including body shape) may be negatively evaluated is hypothesized to play a central role in Eating Disorders (EDs) and in their co-occurrence with Social Anxiety Disorder (SAD). Three studies were conducted among community (N = 1995) and clinical (N = 703) ED samples of 11- to 18-year-old Italian girls and boys to (a) evaluate the psychometric qualities and measurement equivalence/invariance (ME/I) of the Social Appearance Anxiety (SAA) Sc...

  19. Report of the AAPM Task Group No. 105: Issues associated with clinical implementation of Monte Carlo-based photon and electron external beam treatment planning

    International Nuclear Information System (INIS)

    The Monte Carlo (MC) method has been shown through many research studies to calculate accurate dose distributions for clinical radiotherapy, particularly in heterogeneous patient tissues where the effects of electron transport cannot be accurately handled with conventional, deterministic dose algorithms. Despite its proven accuracy and the potential for improved dose distributions to influence treatment outcomes, the long calculation times previously associated with MC simulation rendered this method impractical for routine clinical treatment planning. However, the development of faster codes optimized for radiotherapy calculations and improvements in computer processor technology have substantially reduced calculation times to, in some instances, within minutes on a single processor. These advances have motivated several major treatment planning system vendors to embark upon the path of MC techniques. Several commercial vendors have already released or are currently in the process of releasing MC algorithms for photon and/or electron beam treatment planning. Consequently, the accessibility and use of MC treatment planning algorithms may well become widespread in the radiotherapy community. With MC simulation, dose is computed stochastically using first principles; this method is therefore quite different from conventional dose algorithms. Issues such as statistical uncertainties, the use of variance reduction techniques, the ability to account for geometric details in the accelerator treatment head simulation, and other features, are all unique components of a MC treatment planning algorithm. Successful implementation by the clinical physicist of such a system will require an understanding of the basic principles of MC techniques. The purpose of this report, while providing education and review on the use of MC simulation in radiotherapy planning, is to set out, for both users and developers, the salient issues associated with clinical implementation and

  20. The role of stereotactic ablative radiotherapy in oncological and non-oncological clinical settings: highlights from the 7th Meeting of AIRO--Young Members Working Group (AIRO Giovani).

    Science.gov (United States)

    Franco, Pierfrancesco; De Bari, Berardino; Ciammella, Patrizia; Fiorentino, Alba; Chiesa, Silvia; Amelio, Dante; Pinzi, Valentina; Bonomo, Pierluigi; Vagge, Stefano; Fiore, Michele; Comito, Tiziana; Cecconi, Agnese; Mortellaro, Gianluca; Bruni, Alessio; Trovò, Marco; Filippi, Andrea Riccardo; Greto, Daniela; Alongi, Filippo

    2014-01-01

    Stereotactic ablative radiotherapy is a modern cancer treatment strategy able to deliver highly focused radiation in one or a few fractions with a radical intent in several clinical settings. Young radiation oncologists need a constant and tailored update in this context to improve patient care in daily clinical practice. A recent meeting of AIRO Giovani (AIRO--Young Members Working Group) was specifically addressed to this topic, presenting state-of-the-art knowledge, based on the latest evidence in this field. Highlights of the congress are summarized and presented in this report, including thorough contributions of the speakers dealing with the role of stereotactic ablative radiotherapy in both oncological and non-oncological diseases, divided according to anatomical and clinical scenarios: intra-cranial settings (brain malignant primary tumors, metastases, benign tumors and functional disorders) and extra-cranial indications (lung primary tumors and metastases, thoracic re-irradiation, liver, lymph node and bone metastases, prostate cancer). With literature data discussed during the congress as a background, stereotactic ablative radiotherapy has proved to be a consolidated treatment approach in specific oncological and non-oncological scenarios, as well as a promising option in other clinical settings, requiring a further prospective validation in the near future. We herein present an updated overview of stereotactic ablative radiotherapy use in the clinic. PMID:25688503

  1. Anchoring Adjusted Capital Asset Pricing Model

    OpenAIRE

    Hammad, Siddiqi

    2015-01-01

    An anchoring adjusted Capital Asset Pricing Model (ACAPM) is developed in which the payoff volatilities of well-established stocks are used as starting points that are adjusted to form volatility judgments about other stocks. Anchoring heuristic implies that such adjustments are typically insufficient. ACAPM converges to CAPM with correct adjustment, so CAPM is a special case of ACAPM. The model provides a unified explanation for the size, value, and momentum effects in the stock market. A ke...

  2. Can quiet standing posture predict compensatory postural adjustment?

    Directory of Open Access Journals (Sweden)

    Gabriel Bueno Lahóz Moya

    2009-01-01

    Full Text Available OBJECTIVE: The aim of this study was to analyze whether quiet standing posture is related to compensatory postural adjustment. INTRODUCTION: The latest data in clinical practice suggests that static posture may play a significant role in musculoskeletal function, even in dynamic activities. However, no evidence exists regarding whether static posture during quiet standing is related to postural adjustment. METHODS: Twenty healthy participants standing on a movable surface underwent unexpected, standardized backward and forward postural perturbations while kinematic data were acquired; ankle, knee, pelvis and trunk positions were then calculated. An initial and a final video frame representing quiet standing posture and the end of the postural perturbation were selected in such a way that postural adjustments had occurred between these frames. The positions of the body segments were calculated in these initial and final frames, together with the displacement of body segments during postural adjustments between the initial and final frames. The relationship between the positions of body segments in the initial and final frames and their displacements over this time period was analyzed using multiple regressions with a significance level of p < 0.05. RESULTS: We failed to identify a relationship between the position of the body segments in the initial and final frames and the associated displacement of the body segments. DISCUSSION: The motion pattern during compensatory postural adjustment is not related to quiet standing posture or to the final posture of compensatory postural adjustment. This fact should be considered when treating balance disturbances and musculoskeletal abnormalities. CONCLUSION: Static posture cannot predict how body segments will behave during compensatory postural adjustment.

  3. Chinese SLE Treatment and Research Group Registry: III. Association of Autoantibodies with Clinical Manifestations in Chinese Patients with Systemic Lupus Erythematosus

    Directory of Open Access Journals (Sweden)

    Jing Li

    2014-01-01

    Full Text Available We investigated the characteristics of Chinese SLE patients by analyzing the association between specific autoantibodies and clinical manifestations of 2104 SLE patients from registry data of CSTAR cohort. Significant (P<0.05 associations were found between anti-Sm antibody, anti-rRNP antibody, and malar rash; between anti-RNP antibody, anti-SSA antibody, and pulmonary arterial hypertension (PAH; between anti-SSB antibody and hematologic involvement; and between anti-dsDNA antibody and nephropathy. APL antibody was associated with hematologic involvement, interstitial lung disease, and a lower prevalence of oral ulcerations (P<0.05. Associations were also found between anti-dsDNA antibody and a lower prevalence of photosensitivity, and between anti-SSA antibody and a lower prevalence of nephropathy (P<0.05. Most of these findings were consistent with other studies in the literature but this study is the first report on the association between anti-SSA and a lower prevalence of nephropathy. The correlations of specific autoantibodies and clinical manifestations could provide clues for physicians to predict organ damages in SLE patients. We suggest that a thorough screening of autoantibodies should be carried out when the diagnosis of SLE is established, and repeated echocardiography annually in SLE patients with anti-RNP or anti-SSA antibody should be performed.

  4. 24 CFR 5.611 - Adjusted income.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Adjusted income. 5.611 Section 5... Serving Persons with Disabilities: Family Income and Family Payment; Occupancy Requirements for Section 8 Project-Based Assistance Family Income § 5.611 Adjusted income. Adjusted income means annual income...

  5. 12 CFR 1780.80 - Inflation adjustments.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Inflation adjustments. 1780.80 Section 1780.80... DEVELOPMENT RULES OF PRACTICE AND PROCEDURE RULES OF PRACTICE AND PROCEDURE Civil Money Penalty Inflation Adjustments § 1780.80 Inflation adjustments. The maximum amount of each civil money penalty within...

  6. A support group for fathers whose partners died from cancer.

    Science.gov (United States)

    Yopp, Justin Michael; Rosenstein, Donald Lee

    2013-04-01

    Men who are raising dependent children after their spouses or partners have died from cancer face unique challenges adjusting to single parenthood while managing their grief and the grief of their children. Unfortunately, the needs of those widowers have been overlooked in the clinical literature and no published interventions are designed specifically for that population. The current article details the creation and implementation of a peer support group for fathers recently widowed because of their wives' deaths from cancer. Initial observations and emergent themes from the group are described. Group members suggested that they benefited from participation in the support group and that this form of psychosocial support is a promising intervention for fathers in similar circumstances. PMID:23538252

  7. APPROACH AND TREATMENT OF SUICIDAL BEHAVIOR IN THE CLINICAL PRACTICE OF DIFFERENT GROUPS OF HEALTH PROFESSIONALS IN SPAIN: RESULTS OF THE PROJECT EUREGENA.

    Directory of Open Access Journals (Sweden)

    Juan Luis Muñoz

    2014-12-01

    Full Text Available According to the WHO (World Health Organization and the European Union, suicide is considered to be a health problem of prime importance and to be one of the principal causes of unnatural death. In Spain, the number of suicides has increased 12% since 2005 . The Research Project “European Regions Enforcing Actions against Suicide (EUREGENAS, funded by the Health Program 2008-2013, has as main objective the description of an integrated model of Mental Health orientated to the prevention of suicide. The differences that allow distinguishing the meaning of prevention in suicide behavior are described and explained through a qualitative methodological strategy and through the creation of discussion groups formed by different groups of health professionals. The results highlight the existing differences between the diverse health professionals who come more in contact with this problem and it shows as well the coincidence of meaning that suicide has to be considered as a priority in the field of health.

  8. Clinical practice guidelines for the diagnosis and treatment of patients with soft tissue sarcoma by the Spanish group for research in sarcomas (GEIS)

    OpenAIRE

    García del Muro, Xavier; Alava, Enrique de; Artigas, Vicenç; Bague, Silvia; Braña Vigil, Alejandro Francisco; ,

    2015-01-01

    Soft tissue sarcomas (STS) constitute an uncommon and heterogeneous group of tumours, which require a complex and specialized multidisciplinary management. The diagnostic approach should include imaging studies and core needle biopsy performed prior to undertaking surgery. Wide excision is the mainstay of treatment for localized sarcoma, and associated preoperative or postoperative radiotherapy should be administered in high-risk patients. Adjuvant chemotherapy was associated with a modest im...

  9. 依托行业·注重实训·提升技能——以‘镶行社计调业务——组团计调”为例%Relying on Industry, Focus on Training, Upgrade the Skills Take "The Travel Agency Adjustment Business-group Adjustment" as an example

    Institute of Scientific and Technical Information of China (English)

    赵丽娅

    2012-01-01

    With the development of tourism, travel agents require more tour guides service personnel, especially the talent to master the special skills and practical skills. Actual adjustment for the work process as the main line, to organize course content of the "travel agency adjustment services" to the logical order to complete the actual work tasks, career job require- ments and the needs of the students' development, design-level tourism adjustment for the business curriculum, students have engaged in the work of adjustment for the quality and the formation of the corresponding professional competence.%随着旅游业的发展,旅行社对导游服务人才的需求也越来越大,特别是掌握专业技能和实践技能的人才。本文以实际计调工作过程为主线,以完成实际工作任务的逻辑顺序来对旅行社计调业务课程的教学内容进行组织,从企业的职业岗位要求和学生发展的需求出发,设计中职旅游计调业务的课程体系,使学生具备从事计调工作的素质并形成相应的职业能力。

  10. Neighborhood Assets and Adolescent Adjustment

    Directory of Open Access Journals (Sweden)

    Alfredo Oliva Delgado

    2011-12-01

    Full Text Available This paper presents the results of a study analyzing the relationship between some dimensions or developmental assets in the neighborhood, as measured by the Scale for the Assessment of Developmental Assets in the Neighborhood, and adjustment and life satisfaction of adolescent boys and girls. The sample consisted of 2400 adolescents (1068 boys and 1332 girls between ages 12 and 17 who were secondary students in public and private schools in Western Andalusia. The results showed significant relationships between most dimensions of the scale (youth empowerment, attachment to neighbourhood safety and social control and internalizing and externalizing problems, substance use and life satisfaction of participants. Moreover, the data provide evidence about the external validity of the scale used in the study. From the results some suggestions for intervention in the community environment are extracted.

  11. [Causal relationship between assertiveness and adjustment in children: A short-term longitudinal study].

    Science.gov (United States)

    Eguchi, Megumi; Hamaguchi, Yoshikazu

    2015-08-01

    This study examined the causal relationships between assertiveness and both internal and external adjustment in children. Elementary school children in grades four through six (N = 284) participated in the study, which used a short-term longitudinal design. The children completed questionnaires twice during a 6-months period. They responded to assertiveness questionnaires that included two components: "self-expression" and "consideration of others". They also completed a self-esteem scale as an index of internal adjustment, and the Class Life Satisfaction scale as an index of external adjustment. There was a positive causative relationship between "self-expression" and internal adjustment and between "consideration for others" and external adjustment. In addition, the effects on adjustment varied according to the type of assertiveness. Cluster analysis and MANOVA indicated that the group with high "self-expression" and "consideration for others" had high internal and external adjustment, while the children with poor assertiveness showed the lowest degree of adaptivity. PMID:26402950

  12. Measuring Sojourner Adjustment among American students studying abroad.

    Science.gov (United States)

    Pedersen, Eric R; Neighbors, Clayton; Larimer, Mary E; Lee, Christine M

    2011-11-01

    The literature on "Sojourner Adjustment," a term expanding on the acculturation concept to apply to groups residing temporarily in foreign environments, suggests that engagement, participation, and temporary integration into the host culture may contribute to less psychological and sociocultural difficulty while abroad. The present study was designed to establish a brief multi-component measure of Sojourner Adjustment (the Sojourner Adjustment Measure; SAM) to be used in work with populations residing temporarily in foreign environments (e.g., international students, foreign aid workers). Using exploratory and confirmatory factor analyses on a sample of 248 American study abroad college students, we established a 24-item measure of Sojourner Adjustment composed of four positive factors (social interaction with host nationals, cultural understanding and participation, language development and use, host culture identification) and two negative factors (social interaction with co-nationals, homesickness/feeling out of place). Preliminary convergent validity was examined through correlations with established measures of acculturation. Further research with the SAM is encouraged to explore the relevance of this measure with other groups of sojourners (e.g., foreign aid workers, international businessmen, military personnel) and to determine how SAM factors relate to psychological well-being, health behaviors, and risk behaviors abroad among these diverse groups. PMID:22125351

  13. Measuring Sojourner Adjustment among American students studying abroad.

    Science.gov (United States)

    Pedersen, Eric R; Neighbors, Clayton; Larimer, Mary E; Lee, Christine M

    2011-11-01

    The literature on "Sojourner Adjustment," a term expanding on the acculturation concept to apply to groups residing temporarily in foreign environments, suggests that engagement, participation, and temporary integration into the host culture may contribute to less psychological and sociocultural difficulty while abroad. The present study was designed to establish a brief multi-component measure of Sojourner Adjustment (the Sojourner Adjustment Measure; SAM) to be used in work with populations residing temporarily in foreign environments (e.g., international students, foreign aid workers). Using exploratory and confirmatory factor analyses on a sample of 248 American study abroad college students, we established a 24-item measure of Sojourner Adjustment composed of four positive factors (social interaction with host nationals, cultural understanding and participation, language development and use, host culture identification) and two negative factors (social interaction with co-nationals, homesickness/feeling out of place). Preliminary convergent validity was examined through correlations with established measures of acculturation. Further research with the SAM is encouraged to explore the relevance of this measure with other groups of sojourners (e.g., foreign aid workers, international businessmen, military personnel) and to determine how SAM factors relate to psychological well-being, health behaviors, and risk behaviors abroad among these diverse groups.

  14. Distribution of ABO blood group and the clinical characteristics in gastric cancer%胃癌患者的ABO血型分布及临床特点分析

    Institute of Scientific and Technical Information of China (English)

    徐灵均; 张吉翔

    2012-01-01

    目的 探讨胃癌患者的ABO血型分布及临床特点.方法 选择400例胃癌患者的住院病历资料,分析其ABO血型;比较前后5年患者的ABO血型分布,分析后5年患者的一般情况、首发症状、病理特点.结果 与前5年比较,后5年A型血检出率明显减少(41.5% vs 23.5%,P<0.01),O型血检出率明显增多(27.5% vs 42.5%,P<0.01),B型、AB型血无统计学差异.后5年中,各血型患者的首发症状均以上腹痛、腹胀、纳差、体质量下降为主;B型血低分化腺癌患者明显高于A型血患者(68.1% vs 36.1%,P<0.05),70.7%浸润深度达全层,且66.4%有淋巴结转移;累及周围组织的AB型血患者明显高于B型血患者(61.5%vs 25.5%,P<0.05).结论 前后5年胃癌患者的ABO血型分布发生了变化;提示非遗传因素对胃癌发病的影响逐渐增强,血型可能与肿瘤的生物学行为有关.%Objective To explore the distribution of ABO blood group and the clinical features of the patients with gastric cancer (GC). Methods Inpatient medical records of four hundred cases of the patients with CC were choosed and put into statistical analysis of ABO blood group; To compare the distribution of ABO blood group of the patients before and after five years, at the same time analyzing the clinical data of the patients included the generalconditions, clinical manifestation, pathological features, auxiliary examination, staging, treat ment and so on. Results Compared with the prior five years, the detectable rate of A blood group was greatly decreased in the recent five years (41.5% vs 23.5% , P <0.01) , the detectable rate of 0 blood group was obviously increased in the recent five years (27.5% vs 42.5% , P <0.01), the discrepancy of B blood group and AB blood group were not statistically significant. In the recent five years, initial symptoms in each blood type group were mainly upper abdominal pain or distention, anorexia, marasmus; The rates of poorly

  15. The use of cytosolic enzyme increase in cerebrospinal fluid of patients resuscitated after cardiac arrest. Brain Resuscitation Clinical Trial I Study Group.

    Science.gov (United States)

    Vaagenes, P; Mullie, A; Fodstad, D T; Abramson, N; Safar, P

    1994-11-01

    Levels of brain creatine phosphokinase (CPK), glutamic oxalic transaminase, lactate dehydrogenase, and lactate in lumbar cerebrospinal fluid (CSF) were analyzed as an adjunctive study in a randomized clinical trial evaluating the effects of thiopental loading intravenously in comatose survivors of cardiac arrest. Three hospitals participated and a total of 62 cases of enzyme changes were studied. Enzyme levels but not lactate were higher at 48 hours than at 24 hours after restoration of spontaneous circulation. All enzymes were highly correlated with one another at 24 and 48 hours (P < .001). There was a significant negative correlation between cerebral recovery and increased CPK levels at 24 hours (P < .05), and a highly significant correlation with all three enzyme levels at 48 hours (P < .0001). The increase of cytosolic enzyme activity in lumbar CSF reflects permanent brain damage, and there is a relationship between activity levels and cerebral outcome. PMID:7945601

  16. Clinical indicators of envenoming and serum levels of venom antigens in patients bitten by Bothrops lanceolatus in Martinique. Research Group on Snake Bites in Martinique.

    Science.gov (United States)

    Bucher, B; Canonge, D; Thomas, L; Tyburn, B; Robbe-Vincent, A; Choumet, V; Bon, C; Ketterlé, J; Lang, J

    1997-01-01

    An enzyme-linked immunosorbent assay was developed to measure venom antigen levels in the serum of 40 patients bitten by Bothrops lanceolatus. The grading system used for the severity of envenomation (grades 1 to 4, minor to major) was predominantly based on the presence of local signs. Serum venom levels increased with the grade of severity (P or = 15 ng/mL were observed in all patients with progressive aggravation of swelling despite the use of early antivenom therapy. No venom was detectable in blood samples taken after completion of serotherapy. All patients recovered. These results confirm the efficacy of both the clinical severity scoring system used and the therapeutic regimen. PMID:9196765

  17. Which is Easier, Adjusting to a Similar or to a Dissimilar Culture?

    DEFF Research Database (Denmark)

    Selmer, Jan

    2007-01-01

    The intuitively paradoxical research proposition that it could be as difficult for business expatriates to adjust to a similar as to a dissimilar host culture is tested in this exploratory study. Based on data from a mail survey, a comparison of American business expatriates in Canada and Germany...... respectively did not reveal any difference in their extent of adjustment. Besides a significant between-group difference in cultural distance, confirming that the American expatriates perceived Canada as more culturally similar to America than Germany, no significant inter-group differences were detected for...... general adjustment, interaction adjustment, work adjustment and psychological adjustment.  Neither was there a difference in the time-related variable; time to proficiency. Although highly tentative, the suggestion that the degree of cultural similarity/dissimilarity may be irrelevant as to how easily...

  18. Preanalytical quality improvement. In pursuit of harmony, on behalf of European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working group for Preanalytical Phase (WG-PRE).

    Science.gov (United States)

    Lippi, Giuseppe; Banfi, Giuseppe; Church, Stephen; Cornes, Michael; De Carli, Gabriella; Grankvist, Kjell; Kristensen, Gunn B; Ibarz, Mercedes; Panteghini, Mauro; Plebani, Mario; Nybo, Mads; Smellie, Stuart; Zaninotto, Martina; Simundic, Ana-Maria

    2015-02-01

    Laboratory diagnostics develop through different phases that span from test ordering (pre-preanalytical phase), collection of diagnostic specimens (preanalytical phase), sample analysis (analytical phase), results reporting (postanalytical phase) and interpretation (post-postanalytical phase). Although laboratory medicine seems less vulnerable than other clinical and diagnostic areas, the chance of errors is not negligible and may adversely impact on quality of testing and patient safety. This article, which continues a biennial tradition of collective papers on preanalytical quality improvement, is aimed to provide further contributions for pursuing quality and harmony in the preanalytical phase, and is a synopsis of lectures of the third European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)-Becton Dickinson (BD) European Conference on Preanalytical Phase meeting entitled 'Preanalytical quality improvement. In pursuit of harmony' (Porto, 20-21 March 2015). The leading topics that will be discussed include unnecessary laboratory testing, management of test request, implementation of the European Union (EU) Directive on needlestick injury prevention, harmonization of fasting requirements for blood sampling, influence of physical activity and medical contrast media on in vitro diagnostic testing, recent evidence about the possible lack of necessity of the order of draw, the best practice for monitoring conditions of time and temperature during sample transportation, along with description of problems emerging from inappropriate sample centrifugation. In the final part, the article includes recent updates about preanalytical quality indicators, the feasibility of an External Quality Assessment Scheme (EQAS) for the preanalytical phase, the results of the 2nd EFLM WG-PRE survey, as well as specific notions about the evidence-based quality management of the preanalytical phase.

  19. A randomised phase II trial of preoperative chemotherapy of cisplatin–docetaxel or docetaxel alone for clinical stage IB/II non-small-cell lung cancer: results of a Japan Clinical Oncology Group trial (JCOG 0204)

    OpenAIRE

    Kunitoh, H; Kato, H.; Tsuboi, M; Asamura, H.; Tada, H.; Nagai, K; Mitsudomi, T.; Koike, T.; Nakagawa, K.; Ichinose, Y; Okada, M.; Shibata, T.; Saijo, N.

    2008-01-01

    Preoperative chemotherapy is a promising strategy in patients with early-stage resectable non-small-cell lung cancer (NSCLC); optimal chemotherapy remains unclear. Clinical (c-) stage IB/II NSCLC patients were randomised to receive either two cycles of docetaxel (D)–cisplatin (P) combination chemotherapy (D 60 mg m−2 and P 80 mg m−2 on day 1) every 3–4 weeks or three cycles of D monotherapy (70 mg m−2) every 3weeks. Thoracotomy was performed 4–5 weeks (DP) or 3–4 weeks (D) after chemotherapy....

  20. The EWMA Patient Outcome Group

    DEFF Research Database (Denmark)

    Gottrup, F

    2009-01-01

    Across Europe, clinical experts in wound care and industry representatives have joined forces to propose recommendations for clinical data collection on chronic wound management. Here, the chair of the group, Finn Gottrup, outlines its main objectives.......Across Europe, clinical experts in wound care and industry representatives have joined forces to propose recommendations for clinical data collection on chronic wound management. Here, the chair of the group, Finn Gottrup, outlines its main objectives....

  1. Adjustable recessions in horizontal comitant strabismus: A pilot study

    Directory of Open Access Journals (Sweden)

    Siddharth Agrawal

    2015-01-01

    Full Text Available Aim: To compare the surgical outcome of adjustable with the conventional recession in patients with horizontal comitant strabismus. Patients and Methods: A prospective comparative nonrandomized interventional pilot study was performed on patients with horizontal comitant strabismus. Fifty-four patients (27 in each group were allocated into 2 groups to undergo either adjustable suture (AS recession or non-AS (NAS recession along with conventional resection. The patients were followed up for 6 months. A successful outcome was defined as deviation ±10 prism diopters at 6 months. The results were statistically analyzed by Chi-square test, Fisher′s exact test, and Student′s t-test. Results: A successful outcome was found in 24 (88.8% patients in AS and 17 (62.9% in NAS group (P = 0.02. The postoperative adjustment was done in 13 (48.1% patients in AS group. There was one complication (tenon′s cyst in AS group. Conclusion: AS recession may be considered in all cooperative patients undergoing strabismus surgery for comitant deviations.

  2. The Effects on Interactive Teaching of Group Discussion in the Clinical The-ory Teaching%分组讨论互动教学法在临床理论教学中的应用

    Institute of Scientific and Technical Information of China (English)

    刘桂清; 王秀清; 沈杨; 裴丽丽; 孙茂林; 董洪宇; 孙忠平

    2015-01-01

    Purpose To discuss the effects on interactive teaching of group discussion in the clinical theory teaching.Methods Choose 206 students in our hospital clinical medical profession as the research object from september 201 1 to december 2013.The interactive teaching in the group discussion was adopted in the observation group,the class was divid-ed into several groups to assign tasks,then discussed and summarized after discussion.The traditional teaching method was adopted in the control group.Results Both test score and the excellence rate of the observation group were significantly better than the control group,the questionnaire of two groups showed obvious difference in the satisfaction of teaching meth-od,the equality of teacher-students relationship and the improvment of teaching ability.Conclusion Group discussion teaching method achieved the overall and comprehensive of interactive teaching,reflects the dominant position of the students,and was worthy of promotion.%目的:探讨小组讨论互动教学在临床理论教学中的应用效果。方法以2011年9月至2013年12月我院临床医疗专业206人作为研究对象,观察组110人采用小组讨论互动教学,把班级分成若干小组,分配好任务,组织讨论并讨论后总结;对照组96人采取传统教学法。结果观察组之间无论理论考试成绩,还是优秀率均明显高于对照组,两组的调查问卷在教学方法满意度、体现师生平等关系及思维能力提高方面均有明显统计学差异。结论小组讨论教学法做到了互动教学的全员性、广泛性,体现了学生的主体地位,值得推广。

  3. Capital structure dynamics in private business groups

    OpenAIRE

    Dewaelheyns, Nico; Van Hulle, Cynthia

    2010-01-01

    Dynamic models of capital structure assume that companies trade-off the advantages of a leverage adjustment to its costs. Private companies are expected to have more restricted access to capital markets and are therefore likely to adjust their capital structure less frequently than public ones. However, private companies that are part of a business group have access to both internal and external capital markets and may face lower adjustment costs. We find significant differences in the levera...

  4. Structural adjustment, women, and agriculture in Cameroon.

    Science.gov (United States)

    Fonchingong, C

    1999-11-01

    This article assesses the impact of economic structural programs on the agricultural activities of women's groups in Cameroon, and explores women's ways of coping with the reduction in individual and family income and the loss of public services. It examines the role of 25 women's groups in both rural and urban areas of Cameroon's northwest and southwest provinces in a study conducted from April to June 1999. Economic structural adjustment caused a tremendous increase in the workload of women that are farming usually in lots distant from their homes that yield poor returns. Land for food-crop cultivation has become increasingly scarce, and inputs have become substantially unaffordable. Income generated from the sale of crops is inadequate to supply the economic and social needs of the family. Moreover, the burden of their work has increased as they cope with housework, child-care, and food production, in addition to an expanded participation in paid employment. Moreover, women spend longer working hours than men, meeting both household responsibilities and their outside work. Women have devised strategies to cope with this economic crisis, but they need organizations that will support them with the important resources to be able to operate. Rural women seem to be coping better than urban women cope. In extreme cases, some women in urban areas resort to prostitution to cope with life in this crisis setting. PMID:12349481

  5. Autogenic training as a therapy for adjustment disorder in adolescents

    Directory of Open Access Journals (Sweden)

    Jojić Boris R.

    2005-01-01

    Full Text Available INTRODUCTION Autogenic training is a widespread technique used in psychotherapy. The British school of autogenic training cites a large list of diseases, health states, and life changes, in which autogenic training can be of help. We wanted to explore the application of autogenic training as a therapy for adjustment disorder in adolescents. The sample consisted of a homogeneous group of 31 individuals, with an average age of 17.3±0.2 years, who were diagnosed with adjustment disorder, F 43.2, in accordance with ICD 10 search criteria. OBJECTIVE The aim of our work was to figure out the influence of autogenic training on adjustment disorder, through biophysical and biochemical indicators, and to research the efficacy of autogenic training as a therapy for adjustment disorder in adolescents. METHOD We observed adjustment disorder indicators and their changes in three phases, using initial, final, and control values, which we measured immediately before the beginning, immediately after the completion, and six months after the completion, of the practical course in autogenic training. We measured systolic and diastolic arterial blood pressure, brachial pulse rates, cortisol levels in plasma, cholesterol levels in blood, as well as glucose concentrations. During that period, autogenic training was employed as the sole therapy. RESULTS The study confirmed our preliminary assumptions. The measurements we performed showed that arterial blood pressure, pulse rates, cholesterol and cortisol concentrations, after the application of autogenic training among adolescents suffering from adjustment disorder, were lower than the initial values. They remained lower even six months after the completion of the practical course in autogenic training. CONCLUSION We concluded that autogenic training significantly decreases the values of physiological indicators of adjustment disorder, diminishes the effects of stress in an individual, and eases the adaptation of

  6. Homogeneous group, research, institution

    Directory of Open Access Journals (Sweden)

    Francesca Natascia Vasta

    2014-09-01

    Full Text Available The work outlines the complex connection among empiric research, therapeutic programs and host institution. It is considered the current research state in Italy. Italian research field is analyzed and critic data are outlined: lack of results regarding both the therapeutic processes and the effectiveness of eating disorders group analytic treatment. The work investigates on an eating disorders homogeneous group, led into an eating disorder outpatient service. First we present the methodological steps the research is based on including the strong connection among theory and clinical tools. Secondly clinical tools are described and the results commented. Finally, our results suggest the necessity of validating some more specifical hypothesis: verifying the relationship between clinical improvement (sense of exclusion and painful emotions reduction and specific group therapeutic processes; verifying the relationship between depressive feelings, relapses and transition trough a more differentiated groupal field.Keywords: Homogeneous group; Eating disorders; Institutional field; Therapeutic outcome

  7. Clinical biochemistry

    Science.gov (United States)

    Alexander, W. C.; Leach, C. S.; Fischer, C. L.

    1975-01-01

    The objectives of the biochemical studies conducted for the Apollo program were (1) to provide routine laboratory data for assessment of preflight crew physical status and for postflight comparisons; (2) to detect clinical or pathological abnormalities which might have required remedial action preflight; (3) to discover as early as possible any infectious disease process during the postflight quarantine periods following certain missions; and (4) to obtain fundamental medical knowledge relative to man's adjustment to and return from the space flight environment. The accumulated data presented suggest that these requirements were met by the program described. All changes ascribed to the space flight environment were subtle, whereas clinically significant changes were consistent with infrequent illnesses unrelated to the space flight exposure.

  8. Blood groups systems

    OpenAIRE

    Ranadhir Mitra; Nitasha Mishra; Girija Prasad Rath

    2014-01-01

    International Society of Blood Transfusion has recently recognized 33 blood group systems. Apart from ABO and Rhesus system, many other types of antigens have been noticed on the red cell membranes. Blood grouping and cross-matching is one of the few important tests that the anaesthesiologist orders during perioperative period. Hence, a proper understanding of the blood group system, their clinical significance, typing and cross-matching tests, and current perspective are of paramount importa...

  9. Krypton laser photocoagulation for neovascular lesions of age-related macular degeneration. Results of a randomized clinical trial. Macular Photocoagulation Study Group.

    Science.gov (United States)

    1990-06-01

    The Age-Related Macular Degeneration Study-Krypton Laser (AMDS-K) is a multicenter controlled clinical trial designed to determine whether krypton red laser photocoagulation is of value in preventing visual acuity loss in eyes with macular degeneration that have either choroidal neovascularization 1 to 199 microns from the center of the foveal avascular zone or choroidal neovascularization 200 microns or farther from the foveal avascular zone center with blood and/or blocked fluorescence extending within 200 microns of the foveal avascular zone center. Recruitment ended in December 1987 after 247 patients had been assigned to photocoagulation and 249 patients had been assigned to no treatment. At 3 years after randomization, 49% (86/174) of treated eyes, in contrast to 58% (98/169) of untreated eyes, had lost six or more lines of visual acuity. The average visual acuity of treated and untreated eyes at that time was 20/200 and 20/250, respectively. The benefit of laser treatment was largest among patients without evidence of hypertension and diminished to no apparent benefit among patients who had highly elevated blood pressure and/or used antihypertensive medication. Treatment of lesions meeting the AMDS-K eligibility criteria in eyes of patients with no hypertension is recommended. However, treatment cannot be recommended uniformly for patients with definite hypertension having lesions similar to those of patients enrolled in the AMDS-K. PMID:1693496

  10. Predictors of sociocultural adjustment among sojourning Malaysian students in Britain.

    Science.gov (United States)

    Swami, Viren

    2009-08-01

    The process of cross-cultural migration may be particularly difficult for students travelling overseas for further or higher education, especially where qualitative differences exist between the home and host nations. The present study examined the sociocultural adjustment of sojourning Malaysian students in Britain. Eighty-one Malay and 110 Chinese students enrolled in various courses answered a self-report questionnaire that examined various aspects of sociocultural adjustment. A series of one-way analyses of variance showed that Malay participants experienced poorer sociocultural adjustment in comparison with their Chinese counterparts. They were also less likely than Chinese students to have contact with co-nationals and host nationals, more likely to perceive their actual experience in Britain as worse than they had expected, and more likely to perceive greater cultural distance and greater discrimination. The results of regression analyses showed that, for Malay participants, perceived discrimination accounted for the greatest proportion of variance in sociocultural adjustment (73%), followed by English language proficiency (10%) and contact with host nationals (4%). For Chinese participants, English language proficiency was the strongest predictor of sociocultural adjustment (54%), followed by expectations of life in Britain (18%) and contact with host nationals (3%). By contrast, participants' sex, age, and length of residence failed to emerge as significant predictors for either ethnic group. Possible explanations for this pattern of findings are discussed, including the effects of Islamophobia on Malay-Muslims in Britain, possible socioeconomic differences between Malay and Chinese students, and personality differences between the two ethnic groups. The results are further discussed in relation to practical steps that can be taken to improve the sociocultural adjustment of sojourning students in Britain. PMID:22029555

  11. Design paper: The CapOpus trial: A randomized, parallel-group, observer-blinded clinical trial of specialized addiction treatment versus treatment as usual for young patients with cannabis abuse and psychosis

    Directory of Open Access Journals (Sweden)

    Gluud Christian

    2008-07-01

    Full Text Available Abstract Background A number of studies indicate a link between cannabis-use and psychosis as well as more severe psychosis in those with existing psychotic disorders. There is currently insufficient evidence to decide the optimal way to treat cannabis abuse among patients with psychosis. Objectives The major objective for the CapOpus trial is to evaluate the additional effect on cannabis abuse of a specialized addiction treatment program adding group treatment and motivational interviewing to treatment as usual. Design The trial is designed as a randomized, parallel-group, observer-blinded clinical trial. Patients are primarily recruited through early-psychosis detection teams, community mental health centers, and assertive community treatment teams. Patients are randomized to one of two treatment arms, both lasting six months: 1 specialized addiction treatment plus treatment as usual or 2 treatment as usual. The specialized addiction treatment is manualized and consists of both individual and group-based motivational interviewing and cognitive behavioral therapy, and incorporates both the family and the case manager of the patient. The primary outcome measure will be changes in amount of cannabis consumption over time. Other outcome measures will be psychosis symptoms, cognitive functioning, quality of life, social functioning, and cost-benefit analyses. Trial registration ClinicalTrials.gov NCT00484302.

  12. Efficacy and Safety of Crocus sativus L. in Patients with Mild Cognitive Impairment: One Year Single-Blind Randomized, with Parallel Groups, Clinical Trial.

    Science.gov (United States)

    Tsolaki, Magda; Karathanasi, Elina; Lazarou, Ioulietta; Dovas, Kostas; Verykouki, Eleni; Karacostas, Anastasios; Georgiadis, Kostas; Tsolaki, Anthoula; Adam, Katerina; Kompatsiaris, Ioannis; Sinakos, Zacharias

    2016-07-27

    There is evidence to suggest the efficacy of Crocus (saffron) in the management of cognitive decline. This study examined the efficacy of Crocus in patients with amnesic and multi domain MCI (aMCImd). The participants included 17 patients on Crocus and 18 on a waiting list, who were examined with a short neuropsychological battery, MRI 3T, while some patients were examined via 256-channel electroencephalogram (HD-EEG) at baseline and after 12 months. The results showed that patients on Crocus had improved Mini-Mental State Examination scores (p = 0.015), while the control group deteriorated. Also, MRI, EEG, and ERP showed improvement in specific domains. This led us to conclude that Crocus is a good choice for management of aMCImd.

  13. Palbociclib as a first-line treatment in oestrogen receptor-positive, HER2-negative, advanced breast cancer not cost-effective with current pricing: a health economic analysis of the Swiss Group for Clinical Cancer Research (SAKK).

    Science.gov (United States)

    Matter-Walstra, K; Ruhstaller, T; Klingbiel, D; Schwenkglenks, M; Dedes, K J

    2016-07-01

    Endocrine therapy continues to be the optimal systemic treatment for metastatic ER(+)HER2(-) breast cancer. The CDK4/6 inhibitor palbociclib combined with letrozole has recently been shown to significantly improve progression-free survival. Here we examined the cost-effectiveness of this regimen for the Swiss healthcare system. A Markov cohort simulation based on the PALOMA-1 trial (Finn et al. in Lancet Oncol 16:25-35, 2015) was used as the clinical course. Input parameters were based on summary trial data. Costs were assessed from the Swiss healthcare system perspective. Adding palbociclib to letrozole (PALLET) compared to letrozole monotherapy was estimated to cost an additional CHF342,440 and gain 1.14 quality-adjusted life years, resulting in an incremental cost-effectiveness ratio (ICER) of CHF301,227/QALY gained. In univariate sensitivity analyses, no tested variation in key parameters resulted in an ICER below a willingness-to-pay threshold of CHF100,000/QALY. PALLET had a 0 % probability of being cost-effective in probabilistic sensitivity analyses. Lowering PALLET's price by 75 % resulted in an ICER of CHF73,995/QALY and a 73 % probability of being cost-effective. At current prices, PALLET would cost the Swiss healthcare system an additional CHF155 million/year. Palbociclib plus letrozole cannot be considered cost-effective for the first-line treatment of patients with metastatic breast cancer in the Swiss healthcare system. PMID:27277747

  14. Palbociclib as a first-line treatment in oestrogen receptor-positive, HER2-negative, advanced breast cancer not cost-effective with current pricing: a health economic analysis of the Swiss Group for Clinical Cancer Research (SAKK).

    Science.gov (United States)

    Matter-Walstra, K; Ruhstaller, T; Klingbiel, D; Schwenkglenks, M; Dedes, K J

    2016-07-01

    Endocrine therapy continues to be the optimal systemic treatment for metastatic ER(+)HER2(-) breast cancer. The CDK4/6 inhibitor palbociclib combined with letrozole has recently been shown to significantly improve progression-free survival. Here we examined the cost-effectiveness of this regimen for the Swiss healthcare system. A Markov cohort simulation based on the PALOMA-1 trial (Finn et al. in Lancet Oncol 16:25-35, 2015) was used as the clinical course. Input parameters were based on summary trial data. Costs were assessed from the Swiss healthcare system perspective. Adding palbociclib to letrozole (PALLET) compared to letrozole monotherapy was estimated to cost an additional CHF342,440 and gain 1.14 quality-adjusted life years, resulting in an incremental cost-effectiveness ratio (ICER) of CHF301,227/QALY gained. In univariate sensitivity analyses, no tested variation in key parameters resulted in an ICER below a willingness-to-pay threshold of CHF100,000/QALY. PALLET had a 0 % probability of being cost-effective in probabilistic sensitivity analyses. Lowering PALLET's price by 75 % resulted in an ICER of CHF73,995/QALY and a 73 % probability of being cost-effective. At current prices, PALLET would cost the Swiss healthcare system an additional CHF155 million/year. Palbociclib plus letrozole cannot be considered cost-effective for the first-line treatment of patients with metastatic breast cancer in the Swiss healthcare system.

  15. 椎间融合器临床试验分组及评价指标注册要求的变化%Change of Regulatory Requirement on Cohort Grouping and Endpoint Seting for Intervertebral Fusion Device Clinical Trail

    Institute of Scientific and Technical Information of China (English)

    郭晓磊

    2015-01-01

    结合国际主流监管机构技术要求与我国监管现状,目前常规的椎间融合器临床试验注册要求发生了简化,颈胸腰椎病患同组试验,并以影像学评价为主,较为合理地向减轻企业负担做出了尝试。%Combining technical requirement from main international administration and status quo of China administration, current regulatory requirement on clinical trail of conventional intervertebral fusion devices has been simplified. Cervical, thoracic and lumbar cases can be grouped into the same cohort, and primary endpoints are mainly based on imageology rather than clinical score. This is an attempt to rational y lessen industrial burdensome.

  16. Early management of type 2 diabetes based on a SMBG strategy: the way to diabetes regression--the St Carlos study : a 3-year, prospective, randomized, clinic-based, interventional study with parallel groups.

    Science.gov (United States)

    García de la Torre, Nuria; Durán, Alejandra; Del Valle, Laura; Fuentes, Manuel; Barca, Idoya; Martín, Patricia; Montañez, Carmen; Perez-Ferre, Natalia; Abad, Rosario; Sanz, Fuencisla; Galindo, Mercedes; Rubio, Miguel A; Calle-Pascual, Alfonso L

    2013-08-01

    The aims are to define the regression rate in newly diagnosed type 2 diabetes after lifestyle intervention and pharmacological therapy based on a SMBG (self-monitoring of blood glucose) strategy in routine practice as compared to standard HbA1c-based treatment and to assess whether a supervised exercise program has additional effects. St Carlos study is a 3-year, prospective, randomized, clinic-based, interventional study with three parallel groups. Hundred and ninety-five patients were randomized to the SMBG intervention group [I group; n = 130; Ia: SMBG (n = 65) and Ib: SMBG + supervised exercise (n = 65)] and to the HbA1c control group (C group) (n = 65). The primary outcome was to estimate the regression rate of type 2 diabetes (HbA1c 4 kg was 3.6 (1.8-7); p < 0.001. This study shows that the use of SMBG in an educational program effectively increases the regression rate in newly diagnosed type 2 diabetic patients after 3 years of follow-up. These data suggest that SMBG-based programs should be extended to primary care settings where diabetic patients are usually attended.

  17. Control of Adjustable Compliant Actuators

    Directory of Open Access Journals (Sweden)

    Berno J.E. Misgeld

    2014-05-01

    Full Text Available Adjustable compliance or variable stiffness actuators comprise an additional element to elastically decouple the actuator from the load and are increasingly applied to human-centered robotic systems. The advantages of such actuators are of paramount importance in rehabilitation robotics, where requirements demand safe interaction between the therapy system and the patient. Compliant actuator systems enable the minimization of large contact forces arising, for example, from muscular spasticity and have the ability to periodically store and release energy in cyclic movements. In order to overcome the loss of bandwidth introduced by the elastic element and to guarantee a higher range in force/torque generation, new actuator designs consider variable or nonlinear stiffness elements, respectively. These components cannot only be adapted to the walking speed or the patient condition, but also entail additional challenges for feedback control. This paper introduces a novel design method for an impedance-based controller that fulfills the control objectives and compares the performance and robustness to a classical cascaded control approach. The new procedure is developed using a non-standard positive-real Η2 controller design and is applied to a loop-shaping approach. Robust norm optimal controllers are designed with regard to the passivity of the actuator load-impedance transfer function and the servo control problem. Classical cascaded and positive-real Η2 controller designs are validated and compared in simulations and in a test bench using a passive elastic element of varying stiffness.

  18. Psychosocial adjustment to recurrent cancer.

    Science.gov (United States)

    Mahon, S M; Cella, D F; Donovan, M I

    1990-01-01

    This descriptive study of the perceptions and needs of people with recurrent malignancies asks three questions: How do patients describe the meaning of a recurrence of cancer? Do individuals perceive the diagnosis of recurrence and the initial diagnosis of cancer differently? What are the key psychosocial problems associated with recurrent cancer? The theoretical framework was based on Lazarus and Folkman's theory of stress, appraisal, and coping. Subjects completed the Impact of Event Scale (IES), the Psychosocial Adjustment to Illness Scale--Self-Report (PAIS), and a semistructured qualitative interview. The interview elicited perceptions of the event of recurrence and differences between the diagnosis of recurrence and the initial diagnosis. The convenience sample included 40 patients diagnosed with recurrent cancer within the last 30 days. Many subjects (78%) reported that the recurrence was more upsetting than the initial diagnosis. Scores on both the IES and the PAIS were high when compared to normative samples of patients with cancer suggesting that this sample of patients experienced a lot of psychological distress as well as problems at home, work, and in their social lives. These concerns often were unknown to caregivers. Although more research is needed, the authors propose that, with more accurate assessment, more effective intervention could be implemented and the quality of life improved for patients with recurrent cancer.

  19. Epidemiology and clinical relevance of mutations in postpolycythemia vera and postessential thrombocythemia myelofibrosis: A study on 359 patients of the AGIMM group.

    Science.gov (United States)

    Rotunno, Giada; Pacilli, Annalisa; Artusi, Valentina; Rumi, Elisa; Maffioli, Margherita; Delaini, Federica; Brogi, Giada; Fanelli, Tiziana; Pancrazzi, Alessandro; Pietra, Daniela; Bernardis, Isabella; Belotti, Clara; Pieri, Lisa; Sant'Antonio, Emanuela; Salmoiraghi, Silvia; Cilloni, Daniela; Rambaldi, Alessandro; Passamonti, Francesco; Barbui, Tiziano; Manfredini, Rossella; Cazzola, Mario; Tagliafico, Enrico; Vannucchi, Alessandro M; Guglielmelli, Paola

    2016-07-01

    Transformation to secondary myelofibrosis (MF) occurs as part of the natural history of polycythemia vera (PPV-MF) and essential thrombocythemia (PET-MF). Although primary (PMF) and secondary MF are considered similar diseases and managed similarly, there are few studies specifically focused on the latter. The aim of this study was to characterize the mutation landscape, and describe the main clinical correlates and prognostic implications of mutations, in a series of 359 patients with PPV-MF and PET-MF. Compared with PV and ET, the JAK2V617F and CALR mutated allele burden was significantly higher in PPV-MF and/or PET-MF, indicating a role for accumulation of mutated alleles in the process of transformation to MF. However, neither the allele burden nor the type of driver mutation influenced overall survival (OS), while absence of any driver mutation (triple negativity) was associated with significant reduction of OS in PET-MF, similar to PMF. Of the five interrogated subclonal mutations (ASXL1, EZH2, SRSF2, IDH1, and IDH2), that comprise a prognostically detrimental high molecular risk (HMR) category in PMF, only SRSF2 mutations were associated with reduced survival in PET-MF, and no additional mutation profile with prognostic relevance was highlighted. Overall, these data indicate that the molecular landscape of secondary forms of MF is different from PMF, suggesting that unknown mutational events might contribute to the progression from chronic phase disease to myelofibrosis. These findings also support more extended genotyping approaches aimed at identifying novel molecular abnormalities with prognostic relevance for patients with PPV-MF and PET-MF. Am. J. Hematol. 91:681-686, 2016. © 2016 Wiley Periodicals, Inc. PMID:27037840

  20. Mispricing in the Medicare Advantage Risk Adjustment Model

    Directory of Open Access Journals (Sweden)

    Jing Chen PhD, MBA

    2015-04-01

    Full Text Available The Centers for Medicare and Medicaid Services (CMS implemented hierarchical condition category (HCC models in 2004 to adjust payments to Medicare Advantage (MA plans to reflect enrollees’ expected health care costs. We use Verisk Health’s diagnostic cost group (DxCG Medicare models, refined “descendants” of the same HCC framework with 189 comprehensive clinical categories available to CMS in 2004, to reveal 2 mispricing errors resulting from CMS’ implementation. One comes from ignoring all diagnostic information for “new enrollees” (those with less than 12 months of prior claims. Another comes from continuing to use the simplified models that were originally adopted in response to assertions from some capitated health plans that submitting the claims-like data that facilitate richer models was too burdensome. Even the main CMS model being used in 2014 recognizes only 79 condition categories, excluding many diagnoses and merging conditions with somewhat heterogeneous costs. Omitted conditions are typically lower cost or “vague” and not easily audited from simplified data submissions. In contrast, DxCG Medicare models use a comprehensive, 394-HCC classification system. Applying both models to Medicare’s 2010-2011 fee-for-service 5% sample, we find mispricing and lower predictive accuracy for the CMS implementation. For example, in 2010, 13% of beneficiaries had at least 1 higher cost DxCG-recognized condition but no CMS-recognized condition; their 2011 actual costs averaged US$6628, almost one-third more than the CMS model prediction. As MA plans must now supply encounter data, CMS should consider using more refined and comprehensive (DxCG-like models.