Sample records for alternative diagnostic strategies

  1. Economic analysis including long-term risks and costs of alternative diagnostic strategies to evaluate patients with chest pain (United States)

    Bedetti, Gigliola; Pasanisi, Emilio Maria; Pizzi, Carmine; Turchetti, Giuseppe; Loré, Cosimo


    Background Diagnosis costs for cardiovascular disease waste a large amount of healthcare resources. The aim of the study is to evaluate the clinical and economic outcomes of alternative diagnostic strategies in low risk chest pain patients. Methods We evaluated direct and indirect downstream costs of 6 strategies: coronary angiography (CA) after positive troponin I or T (cTn-I or cTnT) (strategy 1); after positive exercise electrocardiography (ex-ECG) (strategy 2); after positive exercise echocardiography (ex-Echo) (strategy 3); after positive pharmacologic stress echocardiography (PhSE) (strategy 4); after positive myocardial exercise stress single-photon emission computed tomography with technetium Tc 99m sestamibi (ex-SPECT-Tc) (strategy 5) and direct CA (strategy 6). Results The predictive accuracy in correctly identifying the patients was 83,1% for cTn-I, 87% for cTn-T, 85,1% for ex-ECG, 93,4% for ex-Echo, 98,5% for PhSE, 89,4% for ex-SPECT-Tc and 18,7% for CA. The cost per patient correctly identified results $2.051 for cTn-I, $2.086 for cTn-T, $1.890 for ex-ECG, $803 for ex-Echo, $533 for PhSE, $1.521 for ex-SPECT-Tc ($1.634 including cost of extra risk of cancer) and $29.673 for CA ($29.999 including cost of extra risk of cancer). The average relative cost-effectiveness of cardiac imaging compared with the PhSE equal to 1 (as a cost comparator), the relative cost of ex-Echo is 1.5×, of a ex-SPECT-Tc is 3.1×, of a ex-ECG is 3.5×, of cTnI is ×3.8, of cTnT is ×3.9 and of a CA is 56.3×. Conclusion Stress echocardiography based strategies are cost-effective versus alternative imaging strategies and the risk and cost of radiation exposure is void. PMID:18510723

  2. Economic analysis including long-term risks and costs of alternative diagnostic strategies to evaluate patients with chest pain

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    Pizzi Carmine


    Full Text Available Abstract Background Diagnosis costs for cardiovascular disease waste a large amount of healthcare resources. The aim of the study is to evaluate the clinical and economic outcomes of alternative diagnostic strategies in low risk chest pain patients. Methods We evaluated direct and indirect downstream costs of 6 strategies: coronary angiography (CA after positive troponin I or T (cTn-I or cTnT (strategy 1; after positive exercise electrocardiography (ex-ECG (strategy 2; after positive exercise echocardiography (ex-Echo (strategy 3; after positive pharmacologic stress echocardiography (PhSE (strategy 4; after positive myocardial exercise stress single-photon emission computed tomography with technetium Tc 99m sestamibi (ex-SPECT-Tc (strategy 5 and direct CA (strategy 6. Results The predictive accuracy in correctly identifying the patients was 83,1% for cTn-I, 87% for cTn-T, 85,1% for ex-ECG, 93,4% for ex-Echo, 98,5% for PhSE, 89,4% for ex-SPECT-Tc and 18,7% for CA. The cost per patient correctly identified results $2.051 for cTn-I, $2.086 for cTn-T, $1.890 for ex-ECG, $803 for ex-Echo, $533 for PhSE, $1.521 for ex-SPECT-Tc ($1.634 including cost of extra risk of cancer and $29.673 for CA ($29.999 including cost of extra risk of cancer. The average relative cost-effectiveness of cardiac imaging compared with the PhSE equal to 1 (as a cost comparator, the relative cost of ex-Echo is 1.5×, of a ex-SPECT-Tc is 3.1×, of a ex-ECG is 3.5×, of cTnI is ×3.8, of cTnT is ×3.9 and of a CA is 56.3×. Conclusion Stress echocardiography based strategies are cost-effective versus alternative imaging strategies and the risk and cost of radiation exposure is void.

  3. Autocratic strategies for alternating games. (United States)

    McAvoy, Alex; Hauert, Christoph


    Repeated games have a long tradition in the behavioral sciences and evolutionary biology. Recently, strategies were discovered that permit an unprecedented level of control over repeated interactions by enabling a player to unilaterally enforce linear constraints on payoffs. Here, we extend this theory of "zero-determinant" (or, more generally, "autocratic") strategies to alternating games, which are often biologically more relevant than traditional synchronous games. Alternating games naturally result in asymmetries between players because the first move matters or because players might not move with equal probabilities. In a strictly-alternating game with two players, X and Y, we give conditions for the existence of autocratic strategies for player X when (i) X moves first and (ii) Y moves first. Furthermore, we show that autocratic strategies exist even for (iii) games with randomly-alternating moves. Particularly important categories of autocratic strategies are extortionate and generous strategies, which enforce unfavorable and favorable outcomes for the opponent, respectively. We illustrate these strategies using the continuous Donation Game, in which a player pays a cost to provide a benefit to the opponent according to a continuous cooperative investment level. Asymmetries due to alternating moves could easily arise from dominance hierarchies, and we show that they can endow subordinate players with more autocratic strategies than dominant players.


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    Krishna Mochtar


    Full Text Available Recent research findings on pricing strategies both in general and in construction are reviewed and explored. First%2C pricing strategy in general%2C mostly in the manufacturing industry%2C is reviewed. It includes the concepts of pricing strategy%2C predatory pricing%2C price wars%2C and price policy development. Second%2C pricing strategy in construction is explored. It includes various pricing models for bid price determination%2C such as the Friedman-Gates models%2C expected utility models%2C risk-pricing model%2C and the crew-day%2C multiple regression%2C and fuzzy-set pricing models. In conclusion%2C pricing strategies in construction are still predominantly based on a cost-based approach. More recent models try to close the gap between the models and the real life conditions of a bidder%5C%27s decision-making process. It appears that there are more problems in cost-based pricing as opposed to market-based pricing. Consequently%2C it is highly recommended that%2C alternative pricing approach such as that are closer to the proposed market-based pricing model need to be explored and developed for use in the construction industry. Abstract in Bahasa Indonesia : Pricing+strategy%2C+cost-based+pricing%2C+market-based+pricing.

  5. Alternating hemiplegia of childhood: new diagnostic options. (United States)

    Gergont, Aleksandra; Kaciński, Marek


    A syndrome of alternating hemiplegia of childhood (AHC) is a rare disorder first presented in 1971. AHC is characterized by transient episodes of hemiplegia affecting either one or both sides of the body. Age of onset is before 18 months and the common earliest manifestations are dystonic or tonic attacks and nystagmus. Hemiplegic episodes last minutes to days and the frequency and duration tend to decrease with time. Motor and intellectual development is affected, deficits may also develop later. Epileptic seizures occur in some patients. Neuroimaging of the brain usually reveals no abnormalities. The variability of individual clinical presentations and evolution of symptoms have made diagnosis difficult. Therefore the problems of misdiagnosis could account for the low prevalence of this syndrome. This paper hopes to present actual data on AHC, especially of the results of genetic research and new diagnostic tools.

  6. Development of methodology for alternative testing strategies for the assessment of the toxicological profile of nanoparticles used in medical diagnostics. NanoTEST - EC FP7 project

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    Dusinska, Maria; Fjellsbo, Lise Maria; Heimstad, Eldbjorg; Harju, Mikael; Bartonova, Alena [Norwegian Institute for Air Research (Norway)], E-mail:; Tran, Lang [Institute of Occupational Medicine (United Kingdom); Juillerat-Jeanneret, Lucienne; Halamoda, Blanka [Centre Hospitalier Universitaire Vaudois (Switzerland); Marano, Francelyne; Boland, Sonja [University Paris Diderot Paris7 (France); Saunders, Margaret; Cartwright, Laura; Carreira, Sara; Thawley, Susan [University Hospitals Bristol NHS Foundation Trust (United Kingdom); Whelan, Maurice; Klein, Christoph [EC - Directorate General Joint Research Centre (Italy); Housiadas, Christos [National Centre for Scientific Research Demokritos (Greece); Volkovova, Katarina; Tulinska, Jana; Beno, Milan [Slovak Medical University (Slovakia)] (and others)


    Nanoparticles (NPs) have unique, potentially beneficial properties, but their possible impact on human health is still not known. The area of nanomedicine brings humans into direct contact with NPs and it is essential for both public confidence and the nanotech companies that appropriate risk assessments are undertaken in relation to health and safety. There is a pressing need to understand how engineered NPs can interact with the human body following exposure. The FP7 project NanoTEST ( addresses these requirements in relation to the toxicological profile of NPs used in medical diagnostics.

  7. Diagnostic strategies in nasal congestion

    Directory of Open Access Journals (Sweden)

    John Krouse


    Full Text Available John Krouse1, Valerie Lund2, Wytske Fokkens3, Eli O Meltzer41Temple University School of Medicine, Philadelphia, PA, USA; 2Ear Institute, University College London, UK; 3Department of Otorhinolaryngology, Amsterdam Medical Centre, Netherlands; 4Allergy and Asthma Medical Group and Research Center, San Diego, CA and Department of Pediatrics, University of California, San Diego, USAAbstract: Nasal congestion is a major symptom of upper respiratory tract disorders, and its characterization an important part of the diagnosis of these illnesses. Patient history and assessment of nasal symptoms are essential components of diagnosis, providing an initial evaluation that may be adequate to rule out serious conditions. However, current congestion medications are not always fully effective. Thus, if symptoms do not respond adequately to therapy, or symptoms suggestive of more serious conditions are present, specialized assessments may be needed. Various techniques are available for diagnosing patients, including those used chiefly by primary care clinicians and those requiring the expertise of otolaryngologists, allergists, and other specialists. Endoscopy remains a mainstay for evaluating nasal blockage and its causes, while modalities such as peak nasal inspiratory flow and acoustic rhinometry are evolving to provide easy-to-use, noninvasive procedures that are sensitive enough to measure small but clinically important abnormalities and therapeutic changes. Several imaging modalities are available to the specialist for severe or unusual cases, as are specialized diagnostic procedures that measure adjunctive features of congestion, such as impaired mucociliary function.Keywords: allergic rhinitis, congestion, diagnosis, obstruction, rhinosinusitis

  8. Decentralizing Agricultural Extension: Alternative Strategies. (United States)

    Rivera, William M.


    Examines government strategies for decentralizing agricultural extension, concluding that such changes are largely determined by the country's constitutional status. Reviews decentralization guidelines for structural and fiscal reforms and participatory management systems. (SK)

  9. Alternative Youth Employment Strategies Project: Final Report. (United States)

    Sadd, Susan; And Others

    The Alternative Youth Employment Strategies (AYES) Project began as one of the demonstration projects funded under the Youth Employment and Demonstration Project Act in 1980. The program, which features three training models, is targeted toward high-risk, disadvantaged youth, especially minority youths from urban areas who had prior involvement…

  10. Alternative lithography strategies for flexible electronics

    NARCIS (Netherlands)

    Moonen, P.


    Main aim of the research has been the development of alternative lithography strategies for the fabrication of complex, flexible electronic devices. Flexible bottom-contact, bottom-gate thin-film transistors were solely patterned with UV nanoimprint lithography on poly(ethylene naphthalate) foil. Pa

  11. Measurement and evaluation of alternative planning strategies


    Jwala, Vidya Ranya


    Strategic Planning is a function practiced by most public and private sector organizations. Most managers are familiar with the concept of strategic planning and associated processes. There has been some research in the field of management focusing on the alternatives to strategic planning approach. "Management by groping along" is one such approach. The "Management by groping along" strategy attempts to make an organization capable of adapting, responding and, allocating resou...

  12. Dental and dental hygiene students' diagnostic accuracy in oral radiology: effect of diagnostic strategy and instructional method. (United States)

    Baghdady, Mariam T; Carnahan, Heather; Lam, Ernest W N; Woods, Nicole N


    There has been much debate surrounding diagnostic strategies and the most appropriate training models for novices in oral radiology. It has been argued that an analytic approach, using a step-by-step analysis of the radiographic features of an abnormality, is ideal. Alternative research suggests that novices can successfully employ non-analytic reasoning. Many of these studies do not take instructional methodology into account. This study evaluated the effectiveness of non-analytic and analytic strategies in radiographic interpretation and explored the relationship between instructional methodology and diagnostic strategy. Second-year dental and dental hygiene students were taught four radiographic abnormalities using basic science instructions or a step-by-step algorithm. The students were tested on diagnostic accuracy and memory immediately after learning and one week later. A total of seventy-three students completed both immediate and delayed sessions and were included in the analysis. Students were randomly divided into two instructional conditions: one group provided a diagnostic hypothesis for the image and then identified specific features to support it, while the other group first identified features and then provided a diagnosis. Participants in the diagnosis-first condition (non-analytic reasoning) had higher diagnostic accuracy then those in the features-first condition (analytic reasoning), regardless of their learning condition. No main effect of learning condition or interaction with diagnostic strategy was observed. Educators should be mindful of the potential influence of analytic and non-analytic approaches on the effectiveness of the instructional method.

  13. Thyroid malignancies: diagnostic strategy; Primaerdiagnostik des Schilddruesenkarzinoms

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    Leisner, B. [Allgemeines Krankenhaus St. Georg, Hamburg (Germany). Abt. fuer Nuklearmedizin


    The degree of alimentary iodine deficiency and, hence, the prevalence of thyroid nodules influence the diagnostic strategy to be followed in order to - mostly - exclude malignancy. Besides clinical factors like patient age and gender, rapid growth and compressive signs it is primarily the finding of a hypoechoic nodule without radio-nuclide accumulation that makes fine-needle aspiration biopsy (FNAB) mandatory. The accuracy of up to 95% which can be obtained with sufficient skill and expertise leads to a reduction of surgical interventions by at least 80% and to an increase of malignancy found during surgery by a factor of 10. The use of FNAB in the case of a hypoechoic, cold nodule represents a sufficiently accurate and highly cost-effective management of this frequent finding in endemic goitre areas. (orig.) [German] Die Dignitaetsbestimmung von Schilddruesenknoten wird von deren Praevalenz und diese von der alimentaeren Iodversorgung beeinflusst. Neben klinischen Parametern, wie z.B. Patientenalter und -geschlecht, Wachstumsgeschwindigkeit und Verdraengungszeichen, kommen v.a. dem sonographischen Befund der Echoarmut und der fehlenden Radionuklidanreicherung im Szintigramm entscheidende Bedeutung fuer die Selektion zur Feinnadelaspirationsbiopsie zu. Bei einer Treffsicherheit von bis zu 95%, die bei entsprechender Erfahrung und ausreichender Praeparatqualitaet erzielbar ist, kann mit der Zytologie die Zahl unnoetiger Eingriffe um mindestens 80% gesenkt und die operative 'Ausbeute' an malignen Befunden um den Faktor 10 gesteigert werden. Der Beschriebene, diagnostische Ablauf liefert eine ausreichende Sicherheit fuer Arzt und Patient bei hoher Kosteneffizienz. (orig.)

  14. Teaching Posttraining : Influencing Diagnostic Strategy with Instructions at Test (United States)

    Kulatunga-Moruzi, Chan; Brooks, Lee R.; Norman, Geoffrey R.


    It is believed that medical diagnosis involves two complementary processes, analytic and similarity-based. There is considerable debate as to which of these processes defines diagnostic expertise and how best to teach clinical diagnosis and reduce diagnostic errors. The purpose of these studies is to document the use of these strategies in medical…

  15. 24 CFR 248.223 - Alternative State strategy. (United States)


    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Alternative State strategy. 248.223... Preservation Act of 1987 § 248.223 Alternative State strategy. (a) The Commissioner may approve a State strategy providing for State approval of plans of action that involve termination of low...

  16. Neurocysticercosis: Diagnostic problems & current therapeutic strategies (United States)

    Rajshekhar, Vedantam


    Neurocysticercosis (NCC) is the most common single cause of seizures/epilepsy in India and several other endemic countries throughout the world. It is also the most common parasitic disease of the brain caused by the cestode Taenia solium or pork tapeworm. The diagnosis of NCC and the tapeworm carrier (taeniasis) can be relatively inaccessible and expensive for most of the patients. In spite of the introduction of several new immunological tests, neuroimaging remains the main diagnostic test for NCC. The treatment of NCC is also mired in controversy although, there is emerging evidence that albendazole (a cysticidal drug) may be beneficial for patients by reducing the number of seizures and hastening the resolution of live cysts. Currently, there are several diagnostic and management issues which remain unresolved. This review will highlight some of these issues. PMID:28139530

  17. Neurocysticercosis: Diagnostic problems & current therapeutic strategies

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    Vedantam Rajshekhar


    Full Text Available Neurocysticercosis (NCC is the most common single cause of seizures/epilepsy in India and several other endemic countries throughout the world. It is also the most common parasitic disease of the brain caused by the cestode Taenia solium or pork tapeworm. The diagnosis of NCC and the tapeworm carrier (taeniasis can be relatively inaccessible and expensive for most of the patients. In spite of the introduction of several new immunological tests, neuroimaging remains the main diagnostic test for NCC. The treatment of NCC is also mired in controversy although, there is emerging evidence that albendazole (a cysticidal drug may be beneficial for patients by reducing the number of seizures and hastening the resolution of live cysts. Currently, there are several diagnostic and management issues which remain unresolved. This review will highlight some of these issues.

  18. Chromatin conformation capture strategies in molecular diagnostics

    NARCIS (Netherlands)

    Vree, P.J.P. de


    In this thesis I have explored the clinical potential of the 4C-technology and worked on development of a novel chromatin conformation capture based technology, called TLA. In chapter 2 I describe how the 4C-technology can be applied as a targeted strategy to identify putative fusion-genes or chromo

  19. Short Horizon Control Strategies for an Alternating Activated Sludge Process

    DEFF Research Database (Denmark)

    Isaacs, Steven Howard


    Three control strategies allowing improved operational flexibility of an alternating type activated sludge process are presented in a unified model based framework. The control handles employed are the addition rate of an external carbon source to denitrification, the cycle length...


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    Vaduva Cecilia


    Full Text Available Strategic choosing refers to making decisions (selecting the strategic option related to the future of the enterprise and the ways it respond to the action of certain pressure and influence factors identified by analysis and strategic diagnosis. The clear definition of the enterprise objectives is very important from the viewpoint of the business types where it is involved and of the connections existent between them (by means of the SBU mix. But, the successful development of the strategies should consider the fact that they cannot be built only on the existent financial resources, but also on the development of these resources.

  1. Endoscopy as a diagnostic and therapeutic alternative technique of taeniasis

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    Héctor Julian Canaval-Zuleta

    Full Text Available Despite a low incidence in developed countries, gastrointestinal taeniasis should be suspected in patients with abdominal pain, diarrhea, anemia, and/or malabsorption of unknown origin, even more so if they come from endemic regions or areas with poor hygienic and alimentary habits. Diagnosis is traditionally reached by identifying the parasite in stools, but more recently both serological and immunological approaches are also available. Based on a patient diagnosed by gastroscopy, a literature review was undertaken of patients diagnosed by endoscopy. We discuss endoscopy as diagnostic modality, and the effectiveness and safety that endoscopic treatment may provide in view of the potential risk for neurocysticercosis.

  2. Endoscopy as a diagnostic and therapeutic alternative technique of taeniasis. (United States)

    Canaval Zuleta, Héctor Julián; Company Campins, María M; Dolz Abadía, Carlos


    Despite a low incidence in developed countries, gastrointestinal taeniasis should be suspected in patients with abdominal pain, diarrhea, anemia, and/or malabsorption of unknown origin, even more so if they come from endemic regions or areas with poor hygienic and alimentary habits. Diagnosis is traditionally reached by identifying the parasite in stools, but more recently both serological and immunological approaches are also available. Based on a patient diagnosed by gastroscopy, a literature review was undertaken of patients diagnosed by endoscopy. We discuss endoscopy as diagnostic modality, and the effectiveness and safety that endoscopic treatment may provide in view of the potential risk for neurocysticercosis.

  3. Mechanical valve obstruction:Review of diagnostic and treatment strategies

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    Jason Salamon; Jerson Munoz--Mendoza; Jared J Liebelt; Cynthia C Taub


    Prosthetic valve obstruction(PVO) is a rare but feared complication of mechanical valve replacement. Diagno-stic evaluation should focus on differentiating prosthetic valve thrombosis(PVT) from pannus formation,as their treatment options differ. History of sub-optimal anti-coagulation and post-op time course to development of PVO are useful clinical characteristics in differentiating thrombus from pannus formation. Treatment of PVT is influenced by the patient’s symptoms,valve location,degree of obstruction and thrombus size and may include thrombolysis or surgical intervention. Alternatively,pannus formation requires surgical intervention. The purpose of this article is to review the pathophysiology,epidemiology,diagnostic approach and treatment options for aortic and mitral valve PVO.

  4. Rational design of diagnostic and vaccination strategies for tuberculosis

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    Sibele Borsuk


    Full Text Available The development of diagnostic tests which can readily differentiate between vaccinated and tuberculosis-infected individuals is crucial for the wider utilization of bacillus Calmette-Guérin (BCG as vaccine in humans and animals. BCG_0092 is an antigen that elicits specific delayed type hypersensitivity reactions similar in size and morphological aspects to that elicited by purified protein derivative, in both animals and humans infected with the tubercle bacilli. We carried out bioinformatics analyses of the BCG_0092 and designed a diagnostic test by using the predicted MHC class I epitopes. In addition, we performed a knockout of this gene by homologous recombination in the BCG vaccine strain to allow differentiation of vaccinated from infected individuals. For that, the flanking sequences of the target gene (BCG_0092were cloned into a suicide vector. Spontaneous double crossovers, which result in wild type revertants or knockouts were selected using SacB. BCG_0092 is present only in members of the Mycobacterium tuberculosis complex. Eight predicted MHC class I epitopes with potential for immunological diagnosis were defined, allowing the design of a specific diagnostic test. The strategy used to delete the (BCG_0092 gene from BCG was successful. The knockout genotype was confirmed by PCR and by Southern blot. The mutant BCG strain has the potential of inducing protection against tuberculosis without interfering with the diagnostic test based on the use of selected epitopes from BCG_0092.

  5. Optimizing Feedlot Diagnostic Testing Strategies Using Test Characteristics, Disease Prevalence, and Relative Costs of Misdiagnosis. (United States)

    Theurer, Miles E; White, Brad J; Renter, David G


    Diagnostic tests are commonly used by feedlot practitioners and range from clinical observations to more advanced physiologic testing. Diagnostic sensitivity and specificity, estimated prevalence in the population, and the costs of misdiagnoses need to be considered when selecting a diagnostic test strategy and interpreting results. This article describes methods for evaluating diagnostic strategies using economic outcomes to evaluate the most appropriate strategy for the expected situation. The diagnostic sensitivity and specificity, and expected prevalence influence the likelihood of misdiagnosis in a given population, and the estimated direct economic impact can be used to quantify differences among diagnostic strategies.

  6. Proteinuria: The diagnostic strategy based on urine proteins differentiation

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    Stojimirović Biljana B.


    Full Text Available Basal glomerular membrane represents mechanical and electrical barrier for passing of the plasma proteins. Mechanical barrier is composed of cylindrical pores and filtration fissure, and negative layer charge in exterior and interior side of basal glomerular membrane, made of heparan sulphate and sialoglicoproteine, provides certain electrical barrier. Diagnostic strategy based on different serum and urine proteins enables the differentiation of various types of proteinuria. Depending on etiology of proteinuria it can be prerenal, renal and postrenal. By analyzing albumin, armicroglobulin, immunoglobulin G and armacroglobulin, together with total protein in urine, it is possible to detect and differentiate causes of prerenal, renal (glomerular, tubular, glomerulo-tubular and postrenal proteinuria. The adequate and early differentiation of proteinuria type is of an immense diagnostic and therapeutic importance.

  7. Telemetry with an Optical Fiber Revisited: An Alternative Strategy (United States)

    Kraftmakher, Yaakov


    With a new data-acquisition system developed by PASCO scientific, an experiment on telemetry with an optical fiber can be made easier and more accurate. For this aim, an alternative strategy of the remote temperature measurements is proposed: the frequency of light pulses transmitted via the light guide numerically equals the temperature using…

  8. Modular Instruction--An Alternative Strategy in Higher Education. (United States)

    Boren, Angela; Foree, Sherrell

    The problem of developing and evaluating a personalized, competency-based modular instructional strategy was chosen to offer an alternative to the traditional lecture method in a laboratory food and nutrition course at the university level. The content of the course was divided into modules with competency-based objectives. Students passing the…

  9. Reconstruction of the Anterior Cruciate Ligament : Alternative Strategies

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    van Eijk, F.


    This thesis describes the long-term results of reconstruction of the anterior cruciate ligament with an allograft. Due to the poor results found, further studies were performed to investigate alternative strategies for reconstruction of the anterior cruciate ligament in the field of tissue engineeri

  10. Implications of caries diagnostic strategies for clinical management decisions

    DEFF Research Database (Denmark)

    Baelum, Vibeke; Hintze, Hanne; Wenzel, Ann;


    in a low-caries population. METHODS: Each of four examiners independently examined preselected contacting interproximal surfaces in 53 dental students aged 20-37 years using a visual-tactile examination and bitewing radiography. The visual-tactile examination distinguished between noncavitated......OBJECTIVES: In clinical practice, a visual-tactile caries examination is frequently supplemented by bitewing radiography. This study evaluated strategies for combining visual-tactile and radiographic caries detection methods and determined their implications for clinical management decisions......-specificity) were calculated for each diagnostic strategy. RESULTS: Visual-tactile examination provided a true-positive rate of 34.2% and a false-positive rate of 1.5% for the detection of a cavity. The combination of a visual-tactile and a radiographic examination using the lesion in dentin threshold...

  11. CT imaging in acute pulmonary embolism: diagnostic strategies

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    Wildberger, Joachim E.; Mahnken, Andreas H.; Das, Marco; Guenther, Rolf W. [University of Technology (RWTH), Department of Diagnostic Radiology, University Hospital, Aachen (Germany); Kuettner, Axel [Eberhard Karls University, Department of Diagnostic Radiology, Tuebingen (Germany); Lell, Michael [Friedrich Alexander University, Department of Diagnostic Radiology, Erlangen (Germany)


    Computed tomography pulmonary angiography (CTA) has increasingly become accepted as a widely available, safe, cost-effective, and accurate method for a quick and comprehensive diagnosis of acute pulmonary embolism (PE). Pulmonary catheter angiography is still considered the gold standard and final imaging method in many diagnostic algorithms. However, spiral CTA has become established as the first imaging test in clinical routine due to its high negative predictive value for clinically relevant PE. Despite the direct visualization of clot material, depiction of cardiac and pulmonary function in combination with the quantification of pulmonary obstruction helps to grade the severity of PE for further risk stratification and to monitor the effect of thrombolytic therapy. Because PE and deep venous thrombosis are two different aspects of the same disease, additional indirect CT venography may be a valuable addition to the initial diagnostic algorithm - if this was positive for PE - and demonstration of the extent and localization of deep venous thrombosis has an impact on clinical management. Additional and alternate diagnoses add to the usefulness of this method. Using advanced multislice spiral CT technology, some practitioners have advocated CTA as the sole imaging tool for routine clinical assessment in suspected acute PE. This will simplify standards of practice in the near future. (orig.)

  12. Change communication : the impact on satisfaction with alternative workplace strategies


    Bull, Melanie; Brown, Tim


    Communication is fundamental to the Facilities Management (FM) role within organisations; especially when the FM department is implementing changes to the workplace. An evaluation of an instance is presented. A self- administered online questionnaire was used to collect quantitative and qualitative data. The research focused on responses to satisfaction with the communication methods rather than reviewing the merits of alternative workplace strategies. Findings included the impact of...

  13. Identifying Differences in Diagnostic Skills between Physics Students: Students' Self-Diagnostic Performance Given Alternative Scaffolding

    CERN Document Server

    Cohen, Elisheva; Singh, Chandralekha; Yerushalmi, Edit


    "Self-diagnosis tasks" aim at fostering diagnostic behavior by explicitly requiring students to present diagnosis as part of the activity of reviewing their problem solutions. We have been investigating the extent to which introductory physics students can diagnose their own mistakes when explicitly asked to do so with different levels of scaffolding support provided to them. In our study in an introductory physics class with more than 200 students, the recitation classes were split into three different experimental groups in which different levels of guidance were provided for performing the self-diagnosis activities. We present our findings that students' performance was far from perfect. However, differences in the scaffolding in the three experimental groups (i.e. providing a correct solution and a self-diagnosis rubric) noticeably affected the resulting diagnosis.

  14. [Bladder endometriosis and barrenness: diagnostic and treatment strategy]. (United States)

    Piketty, M; Bricou, A; Blumental, Y; de Carné, C; Benifla, J-L


    Deep infiltrating endometriosis is a well-known female disease responsible for chronic pelvic pain, urinary dysfunction, infertility, and altered quality of life. Endometriosis and infertility are complex entities and the optimal choice of management of both of them remains obscure. Mechanism of development of the disease has to be understood to optimize patients care. The link between barrenness and endometriosis is well known, but there is no direct link between bladder lesion and infertility. Bladder endometriosis is a deeply infiltrating endometriosis lesion. Its management is first diagnostic and then remedial. In case of ineffectiveness of medical strategy, surgical treatment is indicated. However, for patient suffering from symptomatic isolated bladder endometriosis, surgical management can be offered in first intention. Isolated bladder injuries due to endometriosis are mostly treated by conservative laparoscopic surgery, after a complete evaluation of endometriosis disease and barrenness by clinical exam and imaging techniques.

  15. Alternating-time temporal logic with finite-memory strategies

    DEFF Research Database (Denmark)

    Vester, Steen


    Model-checking the alternating-time temporal logics ATL and ATL* with incomplete information is undecidable for perfect recall semantics. However, when restricting to memoryless strategies the model-checking problem becomes decidable. In this paper we consider two other types of semantics based...... on finite-memory strategies. One where the memory size allowed is bounded and one where the memory size is unbounded (but must be finite). This is motivated by the high complexity of model-checking with perfect recall semantics and the severe limitations of memoryless strategies. We show that both types...... of semantics introduced are different from perfect recall and memoryless semantics and next focus on the decidability and complexity of model-checking in both complete and incomplete information games for ATL/ATL*. In particular, we show that the complexity of model-checking with bounded-memory semantics...

  16. Direct PCR: Alternative Diagnostic Method for Diagnosis of Diphtheria Rapidly, Easily and Cost Effective

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    Sunarno Sunarno


    Full Text Available Some diseases require immediate and appropriate treatment to decrease the fatality risk patients incident, for example diphtheria. Time to help patients is very crucial since delay of therapy may increase the mortality cases up to 20 times. In other hands, conventional diagnostic methods (the gold standard for diagnosis of diphtheria is time consuming and laborious. Therefore, an alternative diagnostic method which is rapid, easy and inexpensive is needed. In this case, direct PCR has been proved to reduce time and cost in laboratory examination. This study aimed to develop direct PCR as alternative diagnostic method for diagnosis of diphtheria rapidly, easily, and inexpensive. Fifteen samples include 10 isolates of Corynebacterium diphtheriae (toxigenic and 3 isolates of Corynebacterium non- diphtheriae (nontoxigenic and 2 clinical specimens (throat swab was examined by performing direct PCR method and a standard PCR method was used for optimizing the protocols. Result showed that direct PCR can be used to amplify target genes correctly as well as standard PCR. All of C. diphtheriae samples showed bands at 168 bp (dtxR gene marker and 551 bp (tox gene marker while no band appeared in others. Direct PCR detected at least 71 CFU/uL of bacterial cells in samples. We concluded that direct PCR can be used for alternative diagnostic method for diagnosis of diphtheria which is rapid, easy and cost effective.

  17. Alternative Land Management Strategies and Their Impact on Soil Conservation

    Directory of Open Access Journals (Sweden)

    Tiziano Gomiero


    Full Text Available Soil conservation is threatened by a number of factors, namely the effects of intensive agricultural practices, the increasing pressure for food production linked to the increasing human population, the consumption patterns in developed and emerging economies, and the conversion of agriculture from the production of commodities (which is itself a goal in need of discussion to the production of biofuels. The extent of human pressure and the effects of conflicting land use systems need to be addressed. Alternative and conservative agricultural practices need to be explored and widely adopted in order to preserve the soil fertility, assessing their pros and cons. In this paper, the main potential alternative practices are reviewed, focusing in particular on organic farming. It is also argued that in order to better plan to preserve soil health a strategy considering the whole food system is required.

  18. Energy demand analysis in the workshop on alternative energy strategies

    Energy Technology Data Exchange (ETDEWEB)

    Carhart, S C


    The Workshop on Alternative Energy Strategies, conducted from 1974 through 1977, was an international study group formed to develop consistent national energy alternatives within a common analytical framework and global assumptions. A major component of this activity was the demand program, which involved preparation of highly disaggregated demand estimates based upon estimates of energy-consuming activities and energy requirements per unit of activity reported on a consistent basis for North America, Europe, and Japan. Comparison of the results of these studies reveals that North America requires more energy per unit of activity in many consumption categories, that major improvements in efficiency will move North America close to current European and Japanese efficiencies, and that further improvements in European and Japanese efficiencies may be anticipated as well. When contrasted with expected availabilities of fuels, major shortfalls of oil relative to projected demands emerge in the eighties and nineties. Some approaches to investment in efficiency improvements which will offset these difficulties are discussed.

  19. Recursive Algorithm and Alternate Operation Strategy in Sequential Tests

    Institute of Scientific and Technical Information of China (English)

    XU Hong-lin; CHEN Zhan-qi; GUO Lue


    Based on the sequential probability ratio test (SPRT) developed by Wald, an improved method for successful probability test of missile flight is proposed. A recursive algorithm and its program in Matlab are designed to calculate the real risk level of the sequential test decision and the average number of samples under various test conditions. A concept, that is "rejecting as soon as possible", is put forward and an alternate operation strategy is conducted. The simulation results show that it can reduce the test expenses.

  20. Convergence between DSM-IV-TR and DSM-5 diagnostic models for personality disorder: evaluation of strategies for establishing diagnostic thresholds. (United States)

    Morey, Leslie C; Skodol, Andrew E


    The Personality and Personality Disorders Work Group for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) recommended substantial revisions to the personality disorders (PDs) section of DSM-IV-TR, proposing a hybrid categorical-dimensional model that represented PDs as combinations of core personality dysfunctions and various configurations of maladaptive personality traits. Although the DSM-5 Task Force endorsed the proposal, the Board of Trustees of the American Psychiatric Association (APA) did not, placing the Work Group's model in DSM-5 Section III ("Emerging Measures and Models") with other concepts thought to be in need of additional research. This paper documents the impact of using this alternative model in a national sample of 337 patients as described by clinicians familiar with their cases. In particular, the analyses focus on alternative strategies considered by the Work Group for deriving decision rules, or diagnostic thresholds, with which to assign categorical diagnoses. Results demonstrate that diagnostic rules could be derived that yielded appreciable correspondence between DSM-IV-TR and proposed DSM-5 PD diagnoses-correspondence greater than that observed in the transition between DSM-III and DSM-III-R PDs. The approach also represents the most comprehensive attempt to date to provide conceptual and empirical justification for diagnostic thresholds utilized within the DSM PDs.

  1. Analysis of alternative strategies for energy conservation in new buildings

    Energy Technology Data Exchange (ETDEWEB)

    Fang, J.M.; Tawil, J.J.


    Building Energy Performance Standards (BEPS) were mandated by the Energy Conservation Standards for New Buildings Act of 1976 (Title III of Energy Conservation and Production Act) to promote energy efficiency and the use of renewable resources in new buildings. The report analyzes alternative Federal strategies and their component policy instruments and recommends a strategy for achieving the goals of the Act. The concern is limited to space conditioning (heating, cooling, and lighting) and water heating. The policy instruments considered include greater reliance on market forces; research and development; information, education and demonstration programs; tax incentives and sanctions; mortgage and finance programs; and regulations and standards. The analysis starts with an explanation of the barriers to energy conservation in the residential and commercial sectors. Individual policy instruments are then described and evaluated with respect to energy conservation, economic efficiency, equity, political impacts, and implementation and other transitional impacts. Five possible strategies are identified: (1) increased reliance on the market place; (2) energy consumption tax and supply subsidies; (3) BEPS with no sanctions and no incentives; (4) BEPS with sanctions and incentives (price control); and (5) BEPS with sanctions and incentives (no price controls). A comparative analysis is performed. Elements are proposed for inclusion in a comprehensive strategy for conservation in new buildings. (MCW)

  2. Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study (United States)

    Laméris, Wytze; van Randen, Adrienne; van Es, H Wouter; van Heesewijk, Johannes P M; van Ramshorst, Bert; Bouma, Wim H; ten Hove, Wim; van Leeuwen, Maarten S; van Keulen, Esteban M; Dijkgraaf, Marcel G W; Bossuyt, Patrick M M; Boermeester, Marja A


    Objective To identify an optimal imaging strategy for the accurate detection of urgent conditions in patients with acute abdominal pain. Design Fully paired multicentre diagnostic accuracy study with prospective data collection. Setting Emergency departments of two university hospitals and four large teaching hospitals in the Netherlands. Participants 1021 patients with non-traumatic abdominal pain of >2 hours’ and <5 days’ duration. Exclusion criteria were discharge from the emergency department with no imaging considered warranted by the treating physician, pregnancy, and haemorrhagic shock. Intervention All patients had plain radiographs (upright chest and supine abdominal), ultrasonography, and computed tomography (CT) after clinical and laboratory examination. A panel of experienced physicians assigned a final diagnosis after six months and classified the condition as urgent or non-urgent. Main outcome measures Sensitivity and specificity for urgent conditions, percentage of missed cases and false positives, and exposure to radiation for single imaging strategies, conditional imaging strategies (CT after initial ultrasonography), and strategies driven by body mass index and age or by location of pain. Results 661 (65%) patients had a final diagnosis classified as urgent. The initial clinical diagnosis resulted in many false positive urgent diagnoses, which were significantly reduced after ultrasonography or CT. CT detected more urgent diagnoses than did ultrasonography: sensitivity was 89% (95% confidence interval 87% to 92%) for CT and 70% (67% to 74%) for ultrasonography (P<0.001). A conditional strategy with CT only after negative or inconclusive ultrasonography yielded the highest sensitivity, missing only 6% of urgent cases. With this strategy, only 49% (46% to 52%) of patients would have CT. Alternative strategies guided by body mass index, age, or location of the pain would all result in a loss of sensitivity. Conclusion Although CT is the most

  3. Alternating-time temporal logic with finite-memory strategies

    Directory of Open Access Journals (Sweden)

    Steen Vester


    Full Text Available Model-checking the alternating-time temporal logics ATL and ATL* with incomplete information is undecidable for perfect recall semantics. However, when restricting to memoryless strategies the model-checking problem becomes decidable. In this paper we consider two other types of semantics based on finite-memory strategies. One where the memory size allowed is bounded and one where the memory size is unbounded (but must be finite. This is motivated by the high complexity of model-checking with perfect recall semantics and the severe limitations of memoryless strategies. We show that both types of semantics introduced are different from perfect recall and memoryless semantics and next focus on the decidability and complexity of model-checking in both complete and incomplete information games for ATL/ATL*. In particular, we show that the complexity of model-checking with bounded-memory semantics is Delta_2p-complete for ATL and PSPACE-complete for ATL* in incomplete information games just as in the memoryless case. We also present a proof that ATL and ATL* model-checking is undecidable for n >= 3 players with finite-memory semantics in incomplete information games.

  4. Novel non invasive diagnostic strategies in bladder cancer. (United States)

    Truta, Anamaria; Popon, Tudor Adrian Hodor; Saraci, George; Ghervan, Liviu; Pop, Ioan Victor


    Bladder cancer is one of the most commonly diagnosed malignancies worldwide, derived from the urothelium of the urinary bladder and defined by long asymptomatic and atypical clinical picture. Its complex etiopathogenesis is dependent on numerous risk factors that can be divided into three distinct categories: genetic and molecular abnormalities, chemical or environmental exposure and previous genitourinary disorders and family history of different malignancies. Various genetic polymorphisms and microRNA might represent useful diagnostic or prognostic biomarkers. Genetic and molecular abnormalities - risk factors are represented by miRNA or genetic polymorphisms proved to be part of bladder carcinogenesis such as: genetic mutations of oncogenes TP53, Ras, Rb1 or p21 oncoproteins, cyclin D or genetic polymorhisms of XPD,ERCC1, CYP1B1, NQO1C609T, MDM2SNP309, CHEK2, ERCC6, NRF2, NQO1Pro187Ser polymorphism and microRNA (miR-143, -145, -222, -210, -10b, 576-3p). The aim of our article is to highlight the most recent acquisitions via molecular biomarkers (miRNAs and genetic polymorphisms) involved in bladder cancer in order to provide early diagnosis, precise therapy according to the molecular profile of bladder tumors, as well as to improve clinical outcome, survival rates and life quality of oncological patients. These molecular biomarkers play a key role in bladder carcinogenesis, clinical evolution, prognosis and therapeutic response and explain the molecular mechanisms involved in bladder carcinogenesis; they can also be selected as therapeutic targets in developing novel therapeutic strategies in bladder malignancies. Moreover, the purpose in defining these molecular non invasive biomarkers is also to develop non invasive screening programs in bladder malignancies with the result of decreasing bladder cancer incidence in risk population.

  5. Outcome modelling strategies in epidemiology: traditional methods and basic alternatives. (United States)

    Greenland, Sander; Daniel, Rhian; Pearce, Neil


    Controlling for too many potential confounders can lead to or aggravate problems of data sparsity or multicollinearity, particularly when the number of covariates is large in relation to the study size. As a result, methods to reduce the number of modelled covariates are often deployed. We review several traditional modelling strategies, including stepwise regression and the 'change-in-estimate' (CIE) approach to deciding which potential confounders to include in an outcome-regression model for estimating effects of a targeted exposure. We discuss their shortcomings, and then provide some basic alternatives and refinements that do not require special macros or programming. Throughout, we assume the main goal is to derive the most accurate effect estimates obtainable from the data and commercial software. Allowing that most users must stay within standard software packages, this goal can be roughly approximated using basic methods to assess, and thereby minimize, mean squared error (MSE).

  6. A Positive Diagnostic Strategy Is Noninferior to a Strategy of Exclusion for Patients With Irritable Bowel Syndrome

    DEFF Research Database (Denmark)

    Begtrup, Luise M; Engsbro, Anne Line; Kjeldsen, Jens


    registered. RESULTS: A positive strategy was noninferior to a strategy of exclusion (difference, 0.64; 95% confidence interval, -2.74 to 1.45). The positive diagnostic strategy had lower direct costs. Each approach had similar effects on symptoms, satisfaction, and subsequent use of health resources......BACKGROUND & AIMS: Guidelines recommend a positive strategy based on symptom criteria to diagnose patients with irritable bowel syndrome (IBS). We conducted a randomized noninferiority trial to determine whether a positive diagnostic strategy is noninferior to a strategy of exclusion, with regard...... by a strategy of exclusion (analyses of blood, stool samples for intestinal parasites, and sigmoidoscopies with biopsies) or a positive strategy (analyses of blood cell count and C-reactive protein). Patients were followed for 1 year. The primary end point was difference in change of HRQOL from baseline to 1...

  7. Nonequilibrium relaxation method – An alternative simulation strategy

    Indian Academy of Sciences (India)

    Nobuyasu Ito


    One well-established simulation strategy to study the thermal phases and transitions of a given microscopic model system is the so-called equilibrium method, in which one first realizes the equilibrium ensemble of a finite system and then extrapolates the results to infinite system. This equilibrium method traces over the standard theory of the thermal statistical mechanics, and over the idea of the thermodynamic limit. Recently, an alternative simulation strategy has been developed, which analyzes the nonequilibrium relaxation (NER) process. It is called the NER method. NER method has some advantages over the equilibrium method. The NER method provides a simpler analyzing procedure. This implies less systematic error which is inevitable in the simulation and provides efficient resource usage. The NER method easily treats not only the thermodynamic limit but also other limits, for example, non-Gibbsian nonequilibrium steady states. So the NER method is also relevant for new fields of the statistical physics. Application of the NER method have been expanding to various problems: from basic first- and second-order transitions to advanced and exotic phases like chiral, KT spin-glass and quantum phases. These studies have provided, not only better estimations of transition point and exponents, but also qualitative developments. For example, the universality class of a random system, the nature of the two-dimensional melting and the scaling behavior of spin-glass aging phenomena have been clarified.

  8. Cost-effectiveness of different diagnostic strategies in patients with nonresectable upper gastrointestinal tract malignancies

    DEFF Research Database (Denmark)

    Mortensen, M B; Ainsworth, A P; Scheel-Hincke, J D;


    BACKGROUND AND METHODS: Using a simple model, this retrospective study evaluated the cost-effectiveness of different diagnostic strategies used for pretherapeutic detection of patients with disseminated or locally nonresectable upper gastrointestinal tract malignancies (UGIM). Of 162 consecutive...... cost, but a diagnostic strategy based on CT with US or CT with US and laparoscopy was not cost-effective. The inclusion of endoscopic or laparoscopic ultrasonography seemed necessary to the provision of a cost-effective strategy because both techniques had a high diagnostic accuracy combined with a low...

  9. Diagnostics Strategies with Electrochemical Affinity Biosensors Using Carbon Nanomaterials as Electrode Modifiers (United States)

    Campuzano, Susana; Yáñez-Sedeño, Paloma; Pingarrón, José M.


    Early diagnosis is often the key to successful patient treatment and survival. The identification of various disease signaling biomarkers which reliably reflect normal and disease states in humans in biological fluids explain the burgeoning research field in developing new methodologies able to determine the target biomarkers in complex biological samples with the required sensitivity and selectivity and in a simple and rapid way. The unique advantages offered by electrochemical sensors together with the availability of high affinity and specific bioreceptors and their great capabilities in terms of sensitivity and stability imparted by nanostructuring the electrode surface with different carbon nanomaterials have led to the development of new electrochemical biosensing strategies that have flourished as interesting alternatives to conventional methodologies for clinical diagnostics. This paper briefly reviews the advantages of using carbon nanostructures and their hybrid nanocomposites as electrode modifiers to construct efficient electrochemical sensing platforms for diagnosis. The review provides an updated overview of some selected examples involving attractive amplification and biosensing approaches which have been applied to the determination of relevant genetic and protein diagnostics biomarkers. PMID:28035946

  10. Diagnostics Strategies with Electrochemical Affinity Biosensors Using Carbon Nanomaterials as Electrode Modifiers

    Directory of Open Access Journals (Sweden)

    Susana Campuzano


    Full Text Available Early diagnosis is often the key to successful patient treatment and survival. The identification of various disease signaling biomarkers which reliably reflect normal and disease states in humans in biological fluids explain the burgeoning research field in developing new methodologies able to determine the target biomarkers in complex biological samples with the required sensitivity and selectivity and in a simple and rapid way. The unique advantages offered by electrochemical sensors together with the availability of high affinity and specific bioreceptors and their great capabilities in terms of sensitivity and stability imparted by nanostructuring the electrode surface with different carbon nanomaterials have led to the development of new electrochemical biosensing strategies that have flourished as interesting alternatives to conventional methodologies for clinical diagnostics. This paper briefly reviews the advantages of using carbon nanostructures and their hybrid nanocomposites as electrode modifiers to construct efficient electrochemical sensing platforms for diagnosis. The review provides an updated overview of some selected examples involving attractive amplification and biosensing approaches which have been applied to the determination of relevant genetic and protein diagnostics biomarkers.

  11. Cost-effectiveness of diagnostic strategies for patients with chest pain

    NARCIS (Netherlands)

    Kuntz, KM; Fleischmann, KE; Hunink, MGM; Douglas, PS


    Background: Many noninvasive tests exist to determine whether patients should undergo coronary angiography. The routine use of coronary angiography without previous noninvasive testing is typically not advocated. Objective: To determine the cost-effectiveness of diagnostic strategies for patients wi

  12. [Evaluation of the diagnostic power of 3 methods for assaying free T4. Results in the diagnostic strategy of hyperthyroidism]. (United States)

    Fragu, P; Noel, M; Patois, E; Delarue, J C; Paugam-Capelle, J; Parmentier, C


    The free thyroxin (FT4) tests of Amersham, Clinical Assay and Corning Medical were evaluated in 240 patients who were suspected of hyperthyroidism. The diagnostic performances of the Corning method were of less value while those of the other methods were equivalent to that obtained with the free thyroxin index for an average cost reduced. Furthermore our results show that T3 determination is better than T4 determination in patients who remained doubtful after FT4. However the development of ultra-short methods of measurement of total thyroid hormone blood levels using fluorescence polarization could lead to reconsider the diagnostic strategy of hyperthyroidism.

  13. Economic Analysis of Alternative Strategies for Detection of ALK Rearrangements in Non Small Cell Lung Cancer

    Directory of Open Access Journals (Sweden)

    Shivang Doshi


    Full Text Available Identification of alterations in ALK gene and development of ALK-directed therapies have increased the need for accurate and efficient detection methodologies. To date, research has focused on the concordance between the two most commonly used technologies, fluorescent in situ hybridization (FISH and immunohistochemistry (IHC. However, inter-test concordance reflects only one, albeit important, aspect of the diagnostic process; laboratories, hospitals, and payors must understand the cost and workflow of ALK rearrangement detection strategies. Through literature review combined with interviews of pathologists and laboratory directors in the U.S. and Europe, a cost-impact model was developed that compared four alternative testing strategies—IHC only, FISH only, IHC pre-screen followed by FISH confirmation, and parallel testing by both IHC and FISH. Interviews were focused on costs of reagents, consumables, equipment, and personnel. The resulting model showed that testing by IHC alone cost less ($90.07 in the U.S., $68.69 in Europe than either independent or parallel testing by both FISH and IHC ($441.85 in the U.S. and $279.46 in Europe. The strategies differed in cost of execution, turnaround time, reimbursement, and number of positive results detected, suggesting that laboratories must weigh the costs and the clinical benefit of available ALK testing strategies.

  14. Tobacco harm reduction: an alternative cessation strategy for inveterate smokers

    Directory of Open Access Journals (Sweden)

    Godshall William T


    Full Text Available Abstract According to the Centers for Disease Control and Prevention, about 45 million Americans continue to smoke, even after one of the most intense public health campaigns in history, now over 40 years old. Each year some 438,000 smokers die from smoking-related diseases, including lung and other cancers, cardiovascular disorders and pulmonary diseases. Many smokers are unable – or at least unwilling – to achieve cessation through complete nicotine and tobacco abstinence; they continue smoking despite the very real and obvious adverse health consequences. Conventional smoking cessation policies and programs generally present smokers with two unpleasant alternatives: quit, or die. A third approach to smoking cessation, tobacco harm reduction, involves the use of alternative sources of nicotine, including modern smokeless tobacco products. A substantial body of research, much of it produced over the past decade, establishes the scientific and medical foundation for tobacco harm reduction using smokeless tobacco products. This report provides a description of traditional and modern smokeless tobacco products, and of the prevalence of their use in the United States and Sweden. It reviews the epidemiologic evidence for low health risks associated with smokeless use, both in absolute terms and in comparison to the much higher risks of smoking. The report also describes evidence that smokeless tobacco has served as an effective substitute for cigarettes among Swedish men, who consequently have among the lowest smoking-related mortality rates in the developed world. The report documents the fact that extensive misinformation about ST products is widely available from ostensibly reputable sources, including governmental health agencies and major health organizations. The American Council on Science and Health believes that strong support of tobacco harm reduction is fully consistent with its mission to promote sound science in regulation and in

  15. Strategies for adding adaptive learning mechanisms to rule-based diagnostic expert systems (United States)

    Stclair, D. C.; Sabharwal, C. L.; Bond, W. E.; Hacke, Keith


    Rule-based diagnostic expert systems can be used to perform many of the diagnostic chores necessary in today's complex space systems. These expert systems typically take a set of symptoms as input and produce diagnostic advice as output. The primary objective of such expert systems is to provide accurate and comprehensive advice which can be used to help return the space system in question to nominal operation. The development and maintenance of diagnostic expert systems is time and labor intensive since the services of both knowledge engineer(s) and domain expert(s) are required. The use of adaptive learning mechanisms to increment evaluate and refine rules promises to reduce both time and labor costs associated with such systems. This paper describes the basic adaptive learning mechanisms of strengthening, weakening, generalization, discrimination, and discovery. Next basic strategies are discussed for adding these learning mechanisms to rule-based diagnostic expert systems. These strategies support the incremental evaluation and refinement of rules in the knowledge base by comparing the set of advice given by the expert system (A) with the correct diagnosis (C). Techniques are described for selecting those rules in the in the knowledge base which should participate in adaptive learning. The strategies presented may be used with a wide variety of learning algorithms. Further, these strategies are applicable to a large number of rule-based diagnostic expert systems. They may be used to provide either immediate or deferred updating of the knowledge base.

  16. Optimal Sequential Diagnostic Strategy Generation Considering Test Placement Cost for Multimode Systems

    Directory of Open Access Journals (Sweden)

    Shigang Zhang


    Full Text Available Sequential fault diagnosis is an approach that realizes fault isolation by executing the optimal test step by step. The strategy used, i.e., the sequential diagnostic strategy, has great influence on diagnostic accuracy and cost. Optimal sequential diagnostic strategy generation is an important step in the process of diagnosis system construction, which has been studied extensively in the literature. However, previous algorithms either are designed for single mode systems or do not consider test placement cost. They are not suitable to solve the sequential diagnostic strategy generation problem considering test placement cost for multimode systems. Therefore, this problem is studied in this paper. A formulation is presented. Two algorithms are proposed, one of which is realized by system transformation and the other is newly designed. Extensive simulations are carried out to test the effectiveness of the algorithms. A real-world system is also presented. All the results show that both of them have the ability to solve the diagnostic strategy generation problem, and they have different characteristics.

  17. Diagnostic Educational Grouping with Strategies for Teaching Program. (United States)

    Colarusso, Calvin A.; Green, Phyllis P.

    This article describes a Title III project which attempts to introduce principles of child development into teaching in the elementary school in a practical and comprehensive manner, using actual experiences from the classroom as examples. The strategies provide a general set of guidelines for approaching individual children based on emotional and…

  18. [Current and future diagnostic strategies in venous thromboembolic disease]. (United States)

    Gabriel Botella, F; Labiós Gómez, M; Brasó Aznar, J V; Llavador Ros, G; Bort Martí, J


    Thromboembolic disease (TD), which includes deep venous thrombosis (DVT) and pulmonary embolism (PE), is the most common acute cardiovascular condition after ischemic cardiopathy and stroke. It is often difficult to diagnose, as it is well-known that half of PE episodes appear are recognized while the patient is still alive and which appear in 30-40% of symptomatic patients. Nonetheless, there are two well-differentiated phases in the diagnosis of TD: the suspicion, and the diagnosis. The first is very important, and is within the competence of any physician. The second can be ratified when carrying out specific tests. We have developed successive steps in the two phases of diagnosis, we critically review the distinct parts currently implicated in the strategic diagnosis of TD. Finally, we analyze the new diagnostic techniques to substitute, possibly, angiography in many cases, and perhaps to include ventilation/perfusion (V/Q) pulmonary gammagraphy, once become generally available.

  19. The clinical inadequacy of the DSM-5 classification of somatic symptom and related disorders: an alternative trans-diagnostic model. (United States)

    Cosci, Fiammetta; Fava, Giovanni A


    The Diagnostic and Statistical of Mental Disorders, Fifth Edition (DSM-5) somatic symptom and related disorders chapter has a limited clinical utility. In addition to the problems that the single diagnostic rubrics and the deletion of the diagnosis of hypochondriasis entail, there are 2 major ambiguities: (1) the use of the term "somatic symptoms" reflects an ill-defined concept of somatization and (2) abnormal illness behavior is included in all diagnostic rubrics, but it is never conceptually defined. In the present review of the literature, we will attempt to approach the clinical issue from a different angle, by introducing the trans-diagnostic viewpoint of illness behavior and propose an alternative clinimetric classification system, based on the Diagnostic Criteria for Psychosomatic Research.

  20. Punishment and Alternative Strategies for Decreasing a Behavior. (United States)

    Vought, James J.


    Provides an overview on the subject of punishment and alternative procedures to decelerate a behavior. Describes differential reinforcement, extinction, satiation, corrective feedback, using peers as models and rearranging the environment as positive and nonaversive procedures for decreasing a behavior. (LLL)

  1. EMBASE search strategies for identifying methodologically sound diagnostic studies for use by clinicians and researchers

    Directory of Open Access Journals (Sweden)

    Haynes R Brian


    Full Text Available Abstract Background Accurate diagnosis by clinicians is the cornerstone of decision making for recommending clinical interventions. The current best evidence from research concerning diagnostic tests changes unpredictably as science advances. Both clinicians and researchers need dependable access to published evidence concerning diagnostic accuracy. Bibliographic databases such as EMBASE provide the most widely available entrée to this literature. The objective of this study was to develop search strategies that optimize the retrieval of methodologically sound diagnostic studies from EMBASE for use by clinicians. Methods An analytic survey was conducted, comparing hand searches of 55 journals with retrievals from EMBASE for 4,843 candidate search terms and 6,574 combinations. All articles were rated using purpose and quality indicators, and clinically relevant diagnostic accuracy articles were categorized as 'pass' or 'fail' according to explicit criteria for scientific merit. Candidate search strategies were run in EMBASE, the retrievals being compared with the hand search data. The proposed search strategies were treated as "diagnostic tests" for sound studies and the manual review of the literature was treated as the "gold standard." The sensitivity, specificity, precision and accuracy of the search strategies were calculated. Results Of the 433 articles about diagnostic tests, 97 (22.4% met basic criteria for scientific merit. Combinations of search terms reached peak sensitivities of 100% with specificity at 70.4%. Compared with best single terms, best multiple terms increased sensitivity for sound studies by 8.2% (absolute increase, but decreased specificity (absolute decrease 6% when sensitivity was maximized. When terms were combined to maximize specificity, the single term "" (specificity of 98.2% outperformed combinations of terms. Conclusion Empirically derived search strategies combining indexing terms and textwords

  2. Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies

    Energy Technology Data Exchange (ETDEWEB)

    Marincek, B. [Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich (Switzerland)


    Common causes of acute abdominal pain include appendicitis, cholecystitis, bowel obstruction, urinary colic, perforated peptic ulcer, pancreatitis, diverticulitis, and nonspecific, nonsurgical abdominal pain. The topographic classification of acute abdominal pain (pain in one of the four abdominal quadrants, diffuse abdominal pain, flank or epigastric pain) facilitates the choice of the imaging technique. The initial radiological evaluation often consists of plain abdominal radiography, despite significant diagnostic limitations. The traditional indications for plain films - bowel obstruction, pneumoperitoneum, and the search of ureteral calculi - are questioned by helical computed tomography (CT). Although ultrasonography (US) is in many centers the modality of choice for imaging the gallbladder and the pelvis in children and women of reproductive age, CT is considered to be one of the most valued tools for triaging patients with acute abdominal pain. CT is particularly beneficial in patients with marked obesity, unclear US findings, bowel obstruction, and multiple lesions. The introduction of multidetector row CT (MDCT) has further enhanced the utility of CT in imaging patients with acute abdominal pain. (orig.)

  3. Cognitive strategies: a method to reduce diagnostic errors in ER

    Directory of Open Access Journals (Sweden)

    Carolina Prevaldi


    Full Text Available I wonder why sometimes we are able to rapidly recognize patterns of disease presentation, formulate a speedy diagnostic closure, and go on with a treatment plan. On the other hand sometimes we proceed studing in deep our patient in an analytic, slow and rational way of decison making. Why decisions sometimes can be intuitive, while sometimes we have to proceed in a rigorous way? What is the “back ground noise” and the “signal to noise ratio” of presenting sintoms? What is the risk in premature labeling or “closure” of a patient? When is it useful the “cook-book” approach in clinical decision making? The Emergency Department is a natural laboratory for the study of error” stated an author. Many studies have focused on the occurrence of errors in medicine, and in hospital practice, but the ED with his unique operating characteristics seems to be a uniquely errorprone environment. That's why it is useful to understand the underlying pattern of thinking that can lead us to misdiagnosis. The general knowledge of thought processes gives the psysician awareness an the ability to apply different tecniques in clinical decision making and to recognize and avoid pitfalls.

  4. Diagnostic strategy for occult hepatitis B virus infection

    Institute of Scientific and Technical Information of China (English)

    Sara Ocana; Maria Luisa Casas; Ingrid Buhigas; Jose Luis Lledo


    In 2008, the European Association for the study of the liver (EASL) defined occult hepatitis B virus infection (OBI) as the "presence of hepatitis B virus (HBV) DNA in the liver (with detectable or undetectable HBV DNA in the serum) of individuals testing hepatitis B surface antigen (HBsAg) negative by currently available assays". Several aspects of occult HBV infection are still poorly understood, including the definition itself and a standardized approach for laboratory-based detection, which is the purpose of this review. The clinical significance of OBI has not yet been established; however, in terms of public health, the clinical importance arises from the risk of HBV transmission. Consequently, it is important to detect high-risk groups for occult HBV infection to prevent transmission. The main issue is, perhaps, to identify the target population for screening OBI. Viremia is very low or undetectable in occult HBV infection, even when the most sensitive methods are used, and the detection of the viral DNA reservoir in hepatocytes would provide the best evaluation of occult HBV prevalence in a defined set of patients. However, this diagnostic approach is obviously unsuitable: blood detection of occult hepatitis B requires assays of the highest sensitivity and specificity with a lower limit of detection < 10 IU/mL for HBV DNA and < 0.1 ng/mL for HBsAg.

  5. Economics of eradicating Foot-and-Mouth disease epidemics with alternative control strategies

    NARCIS (Netherlands)

    Bergevoet, R.H.M.; Asseldonk, van M.A.P.M.


    The paper presents an economic analysis of Foot-and-Mouth Disease (FMD) control strategies for livestock herds. Alternative vaccination-to-live control strategies were compared to the strategy that involves culling of all susceptible animals in an area of 1 km around infected herds in addition to st

  6. Alternative energy development strategies for China towards 2030

    Institute of Scientific and Technical Information of China (English)

    Linwei MA; Zheng LI; Feng FU; Xiliang ZHANG; Weidou NI


    The purposes, objectives and technology path-ways for alternative energy development are discussed with the aim of reaching sustainable energy development in China. Special attention has been paid to alternative power and alternative vehicle fuels. Instead of limiting alternative energy to energy sources such as nuclear and renewable energy, the scope of discussion is extended to alternative technologies such as coal power with carbon capture and sequestration (CCS), electric and hydrogen vehicles. In order to take account of the fact that China's sustainable energy development involves many dimen-sions, a six-dimensional indicator set has been established and applied with the aim of comprehensively evaluating different technology pathways in a uniform way. The ana-lysis reaches the following conclusions: (a) in the power sector, wind power, nuclear power and hydro power should be developed as much as possible, while R&D of solar power and coal power with CCS should be strengthened continuously for future deployment. (b) in the transporta-tion sector, there is no foreseeable silver bullet to replace oil on a large scale within the time frame of 20 to 30 years. To ease the severe energy security situation, expedient choices like coal derived fuels could be developed. However, its scale should be optimized in accordance to the trade-off of energy security benefits, production costs and environmental costs. Desirable alternative fuels (or technologies) like 2nd generation biofuels and electrical vehicles should be the subject of intensive R&D with the objective to be cost effective as early as possible.

  7. Coping Strategies: an alternative to face situations that produce burnout

    Directory of Open Access Journals (Sweden)

    Aparicio, Miriam Teresita


    Full Text Available The objective of this paper is to study Coping Strategies as explanatory variables of Job Burnout, in employees (University graduates vs. non-university graduates working at government offices in Mendoza Argentina. In order to develop a more comprehensive approach to this issue, the methodology used includes quantitative techniques and qualitative techniques. The research entailed a comparative study. The results obtained from the quantitative data, show significant differences between “university” graduates – who use strategies that seem to be closer to action and problem solving; and “non-university” graduates – who use strategies linked to emotion. From an applied point of view, it is expected that the results may generate Ongoing Training Programs focusing on burnout and stress related to the development of positive Coping Strategies.

  8. Development and Assessment of a Diagnostic Tool to Identify Organic Chemistry Students' Alternative Conceptions Related to Acid Strength (United States)

    McClary, LaKeisha M.; Bretz, Stacey Lowery


    The central goal of this study was to create a new diagnostic tool to identify organic chemistry students' alternative conceptions related to acid strength. Twenty years of research on secondary and college students' conceptions about acids and bases has shown that these important concepts are difficult for students to apply to qualitative problem…


    Directory of Open Access Journals (Sweden)

    O. Bajo-Rubio


    Full Text Available High government deficits are a matter of concern in many European countries. We examine the effects of several alternative measures intended to reduce public deficits, distinguishing between those acting through either taxes or spending. Our analysis is applied to the Spanish economy, using a computable general equilibrium model.

  10. The General Equilibrium Impact of Alternative Antipoverty Strategies. (United States)

    Bishop, John H.


    The paper specifies mathematically the demand and supply functions for interacting factor markets to characterize the impact of alternative antipoverty programs. Wage subsidies were found to be the most transfer-efficient, implying that education and training is the most cost-effective means of aiding the low-skilled. (MF)

  11. Unit Pricing and Alternatives: Developing an Individualized Shopping Strategy. (United States)

    Cude, Brenda; Walker, Rosemary


    This article offers a new perspective on the teaching of unit pricing in consumer economics classes by identifying ways to teach the costs as well as the benefits of unit pricing and realistic guidelines for suggesting situations in which it is most appropriate. Alternatives to unit pricing will also be explored. (CT)

  12. [Diagnostic and therapeutic strategy for acyclovir-resistant herpes encephalitis]. (United States)

    Saijo, Masayuki


    Acyclovir (ACV), which inhibits the replication of herpes simplex virus, is the standard drug for the treatment of herpes simplex encephalitis. Thanks to the introduction of ACV, the morbidity and mortality of HSE patients have significantly improved. However, the disease is still the severe infection, because it makes some patients with HSE suffer from severe consequences. The sensitivity test of the etiological HSV to ACV is very difficult due to the inability of isolation of the virus from cerebrospinal fluid (CSF). The cases of the ACV treatment-resistant HSE patients have been reported. However, these cases were not virologically confirmed. The first case of encephalitis in newborn baby with HSE caused by an ACV-resistant HSV-1, which was virologically confirmed, was reported by our group. According to the sensitivity profile of the causative viruses to antiviral drugs, the drugs of choice for HSE should be properly considered. Strategy for diagnoses of HSE including antiviral sensitivity assessment and selection of drugs in HSE is reviewed.

  13. Diagnostic and therapeutic strategy for confounding radiation myelitis. (United States)

    Higashida, Tetsuhiro; Colen, Chaim B; Guthikonda, Murali


    We report a case of confounding radiation myelitis to demonstrate the usefulness of surgical biopsy in ensuring the correct diagnosis and to avoid unnecessary treatment. The patient was a 40-year-old man with a history of epiglottis carcinoma and sarcoidosis. Six months after radiation therapy and chemotherapy for epiglottis carcinoma, he noticed paresthesia and dysesthesia in the left arm and leg. Two months after that, he complained of severe neck pain and rapidly progressing weakness in all extremities. MRI showed an enhanced intramedullary lesion with extensive edema in the cervical spinal cord. Radiation myelitis, intramedullary spinal tumor, and neurosarcoidosis were considered as differential diagnoses. Spinal cord biopsy with laminectomy was performed and radiation myelitis was diagnosed. After the surgery, the lesion was significantly decreased in size even though corticosteroid therapy was rapidly tapered. We emphasize that a spinal cord biopsy is indicated to obtain a pathological diagnosis and to make a clear treatment strategy for patients with associated diseases causing lesions of the spinal cord.

  14. Coevolution of Semiarid Hillslopes in Response to Alternative Management Strategies (United States)

    Saco, Patricia M.; Moreno-de las Heras, Mariano


    We study the coevolution of landforms, vegetation and soils in semiarid areas with sparse vegetation cover composed by mixed herbaceous and woody plant species. The vegetation is subject to competition and facilitation interactions. Shifts in vegetation structure resulting from human pressures and management strategies that alter the hydrologic response of the hillslopes, can have very diverse impacts on ecosystem functioning. We analyse results from a spatial ecogeormorphologic model that simulates the dynamics of runoff redistribution and erosion for hillslopes with patterned vegetation in Australia. We investigate the effects of shrub clearing strategies for plant species with varying competition and facilitation mechanisms, and the implications for the productivity of Australian rangelands.


    Mikhaĭlova, M V; Zubarovskiĭ, I N; Osipenko, S K


    The article is based on the treatment results of 44 patients with follicular tunor of thyroid gland. A staged morphological assessment of thyroid nodes was performed for all patients: in case of preoperative fine-needle biopsy, urgent intraoperative study and according to results of final histological research. The urgent histological study of surgical material was conducted for 44 patients with diagnosis "follicular tumor" according to fine-needle biopsy. The data of final histological study were matched with findings of intraoperative research. A micro-follicular adenoma was detected in 22 patients (50%) and 6 (13,6%) patients had this diagnosis combined with autoimmune thyroiditis. The general part of patients didn't changed in final study, but the rate of diagnosis "micro-follicular adenoma against the background of autoimmune thyroiditis" increased. Papillary carcinoma was revealed in 5 (11,4%) patients and follicular cancer had 4 (9,1%) patients detected in intraoperative study and 3 (6,8%) more patients according to data of final research. The histopathologic feature of colloid goiter was observed in 7 (15,9%) cases and a part of such patients reduced to 6,8% during final study. One of the patients (2,3%) had final diagnosis "oncocytoma". In case of thyroid nodules detection the needle biopsy should be carried out regardless to the size of nodule. The authors recommended performing the surgery with the urgent histological study in case of undetermined histological report. The following surgical strategy was specified by the results of the urgent histological report.

  16. Withdrawing from Iraq: Alternative Schedules, Associated Risks, and Mitigating Strategies (United States)


    Iraq and the mainte- nance of stability. There is no guarantee that Iran would cooperate, although it might do so if it believes it would gain influence...Shahery, Martha Dunigan, Keith Gierlack, Todd C. Helmus, Renny McPherson, and Olga Oliker. 52 Withdrawing from Iraq: Alternative Schedules, Associated...letter to the MNF-I, February 27, 2009a. ———, interview with ABC reporter Martha Raddatz, Baghdad, March 10, 2009b. The Office of the UN High Commissioner

  17. Improving diagnostic strategies for predicting serious bacterial infections in children with fever

    NARCIS (Netherlands)

    R.G. Nijman (Ruud)


    textabstractThis thesis aimed to improve diagnostic strategies for predicting SBI in febrile children in emergency care settings. Generally, clinical signs and symptoms were of limited use in detecting SBI, even when using modelling techniques that best reflected their predictive ability. C-reactive

  18. Selecting alternative strategies for community health education in guineaworm control. (United States)

    Brieger, W R; Ramakrishna, J; Akpovi, S U; Adeniyi, J D


    Community health education strategies in guineaworm control can be applied at several intervention levels. Community development mobilizes local resources to provide safe water supplies such as wells. Mass education in schools and communities can teach personal protection measures such as filtering water. Training of volunteer community health workers produces front line staff, who by being culturally in tune with the community can demonstrate and promote the use of appropriate prevention and treatment measures. Advocacy assists community members to express their needs to government and ministry decision makers. All of these strategies have been applied in a community health education/primary health care program in Idere, Ibarapa District, Oyo State. Community development for well construction was found to be a long-term strategy that first must overcome problems of village organization and resource location. Mass education, to be effective, must have a simple and acceptable technology to promote. Trained village health workers must overcome traditional beliefs that inhibit use of preventive and treatment measures. Advocacy requires basic political education of community leaders. A variety of health education strategies is needed to address short- and long-term priorities as well as to overcome the different barriers to guineaworm control.

  19. Alternative Schooling Strategies and the Religious Lives of American Adolescents. (United States)

    Uecker, Jeremy E


    I analyze the effects of Catholic schooling, Protestant schooling, and homeschooling on adolescents' religious lives and test three mechanisms through which these schooling strategies might influence religiosity: friendship networks, network closure, and adult mentors. Data from Wave 1 of the National Survey of Youth and Religion suggest that Catholic schoolers attend religious services more frequently and value their faith more highly than public schoolers, but attend religious education classes and youth group less often. Protestant schoolers' involvement in their local congregation is similar to public schoolers', but their faith plays a more salient role in their life and they are more active in private religious activities. Homeschoolers do not differ significantly from public schoolers on any outcome considered. Moreover, friendship networks, network closure, and adult mentors play a very limited role in mediating the relationships between schooling strategies and adolescent religiosity. Interpretations of these findings are presented and discussed.

  20. Alternative Schooling Strategies and the Religious Lives of American Adolescents (United States)

    Uecker, Jeremy E.


    I analyze the effects of Catholic schooling, Protestant schooling, and homeschooling on adolescents’ religious lives and test three mechanisms through which these schooling strategies might influence religiosity: friendship networks, network closure, and adult mentors. Data from Wave 1 of the National Survey of Youth and Religion suggest that Catholic schoolers attend religious services more frequently and value their faith more highly than public schoolers, but attend religious education classes and youth group less often. Protestant schoolers’ involvement in their local congregation is similar to public schoolers’, but their faith plays a more salient role in their life and they are more active in private religious activities. Homeschoolers do not differ significantly from public schoolers on any outcome considered. Moreover, friendship networks, network closure, and adult mentors play a very limited role in mediating the relationships between schooling strategies and adolescent religiosity. Interpretations of these findings are presented and discussed. PMID:21709822

  1. Alternative Schooling Strategies and the Religious Lives of American Adolescents


    Uecker, Jeremy E.


    I analyze the effects of Catholic schooling, Protestant schooling, and homeschooling on adolescents’ religious lives and test three mechanisms through which these schooling strategies might influence religiosity: friendship networks, network closure, and adult mentors. Data from Wave 1 of the National Survey of Youth and Religion suggest that Catholic schoolers attend religious services more frequently and value their faith more highly than public schoolers, but attend religious education cla...

  2. Sustainable consumption: from escape strategies towards real alternatives


    Csutora, Mária; Mózner, Zsófia; Tabi, Andrea


    Better sustainability policy is supposed to lead to better sustainability performance. Nonetheless, recent research predicts further growth of the ecological footprint and stable ecological deficit in Europe and North America despite their impressive policy efforts (Lenzen et al. 2007) [1]. Similarly, individual strategies result in somewhat reduced load for committed consumers, but this reduction cannot offset the total impact of the socio-economic configuration: consumers in higher income c...

  3. Cost-Effectiveness of Different Diagnostic Strategies in Suspected Stable Coronary Artery Disease in Portugal

    Energy Technology Data Exchange (ETDEWEB)

    Ferreira, António Miguel, E-mail: [Hospital da Luz, Lisboa (Portugal); Hospital Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisboa (Portugal); Marques, Hugo [Hospital da Luz, Lisboa (Portugal); Hospital Santa Marta - Centro Hospitalar de Lisboa Central, Lisboa (Portugal); Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa (Portugal); Gonçalves, Pedro Araújo [Hospital da Luz, Lisboa (Portugal); Hospital Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Lisboa (Portugal); Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa (Portugal); Cardim, Nuno [Hospital da Luz, Lisboa (Portugal); Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa (Portugal)


    Cost-effectiveness is an increasingly important factor in the choice of a test or therapy. To assess the cost-effectiveness of various methods routinely used for the diagnosis of stable coronary disease in Portugal. Seven diagnostic strategies were assessed. The cost-effectiveness of each strategy was defined as the cost per correct diagnosis (inclusion or exclusion of obstructive coronary artery disease) in a symptomatic patient. The cost and effectiveness of each method were assessed using Bayesian inference and decision-making tree analyses, with the pretest likelihood of disease ranging from 10% to 90%. The cost-effectiveness of diagnostic strategies was strongly dependent on the pretest likelihood of disease. In patients with a pretest likelihood of disease of ≤50%, the diagnostic algorithms, which include cardiac computed tomography angiography, were the most cost-effective. In these patients, depending on the pretest likelihood of disease and the willingness to pay for an additional correct diagnosis, computed tomography angiography may be used as a frontline test or reserved for patients with positive/inconclusive ergometric test results or a calcium score of >0. In patients with a pretest likelihood of disease of ≥ 60%, up-front invasive coronary angiography appears to be the most cost-effective strategy. Diagnostic algorithms that include cardiac computed tomography angiography are the most cost-effective in symptomatic patients with suspected stable coronary artery disease and a pretest likelihood of disease of ≤50%. In high-risk patients (pretest likelihood of disease ≥ 60%), up-front invasive coronary angiography appears to be the most cost-effective strategy. In all pretest likelihoods of disease, strategies based on ischemia appear to be more expensive and less effective compared with those based on anatomical tests.

  4. Evaluating Alternative Strategies for Investments in Freshwater Conservation (United States)

    Cheruvelil, K. S.; Kramer, D. B.; Zhang, T.; Ligmann-Zielinska, A.; Soranno, P.; Bremigan, M. T.


    Efforts towards systematic conservation planning for freshwaters have progressed far less than similar efforts in the terrestrial and marine environments. Although there are differences in the coupled human and natural systems that distinguish freshwater, terrestrial, and marine environments, many of the tools that have been used in terrestrial and marine systems can also be used for conservation planning for freshwater resources. In this paper, we used one such tool, return on investment (ROI), to identify optimal conservation portfolios. Our overarching research question is: how do different strategies for evaluating ROI benefits influence the resulting portfolio and the outcome of interest - in our case, water quality? Specifically, we examined investments to convert farmed agricultural land to fallow land to improve water quality in 55 inland lakes in southwestern Michigan. We simulated investments and compared the ROIs for the following strategies: 1) economic; 2) ecological; 3) environmental policy and 4) agricultural policy. We also tested the well-established assumption that riparian lands, those abutting and within 30 m of freshwater shorelines, have the greatest potential to influence water quality. We found that 1) investments in freshwater resources through the conservation of riparian land are more effective than the conservation of randomly selected parcels of similar land area in the catchment; 2) the costs and benefits of riparian land conservation vary considerably among lakes; 3) the choice of investment strategies results in very different conservation portfolios; 4) the resulting conservation portfolios have very different distributional and policy implications. These analyses and results provide a foundation on which to improve systematic conservation planning for freshwaters.

  5. Histone deacetylase inhibition as an alternative strategy against invasive aspergillosis

    Directory of Open Access Journals (Sweden)

    Frederic eLamoth


    Full Text Available Invasive aspergillosis (IA is a life-threatening infection due to Aspergillus fumigatus and other Aspergillus spp. Drugs targeting the fungal cell membrane (triazoles, amphotericin B or cell wall (echinocandins are currently the sole therapeutic options against IA. Their limited efficacy and the emergence of resistance warrant the identification of new antifungal targets. Histone deacetylases (HDACs are enzymes responsible of the deacetylation of lysine residues of core histones, thus controlling chromatin remodeling and transcriptional activation. HDACs also control the acetylation and activation status of multiple non-histone proteins, including the heat shock protein 90 (Hsp90, an essential molecular chaperone for fungal virulence and antifungal resistance. This review provides an overview of the different HDACs in Aspergillus spp. as well as their respective contribution to total HDAC activity, fungal growth, stress responses, and virulence. The potential of HDAC inhibitors, currently under development for cancer therapy, as novel alternative antifungal agents against IA is discussed.

  6. Assessing the impact of next-generation rapid diagnostic tests on Plasmodium falciparum malaria elimination strategies. (United States)

    Slater, Hannah C; Ross, Amanda; Ouédraogo, André Lin; White, Lisa J; Nguon, Chea; Walker, Patrick G T; Ngor, Pengby; Aguas, Ricardo; Silal, Sheetal P; Dondorp, Arjen M; La Barre, Paul; Burton, Robert; Sauerwein, Robert W; Drakeley, Chris; Smith, Thomas A; Bousema, Teun; Ghani, Azra C


    Mass-screen-and-treat and targeted mass-drug-administration strategies are being considered as a means to interrupt transmission of Plasmodium falciparum malaria. However, the effectiveness of such strategies will depend on the extent to which current and future diagnostics are able to detect those individuals who are infectious to mosquitoes. We estimate the relationship between parasite density and onward infectivity using sensitive quantitative parasite diagnostics and mosquito feeding assays from Burkina Faso. We find that a diagnostic with a lower detection limit of 200 parasites per microlitre would detect 55% of the infectious reservoir (the combined infectivity to mosquitoes of the whole population weighted by how often each individual is bitten) whereas a test with a limit of 20 parasites per microlitre would detect 83% and 2 parasites per microlitre would detect 95% of the infectious reservoir. Using mathematical models, we show that increasing the diagnostic sensitivity from 200 parasites per microlitre (equivalent to microscopy or current rapid diagnostic tests) to 2 parasites per microlitre would increase the number of regions where transmission could be interrupted with a mass-screen-and-treat programme from an entomological inoculation rate below 1 to one of up to 4. The higher sensitivity diagnostic could reduce the number of treatment rounds required to interrupt transmission in areas of lower prevalence. We predict that mass-screen-and-treat with a highly sensitive diagnostic is less effective than mass drug administration owing to the prophylactic protection provided to uninfected individuals by the latter approach. In low-transmission settings such as those in Southeast Asia, we find that a diagnostic tool with a sensitivity of 20 parasites per microlitre may be sufficient for targeted mass drug administration because this diagnostic is predicted to identify a similar village population prevalence compared with that currently detected using

  7. Identifying strategy use in category learning tasks: a case for more diagnostic data and models. (United States)

    Donkin, Chris; Newell, Ben R; Kalish, Mike; Dunn, John C; Nosofsky, Robert M


    The strength of conclusions about the adoption of different categorization strategies-and their implications for theories about the cognitive and neural bases of category learning-depend heavily on the techniques for identifying strategy use. We examine performance in an often-used "information-integration" category structure and demonstrate that strategy identification is affected markedly by the range of models under consideration, the type of data collected, and model-selection techniques. We use a set of 27 potential models that represent alternative rule-based and information-integration categorization strategies. Our experimental paradigm includes the presentation of nonreinforced transfer stimuli that improve one's ability to discriminate among the predictions of alternative models. Our model-selection techniques incorporate uncertainty in the identification of individuals as either rule-based or information-integration strategy users. Based on this analysis we identify 48% of participants as unequivocally using an information-integration strategy. However, adopting the standard practice of using a restricted set of models, restricted data, and ignoring the degree of support for a particular strategy, we would typically conclude that 89% of participants used an information-integration strategy. We discuss the implications of potentially erroneous strategy identification for the security of conclusions about the categorization capabilities of various participant and patient groups.

  8. Testing and assessment strategies, including alternative and new approaches

    DEFF Research Database (Denmark)

    Meyer, Otto A.


    The object of toxicological testing is to predict possible adverse effect in humans when exposed to chemicals whether used as industrial chemicals, pharmaceuticals or pesticides. Animal models are predominantly used in identifying potential hazards of chemicals. The use of laboratory animals raises...... ethical concern. However, irrespective of animal welfare it is an important aspect of the discipline of toxicology that the primary object is human health. The ideal testing and assessment strategy is simple to use all the available test methods and preferably more in laboratory animal species from which...... we get as many data as possible in order to obtain the most extensive database for the toxicological evaluation of a chemical. Consequently, the society has decided that certain group of chemicals should be tested accordingly. However, realising that, this idea is not obtainable in practice because...

  9. Alternative Strategy for Alzheimer’s Disease: Stress Response Triggers

    Directory of Open Access Journals (Sweden)

    Joan Smith Sonneborn


    Full Text Available Stress resistance capacity is a hallmark of longevity protection and survival throughout the plant and animal kingdoms. Latent pathway activation of protective cascades, triggered by environmental challenges to tolerate heat, oxygen deprivation, reactive oxygen species (ROS, diet restriction, and exercise provides tolerance to these stresses. Age-related changes and disease vulnerability mark an increase in damage, like damage induced by environmental challenges. An alternative approach to immunotherapy intervention in Alzheimer’s Disease is the use of mimetics of stress to upregulate endogenous protective cascades to repair age damage, shift the balance of apoptosis to regeneration to promote delay of onset, and even progression of Alzheimer’s disease memory dysfunction. Mimetics of environmental stress, hormetic agents, and triggers, endogenous or engineered, can “trick” activation of expression patterns of repair and rejuvenation. Examples of known candidate triggers of heat response, endogenous antioxidants, DNA repair, exercise, hibernation, and telomeres are available for AD intervention trials. Telomeres and telomerase emerge as major regulators in crossroads of senescence, cancer, and rejuvenation responsive to mimetics of telomeres. Lessons emerge from transgenic rodent models, the long-lived mole rat, clinical studies, and conserved innate pathways of stress resistance. Cross-reaction of benefits of different triggers promises intervention into seemingly otherwise unrelated diseases.

  10. An alternative strategy to teach biomechanics: The long jump

    Energy Technology Data Exchange (ETDEWEB)

    Vega, G J de la [School of Exactly, Physical and Naturals Science. I de la Roza 590 (Oeste). CP 5413. San Juan (Argentina); Aguilera, J A [School of Exactly, Physical and Naturals Science. I de la Roza 590 (Oeste). CP 5413. San Juan (Argentina); Puzzella, A E [School of Exactly, Physical and Naturals Science. I de la Roza 590 (Oeste). CP 5413. San Juan (Argentina); Mallamaci, C C [School of Exactly, Physical and Naturals Science. I de la Roza 590 (Oeste). CP 5413. San Juan (Argentina)


    The work develops an alternative methodology to teach the Physics principles of Parabolic Cannon Shot in the career of Bioengineering using instead the physic-biological relationship of the long jump performed in Athletics. This is a closer-to-reality example for this discipline, and it is a field- and computer laboratory-reproducible practice that is simple to do by using affordable technology, because the practice can be filmed by the students in a real setting for future analysis off classroom hours. The data extracted from the film can be analysed and used to learn the physics of motion of the participating athletes, and to draw conclusions from their hands-on experience. As a main factor of the proposal, this latter characteristic aims at motivating the students to work and participate within a collaborative framework, so as to motivate them to reason and respond the questionnaire issues that stems from a real experience. A significant improvement of knowledge transference is thus attained by promoting teaching (and self-teaching) through reality-based perception, analysis and learning). This work is undergoing its first stage, and its conclusions arise from the observations on team-work dynamics. Quantitative results are expected for the following stages which are under way of execution.

  11. Bacteriophages as an alternative strategy for fighting biofilm development. (United States)

    Parasion, Sylwia; Kwiatek, Magdalena; Gryko, Romuald; Mizak, Lidia; Malm, Anna


    The ability of microbes to form biofilms is an important element of their pathogenicity, and biofilm formation is a serious challenge for today's medicine. Fighting the clinical complications associated with biofilm formation is very difficult and linked to a high risk of failure, especially in a time of increasing bacterial resistance to antibiotics. Bacterial species most commonly isolated from biofilms include coagulase-negative staphylococci, Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium, Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter spp. The frequent failure of antibiotic therapy led researchers to look for alternative methods and experiment with the use of antibacterial factors with a mechanism of action different from that of antibiotics. Experimental studies with bacteriophages and mixtures thereof, expressing lytic properties against numerous biofilm-forming bacterial species showed that bacteriophages may both prevent biofilm formation and contribute to eradication of biofilm bacteria. A specific role is played here by phage depolymerases, which facilitate the degradation of extracellular polymeric substances (EPS) and thus the permeation of bacteriophages into deeper biofilm layers and lysis of the susceptible bacterial cells. Much hope is placed in genetic modifications of bacteriophages that would allow the equipping bacteriophages with the function of depolymerase synthesis. The use of phage cocktails prevents the development of phage-resistant bacteria.

  12. An alternative strategy to teach biomechanics: The long jump (United States)

    de la Vega, G. J.; Aguilera, J. A.; Puzzella, A. E.; Mallamaci, C. C.


    The work develops an alternative methodology to teach the Physics principles of Parabolic Cannon Shot in the career of Bioengineering using instead the physic-biological relationship of the long jump performed in Athletics. This is a closer-to-reality example for this discipline, and it is a field- and computer laboratory-reproducible practice that is simple to do by using affordable technology, because the practice can be filmed by the students in a real setting for future analysis off classroom hours. The data extracted from the film can be analysed and used to learn the physics of motion of the participating athletes, and to draw conclusions from their hands-on experience. As a main factor of the proposal, this latter characteristic aims at motivating the students to work and participate within a collaborative framework, so as to motivate them to reason and respond the questionnaire issues that stems from a real experience. A significant improvement of knowledge transference is thus attained by promoting teaching (and self-teaching) through reality-based perception, analysis and learning). This work is undergoing its first stage, and its conclusions arise from the observations on team-work dynamics. Quantitative results are expected for the following stages which are under way of execution.

  13. Alternative Testing Strategies for Nanomaterials: State of the Science and Considerations for Risk Analysis. (United States)

    Shatkin, J A; Ong, K J


    The rapid growth of the nanotechnology industry has warranted equal progress in the nanotoxicology and risk assessment fields. In vivo models have traditionally been used to determine human and environmental risk for chemicals; however, the use of these tests has limitations, and there are global appeals to develop reliable alternatives to animal testing. Many have investigated the use of alternative (nonanimal) testing methods and strategies have quickly developed and resulted in the generation of large toxicological data sets for numerous nanomaterials (NMs). Due to the novel physicochemical properties of NMs that are related to surface characteristics, the approach toward toxicity test development has distinct considerations from traditional chemicals, bringing new requirements for adapting these approaches for NMs. The methodical development of strategies that combine multiple alternative tests can be useful for predictive NM risk assessment and help screening-level decision making. This article provides an overview of the main developments in alternative methods and strategies for reducing uncertainty in NM risk assessment, including advantages and disadvantages of in vitro, ex vivo, and in silico methods, and examples of existing comprehensive strategies. In addition, knowledge gaps are identified toward improvements for experimental and strategy design, specifically highlighting the need to represent realistic exposure scenarios and to consider NM-specific concerns such as characterization, assay interferences, and standardization. Overall, this article aims to improve the reliability and utility of alternative testing methods and strategies for risk assessment of manufactured NMs.

  14. WRAP Module 1 sampling strategy and waste characterization alternatives study

    Energy Technology Data Exchange (ETDEWEB)

    Bergeson, C.L.


    The Waste Receiving and Processing Module 1 Facility is designed to examine, process, certify, and ship drums and boxes of solid wastes that have a surface dose equivalent of less than 200 mrem/h. These wastes will include low-level and transuranic wastes that are retrievably stored in the 200 Area burial grounds and facilities in addition to newly generated wastes. Certification of retrievably stored wastes processing in WRAP 1 is required to meet the waste acceptance criteria for onsite treatment and disposal of low-level waste and mixed low-level waste and the Waste Isolation Pilot Plant Waste Acceptance Criteria for the disposal of TRU waste. In addition, these wastes will need to be certified for packaging in TRUPACT-II shipping containers. Characterization of the retrievably stored waste is needed to support the certification process. Characterization data will be obtained from historical records, process knowledge, nondestructive examination nondestructive assay, visual inspection of the waste, head-gas sampling, and analysis of samples taken from the waste containers. Sample characterization refers to the method or methods that are used to test waste samples for specific analytes. The focus of this study is the sample characterization needed to accurately identify the hazardous and radioactive constituents present in the retrieved wastes that will be processed in WRAP 1. In addition, some sampling and characterization will be required to support NDA calculations and to provide an over-check for the characterization of newly generated wastes. This study results in the baseline definition of WRAP 1 sampling and analysis requirements and identifies alternative methods to meet these requirements in an efficient and economical manner.

  15. A field trial of alternative targeted screening strategies for Chagas disease in Arequipa, Peru.

    Directory of Open Access Journals (Sweden)

    Gabrielle C Hunter


    Full Text Available BACKGROUND: Chagas disease is endemic in the rural areas of southern Peru and a growing urban problem in the regional capital of Arequipa, population ∼860,000. It is unclear how to implement cost-effective screening programs across a large urban and periurban environment. METHODS: We compared four alternative screening strategies in 18 periurban communities, testing individuals in houses with 1 infected vectors; 2 high vector densities; 3 low vector densities; and 4 no vectors. Vector data were obtained from routine Ministry of Health insecticide application campaigns. We performed ring case detection (radius of 15 m around seropositive individuals, and collected data on costs of implementation for each strategy. RESULTS: Infection was detected in 21 of 923 (2.28% participants. Cases had lived more time on average in rural places than non-cases (7.20 years versus 3.31 years, respectively. Significant risk factors on univariate logistic regression for infection were age (OR 1.02; p = 0.041, time lived in a rural location (OR 1.04; p = 0.022, and time lived in an infested area (OR 1.04; p = 0.008. No multivariate model with these variables fit the data better than a simple model including only the time lived in an area with triatomine bugs. There was no significant difference in prevalence across the screening strategies; however a self-assessment of disease risk may have biased participation, inflating prevalence among residents of houses where no infestation was detected. Testing houses with infected-vectors was least expensive. Ring case detection yielded four secondary cases in only one community, possibly due to vector-borne transmission in this community, apparently absent in the others. CONCLUSIONS: Targeted screening for urban Chagas disease is promising in areas with ongoing vector-borne transmission; however, these pockets of epidemic transmission remain difficult to detect a priori. The flexibility to adapt to the

  16. Alternative adaptive immunity strategies: coelacanth, cod and shark immunity. (United States)

    Buonocore, Francesco; Gerdol, Marco


    The advent of high throughput sequencing has permitted to investigate the genome and the transcriptome of novel non-model species with unprecedented depth. This technological advance provided a better understanding of the evolution of adaptive immune genes in gnathostomes, revealing several unexpected features in different fish species which are of particular interest. In the present paper, we review the current understanding of the adaptive immune system of the coelacanth, the elephant shark and the Atlantic cod. The study of coelacanth, the only living extant of the long thought to be extinct Sarcopterygian lineage, is fundamental to bring new insights on the evolution of the immune system in higher vertebrates. Surprisingly, coelacanths are the only known jawed vertebrates to lack IgM, whereas two IgD/W loci are present. Cartilaginous fish are of great interest due to their basal position in the vertebrate tree of life; the genome of the elephant shark revealed the lack of several important immune genes related to T cell functions, which suggest the existence of a primordial set of TH1-like cells. Finally, the Atlantic cod lacks a functional major histocompatibility II complex, but balances this evolutionary loss with the expansion of specific gene families, including MHC I, Toll-like receptors and antimicrobial peptides. Overall, these data point out that several fish species present an unconventional adaptive immune system, but the loss of important immune genes is balanced by adaptive evolutionary strategies which still guarantee the establishment of an efficient immune response against the pathogens they have to fight during their life.

  17. Central Vestibular Dysfunction in an Otorhinolaryngological Vestibular Unit: Incidence and Diagnostic Strategy



    Introduction  Vertigo can be due to a variety of central and peripheral causes. The relative incidence of central causes is underestimated. This may have an important impact of the patients' management and prognosis. Objective  The objective of this work is to determine the incidence of central vestibular disorders in patients presenting to a vestibular unit in a tertiary referral academic center. It also aims at determining the best strategy to increase the diagnostic yield of th...

  18. Application of the Systematic Sensor Selection Strategy for Turbofan Engine Diagnostics (United States)

    Sowers, T. Shane; Kopasakis, George; Simon, Donald L.


    The data acquired from available system sensors forms the foundation upon which any health management system is based, and the available sensor suite directly impacts the overall diagnostic performance that can be achieved. While additional sensors may provide improved fault diagnostic performance, there are other factors that also need to be considered such as instrumentation cost, weight, and reliability. A systematic sensor selection approach is desired to perform sensor selection from a holistic system-level perspective as opposed to performing decisions in an ad hoc or heuristic fashion. The Systematic Sensor Selection Strategy is a methodology that optimally selects a sensor suite from a pool of sensors based on the system fault diagnostic approach, with the ability of taking cost, weight, and reliability into consideration. This procedure was applied to a large commercial turbofan engine simulation. In this initial study, sensor suites tailored for improved diagnostic performance are constructed from a prescribed collection of candidate sensors. The diagnostic performance of the best performing sensor suites in terms of fault detection and identification are demonstrated, with a discussion of the results and implications for future research.

  19. Problem-solving strategies in psychiatry: differences between experts and novices in diagnostic accuracy and reasoning

    Directory of Open Access Journals (Sweden)

    Gabriel A


    Full Text Available Adel Gabriel,1,2 Claudio Violato21Departments of Psychiatry, University of Calgary, Calgary; 2Medical Education, Community Health Sciences, University of Calgary Calgary, CanadaBackground: The purpose of this study was to examine and compare diagnostic success and its relationship with the diagnostic reasoning process between novices and experts in psychiatry.Methods: Nine volunteers, comprising five expert psychiatrists and four clinical clerks, completed a think-aloud protocol while attempting to make a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of a selected case with both Axis I and Axis III diagnoses.Results: Expert psychiatrists made significantly more successful diagnoses for both the primary psychiatric and medical diagnoses than clinical clerks. Expert psychiatrists also gave fewer differential options. Analyzing the think-aloud protocols, expert psychiatrists were much more organized, made fewer mistakes, and utilized significantly less time to access their knowledge than clinical clerks. Both novices and experts seemed to use the hypothetic-deductive and scheme-inductive approaches to diagnosis. However, experts utilized hypothetic-deductive approaches significantly more often than novices.Conclusion: The hypothetic-deductive diagnostic strategy was utilized more than the scheme-inductive approach by both expert psychiatrists and clinical clerks. However, a specific relationship between diagnostic reasoning and diagnostic success could not be identified in this small pilot study. The author recommends a larger study that would include a detailed analysis of the think-aloud protocols.Keywords: diagnostic reasoning, knowledge structure, psychiatric diagnosis, hypothetic-deductive, scheme-inductive

  20. Child immunization coverage in rural hard-to-reach Haor areas of Bangladesh: possible alternative strategies. (United States)

    Uddin, Md Jasim; Larson, Charles P; Oliveras, Elizabeth; Khan, Azharul Islam; Quaiyum, Md Abdul; Chandra Saha, Nirod


    This article assessed the status of childhood vaccination coverage and the possibility of using selected alternative vaccination strategies in rural hard-to-reach haor (low lying) areas of Bangladesh. Data were collected through survey, in-depth interviews, group discussion, and observations of vaccination sessions. Complete immunization coverage among 12- to 23-month-old children was found to be significantly lower in study areas when compared with the national coverage levels. The study identified reasons for low complete immunization coverage in hard-to-reach areas, including irregular/cancelled extended program on immunization (EPI) sessions, less time spent in EPI spots by field staff, and absence of any alternative strategy for remote areas. The findings indicated that the existing service delivery strategy is not sufficient to improve immunization coverage in hard-to-reach areas. However, most of the strategies assessed are considered possible to implement by health care providers in hard-to-reach areas. The study suggested that before implementing alternative strategies in hard-to-reach areas, feasibility and effectiveness of the possible strategies need to be tested to identify evidence-based strategies.

  1. Application of Quality Assurance Strategies in Diagnostics and Clinical Support Services in Iranian Hospitals

    Directory of Open Access Journals (Sweden)

    Asgar Aghaei Hashjin


    Full Text Available Background Iran has a widespread diagnostics and clinical support services (DCSS network that plays a crucial role in providing diagnostic and clinical support services to both inpatient and outpatient care. However, very little is known on the application of quality assurance (QA policies in DCSS units. This study explores the extent of application of eleven QA strategies in DCSS units within Iranian hospitals and its association with hospital characteristics. Methods A descriptive cross-sectional study was conducted in 2009/2010. Data were collected from 554 DCSS units among 84 hospitals. Results The average reported application rate for the QA strategies ranged from 57%-94% in the DCSS units. Most frequently reported were checking drugs expiration dates (94%, pharmacopoeia availability (92%, equipment calibration (87% and identifying responsibilities (86%. Least reported was external auditing of the DCSS (57%. The clinical chemistry and microbiology laboratories (84%, pharmacies, blood bank services (83% reported highest average application rates across all questioned QA strategies. Lowest application rates were reported in human tissue banks (50%. There was no significant difference between the reported application rates in DCSS in the general/specialized, teaching/research, nonteaching/research hospitals with the exception of pharmacies and radiology departments. They reported availability of a written QA plan significantly more often in research hospitals. Nearly all QA strategies were reported to be applied significantly more often in the DCSS of Social Security Organization (SSO and private-for-profit hospitals than in governmental hospitals. Conclusion There is still room for strengthening the managerial cycle of QA systems and accountability in the DCSS in Iranian hospitals. Getting feedback, change and learning through application of specific QA strategies (eg, external/internal audits can be improved. Both the effectiveness of QA

  2. An analysis of strategies used by chemistry instructors to address student alternate conceptions in chemical equilibrium (United States)

    Piquette, Jeff Stephen

    This study explored general-chemistry instructors' awareness of and ability to identify common student alternate conceptions in chemical equilibrium. Instructor strategies directed at remediation of student alternate conceptions were also investigated and compared to successful, literature-based conceptual change methods. Fifty-two general chemistry instructor volunteers from 50 U.S. colleges and universities completed an interactive web-based survey that gathered their responses to open-ended questions, a rating scale, classroom scenarios, and a demographic form. The three scenarios asked respondents to evaluate hypothetical student exam answers, justify their evaluations, and report how they would assist students to better understand ideas about which they held alternate conceptions. Survey respondents who provided responses or remediation strategies that needed further clarification were sampled (n = 6); each amplified their views in an individual, researcher-led semi-structured phone interview. All survey responses and interview transcriptions were independently analyzed by three raters who followed Patton's (1990) guidelines for qualitative data analysis. Data analysis established that all 52 instructors of chemistry were able to report and identify common student alternate conceptions in chemical equilibrium. Those instructor-reported alternate conceptions were congruent with previously identified alternate conceptions (misconceptions) found in published literature, thus providing validation support for the earlier compilations. This study revealed that chemistry instructors employ a variety of strategies in efforts to address and remediate alternate conceptions. However, those strategies rarely include all four conditions outlined by Posner, Strike, Hewson, and Gertzog (1982) needed to stimulate conceptual change in students. Instructors are thus encouraged to become familiar with successful conceptual change strategies, using such methods as appropriate in

  3. The Assessment of the Colo-rectal Polyps in Order to the New Diagnostic and Therapeutic Strategies

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    Raluca Diac Andreea


    Full Text Available Objective. Assessment of the histological and endoscopic features of the colo-rectal polyps is requered for the application of the new diagnostic and therapeutical strategies in the managment of the diminutive polyps.

  4. A Current Review of the Diagnostic and Treatment Strategies of Hepatic Encephalopathy

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    Z. Poh


    Full Text Available Hepatic encephalopathy (HE is a serious and potentially fatal complication in patients with cirrhotic liver disease. It is a spectrum ranging from minimal hepatic encephalopathy (MHE without recognizable clinical symptoms or signs, to overt HE with risk of cerebral edema and death. HE results in diminished quality of life and survival. The broad range of neuropsychiatric manifestations reflects the range of pathophysiological mechanisms and impairment in neurotransmission that are purported to cause HE including hyperammonemia, astrocyte swelling, intra-astrocytic glutamine, upregulation of 18-kDa translocator protein (TSPO (formerly known as peripheral benzodiazepine receptor or PBTR, and manganese. There is a myriad of diagnostic tools including simple bedside clinical assessment, and more complex neuropsychological batteries and neurophysiological tests available today. Current treatment strategies are directed at reducing ammonia, with newer agents showing some early promise. This paper describes the pathophysiology of the disease and summarises current diagnostic and treatment therapies available.

  5. Thrombocytosis: Diagnostic Evaluation, Thrombotic Risk Stratification, and Risk-Based Management Strategies

    Directory of Open Access Journals (Sweden)

    Jonathan S. Bleeker


    Full Text Available Thrombocytosis is a commonly encountered clinical scenario, with a large proportion of cases discovered incidentally. The differential diagnosis for thrombocytosis is broad and the diagnostic process can be challenging. Thrombocytosis can be spurious, attributed to a reactive process or due to clonal disorder. This distinction is important as it carries implications for evaluation, prognosis, and treatment. Clonal thrombocytosis associated with the myeloproliferative neoplasms, especially essential thrombocythemia and polycythemia vera, carries a unique prognostic profile, with a markedly increased risk of thrombosis. This risk is the driving factor behind treatment strategies in these disorders. Clinical trials utilizing targeted therapies in thrombocytosis are ongoing with new therapeutic targets waiting to be explored. This paper will outline the mechanisms underlying thrombocytosis, the diagnostic evaluation of thrombocytosis, complications of thrombocytosis with a special focus on thrombotic risk as well as treatment options for clonal processes leading to thrombocytosis, including essential thrombocythemia and polycythemia vera.

  6. Editor's Perspective Article: Alternative Certification Teachers--Strategies for the Transition to a New Career (United States)

    Evans, Brian R.


    New teachers who are prepared to teach through alternative certification pathways may find the transition to a new career stressful and tumultuous. There are techniques that can be used to help make the transition easier on new teachers as they begin their new careers. This article explores several strategies for new teachers, which include…

  7. Improved AFEM algorithm for bioluminescence tomography based on dual-mesh alternation strategy

    Institute of Scientific and Technical Information of China (English)

    Wei Li; Heng Zhao; Xiaochao Qu; Yanbin Hou; Xueli Chen; Duofang Chen; Xiaowei He; Qitan Zhang; Jimin Liang


    Adaptive finite element method (AFEM) is broadly adopted to recover the internal source in biological tissues.In this letter,a novel dual-mesh alternation strategy (dual-mesh AFEM) is developed for bioluminescence tomography.By comprehensively considering the error estimation of the finite element method solution on each mesh,two different adaptive strategies based on the error indicator of the reconstructed source and the photon flux density are used alternately in the process.Combined with the constantly adjusted permissible region in the adaptive process,the new algorithm can achieve a more accurate source location compared with the AFEM in the previous experiments.%Adaptive finite element method (AFEM) is broadly adopted to recover the internal source in biological tissues. In this letter, a novel dual-mesh alternation strategy (dual-mesh AFEM) is developed for biolumi-nescence tomography. By comprehensively considering the error estimation of the finite element method solution on each mesh, two different adaptive strategies based on the error indicator of the reconstructed source and the photon flux density are used alternately in the process. Combined with the constantly adjusted permissible region in the adaptive process, the new algorithm can achieve a more accurate source location compared with the AFEM in the previous experiments.

  8. Testing Alternative Assessment Strategies-the Ups and the Downs for Science-Teaching Faculty. (United States)

    Moscovici, Hedy; Gilmer, Penny J.


    Outlines the different alternative assessment strategies used by different biology instructors at Florida State University, each teaching a section of a new biology course for prospective elementary and early childhood teachers. Provides suggestions for similar relatively small classes as well as for large college classes. (JRH)

  9. Training Pragmatic Language Skills through Alternate Strategies with a Blind Multiply Handicapped Child. (United States)

    Evans, C. J.; Johnson, C. J.


    A blind multiply handicapped preschooler was taught to respond appropriately to two adjacency pair types ("where question-answer" and "comment-acknowledgement"). The two alternative language acquisition strategies available to blind children were encouraged: echolalia to maintain communicative interactions and manual searching…

  10. Alternative strategies to improve the beneficial effects of exercise throughout life : dietary and physiological aspects

    NARCIS (Netherlands)

    R.T. Mankowski (Robert Tomasz)


    markdownabstractAbstract It is certain that the aging process leads to death, but decreasing the levels of pathology throughout life improves the quality of life and extends life span. Therefore, this dissertation focuses on alternative strategies that may contribute to improving the aging process

  11. The War on Drugs and Correctional Warehousing: Alternative Strategies for the Drug Crisis. (United States)

    Welch, Michael


    Examines the current strategy to combat illegal drug use and its effect on corrections. Reviews three schools of thought on drug-control policy and explores the assumptions offered by the public-health generalists, the legalists, and the cost-benefit specialists. Concentrates on issues of race, class, and alternatives to correctional warehousing.…

  12. Brassicacea-based management strategies as an alternative to combat nematode pests

    NARCIS (Netherlands)

    Fourie, Hendrika; Ahuja, Preeti; Lammers, Judith; Daneel, Mieke


    Nematode pests parasitise and cause substantial crop yield and quality losses to a wide range of crops worldwide. To minimize such damage, the exploitation and development of alternative nematode control strategies are becoming increasingly important, particularly as a result of global efforts to

  13. Evaluation of alternative management strategies of muskrat Ondatra zibethicus population control using a population model

    NARCIS (Netherlands)

    Bos, Daan; Ydenberg, Ron


    Muskrats Ondatra zibethicus are considered a pest species in the Netherlands, and a year-round control programme is in effect. Currently, the agency responsible for the management of muskrat populations in the Netherlands (the LCCM) is preparing for field studies to compare alternative strategies of

  14. Study of alternative strategies and methods for conserving energy. Final report

    Energy Technology Data Exchange (ETDEWEB)


    Objectives of the study were: (1) to identify and analyze alternative methods, means, and techniques, for controlling and moderating the consumption of energy; (2) to evaluate the impact of regulatory actions, taxes, incentives, subsidies or other strategies and methods on alternative physical technologies for energy conservation; and (3) to evaluate, macro- and micro-economic impacts and consequences of alternative energy conservation methods, means and techniques on work, leisure, life styles, and institutions on a local, regional, and national level. The study excludes automobile and related road vehicle energy consumption control strategies, but includes those for residential, commercial, industrial, and other energy end-use sectors. The time frame is from 1973 to 1990/2000, with emphasis on the period 1973-1980.

  15. Polygyny, mate-guarding, and posthumous fertilization as alternative male mating strategies. (United States)

    Zamudio, K R; Sinervo, B


    Alternative male mating strategies within populations are thought to be evolutionarily stable because different behaviors allow each male type to successfully gain access to females. Although alternative male strategies are widespread among animals, quantitative evidence for the success of discrete male strategies is available for only a few systems. We use nuclear microsatellites to estimate the paternity rates of three male lizard strategies previously modeled as a rock-paper-scissors game. Each strategy has strengths that allow it to outcompete one morph, and weaknesses that leave it vulnerable to the strategy of another. Blue-throated males mate-guard their females and avoid cuckoldry by yellow-throated "sneaker" males, but mate-guarding is ineffective against aggressive orange-throated neighbors. The ultradominant orange-throated males are highly polygynous and maintain large territories; they overpower blue-throated neighbors and cosire offspring with their females, but are often cuckolded by yellow-throated males. Finally, yellow-throated sneaker males sire offspring via secretive copulations and often share paternity of offspring within a female's clutch. Sneaker males sire more offspring posthumously, indicating that sperm competition may be an important component of their strategy.

  16. [Diagnostic strategy for chronic inflammatory demyelinating polyradiculoneuropathy. Recommendations of the French working group]. (United States)

    Magy, L


    The diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) requires a careful clinical and neurophysiological evaluation, often completed by CSF analysis. In numerous cases, this diagnosis is straightforward and leads to rapid initiation of an immunomodulatory treatment. However, some patients are not diagnosed because of atypical clinical and/or neurophysiological features, and do not benefit from a potentially effective treatment. In this context, a working group was composed with the task of establishing recommendations on diagnostic strategies for CIDP in the main clinical situations where this diagnosis may be suspected. We have summarized these recommendations and tried to present them in the form of a decision-making algorithm.

  17. SNP arrays in Beckwith-Wiedemann syndrome: an improved diagnostic strategy. (United States)

    Keren, Boris; Chantot-Bastaraud, Sandra; Brioude, Frédéric; Mach, Corinne; Fonteneau, Eric; Azzi, Salah; Depienne, Christel; Brice, Alexis; Netchine, Irène; Le Bouc, Yves; Siffroi, Jean-Pierre; Rossignol, Sylvie


    Beckwith-Wiedemann syndrome is an overgrowth disorder with an increased risk of childhood tumors that results from a dysregulation of imprinted gene expression in the 11p15 region. Since epigenetic defects are the most frequent anomalies, first-line diagnostic methods involve methylation analysis. When paternal isodisomy is suspected, it should be confirmed by a second technique capable of distinguishing true 11p15 paternal disomy (patUPD) from paternal 11p15 duplication or 11p15 trisomy. We sought to evaluate the interest of using SNP arrays in the Beckwith-Wiedemann syndrome diagnostic strategy. We analyzed the SNP profiles of 25 Beckwith Wiedemann patients with previously determined methylation indexes. Among them, 3 had 11p15 trisomies, 13 had patUPD, 8 had an inconclusive methylation index and 1 had a normal result. All known trisomies and known patUPDs were detected. Moreover we found 7 low-rate mosaicisms 11p15 patUPDs among the 8 patients with an inconclusive methylation index. We were able to precisely characterize the sizes and mosaicism rates of the anomalies. We demonstrate that SNP arrays are of real diagnostic interest in Beckwith-Wiedemann syndrome: 1) they help to distinguish patUPDs from trisomies more precisely than karyotyping and FISH, 2) they help determine the size and mosaicism rate of patUPDs, 3) they provide complementary information in inconclusive cases, helping to distinguish low-rate patUPD mosaicism from other BWS-related molecular defects.

  18. The Effect of Question Format and Task Difficulty on Reasoning Strategies and Diagnostic Performance in Internal Medicine Residents (United States)

    Heemskerk, Laura; Norman, Geoff; Chou, Sophia; Mintz, Marcy; Mandin, Henry; McLaughlin, Kevin


    Background: Previous studies have suggested an association between reasoning strategies and diagnostic success, but the influence on this relationship of variables such as question format and task difficulty, has not been studied. Our objective was to study the association between question format, task difficulty, reasoning strategies and…

  19. Parasites lost? An overlooked hypothesis for the evolution of alternative reproductive strategies in amphibians. (United States)

    Todd, Brian D


    Amphibians exhibit the greatest diversity of reproductive strategies of all tetrapod vertebrates. While authors have traditionally attributed the evolution of these strategies to factors such as complex topography, unpredictable larval environments, and predation on larvae and eggs, support for any of these hypotheses has been limited. Importantly, most authors have ignored parasites, including unicellular pathogens and multicellular parasites, as selective agents capable of influencing amphibian evolution. Insights in disease transmission, amphibian immunity, and their interaction with various life histories require that we consider parasites to be selective pressures in our exploration of the evolution of amphibian reproductive strategies. I review recent findings and describe how these principles converge to form a novel conceptual hypothesis for the evolution of alternative reproductive strategies in amphibians. I offer some specific predictions and recommend that parasites be considered with other selective pressures when constructing formal, falsifiable hypotheses during evaluative studies of amphibian reproductive behavior.

  20. Assessment of an alternative postdeployment reintegration strategy with soldiers returning from Iraq. (United States)

    Sipos, Maurice L; Foran, Heather M; Wood, Michael D; Wright, Kathleen M; Barnhart, Vincent J; Riviere, Lyndon A; Adler, Amy B


    The present study examined behavioral health outcomes, risk behaviors, aggression, alcohol misuse, marital satisfaction, and attitudes toward reintegration associated with an alternative, front-loaded reintegration strategy compared with a more standardized reintegration process in soldiers returning from combat deployments. The type of reintegration strategy used did not predict differences in posttraumatic stress disorder (PTSD) symptoms, alcohol misuse, aggression, and marital satisfaction, although slightly higher reports of risk behaviors were found in the unit using the standard reintegration approach even after controlling for demographic covariates and combat exposure. These findings may help guide leadership when making decisions regarding reintegration approaches in the future.

  1. Alternative methods of optical diagnostics in the field of standardization and metrology (United States)

    Constantinov, Boris I.; Pasechnic, Teodosie I.; Sircu, Sergiu


    An optical configuration based on the photothermoplastic recording (PTPR) is suggested for the operational optical diagnostics and standardization of the products in the real time scale. The presence of three or four PTPR cameras along the counter of the tested product makes it possible to investigate in the real-time scale not only the appearance of the internal defects, but also the influence of the condition of different units onto the condition of the whole system. Dry development of the images in the real-time scale and instant fixation of images on the photothermoplastic carriers (PTPC) followed by the computer analysis used to compare the product and the standard allow us to gain in time and areas.

  2. MR imaging of the kidneys: new diagnostic strategies; MR-Bildgebung der Nieren. Neue Ansaetze in der Diagnostik

    Energy Technology Data Exchange (ETDEWEB)

    Schoenberg, S.O.; Knopp, M.V.; Bock, M.; Floemer, F.; Essig, M.; Hawighorst, H.; Kaick, G. van [Deutsches Krebsforschungszentrum, Heidelberg (Germany). Forschungsschwerpunkt Radiologische Diagnostik; Kallinowski, F. [Heidelberg Univ. (Germany). Chirurgische Universitaetsklinik; Just, A. [Heidelberg Univ. (Germany). 1. Physiologisches Inst.; Laub, G. [Siemens AG, Erlangen (Germany). Unternehmensbereich Medizinische Technik; Prince, M.R [Michigan Univ., Ann Arbor, MI (United States). Dept. of Radiology


    Aim: New diagnostic strategies for evaluation of the kidney by fast MR imaging of renal morphology, multiphase 3D gadolinium MR angiography, MR urography and MR flow measurements. A signal MR examination is designed to grade renovascular disease and assess the hemodynamic and functional significance, detect and characterize renal lesions and evaluate the urinary tract. Results: The combined analysis of morphologic and functional data allows reliable assessment of renal artery stenosis, benign and malignant renal masses and diseases of the renal collecting system and ureters, as well as congenital abnormalities in good agreement to the results of conventional imaging modalities. The improved tissue contrast and additional functional information compensates for the disadvantage of a lower spatial resolution. Conclusion: Combined morphologic and functional MR examination represents a reliable, non-invasive and cost-effective alternative imaging modality for comprehensive diagnostic evaluation of renal disease. (orig.) [Deutsch] Fragestellung: Darstellung neuer diagnostischer Moeglichkeiten im Bereich der Niere mittels schneller Magnetresonanz (MR)-Bildgebung. Methodik: Vorgestellt wird ein kombiniertes morphologisches und funktionelles Untersuchungskonzept bestehend aus schneller morphologischer Bildgebung, multiphasischer 3D-Gadolinium-MR-Angiographie, MR-Urographie und MR-Flussmessung. In einer einzigen MR-Untersuchung sollen vaskulaere Erkrankungen erfasst, eingestuft und auf ihre haemodynamische und funktionelle Signifikanz ueberprueft werden, renale Laesionen detektiert und differenziert sowie die Harnabflusswege beurteilt werden. Ergebnisse: Durch Integration der gewonnenen morphologischen und funktionellen Daten lassen sich Nierenarterienstenosen, benigne und maligne renale Tumoren, Harnabflussstoerungen und kongenitale Fehlbildungen mit aehnlicher Genauigkeit wie in den konventionellen radiologischen Verfahren erfassen. Der Nachteil der geringeren raeumlichen

  3. Alternative life cycle strategies of Megalodiscus temperatus in tadpoles and metamorphosed anurans

    Directory of Open Access Journals (Sweden)

    Bolek M.G.


    Full Text Available Megalodiscus temperatus (Stafford, 1905 is a common paramphistome trematode of North American amphibians with a two host life cycle and has been reported to infect frogs and rarely tadpoles. In this study we document the alternative life cycle strategy of M. temperatus in tadpoles and metamorphosed anurans. We show through field work and experimental infections that M. temperatus can establish in both anuran life stages and worms become gravid and release eggs in both tadpoles and metamorphosed frogs. However, worms exhibit differences in route of infection, development, egg production, and diet in tadpoles and metamorphosed anurans. These alternative life history strategies of M. temperatus suggest different selective pressures on the development and reproductive success of these worms in tadpoles and metamorphosed anurans, and we discuss the evolutionary avenues for and constraints on amphibian trematode life cycles presented by these two different anuran life stages.

  4. Strategies to teach alternative and complementary therapies in nursing: an integrative review

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    Natália Chantal Magalhães da Silva


    Full Text Available The lack of discussions that clarify the teaching of alternative and complementary therapies in undergraduate nursing programs shows the need for developing research on this topic. The objective of this study was to identify, in scientific literature, the strategies for teaching alternative and complementary therapies in nursing undergraduate programs. The guiding methodology used was integrative review. The search was performed on SCIENCE DIRECT, LILACS and MEDLINE databases. According to the articles included in this study, the proposals for including these therapies in the program are by: lectures, theoretical courses and discussion groups. However, studies should be conducted to confirm the efficacy of these strategies so these therapeutic methods can be included in the Pedagogical Political Project of the nursing undergraduate program, thus allowing for the consolidation of those practices. Descriptors: Education, Nursing; Education, Higher; Complementary Therapies.

  5. Is there an alternative strategy for reducing public debt by 2032?

    Directory of Open Access Journals (Sweden)

    Blot Christophe


    Full Text Available EMU countries have engaged in fiscal consolidation since 2011. This strategy has proven to be costly in terms of GDP. This cost has been amplified by the fact that fiscal multipliers are high in time of crisis, as recently stressed by the literature. Within this context, we wonder whether there is an alternative strategy aiming at bringing back the debt ratio to 60% of GDP in 2032, meanwhile lowering output losses. To this end, we report simulations realized from a simple model describing the Eurozone and the timing for consolidation. Based on a pragmatic view of the fiscal compact, we find an alternative path for consolidation which achieves a 60% threshold for public debt over the next 20 years in most euro area countries.

  6. Economics of eradicating Foot-and-Mouth disease epidemics with alternative control strategies

    Directory of Open Access Journals (Sweden)

    RHM Bergevoet


    Full Text Available The paper presents an economic analysis of Foot-and-Mouth Disease (FMD control strategies for livestock herds. Alternative vaccination-to-live control strategies were compared to the strategy that involves culling of all susceptible animals in an area of 1 km around infected herds in addition to standard measures as culling of infected herds, pre-emptive slaughter of contact herds, establishment of control and surveillance zones. Vaccination strategies differed with respect to the radius of vaccination around infected farms (2 km versus 5 km. As an example to illustrate the economic consequences the Netherlands was used. These strategies were evaluated for a Sparsely Populated Livestock Areas (SPLA with less than 2 farms/km² and a Densely Populated Livestock Areas (DPLA with more than 4 farms/km². Results of the partial budgeting FMD model revealed that for DPLA a control strategy which includes a vaccination radius of 2 km is most cost effective. For SPLA a control strategy which includes a 1 km culling radius around an infected farm is most cost effective.

  7. Ethics and praxis: alternative strategies to physical restraint and seclusion in a psychiatric setting. (United States)

    Taxis, J Carole


    This descriptive article highlights a 42-month project in which a comprehensive program revision was implemented in a psychiatric hospital that included numerous alternative strategies to the use of patient restraint and seclusion. The results of this project include a 94% reduction in the rate of restraint and seclusion, development of extensive staff and patient education programs, and comprehensive programmatic alterations consistent with a paradigm shift emphasizing collaboration, empowerment, and ethical clinical practice.

  8. Analysis of Alternative Rework Strategies for Printed Wiring Assembly Manufacturing Systems


    Driels, Morris; Klegka, John S.


    This paper presents a model for predicting the cost of test, diagnosis, and rework activities in the manufacture of printed wiring assemblies (PWA's). Rework is defined as all actions taken to correct or improve the basic assembly process. These actions may include those of inspectors and solder touchup technicians who do not add value to the PWA, but whose actions are required in order to produce acceptable yields from the manufacturing process. Two alternative rework strategies for cont...

  9. Performance and suggested alternative strategies in developing Indonesian cocoa export business

    Directory of Open Access Journals (Sweden)

    Bambang Dradjat


    Full Text Available This research focussed on the export development of cocoa bean with respect to its export growth, values and competitiveness. Based on this deve-lopment, the aim of this research is to propose alternative development strategies of export business for cocoa bean in the future. The Analysis Hierarchie Process (AHP framework of export business of cocoa bean was arranged consecutively from formulation of focuss or goals, identification of affecting factors and actors, deter mination of actor objectives, and recognition of alternative strategies needed. Each component of goals, factors, actors, objectives, and alternative strategies were valued on the basis of their importance using Saaty scales. Results of interviews with experts were analyzed using AHP technique. The development of cocoa bean export from 2000 to 2006 showed the competitiveness position of Indonesia in the world market was fairly good. In order to increase the growth and values of cocoa bean export, the experts consider the role of government as regulators and facilitators is very important. The government became the main actor for the export development through de/regulation related to the cocoa bean commodity. The objectives of actors could be achieved by combining strategies (i provision of fund in national and regional budget, as well as other sources (ii implementation of recomended technologies of cocoa, (iii acceleration of replanting program, (iv improvement of research productivity in producing high yielding plant materials, (v development of transportation facilities from farms to harbours, (vi development of farmers’ organization and partnerships as well as strategic alliance, and (viii pests and diseases control. Key words: Cocoa bean, expor, role of government, objectives and strategies.

  10. Eosinophilic Esophagitis (EoE: an emerging disease in childhood - Review of diagnostic and management strategies

    Directory of Open Access Journals (Sweden)

    Jorge Amil Dias


    Full Text Available Eosinophilic esophagitis (EoE is a chronic immune/antigen mediated inflammatory disease of the esophagus. It comprises a separate entity of increasing incidence and prevalence in children and adults. The disease is characterized by histological evidence of dense esophageal tissue eosinophilia in the presence of a variety of upper GI symptoms including vomiting, dysphagia, food impaction and odynophagia. Cornerstone of treatment is dietary intervention and/or the off-label use of swallowed topical corticosteroids. New drug therapies are under investigation. In this review we focus on the diagnostic approach and the currently available treatment strategies. Keywords: Eosinophilic esophagitis, oral viscous budesonide, fluticasone propionate, oral steroids, amino acid-based formula, empiric elimination diet, targeted elimination dietKey points:1.A trial with antisecretory medication is necessary to exclude GERD and PPI-responsive esophageal eosinophilia and to fulfil the diagnostic criteria of EoE. 2.Elimination diet and/or off-label use of topical corticosteroids are effective measures for treating EoE. 3.Elimination diet is the first line treatment in atopic children. 4.Systemic corticosteroids are reserved for patients with severe disease requiring immediate relief, or when other treatments have failed. 5.Cromolyn sodium (sodium cromoglycate and leukotriene receptor antagonists, are not currently recommended for treating EoE, due to lack of solid evidence of benefit.6.Immunosuppressive drugs and biologics have shown some value but effect has been limited and therefore not yet recommended as standard therapy.

  11. The blunt liver trauma: Review of current diagnostic and management strategies

    Directory of Open Access Journals (Sweden)

    Doklestic Krstina


    Full Text Available The liver is one of the most commonly injured organs in blunt abdominal trauma. Major liver trauma in polytraumatic patients accounts for significant morbidity and mortality. Therapeutic options for blunt hepatic trauma include both non-operative and operative management. Hemodynamic status, not the grade of the injury, should dictate the management. CT scan of the abdomen and pelvis is a standard diagnostic modality in hemodynamically stable trauma patients. Recent advancements in imaging studies and enhanced critical care strategies have shifted the paradigm for the management of liver injuries. Nonoperative management of both low- and high-grade injuries can be successful in hemodynamically stable patients. Direct suture of bleeding vessels, vascular isolation of the liver, and damage control surgery have improved outcomes in the hemodynamically unstable patients. We have reviewed current position in the treatment of blunt hepatic trau

  12. Diagnostic accuracy of a step-up imaging strategy in pediatric patients with blunt abdominal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Schuppen, J. van [Department of Radiology, Academic Medical Centre, Amsterdam (Netherlands); Olthof, D.C. [Trauma Unit Department of Surgery, Academic Medical Centre, Amsterdam (Netherlands); Wilde, J.C.H. [Department of Paediatric Surgery, Emma' s Children Hospital/Academic Medical Centre, Amsterdam (Netherlands); Beenen, L.F.M.; Rijn, R.R. van [Department of Radiology, Academic Medical Centre, Amsterdam (Netherlands); Goslings, J.C., E-mail: [Trauma Unit Department of Surgery, Academic Medical Centre, Amsterdam (Netherlands)


    Introduction: Blunt abdominal trauma (BAT) is an important but often unrecognized cause of death in children. Imaging plays a vital role in the early detection of abdominal trauma. The exact role of imaging in the management of BAT in children is still under research. The aim of this study was to assess diagnostic accuracy of a step-up imaging strategy, where the decision to observe or to perform an intervention depends on the vital parameters of the patient, in combination with the presence or absence of free fluid at Focused Assessment with Sonography for Trauma (FAST) and the findings on CT (performed selectively), for pediatric patients presenting to the ED with a blunt abdominal trauma. Methods: Consecutive patients aged ≤16 years admitted between January 2008 and December 2012 to a Dutch level 1 trauma centre were included in this retrospective study. Sensitivity, negative predictive value (NPV) and the negative likelihood ratio (LR−) of the imaging strategy were calculated. Results: The cohort consisted of 122 patients; 66 (54%) patients were discharged home after primary survey, 51 (41%) patients were admitted and observed, 3 (2%) patients underwent transarterial embolization and 2 (2%) patients underwent surgery. Treatment failed in 1 patient, initially selected for observation. The sensitivity of the imaging strategy was 0.833 (0.446–0.990). The NPV and LR− were 0.991 (0.963–1.000) and 0.167 (0.028–0.997), respectively. Conclusion: The step-up imaging strategy that is applied in our academic level 1 trauma centre has a high sensitivity and a high negative predictive value. No clinically relevant injuries were missed without doing unnecessary harm, e.g. radiation or an intervention.

  13. Treatment guided by rapid diagnostic tests for malaria in Tanzanian children: safety and alternative bacterial diagnoses

    Directory of Open Access Journals (Sweden)

    Sykes Alma


    Full Text Available Abstract Background WHO guidelines for the treatment of young children with suspected malaria have recently changed from presumptive treatment to anti-malarial treatment guided by a blood slide or malaria rapid diagnostic test (RDT. However, there is limited evidence of the safety of this policy in routine outpatient settings in Africa. Methods Children 3-59 months of age with a non-severe febrile illness and no obvious cause were enrolled over a period of one year in a malaria endemic area of Tanzania. Treatment was determined by the results of a clinical examination and RDT result, and blood culture and serum lactate were also collected. RDT-negative children were followed up over 14 days. Results Over the course of one year, 965 children were enrolled; 158 (16.4% were RDT-positive and treated with artemether-lumefantrine and 807 (83.4% were RDT-negative and treated with non-anti-malarial medicines. Compared with RDT-positives, RDT-negative children were on average younger with a lower axillary temperature and more likely to have a history of cough or difficulty in breathing. Six (0.6% children became RDT-positive after enrolment, all of whom were PCR-negative for Plasmodium falciparum DNA at enrolment. In addition, 12 (1.2% children were admitted to hospital, one with possible malaria, none of whom died. A bacterial pathogen was identified in 9/965 (0.9% children, eight of whom were RDT-negative and one was RDT-positive, but slide-negative. Excluding three children with Salmonella typhi, all of the children with bacteraemia were ≤12 months of age. Compared to double-read research slide results RDTs had a sensitivity of 97.8% (95%CI 96.9-98.7 and specificity of 96.3% (95%CI 96.3-98.4. Conclusions Use of RDTs to direct the use of anti-malarial drugs in young children did not result in any missed diagnoses of malaria although new infections soon after a consultation with a negative RDT result may undermine confidence in results. Invasive

  14. The indication area of a diagnostic test. Part II-the impact of test dependence, physician's decision strategy, and patient's utility

    NARCIS (Netherlands)

    Stalpers, L.J.; Nelemans, P.J.; Geurts, S.M.; Jansen, E.; Boer, P.; Verbeek, A.L.


    OBJECTIVES: Any diagnostic test has an indication area of prior probabilities wherein the gain in diagnostic certainty outweighs its loss. Here, we investigate whether indication area and the maximum diagnostic gain are robust measures if we assume test dependence, alternative physician's heuristics

  15. Using the Astronomy Diagnostic Test to Identify Teaching Strategies that Improve Conceptual Understanding (United States)

    Deming, G. L.; Hufnagel, B.


    The Astronomy Diagnostic Test (ADT) was developed in order to assess learning in undergraduate introductory astronomy classes, but an underlying goal was to use the information supplied by the ADT to improve student learning. The ADT National Project collected pre-course (5346 students) and post-course (3842 students) test results from 97 classes at a variety of institutions in 31 states. These results have been compiled in an extensive database. The overall gain between pre-course and post-course average scores amounts to a disappointing 15%, but significant gains are identifiable for specific questions in individual classes. Results from the ADT National Project database will be presented for specific questions with minimal gains. Astronomy education researchers in Maryland are beginning to use ADT results to identify minimal gain concepts and then to modify and assess instructional strategies with the goal of improving student learning. A comparison will be made between ADT pre-course and post-course responses for several classes in which different teaching methods were used. Successful teaching strategies applicable in a variety of class settings will be offered and instructors are encouraged to become involved in assessing results in their own introductory astronomy classes. This research was supported by the National Science Foundation through grant REC-0089239.

  16. Diagnostic performance of contrast-enhanced MR for acute appendicitis and alternative causes of abdominal pain in children

    Energy Technology Data Exchange (ETDEWEB)

    Koning, Jeffrey L. [University of California San Diego, Department of Radiology, San Diego, CA (United States); Naheedy, John H.; Kruk, Peter G. [University of California San Diego, Department of Radiology, San Diego, CA (United States); Rady Children' s Hospital, Department of Radiology, San Diego, CA (United States)


    Unenhanced MRI has emerged as a useful tool for diagnosing pediatric acute appendicitis. The use of contrast-enhanced MRI for diagnosing pediatric appendicitis has not been documented. The purpose of this study is to examine the diagnostic performance of contrast-enhanced MRI for acute appendicitis and alternative entities in the pediatric population presenting with acute abdominal pain. A retrospective review was conducted of 364 consecutive pediatric patients undergoing contrast-enhanced MRI for the evaluation of possible appendicitis at a single institution between November 2012 and September 2013. There were 132 cases of pathologically confirmed appendicitis out of 364 pediatric patients (36.3%) included in the study. Overall sensitivity and specificity were 96.2% (95% CI [91.4-98.4%]) and 95.7% (95% CI [92.3-97.6%]), respectively. Positive predictive value and negative predictive value were 92.7% (95% CI [86.6-96.3%]) and 97.8% (95% CI [94.7-99.1%]), respectively. The appendix was visualized in 243 cases (66.8%). Imaging confirmed alternative diagnoses in 75 patients, including most commonly colitis, enteritis or terminal ileitis (n = 25, 6.9%), adnexal cysts (n = 25, 6.9%) and mesenteric adenitis (n = 7, 1.9%). Contrast-enhanced MRI is capable of accurately diagnosing acute appendicitis while detecting many alternative entities of abdominal pain, and it allows good visualization of the appendix. Further evaluation is needed to determine whether contrast-enhanced MRI provides an advantage over non-enhanced MRI for imaging evaluation of acute abdominal pain in the pediatric population. (orig.)

  17. Implementation of alternative test strategies for the safety assessment of engineered nanomaterials. (United States)

    Nel, A E


    Nanotechnology introduces a new field that requires novel approaches and methods for hazard and risk assessment. For an appropriate scientific platform for safety assessment, nanoscale properties and functions of engineered nanomaterials (ENMs), including how the physicochemical properties of the materials relate to mechanisms of injury at the nano-bio interface, must be considered. Moreover, this rapidly advancing new field requires novel test strategies that allow multiple toxicants to be screened in robust, mechanism-based assays in which the bulk of the investigation can be carried out at the cellular and biomolecular level whilst maintaining limited animal use and is based on the contribution of toxicological pathways to the pathophysiology of disease. First, a predictive toxicological approach for the safety assessment of ENMs will be discussed against the background of a '21st-century vision' for using alternative test strategies (ATSs) to perform toxicological assessment of large numbers of untested chemicals, thereby reducing a backlog that could otherwise become a problem for nanotechnology. An ATS is defined here as an alternative to animal experiments or refinement/reduction alternative to traditional animal testing. Secondly, the approach of selecting pathways of toxicity to screen for the pulmonary hazard potential of carbon nanotubes and metal oxides will be discussed, as well as how to use these pathways to perform high-content or high-throughput testing and how the data can be used for hazard ranking, risk assessment, regulatory decision-making and 'safer-by-design' strategies. Finally, the utility and disadvantages of this predictive toxicological approach to ENM safety assessment, and how it can assist the 21st-century vision, will be addressed.

  18. Evaluating environmental and economic consequences of alternative pest management strategies: results of modeling workshops (United States)

    Johnson, Richard L.; Andrews, Austin K.; Auble, Gregor T.L.; Ellison, Richard A.; Hamilton, David B.; Roelle, James E.; McNamee, Peter J.


    The U.S. Environmental Protection Agency (EPA) needs a comprehensive method to evaluate the human health and environmental effects of alternative agricultural pest management strategies. This project explored the utility of Adaptive Environmental Assessment (AEA) techniques for meeting this need. The project objectives were to produce models for environmental impact analysis, improve communications, identify research needs and data requirements, and demonstrate a process for resolving conflicts. The project was structured around the construction (in an initial 2 1/2-day workshop) and examination (in a second 2 1/2-day workshop) of a simulation model of a corn agroecosystem.

  19. Alternative Models of Self-regulation and Implications for L2 Strategy Research

    Directory of Open Access Journals (Sweden)

    Jim Ranalli


    Full Text Available In this paper I discuss the proposal of Dörnyei and colleagues (Dörnyei, 2005; Tseng, Dörnyei, & Schmitt, 2006 to replace the construct of learning strategy with that of self-regulation and thus shift the research focus from specific strategic behaviors to a trait that is seen to underlie them. I argue that before doing so, we need a fuller understanding of what self-regulation entails and how it might intersect with traditional concerns of second language strategy research. To contribute to this understanding, I highlight alternative conceptualizations of self-regulation and then use data from my doctoral research to illustrate one in particular, the COPES model of self-regulated learning (Winne & Hadwin, 1998. This model’s explanatory power is contrasted with that of Dörnyei and colleagues’ conceptualization to show that, depending on the model one adopts, self-regulation is not only compatible with the study of specific strategies but useful for shedding new light on strategy research and integrating it with research in other related areas, such as L2 motivation.

  20. The evolution of alternative cryptic female choice strategies in age-structured populations. (United States)

    Jones, Adam G


    Cryptic female choice is a potentially important aspect of the sexual selection process. According to the theory of sexual dialectics, postcopulation manipulation of relative male fertilization success can provide an avenue by which females can circumvent attempts by males to control female reproduction. Here I use stochastic models to investigate the evolution of cryptic female choice in populations with and without age structure. In populations without age structure, cryptic female choice will evolve only when (1) precopulatory mate choice by females is inefficient, (2) variation in male fitness is correlated with a trait upon which a female can base her choice of mates, and (3) the cost of multiple mating is not too high. In populations with age structure, similar conditions apply. However, selection sometimes favors females that employ alternative strategies of female choice at different ages. These results help to define the types of biological systems in which we should expect to see the evolution of cryptic female choice. They also illustrate that the evolution of choice strategies in females may be complex and may mirror in some important respects the evolution of alternative mating tactics in males.

  1. The General Equilibrium Impact of Alternative Antipoverty Strategies: Income Maintenance, Training and Job Creation. Discussion Papers 386-77. (United States)

    Bishop, John H.

    This paper attempts to provide a general equilibrium framework for comparing the merits of alternative methods of raising the income of the employable poor. The strategy is to specify a complete and interacting set of factor markets, parameterize alternative program types in a manner convenient to this specification, and then solve the system of…

  2. Breeding experience, alternative reproductive strategies and reproductive success in a captive colony of zebra finches (Taeniopygia guttata). (United States)

    Baran, Nicole M; Adkins-Regan, Elizabeth


    Birds exhibit a remarkable diversity of different reproductive strategies both between and within species. Species such as the zebra finch (Taeniopygia guttata) may evolve the flexible use of alternative reproductive strategies, as well as benefit from prior breeding experience, which allows them to adaptively respond to unpredictable environments. In birds, the flexible use of alternative reproductive strategies, such as extra-pair mating, has been reported to be associated with fast reproduction, high mortality and environmental variability. However, little is known about the role of previous breeding experience in the adaptive use of alternative reproductive strategies. Here we performed an in-depth study of reproductive outcomes in a population of domesticated zebra finches, testing the impact of prior breeding experience on the use of alternative reproductive strategies and reproductive success. We provide evidence that older females with prior breeding experience are quicker to initiate a clutch with a new partner and have increased success in chick rearing, even in a captive colony of zebra finches with minimal foraging demands. We also find evidence that the breeding experience of other females in the same social group influences reproductive investment by female zebra finches. Furthermore, we demonstrate that the use of alternative reproductive strategies in female zebra finches is associated with previous failed breeding attempts with the same pair partner. The results provide evidence that age and breeding experience play important roles in the flexible use of both facultative and adaptive reproductive strategies in female zebra finches.

  3. Central Vestibular Dysfunction in an Otorhinolaryngological Vestibular Unit: Incidence and Diagnostic Strategy

    Directory of Open Access Journals (Sweden)

    Mostafa, Badr E.


    Full Text Available Introduction Vertigo can be due to a variety of central and peripheral causes. The relative incidence of central causes is underestimated. This may have an important impact of the patients' management and prognosis. Objective The objective of this work is to determine the incidence of central vestibular disorders in patients presenting to a vestibular unit in a tertiary referral academic center. It also aims at determining the best strategy to increase the diagnostic yield of the patients' visit. Methods This is a prospective observational study on 100 consecutive patients with symptoms suggestive of vestibular dysfunction. All patients completed a structured questionnaire and received bedside and vestibular examination and neuroimaging as required. Results There were 69 women and 31 men. Their ages ranged between 28 and 73 (mean 42.48 years. Provisional videonystagmography (VNG results were: 40% benign paroxysmal positional vertigo (BPPV, 23% suspicious of central causes, 18% undiagnosed, 15% Meniere disease, and 4% vestibular neuronitis. Patients with an unclear diagnosis or central features (41 had magnetic resonance imaging (MRI and Doppler studies. Combining data from history, VNG, and imaging studies, 23 patients (23% were diagnosed as having a central vestibular lesion (10 with generalized ischemia/vertebra basilar insufficiency, 4 with multiple sclerosis, 4 with migraine vestibulopathy, 4 with phobic postural vertigo, and 1 with hyperventilation-induced nystagmus. Conclusions Combining a careful history with clinical examination, VNG, MRI, and Doppler studies decreases the number of undiagnosed cases and increases the detection of possible central lesions.

  4. Central vestibular dysfunction in an otorhinolaryngological vestibular unit: incidence and diagnostic strategy. (United States)

    Mostafa, Badr E; Kahky, Ayman O El; Kader, Hisham M Abdel; Rizk, Michael


    Introduction Vertigo can be due to a variety of central and peripheral causes. The relative incidence of central causes is underestimated. This may have an important impact of the patients' management and prognosis. Objective The objective of this work is to determine the incidence of central vestibular disorders in patients presenting to a vestibular unit in a tertiary referral academic center. It also aims at determining the best strategy to increase the diagnostic yield of the patients' visit. Methods This is a prospective observational study on 100 consecutive patients with symptoms suggestive of vestibular dysfunction. All patients completed a structured questionnaire and received bedside and vestibular examination and neuroimaging as required. Results There were 69 women and 31 men. Their ages ranged between 28 and 73 (mean 42.48 years). Provisional videonystagmography (VNG) results were: 40% benign paroxysmal positional vertigo (BPPV), 23% suspicious of central causes, 18% undiagnosed, 15% Meniere disease, and 4% vestibular neuronitis. Patients with an unclear diagnosis or central features (41) had magnetic resonance imaging (MRI) and Doppler studies. Combining data from history, VNG, and imaging studies, 23 patients (23%) were diagnosed as having a central vestibular lesion (10 with generalized ischemia/vertebra basilar insufficiency, 4 with multiple sclerosis, 4 with migraine vestibulopathy, 4 with phobic postural vertigo, and 1 with hyperventilation-induced nystagmus). Conclusions Combining a careful history with clinical examination, VNG, MRI, and Doppler studies decreases the number of undiagnosed cases and increases the detection of possible central lesions.

  5. Intrasexual competition facilitates the evolution of alternative mating strategies in a colour polymorphic fish

    Directory of Open Access Journals (Sweden)

    Uy J Albert C


    Full Text Available Abstract Background Intense competition for access to females can lead to males exploiting different components of sexual selection, and result in the evolution of alternative mating strategies (AMSs. Males of Poecilia parae, a colour polymorphic fish, exhibit five distinct phenotypes: drab-coloured (immaculata, striped (parae, structural-coloured (blue and carotenoid-based red and yellow morphs. Previous work indicates that immaculata males employ a sneaker strategy, whereas the red and yellow morphs exploit female preferences for carotenoid-based colours. Mating strategies favouring the maintenance of the other morphs remain to be determined. Here, we report the role of agonistic male-male interactions in influencing female mating preferences and male mating success, and in facilitating the evolution of AMSs. Results Our study reveals variation in aggressiveness among P. parae morphs during indirect and direct interactions with sexually receptive females. Two morphs, parae and yellow, use aggression to enhance their mating success (i.e., number of copulations by 1 directly monopolizing access to females, and 2 modifying female preferences after winning agonistic encounters. Conversely, we found that the success of the drab-coloured immaculata morph, which specializes in a sneak copulation strategy, relies in its ability to circumvent both male aggression and female choice when facing all but yellow males. Conclusions Strong directional selection is expected to deplete genetic variation, yet many species show striking genetically-based polymorphisms. Most studies evoke frequency dependent selection to explain the persistence of such variation. Consistent with a growing body of evidence, our findings suggest that a complex form of balancing selection may alternatively explain the evolution and maintenance of AMSs in a colour polymorphic fish. In particular, this study demonstrates that intrasexual competition results in phenotypically distinct

  6. [The alternative view on diagnostic of hyperlipoproteinemia, cholesterol lipoproteins of low density and effect of statins: a lecture]. (United States)

    Tupoleva, T A; Tikhomirov, D S; Grumbkova, L O; Ignatova, E N; Romanova, T Iu; Filatov, F P; Garanzha, T A


    The effect of statins occur in several stages: 1) inhibition in hepatocytes of synthesis of functionally specific pool of spirit cholesterol, polar mono-layer of lipoproteins of very low density; 2) activation of hydrolysis of triglycerides in lipoproteins of very low density, formation of apoE/B-100-ligand and absorption of lipoproteins of very low density by insulin-depended cells; 3) decreasing of content of and spirit cholesterol-lipoproteins of very low density in blood plasma; 4) activation of hydrolysis of triglycerides in lipoproteins of low density, formation of apoB-100-ligand and absorption of lipoproteins of low density by insulin-independent cells; 5) decreasing of level of and increasing of content of lipoproteins of high density. During first weeks of effect of statins occurs decreasing of concentration of triglycerides and unesterified spirit cholesterol-lipoproteins of very low density in blood plasma. Then, slower and more durational decreasing of level of spirit cholesterol-lipoproteins of low density occurs. The value of spirit cholesterol-lipoproteins of low density is primarily determined by content of palmitic saturated fatty acid in food, its endogenous synthesis from glucose and concentration of palmitic triglycerides and lipoproteins of very low density of the same name in blood plasma. The effect of preparations is biologically valid and corresponds to alternative hypolipidemic preparations. All these preparations have an effect following a common algorithm: they activate, using different mechanisms, receptor absorption of lipoproteins of very low density or lipoproteins of low density by cells. The level of spirit cholesterol-lipoproteins of low density in full measure depends on content of triglycerides in blood. The concentration of spirit cholesterol in blood plasma has a reliable diagnostic significance only under physiological content of triglycerides. The main criterion of diagnostic and control of hypolipidemic therapy

  7. Gamma knife surgery for pineal region tumors: an alternative strategy for negative pathology

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Peng [Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu (China); Department of Neurosurgery, The Fifth People' s Hospital of Chengdu, Chengdu (China); Mao, Qing; Wang, Wei; Zhou, Liang-Xue; Liu, Yan-Hui, E-mail: [Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu (China)


    Objective: pineal region tumors (PRTs) are uncommon, and treatments vary among neoplasm types. The authors report their experience with gamma knife surgery (GKS) as an initial treatment in a series of PRT patients with unclear pathological diagnoses. Method: seventeen PRT patients with negative pathology who underwent GKS were retrospectively studied. Nine patients had further whole-brain and spinal cord radiotherapy and chemotherapy 6-9 months after GKS. Results: Sixteen of 17 cases were followed up over a mean of 33.3 months. The total response rate was 75%, and the control rate was 81.3%. No obvious neurological deficits or complications were attributable to GKS. Conclusion: the findings indicate that GKS may be an alternative strategy in selected PRT patients who have negative pathological diagnoses, and that good outcomes and quality of life can be obtained with few complications. (author)

  8. Gamma knife surgery for pineal region tumors: an alternative strategy for negative pathology

    Directory of Open Access Journals (Sweden)

    Peng Wang


    Full Text Available Objective : Pineal region tumors (PRTs are uncommon, and treatments vary among neoplasm types. The authors report their experience with gamma knife surgery (GKS as an initial treatment in a series of PRT patients with unclear pathological diagnoses. Method : Seventeen PRT patients with negative pathology who underwent GKS were retrospectively studied. Nine patients had further whole-brain and spinal cord radiotherapy and chemotherapy 6–9 months after GKS. Results : Sixteen of 17 cases were followed up over a mean of 33.3 months. The total response rate was 75%, and the control rate was 81.3%. No obvious neurological deficits or complications were attributable to GKS. Conclusion : The findings indicate that GKS may be an alternative strategy in selected PRT patients who have negative pathological diagnoses, and that good outcomes and quality of life can be obtained with few complications.

  9. The potential impact of various diagnostic strategies in cases of chronic pain syndromes associated with lumbar spine degeneration

    Directory of Open Access Journals (Sweden)

    Bokov A


    Full Text Available Andrey Bokov, Olga Perlmutter, Alexander Aleynik, Marina Rasteryaeva, Sergey Mlyavykh Scientific Research Institute of Traumatology and Orthopedics, Nizhniy Novgorod, Russian Federation Purpose: To study the possible effects of various diagnostic strategies and the relative contribution of various structures in order to determine the optimal diagnostic strategy in treating patients with noncompressive pain syndromes. Study design: Prospective, nonrandomized cohort study of 83 consecutive patients with noncompressive pain syndromes resistant to repeated courses of conservative treatment. The follow-up period was 18 months. Results: Nucleoplasty was effective in cases of discogenic pain; the consequences related to false positive results of the discography were significant. The most specific criterion was 80% pain relief after facet joint blocks, whereas 50% pain relief and any subjective pain relief were not associated with a significant increase in the success rate. A considerable rate of false negative results was associated with 80% pain relief, whereas 50% pain relief after facet joint blocks showed the optimal ratio of sensitivity and specificity. Facet joint pain was detected in 50.6% of cases (95% confidence interval 44.1%–66.3%, discogenic pain in 16.9% cases (95% confidence interval 9.5%–26.7%, and sacroiliac joint pain in 7.2% cases (95% confidence interval 2.7%–15%. It was impossible to differentiate the main source of pain in 25.3% of cases. Conclusion: It is rational to adjust the diagnostic algorithm to the probability of detecting a particular pain source and, in doing so, reduce the number of invasive diagnostic measures to evaluate a pain source. False positive results of diagnostic measures can negatively affect the overall efficacy of a particular technology; therefore, all reasons for the failure should be studied in order to reach an unbiased conclusion. In choosing diagnostic criteria, not only should the success rate

  10. Breast Cancer-Related Arm Lymphedema: Incidence Rates, Diagnostic Techniques, Optimal Management and Risk Reduction Strategies

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Chirag [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Vicini, Frank A., E-mail: [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States)


    As more women survive breast cancer, long-term toxicities affecting their quality of life, such as lymphedema (LE) of the arm, gain importance. Although numerous studies have attempted to determine incidence rates, identify optimal diagnostic tests, enumerate efficacious treatment strategies and outline risk reduction guidelines for breast cancer-related lymphedema (BCRL), few groups have consistently agreed on any of these issues. As a result, standardized recommendations are still lacking. This review will summarize the latest data addressing all of these concerns in order to provide patients and health care providers with optimal, contemporary recommendations. Published incidence rates for BCRL vary substantially with a range of 2-65% based on surgical technique, axillary sampling method, radiation therapy fields treated, and the use of chemotherapy. Newer clinical assessment tools can potentially identify BCRL in patients with subclinical disease with prospective data suggesting that early diagnosis and management with noninvasive therapy can lead to excellent outcomes. Multiple therapies exist with treatments defined by the severity of BCRL present. Currently, the standard of care for BCRL in patients with significant LE is complex decongestive physiotherapy (CDP). Contemporary data also suggest that a multidisciplinary approach to the management of BCRL should begin prior to definitive treatment for breast cancer employing patient-specific surgical, radiation therapy, and chemotherapy paradigms that limit risks. Further, prospective clinical assessments before and after treatment should be employed to diagnose subclinical disease. In those patients who require aggressive locoregional management, prophylactic therapies and the use of CDP can help reduce the long-term sequelae of BCRL.

  11. [Mobile phone based data acquisition and evaluation system for the alternative four diagnostic methods of traditional Chinese medicine]. (United States)

    Yang, Jun; Liu, Jing; Liu, Ran


    This study is dedicated to integrate the theories of the four diagnostic methods of TCM and the methods of mobile healthcare so as to achieve the goal of the four diagnostic functions of TCM on mobile phone. An Android smartphone based data acquisition system has been developed and experimentally demonstrated. It was shown that the prototype could successfully achieve the fundamental function of the four diagnostic methods of TCM and thus help preliminarily interpret the symptoms of human diseases.

  12. The alternative strategies of the development of the nuclear power industry in the 21st century (United States)

    Goverdovskii, A. A.; Kalyakin, S. G.; Rachkov, V. I.


    This paper emphasizes the urgency of scientific-and-technical and sociopolitical problems of the modern nuclear power industry without solving of which the transition from local nuclear power systems now in operation to a large-scale nuclear power industry would be impossible. The existing concepts of the longterm strategy of the development of the nuclear power industry have been analyzed. On the basis of the scenarios having been developed it was shown that the most promising alternative is the orientation towards the closed nuclear fuel cycle with fast neutron reactors (hereinafter referred to as fast reactors) that would meet the requirements on the acceptable safety. It was concluded that the main provisions of "The Strategy of the Development of the Nuclear Power Industry of Russia for the First Half of the 21st Century" approved by the Government of the Russian Federation in the year 2000 remain the same at present as well, although they require to be elaborated with due regard for new realities in the market for fossil fuels, the state of both the Russian and the world economy, as well as tightening of requirements related to safe operation of nuclear power stations (NPSs) (for example, after the severe accident at the Fukushima nuclear power station, Japan) and nonproliferation of nuclear weapons.

  13. Alternative strategies of seed predator escape by early-germinating oaks in Asia and North America. (United States)

    Yi, Xianfeng; Yang, Yueqin; Curtis, Rachel; Bartlow, Andrew W; Agosta, Salvatore J; Steele, Michael A


    Early germination of white oaks is widely viewed as an evolutionary strategy to escape rodent predation; yet, the mechanism by which this is accomplished is poorly understood. We report that chestnut oak Quercus montana (CO) and white oak Q. alba (WO) (from North America), and oriental cork oak Q. variabilis (OO) and Mongolian oak Q. mongolica (MO) (from Asia) can escape predation and successfully establish from only taproots. During germination in autumn, cotyledonary petioles of acorns of CO and WO elongate and push the plumule out of the cotyledons, whereas OO and MO extend only the hypocotyls and retain the plumule within the cotyledons. Experiments showed that the pruned taproots (>6 cm) of CO and WO acorns containing the plumule successfully germinated and survived, and the pruned taproots (≥12 cm) of OO and MO acorns without the plumule successfully regenerated along with the detached acorns, thus producing two seedlings. We argue that these two distinct regeneration morphologies reflect alternative strategies for escaping seed predation.

  14. Targeted alternative splicing of TAF4: a new strategy for cell reprogramming (United States)

    Kazantseva, Jekaterina; Sadam, Helle; Neuman, Toomas; Palm, Kaia


    Reprogramming of somatic cells has become a versatile tool for biomedical research and for regenerative medicine. In the current study, we show that manipulating alternative splicing (AS) is a highly potent strategy to produce cells for therapeutic applications. We demonstrate that silencing of hTAF4-TAFH activity of TAF4 converts human facial dermal fibroblasts to melanocyte-like (iMel) cells. iMel cells produce melanin and express microphthalmia-associated transcription factor (MITF) and its target genes at levels comparable to normal melanocytes. Reprogramming of melanoma cells by manipulation with hTAF4-TAFH activity upon TAFH RNAi enforces cell differentiation towards chondrogenic pathway, whereas ectoptic expression of TAF4 results in enhanced multipotency and neural crest-like features in melanoma cells. In both cell states, iMels and cancer cells, hTAF4-TAFH activity controls migration by supporting E- to N-cadherin switches. From our data, we conclude that targeted splicing of hTAF4-TAFH coordinates AS of other TFIID subunits, underscoring the role of TAF4 in synchronised changes of Pol II complex composition essential for efficient cellular reprogramming. Taken together, targeted AS of TAF4 provides a unique strategy for generation of iMels and recapitulating stages of melanoma progression. PMID:27499390

  15. Field Evaluation of Alternative Testing Strategies for the Detection of HIV Infection in Beijing

    Institute of Scientific and Technical Information of China (English)


    Objective To identify a cost-efficient alternative antibody testing strategy for screening and confirmation of HIV infection by rapid simple tests (RSTs) and enzyme-linked immunosorbent assays (ELISAs). Methods Four RSTs (RST1,RST2, RST3, and RST4 ) and five ELISAs (ELISA1, ELISA2, ELISA3, ELISA4, and ELISA5) were evaluated in two phases by using banked and serum specimens prospectively collected at regional hospitals and voluntary counseling and testing (VCT)centers in Beijing. A total of 200 banked serum specimens were included in the first phase, including 62 HIV-positive, 127 HIV-negative and 11 indeterminate specimens. All specimens were tested by four RSTs and five ELISAs respectively. The second phase involved prospective testing of 389 routine specimens, including 92 HIV-positive, 287 HIV-negative, and 10 indeterminate specimens. All the specimens were tested by two RSTs (RST2 and RST4) and three ELISAs (ELISA1, ELISA3,and ELISA4), which were selected for their respective excellent sensitivity and/or specificity. Western blot (WB) was used as a gold standard for confirming the reactivity of all the specimens. Results Sensitivity, specificity, and efficacy were calculated for each assay in two phases. In the first phase, four assays (ELISA4, RST2, RST3, and RST4) had a specificity of 100%. For the determination of efficacy, ELISA4, RST2, and RST4 were selected in the second phase. ELISA1 and ELISA3 which have a sensitivity of 95.9% and 93.2% respectively also entered this phase. In the second phase, all the five assays (ELISA1, ELISA3, ELISA4, RST2, and RST4) had a sensitivity and specifity of over 90%. ELISA1 had a sensitivity of 99% and ELISA4 a specificity of 99%. Conclusion The sensitivity ELISA1 and the specificit of ELISA4 are comparable to ELISA/WB standard strategy. Application of this alternative testing strategy provides a cost-effective method for determining HIV prevalence in Beijing.

  16. Diagnostic strategies in children with chronic gastrointestinal symptoms in primary care

    NARCIS (Netherlands)

    Holtman, Geeske Atje


    Chronic or recurrent gastrointestinal symptoms are common presentations among children in primary care. Because symptoms of functional gastrointestinal disorders may be indistinguishable from inflammatory bowel disease (IBD), it is a diagnostic challenge for clinicians to differentiate between them

  17. Evaluation of the impact of planning alternative strategies on urban metabolism with the ACASA model (United States)

    Marras, S.; Casula, M.; Pyles, R. D.; Paw U, K. T.; Spano, D.


    A crucial point in urban sustainable development is to evaluate the impact that future planning alternatives has on the main factors affecting the citizens liveableness, as the development of the urban heat island or the carbon emissions level. Recent advances in bio-physical sciences have led to new methods and models to estimate energy, water, and carbon fluxes. Also, several studies have addressed urban metabolism issues, but few have integrated the development of numerical tools and methodologies for the analysis of fluxes between a city and its environment with its validation and application in terms of future development alternatives. Over the past several years and most recently within the European Project "BRIDGE", CMCC tested the ACASA (Advanced-Canopy-Atmosphere-Soil Algorithm) land-surface model over agricultural ecosystems (grapes), wild vegetation (forests and Mediterranean maquis), and urban (Florence) or mixed urban/vegetated land (Helsinki). Preliminary results show success in adapting the model to mixed urban systems in each of the main fluxes of interest. The model was improved to adapt it for urban environment, and key parameterizations of leaf-facet scale interactions permit separate accounting of both biogenic and anthropogenic flux sources and sinks, and allow for easy scenario building for simulations designed to test changes in land use or urban planning. In this way, sustainable planning strategies are proposed based on quantitative assessments of energy, water, and carbon fluxes. In this research, three planning alternatives accounting for an increase in urbanization intensity were tested by ACASA in Helsinki (Finland) for the year 2008. Helsinki is located at a high latitude and is characterized by a rapid urbanization that requires a substantial amount of energy for heating. The model behavior for the baseline and alternatives scenarios (i.e., urban classes with low, mid, and high residential intensity) during the entire year was

  18. Modeling the Impact of Alternative Immunization Strategies: Using Matrices as Memory Lanes.

    Directory of Open Access Journals (Sweden)

    Wladimir J Alonso

    Full Text Available Existing modeling approaches are divided between a focus on the constitutive (micro elements of systems or on higher (macro organization levels. Micro-level models enable consideration of individual histories and interactions, but can be unstable and subject to cumulative errors. Macro-level models focus on average population properties, but may hide relevant heterogeneity at the micro-scale. We present a framework that integrates both approaches through the use of temporally structured matrices that can take large numbers of variables into account. Matrices are composed of several bidimensional (time×age grids, each representing a state (e.g. physiological, immunological, socio-demographic. Time and age are primary indices linking grids. These matrices preserve the entire history of all population strata and enable the use of historical events, parameters and states dynamically in the modeling process. This framework is applicable across fields, but particularly suitable to simulate the impact of alternative immunization policies. We demonstrate the framework by examining alternative strategies to accelerate measles elimination in 15 developing countries. The model recaptured long-endorsed policies in measles control, showing that where a single routine measles-containing vaccine is employed with low coverage, any improvement in coverage is more effective than a second dose. It also identified an opportunity to save thousands of lives in India at attractively low costs through the implementation of supplementary immunization campaigns. The flexibility of the approach presented enables estimating the effectiveness of different immunization policies in highly complex contexts involving multiple and historical influences from different hierarchical levels.

  19. Air Quality and Population Exposure in Urban Areas: Potential Co-Benefits of Alternative Strategies (United States)

    Mikolajczyk, U.; Suppan, P.; Forkel, R.; Williams, M.


    Even though much progress has been achieved through dedicated approaches to improving air quality in many European cities, there are various threats which still remain unchanged. According to the World Health Organization, outdoor air pollution was linked to 3.7 million deaths in year 2012. As climate changes, the frequency of days with harmful levels of air pollutants may significantly increase causing exacerbation of cardiovascular and respiratory diseases. The aim of this study is to conduct health impact assessment by utilizing regionally and spatially specific data in order to assess the influence of alternative emission strategies on human health. In the first stage of this investigation, a modeling study was carried out using the Weather Research and Forecasting (WRF) model coupled with Chemistry (WRF/Chem; Grell et al., 2005) to estimate ambient concentrations of air pollutants. The model set-up included a nesting approach, where three domains with horizontal resolution of 18 km, 6 km and 2 km were defined. The investigation area included the city of Munich (1.5 million inhabitants). The model performance has been evaluated against available air quality observations from the monitoring database "AirBase". The chemical species including O3, NO, NO2 and PM10 simulated by WRF/Chem compare favorably with the observations. The model performs especially well in resolving the observed O3 concentrations. In the ongoing study, different emission reduction scenarios are compared to a baseline 2009 scenario based on Germany's National Emissions Inventory. To investigate health effects associated with air pollution concentrations a local-scale health impact assessment (HIA) will be conducted. Concentration-response functions (CRFs) link the change in mortality rates to the change in concentrations of air pollutants. CRFs are applied to population-weighted mean concentrations to estimate relative risks and hence estimate numbers of attributable deaths and associated

  20. Slip-stacked perylenediimides as an alternative strategy for high efficiency nonfullerene acceptors in organic photovoltaics. (United States)

    Hartnett, Patrick E; Timalsina, Amod; Matte, H S S Ramakrishna; Zhou, Nanjia; Guo, Xugang; Zhao, Wei; Facchetti, Antonio; Chang, Robert P H; Hersam, Mark C; Wasielewski, Michael R; Marks, Tobin J


    Perylenediimide (PDI)-based acceptors offer a potential replacement for fullerenes in bulk-heterojunction (BHJ) organic photovoltaic cells (OPVs). The most promising efforts have focused on creating twisted PDI dimers to disrupt aggregation and thereby suppress excimer formation. Here, we present an alternative strategy for developing high-performance OPVs based on PDI acceptors that promote slip-stacking in the solid state, thus preventing the coupling necessary for rapid excimer formation. This packing structure is accomplished by substitution at the PDI 2,5,8,11-positions ("headland positions"). Using this design principle, three PDI acceptors, N,N-bis(n-octyl)-2,5,8,11-tetra(n-hexyl)-PDI (Hexyl-PDI), N,N-bis(n-octyl)-2,5,8,11-tetraphenethyl-PDI (Phenethyl-PDI), and N,N-bis(n-octyl)-2,5,8,11-tetraphenyl-PDI (Phenyl-PDI), were synthesized, and their molecular and electronic structures were characterized. They were then blended with the donor polymer PBTI3T, and inverted OPVs of the structure ITO/ZnO/Active Layer/MoO3/Ag were fabricated and characterized. Of these, 1:1 PBTI3T:Phenyl-PDI proved to have the best performance with Jsc = 6.56 mA/cm(2), Voc = 1.024 V, FF = 54.59%, and power conversion efficiency (PCE) = 3.67%. Devices fabricated with Phenethyl-PDI and Hexyl-PDI have significantly lower performance. The thin film morphology and the electronic and photophysical properties of the three materials are examined, and although all three materials undergo efficient charge separation, PBTI3T:Phenyl-PDI is found to have the deepest LUMO, intermediate crystallinity, and the most well-mixed domains. This minimizes geminate recombination in Phenyl-PDI OPVs and affords the highest PCE. Thus, slip-stacked PDI strategies represent a promising approach to fullerene replacements in BHJ OPVs.

  1. Alternative Strategies in Response to Saline Stress in Two Varieties of Portulaca oleracea (Purslane.

    Directory of Open Access Journals (Sweden)

    Kristina R Mulry

    Full Text Available Purslane (Portulaca oleracea is a globally-distributed plant with a long history of use in folk medicine and cooking. We have developed purslane as a model system for exploring plant responses to stress. We exposed two varieties of purslane to saline stress with the objective of identifying differences between the varieties in the plasticity of morphological and physiological traits. The varieties responded to saline stress with significantly different changes in the measured traits, which included inter alia biomass, flower counts, proline concentrations and betalain pigment concentrations. The alternative responses of the two varieties consisted of complex, simultaneous changes in multiple traits. In particular, we observed that while both varieties increased production of betalain pigments and proline under saline stress, one variety invested more in betalain pigments while the other invested more in proline. Proline and betalain pigments undoubtedly play multiple roles in plant tissues, but in this case their role as antioxidants deployed to ameliorate saline stress appears to be important. Taken holistically, our results suggest that the two varieties employ different strategies in allocating resources to cope with saline stress. This conclusion establishes purslane as a suitable model system for the study of saline stress and the molecular basis for differential responses.

  2. Range expansion drives the evolution of alternate reproductive strategies in invasive fire ants

    Directory of Open Access Journals (Sweden)

    Jackson A. Helms IV


    Full Text Available Many species are expanding their ranges in response to climate changes or species introductions. Expansion-related selection likely drives the evolution of dispersal and reproductive traits, especially in invasive species introduced into novel habitats. We used an agent-based model to investigate these relationships in the red imported fire ant, Solenopsis invicta, by tracking simulated populations over 25 years. Most colonies of this invasive species produce two types of queens practicing alternate reproductive strategies. Claustral queens found new colonies in vacant habitats, while parasitic queens take over existing colonies whose queens have died. We investigated how relative investment in the two queen types affects population demography, habitat occupancy, and range expansion. We found that parasitic queens extend the ecological lifespan of colonies, thereby increasing a population’s overall habitat occupancy as well as average colony size (number of workers and territory size. At the same time, investment in parasitic queens slowed the rate of range expansion by diverting investment from claustral queens. Divergent selection regimes caused edge and interior populations to evolve different levels of reproductive investment, such that interior populations invested heavily in parasitic queens whereas those at the edge invested almost entirely in claustral queens. Our results highlight factors shaping ant life histories, including the evolution of social parasitism, and have implications for the response of species to range shifts.

  3. Alternative strategies to reduce maternal mortality in India: a cost-effectiveness analysis.

    Directory of Open Access Journals (Sweden)

    Sue J Goldie


    Full Text Available BACKGROUND: Approximately one-quarter of all pregnancy- and delivery-related maternal deaths worldwide occur in India. Taking into account the costs, feasibility, and operational complexity of alternative interventions, we estimate the clinical and population-level benefits associated with strategies to improve the safety of pregnancy and childbirth in India. METHODS AND FINDINGS: Country- and region-specific data were synthesized using a computer-based model that simulates the natural history of pregnancy (both planned and unintended and pregnancy- and childbirth-associated complications in individual women; and considers delivery location, attendant, and facility level. Model outcomes included clinical events, population measures, costs, and cost-effectiveness ratios. Separate models were adapted to urban and rural India using survey-based data (e.g., unmet need for birth spacing/limiting, facility births, skilled birth attendants. Model validation compared projected maternal indicators with empiric data. Strategies consisted of improving coverage of effective interventions that could be provided individually or packaged as integrated services, could reduce the incidence of a complication or its case fatality rate, and could include improved logistics such as reliable transport to an appropriate referral facility as well as recognition of referral need and quality of care. Increasing family planning was the most effective individual intervention to reduce pregnancy-related mortality. If over the next 5 y the unmet need for spacing and limiting births was met, more than 150,000 maternal deaths would be prevented; more than US$1 billion saved; and at least one of every two abortion-related deaths averted. Still, reductions in maternal mortality reached a threshold ( approximately 23%-35% without including strategies that ensured reliable access to intrapartum and emergency obstetrical care (EmOC. An integrated and stepwise approach was

  4. Sustainability indicators, alternative strategies and trade-offs in peasant agroecosystems : analysing 15 case studies from Latin America

    NARCIS (Netherlands)

    Astier, M.; Speelman, E.N.; López-Ridaura, S.; Masera, O.R.; Gonzalez-Esquivel, C.E.


    In view of the urgent need to improve agroecosystem sustainability, several efforts have been made to evaluate the effect of alternative strategies on key environmental and socioeconomic variables at the farm, community and regional levels. Most peasant farmers manage complex and diverse agroecosyst

  5. Fabrication of transistors on flexible substrates: from mass-printing to high-resolution alternative lithography strategies

    NARCIS (Netherlands)

    Moonen, P.; Yakimets, I.; Huskens, J.


    In this report, the development of conventional, mass-printing strategies into high-resolution, alternative patterning techniques is reviewed with the focus on large-area patterning of flexible thin-film transistors (TFTs) for display applications. In the first part, conventional and digital printin

  6. Human organ-on-a-chip BioMEMS devices for testing new diagnostic and therapeutic strategies (United States)

    Leary, James F.; Key, Jaehong; Vidi, Pierre-Alexandre; Cooper, Christy L.; Kole, Ayeeshik; Reece, Lisa M.; Lelièvre, Sophie A.


    MEMS human "organs-on-a-chip" can be used to create model human organ systems for developing new diagnostic and therapeutic strategies. They represent a promising new strategy for rapid testing of new diagnostic and therapeutic approaches without the need for involving risks to human subjects. We are developing multicomponent, superparamagnetic and fluorescent nanoparticles as X-ray and MRI contrast agents for noninvasive multimodal imaging and for antibody- or peptide-targeted drug delivery to tumor and precancerous cells inside these artificial organ MEMS devices. Magnetic fields can be used to move the nanoparticles "upstream" to find their target cells in an organs-on-achip model of human ductal breast cancer. Theoretically, unbound nanoparticles can then be removed by reversing the magnetic field to give a greatly enhanced image of tumor cells within these artificial organ structures. Using branched PDMS microchannels and 3D tissue engineering of normal and malignant human breast cancer cells inside those MEMS channels, we can mimic the early stages of human ductal breast cancer with the goal to improve the sensitivity and resolution of mammography and MRI of very small tumors and test new strategies for treatments. Nanomedical systems can easily be imaged by multicolor confocal microscopy inside the artificial organs to test targeting and therapeutic responses including the differential viability of normal and tumor cells during treatments. Currently we are using 2-dimensional MEMS structures, but these studies can be extended to more complex 3D structures using new 3D printing technologies.

  7. Developing a science of clinical utility in diagnostic classification systems field study strategies for ICD-11 mental and behavioral disorders. (United States)

    Keeley, Jared W; Reed, Geoffrey M; Roberts, Michael C; Evans, Spencer C; Medina-Mora, María Elena; Robles, Rebeca; Rebello, Tahilia; Sharan, Pratap; Gureje, Oye; First, Michael B; Andrews, Howard F; Ayuso-Mateos, José Luís; Gaebel, Wolfgang; Zielasek, Juergen; Saxena, Shekhar


    The World Health Organization (WHO) Department of Mental Health and Substance Abuse has developed a systematic program of field studies to evaluate and improve the clinical utility of the proposed diagnostic guidelines for mental and behavioral disorders in the Eleventh Revision of the International Classification of Diseases and Related Health Problems (ICD-11). The clinical utility of a diagnostic classification is critical to its function as the interface between health encounters and health information, and to making the ICD-11 be a more effective tool for helping the WHO's 194 member countries, including the United States, reduce the global disease burden of mental disorders. This article describes the WHO's efforts to develop a science of clinical utility in regard to one of the two major classification systems for mental disorders. We present the rationale and methodologies for an integrated and complementary set of field study strategies, including large international surveys, formative field studies of the structure of clinicians' conceptualization of mental disorders, case-controlled field studies using experimental methodologies to evaluate the impact of proposed changes to the diagnostic guidelines on clinicians' diagnostic decision making, and ecological implementation field studies of clinical utility in the global settings in which the guidelines will ultimately be implemented. The results of these studies have already been used in making decisions about the structure and content of ICD-11. If clinical utility is indeed among the highest aims of diagnostic systems for mental disorders, as their developers routinely claim, future revision efforts should continue to build on these efforts. (PsycINFO Database Record

  8. Optimizing Preventive Strategies and Malaria Diagnostics to Reduce the Impact of Malaria on US Military Forces (United States)


    Global Electronic Biosurveillance (SAGES) initiative is a platform that allows for syndromic data to be collected and transmitted via smart phones...R&D research and development RDT rapid diagnostic test SAGES Suite for Automated Global Electronic bioSurveillance TATRC Telemedicine

  9. Myocardial Bridging: Contemporary Understanding of Pathophysiology with Implications for Diagnostic and Therapeutic Strategies (United States)

    Eshtehardi, Parham; Rasoul-Arzrumly, Emad; McDaniel, Michael; Mekonnen, Girum; Timmins, Lucas H.; Lutz, Jerre; Guyton, Robert A; Samady, Habib


    Patients with myocardial bridges are often asymptomatic but this anomaly may be associated with exertional angina, acute coronary syndromes, cardiac arrhythmias, syncope or even sudden cardiac death. This review presents our understanding of the pathophysiology of myocardial bridging and describes prevailing diagnostic modalities and therapeutic options for this challenging clinical entity. PMID:24583304

  10. A Strategy to Help Teachers Make a Difference: A Diagnostic-Prescriptive Teaching Model (United States)

    Peterson, Lee T.; McBrayer, John


    The authors discuss the development of a diagnostic-prescriptive teaching and learning program in the Youngstown public school system; give background material; describe organizational form and implementation; and conclude with a series of "points to ponder" for educators contemplating a similar venture. (MB)

  11. Ecology of Fungus Gnats (Bradysia spp. in Greenhouse Production Systems Associated with Disease-Interactions and Alternative Management Strategies

    Directory of Open Access Journals (Sweden)

    Raymond A. Cloyd


    Full Text Available Fungus gnats (Bradysia spp. are major insect pests of greenhouse-grown horticultural crops mainly due to the direct feeding damage caused by the larvae, and the ability of larvae to transmit certain soil-borne plant pathogens. Currently, insecticides and biological control agents are being used successively to deal with fungus gnat populations in greenhouse production systems. However, these strategies may only be effective as long as greenhouse producers also implement alternative management strategies such as cultural, physical, and sanitation. This includes elimination of algae, and plant and growing medium debris; placing physical barriers onto the growing medium surface; and using materials that repel fungus gnat adults. This article describes the disease-interactions associated with fungus gnats and foliar and soil-borne diseases, and the alternative management strategies that should be considered by greenhouse producers in order to alleviate problems with fungus gnats in greenhouse production systems.

  12. What Do You Know about Alternative Energy? Development and Use of a Diagnostic Instrument for Upper Secondary School Science (United States)

    Cheong, Irene Poh-Ai; Johari, Marliza; Said, Hardimah; Treagust, David F.


    The need for renewable and non-fossil fuels is now recognised by nations throughout the world. Consequently, an understanding of alternative energy is needed both in schools and in everyday life-long learning situations. This study developed a two-tier instrument to diagnose students' understanding and alternative conceptions about alternative…

  13. Bouldering: an alternative strategy to long-vertical climbing in root-climbing hortensias. (United States)

    Granados Mendoza, Carolina; Isnard, Sandrine; Charles-Dominique, Tristan; Van den Bulcke, Jan; Rowe, Nick P; Van Acker, Joris; Goetghebeur, Paul; Samain, Marie-Stéphanie


    In the Neotropics, the genus Hydrangea of the popular ornamental hortensia family is represented by climbing species that strongly cling to their support surface by means of adhesive roots closely positioned along specialized anchoring stems. These root-climbing hortensia species belong to the nearly exclusive American Hydrangea section Cornidia and generally are long lianescent climbers that mostly flower and fructify high in the host tree canopy. The Mexican species Hydrangea seemannii, however, encompasses not only long lianescent climbers of large vertical rock walls and coniferous trees, but also short 'shrub-like' climbers on small rounded boulders. To investigate growth form plasticity in root-climbing hortensia species, we tested the hypothesis that support variability (e.g. differences in size and shape) promotes plastic responses observable at the mechanical, structural and anatomical level. Stem bending properties, architectural axis categorization, tissue organization and wood density were compared between boulder and long-vertical tree-climbers of H. seemannii. For comparison, the mechanical patterns of a closely related, strictly long-vertical tree-climbing species were investigated. Hydrangea seemannii has fine-tuned morphological, mechanical and anatomical responses to support variability suggesting the presence of two alternative root-climbing strategies that are optimized for their particular environmental conditions. Our results suggest that variation of some stem anatomical traits provides a buffering effect that regulates the mechanical and hydraulic demands of two distinct plant architectures. The adaptive value of observed plastic responses and the importance of considering growth form plasticity in evolutionary and conservation studies are discussed.

  14. A cluster randomized controlled trial of the Promoting Alternative Thinking Strategies (PATHS) curriculum. (United States)

    Humphrey, Neil; Barlow, Alexandra; Wigelsworth, Michael; Lendrum, Ann; Pert, Kirsty; Joyce, Craig; Stephens, Emma; Wo, Lawrence; Squires, Garry; Woods, Kevin; Calam, Rachel; Turner, Alex


    This randomized controlled trial (RCT) evaluated the efficacy of the Promoting Alternative Thinking Strategies curriculum (PATHS; Kusche & Greenberg, 1994) as a means to improve children's social-emotional competence (assessed via the Social Skills Improvement System (SSIS); Gresham & Elliot, 2008) and mental health outcomes (assessed via the Strengths and Difficulties Questionnaire (SDQ); Goodman, 1997). Forty-five schools in Greater Manchester, England, were randomly assigned to treatment and control groups. Allocation was balanced by proportions of children eligible for free school meals and speaking English as an additional language via minimization. Children (N=4516) aged 7-9years at baseline in the participating schools were the target cohort. During the two-year trial period, teachers of this cohort in schools allocated to the intervention group delivered the PATHS curriculum, while their counterparts in the control group continued their usual provision. Teachers in PATHS schools received initial training and on-going support and assistance from trained coaches. Hierarchical linear modeling of outcome data was undertaken to identify both primary (e.g., for all children) and secondary (e.g., for children classified as "at-risk") intervention effects. A primary effect of the PATHS curriculum was found, demonstrating increases in teacher ratings of changes in children's social-emotional competence. Additionally, secondary effects of PATHS were identified, showing reductions in teacher ratings of emotional symptoms and increases in pro-social behavior and child ratings of engagement among children identified as at-risk at baseline. However, our analyses also identified primary effects favoring the usual provision group, showing reductions in teacher ratings of peer problems and emotional symptoms, and secondary effects demonstrating reductions in teacher ratings of conduct problems and child ratings of co-operation among at-risk children. Effect sizes were small

  15. A Multi-Stakeholder Perspective on the Use of Alternative Test Strategies for Nanomaterial Safety Assessment (United States)

    Nel, Andre E.; Nasser, Elina; Godwin, Hilary; Avery, David; Bahadori, Tina; Bergeson, Lynn; Beryt, Elizabeth; Bonner, James C.; Boverhof, Darrell; Carter, Janet; Castranova, Vince; DeShazo, J. R.; Hussain, Saber M.; Kane, Agnes B.; Klaessig, Fred; Kuempel, Eileen; Lafranconi, Mark; Landsiedel, Robert; Malloy, Timothy; Miller, Mary Beth; Morris, Jeffery; Moss, Kenneth; Oberdorster, Gunter; Pinkerton, Kent; Pleus, Richard C.; Shatkin, Jo Anne; Thomas, Rusty; Tolaymat, Thabet; Wang, Amy; Wong, Jeffrey


    There has been a conceptual shift in toxicological studies from describing what happens to explaining how the adverse outcome occurs, thereby enabling a deeper and improved understanding of how biomolecular and mechanistic profiling can inform hazard identification and improve risk assessment. Compared to traditional toxicology methods, which have a heavy reliance on animals, new approaches to generate toxicological data are becoming available for the safety assessment of chemicals, including high-throughput and high-content screening (HTS, HCS). With the emergence of nanotechnology, the exponential increase in the total number of engineered nanomaterials (ENMs) in research, development, and commercialization requires a robust scientific approach to screen ENM safety in humans and the environment rapidly and efficiently. Spurred by the developments in chemical testing, a promising new toxicological paradigm for ENMs is to use alternative test strategies (ATS), which reduce reliance on animal testing through the use of in vitro and in silico methods such as HTS, HCS, and computational modeling. Furthermore, this allows for the comparative analysis of large numbers of ENMs simultaneously and for hazard assessment at various stages of the product development process and overall life cycle. Using carbon nanotubes as a case study, a workshop bringing together national and international leaders from government, industry, and academia was convened at the University of California, Los Angeles to discuss the utility of ATS for decision-making analyses of ENMs. After lively discussions, a short list of generally shared viewpoints on this topic was generated, including a general view that ATS approaches for ENMs can significantly benefit chemical safety analysis. PMID:23924032

  16. A multi-stakeholder perspective on the use of alternative test strategies for nanomaterial safety assessment. (United States)

    Nel, Andre E; Nasser, Elina; Godwin, Hilary; Avery, David; Bahadori, Tina; Bergeson, Lynn; Beryt, Elizabeth; Bonner, James C; Boverhof, Darrell; Carter, Janet; Castranova, Vince; Deshazo, J R; Hussain, Saber M; Kane, Agnes B; Klaessig, Frederick; Kuempel, Eileen; Lafranconi, Mark; Landsiedel, Robert; Malloy, Timothy; Miller, Mary Beth; Morris, Jeffery; Moss, Kenneth; Oberdorster, Gunter; Pinkerton, Kent; Pleus, Richard C; Shatkin, Jo Anne; Thomas, Russell; Tolaymat, Thabet; Wang, Amy; Wong, Jeffrey


    There has been a conceptual shift in toxicological studies from describing what happens to explaining how the adverse outcome occurs, thereby enabling a deeper and improved understanding of how biomolecular and mechanistic profiling can inform hazard identification and improve risk assessment. Compared to traditional toxicology methods, which have a heavy reliance on animals, new approaches to generate toxicological data are becoming available for the safety assessment of chemicals, including high-throughput and high-content screening (HTS, HCS). With the emergence of nanotechnology, the exponential increase in the total number of engineered nanomaterials (ENMs) in research, development, and commercialization requires a robust scientific approach to screen ENM safety in humans and the environment rapidly and efficiently. Spurred by the developments in chemical testing, a promising new toxicological paradigm for ENMs is to use alternative test strategies (ATS), which reduce reliance on animal testing through the use of in vitro and in silico methods such as HTS, HCS, and computational modeling. Furthermore, this allows for the comparative analysis of large numbers of ENMs simultaneously and for hazard assessment at various stages of the product development process and overall life cycle. Using carbon nanotubes as a case study, a workshop bringing together national and international leaders from government, industry, and academia was convened at the University of California, Los Angeles, to discuss the utility of ATS for decision-making analyses of ENMs. After lively discussions, a short list of generally shared viewpoints on this topic was generated, including a general view that ATS approaches for ENMs can significantly benefit chemical safety analysis.

  17. Systems approaches in osteoarthritis: Identifying routes to novel diagnostic and therapeutic strategies. (United States)

    Mueller, Alan J; Peffers, Mandy J; Proctor, Carole J; Clegg, Peter D


    Systems orientated research offers the possibility of identifying novel therapeutic targets and relevant diagnostic markers for complex diseases such as osteoarthritis. This review demonstrates that the osteoarthritis research community has been slow to incorporate systems orientated approaches into research studies, although a number of key studies reveal novel insights into the regulatory mechanisms that contribute both to joint tissue homeostasis and its dysfunction. The review introduces both top-down and bottom-up approaches employed in the study of osteoarthritis. A holistic and multiscale approach, where clinical measurements may predict dysregulation and progression of joint degeneration, should be a key objective in future research. The review concludes with suggestions for further research and emerging trends not least of which is the coupled development of diagnostic tests and therapeutics as part of a concerted effort by the osteoarthritis research community to meet clinical needs. This article is protected by copyright. All rights reserved.

  18. Immune-Signatures for Lung Cancer Diagnostics: Evaluation of Protein Microarray Data Normalization Strategies



    New minimal invasive diagnostic methods for early detection of lung cancer are urgently needed. It is known that the immune system responds to tumors with production of tumor-autoantibodies. Protein microarrays are a suitable highly multiplexed platform for identification of autoantibody signatures against tumor-associated antigens (TAA). These microarrays can be probed using 0.1 mg immunoglobulin G (IgG), purified from 10 µL of plasma. We used a microarray comprising recombinant proteins der...

  19. Midterm results of diagnostic treatment and repair strategy in older patients presenting with nonrestrictive ventricular septal defect and severe pulmonary artery hypertension

    Institute of Scientific and Technical Information of China (English)

    Liu Aijun; Li Zhiqiang; Li Xiaofeng; Fan Xiangming; Su Junwu; Zhang Jing; He Yan


    Background Congenital heart disease with severe pulmonary arterial hypertension (SPAH),previously thought to have irreversible pulmonary vascular disease (PVD),has been recently successfully corrected using diagnostic treatment and repair strategy by our surgery team.This study aimed to evaluate the midterm results of a selected cohort of older patients with nonrestrictive ventricular septal defect (VSD) and SPAH using diagnostic treatment and repair strategy.Methods The records of 56 patients older than six years with nonrestrictive VSD and SPAH undergoing diagnostic treatment and repair strategy from 2006 to 2012 were retrospectively reviewed.All patients received advanced pulmonary arterial hypertension (PAH) therapy and radical repairs were performed when transcutaneous oxygen saturation (SPO2) increased up to 93%.Results There were no operative deaths.SPO2 and baseline six-minute walk test (SMWT) distance of all selected patients increased significantly and mean pulmonary artery pressure (MPAP) regressed significantly after diagnostic treatment and at late follow-up (P <0.01).The incidence of late postoperative PAH was seen in six (10.7%) patients and by Logistic regression analysis,early postoperative PAH was an independent risk factor related to late postoperative PAH.Conclusions Diagnostic treatment and repair strategy was effective and safe for treatment of nonrestrictive VSD and SPAH and the midterm results were excellent.Diagnostic treatment strategy was effective in assessing the reversibility of SPAH in older patients associated with nonrestrictive VSD and the PVD in these selective patients is generally reversible.

  20. Is a biomarker-based diagnostic strategy for invasive aspergillosis cost effective in high-risk haematology patients? (United States)

    Macesic, N; Morrissey, C O; Liew, D; Bohensky, M A; Chen, S C-A; Gilroy, N M; Milliken, S T; Szer, J; Slavin, M A


    Empirical antifungal therapy is frequently used in hematology patients at high risk of invasive aspergillosis (IA), with substantial cost and toxicity. Biomarkers for IA aim for earlier and more accurate diagnosis and targeted treatment. However, data on the cost-effectiveness of a biomarker-based diagnostic strategy (BDS) are limited. We evaluated the cost effectiveness of BDS using results from a randomized controlled trial (RCT) and individual patient costing data. Data inputs derived from a published RCT were used to construct a decision-analytic model to compare BDS (Aspergillus galactomannan and PCR on blood) with standard diagnostic strategy (SDS) of culture and histology in terms of total costs, length of stay, IA incidence, mortality, and years of life saved. Costs were estimated for each patient using hospital costing data to day 180 and follow-up for survival was modeled to five years using a Gompertz survival model. Treatment costs were determined for 137 adults undergoing allogeneic hematopoietic stem cell transplant or receiving chemotherapy for acute leukemia in four Australian centers (2005-2009). Median total costs at 180 days were similar between groups (US[Formula: see text] for SDS [IQR US[Formula: see text

  1. Teaching science for conceptual change: Toward a proposed taxonomy of diagnostic teaching strategies to gauge students' personal science conceptions (United States)

    Shope, Richard Edwin, III

    Science instruction aims to ensure that students properly construct scientific knowledge so that each individual may play a role as a science literate citizen or as part of the science workforce (National Research Council, 1996, 2000). Students enter the classroom with a wide range of personal conceptions regarding science phenomena, often at variance with prevailing scientific views (Duschl, Hamilton, & Grandy, 1992; Hewson, 1992). The extensive misconceptions research literature emphasizes the importance of diagnosing students' initial understandings in order to gauge the accuracy and depth of what each student knows prior to instruction and then to use that information to adapt the teaching to address student needs. (Ausubel, 1968; Carey, 2000; Driver et al., 1985; Karplus & Thier, 1967; Mintzes, Wandersee, & Novak, 1998; Osborne & Freyberg, 1985; Project 2061, 1993; Strike & Posner, 1982, 1992; Vygotsky, 1934/1987). To gain such insight, teachers diagnose not only the content of the students' personal conceptions but also the thinking processes that produced them (Strike and Posner, 1992). Indeed, when teachers design opportunities for students to express their understanding, there is strong evidence that such diagnostic assessment also enhances science teaching and learning (Black & William, 1998). The functional knowledge of effective science teaching practice resides in the professional practitioners at the front lines---the science teachers in the classroom. Nevertheless, how teachers actually engage in the practice of diagnosis is not well documented. To help fill this gap, the researcher conducted a study of 16 sixth grade science classrooms in four Los Angeles area middle schools. Diagnostic teaching strategies were observed in action and then followed up by interviews with each teacher. Results showed that teachers use strategies that vary by the complexity of active student involvement, including pretests, strategic questions, interactive discussion

  2. The Importance of Alternative Diagnostic Modalities in the Diagnosis of Small Bowel Tumors After a Negative Capsule Endoscopy

    Directory of Open Access Journals (Sweden)

    Iolanda Ribeiro


    We report the case of a patient with overt obscure gastrointestinal bleeding due to a gastrointestinal stromal tumor diagnosed by CT enterography after two negatives capsule endoscopies. This case shows that capsule endoscopy may overlook significant life threatening lesions and highlights the importance of using other diagnostic modalities after a negative capsule endoscopy, especially in patients with a high index of suspicion for small bowel tumoral pathology or persistent/recurrent bleeding.

  3. An unusual presentation of dermatofibrosarcoma protuberans with pleomorphic sarcomatous transformation: potential pitfall and diagnostic strategy. (United States)

    Cesinaro, Anna Maria; Mataca, Ema; Gambini, Claudio; Kutzner, Heinz


    Dermatofibrosarcoma protuberans (DFSP) is a low grade, superficial sarcoma characterized by a proliferation of monomorphous, spindle cells arranged in a storiform pattern and infiltrating the subcutaneous tissue. The tumor is typically CD34 positive, and shows the characteristic COL1A1-PDGFB fusion gene, detectable either by florescent in situ hybridization (FISH) and polymerase chain reaction (PCR). We describe a case of DFSP with a focus of peculiar pleomorphic sarcomatous transformation. The focus constituted the entire bioptic tissue that was initially excised, raising considerable diagnostic problems for pathologist. The use of FISH as an ancillary technique allowed the right diagnosis.

  4. Sedation for pediatric diagnostic imaging: use of pediatric and nursing resources as an alternative to a radiology department sedation team

    Energy Technology Data Exchange (ETDEWEB)

    Ruess, Lynne [Department of Radiology, Tripler Army Medical Center, Honolulu, HI (United States); Uniformed Services University of the Health Scsiences, Bethesda, MD (United States); O' Connor, Stephen C. [Department of Radiology, Tripler Army Medical Center, Honolulu, HI (United States); Mikita, Cecilia P. [Department of Pediatrics, Tripler Army Medical Center, Honolulu, HI (United States); Creamer, Kevin M. [Department of Pediatrics, Tripler Army Medical Center, Honolulu, HI (United States)


    Objective. To develop a pathway to provide safe, effective, and efficient sedation for pediatric diagnostic imaging studies using non-radiology personnel. Materials and methods. A multidisciplinary team considered manpower and training requirements and national sedation standards before designing a sedation pathway, which included scheduling, pre-sedation history and physical, medication protocols, and monitoring. Oral and IV medication protocols were developed based on patient age and weight. Sedation delays were defined as >15 min (IV) or >30 min (PO) from start of sedation to start of imaging. A sedation failure resulted in an incomplete diagnostic imaging study. Failure rates of 124 sedations before and 388 sedations after the pathway were compared.Results. The sedation failure rate for 7 months prior to pathway initiation was 15% (19/124). In the first 25 months after pathway initiation, failures were significantly reduced to 1.5% (6/388) (P<0.0001). Three (50%) of the six failures after pathway initiation were long examinations (>55 min). Deviation from the recommended medication protocol accounted for most of the 115 delays. Only minor adverse events were seen (12/388, 3.1%).Conclusion. Implementing a pediatric sedation pathway significantly decreases the sedation failure rate. Pediatric residents and nurses can safely, effectively and efficiently sedate pediatric patients for routine diagnostic imaging procedures without the need for a radiology department sedation team in a department with a small-to-moderate volume of pediatric patients. (orig.)

  5. Transformation of theoretical-methodological approaches and methodical tools of the individual and territory welfare diagnostics. Part 1. From spreading to the alternative diagnostics approaches (background

    Directory of Open Access Journals (Sweden)

    Aleksandr Anatolyevich Kuklin


    Full Text Available This article presents an evolution of theoretical and methodological approaches to the welfare study. Existing theories of wellbeing are grouped according to accounted method of goods and resources distribution among society members. As a welfare future as a category we highlight objective (measured and subjective (estimated components. Based on the analysis of scientific literature we determine the ratio of individual and social welfare. The main differences between the categories of “ welfare” and “wealth” are given. The main difference consists in multidirectional changes of welfare and wealth for an increase (decrease in income of the individual (country. In this article we present an analysis of modern approaches to the definition of welfare: state, institutional and expendable approach. The welfare level estimation is complicated due to the need to consider the subjective component. The article provides an analysis of existing approaches to quantitative welfare evaluation ranging from the most common techniques (HDI, GDP to alternative techniques (Happy Planet Index.Methodological devices are structured by levels of welfare assessment objects (world, country, region, people. Based on the analysis of the advantages and disadvantages of methods we can conclude that the most reliable method is a comprehensive approach, which includes economic, environmental, social, vital and infrastructure indicators. The author’s approach to the formation of a complex methodological tool for individual and territory welfare estimation is presented in this article.

  6. Strategy for diffusion of alternative energy sources and energetic efficiency; Uma estrategia de divulgacao de energias alternativas e eficiencia energetica

    Energy Technology Data Exchange (ETDEWEB)

    Souza, Hamilton Moss de; Aguiar, Joao Carlos; Sa, Antonio Leite de; Galdino, Marco Antonio [Centro de Pesquisas de Energia Eletrica (CEPEL), Rio de Janeiro, RJ (Brazil); Dutra, Ricardo; Rodrigues, Pierre T. [Fundacao Padre Leonel Franca, Rio de Janeiro, RJ (Brazil); Borges, Hortencio A. [Pontificia Univ. Catolica do Rio de Janeiro, RJ (Brazil)


    This paper presents and evaluates the results obtained up to the present from a technological divulgation strategy which resulted into a cooperation program between the CEPEL and the University-Society Integration Program (PIUES) that is been conducted by the catholic University of Rio de Janeiro. That cooperation was initially restricted to the divulgation and stimulation of technical teaching of alternative energy sources, particularly solar energy, being posteriorly extended to the energy efficiency techniques.

  7. Direct coupling: a possible strategy to control fruit production in alternate bearing (United States)

    Prasad, Awadhesh; Sakai, Kenshi; Hoshino, Yoshinobu


    We investigated the theoretical possibility of applying phenomenon of synchronization of coupled nonlinear oscillators to control alternate bearing in citrus. The alternate bearing of fruit crops is a phenomenon in which a year of heavy yield is followed by an extremely light one. This phenomenon has been modeled previously by the resource budget model, which describes a typical nonlinear oscillator of the tent map type. We have demonstrated how direct coupling, which could be practically realized through grafting, contributes to the nonlinear dynamics of alternate bearing, especially phase synchronization. Our results show enhancement of out-of-phase synchronization in production, which depends on initial conditions obtained under the given system parameters. Based on these numerical experiments, we propose a new method to control alternate bearing, say in citrus, thereby enabling stable fruit production. The feasibility of validating the current results through field experimentation is also discussed. PMID:28051141

  8. Direct coupling: a possible strategy to control fruit production in alternate bearing (United States)

    Prasad, Awadhesh; Sakai, Kenshi; Hoshino, Yoshinobu


    We investigated the theoretical possibility of applying phenomenon of synchronization of coupled nonlinear oscillators to control alternate bearing in citrus. The alternate bearing of fruit crops is a phenomenon in which a year of heavy yield is followed by an extremely light one. This phenomenon has been modeled previously by the resource budget model, which describes a typical nonlinear oscillator of the tent map type. We have demonstrated how direct coupling, which could be practically realized through grafting, contributes to the nonlinear dynamics of alternate bearing, especially phase synchronization. Our results show enhancement of out-of-phase synchronization in production, which depends on initial conditions obtained under the given system parameters. Based on these numerical experiments, we propose a new method to control alternate bearing, say in citrus, thereby enabling stable fruit production. The feasibility of validating the current results through field experimentation is also discussed.

  9. Helicobacter Pylori Infection: Diagnostic Strategies in Primary Diagnosis and After Therapy. (United States)

    Atkinson, Nathan S S; Braden, Barbara


    Accurate diagnosis of Helicobacter pylori infection pre- and post-treatment is mandatory in the current era of decreasing prevalence and increasing antibiotic resistance. The diagnostic performance of most tests is poorer in clinical situations with low bacterial density which is seen in conditions such as atrophic gastritis or intake of antisecretory and antibiotic medications. Noninvasive tests require less cost and resource but provide excellent accuracy; however, endoscopy with testing of gastric biopsy specimens is indicated where alarming symptoms are present or antibiotic susceptibility testing by culture is desired. Newer modalities such as polymerase chain reaction testing provide additional virulence and antibiotic sensitivity profiling. This article outlines new developments and the key parameters of each test, as careful selection of test modality within the clinical context is required for adequate management of infected symptomatic patients.

  10. Self-regulation from Educational Psychology to L2 Pedagogy: an Alternative to Language Learning Strategies

    Directory of Open Access Journals (Sweden)

    Maryam Banisaeid


    Full Text Available Language learning strategy was the focus of many studies during the last two decades. Because of definitional fuzziness and unreliable instrument, the concept of language learning strategy was replaced by self-regulation in educational psychology. Subsequently, this shift affected L2 research. The notion of self-regulation is used in some L2 studies today (Tseng, Dörnyei & Schmitt, 2006; Rose, 2011b, Banisaeid, 2013a, 2013b. Self-regulation is more process-oriented while language learning strategy is more product-oriented. Although it only encompasses the metacognitive strategy, the general domain of it is meaningfully wider than the strategic framework. It covers some aspects in the learning process as motivation, goals and self-efficacy. Keywords: self-regulation, language learning strategy, L2 studies, educational psychology

  11. Differences in Regional Diagnostic Strategies and in Intended Versus Actual First-Line Treatment of Patients With Advanced Ovarian Cancer in Denmark

    DEFF Research Database (Denmark)

    Fagö-Olsen, Carsten Lindberg; Ottesen, Bent; Kehlet, Henrik


    BACKGROUND: Triage of patients with ovarian cancer to primary debulking surgery (PDS) or neoadjuvant chemotherapy (NACT) is challenging. In Denmark, the use of NACT has increased, but substantial differences in the use of NACT or PDS exist among centers. We aimed to characterize the differences b......-line treatments as well as in the diagnostic process and use of NACT, calling for further discussion on diagnostic strategy and therapeutically approach for patients with advanced ovarian cancer....

  12. Verification of in vitro medical diagnostics (IVD) metrological traceability: responsibilities and strategies. (United States)

    Braga, Federica; Panteghini, Mauro


    To be accurate and equivalent, laboratory results should be traceable to higher-order references. Furthermore, their analytical performance should fulfill acceptable measurement uncertainty criteria defined to fit the intended clinical use. With this aim, In Vitro Diagnostics (IVD) manufacturers should define a calibration hierarchy to assign traceable values to their system calibrators and to fulfill during this process uncertainty limits for calibrators, which should represent a proportion of the uncertainty budget allowed for laboratory results. It is important that end-users may know and verify how manufacturers have implemented the traceability of their calibrators and estimated the corresponding uncertainty. However, full information about traceability and combined uncertainty of calibrators is currently not available. Important tools for IVD traceability surveillance are the verification by laboratories of the consistency of declared performance during daily operations performed in accordance with the manufacturer's instructions and the organization of appropriately structured External Quality Assessment (EQA) programs. The former activity should be accomplished by analyzing system control materials and confirming that current measurements are in the manufacturer's established control range. With regard to EQA, it is mandatory that target values for materials are assigned with reference procedures by accredited laboratories, that materials are commutable and that a clinically allowable inaccuracy for participant's results is defined.

  13. An alternative perspective on how laboratory medicine can contribute to solve the health care crisis: a model to save costs by acquiring excellence in diagnostic systems. (United States)

    Mussap, Michele


    The rapid escalation in health care costs has led to the idea to deliver better care at lower costs, reshaping the responsibilities of the health care system to achieve the goal of creating value for the patient. The pressure for fiscal containment and the progressive reduction in available health care resources originated very short term strategies consisting of abrupt reductions in expenditure, specifically in the provision of clinical pathology laboratory medicine services. However, the impact of laboratory test results on diagnostic and therapeutic interventions has increased enormously in the past decade, due to advances in personalized medicine and to the strictly correlated requirement to use new biomarkers with increasing sensitivity and specificity in clinical practice. In order to create savings by delivering better care there is the need to invest financial resources in purchasing high technology and new sophisticated tests and to promote the expertise of clinical pathologists and laboratory medicine professionals. This approach to creating value in patient health care is more productive and sustainable ethically, morally and economically as a long-term strategy. It can be successfully achieved by applying defined rules that make public-private cooperation clearer, skipping incompatible solutions such as transforming clinical laboratories to 'industrially productive premises', outsourcing laboratory medicine services and using central acquisition of diagnostic systems.

  14. Frequent change of procedure during coronary artery bypass surgery suggests insufficient preoperative diagnostic strategy

    DEFF Research Database (Denmark)

    Eckardt, Rozy; Kjeldsen, Bo Juel; Thayssen, Per


    We sought to evaluate how often and in what way surgeons change peroperatively their preoperative coronary artery bypass grafting strategy and to what degree these changes affect postoperative graft patency. A series of 109 patients with stable angina pectoris and at least one occluded coronary...... preoperatively planned grafts were inserted. When shifts occurred, no matter in which direction, it resulted in a decreased patency rate of the inserted grafts. This finding was significant for LAD (P=0.037). Our findings might indicate the necessity of future studies with the use of scintigraphy or fractional...

  15. The time-efficiency principle: time as the key diagnostic strategy in primary care. (United States)

    Irving, Greg; Holden, John


    The test and retest opportunity afforded by reviewing a patient over time substantially increases the total gain in certainty when making a diagnosis in low-prevalence settings (the time-efficiency principle). This approach safely and efficiently reduces the number of patients who need to be formally tested in order to make a correct diagnosis for a person. Time, in terms of observed disease trajectory, provides a vital mechanism for achieving this task. It remains the best strategy for delivering near-optimal diagnoses in low-prevalence settings and should be used to its full advantage.

  16. Undiagnosed invasive candidiasis: incorporating non-culture diagnostics into rational prophylactic and preemptive antifungal strategies. (United States)

    Clancy, Cornelius J; Nguyen, Minh Hong


    The insensitivity of blood cultures for diagnosing invasive candidiasis fuels prophylactic and preemptive antifungal treatment. Assays like serum β-D-glucan or mannan/anti-mannan detection can identify blood culture-negative invasive candidiasis, but their roles in guiding antifungal therapy are undefined. We propose that non-culture tests can be incorporated into rational management strategies, based on clinical setting. As an example, β-D-glucan sensitivity/specificity for blood culture-negative, deep-seated candidiasis is approximately 60/75%. In intensive care units with candidiasis rates, positive/negative predictive values are 99% and 6/98%, respectively. With pre-test likelihoods of 10 and 33%, positive/negative predictive values are 20/94% and 54/79%, respectively. Based on these data, negative and positive β-D-glucan results likely will be most useful for discontinuing prophylaxis among low-risk to moderate-risk patients (pre-test likelihoods ∼3-10%), and triggering preemptive therapy among moderate-risk to high-risk patients (pre-test likelihoods ∼10-25%), respectively. In extremely high-risk patients, universal prophylaxis is likely to be the best strategy.

  17. Single-Case Research Design: An Alternative Strategy for Evidence-Based Practice (United States)

    Stapleton, Drue; Hawkins, Andrew


    Objective: The trend of utilizing evidence-based practice (EBP) in athletic training is now requiring clinicians, researchers, educators, and students to be equipped to both engage in and make judgments about research evidence. Single-case design (SCD) research may provide an alternative approach to develop such skills and inform clinical and…

  18. Long-term strategies for flood risk management: scenario definition and strategic alternative design

    NARCIS (Netherlands)

    Bruijn, de K.; Klijn, F.; McGahey, C.; Mens, M.; Wolfert, H.P.


    This report reviews some mainstream existing methods of scenario development and use, as well as experiences with the design and assessment of strategic alternatives for flood risk management. Next, a procedure and methods are proposed and discussed. Thirdly, the procedure and methods are tried on t

  19. BRAF-mutant melanoma: treatment approaches, resistance mechanisms, and diagnostic strategies. (United States)

    Spagnolo, Francesco; Ghiorzo, Paola; Orgiano, Laura; Pastorino, Lorenza; Picasso, Virginia; Tornari, Elena; Ottaviano, Vincenzo; Queirolo, Paola


    BRAF inhibitors vemurafenib and dabrafenib achieved improved overall survival over chemotherapy and have been approved for the treatment of BRAF-mutated metastatic melanoma. More recently, the combination of BRAF inhibitor dabrafenib with MEK inhibitor trametinib has shown improved progression-free survival, compared to dabrafenib monotherapy, in a Phase II study and has received approval by the US Food and Drug Administration. However, even when treated with the combination, most patients develop mechanisms of acquired resistance, and some of them do not achieve tumor regression at all, because of intrinsic resistance to therapy. Along with the development of BRAF inhibitors, immunotherapy made an important step forward: ipilimumab, an anti-CTLA-4 monoclonal antibody, was approved for the treatment of metastatic melanoma; anti-PD-1 agents achieved promising results in Phase I/II trials, and data from Phase III studies will be ready soon. The availability of such drugs, which are effective regardless of BRAF status, has made the therapeutic approach more complex, as first-line treatment with BRAF inhibitors may not be the best choice for all BRAF-mutated patients. The aim of this paper is to review the systemic therapeutic options available today for patients affected by BRAF V600-mutated metastatic melanoma, as well as to summarize the mechanisms of resistance to BRAF inhibitors and discuss the possible strategies to overcome them. Moreover, since the molecular analysis of tumor specimens is now a pivotal and decisional factor in the treatment strategy of metastatic melanoma patients, the advances in the molecular detection techniques for the BRAF V600 mutation will be reported.

  20. Alternative Strategies for Maximizing the Output of Multi-Junction Photovoltaic Panels

    CERN Document Server

    Abrams, Ze'ev R


    Multi-junction photovoltaics provide a logical method of increasing the utilization of solar power for a given area. However, their current design and fabrication methods invoke numerous material and cost complexities that limit their potential, particularly for flat panel paradigms. In this paper, three general strategies based on the electrical isolation of the internal sub-layers are described. These strategies involve current or voltage matching the sub-layers by varying of fractional absorption and areal coverage of individual cells within each sub-layer, as well as modifying their combined output using power electronics. A simplified theoretical description of these strategies is provided for pairs of junction materials that allows a more streamlined description of the requirements.

  1. Mixed strategies for energy conservation and alternative energy utilization (solar) in buildings. Final report. Volume III. Appendixes. [10 appendices

    Energy Technology Data Exchange (ETDEWEB)



    This appendix summarizes building characteristics used to determine heating and cooling loads for each of the five building types in each of the four regions. For the selected five buildings, the following data are attached: new and existing construction characteristics; new and existing construction thermal resistance; floor plan and elevation; people load schedule; lighting load schedule; appliance load schedule; ventilation schedule; and hot water use schedule. For the five building types (single family, apartment buildings, commercial buildings, office buildings, and schools), data are compiled in 10 appendices. These are Building Characteristics; Alternate Energy Sources and Energy Conservation Techniques Description, Costs, Fuel Price Scenarios; Life Cycle Cost Model; Simulation Models; Solar Heating/Cooling System; Condensed Weather; Single and Multi-Family Dwelling Characteristics and Energy Conservation Techniques; Mixed Strategies for Energy Conservation and Alternative Energy Utilization in Buildings. An extensive bibliography is given in the final appendix. (MCW)

  2. Efficiency of alternative McMC strategies illustrated using the reaction norm model

    DEFF Research Database (Denmark)

    Shariati, M; Sorensen, D


    The Markov chain Monte Carlo (MCMC) strategy provides remarkable flexibility for fitting complex hierarchical models. However, when parameters are highly correlated in their posterior distributions and their number is large, a particular MCMC algorithm may perform poorly and the resulting...... inferences may be affected. The objective of this study was to compare the efficiency (in terms of the asymptotic variance of features of posterior distributions of chosen parameters, and in terms of computing cost) of six MCMC strategies to sample parameters using simulated data generated with a reaction...

  3. First meeting "Cystic echinococcosis in Chile, update in alternatives for control and diagnostics in animals and humans". (United States)

    Alvarez Rojas, Cristian A; Fredes, Fernando; Torres, Marisa; Acosta-Jamett, Gerardo; Alvarez, Juan Francisco; Pavletic, Carlos; Paredes, Rodolfo; Cortés, Sandra


    This report summarizes the outcomes of a meeting on cystic echinococcosis (CE) in animals and humans in Chile held in Santiago, Chile, between the 21st and 22nd of January 2016. The meeting participants included representatives of the Departamento de Zoonosis, Ministerio de Salud (Zoonotic Diseases Department, Ministry of Health), representatives of the Secretarias Regionales del Ministerio de Salud (Regional Department of Health, Ministry of Health), Instituto Nacional de Desarrollo Agropecuario (National Institute for the Development of Agriculture and Livestock, INDAP), Instituto de Salud Pública (National Institute for Public Health, ISP) and the Servicio Agrícola y Ganadero (Animal Health Department, SAG), academics from various universities, veterinarians and physicians. Current and future CE control activities were discussed. It was noted that the EG95 vaccine was being implemented for the first time in pilot control programmes, with the vaccine scheduled during 2016 in two different regions in the South of Chile. In relation to use of the vaccine, the need was highlighted for acquiring good quality data, based on CE findings at slaughterhouse, previous to initiation of vaccination so as to enable correct assessment of the efficacy of the vaccine in the following years. The current world's-best-practice concerning the use of ultrasound as a diagnostic tool for the screening population in highly endemic remote and poor areas was also discussed.

  4. [Gastrointestinal stromal tumors: definition, histological, immunohistochemical, and molecular features, and diagnostic strategy]. (United States)

    Coindre, Jean-Michel; Emile, Jean-François; Monges, Geneviève; Ranchère-Vince, Dominique; Scoazec, Jean-Yves


    , imatinib, which is a pharmacological antagonist of the KIT protein. Proper understanding and utilisation of the diagnostic criteria and classification of GIST by pathologists are essential for good patient management.

  5. Project Cerberus: tobacco industry strategy to create an alternative to the Framework Convention on Tobacco Control. (United States)

    Mamudu, Hadii M; Hammond, Ross; Glantz, Stanton A


    Between 1999 and 2001, British American Tobacco, Philip Morris, and Japan Tobacco International executed Project Cerberus to develop a global voluntary regulatory regime as an alternative to the Framework Convention on Tobacco Control (FCTC). They aimed to develop a global voluntary regulatory code to be overseen by an independent audit body and to focus attention on youth smoking prevention. The International Tobacco Products Marketing Standards announced in September 2001, however, did not have the independent audit body. Although the companies did not stop the FCTC, they continue to promote the International Tobacco Products Marketing Standards youth smoking prevention as an alternative to the FCTC. Public health civil society groups should help policymakers and governments understand the importance of not working with the tobacco industry.

  6. Computer-assisted learning as an alternative to didactic lectures: a study of teaching the physics of diagnostic imaging

    Directory of Open Access Journals (Sweden)

    V.H. M. Dale


    Full Text Available In recent years there has been an expansion in the number of undergraduate students recruited to the veterinary courses in the UK veterinary schools. This growth in student numbers has not been matched by an increase in academic staff devoted to teaching. In addition, higher education has in the 1990s suffered an approximate 20 per cent reduction in government funding if the effects of inflation and student numbers are taken into account. At the same time there has been a demand for the investigation of teaching quality, leading to the Teaching Quality Assurance process (Ellis, 1993. Thus a number of converging factors have stimulated the need to look for alternative and innovative methods of teaching in veterinary undergraduate education.

  7. BRAF-mutant melanoma: treatment approaches, resistance mechanisms, and diagnostic strategies

    Directory of Open Access Journals (Sweden)

    Spagnolo F


    available today for patients affected by BRAF V600-mutated metastatic melanoma, as well as to summarize the mechanisms of resistance to BRAF inhibitors and discuss the possible strategies to overcome them. Moreover, since the molecular analysis of tumor specimens is now a pivotal and decisional factor in the treatment strategy of metastatic melanoma patients, the advances in the molecular detection techniques for the BRAF V600 mutation will be reported. Keywords: melanoma, BRAF, vemurafenib, dabrafenib, resistance, BRAF inhibitor

  8. Investigating portable fluorescent microscopy (CyScope® as an alternative rapid diagnostic test for malaria in children and women of child-bearing age

    Directory of Open Access Journals (Sweden)

    Sousa-Figueiredo José


    Full Text Available Abstract Background Prompt and correct diagnosis of malaria is crucial for accurate epidemiological assessment and better case management, and while the gold standard of light microscopy is often available, it requires both expertise and time. Portable fluorescent microscopy using the CyScope® offers a potentially quicker, easier and more field-applicable alternative. This article reports on the strengths, limitations of this methodology and its diagnostic performance in cross-sectional surveys on young children and women of child-bearing age. Methods 552 adults (99% women of child-bearing age and 980 children (99% ≤ 5 years of age from rural and peri-urban regions of Ugandan were examined for malaria using light microscopy (Giemsa-stain, a lateral-flow test (Paracheck-Pf® and the CyScope®. Results from the surveys were used to calculate diagnostic performance (sensitivity and specificity as well as to perform a receiver operating characteristics (ROC analyses, using light microscopy as the gold-standard. Results Fluorescent microscopy (qualitative reads showed reduced specificity (400 parasites/μL blood: sensitivity of 64.2% and specificity of 86.0%. Overall, the diagnostic performance of the CyScope was found inferior to that of Paracheck-Pf®. Discussion Fluorescent microscopy using the CyScope® is certainly a field-applicable and relatively affordable solution for malaria diagnoses especially in areas where electrical supplies may be lacking. While it is unlikely to miss higher parasitaemia, its application in cross-sectional community-based studies leads to many false positives (i.e. small fluorescent bodies of presently unknown origin mistaken as malaria parasites. Without recourse to other technologies, arbitration of these false positives is presently equivocal, which could ultimately lead to over-treatment; something that should be further explored in future investigations if the CyScope® is to be more widely implemented.

  9. Giving Literacy Away. Alternative Strategies for Increasing Adult Literacy Development, Training Capacity and Program Participation. (United States)

    Reder, Stephen M.

    The phenomenon of adult functional illiteracy in the United States is examined, and strategies are considered for addressing the problem. Reasons for the failure of existing programs (schools, adult education, and volunteer tutoring) to close the literacy gap are explored; among these factors are the relative growth of underserved populations,…

  10. Mindfulness-Based Exposure Strategies as a Transdiagnostic Mechanism of Change: An Exploratory Alternating Treatment Design. (United States)

    Brake, C Alex; Sauer-Zavala, Shannon; Boswell, James F; Gallagher, Matthew W; Farchione, Todd J; Barlow, David H


    The present study explored whether distress reduction in response to strong negative emotions, a putative transdiagnostic mechanism of action, is facilitated by mindfulness strategies. Seven patients (mean age=31.14years, SD=12.28, range 19-48 years, 43% female, 86% Caucasian) with heterogeneous anxiety disorders (i.e., panic disorder with or without agoraphobia, social anxiety, generalized anxiety) were assigned a randomized order of weeklong blocks utilizing either mindfulness- or avoidance-based strategies while ascending a 6-week emotion exposure hierarchy. Participants completed three exposures per block and provided distress and avoidance use ratings following each exposure. Anxiety severity, distress aversion, and distraction/suppression tendencies were also assessed at baseline and the conclusion of each block. Visual, descriptive, and effect size results showing exposures utilizing mindfulness were associated with higher overall distress levels, compared with those utilizing avoidance. Within blocks, the majority of participants exhibited declining distress levels when employing mindfulness strategies, as opposed to more static distress levels in the avoidance condition. Systematic changes in anxiety severity, distress aversion, and distraction/suppression were not observed. These results suggest mindfulness strategies may be effective in facilitating emotion exposure; however, a minimum dosage may be necessary to overcome initial distress elevation. Potential transdiagnostic change mechanisms and clinical implications are discussed.

  11. Structural Equation Models of Latent Interactions: Evaluation of Alternative Estimation Strategies and Indicator Construction (United States)

    Marsh, Herbert W.; Wen, Zhonglin; Hau, Kit-Tai


    Interactions between (multiple indicator) latent variables are rarely used because of implementation complexity and competing strategies. Based on 4 simulation studies, the traditional constrained approach performed more poorly than did 3 new approaches-unconstrained, generalized appended product indicator, and quasi-maximum-likelihood (QML). The…

  12. The long-term outcomes of four alternative treatment strategies for primary open-angle glaucoma

    NARCIS (Netherlands)

    van Gestel, Aukje; Webers, Carroll A.; Severens, Johan L.; Beckers, Henny J.; Jansonius, Nomdo M.; Hendrikse, Fred; Schouten, Jan S.


    Purpose: To evaluate the long-term effects and costs of four treatment strategies for primary open-angle glaucoma compared to usual care. Methods: Cost-effectiveness analyses with a lifelong horizon were made from a societal perspective. Data were generated with a patient-level model based on discre

  13. Strategies in the preparation of DNA oligonucleotide arrays for diagnostic applications. (United States)

    Beaucage, S L


    This report emphasizes the interfacial chemistry that is required to ensure proper attachment of oligonucleotides onto the surface of microarrays. For example, strategies for the covalent attachment of pre-synthesized oligonucleotides to glass slides, gold films, polyacrylamide gel pads, polypyrrole films, and optical fibers are surveyed in an attempt to better define the parameters for optimal formation and detection of DNA hybrids. These parameters include among others, the nature and length of the linkers attaching oligonucleotides to the arrays, and the surface density of oligonucleotides required for unhindered hybridization with DNA targets. Sensitive detection methods such as the use of light-scattering techniques, molecular beacons, surface plasmon resonance, attenuated total internal reflection-FTIR, and the evanescent field excitation of fluorescence from surface-bound fluorophores have been developed to study the kinetics and specificity of hybridization events. Finally, the synthesis of oligonucleotides directly on glass surfaces and polypropylene sheets has been investigated to enable DNA sequencing by hybridization and achieve oligonucleotide densities of ca. 10(6) sequences per cm(2) on DNA chips.

  14. Environmental cost-benefit analysis of alternative timing strategies in greenhouse gas abatement. A data envelopment analysis approach

    Energy Technology Data Exchange (ETDEWEB)

    Kuosmanen, Timo [Economic Research Unit, MTT Agrifood Research Finland, Luutnantintie 13, 00410 Helsinki (Finland); Bijsterbosch, Neil [Environmental Economics and Natural Resources Group, Wageningen University, Hollandseweg 1, 6706 KN Wageningen (Netherlands); MWH B.V., Rijnsburgstraat 9-11, 1059 AT Amsterdam (Netherlands); Dellink, Rob [Environmental Economics and Natural Resources Group, Wageningen University, Hollandseweg 1, 6706 KN Wageningen (Netherlands); Institute for Environmental Studies (IVM), Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam (Netherlands)


    Assessing the benefits of climate policies is complicated due to ancillary benefits: abatement of greenhouse gases also reduces local air pollution. The timing of the abatement measures influences both the economic costs and ancillary benefits. This paper conducts efficiency analysis of ten alternative timing strategies, taking into account the ancillary benefits. We apply the approach by Kuosmanen and Kortelainen [Valuing Environmental Factors in Cost-Benefit Analysis Using Data Envelopment Analysis, Ecological Economics 62 (2007), 56-65], which does not require prior valuation of the environmental impacts. The assessment is based on synthetic data from a dynamic applied general equilibrium model calibrated to The Netherlands. Our assessment shows that if one is only interested in GHG abatement at the lowest economic cost, then equal reduction of GHGs over time is preferred. If society is willing to pay a premium for higher ancillary benefits, an early mid-intensive reduction strategy is optimal. (author)

  15. Diagnostic accuracy of ELISA methods as an alternative screening test to indirect immunofluorescence for the detection of antinuclear antibodies. Evaluation of five commercial kits. (United States)

    Tonuttia, Elio; Bassetti, Danila; Piazza, Anna; Visentini, Daniela; Poletto, Monica; Bassetto, Franca; Caciagli, Patrizio; Villalta, Danilo; Tozzoli, Renato; Bizzaro, Nicola


    Detection of antinuclear antibodies (ANA) is a fundamental laboratory test for diagnosing systemic autoimmune diseases. Currently, the method of choice is indirect immunofluorescence (IIF) on a HEp-2 cell substrate. The goal of this study was to evaluate the diagnostic accuracy of five commercially available enzyme immunoassay (EIA) kits for ANA detection and to verify the possibility of using them as an alternative to the IIF method. The study involved 1513 patients, 315 of whom were diagnosed with a systemic autoimmune disease and 1198 in whom an autoimmune disorder was excluded. For all sera, ANA detection was performed via IIF and with five different EIA kits. The results were evaluated in relation to clinical diagnosis and the presence of possible specific autoantibodies (anti-ENA or anti-dsDNA); lastly, they were compared with the results obtained using ANA-IIF as the method of reference. The positive rate of the ANA-IIF test in subjects with systemic autoimmune diseases was 92%, whereas in the five ANA-EIA kits there was broad diversity in terms of response, with positive rates ranging from 74 to 94%. All the EIA kits correctly detected the presence of antibodies (anti-dsDNA, anti-RNP, anti-Ro/SSA) responsible for homogeneous and speckled fluorescence pattern, but at the same time they showed substantial inaccuracy with the nucleolar pattern, with a mean sensitivity of approximately 50% in this case. Instead, there was a large kit-to-kit difference in terms of identification of anti-Scl70 and centromere patterns, for which sensitivities ranged between 45 and 91%, and between 49 and 100%, respectively. The results of the study demonstrate that the commercially available ANA-EIA kits show different levels of sensitivity and specificity. Some of them have a diagnostic accuracy that is comparable and, in some cases, even higher than the IIF method. Consequently, these could be used as an alternative screening test to IIE. However, others do not ensure acceptable

  16. Transcranial Alternating Current Stimulation in Patients with Chronic Disorder of Consciousness: A Possible Way to Cut the Diagnostic Gordian Knot? (United States)

    Naro, Antonino; Bramanti, Placido; Leo, Antonino; Russo, Margherita; Calabrò, Rocco Salvatore


    Unresponsive wakefulness syndrome (UWS) is a chronic disorder of consciousness (DOC) characterized by a lack of awareness and purposeful motor behaviors, owing to an extensive brain connectivity impairment. Nevertheless, some UWS patients may retain residual brain connectivity patterns, which may sustain a covert awareness, namely functional locked-in syndrome (fLIS). We evaluated the possibility of bringing to light such residual neural networks using a non-invasive neurostimulation protocol. To this end, we enrolled 15 healthy individuals and 26 DOC patients (minimally conscious state-MCS- and UWS), who underwent a γ-band transcranial alternating current stimulation (tACS) over the right dorsolateral prefrontal cortex. We measured the effects of tACS on power and partial-directed coherence within local and long-range cortical networks, before and after the protocol application. tACS was able to specifically modulate large-scale cortical effective connectivity and excitability in all the MCS participants and some UWS patients, who could be, therefore, considered as suffering from fLIS. Hence, tACS could be a useful approach in supporting a DOC differential diagnosis, depending on the level of preservation of the cortical large-scale effective connectivity.

  17. Production of a Rhizopus oryzae lipase from Pichia pastoris using alternative operational strategies. (United States)

    Surribas, Anna; Stahn, Rainer; Montesinos, José Luis; Enfors, Sven-Olof; Valero, Francisco; Jahic, Mehmedalija


    Different cultivation strategies have been compared for the production of Rhizopus oryzae lipase (ROL) from Pichia pastoris. Several drawbacks have been found using a methanol non-limited fed-batch. On the one hand, oxygen limitation appeared at early cell dry weights and, on the other hand, high cell death was observed. A temperature limited fed-batch has been proposed to solve both problems. However, in our case study a methanol non-limited fed-batch results in better productivities. Finally, a lower salt medium were used to overcome cell death problems and a temperature limited fed-batch was applied thereafter to solve oxygen transfer limitations. This combined strategy has resulted in lower productivities when compared to a methanol non-limited fed-batch. However the culture could be longer prolonged and a 1.3-fold purer final product was obtained mainly due to cell death reduction.

  18. Alternative Approach Strategies For Buyer-Seller Relations With The Peoples Republic Of China


    Johnston, W. J.


    This paper examines the issues involved in buyer-seller relations for industrial product sales in the People's Republic of China. The need is genuine in many product categories including plant technology, high technology, and infrastructure. The problem is that buying policies and procedures for foreign firms are still emerging, and therefore, unclear and confusing. Three approach strategies for buyer-seller relations with China are presented: the authorized "buying group," the "agency" repre...

  19. Alternative strategies for activation of the natural lactoperoxidase system in cows' milk: trials in Tanzania. (United States)

    Fweja, Leonard W T; Lewis, Michael J; Grandison, Alistair S


    Thiocyanate content and lactoperoxidase activity of individual cow's milk of different breeds were determined, and the effects of different lactoperoxidase system (LP-s) activation strategies were compared. Lactoperoxidase activity varied significantly between Friesian and both Ayrshire and Tanzania Short Horn Zebu (TSHZ), but differences between Ayrshire and TSHZ were not significant. There was no significant variation in SCN- content between breeds. The LP-s was activated using three strategies based on SCN-: namely; equal concentrations of SCN- and H2O2 (7:7, 10:10, 15:15 mg/l), excess SCN- concentrations (15:10, 20:10, 25:10 mg SCN-:H2O2/l), and excess H2O2 concentrations (10:15, 10:20, 10:25 mg SCN-:H2O2/l), plus a fourth strategy based on I- (15:15 mg I-:H2O2/l). The keeping quality (KQ) was assessed using pH, titratable acidity, clot on boiling and alcohol stability tests. All activation strategies enhanced the shelf life of milk (typically increasing KQ from around 10 to around 20 h), but it was clear that the effectiveness of the LP-s depends on the type and concentrations of the activators of the system. The LP-s activated using I- as an electron donor was more effective than the LP-s activated using SCN- as an electron donor, increasing the KQ by a further 6-8 h compared with SCN-.

  20. Alternative Composite Lisbon Development Strategy Indices: A Comparison of EU, USA, Japan and Korea

    Directory of Open Access Journals (Sweden)

    JongEun Oh


    Full Text Available This study addresses the measurement of two composite Lisbon strategy indices that quantifies the level and patterns of development for ranking countries. The first index is nonparametric labelled as Lisbon strategy index (LSI. It is composed of six components: general economics, employment, innovation research, economic reform, social cohesion and environment, each generated from a number of Lisbon indicators. LSI by reducing the complexity of the set of indicators, it makes the ranking procedures quite simple. The second and parametric index is based on principal component analysis. Despite the difference in the ranking by the two indices, it is shown that the United States outperformed most EU-member states. Our investigations also show evidence of significant dynamic changes taking place, as the countries of the Union struggle to achieve the Lisbon goals. The necessity of a real reform agenda in several old and new members and candidate countries emerges from our analysis. We briefly refer to two important European phenomena emerging from our data analysis and discuss the possible lessons learned from the Korean development strategy

  1. A MILP-based flux alternative generation and NMR experimental design strategy for metabolic engineering. (United States)

    Phalakornkule, C; Lee, S; Zhu, T; Koepsel, R; Ataai, M M; Grossmann, I E; Domach, M M


    A mixed-integer linear program (MILP) is described that can enumerate all the ways fluxes can distribute in a metabolic network while still satisfying the same constraints and objective function. The multiple solutions can be used to (1) generate alternative flux scenarios that can account for limited experimental observations, (2) forecast the potential responses to mutation (e.g., new reaction pathways may be used), and (3) (as illustrated) design (13)C NMR experiments such that different potential flux patterns in a mutant can be distinguished. The experimental design is enabled by using the MILP results as an input to an isotopomer mapping matrices (IMM)-based program, which accounts for the network circulation of (13)C from a precursor such as glucose. The IMM-based program can interface to common plotting programs with the result that the user is provided with predicted NMR spectra that are complete with splittings and Lorentzian line-shape features. The example considered is the trafficking of carbon in an Escherichia coli mutant, which has pyruvate kinase activity deleted for the purpose of eliminating acetate production. Similar yields and extracellular measurements would be manifested by the flux alternatives. The MILP-IMM results suggest how NMR experiments can be designed such that the spectra of glutamate for two flux distribution scenarios differ significantly.

  2. An Evaluation of the Sale of Public Assets as Alternative Public Debt Reduction Strategy in European Countries

    Directory of Open Access Journals (Sweden)

    Irina Bilan


    Full Text Available Against the backdrop of the recent crisis, many European countries have been confronted to high and unsustainable public debts, the issue of conceiving and implementing debt reduction strategies becoming one of great interest to both the scientific community and public policy-makers. Several options have been put forward, some of them (like fiscal consolidation explored in depth by researchers and already applied in many countries, while others have benefited of less, even minor attention. Thus, our paper aims to evaluate the sale of public (financial and non-financial assets as possible alternative for restoring public debt sustainability in European countries, contributes to existing literature by providing a more thorough analysis of a usually overlooked alternative. The paper is designed as a case study, mixing qualitative and quantitative evidence on the topics of interest with regard to the situation of 20 European countries, selected on criteria of data availability. The general conclusion is that the sale of public assets should, at least in the most indebted countries, be incorporated into public debt reduction strategies, but in addition to other measures (mainly fiscal consolidation ones and always on the basis of realistic and extensive cost-benefit analysis.

  3. 'Doctor Google' ending the diagnostic odyssey in lysosomal storage disorders: parents using internet search engines as an efficient diagnostic strategy in rare diseases. (United States)

    Bouwman, Machtelt G; Teunissen, Quirine G A; Wijburg, Frits A; Linthorst, Gabor E


    The expansion of the internet has resulted in widespread availability of medical information for both patients and physicians. People increasingly spend time on the internet searching for an explanation, diagnosis or treatment for their symptoms. Regarding rare diseases, the use of the internet may be an important tool in the diagnostic process. The authors present two cases in which concerned parents made a correct diagnosis of a lysosomal storage disorder in their child by searching the internet after a long doctor's delay. These cases illustrate the utility of publicly available internet search engines in diagnosing rare disorders and in addition illustrate the lengthy diagnostic odyssey which is common in these disorders.

  4. Proper and dark heroes as DADS and CADS : Alternative mating strategies in British Romantic literature. (United States)

    Kruger, Daniel J; Fisher, Maryanne; Jobling, Ian


    Empirical tests described in this article support hypotheses derived from evolutionary theory on the perceptions of literary characters. The proper and dark heroes in British Romantic literature of the late eighteenth and early nineteenth centuries respectively represent long-term and short-term mating strategies. Recent studies indicate that for long-term relationships, women seek partners with the ability and willingness to sustain paternal investment in extended relationships. For short-term relationships, women choose partners whose features indicate high genetic quality. In hypothetical scenarios, females preferred proper heroes for long-term relationships. The shorter the relationship under consideration, the more likely women were to choose dark heroes as partners.

  5. Residual flood-risk: assessing the effectiveness of alternative large-scale mitigation strategies (United States)

    Carisi, Francesca; Domeneghetti, Alessio; Castellarin, Attilio


    The EU Flood Directive (2007/60/CE) requires institutions and public bodies, in order to formulate robust flood-risk management strategies for large European rivers, to address several fundamental tasks. For instance, they have to address the problem of flood-risk mitigation from a global perspective (i.e., entire middle-lower river reaches) by identifying critical reaches, inundation areas and corresponding overflow volumes. To this aim, we focus on the identification of large-scale flood risk mitigation strategies for the middle-lower reach of the Po river, the longest Italian river and the largest in terms of streamflow. We refer to the so-called residual flood-risk and in particular to its portion referring to the possibility to experience events associated with larger return periods than the reference one (e.g. ~200 years in our case). In particular, being a further levee heightening not technically viable nor economically conceivable for the case study, the study develops and tests the applicability of a quasi-2D hydraulic model for the identification of large-scale flood-risk mitigation strategies relative to a 500-year flood event. In particular, we consider and model in the study different geometrical configurations of the main embankment system for a ~400km reach stretching from Isola S.Antonio to the Po river delta in the Adriatic Sea: overtopping without levee breaching, overtopping and natural levee breaching, overtopping and forced levee breaching. The simulations enable the assessment of the overflowed volumes and water depths on flooded areas. Expected damages are estimated using simplified graphical tools, which we termed "Vulnerability Hypsometric Curves" (HVCs) and report the extent of the area for a given land use category that is located below a certain elevation. The analysis aims at finding the optimal configuration that minimizes the expected damages in the areas prone to flood. The outcomes of our study indicate that coupling a large

  6. Strategies for cost-effective carbon reductions: A sensitivity analysis of alternative scenarios

    Energy Technology Data Exchange (ETDEWEB)

    Gumerman, Etan; Koomey, Jonathan G.; Brown, Marilyn


    Analyses of alternative futures often present results for a limited set of scenarios, with little if any sensitivity analysis to identify the factors affecting the scenario results. This approach creates an artificial impression of certainty associated with the scenarios considered, and inhibits understanding of the underlying forces. This paper summarizes the economic and carbon savings sensitivity analysis completed for the Scenarios for a Clean Energy Future study (IWG, 2000). Its 19 sensitivity cases provide insight into the costs and carbon-reduction impacts of a carbon permit trading system, demand-side efficiency programs, and supply-side policies. Impacts under different natural gas and oil price trajectories are also examined. The results provide compelling evidence that policy opportunities exist to reduce carbon emissions and save society money.

  7. Peptide-Centric Proteome Analysis: An Alternative Strategy for the Analysis of Tandem Mass Spectrometry Data

    Energy Technology Data Exchange (ETDEWEB)

    Ting, Ying S.; Egertson, Jarrett D.; Payne, Samuel H.; Kim, Sangtae; MacLean, Brendan; Kall, Lukas; Aebersold, Ruedi; Smith, Richard D.; Noble, William; MacCoss, Michael


    In mass spectrometry-based bottom-up proteomics, data-independent acquisition (DIA) is an emerging technique due to its comprehensive and unbiased sampling of precursor ions. However, current DIA methods use wide precursor isolation windows, resulting in co- fragmentation and complex mixture spectra. Thus, conventional database searching tools that identify peptides by interpreting individual MS/MS spectra are inherently limited in analyzing DIA data. Here we discuss an alternative approach, peptide-centric analysis, which tests directly for the presence and absence of query peptides. We discuss how peptide-centric analysis resolves some limitations of traditional spectrum-centric analysis, and we outline the benefits of peptide-centric analysis in general.

  8. Environmental assessment of alternative municipal solid waste management strategies. A Spanish case study. (United States)

    Bovea, M D; Ibáñez-Forés, V; Gallardo, A; Colomer-Mendoza, F J


    The aim of this study is to compare, from an environmental point of view, different alternatives for the management of municipal solid waste generated in the town of Castellón de la Plana (Spain). This town currently produces 207 ton of waste per day and the waste management system employed today involves the collection of paper/cardboard, glass and light packaging from materials banks and of rest waste at street-side containers. The proposed alternative scenarios were based on a combination of the following elements: selective collection targets to be accomplished by the year 2015 as specified in the Spanish National Waste Plan (assuming they are reached to an extent of 50% and 100%), different collection models implemented nationally, and diverse treatments of both the separated biodegradable fraction and the rest waste to be disposed of on landfills. This resulted in 24 scenarios, whose environmental behaviour was studied by applying the life cycle assessment methodology. In accordance with the ISO 14040-44 (2006) standard, an inventory model was developed for the following stages of the waste management life cycle: pre-collection (bags and containers), collection, transport, pre-treatment (waste separation) and treatment/disposal (recycling, composting, biogasification+composting, landfill with/without energy recovery). Environmental indicators were obtained for different impact categories, which made it possible to identify the key variables in the waste management system and the scenario that offers the best environmental behaviour. Finally, a sensitivity analysis was used to test some of the assumptions made in the initial life cycle inventory model.

  9. TUGAI: An integrated simulation tool for ecological assessment of alternative water management strategies in a degraded river delta. (United States)

    Schlüter, Maja; Rüger, Nadja; Savitsky, Andre G; Novikova, Nina M; Matthies, Michael; Lieth, Helmut


    The development of ecologically sound water allocation strategies that account for the needs of riverine ecosystems is a pressing issue, especially in semiarid river basins. In the Aral Sea Basin, a search for strategies to mitigate ecological and socioeconomic deterioration has been in process since the early 1990s. The Geographic Information System-based simulation tool TUGAI has been developed to support the policy determination process by providing a simple, problem-oriented method to assess ecological effects of alternative water management strategies for the Amudarya River. It combines a multiobjective water allocation model with simple, spatially explicit statistical and rule-based models of landscape dynamics. Changes in environmental conditions are evaluated by a fuzzy habitat suitability index for Populus euphratica, which is the dominant species of the characteristic riverine Tugai forests. Water management scenarios can be developed by altering spatiotemporal water distribution in the delta area or the amount of water inflow into the delta. Outcomes of scenario analysis are qualitative comparisons of the ecological effects of different options for a time period of up to 28 years. The given approach utilizes different types of knowledge, from quantitative hydrological data to qualitative local expert knowledge. The main purpose of the tool is to integrate the knowledge in a comprehensive way to make it available for discussions on alternative policies in moderated workshops with stakeholders. In this article, the modules of the tool, their integration, and three hypothetical scenarios are presented. Based on the experience gained when developing the TUGAI tool, we propose that the general framework can be transferred to other areas where tradeoffs in water allocation between the environment and other water users are of major concern. The potential for a simulation tool to structure and inform a complex resource management situation by involving local

  10. Analysis of climatic conditions and preliminary assessment of alternative cooling strategies for houses in California transition climate zones

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Y.J.; Zhang, H.


    This is a preliminary scoping study done as part of the {open_quotes}Alternatives to Compressive Cooling in California Transition Climates{close_quotes} project, which has the goal of demonstrating that houses in the transitional areas between the coast and the Central Valley of California do not require air-conditioning if they are properly designed and operated. The first part of this report analyzes the climate conditions within the transitional areas, with emphasis on design rather than seasonal conditions. Transitional climates are found to be milder but more variable than those further inland. The design temperatures under the most stringent design criteria, e.g. 0.1 % annual, are similar to those in the Valley, but significantly lower under more relaxed design criteria, e.g., 2% annual frequency. Transition climates also have large day-night temperature swings, indicating significant potential for night cooling, and wet-bulb depressions in excess of 25 F, indicating good potential for evaporative cooling. The second part of the report is a preliminary assessment using DOE-2 computer simulations of the effectiveness of alternative cooling and control strategies in improving indoor comfort conditions in two conventional Title-24 houses modeled in various transition climate locations. The cooling measures studied include increased insulation, light colors, low-emissivity glazing, window overhangs, and exposed floor slab. The control strategies studied include natural and mechanical ventilation, and direct and two-stage evaporative cooling. The results indicate the cooling strategies all have limited effectiveness, and need to be combined to produce significant improvements in indoor comfort. Natural and forced ventilation provide similar improvements in indoor conditions, but during peak cooling periods, these will still be above the comfort zone. Two-stage evaporative coolers can maintain indoor comfort at all hours, but not so direct evaporative coolers.

  11. Two Alternative Strategies for Raising Public Awareness of Science and Technology

    Directory of Open Access Journals (Sweden)

    José Couto Marques


    Full Text Available In today’s knowledge society it is important to keep people informed about emerging technological developments while at the same time providing an accurate scientific and historical framework for such novelties in order to contribute to eradicate existing misconceptions. Dissemination of science and technology is presently essential to convey information within the research communities as well as among the younger generations and the general public. This paper describes two initiatives which pursue this objective by using multimedia tools. One consists in a set of 250 one-minute programs about engineering topics which were broadcast on TV, radio and the multimedia online platform of a daily journal. The other is a collection of videos produced by a research unit in two alternative formats aimed at specialist and general viewers. Both initiatives, based on two very different budgets, may be instrumental for improving the general perception of the role of engineering and for attracting new vocations. The multimedia contents developed are also valuable teaching tools.

  12. Predicting thermally stressful events in rivers with a strategy to evaluate management alternatives (United States)

    Maloney, K.O.; Cole, J.C.; Schmid, M.


    Water temperature is an important factor in river ecology. Numerous models have been developed to predict river temperature. However, many were not designed to predict thermally stressful periods. Because such events are rare, traditionally applied analyses are inappropriate. Here, we developed two logistic regression models to predict thermally stressful events in the Delaware River at the US Geological Survey gage near Lordville, New York. One model predicted the probability of an event >20.0 °C, and a second predicted an event >22.2 °C. Both models were strong (independent test data sensitivity 0.94 and 1.00, specificity 0.96 and 0.96) predicting 63 of 67 events in the >20.0 °C model and all 15 events in the >22.2 °C model. Both showed negative relationships with released volume from the upstream Cannonsville Reservoir and positive relationships with difference between air temperature and previous day's water temperature at Lordville. We further predicted how increasing release volumes from Cannonsville Reservoir affected the probabilities of correctly predicted events. For the >20.0 °C model, an increase of 0.5 to a proportionally adjusted release (that accounts for other sources) resulted in 35.9% of events in the training data falling below cutoffs; increasing this adjustment by 1.0 resulted in 81.7% falling below cutoffs. For the >22.2 °C these adjustments resulted in 71.1% and 100.0% of events falling below cutoffs. Results from these analyses can help managers make informed decisions on alternative release scenarios.

  13. Greek Civil Society’s Online Alternative Networks as Emergent Resilience Strategies in Time of Crisis

    Directory of Open Access Journals (Sweden)

    Maria Zafiropoulou


    Full Text Available The use of new communications technologies and social media, in Greece, during the time of crisis, has led to the development of numerous online informal Civil Society Networks (CSNs (i.e. networking-building platforms, self - organized groups in Facebook, forums, exchange platforms proposing a rethinking of the status quo of formal civil organizations. This research, utilizing the methodology of discourse analysis, aims at summarizing the rise of these networks in Greece that incorporates both solidarity initiatives and autonomous political/economic spaces and identify the indicative predictive factors of their survival and growth. Some basic conclusions that have been drawn through this research is that alternative online networks can be proven as indicative sign of the social dynamism of a given period but in order to be resilient and sustainable they should develop focal points of physical reference, pursue national representation, focus mainly on monothematic goods/services and cultivate, in several cases, links with relevant social movements and local or national NGOs. A general induction through this research is that a CSN, during this current crisis, stands between two classical models of reference in a society seeking modernity and flexibility and can be considered as a proposed type of effective experimentation and mobilization that can pursue common social goals and serve needs of deprived people. Some issues that still remain underexplored and need further elaboration are social and political identity of participants, the potential links with local, national and international communities, the functional balance between structure and flexibility as well as the efficient distribution of energy between solidarity and protest.

  14. Alternative Glycerol Balance Strategies among Saccharomyces Species in Response to Winemaking Stress (United States)

    Pérez-Torrado, Roberto; Oliveira, Bruno M.; Zemančíková, Jana; Sychrová, Hana; Querol, Amparo


    Production and balance of glycerol is essential for the survival of yeast cells in certain stressful conditions as hyperosmotic or cold shock that occur during industrial processes as winemaking. These stress responses are well-known in S. cerevisiae, however, little is known in other phylogenetically close related Saccharomyces species associated with natural or fermentation environments such as S. uvarum, S. paradoxus or S. kudriavzevii. In this work we have investigated the expression of four genes (GPD1, GPD2, STL1, and FPS1) crucial in the glycerol pool balance in the four species with a biotechnological potential (S. cerevisiae; S. paradoxus; S. uvarum; and S. kudriavzevii), and the ability of strains to grow under osmotic and cold stresses. The results show different pattern and level of expression among the different species, especially for STL1. We also studied the function of Stl1 glycerol symporter in the survival to osmotic changes and cell growth capacity in winemaking environments. These experiments also revealed a different functionality of the glycerol transporters among the different species studied. All these data point to different strategies to handle glycerol accumulation in response to winemaking stresses as hyperosmotic or cold-hyperosmotic stress in the different species, with variable emphasis in the production, influx, or efflux of glycerol. PMID:27064588

  15. Nanoparticles as Alternative Strategies for Drug Delivery to the Alzheimer Brain: Electron Microscopy Ultrastructural Analysis. (United States)

    Aliev, Gjumrakch; Daza, Jesús; Herrera, Arturo Solís; del Carmen Arias Esparza, María; Morales, Ludis; Echeverria, Valentina; Bachurin, Sergey Olegovich; Barreto, George Emilio


    One of the biggest problems and challenges for the development of new drugs and treatment strategies against Alzheimer Disease (AD) is the crossing of target drugs into the blood brain barrier. The use of nanoparticles in drug delivery therapy holds much promise in targeting remote tissues, and as a result many studies have attempted to study the ultrastructural localization of nanoparticles in various tissues. However, there are currently no in vivo studies demonstrating the ultrastructural distribution of nanoparticles in the brain. The aim of this study was to address how intraperitoneal injection of silver nanoparticles in the brain leads to leaking on the inter-endothelial contact and luminal plasma membrane, thus elucidating the possibility of penetrating into the most affected areas in the Alzheimer brain (vascular endothelium, perivascular, neuronal and glial cells). Our results show that the silver nanoparticles reached the brain and were found in hippocampal areas, indicating that they can be conjugated and used to deliver the drugs into the cell cytoplasm of the damaged brain cells. The present study can be useful for the development of novel drug delivering therapy and useful in understanding the delivery, distribution and effects of silver nanoparticles in AD brain tissue at cellular and subcellular level.

  16. Control strategy minimizing the converter-alternating current motor losses: application to electric traction; Strategies de commande minimisant les pertes d'un ensemble convertisseur - machine alternative: application a la traction electrique

    Energy Technology Data Exchange (ETDEWEB)

    Bastiani, Ph.


    Improving the efficiency of the converter-alternating current motor system is a major task in electric traction. Global energy optimisation implies a specific approach at system scale. To reach this goal, we have chosen an algebraic method using sub-system models. To start with, a synchronous machine Park model is developed to take account magnetic saturation and iron losses. Then, an averaged model of the voltage inverter is used in order to obtain a simplified model of the losses to be implemented in our optimisation method. This is how the global model is built including losses in the synchronous machine along with the losses of the power converter. Experimental results are there to validate our approach. This study proposes a method based on algebraic formulation of the general laws to control torque. Algorithms take into account magnetic circuits saturation and power losses in both the machine and its converter. Here again, experimental results validate the algorithm on several test benches. Achieved efficiency improvement is important compared to existing usual control strategies. The proposed method can be generalised to other machine-converter systems. As a matter of fact we have extended our study to the induction machine. As a complement ti this study we have looked at the effects natural limitations of voltages and currents in the torque-speed plane. Therefore algebraic formulation of the torque-speed plane and optimisation strategies are proposed including those constraints. (author)

  17. Investigações em geometria via ambiente LOGO LOGO environment as an alternative methodological strategy to teach geometry

    Directory of Open Access Journals (Sweden)

    Raimundo Benedito do Nascimento


    Full Text Available A Matemática torna-se mais significativa para um aluno que está constantemente em contato com ampla variedade de problemas. Este artigo tem o objetivo de motivar o professor a não poupar esforços para estimular suas classes de Geometria com problemas que conduzam os alunos para além dos exercícios rotineiros. O ambiente LOGO é a estratégia metodológica alternativa que nos conduzirá ao objetivo proposto.Students find mathematics more significant if they are constantly in contact with a variety of problems. The purpose of this article is to motivate teachers to enhance their geometry classes with problems taken from the everyday lives of their students. The LOGO environment can be used as an alternative methodological strategy, providing problem situations.

  18. Evaluation of ICA-AROMA and alternative strategies for motion artifact removal in resting state fMRI. (United States)

    Pruim, Raimon H R; Mennes, Maarten; Buitelaar, Jan K; Beckmann, Christian F


    We proposed ICA-AROMA as a strategy for the removal of motion-related artifacts from fMRI data (Pruim et al., 2015). ICA-AROMA automatically identifies and subsequently removes data-driven derived components that represent motion-related artifacts. Here we present an extensive evaluation of ICA-AROMA by comparing our strategy to a range of alternative strategies for motion-related artifact removal: (i) no secondary motion correction, (ii) extensive nuisance regression utilizing 6 or (iii) 24 realignment parameters, (iv) spike regression (Satterthwaite et al., 2013a), (v) motion scrubbing (Power et al., 2012), (vi) aCompCor (Behzadi et al., 2007; Muschelli et al., 2014), (vii) SOCK (Bhaganagarapu et al., 2013), and (viii) ICA-FIX (Griffanti et al., 2014; Salimi-Khorshidi et al., 2014), without re-training the classifier. Using three different functional connectivity analysis approaches and four different multi-subject resting-state fMRI datasets, we assessed all strategies regarding their potential to remove motion artifacts, ability to preserve signal of interest, and induced loss in temporal degrees of freedom (tDoF). Results demonstrated that ICA-AROMA, spike regression, scrubbing, and ICA-FIX similarly minimized the impact of motion on functional connectivity metrics. However, both ICA-AROMA and ICA-FIX resulted in significantly improved resting-state network reproducibility and decreased loss in tDoF compared to spike regression and scrubbing. In comparison to ICA-FIX, ICA-AROMA yielded improved preservation of signal of interest across all datasets. These results demonstrate that ICA-AROMA is an effective strategy for removing motion-related artifacts from rfMRI data. Our robust and generalizable strategy avoids the need for censoring fMRI data and reduces motion-induced signal variations in fMRI data, while preserving signal of interest and increasing the reproducibility of functional connectivity metrics. In addition, ICA-AROMA preserves the temporal non

  19. Multiple intelligences and alternative teaching strategies: The effects on student academic achievement, conceptual understanding, and attitude (United States)

    Baragona, Michelle

    The purpose of this study was to investigate the interactions between multiple intelligence strengths and alternative teaching methods on student academic achievement, conceptual understanding and attitudes. The design was a quasi-experimental study, in which students enrolled in Principles of Anatomy and Physiology, a developmental biology course, received lecture only, problem-based learning with lecture, or peer teaching with lecture. These students completed the Multiple Intelligence Inventory to determine their intelligence strengths, the Students' Motivation Toward Science Learning questionnaire to determine student attitudes towards learning in science, multiple choice tests to determine academic achievement, and open-ended questions to determine conceptual understanding. Effects of intelligence types and teaching methods on academic achievement and conceptual understanding were determined statistically by repeated measures ANOVAs. No significance occurred in academic achievement scores due to lab group or due to teaching method used; however, significant interactions between group and teaching method did occur in students with strengths in logical-mathematical, interpersonal, kinesthetic, and intrapersonal intelligences. Post-hoc analysis using Tukey HSD tests revealed students with strengths in logical-mathematical intelligence and enrolled in Group Three scored significantly higher when taught by problem-based learning (PBL) as compared to peer teaching (PT). No significance occurred in conceptual understanding scores due to lab group or due to teaching method used; however, significant interactions between group and teaching method did occur in students with strengths in musical, kinesthetic, intrapersonal, and spatial intelligences. Post-hoc analysis using Tukey HSD tests revealed students with strengths in logical-mathematical intelligence and enrolled in Group Three scored significantly higher when taught by lecture as compared to PBL. Students with

  20. Dispersal and life history strategies in epiphyte metacommunities: alternative solutions to survival in patchy, dynamic landscapes. (United States)

    Löbel, Swantje; Rydin, Håkan


    Host trees for obligate epiphytes are dynamic patches that emerge, grow and fall, and metacommunity diversity critically depends on efficient dispersal. Even though species that disperse by large asexual diaspores are strongly dispersal limited, asexual dispersal is common. The stronger dispersal limitation of asexually reproducing species compared to species reproducing sexually via small spores may be compensated by higher growth rates, lower sensitivity to habitat conditions, higher competitive ability or younger reproductive age. We compared growth and reproduction of different groups of epiphytic bryophytes with contrasting dispersal (asexual vs. sexual) and life history strategies (colonists, short- and long-lived shuttle species, perennial stayers) in an old-growth forest stand in the boreo-nemoral region in eastern Sweden. No differences were seen in relative growth rates between asexual and sexual species. Long-lived shuttles had lower growth rates than colonists and perennial stayers. Most groups grew best at intermediate bark pH. Interactions with other epiphytes had a small, often positive effect on growth. Neither differences in sensitivity of growth to habitat conditions nor differences in competitive abilities among species groups were found. Habitat conditions, however, influenced the production of sporophytes, but not of asexual diaspores. Presence of sporophytes negatively affected growth, whereas presence of asexual diaspores did not. Sexual species had to reach a certain colony size before starting to reproduce, whereas no such threshold existed for asexual reproduction. The results indicate that the epiphyte metacommunity is structured by two main trade-offs: dispersal distance vs. reproductive age, and dispersal distance vs. sensitivity to habitat quality. There seems to be a trade-off between growth and sexual reproduction, but not asexual. Trade-offs in species traits may be shaped by conflicting selection pressures imposed by habitat

  1. Back to basics: an evaluation of NaOH and alternative rapid DNA extraction protocols for DNA barcoding, genotyping, and disease diagnostics from fungal and oomycete samples. (United States)

    Osmundson, Todd W; Eyre, Catherine A; Hayden, Katherine M; Dhillon, Jaskirn; Garbelotto, Matteo M


    The ubiquity, high diversity and often-cryptic manifestations of fungi and oomycetes frequently necessitate molecular tools for detecting and identifying them in the environment. In applications including DNA barcoding, pathogen detection from plant samples, and genotyping for population genetics and epidemiology, rapid and dependable DNA extraction methods scalable from one to hundreds of samples are desirable. We evaluated several rapid extraction methods (NaOH, Rapid one-step extraction (ROSE), Chelex 100, proteinase K) for their ability to obtain DNA of quantity and quality suitable for the following applications: PCR amplification of the multicopy barcoding locus ITS1/5.8S/ITS2 from various fungal cultures and sporocarps; single-copy microsatellite amplification from cultures of the phytopathogenic oomycete Phytophthora ramorum; probe-based P. ramorum detection from leaves. Several methods were effective for most of the applications, with NaOH extraction favored in terms of success rate, cost, speed and simplicity. Frozen dilutions of ROSE and NaOH extracts maintained PCR viability for over 32 months. DNA from rapid extractions performed poorly compared to CTAB/phenol-chloroform extracts for TaqMan diagnostics from tanoak leaves, suggesting that incomplete removal of PCR inhibitors is an issue for sensitive diagnostic procedures, especially from plants with recalcitrant leaf chemistry. NaOH extracts exhibited lower yield and size than CTAB/phenol-chloroform extracts; however, NaOH extraction facilitated obtaining clean sequence data from sporocarps contaminated by other fungi, perhaps due to dilution resulting from low DNA yield. We conclude that conventional extractions are often unnecessary for routine DNA sequencing or genotyping of fungi and oomycetes, and recommend simpler strategies where source materials and intended applications warrant such use.

  2. Benefit-risk Evaluation for Diagnostics: A Framework (BED-FRAME). (United States)

    Evans, Scott R; Pennello, Gene; Pantoja-Galicia, Norberto; Jiang, Hongyu; Hujer, Andrea M; Hujer, Kristine M; Manca, Claudia; Hill, Carol; Jacobs, Michael R; Chen, Liang; Patel, Robin; Kreiswirth, Barry N; Bonomo, Robert A


    The medical community needs systematic and pragmatic approaches for evaluating the benefit-risk trade-offs of diagnostics that assist in medical decision making. Benefit-Risk Evaluation of Diagnostics: A Framework (BED-FRAME) is a strategy for pragmatic evaluation of diagnostics designed to supplement traditional approaches. BED-FRAME evaluates diagnostic yield and addresses 2 key issues: (1) that diagnostic yield depends on prevalence, and (2) that different diagnostic errors carry different clinical consequences. As such, evaluating and comparing diagnostics depends on prevalence and the relative importance of potential errors. BED-FRAME provides a tool for communicating the expected clinical impact of diagnostic application and the expected trade-offs of diagnostic alternatives. BED-FRAME is a useful fundamental supplement to the standard analysis of diagnostic studies that will aid in clinical decision making.

  3. Mentoring for text editors: Fit for purpose in the era of freelancing, more so than alternative development strategies

    Directory of Open Access Journals (Sweden)

    John Linnegar


    Full Text Available In this article, the supportive role that mentoring relationships currently do and should play in the development and careers of text editors is described against the background of the particular circumstances of these service providers in a sector experiencing great organisational and technological changes. This is a group that is much neglected in the literature on mentoring. Since the mentoring of text editors is distinct from other forms of mentoring in a number of key respects, this article draws together what the literature has to say about both conventional and online or distance mentoring as performed in a range of contexts. I consider the application of Knowles’ (1970, 1984 adult learning theory and Bandura’s (1977 self-efficacy mechanisms to be important potential contributors to the success of mentorships, in particular those involving adult text editors. The article also critically analyses how mentoring for text editors can be distinguished from alternative development strategies such as coaching, training, teaching and counselling. It shows that mentoring is fundamentally different from these strategies according to ten criteria, and is better suited to text editors’ need for professional development as a form of lifelong adult e-learning. The lack of any form of assessment of mentees, in particular, is regarded as a weakness of the currently available mentorship programmes aiming to professionalise adult text editors through a process of lifelong learning.

  4. Coupling of radiofrequency with magnetic nanoparticles treatment as an alternative physical antibacterial strategy against multiple drug resistant bacteria (United States)

    Chaurasia, Akhilesh K.; Thorat, Nanasaheb D.; Tandon, Anshula; Kim, Jin-Hahn; Park, Sung Ha; Kim, Kyeong Kyu


    Antibiotic resistant bacteria not only affect human health and but also threatens the safety in hospitals and among communities. However, the emergence of drug resistant bacteria is inevitable due to evolutionary selection as a consequence of indiscriminate antibiotic usage. Therefore, it is necessary to develop a novel strategy by which pathogenic bacteria can be eliminated without triggering resistance. We propose a novel magnetic nanoparticle-based physical treatment against pathogenic bacteria, which blocks biofilm formation and kills bacteria. In this approach, multiple drug resistant Staphylococcus aureus USA300 and uropathogenic Escherichia coli CFT073 are trapped to the positively charged magnetic core-shell nanoparticles (MCSNPs) by electrostatic interaction. All the trapped bacteria can be completely killed within 30 min owing to the loss of membrane potential and dysfunction of membrane-associated complexes when exposed to the radiofrequency current. These results indicate that MCSNP-based physical treatment can be an alternative antibacterial strategy without leading to antibiotic resistance, and can be used for many purposes including environmental and therapeutic applications. PMID:27670157

  5. Coupling of radiofrequency with magnetic nanoparticles treatment as an alternative physical antibacterial strategy against multiple drug resistant bacteria (United States)

    Chaurasia, Akhilesh K.; Thorat, Nanasaheb D.; Tandon, Anshula; Kim, Jin-Hahn; Park, Sung Ha; Kim, Kyeong Kyu


    Antibiotic resistant bacteria not only affect human health and but also threatens the safety in hospitals and among communities. However, the emergence of drug resistant bacteria is inevitable due to evolutionary selection as a consequence of indiscriminate antibiotic usage. Therefore, it is necessary to develop a novel strategy by which pathogenic bacteria can be eliminated without triggering resistance. We propose a novel magnetic nanoparticle-based physical treatment against pathogenic bacteria, which blocks biofilm formation and kills bacteria. In this approach, multiple drug resistant Staphylococcus aureus USA300 and uropathogenic Escherichia coli CFT073 are trapped to the positively charged magnetic core-shell nanoparticles (MCSNPs) by electrostatic interaction. All the trapped bacteria can be completely killed within 30 min owing to the loss of membrane potential and dysfunction of membrane-associated complexes when exposed to the radiofrequency current. These results indicate that MCSNP-based physical treatment can be an alternative antibacterial strategy without leading to antibiotic resistance, and can be used for many purposes including environmental and therapeutic applications.

  6. Adoption of alternative financing strategies to increase the diffusion of picture archiving and communication systems into the radiology marketplace. (United States)

    Reiner, B; Siegel, E; McKay, P


    The objective of the study was to evaluate current marketplace conditions and strategies employed by major picture archiving and communication systems (PACS) vendors in the creation of alternative financing strategies, to enhance the diffusion of filmless imaging. Data were collected from the major PACS vendors in the forms of survey questionnaires and review of existing leases. Topics evaluated in the survey included current financing options available, foreseeable changes in PACS financing, role of third-party financiers, and creation of risk-sharing arrangements. Generic leases were also reviewed evaluating the presence or absence of several key variables including technology obsolescence protection, hardware/software upgrades, end-of-term options, determination of fair market value, functionality/acceptance testing, uptime guarantees, and workflow management consulting. Eight of the 10 PACS vendors surveyed participated in the data collection. The vast majority of current PACS implementations (60% to 90%) occur through direct purchase, with conventional leasing (operating or capital) accounting for only 5% to 30% of PACS installations. The majority of respondents view fee-for-lease arrangements and other forms of risk sharing as increasing importance for future PACS financing. The specific targets for such risk-sharing arrangements consist of small hospital and privately owned imaging centers. Leases currently offered range in duration from 3 to 5 years and frequently offer technology obsolescence protection with upgrades, multiple end-of-term options, and some form of acceptance testing. A number of important variables frequently omitted from leases include uptime guarantees, flexibility in changing financing or vendors, and incorporation of expected productivity/operational efficiency gains. As vendors strive to increase the penetration of PACS into the radiology marketplace, there will be a shift from conventional financing (loan or purchase) to leasing. Fee

  7. Methodology for assessing alternative water-acquisition-and-use strategies for energy facilities in the American West

    Energy Technology Data Exchange (ETDEWEB)

    Shaw, J.J.; Adams, E.E.; Harleman, D.R.F.; Marks, D.H.


    A method for assessing alternative strategies for acquiring and using water at western energy plants was developed. The method was tested in a case study of cooling-water use for a hypothetical steam-electric power plant on the Crazy Woman Creek, an unregulated stream in Wyoming. The results from the case study suggest a careful analysis of reservoir design and water-right purchase strategies can reduce the cost of acquiring and using water at an energy facility. The method uses simulation models to assess the capital and operating costs and expected monthly water-consumption rates for different cooling-system designs. The method also uses reservoir operating algorithms to select, for a fixed cooling-system design, the optimal tradeoff between building a make-up water reservoir and purchasing water rights. These tradeoffs can be used to derive the firm's true demand curve for different sources of water. The analysis also reveals the implicit cost of selecting strategies that minimize conflicts with other water users. Results indicate that: (1) cooling ponds are as good as or preferred to wet towers because their costs already include provisions for storing water for use during the normally dry summer months and during occasional drought years; (2) the energy firm's demand for overall water consumption in the cooling system was found to be inversely proportional to both the cost of installing make-up water reservoirs, and the size of the energy facility; and (3) the firm's willingness to pay for existing rights is proportional to both the cost of installing reservoirs, and the size of the energy facility.

  8. The role of appropriate diagnostic testing in acute respiratory tract infections: An antibiotic stewardship strategy to minimise diagnostic uncertainty in primary care. (United States)

    Brink, Adrian John; Van Wyk, Johan; Moodley, V M; Corcoran, Craig; Ekermans, Pieter; Nutt, Louise; Boyles, Tom; Perovic, Olga; Feldman, Charles; Richards, Guy; Mendelson, Marc


    Antibiotic resistance has increased worldwide to the extent that it is now regarded as a global public health crisis. Interventions to reduce excessive antibiotic prescribing to patients can reduce resistance and improve microbiological and clinical outcomes. Therefore, although improving outpatient antibiotic use is crucial, few data are provided on the key interventional components and the effectiveness of antibiotic stewardship in the primary care setting, in South Africa. The reasons driving the excessive prescription of antibiotics in the community are multifactorial but, perhaps most importantly, the overlapping clinical features of viral and bacterial infections dramatically reduce the ability of GPs to distinguish which patients would benefit from an antibiotic or not. As a consequence, the need for tools to reduce diagnostic uncertainty is critical. In this regard, besides clinical algorithms, a consensus of collaborators in European and UK consortia recently provided guidance for the use of C-reactive protein point-of-care testing in outpatients presenting with acute respiratory tract infections (ARTIs) and/or acute cough, if it is not clear after proper clinical assessment whether antibiotics should be prescribed or not. A targeted application of stewardship principles, including diagnostic stewardship as described in this review, to the ambulatory setting has the potential to affect the most common indications for systemic antibiotic use, in that the majority (80%) of antibiotic use occurs in the community, with ARTIs the most common indication.

  9. Does Gadoxetic acid-enhanced 3.0T MRI in addition to 64-detector-row contrast-enhanced CT provide better diagnostic performance and change the therapeutic strategy for the preoperative evaluation of colorectal liver metastases?

    Energy Technology Data Exchange (ETDEWEB)

    Sofue, Keitaro [National Cancer Center Hospital, Division of Diagnostic Radiology, Tokyo (Japan); Kobe University, Department of Radiology, Graduate School of Medicine, Kobe (Japan); Tsurusaki, Masakatsu [National Cancer Center Hospital, Division of Diagnostic Radiology, Tokyo (Japan); Kinki University, Department of Radiology, Faculty of Medicine, Osakasayama, Osaka (Japan); Murakami, Takamichi [Kinki University, Department of Radiology, Faculty of Medicine, Osakasayama, Osaka (Japan); Onoe, Shunsuke [National Cancer Center Hospital, Department of Hepatobiliary and Pancreatic Surgery, Tokyo (Japan); Tokue, Hiroyuki; Shibamoto, Kentaro; Arai, Yasuaki [National Cancer Center Hospital, Division of Diagnostic Radiology, Tokyo (Japan); Sugimura, Kazuro [Kobe University, Department of Radiology, Graduate School of Medicine, Kobe (Japan)


    To compare diagnostic performance in the detection of colorectal liver metastases between 64-detector-row contrast-enhanced CT (CE-CT) alone and the combination of CE-CT and gadoxetic acid-enhanced MRI (EOB-MRI) at 3.0T, and to assess whether EOB-MRI in addition to CE-CT results in a change to initially planned operative strategy. A total of 39 patients (27 men, mean age 65 years) with 85 histopathologically confirmed liver metastases were included. At EOB-MRI, unenhanced (T1- and T2-weighted), dynamic, and hepatocyte-phase images were obtained. At CE-CT, four-phase dynamic contrast-enhanced images were obtained. One on-site reader and three off-site readers independently reviewed both CE-CT alone and the combination of CE-CT and EOB-MRI. Sensitivity, positive predictive value, and alternative free-response receiver operating characteristic (AFROC) method were calculated. Differences in therapeutic strategy before and after the EOB-MRI examination were also evaluated. Sensitivity and area under the AFROC curve with the combination of CE-CT and EOB-MRI were significantly superior to those with CE-CT alone. Changes in surgical therapy were documented in 13 of 39 patients. The combination of CE-CT and EOB-MRI may provide better diagnostic performance than CE-CT alone for the detection of colorectal liver metastases, and EOB-MRI in addition to CE-CT resulted in changes to the planned operative strategy in one-third of the patients. (orig.)

  10. Strategies in protein sequencing and characterization: Multi-enzyme digestion coupled with alternate CID/ETD tandem mass spectrometry

    Energy Technology Data Exchange (ETDEWEB)

    Nardiello, Donatella; Palermo, Carmen, E-mail:; Natale, Anna; Quinto, Maurizio; Centonze, Diego


    Highlights: • Multi-enzyme digestion for protein sequencing and characterization by CID/ETD. • Simultaneous use of trypsin/chymotrypsin for the maximization of sequence. • Identification of PTMs, sequence variants and species-specific residues. • Increase of accuracy in sequence assignments by orthogonal fragmentation techniques. - Abstract: A strategy based on a simultaneous multi-enzyme digestion coupled with electron transfer dissociation (ETD) and collision-induced dissociation (CID) was developed for protein sequencing and characterization, as a valid alternative platform in ion-trap based proteomics. The effect of different proteolytic procedures using chymotrypsin, trypsin, a combination of both, and Lys-C, was carefully evaluated in terms of number of identified peptides, protein coverage, and score distribution. A systematic comparison between CID and ETD is shown for the analysis of peptides originating from the in-solution digestion of standard caseins. The best results were achieved with a trypsin/chymotrypsin mix combined with CID and ETD operating in alternating mode. A post-database search validation of MS/MS dataset was performed, then, the matched peptides were cross checked by the evaluation of ion scores, rank, number of experimental product ions, and their relative abundances in the MS/MS spectrum. By integrated CID/ETD experiments, high quality-spectra have been obtained, thus allowing a confirmation of spectral information and an increase of accuracy in peptide sequence assignments. Overlapping peptides, produced throughout the proteins, reduce the ambiguity in mapping modifications between natural variants and animal species, and allow the characterization of post translational modifications. The advantages of using the enzymatic mix trypsin/chymotrypsin were confirmed by the nanoLC and CID/ETD tandem mass spectrometry of goat milk proteins, previously separated by two-dimensional gel electrophoresis.

  11. Advancing Risk Analysis for Nanoscale Materials: Report from an International Workshop on the Role of Alternative Testing Strategies for Advancement. (United States)

    Shatkin, J A; Ong, Kimberly J; Beaudrie, Christian; Clippinger, Amy J; Hendren, Christine Ogilvie; Haber, Lynne T; Hill, Myriam; Holden, Patricia; Kennedy, Alan J; Kim, Baram; MacDonell, Margaret; Powers, Christina M; Sharma, Monita; Sheremeta, Lorraine; Stone, Vicki; Sultan, Yasir; Turley, Audrey; White, Ronald H


    The Society for Risk Analysis (SRA) has a history of bringing thought leadership to topics of emerging risk. In September 2014, the SRA Emerging Nanoscale Materials Specialty Group convened an international workshop to examine the use of alternative testing strategies (ATS) for manufactured nanomaterials (NM) from a risk analysis perspective. Experts in NM environmental health and safety, human health, ecotoxicology, regulatory compliance, risk analysis, and ATS evaluated and discussed the state of the science for in vitro and other alternatives to traditional toxicology testing for NM. Based on this review, experts recommended immediate and near-term actions that would advance ATS use in NM risk assessment. Three focal areas-human health, ecological health, and exposure considerations-shaped deliberations about information needs, priorities, and the next steps required to increase confidence in and use of ATS in NM risk assessment. The deliberations revealed that ATS are now being used for screening, and that, in the near term, ATS could be developed for use in read-across or categorization decision making within certain regulatory frameworks. Participants recognized that leadership is required from within the scientific community to address basic challenges, including standardizing materials, protocols, techniques and reporting, and designing experiments relevant to real-world conditions, as well as coordination and sharing of large-scale collaborations and data. Experts agreed that it will be critical to include experimental parameters that can support the development of adverse outcome pathways. Numerous other insightful ideas for investment in ATS emerged throughout the discussions and are further highlighted in this article.

  12. The use of body weight support on ground level: an alternative strategy for gait training of individuals with stroke

    Directory of Open Access Journals (Sweden)

    Barela Ana MF


    Full Text Available Abstract Background Body weight support (BWS systems on treadmill have been proposed as a strategy for gait training of subjects with stroke. Considering that ground level is the most common locomotion surface and that there is little information about individuals with stroke walking with BWS on ground level, it is important to investigate the use of BWS on ground level in these individuals as a possible alternative strategy for gait training. Methods Thirteen individuals with chronic stroke (four women and nine men; mean age 54.46 years were videotaped walking on ground level in three experimental conditions: with no harness, with harness bearing full body weight, and with harness bearing 30% of full body weight. Measurements were recorded for mean walking speed, cadence, stride length, stride speed, durations of initial and terminal double stance, single limb support, swing period, and range of motion of ankle, knee, and hip joints; and foot, shank, thigh, and trunk segments. Results The use of BWS system leads to changes in stride length and speed, but not in stance and swing period duration. Only the hip joint was influenced by the BWS system in the 30% BWS condition. Shank and thigh segments presented less range of motion in the 30% BWS condition than in the other conditions, and the trunk was held straighter in the 30% BWS condition than in the other conditions. Conclusion Individuals with stroke using BWS system on ground level walked slower and with shorter stride length than with no harness. BWS also led to reduction of hip, shank, and thigh range of motion. However, this system did not change walking temporal organization and body side asymmetry of individuals with stroke. On the other hand, the BWS system enabled individuals with chronic stroke to walk safely and without physical assistance. In interventions, the physical therapist can watch and correct gait pattern in patients' performance without the need to provide physical

  13. Biodiesel Drives Florida Power & Light's EPAct Alternative Compliance Strategy; EPAct Alternative Fuel Transportation Program: Success Story (Fact Sheet)

    Energy Technology Data Exchange (ETDEWEB)


    This success story highlights how Florida Power & Light Company has successfully complied with the Energy Policy Act of 1992 (EPAct) through Alternative Compliance using biodiesel technologies and how it has become a biofuel leader, reducing petroleum use and pollutant emissions throughout Florida.

  14. Design strategy and implementation of the medical diagnostic image support system at two large military medical centers (United States)

    Smith, Donald V.; Smith, Stan M.; Sauls, F.; Cawthon, Michael A.; Telepak, Robert J.


    The Medical Diagnostic Imaging Support (MDIS) system contract for federal medical treatment facilities was awarded to Loral/Siemens in the Fall of 1991. This contract places ''filmless'' imaging in a variety of situations from small clients to large medical centers. The MDIS system approach is a ''turn-key'', performance based specification driven by clinical requirements.

  15. The Northeastern United States Energy-Water Nexus: Climate Change Impacts and Alternative Water Management Strategies for the Power Sector (United States)

    Miara, A.; Macknick, J.; Vorosmarty, C. J.; Cohen, S. M.; Rosenzweig, B.


    The Northeastern United States (NE) relies heavily on thermoelectric power plants (90% of total capacity) to provide electricity to more than 70 million people. This region's power plants require consistent, large volumes of water at sufficiently cold temperatures to generate electricity efficiently, and withdraw approximately 10.5 trillion gallons of water annually. Previous findings indicate that assessments of future electricity pathways must account for water availability, water temperature and the changing climate, as changes in these conditions may limit operational efficiency in the future. To account for such electric system vulnerabilities, we have created a link between an electricity system capacity expansion model (ReEDS) and a hydrologic model that is coupled to a power plant simulation model (FrAMES-TP2M) that allows for a new approach to analyze electricity system development, performance, and environmental impacts. Together, these coupled tools allow us to estimate electricity development and operations in the context of a changing climate and impacts on the seasonal spatial and temporal variability of water resources, downstream thermal effluents that cause plant-to-plant interferences and harm aquatic habitat, economic costs of water conservation methods and associated carbon emissions. In this study, we test and compare a business-as-usual strategy with three alternative water management scenarios that include changes in cooling technologies and water sources utilized for the years 2014-2050. Results of these experiments can provide useful insight into the feasibility of the electricity expansion scenarios in terms of associated water use and thermal impacts, carbon emissions, the cost of generating electricity, and also highlight the importance of accounting for water resources in future power sector planning and performance assessments.

  16. Balance sheet method assessment for nitrogen fertilization in winter wheat: II. alternative strategies using the CropSyst simulation model

    Directory of Open Access Journals (Sweden)

    Maria Corbellini


    Full Text Available It is important, both for farmer profit and for the environment, to correctly dose fertilizer nitrogen (N for winter wheat growth. Balance-sheet methods are often used to calculate the recommended dose of N fertilizer. Other methods are based on the dynamic simulation of cropping systems. Aim of the work was to evaluate the balance-sheet method set up by the Region Emilia-Romagna (DPI, by comparing it with the cropping systems simulation model CropSyst (CS, and with an approach based on fixed supplies of N (T. A 3-year trial was structured as a series of N fertility regimes at 3 sites (Papiano di Marsciano, Ravenna, San Pancrazio. The N-regimes were generated at each site-year as separate trials in which 3 N rates were applied: N1 (DPI, N2 (DPI+50 kg ha-1 N at spike initiation, N3 (DPI + 50 kg ha-1 N at early booting. Above ground biomass and soil data (NO3-N and water were sampled and used to calibrate CS. Doses of fertilizer N were calculated by both DPI and CS for winter wheat included in three typical rotations for Central and Northern Italy. Both these methods and method T were simulated at each site over 50 years, by using daily generated weather data. The long-term simulation allowed evaluating such alternative fertilization strategies. DPI and CS estimated comparable crop yields and N leached amounts, and both resulted better than T. Minor risk of leaching emerged for all N doses. The N2 and N3 rates allowed slightly higher crop yields than N1.

  17. Attitudes and perceptions of three groups of family farmers in Brazil on problems they perceive in raising broilers and alternative feeding strategies

    DEFF Research Database (Denmark)

    Almeida, Gustavo Fonseca; Horsted, Klaus; Figueiredo, E.A.;


    . In addition, farmers producing AF broilers highlighted subclinical coccidiosis as of high economic importance. Production of slow-growing broilers in free-range systems would benefit from local resources for the finishing period. Novel feeding strategies for broilers are suggested based on the farmers’ report......With the purpose to identify alternatives to the use of oil seed crops and cereals in broiler feeding, we interviewed 21 family farmers raising broilers in alternative systems located in three relevant sites for the poultry industry in Brazil. Two groups in the south (Parana and Rio Grande do Sul...

  18. Alternative strategies for the reading EFL classroom. Estrategias Alternativas para el aula de lectura de Inglés como Lengua Extranjera.


    Suescún Giraldo, Claudia Marcela


    AbstractThis article presents the results of a research project which objective was to analyze the impact of a program with alternative reading strategies for EFL development. This research pretends to cast new lights in the constant effort from both EFLteachers and teacher trainers to promote reading among their students, through the implementation and analysis of some specific strategies, applied on a group of students of the B.A in EFL Teaching from Fundación Universitaria Luis Amigó, focu...

  19. Non-traumatic thoracic emergencies: CT venography in an integrated diagnostic strategy of acute pulmonary embolism and venous thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Ghaye, Benoit; Dondelinger, Robert F. [Department of Medical Imaging, University Hospital Sart Tilman, Domaine Universitaire du Sart Tilman B35, 4000 Liege (Belgium)


    Deep venous thrombosis and pulmonary embolism are the two aspects of venous thrombo-embolism. Investigation of lower limb veins has been part of various diagnostic algorithms in the past 15 years. Recently, the combination of CT venography (CTV) of lower limbs and abdominal veins together with CT angiography of the pulmonary arteries has allowed a complete examination of venous thrombo-embolism in one session. The technical aspects, imaging findings, venous anatomy on CT, interpretative pitfalls, results and advantages of CT venography are reviewed. (orig.)

  20. Diagnostic strategy and differential therapeutic approach for cystic lesions of the pancreas; Diagnostische Strategie und differenzialtherapeutisches Vorgehen bei zystischen Laesionen des Pankreas

    Energy Technology Data Exchange (ETDEWEB)

    Mayer, P.; Klauss, M. [Universitaetsklinikum Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg (Germany); Tjaden, C. [Universitaetsklinikum Heidelberg, Chirurgie, Heidelberg (Germany)


    Cystic pancreatic lesions (CPL) are diagnosed with increasing frequency. Because up to 60 % of CPL are classified as malignant or premalignant, every CPL should be fully investigated and clarified. Serous CPL with low risk of malignancy must be differentiated from mucinous CPL with relevant potential malignancy (intraductal papillary mucinous neoplasm IPMN) and mucinous cystic neoplasm (MCN) as well as from harmless pseudocysts. Cross-sectional imaging with computed tomography (CT) and magnetic resonance imaging (MRI) plays a crucial role in the diagnostics of CPL. An algorithm for the differential diagnostic classification of CPL is presented. The connection to the pancreatic duct is the key diagnostic criterion to differentiate IPMN from all other CPL. An exception to this rule is that pseudocysts can also show a connection to the pancreatic duct. A further classification of CPL with no connection to the pancreatic duct can be made by morphological criteria and correlation of the radiological findings with patient age, sex, history and symptoms. Depending on the diagnosis and hence the malignant potential the indications for surgery or watch and wait have to be discussed in an interdisciplinary cooperation. Due to its higher soft tissue contrast MRI is often superior to CT for depiction of CPL morphology. (orig.) [German] Zystische Pankreaslaesionen (ZPL) werden zunehmend haeufiger diagnostiziert. Da bis zu 60 % der ZPL als praemaligne oder maligne einzustufen sind, sollte jede ZPL diagnostisch abgeklaert werden. Seroese ZPL mit geringem Entartungsrisiko (seroes zystische Neoplasien, SZN) muessen von muzinoesen ZPL mit relevantem Malignitaetspotenzial (intraduktale papillaer-muzinoese Neoplasien [IPMN] und muzinoes zystische Neoplasie [MZN]) und harmlosen Pseudozysten unterschieden werden. Die Schnittbildgebung mithilfe der CT und MRT spielt bei der Diagnostik von ZPL eine entscheidende Rolle. Vorgestellt wird ein Algorithmus zur differenzialdiagnostischen

  1. Evaluating a counselling strategy for diagnostic WES in paediatric neurology: an exploration of parents' information and communication needs. (United States)

    Krabbenborg, L; Schieving, J; Kleefstra, T; Vissers, L E L M; Willemsen, M A; Veltman, J A; van der Burg, S


    As whole exome sequencing (WES) is just starting to be used as a diagnostic tool in paediatric neurology for children with a neurological disorder, and patient experiences and preferences with regard to counselling are relatively underexplored. This article explores experiences and preferences of parents with pre-test and post-test counselling in a trial that uses WES for diagnostics. Second, it maps information and communication needs which exceed the counselling protocol, in order to acquire insight into how it can be improved. Data were gathered through in-depth interviews with parents of 15 children who were included in the trial. Information and communication needs of parents differed from the protocol with respect to (i) the type and amount of information provided about WES research, (ii) incidental findings, (iii) communication about progress of the study, and (iv) the communication of the results. Furthermore, parents preferred to have more of a communicative exchange with health care providers about their daily struggles and concerns related to their life with a diseased child and wanted to know how a diagnosis could offer help. There are different ways to meet parental needs, but we suggest that assigning a case manager might be a helpful option that deserves further exploration.

  2. Do Students Know What They Know and What They Don't Know? Using a Four-Tier Diagnostic Test to Assess the Nature of Students' Alternative Conceptions (United States)

    Caleon, Imelda S.; Subramaniam, R.


    This study reports on the development and application of a four-tier multiple-choice (4TMC) diagnostic instrument, which has not been reported in the literature. It is an enhanced version of the two-tier multiple-choice (2TMC) test. As in 2TMC tests, its answer and reason tiers measure students' content knowledge and explanatory knowledge,…

  3. Intercross real-time control strategy in alternating activated sludge process for short-cut biological nitrogen removal treating domestic wastewater

    Institute of Scientific and Technical Information of China (English)

    WANG Shuying; ZHANG Shanfeng; PENG chengyao; AKIOTAKIGAWA


    To develop technically feasible and economically favorable dynamic process control (DPC) strategies for an alternating activated sludge (AAS) system, a bench-scale continuous-flow alternating aerobic and anoxic reactor, performing short-cut nitrogen removal from real domestic wastewater was operated under different control strategies for more than five months. A fixed-time control (FTC) study showed that bending-points on pH and oxidation reduction potential (ORP) profiles accurately coincided with the major biological activities. "Ammonia valley" on the pH profile represented the end of nitrification, whereas, the "nitrite knee" on the ORP profile and "nitrite apex" on the pH profile both indicated the end of denitrification. Therefore, a new reliable and effective real-time control strategy was developed using pH and ORP as control parameters, to improve the performance of the AAS process. The online control strategy could achieve up to 87% of the total nitrogen [G1](TN) removal efficiency on an average, and saving approximately 20% aeration energy, as compared to the conventional steady-state control systems. Moreover, stable short-cut nitrification and denitrification were successfully achieved with an average nitrite accumulation ratio of above 95%.

  4. Classification diagnostic assessment strategies of psychosomatic medicine%心身医学分类诊断评估策略

    Institute of Scientific and Technical Information of China (English)



    心身疾病的心理病理与心理生理机理和临床特征不同于精神疾病。影响心身疾病患者的易损性、病程、预后、康复的心理社会因素的评估受到日益关注。提出心身疾病临床多轴诊断系统( MAS),心身医学研究的诊断标准( DCPR)临床诊断概念和结构框架。 DCPR将来源于心身研究的心理变量转变成用以鉴别诊断的可操作性诊断标准。 DCPR是一个简单、有效和可靠的定式访谈工具,可用于筛查、诊断心身疾病和心理生理障碍,补充ICD-10、DSM、CCMD的临床诊断应用的不足。包含了十二组心身疾病综合症,将影响躯体状况预后和治疗价值中的心理变量转化为客观的心身医学研究用诊断标准用工具。十二组症状包括健康焦虑、死亡恐惧症、疾病恐惧症、疾病否认、持续的躯体化症状、转换性障碍、继发于精神障碍的功能性躯体症状、周年反应、精神消沉、易激惹心境、A型行为和述情障碍。%[Abstarct] The psychological pathology and psychological physiological mechanism of psychosomatic diseases are different from mental diseases.So are the clinical characteristics.Evaluation of psychological social factors that affect the vulnerability, the course of the disease, the prognosis and the recovery in patients with psychosomatic disease has been attracted an increasing attention.The con-cept and structure framework of clinical diagnosis such as clinical multiaxial system( MAS) of psychosomatic disease and diagnostic cri-teria for psychosomatic research( DCPR) have been proposed.The DCPR that derives from the psychological variables in psychosomatic research will translate into operational diagnostic criteria for differential diagnosis.DCPR is a simple, effective and reliable stereotypes interview tool that can be used for screening and diagnosing the psychosomatic diseases and psychophysiological disorders.This can also replenish the

  5. Efficacy of a diagnostic strategy for patients with chest pain and no ST-segment elevation in the emergency room

    Directory of Open Access Journals (Sweden)

    Roberto Bassan


    Full Text Available PURPOSE: To evaluate the efficacy of a systematic model of care for patients with chest pain and no ST segment elevation in the emergency room. METHODS: From 1003 patients submitted to an algorithm diagnostic investigation by probability of acute ischemic syndrome. We analyzed 600 ones with no elevation of ST segment, then enrolled to diagnostic routes of median (route 2 and low probability (route 3 to ischemic syndrome. RESULTS: In route 2 we found 17% acute myocardial infarction and 43% unstable angina, whereas in route 3 the rates were 2% and 7%, respectively. Patients with normal/non--specific ECG had 6% probability of AMI whereas in those with negative first CKMB it was 7%; the association of the 2 data only reduced it to 4%. In patients in route 2 the diagnosis of AMI could only be ruled out with serial CKMB measurement up to 9 hours, while in route 3 it could be done in up to 3 hours. Thus, sensitivity and negative predictive value of admission CKMB for AMI were 52% and 93%, respectively. About one-half of patients with unstable angina did not disclose objective ischemic changes on admission. CONCLUSION: The use of a systematic model of care in patients with chest pain offers the opportunity of hindering inappropriate release of patients with ACI and reduces unnecessary admissions. However some patients even with normal ECG should not be released based on a negative first CKMB. Serial measurement of CKMB up to 9 hours is necessary in patients with medium probability of AMI.

  6. Diagnostic accuracy and cost-effectiveness of alternative methods for detection of soil-transmitted helminths in a post-treatment setting in western Kenya.

    Directory of Open Access Journals (Sweden)

    Liya M Assefa


    Full Text Available OBJECTIVES: This study evaluates the diagnostic accuracy and cost-effectiveness of the Kato-Katz and Mini-FLOTAC methods for detection of soil-transmitted helminths (STH in a post-treatment setting in western Kenya. A cost analysis also explores the cost implications of collecting samples during school surveys when compared to household surveys. METHODS: Stool samples were collected from children (n = 652 attending 18 schools in Bungoma County and diagnosed by the Kato-Katz and Mini-FLOTAC coprological methods. Sensitivity and additional diagnostic performance measures were analyzed using Bayesian latent class modeling. Financial and economic costs were calculated for all survey and diagnostic activities, and cost per child tested, cost per case detected and cost per STH infection correctly classified were estimated. A sensitivity analysis was conducted to assess the impact of various survey parameters on cost estimates. RESULTS: Both diagnostic methods exhibited comparable sensitivity for detection of any STH species over single and consecutive day sampling: 52.0% for single day Kato-Katz; 49.1% for single-day Mini-FLOTAC; 76.9% for consecutive day Kato-Katz; and 74.1% for consecutive day Mini-FLOTAC. Diagnostic performance did not differ significantly between methods for the different STH species. Use of Kato-Katz with school-based sampling was the lowest cost scenario for cost per child tested ($10.14 and cost per case correctly classified ($12.84. Cost per case detected was lowest for Kato-Katz used in community-based sampling ($128.24. Sensitivity analysis revealed the cost of case detection for any STH decreased non-linearly as prevalence rates increased and was influenced by the number of samples collected. CONCLUSIONS: The Kato-Katz method was comparable in diagnostic sensitivity to the Mini-FLOTAC method, but afforded greater cost-effectiveness. Future work is required to evaluate the cost-effectiveness of STH surveillance in

  7. Is case-based learning an effective teaching strategy to challenge students' alternative conceptions regarding chemical kinetics? (United States)

    Yalçınkaya, Eylem; Taştan-Kırık, Özgecan; Boz, Yezdan; Yıldıran, Demet


    Background: Case-based learning (CBL) is simply teaching the concept to the students based on the cases. CBL involves a case, which is a scenario based on daily life, and study questions related to the case, which allows students to discuss their ideas. Chemical kinetics is one of the most difficult concepts for students in chemistry. Students have generally low levels of conceptual understanding and many alternative conceptions regarding it. Purpose: This study aimed to explore the effect of CBL on dealing with students' alternative conceptions about chemical kinetics. Sample: The sample consists of 53 high school students from one public high school in Turkey. Design and methods : Nonequivalent pre-test and post-test control group design was used. Reaction Rate Concept Test and semi-structured interviews were used for data collection. Convenience sampling technique was followed. For data analysis, the independent samples t-test and ANOVA was performed. Results : Both concept test and interview results showed that students instructed with cases had better understanding of core concepts of chemical kinetics and had less alternative conceptions related to the subject matter compared to the control group students, despite the fact that it was impossible to challenge all the alternative conceptions in the experimental group. Conclusions: CBL is an effective teaching method for challenging students' alternative conceptions in the context of chemical kinetics. Since using cases in small groups and whole class discussions has been found to be an effective way to cope with the alternative conceptions, it can be applied to other subjects and grade levels in high schools with a higher sample size. Furthermore, the effect of this method on academic achievement, motivation and critical thinking skills are other variables that can be investigated for future studies in the subject area of chemistry.

  8. Global metabolite profiling and diagnostic ion filtering strategy by LC-QTOF MS for rapid identification of raw and processed pieces of Rheum palmatum L. (United States)

    Liu, Ying; Li, Li; Xiao, Yong-Qing; Yao, Jia-Qi; Li, Peng-Yuan; Yu, Ding-Rong; Ma, Yin-Lian


    Due to its variety of functions, rhubarb has been used for thousands of years in many countries. It is commonly used after processing. Processing usually affect the chemical profile and the contents of active compounds in herbals, leading to changes of their bioactivities. Here, an approach of metabolite profiling and diagnostic ion filtering strategy with liquid chromatography-quadrupole/time-of-flight mass spectrometry was established for rapid identification of raw and processed pieces of Rheum palmatum L. (RPL). The comprehensive and unbiased information of 30 batches of RPL covering raw and two general processing methods were given by metabolomic profiles. Using molecular feature extraction algorithm, non-targeted compounds were analyzed in minutes. In total, 73 characteristic markers were extracted and identified by diagnostic ion filtering. They have been further analyzed by partial least squares-support vector machine-based pattern recognition. The comprehensive and rapid method for raw and processed pieces of RPL classification shows good sensitivity, specificity and prediction performance.

  9. Optimality of the barrier strategy in de Finetti's dividend problem for spectrally negative Lévy processes: An alternative approach (United States)

    Yin, Chuancun; Wang, Chunwei


    The optimal dividend problem proposed in de Finetti [1] is to find the dividend-payment strategy that maximizes the expected discounted value of dividends which are paid to the shareholders until the company is ruined. Avram et al. [9] studied the case when the risk process is modelled by a general spectrally negative Lévy process and Loeffen [10] gave sufficient conditions under which the optimal strategy is of the barrier type. Recently Kyprianou et al. [11] strengthened the result of Loeffen [10] which established a larger class of Lévy processes for which the barrier strategy is optimal among all admissible ones. In this paper we use an analytical argument to re-investigate the optimality of barrier dividend strategies considered in the three recent papers.

  10. Impact Assessment and Multicriteria Decision Analysis of Alternative Managed Aquifer Recharge Strategies Based on Treated Wastewater in Northern Gaza

    Directory of Open Access Journals (Sweden)

    Mohammad Azizur Rahman


    Full Text Available For better planning of a managed aquifer recharge (MAR project, the most promising strategies should analyze the environmental impact, socio-economic efficiency, and their contribution to the existing or future water resource conditions in the region. The challenge of such studies is to combine and quantify a wide range of criteria from the environment and society. This necessity leads to an integrated concept and analysis. This paper outlines an integrated approach considering environmental, health, social and economic aspects to support in the decision-making process to implement a managed aquifer recharge project as a potential response to water resource problems. In order to demonstrate the approach in detail, this paper analysed several water resources management strategies based on MAR implementation, by using treated wastewater in the Northern Gaza Strip and the potential impacts of the strategies on groundwater resources, agriculture, environment, health, economy and society. Based on the Palestinian water policy (Year 2005–2025 on wastewater reuse, three MAR strategies were developed in close cooperation with the local decision makers. The strategies were compared with a base line strategy referred to as the so-called “Do Nothing Approach”. The results of the study show that MAR project implementation with treated wastewater at a maximum rate, considered together with sustainable development of groundwater, is the best and most robust strategy amongst those analyzed. The analysis shows the defined MAR strategies contribute to water resources development and environmental protection or improvement including an existing eutrophic lake. The integrated approach used in this paper may be applicable not only to MAR project implementation but also to other water resources and environmental development projects.

  11. 车用替代能源综合评价与发展策略%Comprehensive Evaluation of Vehicle Alternative Energy and Development Strategy

    Institute of Scientific and Technical Information of China (English)



    本文从技术性与政策性角度分析了各种车用替代能源的技术优缺点以及政策支持力度.研究表明:首先,发展车用替代能源应该以新能源汽车及传统汽车的替代燃料两个方面为重点.其中,新能源汽车以燃气汽车、混合动力汽车与甲醇汽车为主要发展方向,使用替代能源为天然气或液化石油气、电与甲醇;传统汽车替代燃料以甲醇汽油、生物柴油与二甲醚为主要发展方向.其次,由于发展的多元性,车用替代能源发展策略应该同时注重区域性、技术性以及政策性.%This paper analyzes technology advantages or disadvantages and the policy support of various alternative energy for vehicles in terms of technicality and policy. The results show that: firstly, the development focus of alternative energy should be concentrated on the new energy vehicles and alternative fuels for traditional vehicles. Among them, the main developing directions for the new energy vehicles are gas, hybrid and methanol vehicles. The alternative energy is natural gas or liquefied petroleum gas, electricity and methanol. And the main developing directions for the traditional alternative fuels are methanol-gasoline, biodiesel and dimethyl ether. Secondly, because of the diversity of development, the developing strategies for alternative energy of vehicles should take the regional, technical and policy natures into considerations.

  12. Evaluation of alternative groundwater-management strategies for the Bureau of Reclamation Klamath Project, Oregon and California (United States)

    Wagner, Brian J.; Gannett, Marshall W.


    The water resources of the upper Klamath Basin, in southern Oregon and northern California, are managed to achieve various complex and interconnected purposes. Since 2001, irrigators in the Bureau of Reclamation Klamath Irrigation Project (Project) have been required to limit surface-water diversions to protect habitat for endangered freshwater and anadromous fishes. The reductions in irrigation diversions have led to an increased demand for groundwater by Project irrigators, particularly in drought years. The potential effects of sustained pumping on groundwater and surface-water resources have caused concern among Federal and state agencies, Indian tribes, wildlife groups, and groundwater users. To aid in the development of a viable groundwater-management strategy for the Project, the U.S. Geological Survey, in collaboration with the Klamath Water and Power Agency and the Oregon Water Resources Department, developed a groundwater-management model that links groundwater simulation with techniques of constrained optimization. The overall goal of the groundwater-management model is to determine the patterns of groundwater pumping that, to the extent possible, meet the supplemental groundwater demands of the Project. To ensure that groundwater development does not adversely affect groundwater and surface-water resources, the groundwater-management model includes constraints to (1) limit the effects of groundwater withdrawal on groundwater discharge to streams and lakes that support critical habitat for fish listed under the Endangered Species Act, (2) ensure that drawdowns do not exceed limits allowed by Oregon water law, and (3) ensure that groundwater withdrawal does not adversely affect agricultural drain flows that supply a substantial portion of water for irrigators and wildlife refuges in downslope areas of the Project. Groundwater-management alternatives were tested and designed within the framework of the Klamath Basin Restoration Agreement (currently [2013

  13. Portfolios as alternative assessment strategy for enviromental education in pre-service teaching education at university level

    Directory of Open Access Journals (Sweden)

    Mata Segreda, Alejandrina


    Full Text Available This article describes the development of the portfolio assessment technique as a strategy for teacher education at university level, in order to create a positive relationship between humans and environment. It shows the theorist approach and the research process used to validate the ground hypothesis. As a result, we found that this strategy stimulates the capacity for self-evaluation, empowers students to act responsibly towards the environment, and helps them develop skills for applying environmental knowledge, even though the performance of the students that participated on the experimental design had no statistic significance. Furthermore, it describes a specific experience in order to facilitate the implementation of the strategy by university faculty in any discipline. Environmental Education, Assessment Portfolios, College Education.

  14. An Overview on Coronary Heart Disease (A Comparative Evaluation of Turkey and Europe and Cost-effectiveness of Diagnostic Strategies

    Directory of Open Access Journals (Sweden)

    Cengiz Taşçı


    Full Text Available Objective: Coronary heart disease (CHD is the leading cause of death for men and women in Turkey as it is in Europe and US. The prevalence of the disease is 3.8% in Turkey and 200,000 patients are added to the pool of CHD annually Because of genetic predis¬position and high proportions of physical inactivity, smoking habit, and obesity, CHD is encountered in earlier ages in our country So, the economic burden of the disease is expected to be relatively high, but the amount of health expenditure is not always parallel to the prevalence of a disease in the community. This article was written to overview CHD statistics to make a comparison between Turkey and some European countries and to investigate the value of myocardial perfusion scan (MPS as a gatekeeper in diagnosing CHD before invasive coronary angiography (ICA. The consequences were evaluated for Turkey In diagnosis; noninvasive testing gains impor¬tance in connection with the new approaches in treatment strategies, because a direct ICA strategy results in higher rates of revascu¬larization without improvement in clinical outcomes. A "gatekeeper" is needed to select the patients who are not required to under¬go angiography. MPS with its proved power in diagnosis and predicting prognosis, provides a cost-effective solution, and is accepted in some extensive analyses as a "gatekeeper" particularly in intermediate and high risk patients and in patients with known CHD. In conclusion, MPS may provide an optimal solution better than the ongoing situation in Turkey as well, when it is approved as a "gatekeeper in an algorithm before ICA. (MIRT 2011;20:75-93

  15. Development of alternative strategies for the control of the important phytopathogens Phytophthora infestans (Mont.) and Erwinia amylovora (Burrill)



    Within the framework of two projects, financed by DBU (Deutsche Bundesstiftung Umwelt) and ProInno ("Förderung der Erhöhung der Innovationskompetenz mittelständischer Unternehmen"), respectively, in co-operation with an industrial partner, alternative phytosanitary compounds from natural sources have been screened. High throughput screening systems were developed and used for testing of large numbers of extracts of Actinomycetes in 96-well multiplates against Phytophthora infestans and Erwini...

  16. Designing Strategy and Competence-targeted Analysis of Assessment and Diagnostic Materials for the Master’s Studies Tests

    Directory of Open Access Journals (Sweden)

    A. A. Dorofeev


    Full Text Available The paper describes technique, design process, and examples of assessment and diagnostic materials for the written tests for applicants to be admitted to Master’s studies. Their development is based on the objectives of the learning outcomes (LO gained in the course of bachelor, specialist, and master study programmes. The objective is characterised both by category of acquired knowledge, from the fact-gathering one to the meta-knowledge, and by necessary level of activities, which realise gained reproductive-to-creative knowledge, abilities, and skills, and show desirable human personalities appropriate for these activities, i.e. human’s competence.The paper offers and analyses a task option aimed at revealing competence of heterogeneous test for entrance trials. The test includes problems of three levels, which are different in structural complexity and activity in their solution: from reproduction and interpretation of data to the analysis and synthesis of the new information contents with creative elements. It demands that a future graduate has to possess certain personal qualities, be qualified and psychologically ready for the learning activity with a research component.Thus the paper gives examples of tasks with text and graphic interfaces and their benchmark (model solutions. The tasks are formulated on a case technique as a problem situation in the substantive area of the future professional activity. The maximum score assessment is based both on the number of attributive didactic points and on the necessary level of activity. To assess the fulfilled tasks the paper offers a technique that takes into consideration how the result is approximated to the benchmark solution.In developing a substantive ground of the test tasks the paper proposes to use the programmes of propaedeutic disciplines and a local issue of the coursework design. As to drawing up tasks and control of their fulfilment the offer is to involve the faculty staff in

  17. Evaluation of alternative PCB clean-up strategies using an individual-based population model of mink

    Energy Technology Data Exchange (ETDEWEB)

    Salice, Christopher J., E-mail: [Department of Environmental Toxicology, Texas Tech University, Lubbock, TX 79410 (United States); Sample, Bradley E., E-mail: [Ecological Risk Inc., Rancho Murieta, CA 95683 (United States); Miller Neilan, Rachael; Rose, Kenneth A.; Sable, Shaye [Department of Oceanography and Coastal Sciences, Energy, Coast and Environment Building, Louisiana State University, Baton Rouge, LA 70803 (United States)


    Population models can be used to place observed toxic effects into an assessment of the impacts on population-level endpoints, which are generally considered to provide greater ecological insight and relevance. We used an individual-based model of mink to evaluate the population-level effects of exposure to polychlorinated biphenyls (PCBs) and the impact that different remediation strategies had on mink population endpoints (population size and extinction risk). Our simulations indicated that the initial population size had a strong impact on mink population dynamics. In addition, mink populations were extremely responsive to clean-up scenarios that were initiated soon after the contamination event. In fact, the rate of PCB clean-up did not have as strong a positive effect on mink as did the initiation of clean-up (start time). We show that population-level approaches can be used to understand adverse effects of contamination and to also explore the potential benefits of various remediation strategies. - Highlights: > We used an individual-based model of mink to evaluate population-level impacts of PCB contamination. > The model was also used to explore the population responses to different PCB remediation strategies. > Population size had a large impact on whether mink populations persisted or went extinct. > Starting remediation sooner had a stronger positive effect on mink populations than did the rate of PCB clean-up. > Individual-based models are useful in understanding effects of contamination and different remediation strategies. - An individual-based model of mink showed strong population-level effects of PCB contamination and provided insight into optimal PCB remediation strategies.

  18. [Gadolinium as an alternative radiocontrast agent in patients with allergy to iodine-based contrast provide for useful diagnostic imagings and safely treatment of biliary tract diseases]. (United States)

    Natsume, Makoto; Sano, Hitoshi; Fukusada, Shigeki; Kachi, Kenta; Inoue, Tadahisa; Anbe, Kaiki; Nishie, Hirotada; Nishi, Yuji; Yoshimura, Norihiro; Mizushima, Takashi; Okumura, Fumihiro; Miyabe, Katsuyuki; Naitoh, Itaru; Hayashi, Kazuki; Nakazawa, Takahiro


    Diagnosis and treatment of biliary tract disease requires an intraductal radiocontrast agent. Although iodine-based contrast medium is commonly used, some patients show severe allergy to iodinated contrast agent. We have retrospectively reviewed the usefulness and safety of gadolinium as an alternative radiocontrast agent in 3 patients with allergy to iodine-based contrast medium in the diagnosis and treatment of biliary tract diseases. In case 1, percutaneous transhepatic biliary drainage and cholangiography were performed successfully and it was possible to visualize an intrahepatic bile duct stone. Percutaneous transhepatic cholangioscopic lithotomy was performed and the intrahepatic bile duct stone was removed. In case 2, endoscopic biliary lithotripsy was performed. In case 3, percutaneous transhepatic cholangiography and cholangioscopy provided a diagnosis of moderately differentiated carcinoma. He underwent pancreatoduodenectomy. Postoperative cholangiograms were also obtained successfully. Gadolinium contrast agent is an alternative to iodine-based cholangiography for the patients with allergy to iodine.

  19. Immobilization strategy for enhancing sensitivity of immunosensors: L-Asparagine-AuNPs as a promising alternative of EDC-NHS activated citrate-AuNPs for antibody immobilization. (United States)

    Raghav, Ragini; Srivastava, Sudha


    This paper addresses the question - Is EDC-NHS activated gold nanoparticles modified electrode surface the best available option for antibody immobilization for immunosensor fabrication? Is there any other alternative covalent immobilization strategy for orthogonal orientation of antibody, ensuring enhanced sensitivity of immunosensors? Does EDC-NHS activation of carboxyl functionalized nanoparticles surface really leads to orthogonal or directed immobilization of antibody? Gold nanoparticles synthesized using L-Asparagine as reducing and stabilization agent were employed for orthogonal immobilization of antibody for immunosensor fabrication. Anti-CA125 antibody was used as a model system for immunosensor fabrication. A comparative evaluation of immunosensors fabricated using L-Asparagine stabilized gold nanoparticles and citrate stabilized gold nanoparticles via different immobilization strategies/chemistries was done. The three strategies involved immobilization of Anti-CA125 antibody - (1) after EDC-NHS activation of citrate stabilized gold nanoparticles, (2) directly onto citrate stabilized gold nanoparticles and (3) directly onto L-Asparagine stabilized gold nanoparticles modified electrode surfaces. Comparative evaluation of Impedimetric response characteristics showed 2.5 times increase in sensitivity (349.36 Ω/(IU/mL)/cm(2)) in case of third strategy as compared to first (147.53 Ω/(IU/mL)/cm(2)) and twice that of second strategy (166.24 Ω/(IU/mL)/cm(2)). Additionally, an extended dynamic range of 0-750 IU/mL was observed while for others it was up to 500 IU/mL. Amino acid coated gold nanoparticles ensured orthogonal immobilization, lesser randomization, with 88% of active antibody available for antigen binding as opposed to other two strategies with less than 30% active antibody.

  20. Clinical outcomes with alternative dosing strategies for piperacillin/tazobactam: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Hui Yang

    Full Text Available A better dosing strategy can improve clinical outcomes for patients. We sought to compare the extended or continuous infusion with conventional intermittent infusion of piperacillin/tazobactam, investigating which approach is better and worthy of recommendation for clinical use.Articles were gathered from PubMed, Web of Science, ProQuest, Science Direct, Cochrane, two Chinese literature databases (CNKI, Wan Fang Data and related ICAAC and ACCP conferences. Randomized controlled and observational studies that compared extended or continuous infusion with conventional intermittent infusion of piperacillin/tazobactam were identified from the databases above and analyzed. Two reviewers independently extracted and investigated the data. A meta-analysis was performed using Revman 5.2 software. The quality of each study was assessed. Sensitivity analysis and publication bias were evaluated.Five randomized controlled trials and nine observational studies were included in this study. All included studies had high quality and no publication bias was found. Compared to the conventional intermittent infusion approach, the extended or continuous infusion group had a significantly higher clinical cure rate (OR 1.88, 95% CI 1.29-2.73, P = 0.0009 and a lower mortality rate (OR 0.67, 95% CI 0.50-0.89, P = 0.005. No statistical difference was observed for bacteriologic cure (OR 1.40, 95% CI 0.82-2.37, P = 0.22 between the two dosing regimens. The sensitivity analysis showed the results were stable.Our systematic review and meta-analysis suggested that the extended or continuous infusion strategy of piperacillin/tazobactam should be recommended for clinical use considering its higher clinical cure rate and lower mortality rate in comparison with conventional intermittent strategy. Data from this study could be extrapolated for other β-lactam antimicrobials. Therefore, this dosing strategy could be considered in clinical practice.

  1. Balanced trade-offs between alternative strategies shape the response of C. elegans reproduction to chronic heat stress. (United States)

    Aprison, Erin Z; Ruvinsky, Ilya


    To ensure long-term reproductive success organisms have to cope with harsh environmental extremes. A reproductive strategy that simply maximizes offspring production is likely to be disadvantageous because it could lead to a catastrophic loss of fecundity under unfavorable conditions. To understand how an appropriate balance is achieved, we investigated reproductive performance of C. elegans under conditions of chronic heat stress. We found that following even prolonged exposure to temperatures at which none of the offspring survive, worms could recover and resume reproduction. The likelihood of producing viable offspring falls precipitously after exposure to temperatures greater than 28°C primarily due to sperm damage. Surprisingly, we found that worms that experienced higher temperatures can recover considerably better, provided they did not initiate ovulation. Therefore mechanisms controlling this process must play a crucial role in determining the probability of recovery. We show, however, that suppressing ovulation is only beneficial under relatively long stresses, whereas it is a disadvantageous strategy under shorter stresses of the same intensity. This is because the benefit of shutting down egg laying, and thus protecting the reproductive system, is negated by the cost associated with implementing this strategy--it takes considerable time to recover and produce offspring. We interpret these balanced trade-offs as a dynamic response of the C. elegans reproductive system to stress and an adaptation to life in variable and unpredictable conditions.

  2. Balanced trade-offs between alternative strategies shape the response of C. elegans reproduction to chronic heat stress.

    Directory of Open Access Journals (Sweden)

    Erin Z Aprison

    Full Text Available To ensure long-term reproductive success organisms have to cope with harsh environmental extremes. A reproductive strategy that simply maximizes offspring production is likely to be disadvantageous because it could lead to a catastrophic loss of fecundity under unfavorable conditions. To understand how an appropriate balance is achieved, we investigated reproductive performance of C. elegans under conditions of chronic heat stress. We found that following even prolonged exposure to temperatures at which none of the offspring survive, worms could recover and resume reproduction. The likelihood of producing viable offspring falls precipitously after exposure to temperatures greater than 28°C primarily due to sperm damage. Surprisingly, we found that worms that experienced higher temperatures can recover considerably better, provided they did not initiate ovulation. Therefore mechanisms controlling this process must play a crucial role in determining the probability of recovery. We show, however, that suppressing ovulation is only beneficial under relatively long stresses, whereas it is a disadvantageous strategy under shorter stresses of the same intensity. This is because the benefit of shutting down egg laying, and thus protecting the reproductive system, is negated by the cost associated with implementing this strategy--it takes considerable time to recover and produce offspring. We interpret these balanced trade-offs as a dynamic response of the C. elegans reproductive system to stress and an adaptation to life in variable and unpredictable conditions.

  3. ss-siRNAs allele selectively inhibit ataxin-3 expression: multiple mechanisms for an alternative gene silencing strategy. (United States)

    Liu, Jing; Yu, Dongbo; Aiba, Yuichiro; Pendergraff, Hannah; Swayze, Eric E; Lima, Walt F; Hu, Jiaxin; Prakash, Thazha P; Corey, David R


    Single-stranded silencing RNAs (ss-siRNAs) provide an alternative approach to gene silencing. ss-siRNAs combine the simplicity and favorable biodistribution of antisense oligonucleotides with robust silencing through RNA interference (RNAi). Previous studies reported potent and allele-selective inhibition of human huntingtin expression by ss-siRNAs that target the expanded CAG repeats within the mutant allele. Mutant ataxin-3, the genetic cause of Machado-Joseph Disease, also contains an expanded CAG repeat. We demonstrate here that ss-siRNAs are allele-selective inhibitors of ataxin-3 expression and then redesign ss-siRNAs to optimize their selectivity. We find that both RNAi-related and non-RNAi-related mechanisms affect gene expression by either blocking translation or affecting alternative splicing. These results have four broad implications: (i) ss-siRNAs will not always behave similarly to analogous RNA duplexes; (ii) the sequences surrounding CAG repeats affect allele-selectivity of anti-CAG oligonucleotides; (iii) ss-siRNAs can function through multiple mechanisms and; and (iv) it is possible to use chemical modification to optimize ss-siRNA properties and improve their potential for drug discovery.

  4. Compensatory motor control after stroke: an alternative joint strategy for object-dependent shaping of hand posture. (United States)

    Raghavan, Preeti; Santello, Marco; Gordon, Andrew M; Krakauer, John W


    Efficient grasping requires planned and accurate coordination of finger movements to approximate the shape of an object before contact. In healthy subjects, hand shaping is known to occur early in reach under predominantly feedforward control. In patients with hemiparesis after stroke, execution of coordinated digit motion during grasping is impaired as a result of damage to the corticospinal tract. The question addressed here is whether patients with hemiparesis are able to compensate for their execution deficit with a qualitatively different grasp strategy that still allows them to differentiate hand posture to object shape. Subjects grasped a rectangular, concave, and convex object while wearing an instrumented glove. Reach-to-grasp was divided into three phases based on wrist kinematics: reach acceleration (reach onset to peak horizontal wrist velocity), reach deceleration (peak horizontal wrist velocity to reach offset), and grasp (reach offset to lift-off). Patients showed reduced finger abduction, proximal interphalangeal joint (PIP) flexion, and metacarpophalangeal joint (MCP) extension at object grasp across all three shapes compared with controls; however, they were able to partially differentiate hand posture for the convex and concave shapes using a compensatory strategy that involved increased MCP flexion rather than the PIP flexion seen in controls. Interestingly, shape-specific hand postures did not unfold initially during reach acceleration as seen in controls, but instead evolved later during reach deceleration, which suggests increased reliance on sensory feedback. These results indicate that kinematic analysis can identify and quantify within-limb compensatory motor control strategies after stroke. From a clinical perspective, quantitative study of compensation is important to better understand the process of recovery from brain injury. From a motor control perspective, compensation can be considered a model for how joint redundancy is exploited

  5. Sustainable alternatives for land-based biofuels in the European Union. Assessment of options and development of a policy strategy

    Energy Technology Data Exchange (ETDEWEB)

    Kampman, B.; Van Grinsven, A.; Croezen, H.


    It is feasible for EU member states to meet their commitments regarding transport fuels under the Renewable Energy Directive (RED) and the Fuel Quality Directive (FQD) without resorting to biofuels from food crops. The RED target (10% renewable transport energy in 2020) can be met by a mix of measures aimed at improving energy efficiency, combined with a strong focus on growth of renewable electricity use and biofuels and biomethane from waste and residues. These measures also contribute to the FQD target (6% reduction in carbon intensity of fuels by 2020), but will need to be complemented by other measures such as reduced flaring and venting during oil production. The report shows how EU transport energy policy could reduce its reliance on biofuels from food crops that are likely to cause land use change. This alternative vision for the transport sector in 2020 would cut CO2 emissions by 205 million tonnes.

  6. Distributed and dynamic modelling of hydrology, phosphorus and ecology in the Hampshire Avon and Blashford Lakes: evaluating alternative strategies to meet WFD standards. (United States)

    Whitehead, P G; Jin, L; Crossman, J; Comber, S; Johnes, P J; Daldorph, P; Flynn, N; Collins, A L; Butterfield, D; Mistry, R; Bardon, R; Pope, L; Willows, R


    The issues of diffuse and point source phosphorus (P) pollution in the Hampshire Avon and Blashford Lakes are explored using a catchment model of the river system. A multibranch, process based, dynamic water quality model (INCA-P) has been applied to the whole river system to simulate water fluxes, total phosphorus (TP) and soluble reactive phosphorus (SRP) concentrations and ecology. The model has been used to assess impacts of both agricultural runoff and point sources from waste water treatment plants (WWTPs) on water quality. The results show that agriculture contributes approximately 40% of the phosphorus load and point sources the other 60% of the load in this catchment. A set of scenarios have been investigated to assess the impacts of alternative phosphorus reduction strategies and it is shown that a combined strategy of agricultural phosphorus reduction through either fertiliser reductions or better phosphorus management together with improved treatment at WWTPs would reduce the SRP concentrations in the river to acceptable levels to meet the EU Water Framework Directive (WFD) requirements. A seasonal strategy for WWTP phosphorus reductions would achieve significant benefits at reduced cost.

  7. 自发性气胸致失血性休克诊疗策略%The Diagnostic and Therapeutic Strategies of Spontaneous Pneumothorax with Hemorrhagic Shock

    Institute of Scientific and Technical Information of China (English)

    柯弢; 刘青; 范菁


    To understand the clinical features and research diagnostic and therapeutic strategies of spontaneous pneumothorax (SP) with hemorrhagic shock, 331 cases of SP with hemorrhagic shock were analyzed. The Operative treatment has the best effects. SP with hemorrhagic shock is found mostly in young males. The site of bleeding was mostly located in a torn adhesion of parietal pleura. Emergency minimally invasive technique is the direction of development.%分析自发性气胸(spontaneous pneumothorax,SP)出现失血性休克时的临床特点、探讨诊疗策略.分析331例SP并失血性休克的病例资料.结果采用手术治疗者效果最佳.SP致失血性休克者多见于青年男性,多为胸膜顶粘连带出血,急诊微创手术是治疗发展方向.

  8. The Unsuccessful Poverty Reduction Strategies in Indonesia and the Alternatives Solutions (The Study on BLT and Jamkesmas

    Directory of Open Access Journals (Sweden)

    Dewi Iriani


    Full Text Available Indonesia as the 16th largest economy in the world, the 4th in Asia-after China, Japan and India as well as Southeast Asia’s largest-has the potential to be the seventh biggest by 2030, due to the increasing economic. Indonesia also has many potential natural resources that can be utilized to support development in order to increase the nation welfare. However, the number of poor people still has not been significantly reduced, reaching 28.07 million or 11.37% of the total population in 2013. The Government has tried to reduce poverty with some programs such as BLT (Bantuan Langsung Tunai/Direct Cash Assistance and Jamkesmas (Jaminan Kesehatan Masyarakat/ Community Health Protection Scheme. However, the programs are considered not effective and do not make poor people become financially independent. Ironically, in inadequate evaluation, the Government continues to runs the programs. By using a qualitative approach, researchers will provide policy alternatives that can be implemented by Government.

  9. Endopolyploidy as a potential alternative adaptive strategy for Arabidopsis leaf size variation in response to UV-B. (United States)

    Gegas, Vasilis C; Wargent, Jason J; Pesquet, Edouard; Granqvist, Emma; Paul, Nigel D; Doonan, John H


    The extent of endoreduplication in leaf growth is group- or even species-specific, and its adaptive role is still unclear. A survey of Arabidopsis accessions for variation at the level of endopolyploidy, cell number, and cell size in leaves revealed extensive genetic variation in endopolyploidy level. High endopolyploidy is associated with increased leaf size, both in natural and in genetically unstructured (mapping) populations. The underlying genes were identified as quantitative trait loci that control endopolyploidy in nature by modulating the progression of successive endocycles during organ development. This complex genetic architecture indicates an adaptive mechanism that allows differential organ growth over a broad geographic range and under stressful environmental conditions. UV-B radiation was identified as a significant positive climatic predictor for high endopolyploidy. Arabidopsis accessions carrying the increasing alleles for endopolyploidy also have enhanced tolerance to UV-B radiation. UV-absorbing secondary metabolites provide an additional protective strategy in accessions that display low endopolyploidy. Taken together, these results demonstrate that high constitutive endopolyploidy is a significant predictor for organ size in natural populations and is likely to contribute to sustaining plant growth under high incident UV radiation. Endopolyploidy may therefore form part of the range of UV-B tolerance mechanisms that exist in natural populations.

  10. Natural genetic and induced plant resistance, as a control strategy to plant-parasitic nematodes alternative to pesticides. (United States)

    Molinari, Sergio


    Plant-parasitic nematodes are pests of a wide range of economically important crops, causing severe losses to agriculture. Natural genetic resistance of plants is expected to be a valid solution of the many problems nematodes cause all over the world. Progress in resistance applications is particularly important for the less-developed countries of tropical and subtropical regions, since use of resistant cultivars may be the only possible and economically feasible control strategy in those farming systems. Resistance is being considered of particular importance also in modern high-input production systems of developed countries, as the customary reliance on chemical nematicides has been restricted or has come to an end. This review briefly describes the genetic bases of resistance to nematodes in plants and focuses on the chances and problems of its exploitation as a key element in an integrated management program. Much space is dedicated to the major problem of resistance durability, in that the intensive use of resistant cultivars is likely to increasingly induce the selection of virulent populations able to "break" the resistance. Protocols of pest-host suitability are described, as bioassays are being used to evaluate local nematode populations in their potential to be selected on resistant germplasm and endanger resistant crops. The recent progress in using robust and durable resistances against nematodes as an efficient method for growers in vegetable cropping systems is reported, as well as the possible use of chemicals that do not show any unfavorable impact on environment, to induce in plants resistance against plant-parasitic nematodes.

  11. Laboratory Diagnostic Strategy for Thrombophilia

    Institute of Scientific and Technical Information of China (English)



    @@ Thrombophilia is described as a tendency to develop thrombosis as a consequence of predisposing factors that may be genetically determined, acquired, or both. The risk factors associated with venous thromboembolism are different from those associated with arterial thrombosis. Venous and arterial thromboses are also distinct clinical entities that differ in the microenvironment of clot formation and the structure of the clots formed. Therefore, the tests to be used in laboratory investigation of these two conditions are different.

  12. 肺部孤立性结节的评估及诊断策略的选择%Evaluation and diagnostic strategies of solitary pulmonary nodules

    Institute of Scientific and Technical Information of China (English)

    王辉; 解卫平; 陈亮


    随着胸部CT的广泛应用,肺部孤立性结节的发现率越来越高.如何确认发现的肺部孤立性结节的性质成为临床上亟待解决的问题.少数结节的性质可以通过患者的临床特征及胸部CT特点得到确认,但绝大多数的结节的性质需要通过进一步的检查,包括经验性抗感染治疗、胸部CT定期随访观察、PET/CT检查、纤维支气管镜榆查、CT引导下经胸针吸肺活检、电视胸腔镜手术等.随着对肺部孤立性结节认识的日益加深及诊断策略的日趋完善,肺部孤立性结节的诊治得到了较快的发展.%With the extensive use of chest CT, the detection rate of solitary pulmonary nodules is increasing. How to determine the nature of solitary pulmonary nodules is a urgent problem in clinic. The nature of a small number of nodules can be confirmed by clinical features of patients and characteristic of chest CT, but the nature of majority of nodules need to be further examined by empirical anti-infective therapy, regular follow-up observation of chest CT scan. PET/CT scan, bronchoscopy, CT-guided transthoracic needle aspiration biopsy,and video assisted thoracoscopy. With the deepening understanding of solitary pulmonary nodules and the gradual improvement of diagnostic strategies, diagnosis and treatment of solitary pulmonary nodules has rapid development.

  13. Motor neurone disease: diagnostic pitfalls. (United States)

    Williams, Timothy L


    The misdiagnosis of MND (particularly of the ALS phenotype), is uncommon. Atypical presentations, particularly of focal onset and with pure LMN or UMN signs, present a more difficult diagnostic challenge, although perhaps reassuringly, treatable mimics are rare. A working knowledge of potential alternative conditions and MND diagnostic pitfalls should help to reduce the misdiagnosis rate, particularly if the key points are considered.

  14. Advancing Risk Analysis for Nanoscale Materials: Report from an International Workshop on the Role of Alternative Testing Strategies for Advancement: Advancing Risk Analysis for Nanoscale Materials

    Energy Technology Data Exchange (ETDEWEB)

    Shatkin, J. A. [Vireo Advisors, Boston MA USA; Ong, Kimberly J. [Vireo Advisors, Boston MA USA; Beaudrie, Christian [Compass RM, Vancouver CA USA; Clippinger, Amy J. [PETA International Science Consortium Ltd, London UK; Hendren, Christine Ogilvie [Center for the Environmental Implications of NanoTechnology, Duke University, Durham NC USA; Haber, Lynne T. [TERA, Cincinnati OH USA; Hill, Myriam [Health Canada, Ottawa Canada; Holden, Patricia [UC Santa Barbara, Bren School of Environmental Science & Management, ERI, and UC CEIN, University of California, Santa Barbara CA USA; Kennedy, Alan J. [U.S. Army Engineer Research and Development Center, Environmental Laboratory, Vicksburg MS USA; Kim, Baram [Independent, Somerville MA USA; MacDonell, Margaret [Argonne National Laboratory, Environmental Science Division, Argonne IL USA; Powers, Christina M. [U.S. Environmental Protection Agency, Office of Air and Radiation, Office of Transportation and Air Quality, Ann Arbor MI USA; Sharma, Monita [PETA International Science Consortium Ltd, London UK; Sheremeta, Lorraine [Alberta Ingenuity Labs, Edmonton Alberta Canada; Stone, Vicki [John Muir Building Gait 1 Heriot-Watt University, Edinburgh Scotland UK; Sultan, Yasir [Environment Canada, Gatineau QC Canada; Turley, Audrey [ICF International, Durham NC USA; White, Ronald H. [RH White Consultants, Silver Spring MD USA


    The Society for Risk Analysis (SRA) has a history of bringing thought leadership to topics of emerging risk. In September 2014, the SRA Emerging Nanoscale Materials Specialty Group convened an international workshop to examine the use of alternative testing strategies (ATS) for manufactured nanomaterials (NM) from a risk analysis perspective. Experts in NM environmental health and safety, human health, ecotoxicology, regulatory compliance, risk analysis, and ATS evaluated and discussed the state of the science for in vitro and other alternatives to traditional toxicology testing for NM. Based on this review, experts recommended immediate and near-term actions that would advance ATS use in NM risk assessment. Three focal areas-human health, ecological health, and exposure considerations-shaped deliberations about information needs, priorities, and the next steps required to increase confidence in and use of ATS in NM risk assessment. The deliberations revealed that ATS are now being used for screening, and that, in the near term, ATS could be developed for use in read-across or categorization decision making within certain regulatory frameworks. Participants recognized that leadership is required from within the scientific community to address basic challenges, including standardizing materials, protocols, techniques and reporting, and designing experiments relevant to real-world conditions, as well as coordination and sharing of large-scale collaborations and data. Experts agreed that it will be critical to include experimental parameters that can support the development of adverse outcome pathways. Numerous other insightful ideas for investment in ATS emerged throughout the discussions and are further highlighted in this article.

  15. Computational modeling as part of alternative testing strategies in the respiratory and cardiovascular systems: inhaled nanoparticle dose modeling based on representative aerosol measurements and corresponding toxicological analysis. (United States)

    Pilou, Marika; Mavrofrydi, Olga; Housiadas, Christos; Eleftheriadis, Kostas; Papazafiri, Panagiota


    The objectives of modeling in this work were (a) the integration of two existing numerical models in order to connect external exposure to nanoparticles (NPs) with internal dose through inhalation, and (b) to use computational fluid-particle dynamics (CFPD) to analyze the behavior of NPs in the respiratory and the cardiovascular system. Regarding the first objective, a lung transport and deposition model was combined with a lung clearance/retention model to estimate NPs dose in the different regions of the human respiratory tract and some adjacent tissues. On the other hand, CFPD was used to estimate particle transport and deposition of particles in a physiologically based bifurcation created by the third and fourth lung generations (respiratory system), as well as to predict the fate of super-paramagnetic particles suspended in a liquid under the influence of an external magnetic field (cardiovascular system). All the above studies showed that, with proper refinement, the developed computational models and methodologies may serve as an alternative testing strategy, replacing transport/deposition experiments that are expensive both in time and resources and contribute to risk assessment.

  16. Cost-Effectiveness of Alternative Management Strategies for Patients with Solitary Pulmonary Nodules%肺部孤立结节患者处理新策略的效价比

    Institute of Scientific and Technical Information of China (English)

    樊旼; 徐崇锐


    1文献来源Gould,MK,Sanders GD,Barnett PG,etal.Cost-effectiveness of alternative management strategies for patients with solitary pulmonary nodules[J].Ann Intern Med,2003,138(9):724-735.2证据水平1a。

  17. Strategie podniku


    Podhradská, Martina


    This paper deals with a process of strategy definition of Starkl -- zahradník s.r.o. company. The main target of this diploma thesis is to elaborate external and internal analysis and to assess present strategy, alternatively to suggest a new strategy reflecting competitive environment.

  18. The Repellent DEET Potentiates Carbamate Effects via Insect Muscarinic Receptor Interactions: An Alternative Strategy to Control Insect Vector-Borne Diseases.

    Directory of Open Access Journals (Sweden)

    Aly Abd-Ella

    Full Text Available Insect vector-borne diseases remain one of the principal causes of human mortality. In addition to conventional measures of insect control, repellents continue to be the mainstay for personal protection. Because of the increasing pyrethroid-resistant mosquito populations, alternative strategies to reconstitute pyrethroid repellency and knock-down effects have been proposed by mixing the repellent DEET (N,N-Diethyl-3-methylbenzamide with non-pyrethroid insecticide to better control resistant insect vector-borne diseases. By using electrophysiological, biochemichal, in vivo toxicological techniques together with calcium imaging, binding studies and in silico docking, we have shown that DEET, at low concentrations, interacts with high affinity with insect M1/M3 mAChR allosteric site potentiating agonist effects on mAChRs coupled to phospholipase C second messenger pathway. This increases the anticholinesterase activity of the carbamate propoxur through calcium-dependent regulation of acetylcholinesterase. At high concentrations, DEET interacts with low affinity on distinct M1/M3 mAChR site, counteracting the potentiation. Similar dose-dependent dual effects of DEET have also been observed at synaptic mAChR level. Additionally, binding and in silico docking studies performed on human M1 and M3 mAChR subtypes indicate that DEET only displays a low affinity antagonist profile on these M1/M3 mAChRs. These results reveal a selective high affinity positive allosteric site for DEET in insect mAChRs. Finally, bioassays conducted on Aedes aegypti confirm the synergistic interaction between DEET and propoxur observed in vitro, resulting in a higher mortality of mosquitoes. Our findings reveal an unusual allosterically potentiating action of the repellent DEET, which involves a selective site in insect. These results open exciting research areas in public health particularly in the control of the pyrethroid-resistant insect-vector borne diseases. Mixing low

  19. Clean Cities ozone air quality attainment and maintenance strategies that employ alternative fuel vehicles, with special emphasis on natural gas and propane

    Energy Technology Data Exchange (ETDEWEB)

    Santini, D.J.; Saricks, C.L.


    Air quality administrators across the nation are coming under greater pressure to find new strategies for further reducing automotive generated non-methane hydrocarbon (NMHC) and nitrogen oxide (NOx) emissions. The US Environmental Protection Agency (EPA) has established stringent emission reduction requirements for ozone non-attainment areas that have driven the vehicle industry to engineer vehicles meeting dramatically tightened standards. This paper describes an interim method for including alternative-fueled vehicles (AFVs) in the mix of strategies to achieve local and regional improvements in ozone air quality. This method could be used until EPA can develop the Mobile series of emissions estimation models to include AFVs and until such time that detailed work on AFV emissions totals by air quality planners and emissions inventory builders is warranted. The paper first describes the challenges confronting almost every effort to include AFVs in targeted emissions reduction programs, but points out that within these challenges resides an opportunity. Next, it discusses some basic relationships in the formation of ambient ozone from precursor emissions. It then describes several of the salient provisions of EPA`s new voluntary emissions initiative, which is called the Voluntary Mobile Source Emissions Reduction Program (VMEP). Recent emissions test data comparing gaseous-fuel light-duty AFVs with their gasoline-fueled counterparts is examined to estimate percent emissions reductions achievable with CNG and LPG vehicles. Examples of calculated MOBILE5b emission rates that would be used for summer ozone season planning purposes by an individual Air Quality Control Region (AQCR) are provided. A method is suggested for employing these data to compute appropriate voluntary emission reduction credits where such (lighter) AFVs would be acquired. It also points out, but does not quantify, the substantial reduction credits potentially achievable by substituting gaseous

  20. The Repellent DEET Potentiates Carbamate Effects via Insect Muscarinic Receptor Interactions: An Alternative Strategy to Control Insect Vector-Borne Diseases. (United States)

    Abd-Ella, Aly; Stankiewicz, Maria; Mikulska, Karolina; Nowak, Wieslaw; Pennetier, Cédric; Goulu, Mathilde; Fruchart-Gaillard, Carole; Licznar, Patricia; Apaire-Marchais, Véronique; List, Olivier; Corbel, Vincent; Servent, Denis; Lapied, Bruno


    Insect vector-borne diseases remain one of the principal causes of human mortality. In addition to conventional measures of insect control, repellents continue to be the mainstay for personal protection. Because of the increasing pyrethroid-resistant mosquito populations, alternative strategies to reconstitute pyrethroid repellency and knock-down effects have been proposed by mixing the repellent DEET (N,N-Diethyl-3-methylbenzamide) with non-pyrethroid insecticide to better control resistant insect vector-borne diseases. By using electrophysiological, biochemichal, in vivo toxicological techniques together with calcium imaging, binding studies and in silico docking, we have shown that DEET, at low concentrations, interacts with high affinity with insect M1/M3 mAChR allosteric site potentiating agonist effects on mAChRs coupled to phospholipase C second messenger pathway. This increases the anticholinesterase activity of the carbamate propoxur through calcium-dependent regulation of acetylcholinesterase. At high concentrations, DEET interacts with low affinity on distinct M1/M3 mAChR site, counteracting the potentiation. Similar dose-dependent dual effects of DEET have also been observed at synaptic mAChR level. Additionally, binding and in silico docking studies performed on human M1 and M3 mAChR subtypes indicate that DEET only displays a low affinity antagonist profile on these M1/M3 mAChRs. These results reveal a selective high affinity positive allosteric site for DEET in insect mAChRs. Finally, bioassays conducted on Aedes aegypti confirm the synergistic interaction between DEET and propoxur observed in vitro, resulting in a higher mortality of mosquitoes. Our findings reveal an unusual allosterically potentiating action of the repellent DEET, which involves a selective site in insect. These results open exciting research areas in public health particularly in the control of the pyrethroid-resistant insect-vector borne diseases. Mixing low doses of DEET and a

  1. Alternative energies; Energies alternatives

    Energy Technology Data Exchange (ETDEWEB)

    Bonal, J.; Rossetti, P


    The earth took millions years to made the petroleum, the gas the coal and the uranium. Only a few centuries will be needed to exhaust these fossil fuels and some years to reach expensive prices. Will the wold continue on this way of energy compulsive consumption? The renewable energies and some citizen attitudes are sufficient to break this spiral. This book proposes to discuss these alternative energies. It shows that this attitude must be supported by the government. It takes stock on the more recent information concerning the renewable energies. it develops three main points: the electricity storage, the housing and the transports. (A.L.B.)

  2. 基于临界区划分的实时事务并发控制机制%COR-based Concurrency Control Strategies in the Real-time Transaction Model Supporting Functional Alternatives

    Institute of Scientific and Technical Information of China (English)

    夏家莉; 王文乐; 朱文婷; 曹重华


    针对支持功能替代的实时事务模型,根据替代做处理的数据对象将替代划分为若干个临界区,提出了临界区动态相容检测方法,提出了基于临界区动态相容的并发控制策略COR-CCS:分区封锁策略、支持预释放的封锁策略、按序提交策略和级联回滚策略,并给出了相应的并发控制实现算法.当实时系统中存在资源冲突时,若高优先级替代未完成的临界区与低优先级替代动态相容,可令二者并发执行.实验仿真结果证明,COR-CCS策略有利减少低优先级替代等待时间、提高系统成功率和CPU有效利用率.%In the real-time system model based on functional alternatives, we divided the alternatives into Critical Operation Regions (short for CORs) according to the data that they handled, and proposed the method to examine the dynamic compatibility between two CORs. Also, we present the strategies, named COR-CCS, that can improve the concurrence of the alternatives, such as: the strategy of locking each by COR, the strategy of pre-releasing lock, the strategy of orderly submitting and the strategy of cascaded roll-backing. After that we gave the algorithm of COR-based concurrency control. When scheduling the real-time system with data confliction, the alternatives can concurrently executed if the CORS in the alternative with higher priority is dynamic compatibility with the lower priority alternative. The experimental results showed that the COR-CCS is effect on reducing the waiting time of the lower priority alternatives, increasing the successful execution ratio of the transactions, and improving the CPU usage.

  3. Alternative additives; Alternative additiver

    Energy Technology Data Exchange (ETDEWEB)


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

  4. Costruzione di un modello decisionale per valutare la costo/efficacia delle strategie alternative nella terapia della polmonite acquisita in comunità

    Directory of Open Access Journals (Sweden)

    Mario Eandi


    Full Text Available Aim of this paper was to analyse the cost effectiveness of the main alternative (and complementary strategies in the disease menagement of the Community-Acquired Pneumonia (CAP: hospital admission vs home-care, antibiotic parental vs oral therapy, switch vs no-switch therapy, and early discarge vs conventional hospitalization. The cost effectivenessanalysis (CEA has been performed by implementing a general decision tree model wich describes all the main decisional and change nodes encountered in the clinical course from the firm sign and symptoms of CAP (root to the final aoutcomes: full recovery or death (terminal nodes. We assumed the perspectives of three main institutional decision-makers: the society, the italian national healthcare system (NACS, and the hospital. In the perspective of society both the direct (health and non-health costs and the indirect costs have been included, while in the perspective of the NACS only the health-direct costs were considered. In the perspective of the hospital we considered the overall mean expences sustained for each day of staying in the general and in the intensive care unit. Separately, the antibiotic treatement costs to hospital have been accounted. As effectiveness we considered the percentage of recovery for each class of mortality aqccording to fine. Most of the probability data used in the model were obtained or derived from the published literature. The cost were valued according to the Italian NACS charges and prices in use during the year 2000. According to the model structure, the main expenditure factor for the SSN is the hospitalization cost, while the home care is less expensive. The antibiotic parentenal therapy, during hospedalization or home care, is more expensive than the antibiotic oral therapy; but the cost difference between one therapy and the other is clearly lower than the cost difference between the hospitalization and the home care. The optimum expenditure situation for the

  5. Gelişen Piyasa Ekonomilerinde Alternatif Para Politikası Stratejileri, Türkiye Ekonomisi Açısından Bir Değerlendirme(Alternative Monetary Policy Strategies in Emerging Countries, An Assessing For Turkish Economy

    Directory of Open Access Journals (Sweden)

    Şehnaz Bakır YİĞİTBAŞ


    Full Text Available This paper assesses the advantages and disadvantages of alternative monetary policy strategies involves for emerging market countries. Then it discusses two emerging market countries which illustrate what it takes to make inflation targeting work well, Chile and Brazil. The next topic that assessing inflation targeting as a monetary policy strategy for Turkey. The conclusion from this analysis is that inflation targeting is more complicated in Turkey. In order to improve inflation targeting’s performance in Turkey, the role of communication and transparency which is crutial for the process of building credibility, should be increased.

  6. Astrovirus Diagnostics (United States)

    Pérot, Philippe; Lecuit, Marc; Eloit, Marc


    Various methods exist to detect an astrovirus infection. Current methods include electron microscopy (EM), cell culture, immunoassays, polymerase chain reaction (PCR) and various other molecular approaches that can be applied in the context of diagnostic or in surveillance studies. With the advent of metagenomics, novel human astrovirus (HAstV) strains have been found in immunocompromised individuals in association with central nervous system (CNS) infections. This work reviews the past and current methods for astrovirus detection and their uses in both research laboratories and for medical diagnostic purposes. PMID:28085120

  7. The architecture of diagnostic research

    DEFF Research Database (Denmark)

    Colli, Agostino; Fraquelli, Mirella; Casazza, Giovanni


    The diagnostic research process can be divided into five phases, designed to establish the clinical utility of a new diagnostic test - the index test. The aim of the present review is to illustrate the study designs that are appropriate for each diagnostic phase, using clinical examples regarding...... the present strategy. Phase 4 comprises large surveillance cohort studies that aim to assess the effectiveness of the new diagnostic-therapeutic strategy in clinical practice. As common in clinical research, putting excessive weight on the results of single studies and trials is likely to divert from...... the totality of evidence reached through the systematic reviews of these studies, conducted with rigorous methodology and statistical methods. (Hepatology 2013;)....

  8. Economic analysis of empiric versus diagnostic-driven strategies for immunocompromised patients with suspected fungal infections in the People's Republic of China

    Directory of Open Access Journals (Sweden)

    Mao NY


    Full Text Available Ningying Mao,1 Beth Lesher,2 Qifa Liu,3 Lei Qin,2 Yixi Chen,4 Xin Gao,2 Stephanie R Earnshaw,5 Cheryl L McDade,5 Claudie Charbonneau,61School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, People's Republic of China; 2Pharmerit International, Bethesda, MD, USA; 3Hematology Department, Nanfang Hospital, Southern Medical University, Guangzhou, 4Pfizer Investment Co. Ltd., Beijing, People's Republic of China; 5RTI Health Solutions, Research Triangle Park, NC, USA; 6Pfizer International Operations, Paris, France Abstract: Invasive fungal infections (IFIs require rapid diagnosis and treatment. A decision-analytic model was used to estimate total costs and survival associated with a diagnostic-driven (DD or an empiric treatment approach in neutropenic patients with hematological malignancies receiving chemotherapy or autologous/allogeneic stem cell transplants in Shanghai, Beijing, Chengdu, and Guangzhou, the People's Republic of China. Treatment initiation for the empiric approach occurred after clinical suspicion of an IFI; treatment initiation for the DD approach occurred after clinical suspicion and a positive IFI diagnostic test result. Model inputs were obtained from the literature; treatment patterns and resource use were based on clinical opinion. Total costs were lower for the DD versus the empiric approach in Shanghai (¥3,232 vs ¥4,331, Beijing (¥3,894 vs ¥4,864, Chengdu, (¥4,632 vs ¥5,795, and Guangzhou (¥8,489 vs ¥9,795. Antifungal administration was lower using the DD (5.7% than empiric (9.8% approach, with similar survival rates. Results from one-way and probabilistic sensitivity analyses were most sensitive to changes in diagnostic test sensitivity and IFI incidence; the DD approach dominated the empiric approach in 88% of scenarios. These results suggest that a DD compared to an empiric treatment approach in the People’s Republic of China may be cost saving, with similar overall survival

  9. Are there alternative adaptive strategies to human pro-sociality? The role of collaborative morality in the emergence of personality variation and autistic traits


    Spikins, P.; Wright, Barry; Hodgson, Derek


    Selection pressures to better understand other’s thoughts and feelings are seen as a primary driving force in human cognitive evolution. Yet might the evolution of social cognition be more complex than we assume, with more than one strategy towards social understanding and developing a positive pro-social reputation? Here we argue that social buffering of vulnerabilities through the emergence of collaborative morality will have opened new niches for adaptive cognitive strategies and widened p...

  10. Status of US ITER Diagnostics (United States)

    Stratton, B.; Delgado-Aparicio, L.; Hill, K.; Johnson, D.; Pablant, N.; Barnsley, R.; Bertschinger, G.; de Bock, M. F. M.; Reichle, R.; Udintsev, V. S.; Watts, C.; Austin, M.; Phillips, P.; Beiersdorfer, P.; Biewer, T. M.; Hanson, G.; Klepper, C. C.; Carlstrom, T.; van Zeeland, M. A.; Brower, D.; Doyle, E.; Peebles, A.; Ellis, R.; Levinton, F.; Yuh, H.


    The US is providing 7 diagnostics to ITER: the Upper Visible/IR cameras, the Low Field Side Reflectometer, the Motional Stark Effect diagnostic, the Electron Cyclotron Emission diagnostic, the Toroidal Interferometer/Polarimeter, the Core Imaging X-Ray Spectrometer, and the Diagnostic Residual Gas Analyzer. The front-end components of these systems must operate with high reliability in conditions of long pulse operation, high neutron and gamma fluxes, very high neutron fluence, significant neutron heating (up to 7 MW/m3) , large radiant and charge exchange heat flux (0.35 MW/m2) , and high electromagnetic loads. Opportunities for repair and maintenance of these components will be limited. These conditions lead to significant challenges for the design of the diagnostics. Space constraints, provision of adequate radiation shielding, and development of repair and maintenance strategies are challenges for diagnostic integration into the port plugs that also affect diagnostic design. The current status of design of the US ITER diagnostics is presented and R&D needs are identified. Supported by DOE contracts DE-AC02-09CH11466 (PPPL) and DE-AC05-00OR22725 (UT-Battelle, LLC).

  11. Re-exploring the high-throughput potential of microextraction techniques, SPME and MEPS, as powerful strategies for medical diagnostic purposes. Innovative approaches, recent applications and future trends. (United States)

    Pereira, Jorge; Silva, Catarina Luís; Perestrelo, Rosa; Gonçalves, João; Alves, Vera; Câmara, José S


    The human population continues to grow exponentially in the fast developing and most populated countries, whereas in Western Europe it is getting older and older each year. This inevitably raises the demand for better and more efficient medical services without increasing the economic burden in the same proportion. To meet these requirements, improvement of medical diagnosis is certainly a key aspect to consider. Therefore, we need powerful analytical methodologies able to go deeper and further in the characterization of human metabolism and identification of disease biomarkers and endogenous molecules in body fluids and tissues. The ultimate goal is to have a reliable and early medical diagnosis, mitigating the disease complications as much as possible. Microextraction techniques (METs) represent a key step in these analytical methodologies by providing samples in the suitable volumes and purification levels necessary for the characterization of the target analytes. In this aspect, solid-phase microextraction (SPME) and, more recently, microextraction by packed sorbent (MEPS), are powerful sample preparation techniques, characterized by their reduced time of analysis, low solvent consumption, and broad application. Moreover, as miniaturized techniques, they can be easily automatized to have a high-throughput performance in the clinical environment. In this review, we explore some of the most interesting MEPS and SPME applications, focusing on recent trends and applications to medical diagnostic, particularly the in vivo and near real time applications.

  12. A distributed computational search strategy for the identification of diagnostics targets: application to finding aptamer targets for methicillin-resistant staphylococci. (United States)

    Flanagan, Keith; Cockell, Simon; Harwood, Colin; Hallinan, Jennifer; Nakjang, Sirintra; Lawry, Beth; Wipat, Anil


    The rapid and cost-effective identification of bacterial species is crucial, especially for clinical diagnosis and treatment. Peptide aptamers have been shown to be valuable for use as a component of novel, direct detection methods. These small peptides have a number of advantages over antibodies, including greater specificity and longer shelf life. These properties facilitate their use as the detector components of biosensor devices. However, the identification of suitable aptamer targets for particular groups of organisms is challenging. We present a semi-automated processing pipeline for the identification of candidate aptamer targets from whole bacterial genome sequences. The pipeline can be configured to search for protein sequence fragments that uniquely identify a set of strains of interest. The system is also capable of identifying additional organisms that may be of interest due to their possession of protein fragments in common with the initial set. Through the use of Cloud computing technology and distributed databases, our system is capable of scaling with the rapidly growing genome repositories, and consequently of keeping the resulting data sets up-to-date. The system described is also more generically applicable to the discovery of specific targets for other diagnostic approaches such as DNA probes, PCR primers and antibodies.

  13. Uranium recovery from acid rock drainage: an alternative strategy for the decommissioning of the uranium mining and milling facilities of Pocos de Caldas, Brazil

    Energy Technology Data Exchange (ETDEWEB)

    Fernandes, H.M.; Franklin, M.R. [Instituto de Radioprotecao e Dosimetria, Rio de Janeiro (Brazil)


    Acid Rock Drainage is of great concern to environmental regulators and mine operators in many countries around the world. During the operational life of an installation, the collect and treat strategy is a commonly employed strategy to reduce pollutant emissions to the environment. Regarding the post-operational scenarios a suite of different strategies is available in the literature. Acid drainage is a crucial problem at the uranium mining and milling site of Pocos de Caldas. Two waste-rock piles (of about 60 ha each) resulted from mining activities. Presently acid waters are being collected and neutralized, the solid material being disposed in the tailings dam. The Institute of Radiation Protection Dosimetry, has developed studies that concluded that a permanent solution to the problem should favor covering the dumps with a three layered cover system. However if the uranium average concentration in the drainage (about 10 mg/L) is taken into consideration, its economical recovery may be thought about. This strategy will imply in the recovery of 30 tons U{sub 3}O{sub 8} per year - representing c.a. 30% of the mean annual production of the installation. The recovery would include the use of ion-exchange resins. The technical and economical viability of the strategy as well as technical and economical issues concerning the application of a dry cover to the waste rock piles will be presented and discussed in detail. (author)

  14. SNP Variation in MicroRNA Biogenesis Pathway Genes as a New Innovation Strategy for Alzheimer Disease Diagnostics: A Study of 10 Candidate Genes in an Understudied Population From the Eastern Mediterranean. (United States)

    Görücü Yilmaz, Şenay; Erdal, Mehmet E; Avci Özge, Aynur; Sungur, Mehmet A


    Alzheimer disease (AD) is a common complex neurodegenerative disorder accounting for nearly 50% to 70% of dementias worldwide. Yet the current diagnostic options for AD are limited. New diagnostic innovation strategies focusing on novel molecules and pathways are sorely needed. In this connection, microRNAs (miRNAs) are conserved small noncoding RNAs that regulate posttranscriptional gene expression and are vital for neuronal development and its functional sustainability. Conceivably, biological pathways responsible for the biogenesis of miRNAs represent a veritable set of upstream candidate genes that can be potentially associated with the AD pathophysiology. Notably, whereas functional single-nucleotide polymorphisms (SNPs) in miRNA biogenesis pathway genes have been studied in other complex diseases, surprisingly, virtually no such study has been conducted on their relevance in AD. Moreover, novel diagnostics identified in easily accessible peripheral tissues such as the whole blood samples represent the initial entry or gateway points on the biomarker discovery critical path for AD. To the best of our knowledge, we report here the first association study of functional SNPs, as measured by real-time PCR in 10 "upstream" candidate genes critically situated on the miRNA biogenesis pathway, in a large sample of AD patients (N=172) and healthy controls (N=109) in a hitherto understudied world population from the Mersin region of the Eastern Mediterranean. We observed a significant association between 2 candidate genes and AD, TARBP2 rs784567 genotype and AD (χ=6.292, P=0.043), and a trend for RNASEN rs10719 genotype (χ=4.528, P=0.104) and allele (P=0.035). Functional SNP variations in the other 8 candidate genes (DGCR8, XPO5, RAN, DICER1, AGO1, AGO2, GEMIN3, and GEMIN4) did not associate with AD in our sample. Given the putative biological importance of miRNA biogenesis pathways, these emerging data can provide a new foundation to stimulate future debate and

  15. Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions

    Energy Technology Data Exchange (ETDEWEB)

    Hammerstingl, Renate; Vogl, Thomas J. [Johann Wolfgang Goethe-Univ., Inst. of Diagnostic and Interventional Radiology, Frankfurt am Main (Germany); Huppertz, Alexander [Imaging Science Inst., Charite - Siemens, Berlin (Germany); Breuer, Josy; Balzer, Thomas [Gobal Clinical Development Diagnostics, Bayer Schering Pharma AG, Berlin (Germany); Blakeborough, Anthony [Royal Hallamshire Hospital, Dept. of Radiology, Sheffield (United Kingdom); Carter, Rick [Bayer Health Care Ltd., Burgess Hill, West Sussex (United Kingdom); Castells Fuste, Lluis [Hospital Vall d' Hebron, Liver Unit, Dept. of Internal Medicine, Barcelona (Spain); Heinz-Peer, Gertraud [Universitaetsklinik fuer Radiodiagnostik, Allg. Krankenhaus der Stadt Wien, Wien (Germany); Judmaier, Werner [Univ. Hospital Innsbruck, Dept. of Magnetic Resonance Imaging and Spectroscopy, Innsbruck (Austria); Laniado, Michael [Universitaetsklinikum Carl Gustav Carus, Technische Univ. Dresden, Inst. for Diagnostic Radiology, Dresden (Germany); Manfredi, Riccardo M. [Univ. of Verona, Dept. of Radiology, Verona (Italy); Mathieu, Didier G. [Centre d' Imagerie, Aix en Provence (France); Mueller, Dieter [Georg-August Univ., Dept. of Radiology, Goettingen (Germany); Mortele, Koenraad [Brigham and Women' s Hospital, Dept. of Radiology (L1), Boston, MA (United States); Reimer, Peter [Klinikum Karlsruhe, Dept. of Radiology, Karlsruhe (Germany); Reiser, Maximilian F. [Ludwig-Maximilians-Univ. Munich - Klinikum Grosshadern, Inst. of Clinical Radiology, Munich (Germany); Robinson, Philip J. [St James' s Univ. Hospital, Dept. of Clinical Radiology, Leeds (United Kingdom); Shamsi, Kohkan [Berlex Labs. Inc., Montville, NJ (United States); Strotzer, Michael [Univ. Hospital, Dept. of Diagnostic Radiology, Regensburg (Germany); Taupitz, Matthias [Universitaetsklinikum Charite, Med. Fakultaet der Humboldt-Univ., Dept. of Radiology, Berlin (Germany); Tombach, Bernd; Valeri, Gianluca; Beers, Bernhard E. van [and others


    A multicenter study has been employed to evaluate the diagnostic efficacy of magnetic resonance imaging (MRI) using the new liver-specific contrast agent gadoxetic acid (Gd-EOB-DTPA, Primovist), as opposed to contrast-enhanced biphasic spiral computed tomography (CT), in the diagnosis of focal liver lesions, compared with a standard of reference (SOR). One hundred and sixty-nine patients with hepatic lesions eligible for surgery underwent Gd-EOB-DTPA-enhanced MRI as well as CT within 6 weeks. Pathologic evaluation of the liver specimen combined with intraoperative ultrasound established the SOR. Data sets were evaluated on-site (14 investigators) and off-site (three independent blinded readers). Gd-EOB-DTPA was well tolerated. Three hundred and two lesions were detected in 131 patients valid for analysis by SOR. The frequency of correctly detected lesions was significantly higher on Gd-EOB-DTPA-enhanced MRI compared with CT in the clinical evaluation [10.44%; 95% confidence interval (CI): 4.88, 16.0]. In the blinded reading there was a trend towards Gd-EOB-DTPA-enhanced MRI, not reaching statistical significance (2.14%; 95% CI: -4.32, 8.6). However, the highest rate of correctly detected lesions with a diameter below 1 cm was achieved by Gd-EOB-DTPA-enhanced MRI. Differential diagnosis was superior for Gd-EOB-DTPA-enhanced MRI (82.1%) versus CT (71.0%). A change in surgical therapy was documented in 19 of 131 patients (14.5%) post Gd-EOB-DTPA-enhanced MRI. Gd-EOB-DTPA-enhanced MRI was superior in the diagnosis and therapeutic management of focal liver lesions compared with CT. (orig.)

  16. Does Digital Game-Based Learning Improve Student Time-on-Task Behavior and Engagement in Comparison to Alternative Instructional Strategies? (United States)

    Schaaf, Ryan


    Digital Game-Based Learning (DGBL) activities were examined in comparison with effective, research-based learning strategies to observe any difference in student engagement and time-on task behavior. Experimental and control groups were randomly selected amongst the intermediate elementary school students ages 8 to 10 years old. Student…

  17. Fragment ion diagnostic strategies for the comprehensive identification of chemical profile of Gui-Zhi-Tang by integrating high-resolution MS, multiple-stage MS and UV information. (United States)

    Wang, Shufang; Chen, Lulin; Leng, Jing; Chen, Pinghong; Fan, Xiaohui; Cheng, Yiyu


    Gui-Zhi-Tang was considered to be the most famous formula in Shang-Han-Lun, treating 32 symptoms of disease after adding up or cutting down crude drugs. The chemical constituents in Gui-Zhi-Tang were comprehensively studied by rapid resolution liquid chromatography quadrupole time-of-flight mass spectrometry (RRLC-Q-TOF-MS) combined with rapid resolution liquid chromatography - diode array detector - ion trap mass spectrometry (RRLC-DAD-IT-MS) in this work, and a total number of 187 compounds were detected. Systematic diagnostic ion filtering strategies were recommended for flavonoids and oleanane-type triterpenoids, respectively. On the basis of the summarized strategies, compounds in Glycyrrhizae could be easily classified into flavones, isoflavones, flavanones or chalcones with special structures, and triterpene saponins with different sugar moieties. Consequently, among 187 compounds, 144 ones were confirmed or assumed tentatively. In addition, nine potential novel compounds were reported for the first time. This approach provided a rapid method for characterizing the constituents in Gui-Zhi-Tang, and would be also helpful in other TCM formulae analysis.

  18. Thyroid diagnostics

    Energy Technology Data Exchange (ETDEWEB)

    Scriba, P.C.; Boerner, W.; Emrich, S.; Gutekunst, R.; Herrmann, J.; Horn, K.; Klett, M.; Krueskemper, H.L.; Pfannenstiel, P.; Pickardt, C.R.


    None of the in-vitro and in-vivo methods listed permits on unambiguous diagnosis when applied alone, owing to the fact that similar or even identical findings are obtained for various individual parameters in different thyroid diseases. Further, especially the in-vitro tests are also subject to extrathyroidal effects which may mask the typical findings. The limited and varying specificity and sensitivity of the tests applied, as well as the falsification of results caused by the patients' idiosyncracies and the methodology, make it necessary to interpret and evaluate the in-vivo and in-vitro findings only if the clinical situation (anamnesis and physical examination) is known. For maximum diagnostic quality of the tests, the initial probability of the assumed type of thyroid disease must be increased (formulation of the clinical problem). The concepts of exclusion diagnosis and identification must be distinguished as well as the diagnosis of functional disturbances on the one hand and of thyroid diseases on the other. Both of this requires a qualified, specific and detailed anamnesis and examination procedure, and the clinical examination remains the obligatory basis of clinical diagnostics. In case of inexplicable discrepancies between the clinical manifestations and the findings obtained with specific methods, or between the findings obtained with a specific method, the patient should be referred to an expert institution, or the expert institution should be consulted.

  19. PROcess Based Diagnostics PROBE (United States)

    Clune, T.; Schmidt, G.; Kuo, K.; Bauer, M.; Oloso, H.


    Many of the aspects of the climate system that are of the greatest interest (e.g., the sensitivity of the system to external forcings) are emergent properties that arise via the complex interplay between disparate processes. This is also true for climate models most diagnostics are not a function of an isolated portion of source code, but rather are affected by multiple components and procedures. Thus any model-observation mismatch is hard to attribute to any specific piece of code or imperfection in a specific model assumption. An alternative approach is to identify diagnostics that are more closely tied to specific processes -- implying that if a mismatch is found, it should be much easier to identify and address specific algorithmic choices that will improve the simulation. However, this approach requires looking at model output and observational data in a more sophisticated way than the more traditional production of monthly or annual mean quantities. The data must instead be filtered in time and space for examples of the specific process being targeted.We are developing a data analysis environment called PROcess-Based Explorer (PROBE) that seeks to enable efficient and systematic computation of process-based diagnostics on very large sets of data. In this environment, investigators can define arbitrarily complex filters and then seamlessly perform computations in parallel on the filtered output from their model. The same analysis can be performed on additional related data sets (e.g., reanalyses) thereby enabling routine comparisons between model and observational data. PROBE also incorporates workflow technology to automatically update computed diagnostics for subsequent executions of a model. In this presentation, we will discuss the design and current status of PROBE as well as share results from some preliminary use cases.

  20. Alternative growth and defensive strategies reveal potential and gender specific trade-offs in dioecious plants Salix paraplesia to nutrient availability

    Directory of Open Access Journals (Sweden)

    Hao Jiang


    Full Text Available Population sex ratios of many dioecious plants in nature are biased. This may be attributed to sexually different resource demands and adaptive capacity. In male-biased Populus, males often display stronger physiological adaptation than females. Interestingly, Populus and Salix, belonging to Salicaceae, display an opposite biased sex ratio, especially in nutrient-poor environmental conditions. Do female willows have a greater tolerance to nutrient deficiency than males? In this study, we investigated the growth and defensive strategies of Salix paraplesia cuttings, which were grown with high and low soil fertility for about 140 days over one growing season. Results suggest that different strategies for biomass allocation may result in sexually different defence capacities and trade-offs between growth and defence. Females are likely to adopt radical strategies, overdrawing on available resources to satisfy both growth and defence, which seems to be more like a gamble compared with males. It is also suggested that females may have an extra mechanism to compensate for the investment in growth under nutrient-poor conditions. In summary, the results may help focus restoration efforts on sex selection such that a moderate increase in female willow quantity could increase the resistance and resilience of willow populations to early sporadic desertification.

  1. Alternative Growth and Defensive Strategies Reveal Potential and Gender Specific Trade-Offs in Dioecious Plants Salix paraplesia to Nutrient Availability. (United States)

    Jiang, Hao; Zhang, Sheng; Lei, Yanbao; Xu, Gang; Zhang, Dan


    Population sex ratios of many dioecious plants in nature are biased. This may be attributed to sexually different resource demands and adaptive capacity. In male-biasedPopulus, males often display stronger physiological adaptation than females. Interestingly, Populus and Salix, belonging to Salicaceae, display an opposite biased sex ratio, especially in nutrient-poor environmental conditions. Do female willows have a greater tolerance to nutrient deficiency than males? In this study, we investigated the growth and defensive strategies of Salix paraplesia cuttings, which were grown with high and low soil fertility for about 140 days over one growing season. Results suggest that different strategies for biomass allocation may result in sexually different defense capacities and trade-offs between growth and defense. Females are likely to adopt radical strategies, overdrawing on available resources to satisfy both growth and defense, which seems to be more like a gamble compared with males. It is also suggested that females may have an extra mechanism to compensate for the investment in growth under nutrient-poor conditions. In summary, the results may help focus restoration efforts on sex selection such that a moderate increase in female willow quantity could increase the resistance and resilience of willow populations to early sporadic desertification.

  2. Prevalence, socio-demographic and clinical predictors of post-diagnostic utilisation of different types of complementary and alternative medicine (CAM) in a nationwide cohort of Danish women treated for primary breast cancer

    DEFF Research Database (Denmark)

    Pedersen, Christina Gundgaard; Christensen, Søren; Jensen, Anders Bonde;


    This study investigated the prevalence and predictors of use of complementary and alternative medicine (CAM) in a nationwide inception cohort of Danish women treated for early-stage breast cancer as well as differences in user patterns for individual types of CAM.......This study investigated the prevalence and predictors of use of complementary and alternative medicine (CAM) in a nationwide inception cohort of Danish women treated for early-stage breast cancer as well as differences in user patterns for individual types of CAM....

  3. Rotorcraft Diagnostics (United States)

    Haste, Deepak; Azam, Mohammad; Ghoshal, Sudipto; Monte, James


    Health management (HM) in any engineering systems requires adequate understanding about the system s functioning; a sufficient amount of monitored data; the capability to extract, analyze, and collate information; and the capability to combine understanding and information for HM-related estimation and decision-making. Rotorcraft systems are, in general, highly complex. Obtaining adequate understanding about functioning of such systems is quite difficult, because of the proprietary (restricted access) nature of their designs and dynamic models. Development of an EIM (exact inverse map) solution for rotorcraft requires a process that can overcome the abovementioned difficulties and maximally utilize monitored information for HM facilitation via employing advanced analytic techniques. The goal was to develop a versatile HM solution for rotorcraft for facilitation of the Condition Based Maintenance Plus (CBM+) capabilities. The effort was geared towards developing analytic and reasoning techniques, and proving the ability to embed the required capabilities on a rotorcraft platform, paving the way for implementing the solution on an aircraft-level system for consolidation and reporting. The solution for rotorcraft can he used offboard or embedded directly onto a rotorcraft system. The envisioned solution utilizes available monitored and archived data for real-time fault detection and identification, failure precursor identification, and offline fault detection and diagnostics, health condition forecasting, optimal guided troubleshooting, and maintenance decision support. A variant of the onboard version is a self-contained hardware and software (HW+SW) package that can be embedded on rotorcraft systems. The HM solution comprises components that gather/ingest data and information, perform information/feature extraction, analyze information in conjunction with the dependency/diagnostic model of the target system, facilitate optimal guided troubleshooting, and offer

  4. Sensitive Diagnostics for Chemically Reacting Flows

    KAUST Repository

    Farooq, Aamir


    This talk will feature latest diagnostic developments for sensitive detection of gas temperature and important combustion species. Advanced optical strategies, such as intrapulse chirping, wavelength modulation, and cavity ringdown are employed.

  5. Optimization of diagnostic strategy in non-redundant multi-fault system based on probability threshold%基于概率阈的非冗余多故障系统诊断策略优化

    Institute of Scientific and Technical Information of China (English)

    朱海鹏; 景博; 黄以锋; 苏俊阳


    针对传统的单故障假设无法诊断复杂系统多故障并发的情况,提出了一种基于概率阈的非冗余系统多故障诊断策略.首先对系统的相关性模型进行扩展,并删除低于概率阈的故障状态,建立非冗余系统的多故障测试诊断模型;其次在信息熵算法的基础上建立Rollout算法,获得了最优测试序列;然后建立故障诊断树并计算测试代价;最后以某机载电子系统为例验证了该方法的有效性.该方法可以在保证测试费用最小的情况下获得非冗余系统的最优测试序列.%This paper propsoed a multiple fault diagnostic strategy for non-redundant system based on probability threshold. Firstly,it expanded system dependency models, removed fault states which were below probability threshold, and established multiple fault diagnostic models of non-redundant system. Then using entropy algorithm as base algorithm, it presented Rollout algorithm to obtain best test sequence. At built the fault diagnosis tree and calculated test cost. It put forward an airborne electronic system to prove its effectiveness. It can obtain the best test sequence by minimums cost test.

  6. Diagnostic fragment-ion-based and extension strategy coupled to DFIs intensity analysis for identification of chlorogenic acids isomers in Flos Lonicerae Japonicae by HPLC-ESI-MS(n). (United States)

    Zhang, Jia-Yu; Zhang, Qian; Li, Ning; Wang, Zi-Jian; Lu, Jian-Qiu; Qiao, Yan-Jiang


    A method of modified diagnostic fragment-ion-based extension strategy (DFIBES) coupled to DFIs (diagnostic fragmentation ions) intensity analysis was successfully established to simultaneously screen and identify the chlorogenic acids (CGAs) in Flos Lonicerae Japonicae (FLJ) by HPLC-ESI-MS(n). DFIs, such as m/z 191 [quinic acid-H](-), m/z 179 [caffeic acid-H](-) and m/z 173 [quinic acid-H-H2O](-) were determined or proposed from the fragmentation patterns analysis of corresponding reference substances for every chemical family of CGAs. A "structure extension" method was then proposed based on the well-demonstrated fragmentation patterns and was successively applied into the rapid screening of CGAs in FLJ. Considering that substitution isomerism is a common phenomenon, a full ESI-MS(n) fragmentation analysis according to the intensity of DFIs has been performed to identify the CGA isomers. Based on the DFIs and intensity analysis, 41 peaks attributed to CGAs including 4 caffeoylquinic acids (CQA), 7 CQA glycosides, 6 dicaffeoylquinic acids (DiCQA), 10 DiCQA glycosides, 1 tricaffeoylquinic acids (TriCQA), 4p-coumaroylquinic acids (pCoQA), 3 feruloylquinic acids (FQA) and 6 caffeoylferuloylquinic acids (CFQA) were identified preliminarily in a 65-min chromatographic run. It was the first time to systematically report the presence of CGAs in FLJ, especially for CQA glycosides, DiCQA glycosides, TriCQA, pCoQA and CFQA. All the results indicated that the method of developed DFIBES coupled to DFIs analysis was feasible, reliable and universal for screening and identifying the constituents with the same carbon skeletons especially the isomeric compounds from the complex extract of TCMs.

  7. A microcosting study of diagnostic tests for the detection of coronary artery disease in the Netherlands

    Energy Technology Data Exchange (ETDEWEB)

    Tan, S.S. [Erasmus MC University Medical Center, Institute for Medical Technology Assessment, P.O. Box 1738, 3000 DR Rotterdam (Netherlands)], E-mail:; Oppe, M. [Erasmus MC University Medical Center, Institute for Medical Technology Assessment, P.O. Box 1738, 3000 DR Rotterdam (Netherlands)], E-mail:; Zoet-Nugteren, S.K. [Ikazia Hospital Rotterdam, Department of Cardiology, P.O. Box 5009, 3008 AA Rotterdam (Netherlands)], E-mail:; Niezen, R.A. [Medical Center Rijnmond-Zuid, Department of Radiology, P.O. Box 9100, 3007 AC Rotterdam (Netherlands)], E-mail:; Kofflard, M.J.M. [Albert Schweitzer Hospital, Department of Cardiology, P.O. Box 444, 3300 AK Dordrecht (Netherlands)], E-mail:; Ten Cate, F.J. [Erasmus MC University Medical Center, Department of Cardiology, P.O. Box 2040, 3000 CA Rotterdam (Netherlands)], E-mail:; Roijen, L. Hakkaart-van [Erasmus MC University Medical Center, Institute for Medical Technology Assessment, P.O. Box 1738, 3000 DR Rotterdam (Netherlands)], E-mail:


    Objective: The primary aim of the present study was to calculate the actual costs of four diagnostic tests for the detection of coronary artery disease in the Netherlands using a microcosting methodology. As a secondary objective, the cost effectiveness of eight diagnostic strategies was examined, using microcosting and reimbursement fees subsequently as the cost estimate. Design: A multicenter, retrospective cost analysis from a hospital perspective. Setting: The study was conducted in three general hospitals in the Netherlands for 2006. Interventions: Exercise electrocardiography (exECG), stress echocardiography (sECHO), single-photon emission computed tomography (SPECT) and coronary angiography (CA). Results: The actual costs of exECG, sECHO, SPECT and CA were Euro 33, 216, 614 and 1300 respectively. For all diagnostic tests, labour and indirect cost components (overheads and capital) together accounted for over 75% of the total costs. Consumables played a relatively important role in SPECT (14%). Hotel and nutrition were only applicable to SPECT and CA. Diagnostic services were solely performed for CA, but their costs were negligible (2%). Using microcosting estimates, exECG-sECHO-SPECT-CA was the most and CA the least cost effective strategy ( Euro 397 and 1302 per accurately diagnosed patient). Using reimbursement fees, exECG-sECHO-CA was most and SPECT-CA least cost effective ( Euro 147 and 567 per accurately diagnosed patient). Conclusions: The use of microcosting estimates instead of reimbursement fees led to different conclusions regarding the relative cost effectiveness of alternative strategies.

  8. "Eco-Infill" as an alternative strategy for postindustrial landscape in the light of climate change: The case of Belgrade shipyard

    Directory of Open Access Journals (Sweden)

    Nikezić Ana


    Full Text Available At this moment, and under the circumstances that surround us, we have recognized as a definite global challenge the problem of climate change, and in general, the ecological misbalance of cities. In an attempt to meet this challenge, we will try to discuss possibilities of implementing the "Eco-Infill" strategy (fragments of nature incorporated into abandoned artificial environment as a viable, somewhat “alternative”, urban development strategy. The contemporary matrix of the post-industrial urban landscape is dotted with large and small fragments of abandoned spaces, which need to be incorporated into the city texture. Belgrade is a city with a potential, one of the larger capitals of the region, standing on the threshold of the European Union and undergoing an intensive process of political, economic and social transition. Similar to other large cities, it was previously an industrial city, but is now increasingly relying on the tertiary sector, promoting itself through its geographical, morphological, and cultural advantages. The consequences of privatization during transition and an exceptionally long and difficult political and economic crisis produced Brownfield and other abandoned spaces of the city centre with a complicated proprietary-ownership status, and no realistic guidelines for a much needed regeneration of the city centre in terms of contemporary problems linked to ecological, social and cultural values. In this article, there is a tendency to define principles on which the transformation of these abandoned places is based on and to try to apply these strategies onto the Belgrade shipyard on the river Sava. If we accept the previously set general views, these spaces can become crucial in developing a strategy for mitigation and adaptation to climate change. Although these effects are primarily aimed at confronting climate change, they are bound to upgrade the quality of life and offer new life styles, potentially affecting

  9. Ultra-low-dose dual-source CT coronary angiography with high pitch: diagnostic yield of a volumetric planning scan and effects on dose reduction and imaging strategy (United States)

    Hamm, B; Huppertz, A; Lembcke, A


    Objective: To evaluate the role of an ultra-low-dose dual-source CT coronary angiography (CTCA) scan with high pitch for delimiting the range of the subsequent standard CTCA scan. Methods: 30 patients with an indication for CTCA were prospectively examined using a two-scan dual-source CTCA protocol (2.0 × 64.0 × 0.6 mm; pitch, 3.4; rotation time of 280 ms; 100 kV): Scan 1 was acquired with one-fifth of the tube current suggested by the automatic exposure control software [CareDose 4D™ (Siemens Healthcare, Erlangen, Germany) using 100 kV and 370 mAs as a reference] with the scan length from the tracheal bifurcation to the diaphragmatic border. Scan 2 was acquired with standard tube current extending with reduced scan length based on Scan 1. Nine central coronary artery segments were analysed qualitatively on both scans. Results: Scan 2 (105.1 ± 10.1 mm) was significantly shorter than Scan 1 (127.0 ± 8.7 mm). Image quality scores were significantly better for Scan 2. However, in 5 of 6 (83%) patients with stenotic coronary artery disease, a stenosis was already detected in Scan 1 and in 13 of 24 (54%) patients with non-stenotic coronary arteries, a stenosis was already excluded by Scan 1. Using Scan 2 as reference, the positive- and negative-predictive value of Scan 1 was 83% (5 of 6 patients) and 100% (13 of 13 patients), respectively. Conclusion: An ultra-low-dose CTCA planning scan enables a reliable scan length reduction of the following standard CTCA scan and allows for correct diagnosis in a substantial proportion of patients. Advances in knowledge: Further dose reductions are possible owing to a change in the individual patient's imaging strategy as a prior ultra-low-dose CTCA scan may already rule out the presence of a stenosis or may lead to a direct transferal to an invasive catheter procedure. PMID:25710210

  10. Alternative metrics (United States)


    As the old 'publish or perish' adage is brought into question, additional research-impact indices, known as altmetrics, are offering new evaluation alternatives. But such metrics may need to adjust to the evolution of science publishing.

  11. The alternative strategy for designing covalent drugs through kinetic effects of pi-stacking on the self-assembled nanoparticles: a model study with antibiotics (United States)

    Du, Libo; Suo, Siqingaowa; Zhang, Han; Jia, Hongying; Liu, Ke Jian; Zhang, Xue Ji; Liu, Yang


    It is still a huge challenge to find a new strategy for rationally designing covalent drugs because most of them are discovered by serendipity. Considering that the effect of covalent drugs is closely associated with the kinetics of the reaction between drug molecule and its target protein, here we first demonstrate an example of the kinetic effect of pi-stacking of drug molecules on covalent antimicrobial drug design. When PEGylated 7-aminocephalosporanic acid (PEG-ACA) is used as a substrate drug, pi-stacking of the ACA group via the self-assembly of PEG-ACA on the surface of gold nanoparticles (i.e. Au@ACA) exhibits antibacterial activity against E. coli fourfold higher than a PEG-ACA monomer does. The reason can be reasonably attributed to the kinetic rate enhancement for the covalent reaction between Au@ACA and penicillin binding proteins. We believe that the self-assembly of functional groups onto the surface of gold nanoparticles represents a new strategy for covalent drug design.

  12. Alternative strategies to manipulate fibrocyte involvement in the fibrotic tissue response: pharmacokinetic inhibition and the feasibility of directed-adipogenic differentiation. (United States)

    Baker, David W; Tsai, Yi-Ting; Weng, Hong; Tang, Liping


    Fibrocytes have previously been identified as important mediators in several inflammatory and fibrotic diseases. However, there is no effective treatment thus far to reduce fibrotic tissue responses without affecting wound healing reactions. Here we investigate two strategies to alleviate fibrocyte interactions at the biomaterial interface, reducing collagen production and scar tissue formation. First, in an indirect approach, TGF-β inhibitor-SB431542 and IL-1β/TNF-α inhibitor SB203580 were locally released from scaffold implants to block their respective signaling pathways. We show that the inhibition of IL-1β/TNF-α has no influence on overall fibrotic tissue reactions to the implants. However, the reduction of localized TGF-β significantly decreases the fibrocyte accumulation and myofibroblast activation while reducing the fibrotic tissue formation. Since fibrocytes can be differentiated into non-fibrotic cell types, such as adipocytes, we further sought a more direct approach to reduce fibrocyte responses by directing fibrocyte differentiation into adipocytes. Interestingly, by initiating fibrocyte-to-adipocyte differentiation through sustained differentiation cocktail release, we find that adipogenic differentiation forces incoming fibrocytes away from the traditional myofibroblast lineage, leading to a substantial reduction in the collagen formation and fibrotic response. Our results support a novel and effective strategy to improve implant safety by reducing implant-associated fibrotic tissue reactions via directing non-fibrotic differentiation of fibrocytes.

  13. Diagnostic thoracoscopy

    Directory of Open Access Journals (Sweden)

    Plavec Goran


    Full Text Available Diagnostic thoracoscopy in patients with pleural effusion of unclear origin mostly provides the correct diagnosis. Results from published reports of previous researches are not uniform. In 47 male and 20 female patients with pleural effusion of unknown etiology, after receiving negative results obtained from cytological finding of pleural effusion and percutaneous needle biopsy, thoracoscopy with biopsy of one or both pleurae was performed. Procedure was done in local anesthesia using Stortz rigid thoracoscope. In 37 patients with malignant disease (primary or metastatic diagnosis was confirmed histopathologically in 31 patient (81.12%. In 27 patients with inflammatory pleural disease diagnosis was confirmed histopathologically in 22 patients (81.4%. Among 11 patients with specific pleural effusions, tuberculosis was confirmed in 10 (90.91%. Normal finding in cases of spontaneous pneumothorax and pulmonary embolism was taken as a positive result. Total number of positive findings was 55 (82.10%. In one patient, the third spontaneous pneumothorax was the indication for thoracoscopy, and after numerous bullae were seen during the procedure, talcum powder pleurodesis was done. In four patients low intensity subcutaneous emphysema occurred one day after thoracoscopy. It can be concluded that thoracoscopy in local anesthesia out of the operating room is good and practical method for solving the unclear pleural effusions, with neglectable rate of complications.

  14. New religious movements and alternative religions in France: the use of digital media as a counter-strategy against social and legal exclusion

    Directory of Open Access Journals (Sweden)

    Christiane Königstedt


    Full Text Available The internet is widely used internationally by individuals and groups who otherwise perceive and experience a lack of influence and even repression by authorities and whose opinions remain invisible in or are ignored by the mass media. The new media are a frequently-used means of expression in the political struggles of social and religious movements, especially as part of attempts to increase the number of supporters and to mobilise public opinion. The extent, of the usage as well as its degree of success, does vary and because of this variety, a comparative analysis can illuminate parts of the whole conflictuous configuration as well as the chances and limits of resistance and opposition via these media channels. Organisations which were chosen to be investigated here were the so-called ‘new religious movements’, or more precisely, the many forms of alternative religion in France who face significant levels of social and legal exclusion, while most of their members are themselves usually strongly committed to democracy and their identities as equal French citizens. Therefore, they choose to perform counter-actions which are within the law and act strategically, which makes them a special case compared to revolutionary political movements which may question the social order of the state as a whole. France, with its ‘anti-cult’ policy, has come to a unique standing within the Western world in this respect. Though religious freedom and state neutrality in relation to religious issues are constitutionally granted, a differentiation is made – and partially even legally enforced – between good religions and harmful ones which attempt to manipulate their adepts mentally. The debates are held in a constant dynamic between the struggling parties of ‘anti-cult’ movements and alternative religions. The exclusion of the latter from the mass media is revealed be one central means of hindering them from gaining approval within society

  15. Interrupting transmission of soil-transmitted helminths: a study protocol for cluster randomised trials evaluating alternative treatment strategies and delivery systems in Kenya (United States)

    Brooker, Simon J; Mwandawiro, Charles S; Halliday, Katherine E; Njenga, Sammy M; Mcharo, Carlos; Gichuki, Paul M; Wasunna, Beatrice; Kihara, Jimmy H; Njomo, Doris; Alusala, Dorcas; Chiguzo, Athuman; Turner, Hugo C; Teti, Caroline; Gwayi-Chore, Claire; Nikolay, Birgit; Truscott, James E; Hollingsworth, T Déirdre; Balabanova, Dina; Griffiths, Ulla K; Freeman, Matthew C; Allen, Elizabeth; Pullan, Rachel L; Anderson, Roy M


    Introduction In recent years, an unprecedented emphasis has been given to the control of neglected tropical diseases, including soil-transmitted helminths (STHs). The mainstay of STH control is school-based deworming (SBD), but mathematical modelling has shown that in all but very low transmission settings, SBD is unlikely to interrupt transmission, and that new treatment strategies are required. This study seeks to answer the question: is it possible to interrupt the transmission of STH, and, if so, what is the most cost-effective treatment strategy and delivery system to achieve this goal? Methods and analysis Two cluster randomised trials are being implemented in contrasting settings in Kenya. The interventions are annual mass anthelmintic treatment delivered to preschool- and school-aged children, as part of a national SBD programme, or to entire communities, delivered by community health workers. Allocation to study group is by cluster, using predefined units used in public health provision—termed community units (CUs). CUs are randomised to one of three groups: receiving either (1) annual SBD; (2) annual community-based deworming (CBD); or (3) biannual CBD. The primary outcome measure is the prevalence of hookworm infection, assessed by four cross-sectional surveys. Secondary outcomes are prevalence of Ascaris lumbricoides and Trichuris trichiura, intensity of species infections and treatment coverage. Costs and cost-effectiveness will be evaluated. Among a random subsample of participants, worm burden and proportion of unfertilised eggs will be assessed longitudinally. A nested process evaluation, using semistructured interviews, focus group discussions and a stakeholder analysis, will investigate the community acceptability, feasibility and scale-up of each delivery system. Ethics and dissemination Study protocols have been reviewed and approved by the ethics committees of the Kenya Medical Research Institute and National Ethics Review Committee, and

  16. 电能替代的市场推广策略及实施%Marketing strategies and implementation of electric power alternatives

    Institute of Scientific and Technical Information of China (English)

    张婧; 张建中


    This paper constructs"four⁃in⁃one"market promo⁃tion strategy. Chongqing Power Supply Branch Company integrates the inner and outer resources and catches the market opportunities during the market promotion of heat⁃pump boiler, electric furnace and electro⁃magnetic stove. By using data as backup and accelerat⁃ing the business process, the market sales persons can collect the market information fast, follow up the potential cooperation project rapidly and convince the customer of the necessity of using energy⁃saving electric equipments. It can both save the energy bills of pow⁃er customers and increase the power sales by using this strategy.%国网重庆市区供电分公司构建了“四全”市场推广策略,即资源整合全方位、机遇把握全掌控、数据支撑全过程和业务办理全快速。通过整合公司内部和外部资源,开展热泵热水锅炉、电窑炉、商用电磁灶等技术推广工作。在推广过程中依托科学的样本数据、已实施项目运行数据和政府补贴政策,说服客户快速锁定电能替代项目,最终实现用户能源费用的节约和售电市场的增长。

  17. Strategy Development in Organisations

    DEFF Research Database (Denmark)

    Sørensen, Lene


    " as used in practice and literature. Emphasis is put on how the term is related to the problem, the organisation, the strategy process and the practical way of methodologically developing the strategy. Finally, alternative strategy developing perspectives are presented.......There exist certain ambiguities with the converging fields of information technology and organisational strategy development. The term "IT strategy" has evolved and reflects in some respects this confusion. This paper discusses some of the ambiguities and difficulties of the term "IT strategy...

  18. The urban solid wastes in La Habana (Cuba): management diagnostics and alternatives for their improvement; Los residuos solidos urbanos en la ciudad de La Habana: Diagnostico de la gestion y alternativas para su aprovechamiento

    Energy Technology Data Exchange (ETDEWEB)

    Ponjuan Reyes, G. T. [Univsersidad de Las Palmas de Gran Canaria (Spain)


    In this study, it is carried out a diagnosis of all the looks of the Systems of Administration of the R. S. U. in the country of Ciudad de la Habana and they propose alternating for the economical development of the R. S. U. in the county, starting from classifying and study the actions according to the politics of the country concerning the protection of the 2environment and the saving of natural resources. (Author) 22 refs.

  19. Impact of alternative reimbursement strategies in the new cooperative medical scheme on caesarean delivery rates: a mixed-method study in rural China

    Directory of Open Access Journals (Sweden)

    Huang Kun


    Full Text Available Abstract Background The rate of caesarean delivery (CD in rural China has been rapidly increasing in recent decades. Due to the exorbitant costs associated with CD, paying for this expensive procedure is often a great challenge for the majority of rural families. Since 2003, the Chinese government has re-established the New Cooperative Medical Scheme (NCMS, aimed to improve the access of essential healthcare to rural residents and reduce financial burden owing to high out of pocket payments. This paper seeks to test the hypothesis that NCMS may provide service users and providers with financial incentives to select CD. It also assesses the effect of different health insurance reimbursement strategies of NCMS on CD rates in rural China. Methods Mixed quantitative and qualitative methods were adopted for data collection. Two cross-sectional household surveys were conducted with women having babies delivered in 2006 and 2009; 2326 and 1515 women, respectively, from the study sites were interviewed using structured questionnaires, to collect demographic and socio-economic data, maternal and child care characteristics and health-related expenditures. Focus group discussions (FGDs and in-depth key informant interviews (KIIs were undertaken with policy makers, health managers, providers and mothers to understand their perceptions of the influence of NCMS on the choices of delivery mode. Results The CD rates in the two study counties were 46.0 percent and 64.7 percent in 2006, increasing to 63.6 percent and 82.1 percent, respectively, in 2009. The study found that decisions on the selection of CD largely came from the pregnant women. Logistic regression analysis, after adjusting for socio-economic, maternal and fetal characteristics, did not indicate a significant effect of either proportional reimbursement or fixed amount reimbursement on the choice of CD for both study years. Interviews with stakeholders reflected that different reimbursable rates for

  20. Invitational rhetoric: Alternative rhetorical strategy for transformation of perception and use of energy in the residential built environment from the Keweenaw to Kerala (United States)

    Kindred, Merle Niemi

    This dissertation explores the viability of invitational rhetoric as a mode of advocacy for sustainable energy use in the residential built environment. The theoretical foundations for this study join ecofeminist concepts and commitments with the conditions and resources of invitational rhetoric, developing in particular the rhetorical potency of the concepts of re-sourcement and enfoldment. The methodological approach is autoethnography using narrative reflection and journaling, both adapted to and developed within the autoethnographic project. Through narrative reflection, the author explores her lived experiences in advocating for energy-responsible residential construction in the Keweenaw Peninsula of Michigan. The analysis reveals the opportunities for cooperative, collaborative advocacy and the struggle against traditional conventions of persuasive advocacy, particularly the centrality of the rhetor. The author also conducted two field trips to India, primarily the state of Kerala. Drawing on autoethnographic journaling, the analysis highlights the importance of sensory relations in lived advocacy and the resonance of everyday Indian culture to invitational principles. Based on field research, the dissertation proposes autoethnography as a critical development in encouraging invitational rhetoric as an alternative mode of effecting change. The invitational force of autoethnography is evidenced in portraying the material advocacy of the built environment itself, specifically the sensual experience of material arrangements and ambience, as well as revealing the corporeality of advocacy, that is, the body as the site of invitational engagement, emotional encounter, and sensory experience. This study concludes that vulnerability of self in autoethnographic work and the vulnerability of rhetoric as invitational constitute the basis for transformation. The dissertation confirms the potential of an ecofeminist invitational advocacy conveyed autoethnographically for

  1. Alternative fuelds in urban fleets

    Energy Technology Data Exchange (ETDEWEB)

    Lindsay, T.


    In this presentation the author addresses four main objectives. They are to: discuss programs that are driving the introduction of alternative fuels into fleet operations in urban areas around the country; define alternative fuels; quantify the present use and future projections on alternative fuel vehicles (AVFs) in the Chicago metropolitan statistical area; and discuss benefits of increased use of alternative fuels in urban areas. Factors which touch on these points include: present domestic dependence on petroleum for autos, with usage exceeding production; the large populations in urban areas which do not meet Clean Air Standards; recent legislative initiatives which give guidance and aid in the adoption of such strategies.

  2. Magnetostrictive Alternator (United States)

    Dyson, Rodger; Bruder, Geoffrey


    This innovation replaces the linear alternator presently used in Stirling engines with a continuous-gradient, impedance-matched, oscillating magnetostrictive transducer that eliminates all moving parts via compression, maintains high efficiency, costs less to manufacture, reduces mass, and eliminates the need for a bearing system. The key components of this new technology are the use of stacked magnetostrictive materials, such as Terfenol-D, under a biased magnetic and stress-induced compression, continuous-gradient impedance-matching material, coils, force-focusing metallic structure, and supports. The acoustic energy from the engine travels through an impedancematching layer that is physically connected to the magnetostrictive mass. Compression bolts keep the structure under compressive strain, allowing for the micron-scale compression of the magnetostrictive material and eliminating the need for bearings. The relatively large millimeter displacement of the pressure side of the impedance-matching material is reduced to micron motion, and undergoes stress amplification at the magnetostrictive interface. The alternating compression and expansion of the magnetostrictive material creates an alternating magnetic field that then induces an electric current in a coil that is wound around the stack. This produces electrical power from the acoustic pressure wave and, if the resonant frequency is tuned to match the engine, can replace the linear alternator that is commonly used.

  3. Growing Alternatives

    DEFF Research Database (Denmark)

    Bagger-Petersen, Mai Corlin


    From 2014, Anhui Province will pilot a reform of the residential land market in China, thus integrating rural Anhui in the national housing market. In contrast, artist and activist Ou Ning has proposed the Bishan time money currency, intending to establish an alternative economic circuit in Bishan...

  4. Alternative Treatments (United States)

    ... triglyceride (fat) produced by processing coconut oil or palm kernel oil. The body breaks down caprylic acid into substances called “ketone bodies.” The theory behind Axona is that the ketone bodies derived from caprylic acid may provide an alternative energy source for brain cells that have lost ...

  5. Alternative fluorescent labeling strategies for characterizing gram-positive pathogenic bacteria: Flow cytometry supported counting, sorting, and proteome analysis of Staphylococcus aureus retrieved from infected host cells. (United States)

    Hildebrandt, Petra; Surmann, Kristin; Salazar, Manuela Gesell; Normann, Nicole; Völker, Uwe; Schmidt, Frank


    Staphylococcus aureus is a Gram-positive opportunistic pathogen that is able to cause a broad range of infectious diseases in humans. Furthermore, S. aureus is able to survive inside nonprofessional phagocytic host cell which serve as a niche for the pathogen to hide from the immune system and antibiotics therapies. Modern OMICs technologies provide valuable tools to investigate host-pathogen interactions upon internalization. However, these experiments are often hampered by limited capabilities to retrieve bacteria from such an experimental setting. Thus, the aim of this study was to develop a labeling strategy allowing fast detection and quantitation of S. aureus in cell lysates or infected cell lines by flow cytometry for subsequent proteome analyses. Therefore, S. aureus cells were labeled with the DNA stain SYTO(®) 9, or Vancomycin BODIPY(®) FL (VMB), a glycopeptide antibiotic binding to most Gram-positive bacteria which was conjugated to a fluorescent dye. Staining of S. aureus HG001 with SYTO 9 allowed counting of bacteria from pure cultures but not in cell lysates from infection experiments. In contrast, with VMB it was feasible to stain bacteria from pure cultures as well as from samples of infection experiments. VMB can also be applied for histocytochemistry analysis of formaldehyde fixed cell layers grown on coverslips. Proteome analyses of S. aureus labeled with VMB revealed that the labeling procedure provoked only minor changes on proteome level and allowed cell sorting and analysis of S. aureus from infection settings with sensitivity similar to continuous gfp expression. Furthermore, VMB labeling allowed precise counting of internalized bacteria and can be employed for downstream analyses, e.g., proteomics, of strains not easily amendable to genetic manipulation such as clinical isolates. © 2016 International Society for Advancement of Cytometry.

  6. Presacral Ganglioneuroma: Diagnostic Considerations and Therapeutic Strategy

    Directory of Open Access Journals (Sweden)

    Konstantinos Vardas


    Full Text Available Presacral ganglioneuroma is an extremely rare tumor of neural crest origin. To the best of our knowledge, less than 20 cases have been reported previously. The present study reports on a presacral ganglioneuroma, 10.5 × 8 × 4 cm in size, that was found incidentally in a 35-year-old man with prior history of diverticulitis. He was admitted to our hospital due to lower left abdominal pain. Abdominal computed tomography and magnetic resonance imaging confirmed the extension of the lesion from the S2 level to the coccyx. The mass had low signal intensity on T1-weighted images and heterogeneous high signal intensity on T2-weighted images with no intraspinal or rectal extension. T2-weighted images demonstrated a compartmentalized solid tumor with cystic components. Complete tumor resection with free surgical margins was achieved using an abdominal approach. The patient remains asymptomatic 2 years after surgery. We emphasize on clinical features, radiologic appearance and surgical treatment of this rare entity. The clinical and pathologic features of previously reported studies are also briefly reviewed.

  7. Immunosensors in Clinical Laboratory Diagnostics. (United States)

    Justino, Celine I L; Duarte, Armando C; Rocha-Santos, Teresa A P


    The application of simple, cost-effective, rapid, and accurate diagnostic technologies for detection and identification of cardiac and cancer biomarkers has been a central point in the clinical area. Biosensors have been recognized as efficient alternatives for the diagnostics of various diseases due to their specificity and potential for application on real samples. The role of nanotechnology in the construction of immunological biosensors, that is, immunosensors, has contributed to the improvement of sensitivity, since they are based in the affinity between antibody and antigen. Other analytes than biomarkers such as hormones, pathogenic bacteria, and virus have also been detected by immunosensors for clinical point-of-care applications. In this chapter, we first introduced the various types of immunosensors and discussed their applications in clinical diagnostics over the recent 6 years, mainly as point-of-care technologies for the determination of cardiac and cancer biomarkers, hormones, pathogenic bacteria, and virus. The future perspectives of these devices in the field of clinical diagnostics are also evaluated.

  8. Application of Alternative Strategy Ⅲ in HIV Antibody Test at Jiangxi Port.%HIV抗体检测替代策略Ⅲ在江西口岸的应用

    Institute of Scientific and Technical Information of China (English)

    刘岚; 王建军; 黄晶晶; 廖立新; 邓菲菲; 吴燕萍


    [目的]寻找用于江西口岸的HIV抗体检测筛查程序,及时准确出具HIV抗体检测报告.[方法]分析本中心初筛确认为HIV抗体阳性的28份标本,应用免疫印迹法(WB)进行确认的结果,再采用第2章HIV抗体检测中的替代策略Ⅲ进行验证比较.[结果]ELISA和另一种不同原理的胶体硒筛查方法呈阳性反应的标本,用明胶颗粒凝集方法检测,结果均呈阳性反应,与确认结果一致;仅ELISA筛查出现阳性的标本,用胶体硒与明胶颗粒凝集方法检测结果为阴性.确认检测结果为阴性或不确定.[结论]应用HIV抗体检测的替代策略Ⅲ,可以为江西口岸HIV的筛查出具快速、准确的HIV抗体阴性报告提供技术上的依据.%Objective To find the screening procedures of HIV antibody test at Jiangxi Port, and to timely and accurately issue reports of HIV test. Method In this study, 28 cases as HIV antibody positive were analyzed and confirmed by WB assay. Meanwhile, the "alternative Strategies Ⅲ in HIV antibody test" in chapter 2 of "National HIV Testing Technology specification (edition 2004)" was adopted to verify and compare. Result The samples by using EIJSA and Electroselenium method of different principle screening was positive. The results were positive by using PA method, and consisitent whith confirmed results. The samples were positive by ELISA, however the testing results were negative by Electroselenium and PA method, the results were confirmed as negative or uncertain. Conclusion The application of Alternative Strategies Ⅲ in HIV antibody test can provide a technical basis for issuing the negative report of HIV screening accurately and rapidly at Jiangxi Ports.

  9. [Alternatives to animal testing]. (United States)

    Fabre, Isabelle


    The use of alternative methods to animal testing are an integral part of the 3Rs concept (refine, reduce, replace) defined by Russel & Burch in 1959. These approaches include in silico methods (databases and computer models), in vitro physicochemical analysis, biological methods using bacteria or isolated cells, reconstructed enzyme systems, and reconstructed tissues. Emerging "omic" methods used in integrated approaches further help to reduce animal use, while stem cells offer promising approaches to toxicologic and pathophysiologic studies, along with organotypic cultures and bio-artificial organs. Only a few alternative methods can so far be used in stand-alone tests as substitutes for animal testing. The best way to use these methods is to integrate them in tiered testing strategies (ITS), in which animals are only used as a last resort.

  10. Development of mathematical models to elaborate strategies, select alternatives and development of plans for adaptation of communities to climate change in different geographical areas including costs to implement it (United States)

    Anton, J. M.; Grau, J. B.; Tarquis, A. M.; Andina, D.; Cisneros, J. M.


    There is evidence that the climate changes and that now, the change is influenced and accelerated by the CO2 augmentation in atmosphere due to combustion by humans. Such "Climate change" is on the policy agenda at the global level, with the aim of understanding and reducing its causes and to mitigate its consequences. In most countries and international organisms UNO (e.g. Rio de Janeiro 1992), OECD, EC, etc … the efforts and debates have been directed to know the possible causes, to predict the future evolution of some variable conditioners, and trying to make studies to fight against the effects or to delay the negative evolution of such. The Protocol of Kyoto 1997 set international efforts about CO2 emissions, but it was partial and not followed e.g. by USA and China …, and in Durban 2011 the ineffectiveness of humanity on such global real challenges was set as evident. Among all that, the elaboration of a global model was not boarded that can help to choose the best alternative between the feasible ones, to elaborate the strategies and to evaluate the costs, and the authors propose to enter in that frame for study. As in all natural, technological and social changes, the best-prepared countries will have the best bear and the more rapid recover. In all the geographic areas the alternative will not be the same one, but the model must help us to make the appropriated decision. It is essential to know those areas that are more sensitive to the negative effects of climate change, the parameters to take into account for its evaluation, and comprehensive plans to deal with it. The objective of this paper is to elaborate a mathematical model support of decisions, which will allow to develop and to evaluate alternatives of adaptation to the climatic change of different communities in Europe and Latin-America, mainly in especially vulnerable areas to the climatic change, considering in them all the intervening factors. The models will consider criteria of physical

  11. Electrochemical Biosensors for Early Stage Zika Diagnostics. (United States)

    Kaushik, Ajeet; Tiwari, Sneham; Jayant, Rahul D; Vashist, Arti; Nikkhah-Moshaie, Roozbeh; El-Hage, Nazira; Nair, Madhavan


    Health agencies have declared the recent Zika virus (ZIKV) infection an epidemic and a public health emergency of global concern due to its association with microcephaly and serious neurological disorders. The unavailability of effective drugs, vaccines, and diagnostic tools increases the demand for efficient analytical devices to detect ZIKV infection. However, high costs, longer diagnostic times, and stringent expertise requirements limit the utility of reverse transcriptase-PCR methods for rapid diagnostics. Therefore, developing portable, sensitive, selective, and cost-effective sensing systems to detect ZIKV at picomolar concentrations in biofluids would be a breakthrough in diagnostics and therapeutics. This paper highlights the advancements in developing smart sensing strategies to monitor ZIKV progression, with rapid point-of-care diagnostics as the ultimate aim.

  12. Alternative Energies

    Energy Technology Data Exchange (ETDEWEB)

    Planting, A.; De saint Jacob, Y.; Verwijs, H.; Belin, H.; Preesman, L.


    In two articles, one interview and one column attention is paid to alternative energies. The article 'A new light on saving energy' discusses the option to save energy by modernising lighting systems in urban areas. The column 'View from Paris' focuses on investment decisions in France with regard to renewable energy and energy savings. The article 'Europe turns a blind eye to big battery' discusses developments in batteries to store energy. The interview concerns fuel cell expert and formerly President of UTC Power Jan van Dokkum. The last article gives a brief overview of the European Energy Research Alliance (EERA) and the challenges this alliance will have to face with regard to climate change and energy security.

  13. Unproven diagnostic procedures in IgE-mediated allergic diseases. (United States)

    Niggemann, B; Grüber, C


    A considerable body of literature on therapeutic aspects of complementary and alternative medicine has been published in recent years, but little is known on diagnostic procedures. This short review lists complementary and alternative diagnostic procedures for the diagnosis of allergic diseases and presents an assessment of their usefulness for the daily practice. The review of the literature revealed that neither the determination of specific immunoglobulin G-antibodies in serum, the hair-analysis, the cytotoxic test, kinesiology, iridology, or electrodermal testing represent useful tests for the daily practice. To date, no complementary or alternative diagnostic procedure can be recommended as a meaningful element in the diagnostic work-up of allergic diseases. This is especially true for food allergy: properly performed oral food challenges still represent the gold standard for implementing specific diets in food allergic individuals. Ineffective diagnostic approaches may be costly for the consumer and delay appropriate therapy.

  14. Searching for the elusive typhoid diagnostic

    Directory of Open Access Journals (Sweden)

    Baker Stephen


    Full Text Available Abstract Typhoid (enteric fever is still a common disease in many developing countries but current diagnostic tests are inadequate. Studies on pathogenesis and genomics have provided new insight into the organisms that cause enteric fever. Better understanding of the microorganisms explains, in part, why our current typhoid methodologies are limited in their diagnostic information and why developing new strategies may be a considerable challenge. Here we discuss the current position of typhoid diagnostics, highlight the need for technological improvements and suggest potential ways of advancing this area.

  15. Greenhouse gas emissions from alternative strategies for waste management in the military - climate account for five selected localities; Klimagassutslipp fra alternative strategier for avfallsh#Latin Small Letter A With Ring Above#ndtering i Forsvaret #En Dash# et klimaregnskap for fem utvalgte lokaliteter

    Energy Technology Data Exchange (ETDEWEB)

    Myhre, Oddvar; Reistad, Trine; Longva, Kjetil


    Greenhouse gas (GHG) emissions emanating from waste management practices in the Norwegian Armed Forces were assessed. Focus was on use of a material recovery facility (MRF) where the initial sorting of waste takes place. The MRF upgrades the waste before it is delivered to other industries to produce new products; alternatively, it undergoes incineration with energy recovery as an alternative to burning fossil fuel. The GHG emissions accounting practices examined in this paper included upstream emissions from fuel consumption of collection and transport of waste, operational activities at the MRF, and downstream processes. The latter means recycling of waste (glass, plastics, paper, ferrous metal, electrical and electronic equipment, and tires) compared to primary production using virgin materials, or the incineration of waste with energy recovery (mixed waste, food waste, wood waste, and infectious waste) compared to energy production from sources of fossil origin. The results show that recycling proves to be beneficial over primary production, and incineration of waste in waste to energy plants is favorable compared to the use of fossil fuel (savings of 0.9 and 0.3 kg Co2-equivalents kg#Minus Sign#1 waste, respectively). Sorting of all the mixed waste at military camp collection sites followed by recycling of the separated fractions at MRF would result in avoided GHG emissions of 44%, compared to the current practice of incineration with energy recovery. Further research is needed to fully elucidate the importance and benefits of increased sorting of mixed waste in the Norwegian Armed Forces seen from a GHG perspective. (author)

  16. Selection of Fusion Levels Using the Fulcrum Bending Radiograph for the Management of Adolescent Idiopathic Scoliosis Patients with Alternate Level Pedicle Screw Strategy: Clinical Decision-making and Outcomes.

    Directory of Open Access Journals (Sweden)

    Dino Samartzis

    Full Text Available Selecting fusion levels based on the Luk et al criteria for operative management of thoracic adolescent idiopathic scoliosis (AIS with hook and hybrid systems yields acceptable curve correction and balance parameters; however, it is unknown whether utilizing a purely pedicle screw strategy is effective. Utilizing the fulcrum bending radiographic (FBR to assess curve flexibility to select fusion levels, the following study assessed the efficacy of pedicle screw fixation with alternate level screw strategy (ALSS for thoracic AIS.A retrospective study with prospective radiographic data collection/analyses (preoperative, postoperative 1-week and minimum 2-year follow-up of 28 operative thoracic AIS patients undergoing ALSS was performed. Standing coronal/sagittal and FBR Cobb angles, FBR flexibility, fulcrum bending correction index (FBCI, trunkal shift, radiographic shoulder height (RSH, and list were assessed on x-rays. Fusion level selection was based on the Luk et al criteria and compared to conventional techniques.In the primary curve, the mean preoperative and postoperative 1 week and last follow-up standing coronal Cobb angles were 59.9, 17.2 and 20.0 degrees, respectively. Eighteen patients (64.3% had distal levels saved (mean: 1.6 levels in comparison to conventional techniques. Mean immediate and last follow-up FBCIs were 122.6% and 115.0%, respectively. Sagittal alignment did not statistically differ between any assessment intervals (p>0.05. A decrease in trunkal shift was noted from preoperative to last follow-up (p = 0.003. No statistically significant difference from preoperative to last follow-up was noted in RSH and list (p>0.05. No "add-on" of other vertebra or decompensation was noted and all patients achieved fusion.This is the first report to note that using the FBR for decision-making in selecting fusion levels in thoracic AIS patients undergoing management with pedicle screw constructs (e.g. ALSS is a cost-effective strategy

  17. Diagnostic management of renal colic. (United States)

    Nicolau, C; Salvador, R; Artigas, J M


    Renal colic is a common reason for presentation to emergency departments, and imaging has become fundamental for the diagnosis and clinical management of this condition. Ultrasonography and particularly noncontrast computed tomography have good diagnostic performance in diagnosing renal colic. Radiologic management will depend on the tools available at the center and on the characteristics of the patient. It is essential to use computed tomography techniques that minimize radiation and to use alternatives like ultrasonography in pregnant patients and children. In this article, we review the epidemiology, clinical and radiologic presentations, and clinical management of ureteral lithiasis.

  18. Diagnostic errors in pediatric radiology

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, George A.; Voss, Stephan D. [Children' s Hospital Boston, Department of Radiology, Harvard Medical School, Boston, MA (United States); Melvin, Patrice R. [Children' s Hospital Boston, The Program for Patient Safety and Quality, Boston, MA (United States); Graham, Dionne A. [Children' s Hospital Boston, The Program for Patient Safety and Quality, Boston, MA (United States); Harvard Medical School, The Department of Pediatrics, Boston, MA (United States)


    Little information is known about the frequency, types and causes of diagnostic errors in imaging children. Our goals were to describe the patterns and potential etiologies of diagnostic error in our subspecialty. We reviewed 265 cases with clinically significant diagnostic errors identified during a 10-year period. Errors were defined as a diagnosis that was delayed, wrong or missed; they were classified as perceptual, cognitive, system-related or unavoidable; and they were evaluated by imaging modality and level of training of the physician involved. We identified 484 specific errors in the 265 cases reviewed (mean:1.8 errors/case). Most discrepancies involved staff (45.5%). Two hundred fifty-eight individual cognitive errors were identified in 151 cases (mean = 1.7 errors/case). Of these, 83 cases (55%) had additional perceptual or system-related errors. One hundred sixty-five perceptual errors were identified in 165 cases. Of these, 68 cases (41%) also had cognitive or system-related errors. Fifty-four system-related errors were identified in 46 cases (mean = 1.2 errors/case) of which all were multi-factorial. Seven cases were unavoidable. Our study defines a taxonomy of diagnostic errors in a large academic pediatric radiology practice and suggests that most are multi-factorial in etiology. Further study is needed to define effective strategies for improvement. (orig.)

  19. Diagnostic Algorithm Benchmarking (United States)

    Poll, Scott


    A poster for the NASA Aviation Safety Program Annual Technical Meeting. It describes empirical benchmarking on diagnostic algorithms using data from the ADAPT Electrical Power System testbed and a diagnostic software framework.

  20. Thioaptamer Diagnostic System Project (United States)

    National Aeronautics and Space Administration — AM Biotechnologies (AM) will develop a diagnostic system in response to SBIR Topic X10.01 Reusable Diagnostic Lab Technology that will simultaneously detect and...

  1. 40 CFR 86.1806-04 - On-board diagnostics. (United States)


    ... 40 Protection of Environment 19 2010-07-01 2010-07-01 false On-board diagnostics. 86.1806-04..., and Complete Otto-Cycle Heavy-Duty Vehicles § 86.1806-04 On-board diagnostics. This § 86.1806-04... alternative to SAE J1850. (iii) ISO 15765-4.3:2001 “Road Vehicles-Diagnostics on Controller Area Network...

  2. Fuel-motion diagnostics and cineradiography

    Energy Technology Data Exchange (ETDEWEB)

    DeVolpi, A.


    Nuclear and non-nuclear applications of cineradiography are reviewed, with emphasis on diagnostic instrumentation for in-pile transient-reactor safety testing of nuclear fuel motion. The primary instrument for this purpose has been the fast-neutron hodoscope, which has achieved quantitative monitoring of time, location, mass, and velocity of fuel movement under the difficult conditions associated with transient-reactor experiments. Alternative diagnostic devices that have been developed have not matched the capabilities of the hodoscope. Other applications for the fuel-motion diagnostic apparatus are also evolving, including time-integrated radiography and direct time- and space-resolved fuel-pin power monitoring. Although only two reactors are now actively equipped with high-resolution fuel-motion diagnostic systems, studies and tests have been carried out in and for many other reactors.

  3. Traditional Assessment versus Alternative Assessment. (United States)

    Belle, Dana

    The purpose of this study was to determine whether a teacher can use one type of assessment to evaluate students' abilities fairly. The question is whether or not alternative assessment strategies are necessary to meet students' individual needs. The research, conducted with 28 fifth-grade students, compared their traditional and alternative…

  4. Do companion diagnostics make economic sense for drug developers? (United States)

    Agarwal, Amit


    Drug developers are grappling with the impact of personalized medicine on their portfolios. The combination of molecular diagnostics with targeted biologic therapies has been hailed as a recent innovation with few historical analogs to guide behavior. However, if the definition of companion diagnostics is broadened to include any drug whose FDA approved label requires diagnostic testing before prescription then over 50 drugs across multiple therapeutic areas arise. Most importantly for current drug developers, these drugs represent a wide variety of market situations and with sufficient historical data to evaluate different commercialization strategies for the combination. Included in these examples are drugs which were not initially launched with companion diagnostics but were required to implement companion diagnostics after they were on the market for a period of time. The historical case studies demonstrate that companion diagnostics are neither a universal panacea nor an unmitigated disaster for drug developers but require an understanding of specific situations to determine the utility of companion diagnostics. Numerous case studies highlight how companion diagnostics have been a boon to drug developers including Iressa, statins, Soriatane, Arthrotec, Promacta, Nplate, Letairis, and Tracleer. Other examples provide lessons on how to avoid pitfalls such as Accutane, Ticlid, Tegretol, Ziagen, Actigall and Clozaril. By carefully evaluating these case studies, drug developers can gain insight on the appropriate companion diagnostic strategy to implement for their specific situation and develop the elements of a successful companion diagnostic strategy.

  5. Processes Affecting Phosphorus and Copper Concentrations and Their Relation to Algal Growth in Two Supply Reservoirs in the Lower Coastal Plain of Virginia, 2002-2003, and Implications for Alternative Management Strategies (United States)

    Speiran, Gary K.; Simon, Nancy S.; Mood-Brown, Maria L.


    Elevated phosphorus concentrations commonly promote excessive growth of algae in waters nationwide. When such waters are used for public supply, the algae can plug filters during treatment and impart tastes and odors to the finished water. This increases treatment costs and results in finished water that may not be of the quality desired for public supply. Consequently, copper sulfate is routinely applied to many reservoirs to control algal growth but only is a 'temporary fix' and must be reapplied at intervals that can range from more than 30 days in the winter to less than 7 days in the summer. Because copper has a maximum allowable concentration in public drinking water and can be toxic to aquatic life, water suppliers commonly seek to develop alternative, long-term strategies for managing reservoirs. Because these are nationwide issues and part of the mission of the U.S. Geological Survey (USGS) is to define and protect the quality of the Nation's water resources and better understand the physical, chemical, and biological processes in wetlands, lakes, reservoirs, and estuaries, investigations into these issues are important to the fulfillment of the mission of the USGS. The City of Newport News, Virginia, provides 50 million gallons per day of treated water for public supply from Lee Hall and Harwoods Mill Reservoirs (terminal reservoirs) to communities on the lower York-James Peninsula. About 3,500 pounds of copper sulfate are applied to each reservoir at 3- to 99-day intervals to control algal growth. Consequently, the USGS, in cooperation with the City of Newport News, investigated the effects of management practices and natural processes on phosphorus (the apparent growth-limiting nutrient), copper, and algal concentrations in the terminal reservoirs to provide information that can be used to develop alternative management strategies for the terminal reservoirs. Initial parts of the research evaluated circulation and stratification in the reservoirs

  6. Looking for an Alternative. (United States)

    Kennedy, Jack


    Argues that high school newspapers might do well to create stronger ties with alternative weeklies. Discusses issues of niche marketing, alternative content, and alternative presentation. Notes that high school papers could learn a lot from alternative newspapers. (SR)

  7. Chordoid meningioma: A diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    Fouzia Siraj


    Full Text Available Chordoid meningioma (CM, classified as Grade II/atypical meningioma according to the World Health Organization classification, is a rare subtype, which represents only 0.5% of all meningiomas. Morphologically, it can mimic other chondroid and myxoid tumors within the brain and its vicinity thus posing a diagnostic challenge. Accurate diagnosis, therefore, assumes importance as these tumors have an aggressive clinical course and propensity to recur compared to classical meningiomas. Furthermore, the prognosis and treatment strategies vary when compared to tumors with morphological overlap. We present a case of CM in a 14-year-old girl and discuss its clinicopathological and immunohistochemical features.

  8. Literacy: Development and Teaching Strategies. (United States)

    Orme, Liz; Masson, Susan

    This paper seeks to provide teachers with a sampling of before, during, and after reading strategies that are appropriate for use in K-12 classrooms. The paper first discusses diagnostic assessment methods in the classroom and presents activities which provide samples of informal diagnostic assessment. It then outlines some "before reading"…

  9. ISTTOK plasma control with the tomography diagnostic

    Energy Technology Data Exchange (ETDEWEB)

    Fernandes, H.; Caralho, P.J.; Duarte, P.; Pereira, T.; Coelho, R.; Silva, C. [Association Euratom/IST, Institute of Plasmas and Nuclear Fusion, Technology Graduate Institute, P-1049-001 Lisbon (Portugal)


    A real-time plasma position control system is mandatory to achieve long duration (up to 250 ms), Alternating Current (AC) discharges on the ISTTOK tokamak. Such a system has been used for some time supported only on magnetic field diagnostic data. However, this system does not function accurately when the plasma current is low, rendering it inoperative during the plasma current reversal. A tomography diagnostic with 3 pinhole cameras and 8 silicone photodiode channels per camera was installed and customized to supply alternative plasma position to be used for plasma position control. As no filtering is applied, most of the radiation detected is in the visible/near-UV range. This system (i) executes a tomographic reconstruction, (ii) determines the average emissivity position from it, (iii) calculates the shift from the required position and (iv) supplies the vertical field power supply unit with the desired current value, all in less than 100 {mu}s. The horizontal magnetic field power supply unit is expected to be included in the system and will have no impact in the process time. This paper presents the tomography diagnostic architecture together with results of its scientific exploitation in ISTTOK AC discharges, where it has proven to be capable of supplying an accurate plasma position during the current reversal. The use of the tomography diagnostic for plasma position overcomes some limitations of the magnetic diagnostics, but poses challenges of its own such as blindness to plasma current direction. (authors)

  10. Marketing considerations for diagnostic imaging centers. (United States)

    McCue, P


    Diagnostic imaging centers seek every possible advantage to maintain a successful practice in the face of competition from hospitals and other freestanding operators. Several radiologists and business managers involved in existing or planned centers discuss their marketing strategies, modality choices, organizational structure, and other issues pertinent to the start-up and operation of a viable free-standing operation.

  11. 甲型H1N1流感病毒临床实验室诊断策略%Clinical Laboratory Diagnostic Strategies of Influenza A/H1N1 Virus

    Institute of Scientific and Technical Information of China (English)

    苏明权; 杨柳; 马越云; 郝晓柯


    Objective To study a clinical labaratory diagnostic strategy for influenza A/H1N1 patients. Methods To detect the influenza A virus antigen by Dot-ELISA method in influenza patients , initially diagnosed as influenza A or non-influenza; for the influenza A virus antigen-positive patients ,further testing influenza A/H1N1 virus-specific nucleic acid using real-time RT-PCR method. Results For 44.448 cases of influenza patients in xi'an to screened influenza A virus antigen,the positive rate as 28. 25%;further detected influenza A/H1N1 virus nucleic acid for 17 714 cases of antigen-positive patients,the positive rate of 41. 92%.Conclusion First screening the influenza A virus antigen,to exclude non-influenza A virus;and then within the framewark of influenza A virus to detect influenza A/H1N1 virus,that increased the detection efficiency of influenza A viruses,but also reduced the pressure on influenza A/H1N1 virus nucleic acid testing and the economic burden of patients. This detection strategy provided reference for laboratory diagnosis of influenza A/H1N1,and more effective control,diagnose influenza A/H1N1 virus infection.%目的 探讨用于甲型H1N1流感患者临床实验室诊断的策略.方法 采用Dot-ELISA法检测流感患者中的甲型流感病毒的抗原,初步明确为甲型流感或排除非甲型流感;采用real-time RT-PCR法检测甲型流感病毒抗原阳性患者中的甲型H1N1流感病毒特异性核酸,进一步确定甲型H1N1流感病毒.结果 对44 448例在西安地区就诊的发热伴有流感样症状者的鼻咽腔取分泌物进行甲型流感病毒抗原筛查,其阳性筛检率为28.25%;对甲型流感病毒抗原筛查阳性的17 714例患者进行甲型H1N1流感病毒核酸检测,其阳性检出率为41.92%.结论 首先用甲型流感病毒抗原筛查,排除非甲型流感病毒;进而在甲型流感病毒的范围内进行甲型H1N1流感病毒的检测,即加快了甲型流感病毒的排

  12. Diagnostic Development on NSTX

    Energy Technology Data Exchange (ETDEWEB)

    A.L. Roquemore; D. Johnson; R. Kaita; et al


    Diagnostics are described which are currently installed or under active development for the newly commissioned NSTX device. The low aspect ratio (R/a less than or equal to 1.3) and low toroidal field (0.1-0.3T) used in this device dictate adaptations in many standard diagnostic techniques. Technical summaries of each diagnostic are given, and adaptations, where significant, are highlighted.

  13. Diagnostic methods I: sensitivity, specificity, and other measures of accuracy

    NARCIS (Netherlands)

    K.J. van Stralen; V.S. Stel; J.B. Reitsma; F.W. Dekker; C. Zoccali; K.J. Jager


    For most physicians, use of diagnostic tests is part of daily routine. This paper focuses on their usefulness by explaining the different measures of accuracy, the interpretation of test results, and the implementation of a diagnostic strategy. Measures of accuracy include sensitivity and specificit

  14. ITER perspective on fusion reactor diagnostics - A spectroscopic view

    DEFF Research Database (Denmark)

    De Bock, M. F. M.; Barnsley, R.; Bassan, M.


    challenges to the development of spectroscopic (but also other) diagnostics. This contribution presents an overview of recent achievements in 4 topical areas: First mirror protection and cleaning, Nuclear confinement, Radiation mitigation strategy for optical and electronic components and Calibration...

  15. Recent progress in nanomedicine: therapeutic, diagnostic and theranostic applications

    NARCIS (Netherlands)

    Rizzo, L.Y.; Theek, B.; Storm, G.; Kiessling, F.; Lammers, T.G.G.M.


    In recent years, the use of nanomedicine formulations for therapeutic and diagnostic applications has increased exponentially. Many different systems and strategies have been developed for drug targeting to pathological sites, as well as for visualizing and quantifying important (patho-) physiologic

  16. Cost-effectiveness and total costs of three alternative strategies for the prevention and management of severe skin reactions attributable to thiacetazone in the treatment of Human Immunodeficiency Virus positive patients with tuberculosis in Kenya. (United States)

    van Gorkom, J; Kibuga, D K


    In Kenya, the National Leprosy Tuberculosis Programme (NLTP) used previously reported data from Nairobi to compare the cost-effectiveness and total costs of a hypothetical strategy with three intervention strategies for the prevention and management of severe skin reactions caused by thiacetazone in treating HIV-positive patients with tuberculosis (TB). The hypothetical strategy was continued use of thiacetazone despite adverse skin reactions. The intervention strategies included patient education about possible side effects of anti-TB drugs (discontinue use if skin rash develops, report situation to clinic, replace thiacetazone with ethambutol when other skin diseases have been excluded), abandonment of thiacetazone and replacement with ethambutol, and HIV testing and pre- and post-test counseling. NLTP currently used the education strategy. It assumed a mortality rate of 5%. When the HIV prevalence rate is 1-90%, the education strategy is the most cost-effective strategy. In terms of total costs, the education strategy was also the most inexpensive strategy regardless of the HIV prevalence. At an HIV prevalence rate greater than 65%, the abandonment of thiacetazone strategy was the cheapest strategy. When the assumed mortality rate was 3%, the cost per averted death for the education strategy was reduced from about US$120 to about US$80 and the education strategy became the most cost-effective strategy over the entire range of HIV prevalence. In addition, the cost of HIV testing significantly increased the cost per averted death. Thus, the findings of this study are truly sensitive to different program conditions. Based on these findings, the authors recommended that the education strategy be applied with a range of HIV prevalence of 1-45%, that HIV testing be applied with a range of 46-72%, and that total abandonment be applied with an HIV prevalence greater than 72%.

  17. Improved Sampling for Diagnostic Reasoning in Bayesian Networks


    Hulme, Mark


    Bayesian networks offer great potential for use in automating large scale diagnostic reasoning tasks. Gibbs sampling is the main technique used to perform diagnostic reasoning in large richly interconnected Bayesian networks. Unfortunately Gibbs sampling can take an excessive time to generate a representative sample. In this paper we describe and test a number of heuristic strategies for improving sampling in noisy-or Bayesian networks. The strategies include Monte Carlo Markov chain sampling...

  18. Fringe Mind Strategies

    Directory of Open Access Journals (Sweden)

    Jan Sleutels


    Full Text Available This paper discusses a number of basic strategies for modeling the mind in historical perspective. The best-known strategies are expansionism and eliminativism, which are both problematic: eliminativism compromises our self-understanding, while expansionism is unable to cope with fringe minds. Using Julian Jaynes’s theory of the bicameral mind as an example, an alternative strategy is outlined to meet the challenges posed by the history of the mind.

  19. Diagnostics of Nanodusty Plasma (United States)

    Greiner, Franko; Groth, Sebastian; Tadsen, Bejamin; Piel, Alexander


    The diagnostic of nanodusty plasmas, i.e. plasmas including nano-sized dust particles, is a challenging task. For both, the diagnostic of the nanodusty plasma itself, and the in-situ diagnostic of the nanoparticles, no standard diagnostic exist. Nanodust particle size and density can be estimated using light scattering techniques, namely kinetic Mie ellipsometry and extinction measurements. The charge of the nanoparticles can be estimated from the analysis of dust density waves (DDW). Parameters like the electron density, which give information about the plasma itself, may be deduced from the DDW analysis. We present detailed investigations on nanodust in a reactive Argon-Acetylene plasma created in an rf-driven parallel plate reactor at low pressure using the above mentioned portfolio of diagnostic. Funded by DFG under contract SFB TR-24/A2.

  20. Hospital diversification: evaluating alternatives. (United States)

    Hammer, L


    The appropriateness of diversification as a growth strategy for hospitals is discussed, and planning for diversification is described. Because new forms of health-care delivery are now in direct competition with hospitals, many hospitals are confronting environmental pressures and preparing for future survival through diversification. To explore the potential risks and benefits of diversification, the hospital must identify opportunities for new business ventures. Diversification can be "related," through an expansion of the primary product line (health care), or "unrelated," into areas not directly associated with health care. The hospital must establish specific criteria for evaluating each diversification alternative, and the two or three most attractive options should be analyzed further through a financial feasibility study. The hospital should also seek legal advice to determine the implications of diversification for maintenance of tax status, antitrust limitations, and applicability of certificate of need. Although diversification may not be appropriate for every institution, hospitals should consider it as a strategy for increasing their revenue base, confronting environmental pressures, and securing future survival.

  1. Alternative medicine - pain relief (United States)

    Alternative medicine refers to treatments that are used instead of conventional (standard) ones. If you use an alternative ... with conventional medicine or therapy, it is considered complementary therapy. There are many forms of alternative medicine. Acupuncture ...

  2. Experiences in mainstreaming alternative energy

    Energy Technology Data Exchange (ETDEWEB)

    Cabraal, A.


    The author discusses efforts by the Asia Alternative Energy Unit (ASTAE) of the World Bank in supporting alternative energy source projects in Asia. Energy growth rates have been as high as 18% per year, with power capacity doubling each decade in the 1960`s, 70`s and 80`s. Much of this has come from fossil fuel projects coupled with major hydroelectric projects. One consequence is developing air pollution loads originating in Asia. ASTAE has been supporting pilot programs in applying alternative energy sources. The goal has been to mainstream renewable energy sources in World Bank operations, by working with managers from different countries to: include renewable energy in country assistance strategies and sectorial development plans; provide assistance to renewable energy initiatives; expand initiatives to new countries, sectors and technologies.

  3. Strategier ved udredning af malassimilation. En kritisk status

    DEFF Research Database (Denmark)

    Rumessen, J J


    This review reevaluates the rational basis for choice of diagnostic strategies in patients with suspected malassimilation. Prospective evaluation of diagnostic tests must fulfil several requirements for a correct assessment of their clinical value. Very few studies meet such requirements, resulti...

  4. Diagnostics in critical conditions

    Directory of Open Access Journals (Sweden)



    Full Text Available The purpose of research: improvement of quality of diagnostics at the patients in a critical condition in intensive care unit. Material and methods. In total have analyzed 1957 medical cards of the patients who have died in ICU»s. At the first stage studied the factors influencing on diagnostics of critically ill patients (medical cards of 1557 patients; at the second stage investigated influence of the diagnostic standards in ICU»s practice on improvement of quality of diag- nostics of critically ill patients (400 medical cards of the patients who have died. Entry criterions were standards and algorithm of diagnostics. Techniques of research: average bed-day in groups, first-day lethality, quantity of the carried out laboratory tests and tool methods of research, level of consciousness of the patients (Glasgow come score, severity of disease by ICU»s patients (APACHE II scores. Results. Quality of diagnostics depend on carried out laboratory tests and tool methods of research, level of consciousness of the patients (Glasgow come score, severity of disease by ICU»s patients (APACHE II score. The conclusion. The laboratory tests and tool methods of research conforming to the standards of diagnostics are necessary for improvement of quality of diagnostics, it is necessary to take into account an altered level of consciousness (Glasgow come score and severity of disease by ICU»s patients (APACHE II scores

  5. Cable Diagnostic Focused Initiative

    Energy Technology Data Exchange (ETDEWEB)

    Hartlein, R.A.; Hampton, R.N.


    This report summarizes an extensive effort made to understand how to effectively use the various diagnostic technologies to establish the condition of medium voltage underground cable circuits. These circuits make up an extensive portion of the electric delivery infrastructure in the United States. Much of this infrastructure is old and experiencing unacceptable failure rates. By deploying efficient diagnostic testing programs, electric utilities can replace or repair circuits that are about to fail, providing an optimal approach to improving electric system reliability. This is an intrinsically complex topic. Underground cable systems are not homogeneous. Cable circuits often contain multiple branches with different cable designs and a range of insulation materials. In addition, each insulation material ages differently as a function of time, temperature and operating environment. To complicate matters further, there are a wide variety of diagnostic technologies available for assessing the condition of cable circuits with a diversity of claims about the effectiveness of each approach. As a result, the benefits of deploying cable diagnostic testing programs have been difficult to establish, leading many utilities to avoid the their use altogether. This project was designed to help address these issues. The information provided is the result of a collaborative effort between Georgia Tech NEETRAC staff, Georgia Tech academic faculty, electric utility industry participants, as well as cable system diagnostic testing service providers and test equipment providers. Report topics include: •How cable systems age and fail, •The various technologies available for detecting potential failure sites, •The advantages and disadvantages of different diagnostic technologies, •Different approaches for utilities to employ cable system diagnostics. The primary deliverables of this project are this report, a Cable Diagnostic Handbook (a subset of this report) and an online

  6. [Vasculitis - diagnostic and therapeutic advances]. (United States)

    De Albuquerque, R; Machado, Filipa


    Vasculitis is characterized by inflammation and necrosis of blood vessels walls. It represents a heterogeneous group of conditions, whose etiopathogenic mechanisms remain unclear. Although uncommon, with an annual incidence of 40-54 cases per 1.000.000 persons, this is an important cause of multiorganic dysfunction and premature mortality. Depending on the affected vessels, it can cause diverse clinical presentations, which makes difficult its recognition. It is therefore a challenge for any clinician. This paper reviews the diagnostic and therapeutic advances of the most common forms of vasculitis, in order to optimize the approach and management of this clinical entity. We have conducted a search in Medline database on articles written in English, published for the last 10 years using the keywords: vasculitis, epidemiology, classification, diagnosis and treatment. To minimize the impact of vasculitis it is essential an early diagnosis, allowing a timely institution of the appropriate treatment. The diagnosis depends on the integration of clinical, laboratory, imaging and histopathologic data. According to the clinical condition, it may be indicated the removal of the offending antigen, the treatment of the underlying disease or specific treatment of the primary vasculitis. The introduction of immunosuppressive therapy with glucocorticoids and cyclophosphamide has revolutionized the prognosis of these patients but, despite its efficacy, it is associated with frequent relapses and significant toxicity. The study of the pathogenesis has been providing more effective and safer diagnostic and therapeutic options, for example B-cell depleting agents, but additional studies are needed to confirm the potential of these alternatives.

  7. New tuberculosis diagnostics and rollout

    Directory of Open Access Journals (Sweden)

    Ruth McNerney


    Full Text Available Early detection and effective treatment are crucial for tuberculosis control, but global case detection rates remain low. The diagnosis of paediatric and extrapulmonary disease is problematic and there are, as yet, no rapid screening tests to assist active case finding in the community. Progress has been made in clinic-based detection tools with the introduction of Xpert MTB/RIF, a nucleic acid amplification test that combines sample processing and analysis in a single instrument to provide a diagnostic result and detection of resistance to rifampicin in under 2 h. Enthusiasm for Xpert MTB/RIF has been high and global rollout has been facilitated by donor agencies. However, concerns remain about access and sustainability due to the high cost and infrastructure requirements. Although more sensitive than smear microscopy, early studies suggest the impact of the new test on case detection rates and patient survival has been limited. Alternative technologies are being developed, including non-sputum-based tests to assist the detection of extrapulmonary disease. Evaluation studies are needed to provide evidence of the impact of the new technologies on patient outcomes. This will enable appropriate placement of new diagnostic products in the healthcare system to support the control and eventual eradication of tuberculosis disease.

  8. Cyclic Polymer with Alternating Monomer Sequence. (United States)

    Zhu, Wen; Li, Zi; Zhao, Youliang; Zhang, Ke


    Cyclic polymers with alternating monomer sequence are synthesized for the first time based on the ring-closure strategy. Well-defined telechelic alternating polymers are synthesized by reversible addition-fragmentation chain transfer polymerization by copolymerizing the electron acceptor monomer of N-benzylmaleimide and donor monomer of styrene with a feed ratio of 1 between them. The corresponding cyclic alternating polymers are then produced by the UV-induced Diels-Alder click reaction to ring-close the linear alternating polymer precursors under highly diluted reaction solution.

  9. Assessment Strategies for the Handicapped. (United States)

    Guidubaldi, John; And Others


    This review of assessment strategies for handicapped populations is intended to provide counselors with assessment perspectives as well as specific suggestions. The review emphasizes the counselor's role as a member of a diagnostic team and the need to consider a variety of information in formation of meaningful intervention strategies. (Author)

  10. Marketing diagnostics in consumer cooperatives trade enterprises

    Directory of Open Access Journals (Sweden)

    O.S. Krivoruchko


    Full Text Available The aim of the article. The article highlights main demands and levels of realization of consumer cooperatives trade enterprises` diagnostics.We demonstrate the chain of marketing diagnostics; we offer the model of diagnostics process of marketing problems (opportunities of cooperative trade enterprises.The results of the analysis. Marketing diagnostics is one of the marketing researches directions, which is matching of the researched object characteristics with comparison base for definition of objects quality condition (its diagnosis. In the context of our research marketing diagnostics should be considered as separate technological module which enables to form development backgrounds of competitive marketing strategies of consumer cooperatives trade enterprises according to conditions of inner and outer environment.We consider the following demands of marketing diagnostics conduction of consumer cooperatives trade enterprises: authenticity, objectivity, accuracy, resultativity, systematicness, sequence, scientific foundation, flexibility, timeliness, effectiveness, validity.Strategic diagnostics is the direction of researches that is responsible for receiving the information, necessary for further functioning of the enterprise. We should refer to comparative researches of strategic state of enterprise economy portfolio, enterprise competitiveness estimation, and enterprise activity threats and possibilities definition.Tactical diagnostics is the researches direction which forms information for plans programs development. Economy interest matching of marketing activity participants in this situation gains special meaning. Due to this meaning the procedures of their sequence can be developed. We consider the mentioned type of diagnostics to be insufficiently researched nowadays, though it has significant importance in the process of managerial decisions supporting and making.The main task of operative diagnostics is defining deviation borders

  11. Thioaptamer Diagnostic System Project (United States)

    National Aeronautics and Space Administration — AM Biotechnologies (AM) in partnership with Sandia National Laboratories will develop a Thioaptamer Diagnostic System (TDS) in response to Topic X10.01 Reusable...

  12. Rotorcraft Diagnostics Project (United States)

    National Aeronautics and Space Administration — Under this SBIR program, Ridgetop will introduce the first low-cost, low-power, and lightweight data monitoring solution for rotorcraft diagnostics. The solution is...

  13. National Convective Weather Diagnostic (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Current convective hazards identified by the National Convective Weather Detection algorithm. The National Convective Weather Diagnostic (NCWD) is an automatically...

  14. Prenatal Genetic Diagnostic Tests (United States)

    ... are offered to all pregnant women. What is amniocentesis? Amniocentesis is a diagnostic test. It usually is done ... a very small chance of pregnancy loss with amniocentesis. Leakage of amniotic fluid and slight bleeding can ...

  15. Optics/Optical Diagnostics Laboratory (United States)

    Federal Laboratory Consortium — The Optics/Optical Diagnostics Laboratory supports graduate instruction in optics, optical and laser diagnostics and electro-optics. The optics laboratory provides...

  16. All About Alternatives (United States)

    Barr, Robert D.; And Others


    A primer on alternative schools. Described are existing programs in different areas, philosophy of the alternative schools, funding, student behavior, community relations, accountability, State regulations, management, and the environment of the alternative school. A list of sources of additional information on alternative schools is included.…

  17. [Diagnostics in osteology]. (United States)

    Jakob, F; Genest, F; Seefried, L; Tsourdi, E; Lapa, C; Hofbauer, L C


    Clinical diagnostics in metabolic bone diseases cover a broad spectrum of conventional and state of the art methods ranging from the medical history and clinical examination to molecular imaging. Patient treatment is carried out in an interdisciplinary team due to the multiple interactions of bone with other organ systems. Diagnosis of osteoporosis is supported by high level national guidelines. A paradigm shift concerning the clinical relevance of bone mineral density measurement renders this now to be a strong risk factor rather than a diagnostic parameter, while strengthening the value of other clinical factors for risk assessment. The impact of parameters for muscle mass, structure and function is steadily increasing in all age groups. In order to identify underlying diseases that influence bone metabolism a panel of general laboratory diagnostic parameters is recommended. Markers for bone formation and resorption and specific parameters for the regulation of calcium and phosphate metabolism should be evaluated by specialists because they require diligence in preanalytics and experience in interpretation. Genetic diagnosis is well established for rare bone diseases while diagnostic panels are not yet available for routine diagnostics in polygenetic diseases such as osteoporosis. Conventional radiology is still very important to identify, e. g. fractures, osteolytic and osteoblastic lesions and extraosseous calcifications; however tomography-based methods which combine, e. g. scintigraphy or positron emission technologies with anatomical imaging are of increasing significance. Clinical diagnostics in osteology require profound knowledge and are subject to a dynamic evolution.

  18. Molecular Diagnostic Applications in Colorectal Cancer

    Directory of Open Access Journals (Sweden)

    Laura Huth


    Full Text Available Colorectal cancer, a clinically diverse disease, is a leading cause of cancer-related death worldwide. Application of novel molecular diagnostic tests, which are summarized in this article, may lead to an improved survival of colorectal cancer patients.  Distinction of these applications is based on the different molecular principles found in colorectal cancer (CRC. Strategies for molecular analysis of single genes (as KRAS or TP53 as well as microarray based techniques are discussed. Moreover, in addition to the fecal occult blood testing (FOBT and colonoscopy some novel assays offer approaches for early detection of colorectal cancer like the multitarget stool DNA test or the blood-based Septin 9 DNA methylation test. Liquid biopsy analysis may also exhibit great diagnostic potential in CRC for monitoring developing resistance to treatment. These new diagnostic tools and the definition of molecular biomarkers in CRC will improve early detection and targeted therapy of colorectal cancer.

  19. Microarray-based genomic profiling as a diagnostic tool in acute lymphoblastic leukemia. (United States)

    Simons, Annet; Stevens-Kroef, Marian; El Idrissi-Zaynoun, Najat; van Gessel, Sabine; Weghuis, Daniel Olde; van den Berg, Eva; Waanders, Esmé; Hoogerbrugge, Peter; Kuiper, Roland; van Kessel, Ad Geurts


    In acute lymphoblastic leukemia (ALL) specific genomic abnormalities provide important clinical information. In most routine clinical diagnostic laboratories conventional karyotyping, in conjunction with targeted screens using e.g., fluorescence in situ hybridization (FISH), is currently considered as the gold standard to detect such aberrations. Conventional karyotyping, however, is limited in its resolution and yield, thus hampering the genetic diagnosis of ALL. We explored whether microarray-based genomic profiling would be feasible as an alternative strategy in a routine clinical diagnostic setting. To this end, we compared conventional karyotypes with microarray-deduced copy number aberration (CNA) karyotypes in 60 ALL cases. Microarray-based genomic profiling resulted in a CNA detection rate of 90%, whereas for conventional karyotyping this was 61%. In addition, many small (< 5 Mb) genetic lesions were encountered, frequently harboring clinically relevant ALL-related genes such as CDKN2A/B, ETV6, PAX5, and IKZF1. From our data we conclude that microarray-based genomic profiling serves as a robust tool in the genetic diagnosis of ALL, outreaching conventional karyotyping in CNA detection both in terms of sensitivity and specificity. We also propose a practical workflow for a comprehensive and objective interpretation of CNAs obtained through microarray-based genomic profiling, thereby facilitating its application in a routine clinical diagnostic setting.

  20. Interstitial lung disease: Diagnostic approach

    Directory of Open Access Journals (Sweden)

    Kaushik Saha


    Full Text Available Interstitial lung disease (ILD is a final common pathway of a broad heterogeneous group of parenchymal lung disorders. It is characterized by progressive fibrosis of the lung leading to restriction and diminished oxygen transfer. Clinically, the presenting symptoms of ILD are non-specific (cough and progressive dyspnea on exertion and are often attributed to other diseases, thus delaying diagnosis and timely therapy. Clues from the medical history along with the clinical context and radiologic findings provide the initial basis for prioritizing diagnostic possibilities for a patient with ILD. An accurate prognosis and optimal treatment strategy for patients with ILDs can only be after an accurate diagnosis. This review will assist pulmonary physicians and medicine specialist in recognition of ILD. Extensive literature search has been made through PubMed and also Book References has been used for writing this review.

  1. [Diagnostic-therapeutic approach for retroperitoneal tumors]. (United States)

    Cariati, A


    After a careful review of the Literature, diagnostic and therapeutic strategies for Primary Retroperitoneal Tumours (PRT) are reported. The Author analyzes the experience of the Institute of Clinica Chirurgica "R" (Chief: Prof. E. Tosatti) as well as that of Anatomia Chirurgica (Chief: Prof. E. Cariati),--University of Genoa--in the management of PRT, stressing the importance of preoperative staging for a correct surgical approach.

  2. Fusion neutron diagnostics on ITER tokamak (United States)

    Bertalot, L.; Barnsley, R.; Direz, M. F.; Drevon, J. M.; Encheva, A.; Jakhar, S.; Kashchuk, Y.; Patel, K. M.; Arumugam, A. P.; Udintsev, V.; Walker, C.; Walsh, M.


    ITER is an experimental nuclear reactor, aiming to demonstrate the feasibility of nuclear fusion realization in order to use it as a new source of energy. ITER is a plasma device (tokamak type) which will be equipped with a set of plasma diagnostic tools to satisfy three key requirements: machine protection, plasma control and physics studies by measuring about 100 different parameters. ITER diagnostic equipment is integrated in several ports at upper, equatorial and divertor levels as well internally in many vacuum vessel locations. The Diagnostic Systems will be procured from ITER Members (Japan, Russia, India, United States, Japan, Korea and European Union) mainly with the supporting structures in the ports. The various diagnostics will be challenged by high nuclear radiation and electromagnetic fields as well by severe environmental conditions (ultra high vacuum, high thermal loads). Several neutron systems with different sensitivities are foreseen to measure ITER expected neutron emission from 1014 up to almost 1021 n/s. The measurement of total neutron emissivity is performed by means of Neutron Flux Monitors (NFM) installed in diagnostic ports and by Divertor Neutron Flux Monitors (DNFM) plus MicroFission Chambers (MFC) located inside the vacuum vessel. The neutron emission profile is measured with radial and vertical neutron cameras. Spectroscopy is accomplished with spectrometers looking particularly at 2.5 and 14 MeV neutron energy. Neutron Activation System (NAS), with irradiation ends inside the vacuum vessel, provide neutron yield data. A calibration strategy of the neutron diagnostics has been developed foreseeing in situ and cross calibration campaigns. An overview of ITER neutron diagnostic systems and of the associated challenging engineering and integration issues will be reported.

  3. Real-time control for long ohmic alternate current discharges

    Energy Technology Data Exchange (ETDEWEB)

    Carvalho, Ivo S., E-mail:; Duarte, Paulo; Fernandes, Horácio; Valcárcel, Daniel F.; Carvalho, Pedro J.; Silva, Carlos; Duarte, André S.; Neto, André; Sousa, Jorge; Batista, António J.N.; Hekkert, Tiago; Carvalho, Bernardo B.; Gomes, Rui B.


    Highlights: • 40 Alternate plasma current (AC) semi-cycles without loss of ionization, more than 1 s of operation. • AC discharges automatic control: feedback loops, time-windows control strategy, goal oriented time-windows and exception handling. • Energy deposition and Carbon radiation evolution during the AC discharges. - Abstract: The ISTTOK tokamak has a long tradition on alternate plasma current (AC) discharges, but the old control system was limiting and lacked full system integration. In order to improve the AC discharges performance the ISTTOK fast control system was updated. This control system developed on site based on the Advanced Telecommunications Computing Architecture (ATCA) standard now integrates the information gathered by all the tokamak real-time diagnostics to produce an accurate observation of the plasma parameters. The real-time actuators were also integrated, allowing a Multiple Input Multiple Output (MIMO) control environment with several synchronization strategies available. The control system software was developed in C++ on top of a Linux system with the Multi-threaded Application Real-Time executor (MARTe) Framework to synchronize the real-time code execution under a 100μs control cycle. In addition, to simplify the discharge programming, a visual Human–Machine Interface (HMI) was also developed using the BaseLib2 libraries included in the MARTe Framework. This paper presents the ISTTOK control system and the optimizations that extended the AC current discharges duration to more than 1 s, corresponding to 40 semi-cycles without apparent degradation of the plasma parameters. This upgrade allows ISTTOK to be used as a low-cost material testing facility with long time exposures to nuclear fusion relevant plasmas, comparable (in duration) with medium size tokamaks.

  4. Development of Companion Diagnostics. (United States)

    Mankoff, David A; Edmonds, Christine E; Farwell, Michael D; Pryma, Daniel A


    The goal of individualized and targeted treatment and precision medicine requires the assessment of potential therapeutic targets to direct treatment selection. The biomarkers used to direct precision medicine, often termed companion diagnostics, for highly targeted drugs have thus far been almost entirely based on in vitro assay of biopsy material. Molecular imaging companion diagnostics offer a number of features complementary to those from in vitro assay, including the ability to measure the heterogeneity of each patient's cancer across the entire disease burden and to measure early changes in response to treatment. We discuss the use of molecular imaging methods as companion diagnostics for cancer therapy with the goal of predicting response to targeted therapy and measuring early (pharmacodynamic) response as an indication of whether the treatment has "hit" the target. We also discuss considerations for probe development for molecular imaging companion diagnostics, including both small-molecule probes and larger molecules such as labeled antibodies and related constructs. We then describe two examples where both predictive and pharmacodynamic molecular imaging markers have been tested in humans: endocrine therapy for breast cancer and human epidermal growth factor receptor type 2-targeted therapy. The review closes with a summary of the items needed to move molecular imaging companion diagnostics from early studies into multicenter trials and into the clinic.

  5. MJO Simulation Diagnostics

    Energy Technology Data Exchange (ETDEWEB)

    Waliser, D; Sperber, K; Hendon, H; Kim, D; Maloney, E; Wheeler, M; Weickmann, K; Zhang, C; Donner, L; Gottschalck, J; Higgins, W; Kang, I; Legler, D; Moncrieff, M; Schubert, S; Stern, W; Vitart, F; Wang, B; Wang, W; Woolnough, S


    The Madden-Julian Oscillation (MJO) interacts with, and influences, a wide range of weather and climate phenomena (e.g., monsoons, ENSO, tropical storms, mid-latitude weather), and represents an important, and as yet unexploited, source of predictability at the subseasonal time scale. Despite the important role of the MJO in our climate and weather systems, current global circulation models (GCMs) exhibit considerable shortcomings in representing this phenomenon. These shortcomings have been documented in a number of multi-model comparison studies over the last decade. However, diagnosis of model performance has been challenging, and model progress has been difficult to track, due to the lack of a coherent and standardized set of MJO diagnostics. One of the chief objectives of the US CLIVAR MJO Working Group is the development of observation-based diagnostics for objectively evaluating global model simulations of the MJO in a consistent framework. Motivation for this activity is reviewed, and the intent and justification for a set of diagnostics is provided, along with specification for their calculation, and illustrations of their application. The diagnostics range from relatively simple analyses of variance and correlation, to more sophisticated space-time spectral and empirical orthogonal function analyses. These diagnostic techniques are used to detect MJO signals, to construct composite life-cycles, to identify associations of MJO activity with the mean state, and to describe interannual variability of the MJO.

  6. Pitfalls in diagnostic radiology

    Energy Technology Data Exchange (ETDEWEB)

    Peh, Wilfred C.G. (ed.) [Khoo Teck Puat Hospital (Singapore). Dept. of Diagnostic Radiology


    Only textbook to focus primarily on the topic of pitfalls in diagnostic radiology. Highlights the pitfalls in a comprehensive and systematic manner. Written by experts in different imaging modalities and subspecialties from reputable centers across the world. The practice of diagnostic radiology has become increasingly complex, with the use of numerous imaging modalities and division into many subspecialty areas. It is becoming ever more difficult for subspecialist radiologists, general radiologists, and residents to keep up with the advances that are occurring year on year, and this is particularly true for less familiar topics. Failure to appreciate imaging pitfalls often leads to diagnostic error and misinterpretation, and potential medicolegal problems. Diagnostic errors may be due to various factors such as inadequate imaging technique, imaging artifacts, failure to recognize normal structures or variants, lack of correlation with clinical and other imaging findings, and poor training or inexperience. Many, if not most, of these factors are potentially recognizable, preventable, or correctable. This textbook, written by experts from reputable centers across the world, systematically and comprehensively highlights the pitfalls that may occur in diagnostic radiology. Both pitfalls specific to different modalities and techniques and those specific to particular organ systems are described with the help of numerous high-quality illustrations. Recognition of these pitfalls is crucial in helping the practicing radiologist to achieve a more accurate diagnosis.

  7. System-related factors contributing to diagnostic errors. (United States)

    Thammasitboon, Satid; Thammasitboon, Supat; Singhal, Geeta


    Several studies in primary care, internal medicine, and emergency departments show that rates of errors in test requests and result interpretations are unacceptably high and translate into missed, delayed, or erroneous diagnoses. Ineffective follow-up of diagnostic test results could lead to patient harm if appropriate therapeutic interventions are not delivered in a timely manner. The frequency of system-related factors that contribute directly to diagnostic errors depends on the types and sources of errors involved. Recent studies reveal that the errors and patient harm in the diagnostic testing loop have occurred mainly at the pre- and post-analytic phases, which are directed primarily by clinicians who may have limited expertise in the rapidly expanding field of clinical pathology. These errors may include inappropriate test requests, failure/delay in receiving results, and erroneous interpretation and application of test results to patient care. Efforts to address system-related factors often focus on technical errors in laboratory testing or failures in delivery of intended treatment. System-improvement strategies related to diagnostic errors tend to focus on technical aspects of laboratory medicine or delivery of treatment after completion of the diagnostic process. System failures and cognitive errors, more often than not, coexist and together contribute to the incidents of errors in diagnostic process and in laboratory testing. The use of highly structured hand-off procedures and pre-planned follow-up for any diagnostic test could improve efficiency and reliability of the follow-up process. Many feedback pathways should be established so that providers can learn if or when a diagnosis is changed. Patients can participate in the effort to reduce diagnostic errors. Providers should educate their patients about diagnostic probabilities and uncertainties. The patient-safety strategies focusing on the interface between diagnostic system and therapeutic

  8. Presenting evidence and summary measures to best inform societal decisions when comparing multiple strategies. (United States)

    Eckermann, Simon; Willan, Andrew R


    Multiple strategy comparisons in health technology assessment (HTA) are becoming increasingly important, with multiple alternative therapeutic actions, combinations of therapies and diagnostic and genetic testing alternatives. Comparison under uncertainty of incremental cost, effects and cost effectiveness across more than two strategies is conceptually and practically very different from that for two strategies, where all evidence can be summarized in a single bivariate distribution on the incremental cost-effectiveness plane. Alternative methods for comparing multiple strategies in HTA have been developed in (i) presenting cost and effects on the cost-disutility plane and (ii) summarizing evidence with multiple strategy cost-effectiveness acceptability (CEA) and expected net loss (ENL) curves and frontiers. However, critical questions remain for the analyst and decision maker of how these techniques can be best employed across multiple strategies to (i) inform clinical and cost inference in presenting evidence, and (ii) summarize evidence of cost effectiveness to inform societal reimbursement decisions where preferences may be risk neutral or somewhat risk averse under the Arrow-Lind theorem. We critically consider how evidence across multiple strategies can be best presented and summarized to inform inference and societal reimbursement decisions, given currently available methods. In the process, we make a number of important original findings. First, in presenting evidence for multiple strategies, the joint distribution of costs and effects on the cost-disutility plane with associated flexible comparators varying across replicates for cost and effect axes ensure full cost and effect inference. Such inference is usually confounded on the cost-effectiveness plane with comparison relative to a fixed origin and axes. Second, in summarizing evidence for risk-neutral societal decision making, ENL curves and frontiers are shown to have advantages over the CEA frontier

  9. Diagnosis of periprosthetic infection following total hip arthroplasty – evaluation of the diagnostic values of pre- and intraoperative parameters and the associated strategy to preoperatively select patients with a high probability of joint infection

    Directory of Open Access Journals (Sweden)

    Perka Carsten


    Full Text Available Abstract Background The correct diagnosis of a prosthetic joint infection (PJI is crucial for adequate surgical treatment. The detection may be a challenge since presentation and preoperative tests are not always obvious and precise. This prospective study was performed to evaluate a variety of pre- and intraoperative investigations. Furthermore a detailed evaluation of concordance of each preoperative diagnosis was performed, together with a final diagnosis to assess the accuracy of the pre-operative assumption of PJI. Methods Between 01/2005 and 02/2007, a prospective analysis was performed in 50 patients, who had a two stage revision because of assumed PJI. Based on clinical presentation, radiography, haematological screening, or early failure, infection was assumed and a joint aspiration was performed. Depending upon these findings, a two stage revision was performed, with intra-operative samples for culture and histological evaluation obtained. Final diagnosis of infection was based upon the interpretation of the clinical presentation and the pre- and intraoperative findings. Results In 37 patients a positive diagnosis of PJI could be made definitely. The histopathology yielded the highest accuracy (0.94 in identification of PJI and identified 35 of 37 infections (sensitivity 0.94, specificity 0.94, positive-/negative predictive value 0.97/0.86. Intra-operative cultures revealed sensitivities, specificities, positive-/negative predictive values and accuracy of 0.78, 0.92, 0.96, 0.63 and 0.82. These values for blood screening tests were 0.95, 0.62, 0.88, 0.80, and 0.86 respectively for the level of C-reactive protein, and 0.14, 0.92, 0.83, 0.29 and, 0.34 respectively for the white blood-cell count. The results of aspiration were 0.57, 0.5, 0.78, 0.29, and 0.54. Conclusion The detection of PJI is still a challenge in clinical practice. The histopathological evaluation emerges as a highly practical diagnostic tool in detection of PJI

  10. 心身疾病新的评估策略:心身医学研究诊断标准%Development of a New Assessment Strategy in Psychosomatic Medicine:The Diagnostic Criteria for Psychosomatic Research

    Institute of Scientific and Technical Information of China (English)



    The Diagnostic Criteria for Psychosomatic Research (DCPR) are a diagnostic and conceptual framework that was proposed a decade ago by an international group of investigators. The DCPR's rational was to translate psychosocial variables that derived from psychosomatic research into operational tools whereby individual patients could be identified. A set of 12 syndromes was developed: health anxiety, thanatophobia, disease phobia, illness denial, persistent somatization, conversion symptoms, functional somatic symptoms secondary to a psychiatric disorder, anniversary reaction, demoralization, irritable mood, type A behavior and alexithymia. These criteria were meant to be used in a multiaxial approach. The aim of this work is to survey the research evidence which has accumulated on the DCPR, to provide specification for their development and validation and to examine the specific DCPR clusters.%心身研究的诊断标准(DCPR)是由国际调研组提出的心身医学研究临床诊断概念和结构框架.人们对影响躯体疾病的易损性,病程,预后,康复的心理因素的评估受到日益关注.DCPR的研发理论基础是将来源于心身研究的心理变量转变成用以鉴别诊断的可操作性诊断标准.ICPR是一个简单、有效和可靠的定式访谈工具,可用于筛查、诊断心身疾病和心理生理障碍.补充ICD- 10、DSM、CCMD的临床诊断应用的不足.包含了十二组心身综合征,其目的是将影响躯体状况预后和治疗价值中的心理变量转化为客观的心身医学研究用诊断标准用工具.这十二组症状包括健康焦虑,死亡恐惧症,疾病恐惧症,疾病否认,持续的躯体化症状,转换性障碍,继发于精神障碍的功能性躯体症状,周年反应,精神消沉,易激惹心境,A型行为和述情障碍.提出心身疾病临床多轴诊断系统.

  11. ORION laser target diagnostics

    Energy Technology Data Exchange (ETDEWEB)

    Bentley, C. D.; Edwards, R. D.; Andrew, J. E.; James, S. F.; Gardner, M. D.; Comley, A. J.; Vaughan, K.; Horsfield, C. J.; Rubery, M. S.; Rothman, S. D.; Daykin, S.; Masoero, S. J.; Palmer, J. B.; Meadowcroft, A. L.; Williams, B. M.; Gumbrell, E. T.; Fyrth, J. D.; Brown, C. R. D.; Hill, M. P.; Oades, K. [Plasma Physics Department, Atomic Weapons Establishment, Aldermaston, Reading, Berkshire RG7 4PR (United Kingdom); and others


    The ORION laser facility is one of the UK's premier laser facilities which became operational at AWE in 2010. Its primary mission is one of stockpile stewardship, ORION will extend the UK's experimental plasma physics capability to the high temperature, high density regime relevant to Atomic Weapons Establishment's (AWE) program. The ORION laser combines ten laser beams operating in the ns regime with two sub ps short pulse chirped pulse amplification beams. This gives the UK a unique combined long pulse/short pulse laser capability which is not only available to AWE personnel but also gives access to our international partners and visiting UK academia. The ORION laser facility is equipped with a comprehensive suite of some 45 diagnostics covering optical, particle, and x-ray diagnostics all able to image the laser target interaction point. This paper focuses on a small selection of these diagnostics.

  12. Beamlet laser diagnostics

    Energy Technology Data Exchange (ETDEWEB)

    Burkhart, S.C.; Behrendt, W.C.; Smith, I.


    Beamlet is instrumented extensively to monitor the performance of the overall laser system and many of its subsystems. Beam diagnostics, installed in key locations, are used to fully characterize the beam during its propagation through the multipass cavity and the laser`s output section. This article describes the diagnostics stations located on Beamlet and discusses the design, calibration, and performance of the Beamlet calorimeters. The authors used Nova`s diagnostics packages to develop the Beamlet design to determine beam energy, spatial profile, temporal profile, and other beam parameters. Technologic improvements within the last several years in controls, charge-coupled device (CCD) cameras, and fast oscilloscopes have allowed the authors to obtain more accurate measurements on the Beamlet laser system. They briefly cover some of these techniques, including a description of their LabVIEW based data acquisition system.

  13. ORION laser target diagnostics. (United States)

    Bentley, C D; Edwards, R D; Andrew, J E; James, S F; Gardner, M D; Comley, A J; Vaughan, K; Horsfield, C J; Rubery, M S; Rothman, S D; Daykin, S; Masoero, S J; Palmer, J B; Meadowcroft, A L; Williams, B M; Gumbrell, E T; Fyrth, J D; Brown, C R D; Hill, M P; Oades, K; Wright, M J; Hood, B A; Kemshall, P


    The ORION laser facility is one of the UK's premier laser facilities which became operational at AWE in 2010. Its primary mission is one of stockpile stewardship, ORION will extend the UK's experimental plasma physics capability to the high temperature, high density regime relevant to Atomic Weapons Establishment's (AWE) program. The ORION laser combines ten laser beams operating in the ns regime with two sub ps short pulse chirped pulse amplification beams. This gives the UK a unique combined long pulse/short pulse laser capability which is not only available to AWE personnel but also gives access to our international partners and visiting UK academia. The ORION laser facility is equipped with a comprehensive suite of some 45 diagnostics covering optical, particle, and x-ray diagnostics all able to image the laser target interaction point. This paper focuses on a small selection of these diagnostics.

  14. Diagnostic hematology of reptiles. (United States)

    Stacy, Nicole I; Alleman, A Rick; Sayler, Katherine A


    The hematologic evaluation of reptiles is an indispensable diagnostic tool in exotic veterinary practice. The diversity of reptile species, their characteristic physiologic features, and effects of intrinsic and extrinsic factors present unique challenges for accurate interpretation of the hemogram. Combining the clinical presentation with hematologic findings provides valuable information in the diagnosis and monitoring of disease and helps guide the clinician toward therapy and further diagnostic testing. This article outlines the normal and pathologic morphology of blood cells of reptile species. The specific comparative aspects of reptiles are emphasized, and structural and functional abnormalities in the reptilian hemogram are described.

  15. [Molecular diagnostics and imaging]. (United States)

    Fink, Christian; Fisseler-Eckhoff, Annette; Huss, Ralf; Nestle, Ursula


    Molecular diagnostic methods and biological imaging techniques can make a major contribution to tailoring patients' treatment needs with regard to medical, ethical and pharmaco-economic aspects. Modern diagnostic methods are already being used to help identify different sub-groups of patients with thoracic tumours who are most likely to benefit significantly from a particular type of treatment. This contribution looks at the most recent developments that have been made in the field of thoracic tumour diagnosis and analyses the pros and cons of new molecular and other imaging techniques in day-to-day clinical practice.

  16. Consumer Health: Alternative Therapy (United States)

    Healthy Lifestyle Consumer health What's considered an alternative therapy is a moving target. Get the facts about what CAM means and ... Original article: . Mayo ...

  17. Centre for Alternative Technology Publications,Zero Carbon Britain 2030: a new energy strategy.The second report of the Zero Carbon Britain project. Llwyngwern, 2010, 368 p.

    Directory of Open Access Journals (Sweden)

    Mathilde Szuba


    Full Text Available Le Centre for Alternative Technology (CAT, au Pays de Galles, vient pour la troisième fois de publier un programme de décarbonisation totale de la production d’énergie en Grande-Bretagne. A sa création en 1974, le CAT était une communauté de vie alternative visant l’autosuffisance énergétique dans un but d’exemplarité : « nous cherchons à encourager une plus grande autosuffisance nationale en montrant que l’on peut vivre avec moins de gaspillages » (CAT mimeo, 1976. Au fil des ans, le CAT s...

  18. A user-friendly, open-source tool to project impact and cost of diagnostic tests for tuberculosis. (United States)

    Dowdy, David W; Andrews, Jason R; Dodd, Peter J; Gilman, Robert H


    Most models of infectious diseases, including tuberculosis (TB), do not provide results customized to local conditions. We created a dynamic transmission model to project TB incidence, TB mortality, multidrug-resistant (MDR) TB prevalence, and incremental costs over 5 years after scale-up of nine alternative diagnostic strategies. A corresponding web-based interface allows users to specify local costs and epidemiology. In settings with little capacity for up-front investment, same-day microscopy had the greatest impact on TB incidence and became cost-saving within 5 years if delivered at $10/test. With greater initial investment, population-level scale-up of Xpert MTB/RIF or microcolony-based culture often averted 10 times more TB cases than narrowly-targeted strategies, at minimal incremental long-term cost. Xpert for smear-positive TB had reasonable impact on MDR-TB incidence, but at substantial price and little impact on overall TB incidence and mortality. This user-friendly modeling framework improves decision-makers' ability to evaluate the local impact of TB diagnostic strategies.

  19. Beamlet focal plane diagnostic

    Energy Technology Data Exchange (ETDEWEB)

    Caird, J.A.; Nielsen, N.D.; Patton, H.G.; Seppala, L.G.; Thompson, C.E.; Wegner, P.J.


    This paper describes the major optical and mechanical design features of the Beamlet Focal Plane Diagnostic system as well as measurements of the system performance, and typical data obtained to date. We also discuss the NIF requirements on the focal spot that we are interested in measuring, and some of our plans for future work using this system.

  20. Diagnostic and interventional radiology

    Energy Technology Data Exchange (ETDEWEB)

    Vogl, Thomas J. [Klinikum der Johann Wolfgang Goethe-Universitaet, Frankfurt am Main (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Reith, Wolfgang [Universitaetsklinikum des Saarlandes, Homburg/Saar (Germany). Klinik fuer Diagnostische und Interventionelle Neuroradiologie; Rummeny, Ernst J. (ed.) [Technische Univ. Muenchen Klinikum rechts der Isar, Muenchen (Germany). Inst. fuer Radiologie


    This exceptional book covers all aspects of diagnostic and interventional radiology within one volume, at a level appropriate for the specialist. From the basics through diagnosis to intervention: the reader will find a complete overview of all areas of radiology. The clear, uniform structure, with chapters organized according to organ system, facilitates the rapid retrieval of information. Features include: Presentation of the normal radiological anatomy Classification of the different imaging procedures according to their diagnostic relevance Imaging diagnosis with many reference images Precise description of the interventional options The inclusion of many instructive aids will be of particular value to novices in decision making: Important take home messages and summaries of key radiological findings smooth the path through the jungle of facts Numerous tables on differential diagnosis and typical findings in the most common diseases offer a rapid overview and orientation Diagnostic flow charts outline the sequence of diagnostic evaluation All standard procedures within the field of interventional radiology are presented in a clinically relevant and readily understandable way, with an abundance of illustrations. This is a textbook, atlas, and reference in one: with more than 2500 images for comparison with the reader's own findings. This comprehensive and totally up-to-date book provides a superb overview of everything that the radiology specialist of today needs to know.

  1. Recent Progress in Nanomedicine: Therapeutic, Diagnostic and Theranostic Applications


    Rizzo, Larissa Y.; Theek, Benjamin; Storm, Gert; Kiessling, Fabian; Lammers, Twan


    In recent years, the use of nanomedicine formulations for therapeutic and diagnostic applications has increased exponentially. Many different systems and strategies have been developed for drug targeting to pathological sites, as well as for visualizing and quantifying important (patho-) physiological processes. In addition, ever more efforts have been undertaken to combine diagnostic and therapeutic properties within a single nanomedicine formulation. These so-called nanotheranostics are abl...

  2. Constructing evidence-based treatment strategies using methods from computer science. (United States)

    Pineau, Joelle; Bellemare, Marc G; Rush, A John; Ghizaru, Adrian; Murphy, Susan A


    This paper details a new methodology, instance-based reinforcement learning, for constructing adaptive treatment strategies from randomized trials. Adaptive treatment strategies are operationalized clinical guidelines which recommend the next best treatment for an individual based on his/her personal characteristics and response to earlier treatments. The instance-based reinforcement learning methodology comes from the computer science literature, where it was developed to optimize sequences of actions in an evolving, time varying system. When applied in the context of treatment design, this method provides the means to evaluate both the therapeutic and diagnostic effects of treatments in constructing an adaptive treatment strategy. The methodology is illustrated with data from the STAR*D trial, a multi-step randomized study of treatment alternatives for individuals with treatment-resistant major depressive disorder.

  3. Aircraft Engine Gas Path Diagnostic Methods: Public Benchmarking Results (United States)

    Simon, Donald L.; Borguet, Sebastien; Leonard, Olivier; Zhang, Xiaodong (Frank)


    Recent technology reviews have identified the need for objective assessments of aircraft engine health management (EHM) technologies. To help address this issue, a gas path diagnostic benchmark problem has been created and made publicly available. This software tool, referred to as the Propulsion Diagnostic Method Evaluation Strategy (ProDiMES), has been constructed based on feedback provided by the aircraft EHM community. It provides a standard benchmark problem enabling users to develop, evaluate and compare diagnostic methods. This paper will present an overview of ProDiMES along with a description of four gas path diagnostic methods developed and applied to the problem. These methods, which include analytical and empirical diagnostic techniques, will be described and associated blind-test-case metric results will be presented and compared. Lessons learned along with recommendations for improving the public benchmarking processes will also be presented and discussed.

  4. Diagnostic Performance of F-18 FDG PET/CT in Patients with Cancer of Unknown Primary: Additional Benefit over CT-Based Conventional Work up

    Directory of Open Access Journals (Sweden)

    Mehrdad Bakhshayeshkaram


    Full Text Available Background: In the era of well-developed site-specific treatment strategies in cancer, identification of occult primary is of paramount importance in CUP patients. Furthermore, exact determination of the extent of the disease may help in optimizing treatment planning. The aim of the present study was to investigate additional value of F-18 FDG PET/CT in patients with cancer of unknown primary (CUP as an appropriate imaging tool in early phase of initial standard work up.Materials and Methods: Sixty-two newly diagnosed CUP patients with inconclusive diagnostic CT scan of chest, abdomen and pelvis referring for F-18 FDG PET/CT were enrolled in this study. Standard of reference was defined as histopathology, other diagnostic procedures and a 3-month formal clinical follow up. The results of PET/CT were categorized as suggestion for primary site and additional metastasis and classified as true positive, false positive, false negative and true negative. The impact of additional metastasis revealed by F-18 FDG PET/CT on treatment planning and the time contribution of F-18 FDG PET/CT in diagnostic pathway was investigated.Results: Sixty-two patients with mean age of 62 (30 men, 32 women, PET/CT correctly identified primary origin in 32% with false positive rate of 14.8%. No primary lesion was detected after negative PET/CT according to standard of reference. Sensitivity, Specificity and accuracy were 100%, 78% and 85%, respectively. Additional metastatic site was found in 56% with 22% impact on treatment planning. Time contribution for PET/CT was 10% of total diagnostic pathway.Conclusion: Providing higher detection rate of primary origin with excellent diagnostic performance, shortening the diagnostic pathway and improving treatment planning, F-18 FDG PET/CT may play a major role in diagnostic work up of CUP patients and may be recommended as an alternative imaging tool in early phase of investigation.

  5. Diagnostic and Therapeutic Strategies of Gastric Motility Disorder in Different Stages of Diabetes%不同阶段糖尿病胃运动障碍诊治对策

    Institute of Scientific and Technical Information of China (English)

    蓝宇; 路国涛


    Gastric motility disorder is common in patients with diabetes. The cardinal symptoms include bloating, early satiety, epigastric discomfort, nausea, vomiting and delayed gastric emptying. Delayed gastric emptying affects pharmacokinetics of hypoglycemic agents, causes mismatch of peak postprandial blood glucose level and peak concentration of insulin and oral hypoglycemic agents, thereby affects glycemic control. There are different patterns of gastric motility disorder in different stages of diabetes. The most commonly used diagnostic method for gastric emptying is scintigraphic measurement. Treatment of gastric motility disorder in diabetes includes dietary modifications and prokinetic agents to ameliorate symptoms and improve glycemic control. Therapeutic approaches of gastroparesis include gastric electrical stimulation, endoscopic pyloric injection of botulinum toxin A, endoscopic placement of nasal-jejunum nutrient feeding tube and percutaneous endoscopic gastrostomy/jejunostomy and surgical therapy.%糖尿病患者常见胃运动障碍,表现为上腹胀、早饱、上腹不适、恶心、呕吐等症状以及胃排空延迟,胃排空延迟影响降血糖药的药代动力学,造成餐后血糖升高与降血糖药或胰岛素的血浓度高峰不匹配,进而影响血糖的控制与稳定.糖尿病不同阶段胃运动障碍表现形式不同.核素法是最常用的胃排空诊断方法.糖尿病胃运动障碍的处理包括饮食调节、促动力药以减轻症状、控制血糖,针对胃轻瘫的治疗包括胃电刺激、内镜下幽门注射肉毒杆菌毒素A、内镜下放置鼻胃空肠营养管或经皮内镜下胃(空肠)造瘘、外科手术等.

  6. The Health Technology Assessment of companion diagnostics: experience of NICE. (United States)

    Byron, Sarah K; Crabb, Nick; George, Elisabeth; Marlow, Mirella; Newland, Adrian


    Companion diagnostics are used to aid clinical decision making to identify patients who are most likely to respond to treatment. They are becoming increasingly important as more new pharmaceuticals receive licensed indications that require the use of a companion diagnostic to identify the appropriate patient subgroup for treatment. These pharmaceuticals have proven benefit in the treatment of some cancers and other diseases, and also have potential to precisely tailor treatments to the individual in the future. However, the increasing use of companion diagnostics could place a substantial burden on health system resources to provide potentially high volumes of testing. This situation, in part, has led policy makers and Health Technology Assessment (HTA) bodies to review the policies and methods used to make reimbursement decisions for pharmaceuticals requiring companion diagnostics. The assessment of a pharmaceutical alongside the companion diagnostic used in the clinical trials may be relatively straightforward, although there are a number of challenges associated with assessing pharmaceuticals where a range of alternative companion diagnostics are available for use in routine clinical practice. The UK HTA body, the National Institute for Health and Care Excellence (NICE), has developed policy for considering companion diagnostics using its Technology Appraisal and Diagnostics Assessment Programs. Some HTA bodies in other countries have also adapted their policies and methods to accommodate the assessment of companion diagnostics. Here, we provide insight into the HTA of companion diagnostics for reimbursement decisions and how the associated challenges are being addressed, in particular by NICE. See all articles in this CCR Focus section, "The Precision Medicine Conundrum: Approaches to Companion Diagnostic Co-development."

  7. Clinical outcomes of fractional flow reserve by computed tomographic angiography-guided diagnostic strategies vs. usual care in patients with suspected coronary artery disease: the prospective longitudinal trial of FFRCT: outcome and resource impacts study (United States)

    Douglas, Pamela S.; Pontone, Gianluca; Hlatky, Mark A.; Patel, Manesh R.; Norgaard, Bjarne L.; Byrne, Robert A.; Curzen, Nick; Purcell, Ian; Gutberlet, Matthias; Rioufol, Gilles; Hink, Ulrich; Schuchlenz, Herwig Walter; Feuchtner, Gudrun; Gilard, Martine; Andreini, Daniele; Jensen, Jesper M.; Hadamitzky, Martin; Chiswell, Karen; Cyr, Derek; Wilk, Alan; Wang, Furong; Rogers, Campbell; De Bruyne, Bernard


    Aims In symptomatic patients with suspected coronary artery disease (CAD), computed tomographic angiography (CTA) improves patient selection for invasive coronary angiography (ICA) compared with functional testing. The impact of measuring fractional flow reserve by CTA (FFRCT) is unknown. Methods and results At 11 sites, 584 patients with new onset chest pain were prospectively assigned to receive either usual testing (n = 287) or CTA/FFRCT (n = 297). Test interpretation and care decisions were made by the clinical care team. The primary endpoint was the percentage of those with planned ICA in whom no significant obstructive CAD (no stenosis ≥50% by core laboratory quantitative analysis or invasive FFR < 0.80) was found at ICA within 90 days. Secondary endpoints including death, myocardial infarction, and unplanned revascularization were independently and blindly adjudicated. Subjects averaged 61 ± 11 years of age, 40% were female, and the mean pre-test probability of obstructive CAD was 49 ± 17%. Among those with intended ICA (FFRCT-guided = 193; usual care = 187), no obstructive CAD was found at ICA in 24 (12%) in the CTA/FFRCT arm and 137 (73%) in the usual care arm (risk difference 61%, 95% confidence interval 53–69, P< 0.0001), with similar mean cumulative radiation exposure (9.9 vs. 9.4 mSv, P = 0.20). Invasive coronary angiography was cancelled in 61% after receiving CTA/FFRCT results. Among those with intended non-invasive testing, the rates of finding no obstructive CAD at ICA were 13% (CTA/FFRCT) and 6% (usual care; P = 0.95). Clinical event rates within 90 days were low in usual care and CTA/FFRCT arms. Conclusions Computed tomographic angiography/fractional flow reserve by CTA was a feasible and safe alternative to ICA and was associated with a significantly lower rate of invasive angiography showing no obstructive CAD. PMID:26330417

  8. Cardiovascular modeling and diagnostics

    Energy Technology Data Exchange (ETDEWEB)

    Kangas, L.J.; Keller, P.E.; Hashem, S.; Kouzes, R.T. [Pacific Northwest Lab., Richland, WA (United States)


    In this paper, a novel approach to modeling and diagnosing the cardiovascular system is introduced. A model exhibits a subset of the dynamics of the cardiovascular behavior of an individual by using a recurrent artificial neural network. Potentially, a model will be incorporated into a cardiovascular diagnostic system. This approach is unique in that each cardiovascular model is developed from physiological measurements of an individual. Any differences between the modeled variables and the variables of an individual at a given time are used for diagnosis. This approach also exploits sensor fusion to optimize the utilization of biomedical sensors. The advantage of sensor fusion has been demonstrated in applications including control and diagnostics of mechanical and chemical processes.

  9. Gene Disease Diagnostic System

    Institute of Scientific and Technical Information of China (English)

    黄国亮; 张腾飞; 程京; 周玉祥; 刘诚迅; 金国藩; 邬敏贤; 严瑛白; 杨蓉


    Binary optics, where the optical element can be fabricated on a thin glass plate with micro-ion-etching film layer, has been widely applied in recent years. A novel optical scanning system for gene disease diagnostics described in this paper has four kinds of optical devices, including beam splitters, an array lens, an array filter and detection arrays. A software was developed to design the binary optics system using an iterative method. Two beam splitters were designed and fabricated, which can divide a beam into a 9×9 array or into a 13×13 array. The beam splitters have good diffraction efficiencies (>70%) and an even energy distribution. The gene disease diagnostic system is a portable biochip and binary optics technology. The binary optical devices in the non-confocal scanning system can raise the fluorescence detection sensitivity of the micro-array hybrid biochip.

  10. Idiopathic chondrolysis - diagnostic difficulties

    Energy Technology Data Exchange (ETDEWEB)

    Kozlowski, K.; Scougall, J.


    Four cases of idiopathic chondrolysis of the hip in three white girls and one Maori girl are reported. The authors stress the causes why a disease with characteristic clinical and radiographic appearances and normal biochemical findings presents diagnostic difficulties. It is suspected that idiopathic chondrolysis is a metabolic disorder of chondrocytes, triggered by environment circumstances in susceptible individuals. Idiopathic chondrolysis is probably one of the most common causes of coxarthrosis in women.

  11. STELLA Experiment - Microbunch Diagnostic

    Energy Technology Data Exchange (ETDEWEB)

    He, P.; Liu, Y.; Cline, D. B.; Babzien, M.; Gallardo, J. C.; Kusche, K. P.; Pogorelsky, I. V.; Skaritka, J.; van Steenbergen, A.; Yakimenko, V.; Kimura, W. D.


    A microbunch diagnostic system is built at the Accelerator Test Facility (ATF) of Brookhaven National Laboratory for monitoring microbunches (10-fs bunch length) produced by the Inverse Free Electron Laser accelerator in Staged Electron Laser Acceleration experiment. It is similar to one already demonstrated at the ATF. With greatly improved beam optics conditions higher order harmonic coherent transition radiation will be measurable to determine the microbunch length and shape.

  12. SNS Diagnostics Timing Integration

    CERN Document Server

    Long, Cary D; Murphy, Darryl J; Pogge, James; Purcell, John D; Sundaram, Madhan


    The Spallation Neutron Source (SNS) accelerator systems will deliver a 1.0 GeV, 1.4 MW proton beam to a liquid mercury target for neutron scattering research. The accelerator complex consists of a 1 GeV linear accelerator, an accumulator ring and associated transport lines. The SNS diagnostics platform is PC-based running Windows XP Embedded for its OS and LabVIEW as its programming language. Coordinating timing among the various diagnostics instruments with the generation of the beam pulse is a challenging task that we have chosen to divide into three phases. First, timing was derived from VME based systems. In the second phase, described in this paper, timing pulses are generated by an in house designed PCI timing card installed in ten diagnostics PCs. Using fan-out modules, enough triggers were generated for all instruments. This paper describes how the Timing NAD (Network Attached Device) was rapidly developed using our NAD template, LabVIEW's PCI driver wizard, and LabVIEW Channel Access library. The NAD...

  13. [Histopathological meniscus diagnostic]. (United States)

    Fisseler-Eckhoff, A; Müller, K-M


    Menisci fulfill many functions within the complex biomechanics of the knee joint. In the case of meniscus lesions, sparing arthroscopic resections and operative refixation are the treatments of choice. With regard to diagnostics, this means that in general terms, the histopathologic diagnostics are carried out on detached meniscus fragments of between 5 mm and 2 cm in size. An experienced pathologist's knowledge of physiologically possible cellular and fibrous histological meniscus damage, as opposed to nonphysiological change regarded as normal with respect to age, is essential during a diagnostic meniscus evaluation. The clinician expects clear statements from the pathologist regarding the severity of previous or secondary degenerative meniscus damage, the age and type of traumatic tears, and appraisal of the relationship between trauma and meniscus damage from an insurance point of view. Close cooperation between the clinician and the pathologist allows for fast and unambiguous correlation of anamnesis, the clinical picture, and morphological reporting so that cases involving insurance problems - which are numerous, often long-term, and often unsatisfactory - can be clarified quickly.

  14. Diagnostics for Developing Countries

    Directory of Open Access Journals (Sweden)

    Ruth McNerney


    Full Text Available Improving the availability of high quality diagnostic tests for infectious diseases is a global priority. Lack of access by people living in low income countries may deprive them of life saving treatment and reduces opportunities to prevent onward transmission and spread of the disease. Diagnostic laboratories are often poorly resourced in developing countries, and sparsely distributed. Improved access may be achieved by using tests that do not require laboratory support, including rapid tests for use at the point-of-care. Despite increased interest, few new in vitro diagnostic (IVD products reach the majority populations in low income countries. Barriers to uptake include cost and lack of robustness, with reduced test performances due to environmental pressures such as high ambient temperatures or dust. In addition to environmental factors test developers must consider the local epidemiology. Confounding conditions such as immunosuppression or variations in antigen presentation or genotype can affect test performance. Barriers to product development include access to finance to establish manufacturing capacity and cover the costs of market entry for new devices. Costs and delays may be inflated by current regulatory preregistration processes to ensure product safety and quality, and more harmonized approaches are needed.

  15. On alternating quantum walks (United States)

    Rousseva, Jenia; Kovchegov, Yevgeniy


    We study an inhomogeneous quantum walk on a line that evolves according to alternating coins, each a rotation matrix. For the quantum walk with the coin alternating between clockwise and counterclockwise rotations by the same angle, we derive a closed form solution for the propagation of probabilities, and provide its asymptotic approximation via the method of stationary phase. Finally, we observe that for a x03c0;/4 angle, this alternating rotation walk will replicate the renown Hadamard walk.

  16. Alternative Solar Indices

    Energy Technology Data Exchange (ETDEWEB)

    Lantz, L.J.


    Possible alternative Solar Indices which could either be a perturbation from the currently defined Solar Index or possible indices based on current technologies for other media markets are discussed. An overview is given of the current project, including the logic that was utilized in defining its current structure and then alternative indices and definitions are presented and finally, recommendations are made for adopting alternative indices.

  17. On an Alternative Cosmology

    CERN Document Server

    Vankov, A


    The suggested alternative cosmology is based on the idea of barion symmetric universe, in which our home universe is a representative of multitude of typical matter and antimatter universes. This alternative concept gives a physically reasonable explanation of all major problems of the Standard Cosmological Model. Classification Code MSC: Cosmology 524.8 Key words: standard cosmological model, alternative cosmology, barionic symmetry, typical universe, quasars, cosmic rays.

  18. Technological Strategies and National Purpose (United States)

    Gilpin, Robert


    Discusses the international and domestic implications of technological growth. Defines three basic national strategies: a broad front approach, scientific and technological specialization and importation. Analyzes the strategies followed by form countries - France, the United States, Sweden, and Japan- to illustrate the alternatives and the…

  19. Brandmodstandsbidrag for alternative isoleringsmaterialer

    DEFF Research Database (Denmark)

    Hansen, Ernst Jan de Place


    Resume af rapport om alternative isoleringsmaterialers brandmodstandsbidrag, udarbejdet af Dansk Brandteknisk Institut under Energistyrelsens udviklingsprogram "Miljø- og arbejdsmiljøvenlig isolering"...

  20. The challenge of Clostridium difficile infection: Overview of clinical manifestations, diagnostic tools and therapeutic options. (United States)

    Postma, Nynke; Kiers, Dorien; Pickkers, Peter


    The most important infectious cause of antibiotic-associated diarrhoea and colitis is Clostridium difficile, which is a Gram-positive, anaerobic, spore-forming, toxin-producing bacillus. In this overview we will discuss the diagnostic and therapeutic management of patients presenting with suspected or proven C. difficile infection (CDI). The clinical spectrum varies from asymptomatic C. difficile carriers to fulminant colitis with multi-organ failure. The onset of symptoms is usually within 2 weeks after initiation of antibiotic treatment. Diagnosis is based on the combination of clinical symptoms and either a positive stool test for C. difficile toxins or endoscopic or histological findings of pseudomembranous colitis. There is no indication for treatment of asymptomatic carriers, but patients with proven CDI should be treated. Treatment consists of cessation of the provoking antibiotic treatment, secondary prevention by infection control strategies, and treatment with metronidazole or vancomycin. Treatment of recurring CDI, severe infection, the need for surgery, and novel alternative potential treatment strategies will be discussed. The concurrent increase in multiresistant colonisation and increasing numbers of asymptomatic carriers of C. difficile will lead to an increase of the situation in which patients with severe infections, treated with broad-spectrum antibiotics, will develop concurrent severe CDI. We will discuss possible therapy strategies for these patients.

  1. Paper-based sample-to-answer molecular diagnostic platform for point-of-care diagnostics. (United States)

    Choi, Jane Ru; Tang, Ruihua; Wang, ShuQi; Wan Abas, Wan Abu Bakar; Pingguan-Murphy, Belinda; Xu, Feng


    Nucleic acid testing (NAT), as a molecular diagnostic technique, including nucleic acid extraction, amplification and detection, plays a fundamental role in medical diagnosis for timely medical treatment. However, current NAT technologies require relatively high-end instrumentation, skilled personnel, and are time-consuming. These drawbacks mean conventional NAT becomes impractical in many resource-limited disease-endemic settings, leading to an urgent need to develop a fast and portable NAT diagnostic tool. Paper-based devices are typically robust, cost-effective and user-friendly, holding a great potential for NAT at the point of care. In view of the escalating demand for the low cost diagnostic devices, we highlight the beneficial use of paper as a platform for NAT, the current state of its development, and the existing challenges preventing its widespread use. We suggest a strategy involving integrating all three steps of NAT into one single paper-based sample-to-answer diagnostic device for rapid medical diagnostics in the near future.

  2. Implementation of Targeted Next Generation Sequencing in Clinical Diagnostics

    DEFF Research Database (Denmark)

    Larsen, Martin Jakob; Burton, Mark; Thomassen, Mads;

    Accurate mutation detection is essential in clinical genetic diagnostics of monogenic hereditary diseases. Targeted next generation sequencing (NGS) provides a promising and cost-effective alternative to Sanger sequencing and MLPA analysis currently used in most diagnostic laboratories. One...... advantage of targeted NGS is that multiple disease-specific genes can easily be sequenced simultaneously, which is favorable in genetic heterogeneous diseases. Prior to implementation in our diagnostic setting, we aimed to assess the sensitivity and specificity of targeted NGS by sequencing a collection......, respectively. For diagnostics, the sequencing coverage is essential, wherefore a minimum coverage of 30x per nucleotide in the coding regions was used as our primary quality criterion. For the majority of the included genes, we obtained adequate gene coverage, in which we were able to detect 100% of the known...

  3. Nonparametric reconstruction of the Om diagnostic to test LCDM

    CERN Document Server

    Escamilla-Rivera, Celia


    Cosmic acceleration is usually related with the unknown dark energy, which equation of state, w(z), is constrained and numerically confronted with independent astrophysical data. In order to make a diagnostic of w(z), the introduction of a null test of dark energy can be done using a diagnostic function of redshift, Om. In this work we present a nonparametric reconstruction of this diagnostic using the so-called Loess-Simex factory to test the concordance model with the advantage that this approach offers an alternative way to relax the use of priors and find a possible 'w' that reliably describe the data with no previous knowledge of a cosmological model. Our results demonstrate that the method applied to the dynamical Om diagnostic finds a preference for a dark energy model with equation of state w =-2/3, which correspond to a static domain wall network.

  4. Meta-Analysis and Cost Comparison of Empirical versus Pre-Emptive Antifungal Strategies in Hematologic Malignancy Patients with High-Risk Febrile Neutropenia.

    Directory of Open Access Journals (Sweden)

    Monica Fung

    Full Text Available Invasive fungal disease (IFD causes significant morbidity and mortality in hematologic malignancy patients with high-risk febrile neutropenia (FN. These patients therefore often receive empirical antifungal therapy. Diagnostic test-guided pre-emptive antifungal therapy has been evaluated as an alternative treatment strategy in these patients.We conducted an electronic search for literature comparing empirical versus pre-emptive antifungal strategies in FN among adult hematologic malignancy patients. We systematically reviewed 9 studies, including randomized-controlled trials, cohort studies, and feasibility studies. Random and fixed-effect models were used to generate pooled relative risk estimates of IFD detection, IFD-related mortality, overall mortality, and rates and duration of antifungal therapy. Heterogeneity was measured via Cochran's Q test, I2 statistic, and between study τ2. Incorporating these parameters and direct costs of drugs and diagnostic testing, we constructed a comparative costing model for the two strategies. We conducted probabilistic sensitivity analysis on pooled estimates and one-way sensitivity analyses on other key parameters with uncertain estimates.Nine published studies met inclusion criteria. Compared to empirical antifungal therapy, pre-emptive strategies were associated with significantly lower antifungal exposure (RR 0.48, 95% CI 0.27-0.85 and duration without an increase in IFD-related mortality (RR 0.82, 95% CI 0.36-1.87 or overall mortality (RR 0.95, 95% CI 0.46-1.99. The pre-emptive strategy cost $324 less (95% credible interval -$291.88 to $418.65 pre-emptive compared to empirical than the empirical approach per FN episode. However, the cost difference was influenced by relatively small changes in costs of antifungal therapy and diagnostic testing.Compared to empirical antifungal therapy, pre-emptive antifungal therapy in patients with high-risk FN may decrease antifungal use without increasing mortality

  5. Determine separations process strategy decision

    Energy Technology Data Exchange (ETDEWEB)

    Slaathaug, E.J.


    This study provides a summary level comparative analysis of selected, top-level, waste treatment strategies. These strategies include No Separations, Separations (high-level/low-level separations), and Deferred Separations of the tank waste. These three strategies encompass the full range of viable processing alternatives based upon full retrieval of the tank wastes. The assumption of full retrieval of the tank wastes is a predecessor decision and will not be revisited in this study.

  6. Alternative Schools, Mainstream Education (United States)

    McKee, Jan; Conner, Evguenia


    Alternative education has its own history. Having emerged in the sixties as a response to the social crisis, its goal was primarily to fight increasing bureaucracy and the depersonalization of public education by giving students more freedom and minimal adult supervision. In the eighties, the understanding of "alternative education" narrowed to…

  7. Alternative Fuels Data Center

    Energy Technology Data Exchange (ETDEWEB)



    Fact sheet describes the Alternative Fuels Data Center, which provides information, data, and tools to help fleets and other transportation decision makers find ways to reduce petroleum consumption through the use of alternative and renewable fuels, advanced vehicles, and other fuel-saving measures.

  8. Acquisition of Voicing Alternations

    NARCIS (Netherlands)

    Kerkhoff, Annemarie


    "Morpho-phonological alternations are central to phonological theory, but little is known about how they are acquired. Acquiring alternations amounts to dealing with variation in a morpheme’s shape depending on its morphological context. It is generally assumed that children start with an initial st

  9. Alternative health insurance schemes

    DEFF Research Database (Denmark)

    Keiding, Hans; Hansen, Bodil O.


    In this paper, we present a simple model of health insurance with asymmetric information, where we compare two alternative ways of organizing the insurance market. Either as a competitive insurance market, where some risks remain uninsured, or as a compulsory scheme, where however, the level...... competitive insurance; this situation turns out to be at least as good as either of the alternatives...

  10. Invasive mycoses: diagnostic challenges. (United States)

    Ostrosky-Zeichner, Luis


    Despite the availability of newer antifungal drugs, outcomes for patients with invasive fungal infections (IFIs) continue to be poor, in large part due to delayed diagnosis and initiation of appropriate antifungal therapy. Standard histopathologic diagnostic techniques are often untenable in at-risk patients, and culture-based diagnostics typically are too insensitive or nonspecific, or provide results after too long a delay for optimal IFI management. Newer surrogate markers of IFIs with improved sensitivity and specificity are needed to enable earlier diagnosis and, ideally, to provide prognostic information and/or permit therapeutic monitoring. Surrogate assays should also be accessible and easy to implement in the hospital. Several nonculture-based assays of newer surrogates are making their way into the medical setting or are currently under investigation. These new or up-and-coming surrogates include antigens/antibodies (mannan and antimannan antibodies) or fungal metabolites (d-arabinitol) for detection of invasive candidiasis, the Aspergillus cell wall component galactomannan used to detect invasive aspergillosis, or the fungal cell wall component and panfungal marker β-glucan. In addition, progress continues with use of polymerase chain reaction- or other nucleic acid- or molecular-based assays for diagnosis of either specific or generic IFIs, although the various methods must be better standardized before any of these approaches can be more fully implemented into the medical setting. Investigators are also beginning to explore the possibility of combining newer surrogate markers with each other or with more standard diagnostic approaches to improve sensitivity, specificity, and capacity for earlier diagnosis, at a time when fungal burden is still relatively low and more responsive to antifungal therapy.

  11. Diagnostic electron microscopy

    Energy Technology Data Exchange (ETDEWEB)

    Dickersin, G.R.


    In this book the author presents a comprehensive reference text on diagnostic electron microscopy. Throughout the book he illustrates how ultrastructural identification can be helpful for the recognition of cell type and the identification of mechanisms of pathogenesis in various diseases. In addition to electron microscopy photographs, there are also numerous light microscopy photographs for comparison. This text presents the classification of neoplasms in the order and arrangement most familiar to the pathologist. Contents: Introduction; Diagram of a Normal Cell; Normal Cell Function; Embryology; Neoplasms; Infectious Agents; Metabolic Diseases; Renal Diseases; Skeletal Muscle and Peripheral Nerve Diseases; Index.

  12. Diagnostic management of chronic obstructive pulmonary disease. (United States)

    Broekhuizen, B D L; Sachs, A P E; Hoes, A W; Verheij, T J M; Moons, K G M


    Detection of early chronic obstructive pulmonary disease (COPD) in patients presenting with respiratory symptoms is recommended; however, diagnosing COPD is difficult because a single gold standard is not available. The aim of this article is to review and interpret the existing evidence, theories and consensus on the individual parts of the diagnostic work-up for COPD. Relevant articles are discussed under the subheadings: history taking, physical examination, spirometry and additional lung function assessment. Wheezing, cough, phlegm and breathlessness on exertion are suggestive signs for COPD. The diagnostic value of the physical examination is limited, except for auscultated pulmonary wheezing or reduced breath sounds, increasing the probability of COPD. Spirometric airflow obstruction after bronchodilation, defined as a lowered ratio of the forced volume in one second to the forced vital capacity (FEV1/FVC ratio), is a prerequisite, but can only confirm COPD in combination with suggestive symptoms. Different thresholds are being recommended to define low FEV1/FVC, including a fixed threshold, and one varying with gender and age; however, the way physicians interpret these thresholds in their assessment is not well known. Body plethysmography allows a more complete assessment of pulmonary function, providing results on the total lung capacity and the residual volume and is indicated when conventional spirometry results are inconclusive. Chest radiography has no diagnostic value for COPD but is useful to exclude alternative diagnoses such as heart failure or lung cancer. Extensive history taking is of key importance in diagnosing COPD.

  13. Combustion Chemistry Diagnostics for Cleaner Processes. (United States)

    Kohse-Höinghaus, Katharina


    Climate change, environmental problems, urban pollution, and the dependence on fossil fuels demand cleaner, renewable energy strategies. However, they also ask for urgent advances in combustion science to reduce emissions. For alternative fuels and new combustion regimes, crucial information about the chemical reactions from fuel to exhaust remains lacking. Understanding such relations between combustion process, fuel, and emissions needs reliable experimental data from a wide range of conditions to provide a firm basis for predictive modeling of practical combustion processes.

  14. Development and Evaluation of the Diagnostic Power for a Computer-Based Two-Tier Assessment (United States)

    Lin, Jing-Wen


    This study adopted a quasi-experimental design with follow-up interview to develop a computer-based two-tier assessment (CBA) regarding the science topic of electric circuits and to evaluate the diagnostic power of the assessment. Three assessment formats (i.e., paper-and-pencil, static computer-based, and dynamic computer-based tests) using two-tier items were conducted on Grade 4 ( n = 90) and Grade 5 ( n = 86) students, respectively. One-way ANCOVA was conducted to investigate whether the different assessment formats affected these students' posttest scores on both the phenomenon and reason tiers, and confidence rating for an answer was assessed to diagnose the nature of students' responses (i.e., scientific answer, guessing, alternative conceptions, or knowledge deficiency). Follow-up interview was adopted to explore whether and how the various CBA representations influenced both graders' responses. Results showed that the CBA, in particular the dynamic representation format, allowed students who lacked prior knowledge (Grade 4) to easily understand the question stems. The various CBA representations also potentially encouraged students who already had learning experience (Grade 5) to enhance the metacognitive judgment of their responses. Therefore, CBA could reduce students' use of test-taking strategies and provide better diagnostic power for a two-tier instrument than the traditional paper-based version.

  15. Assembling Amperometric Biosensors for Clinical Diagnostics

    Directory of Open Access Journals (Sweden)

    Claudia Marina Lagier


    Full Text Available Clinical diagnosis and disease prevention routinely require the assessment ofspecies determined by chemical analysis. Biosensor technology offers several benefits overconventional diagnostic analysis. They include simplicity of use, specificity for the targetanalyte, speed to arise to a result, capability for continuous monitoring and multiplexing,together with the potentiality of coupling to low-cost, portable instrumentation. This workfocuses on the basic lines of decisions when designing electron-transfer-based biosensorsfor clinical analysis, with emphasis on the strategies currently used to improve the deviceperformance, the present status of amperometric electrodes for biomedicine, and the trendsand challenges envisaged for the near future.

  16. Cost-effectiveness analysis of the available strategies for diagnosing malaria in outpatient clinics in Zambia

    Directory of Open Access Journals (Sweden)

    Chanda Pascalina


    Full Text Available Abstract Background Malaria in Zambia accounts for about 4 million clinical cases and 8 000 deaths annually. Artemether-lumefantrine (ACT, a relatively expensive drug, is being used as first line treatment of uncomplicated malaria. However, diagnostic capacity in Zambia is low, leading to potentially avoidable wastage of drugs due to unnecessary anti malarial treatment. Methods A cost-effectiveness evaluation of the three current alternatives to malaria diagnosis (clinical, microscopy and Rapid Diagnostic Tests- RDT was conducted in 12 facilities from 4 districts in Zambia. The analysis was conducted along an observational study, thus reflecting practice in health facilities under routine conditions. Average and incremental cost effectiveness ratios were estimated from the providers' perspective. Effectiveness was measured in relation to malaria cases correctly diagnosed by each strategy. Results Average cost-effectiveness ratios show that RDTs were more efficient (US$ 6.5 than either microscopy (US$ 11.9 or clinical diagnosis (US$ 17.1 for malaria case correctly diagnosed. In relation to clinical diagnoses the incremental cost per case correctly diagnosed and treated was US$ 2.6 and US$ 9.6 for RDT and microscopy respectively. RDTs would be much cheaper to scale up than microscopy. The findings were robust to changes in assumptions and various parameters. Conclusion RDTs were the most cost effective method at correctly diagnosing malaria in primary health facilities in Zambia when compared to clinical and microscopy strategies. However, the treatment prescription practices of the health workers can impact on the potential that a diagnostic test has to lead to savings on antimalarials. The results of this study will serve to inform policy makers on which alternatives will be most efficient in reducing malaria misdiagnosis by taking into account both the costs and effects of each strategy.

  17. Diagnostic approaches for cholangiocarcinoma

    Institute of Scientific and Technical Information of China (English)


    Cholangiocarcinomas arise from the epithelial cells of the bile ducts and are associated with poor prognosis. Despite new diagnostic approaches, the definite diagnosis of this malignancy continues to be challenging. Cholangiocarcinomas often grow longitudinally along the bile duct rather than in a radial direction. Thus, large tumor masses are frequently absent and imaging techniques, including ultrasound, CT, and MRI have only limited sensitivity. Tissue collection during endoscopic (ERCP) and/or percutaneous transhepatic (PTC) procedures are usually used to confirm a definitive diagnosis of cholangiocarcinoma. However, forceps biopsy and brush cytology provide positive results for malignancy in about only 50% of patients. Percutaneous and peroral cholangioscopy using fiber-optic techniques were therefore developed for direct visualization of the biliary tree, yielding additional information about endoscopic appearance and tumor extension, as well as a guided biopsy acquistion. Finally, endoscopic ultrasonography (EUS) complements endoscopic and percutaneous approaches and may provide a tissue diagnosis of tumors in the biliary region through fine- needle aspiration. In the future, new techniques allowing for early detection, including molecular markers, should be developed to improve the diagnostic sensitivity in this increasing tumor entity.

  18. "Building a Mystery": Alternative Research Writing and the Academic Act of Seeking. (United States)

    Davis, Robert; Shadle, Mark


    Presents a series of alternatives to the modernist research paper: the argumentative research paper, the personal research paper, the research essay, and the multi-genre/media/disciplinary/cultural research paper. Addresses theoretical implications of alternative research writing strategies. (NH)

  19. Alternative cardioprotective strategy during reperfusion: postconditioning vs preconditioning%再灌注心脏保护的新策略:后处理和预处理的比较

    Institute of Scientific and Technical Information of China (English)

    赵志青; 臧益民


    心肌缺血/再灌注引起的损伤(RMMI)是由多种触发物、媒介物和效应器参与的复杂生物反应过程,导致炎症反应、内皮细胞损伤、血流障碍、心功能异常、心肌细胞坏死和凋亡.过去二十多年来,尽管人们开发了多种心脏保护措施(药物性干预)以减少RMMI,但结果并不令人满意.因此,在临床上寻求可行和有效的治疗措施以减轻RMMI有着极大的价值.我们实验室近来报道了在再灌注或恢复供氧早期,快速反复中断冠脉血流或氧供(缺血或缺氧后处理),可减少心肌组织或细胞内自由基的生成,减轻钙超载,减轻内皮功能的损伤,降低黏附蛋白的表达,减少坏死和凋亡.后处理的这些保护作用可能和内源性生成物如腺苷和一氧化氮增多、蛋白酶(包括PI-3K-Akt和ERKI/2)的激活、线粒体的ATP依赖性K+通道开放和线粒体通透性转换孔关闭有关.与预处理比较,后处理具有同样的保护效应.在长时间再灌注后仍有减少梗死范围的作用.目前的实验结果和临床观察证实,在缺血后恢复血供时,后处理的应用在治疗缺血/再灌注损伤方面开启了一个新的治疗窗口.%Reperfusion of ischemic myocardium is a complex biological process that involves multiple triggers, mediators and end-effectors, resulting in inflammatory and endothelial damage blood flow defects, cardiac dysfunction, necrosis and apoptosis. In the last two decades, although considerable effort has been exerted in exploring cardioprotective strategies in an attempt to limit reperfusion-induced myocardial injury, most of the clinical trails using various pharmacological agents to attenuate reperfusion injury have been rather unsatisfactory. Therefore, it is extremely valuable to explore some clinically feasible and effective therapeutic strategies that address post-ischemic myocardial injury. Reduction in infarct size and cell death with rapid sequential intermittent

  20. HL-LHC alternatives

    CERN Document Server

    Tomás, R; White, S


    The HL-LHC parameters assume unexplored regimes for hadron colliders in various aspects of accelerator beam dynamics and technology. This paper reviews three alternatives that could potentially improve the LHC performance: (i) the alternative filling scheme 8b+4e, (ii) the use of a 200 MHz RF system in the LHC and (iii) the use of proton cooling methods to reduce the beam emittance (at top energy and at injection). The alternatives are assessed in terms of feasibility, pros and cons, risks versus benefits and the impact on beam availability.

  1. Alternative loop rings

    CERN Document Server

    Goodaire, EG; Polcino Milies, C


    For the past ten years, alternative loop rings have intrigued mathematicians from a wide cross-section of modern algebra. As a consequence, the theory of alternative loop rings has grown tremendously. One of the main developments is the complete characterization of loops which have an alternative but not associative, loop ring. Furthermore, there is a very close relationship between the algebraic structures of loop rings and of group rings over 2-groups. Another major topic of research is the study of the unit loop of the integral loop ring. Here the interaction between loop rings and group ri

  2. Angiomyofibroblastoma: A diagnostic dilemma. (United States)

    Mallya, Varuna; Sahai, Kavita; Rathi, K R; Prasad, Urmila


    Angiomyofibroblastoma is a very rare benign mesenchymal tumor of the superficial soft-tissues. Most of the cases have been reported in the vulva. It presents usually in the reproductive age group. Histologically it is characterized by alternating hypo and hypercellular areas admixed with thin walled blood vessels with a perivascular concentration of stromal cells. We report a case of this lesion arising in the vagina in a 46-year-old woman.

  3. Angiomyofibroblastoma: A diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    Varuna Mallya


    Full Text Available Angiomyofibroblastoma is a very rare benign mesenchymal tumor of the superficial soft-tissues. Most of the cases have been reported in the vulva. It presents usually in the reproductive age group. Histologically it is characterized by alternating hypo and hypercellular areas admixed with thin walled blood vessels with a perivascular concentration of stromal cells. We report a case of this lesion arising in the vagina in a 46-year-old woman.

  4. Using genetic diagnostics in hemophilia and von Willebrand disease. (United States)

    Swystun, Laura L; James, Paula


    Most bleeding disorders encountered in clinical practice will be diagnosed, at least initially, by phenotypic assays. However, since the characterization of the genes that encode coagulation factors in the 1980s, significant progress has been made in translating this knowledge for diagnostic and therapeutic purposes. For hemophilia A and B, molecular genetic testing to determine carrier status, prenatal diagnosis, and likelihood of inhibitor development or anaphylaxis to infused coagulation factor concentrates is an established component of comprehensive clinical management. In contrast, although significant recent advances in our understanding of the molecular genetic basis of von Willebrand disease (VWD) have allowed for the development of rational approaches to genetic diagnostics, questions remain about this complex genetic disorder and how to incorporate emerging knowledge into diagnostic strategies. This article will review the state-of-the-art for molecular diagnostics for both hemophilia and VWD.

  5. Detection of Scabies: A Systematic Review of Diagnostic Methods

    Directory of Open Access Journals (Sweden)

    Victor Leung


    Full Text Available This study systematically reviewed the accuracy and precision of history, physical examination and tests for diagnosing scabies. Using a structured search strategy, Medline and Embase databases were searched for English and French language articles that included a diagnosis of scabies. Studies comparing history, physical examination and/or any diagnostic tests with the reference standard of microscopic visualization of mites, eggs or fecal elements obtained from skin scrapings or biopsies were included for analysis. History and examination of pruritic dermatoses failed to accurately diagnose scabies infection. The accuracy of dermatoscopy, performed by a trained practitioner, was determined; however, the accuracy of other diagnostic tests could not be calculated from the data in the literature. In the face of such diagnostic inaccuracy, research to identify or develop accurate diagnostic tests for scabies infection is needed and justifiable.

  6. Coping with worry while waiting for diagnostic results

    DEFF Research Database (Denmark)

    Lou, Stina; Nielsen, Camilla P; Hvidman, Lone;


    ' during this period, however, not enough is known about how high-risk women and their partners cope while waiting for diagnostic results. The aim of this study was to identify the strategies employed to cope with worry and uncertainty. METHODS: Qualitative, semi-structured interviews with 16 high......BACKGROUND: It is well documented that pregnant women experience increased worry and uncertainty following a high-risk prenatal screening result. While waiting for diagnostic results this worry continues to linger. It has been suggested that high-risk women put the pregnancy mentally 'on hold......-risk couples who underwent diagnostic testing. The couples were recruited at a university hospital fetal medicine unit in Denmark. Data were analysed using thematic analysis. RESULTS: All couples reported feeling worried and sad upon receiving a high-risk screening result. While waiting for diagnostic results...

  7. Do diagnostic blocks have beneficial effects on pain processing?

    NARCIS (Netherlands)

    Chua Hai Liang, N.; Vissers, K.C.P.; Arendt-Nielsen, L.; Wilder-Smith, O.H.G.


    BACKGROUND AND OBJECTIVES: Diagnostic blocks of cervical zygapophysial joints have been used as part of the management strategy for patients with chronic neck pain. Little information is available regarding the sensory processing changes that occur after these common procedures. In a hypothesis-gene

  8. Review of laser diagnostics at the Vulcan laser facility

    Institute of Scientific and Technical Information of China (English)

    Ian Musgrave; Marco Galimberti; Alexis Boyle; Cristina Hernandez-Gomez; Andrew Kidd; Bryn Parry; Dave Pepler; Trevor Winstone; John Collier


    In this paper we review the provision of the laser diagnostics that are installed on the Vulcan laser facility. We will present strategies for dealing with the energy of high energy systems and with ways of handling the beam sizes of the lasers. We present data captured during typical experimental campaigns to demonstrate their reliability and variation in shot to shot values.


    The report discusses the development of radon diagnostic procedures and mitigation strategies applicable to a variety of large non-residential buildings commonly found in Florida. The investigations document and evaluate the nature of radon occurrence and entry mechanisms for rad...

  10. Global Strategy

    DEFF Research Database (Denmark)

    Li, Peter Ping


    Global strategy differs from domestic strategy in terms of content and process as well as context and structure. The content of global strategy can contain five key elements, while the process of global strategy can have six major stages. These are expounded below. Global strategy is influenced...... by rich and complementary local contexts with diverse resource pools and game rules at the national level to form a broad ecosystem at the global level. Further, global strategy dictates the interaction or balance between different entry strategies at the levels of internal and external networks....

  11. Evaluating Alternative High Schools: Program Evaluation in Action (United States)

    Hinds, Drew Samuel Wayne


    Alternative high schools serve some of the most vulnerable students and their programs present a significant challenge to evaluate. Determining the impact of an alternative high school that serves mostly at-risk students presented a significant research problem. Few studies exist that dig deeper into the characteristics and strategies of…

  12. Diagnostics for invasive Salmonella infections: Current challenges and future directions. (United States)

    Andrews, Jason R; Ryan, Edward T


    Invasive Salmonellosis caused by Salmonella enterica serotype Typhi or Paratyphi A, B, C, or invasive non-typhoidal Salmonella serotypes, is an immensely important disease cluster for which reliable, rapid diagnostic tests are not available. Blood culture remains the gold standard but is insensitive, slow, and resource-intensive. Existing molecular diagnostics have poor sensitivity due to the low organism burden in bodily fluids. Commercially available serologic tests for typhoidal Salmonella have had limited sensitivity and specificity. In high burden, resource-limited settings, reliance on clinical diagnosis or inaccurate tests often results in frequent, unnecessary treatment, which contributes selective pressure for the emergence of antimicrobial resistance. This practice also results in inadequate therapy for other etiologies of acute febrile illnesses, including leptospirosis and rickettsial infections. A number of novel serologic, molecular, transcriptomic and metabolomic approaches to diagnostics are under development. Target product profiles that outline specific needs may focus development and investment, and establish benchmarks for accuracy, cost, speed, and portability of new diagnostics. Of note, a critical barrier to diagnostic assay rollout will be the low cost and low perceived harm of empiric therapy on behalf of providers and patients, which leaves few perceived incentives to utilize diagnostics. Approaches that align incentives with societal goals of limiting inappropriate antimicrobial use, such as subsidizing diagnostics, may be essential for stimulating development and uptake of such assays in resource-limited settings. New diagnostics for invasive Salmonellosis should be developed and deployed alongside diagnostics for alternative etiologies of acute febrile illnesses to improve targeted use of antibiotics.

  13. Diagnostic reasoning in action

    DEFF Research Database (Denmark)

    Rasmussen, J.


    of system failures; and in medicine, diagnosis is the basis for any patient treatment. The paper presents a discussion of the basic nature of causal reasoning as applied for diagnosis and the mental strategies applied when diagnosis is viewed as an integrated part of ''natural decision making...

  14. Cancer stem cells display extremely large evolvability: alternating plastic and rigid networks as a potential Mechanism: network models, novel therapeutic target strategies, and the contributions of hypoxia, inflammation and cellular senescence. (United States)

    Csermely, Peter; Hódsági, János; Korcsmáros, Tamás; Módos, Dezső; Perez-Lopez, Áron R; Szalay, Kristóf; Veres, Dániel V; Lenti, Katalin; Wu, Ling-Yun; Zhang, Xiang-Sun


    Cancer is increasingly perceived as a systems-level, network phenomenon. The major trend of malignant transformation can be described as a two-phase process, where an initial increase of network plasticity is followed by a decrease of plasticity at late stages of tumor development. The fluctuating intensity of stress factors, like hypoxia, inflammation and the either cooperative or hostile interactions of tumor inter-cellular networks, all increase the adaptation potential of cancer cells. This may lead to the bypass of cellular senescence, and to the development of cancer stem cells. We propose that the central tenet of cancer stem cell definition lies exactly in the indefinability of cancer stem cells. Actual properties of cancer stem cells depend on the individual "stress-history" of the given tumor. Cancer stem cells are characterized by an extremely large evolvability (i.e. a capacity to generate heritable phenotypic variation), which corresponds well with the defining hallmarks of cancer stem cells: the possession of the capacity to self-renew and to repeatedly re-build the heterogeneous lineages of cancer cells that comprise a tumor in new environments. Cancer stem cells represent a cell population, which is adapted to adapt. We argue that the high evolvability of cancer stem cells is helped by their repeated transitions between plastic (proliferative, symmetrically dividing) and rigid (quiescent, asymmetrically dividing, often more invasive) phenotypes having plastic and rigid networks. Thus, cancer stem cells reverse and replay cancer development multiple times. We describe network models potentially explaining cancer stem cell-like behavior. Finally, we propose novel strategies including combination therapies and multi-target drugs to overcome the Nietzschean dilemma of cancer stem cell targeting: "what does not kill me makes me stronger".

  15. Alternative disinfectant water treatments (United States)

    Alternative disinfestant water treatments are disinfestants not as commonly used by the horticultural industry. Chlorine products that produce hypochlorous acid are the main disinfestants used for treating irrigation water. Chlorine dioxide will be the primary disinfestant discussed as an alternativ...

  16. Alternative fuel information sources

    Energy Technology Data Exchange (ETDEWEB)


    This short document contains a list of more than 200 US sources of information (Name, address, phone number, and sometimes contact) related to the use of alternative fuels in automobiles and trucks. Electric-powered cars are also included.

  17. Seal design alternatives study

    Energy Technology Data Exchange (ETDEWEB)

    Van Sambeek, L.L. [RE/SPEC Inc., Rapid City, SD (US); Luo, D.D.; Lin, M.S.; Ostrowski, W.; Oyenuga, D. [Parsons Brinckerhoff Quade & Douglas, Inc., San Francisco, CA (US)


    This report presents the results from a study of various sealing alternatives for the WIPP sealing system. Overall, the sealing system has the purpose of reducing to the extent possible the potential for fluids (either gas or liquid) from entering or leaving the repository. The sealing system is divided into three subsystems: drift and panel seals within the repository horizon, shaft seals in each of the four shafts, and borehole seals. Alternatives to the baseline configuration for the WIPP seal system design included evaluating different geometries and schedules for seal component installations and the use of different materials for seal components. Order-of-magnitude costs for the various alternatives were prepared as part of the study. Firm recommendations are not presented, but the advantages and disadvantages of the alternatives are discussed. Technical information deficiencies are identified and studies are outlined which can provide required information.

  18. Alternatives to Nursing Homes (United States)

    ... this website may not be available. Alternatives to nursing homes Before you make any decisions about long ... live and what help you may need. A nursing home may not be your only choice. Discharge ...

  19. Breast Reconstruction Alternatives (United States)

    ... Breast Reconstruction Surgery Breast Cancer Breast Reconstruction Surgery Breast Reconstruction Alternatives Some women who have had a ... chest. What if I choose not to get breast reconstruction? Some women decide not to have any ...

  20. Vaginal dryness alternative treatments (United States)

    Alternative treatments for vaginal dryness ... Question: Is there a drug-free treatment for vaginal dryness? Answer: There are many causes of vaginal dryness . It may be caused by reduced estrogen level, infection, medicines, and ...

  1. [Diagnostic and clinical behaviour with Tarlov cyst in gynaecology practice]. (United States)

    Hristova, R; Hadjidekov, G


    The following presents cases from the gynaecological practice which resulted in a surgical intervention due to the detection of cystic formations of origin out of the reproductive system. Although rare, Tarlov cyst has its place in the differential diagnostic plan of ovarian formations. MRI scan remains an alternative to the ultrasound imagery and is the main diagnostic method for obtaining the right diagnosis. This further aids the set of actions appropriate with patients suffering from Tarlov cyst. Thus, unnecessary abdominal surgical interventions are not to be undertaken.

  2. Diagnostics for Hypersonic Engine Control (United States)


    AFRL-RQ-WP-TR-2015-0037 DIAGNOSTICS FOR HYPERSONIC ENGINE CONTROL Michael S. Brown and Jeffrey M. Donbar Hypersonic Sciences Branch...DD-MM-YY) 2. REPORT TYPE 3. DATES COVERED (From - To) February 2015 Interim 01 March 2013 – 24 February 2015 4. TITLE AND SUBTITLE DIAGNOSTICS FOR...SUPPLEMENTARY NOTES PA Case Number: 88ABW-2015-0636; Clearance Date: 23 Feb 2015. 14. ABSTRACT The overall goal of the research is to find diagnostic

  3. Nanophotonics for Molecular Diagnostics and Therapy Applications

    Directory of Open Access Journals (Sweden)

    João Conde


    Full Text Available Light has always fascinated mankind and since the beginning of recorded history it has been both a subject of research and a tool for investigation of other phenomena. Today, with the advent of nanotechnology, the use of light has reached its own dimension where light-matter interactions take place at wavelength and subwavelength scales and where the physical/chemical nature of nanostructures controls the interactions. This is the field of nanophotonics which allows for the exploration and manipulation of light in and around nanostructures, single molecules, and molecular complexes. What is more is the use of nanophotonics in biomolecular interactions—nanobiophotonics—has prompt for a plethora of molecular diagnostics and therapeutics making use of the remarkable nanoscale properties. In this paper, we shall focus on the uses of nanobiophotonics for molecular diagnostics involving specific sequence characterization of nucleic acids and for gene delivery systems of relevance for therapy strategies. The use of nanobiophotonics for the combined diagnostics/therapeutics (theranostics will also be addressed, with particular focus on those systems enabling the development of safer, more efficient, and specific platforms. Finally, the translation of nanophotonics for theranostics into the clinical setting will be discussed.

  4. Diagnostic and forensic toxicology. (United States)

    Galey, F D


    In most competent veterinary diagnostic laboratories, analytical findings are interpreted by the veterinary toxicologist to determine the significance of the finding in view of historic, clinical, and pathologic findings. A veterinary toxicologist also will provide consultation about possible toxic rule-outs for a case, treatment of affected animals, and prevention of additional cases. Once all of the information is available, a complete summary of the findings can be provided to the client. When the procedures outlined are followed, including a systematic approach to collecting all the evidence (historic, clinical, pathologic, and analytic), proper sampling techniques, and good communication between the clinician and the client and laboratory, the usefulness of the toxicology investigation will be maximized.

  5. Diagnostics and Microelectronics

    Energy Technology Data Exchange (ETDEWEB)

    Balch, J.W.


    This report discusses activities of the Diagnostics and Microelectronics thrust area which conducts activities in semiconductor devices and semiconductor fabrication technology for programs at Lawrence Livermore National Laboratory. Our multidisciplinary engineering and scientific staff use modern computational tools and semi-conductor microfabrication equipment to develop high-performance devices. Our work concentrates on three broad technologies of semiconductor microdevices: (1) silicon on III-V semiconductor microeletronics, (2) lithium niobate-based and III-V semiconductor-based photonics, and (3) silicon-based micromaching for application to microstructures and microinstruments. In FY-92, we worked on projects in seven areas, described in this report: novel photonic detectors; a wideband phase modulator; an optoelectronic terahertz beam system; the fabrication of microelectrode electrochemical sensors; diamond heatsinks; advanced micromachining technologies; and electrophoresis using silicon microchannels.

  6. Diagnostics procedures in rabies

    Directory of Open Access Journals (Sweden)

    Malovrh Tadej


    Full Text Available Rabies is a major zoonosis for which diagnostic techniques can only be performed in the laboratory. Laboratory techniques are preferably oriented on tissue removed from the cranium: hippocampus (Ammon's horn, cerebellum and the medulla oblongata or tissue liquids. Clinical observation may only lead to a suspicion of rabies. The only way to perform a reliable diagnosis of the disease is to identify the virus or some of its specific components using laboratory tests such as histological identification of characteristic cell lesions, immunochemical identification of rabies virus antigen and virus isolation. Serological tests are rarely used in epidemiological surveys but much more frequently in control of the vaccination programs (e.g. oral vaccination. Most commonly used serological tests are the virus neutralization test on cell culture (FAVN, virus neutralization in mice and ELISA.

  7. Diagnostic Challenges at SNS

    CERN Document Server

    Plum, M A


    The Spallation Neutron Source now being built in Oak Ridge, Tennessee, USA, accelerates an H- ion beam to 1000 MeV with an average power of 1.4 MW. The H- beam is then stripped to H+, compressed in a storage ring to a pulse length of 695 ns, and then directed onto a mercury neutron spallation target. Most of the acceleration is accomplished with superconducting rf cavities. The presence of these cavities, the high average beam power, and the large range of beam intensity in the storage ring, provide unique challenges to the beam diagnostics systems. In this talk we will discuss these challenges and some of our solutions, including the laser profile monitor system, the residual gas ionization profile monitors, and network attached devices. Measurements performed using prototype instrumentation will also be presented.

  8. Exploring Ways to Provide Diagnostic Feedback with an ESL Placement Test: Cognitive Diagnostic Assessment of L2 Reading Ability (United States)

    Kim, Ah-Young


    Previous research in cognitive diagnostic assessment (CDA) of L2 reading ability has been frequently conducted using large-scale English proficiency exams (e.g., TOEFL, MELAB). Using CDA, it is possible to analyze individual learners' strengths and weaknesses in multiple attributes (i.e., knowledge, skill, strategy) measured at the item level.…

  9. Oral vs. salivary diagnostics (United States)

    Marques, Joana; Corby, Patricia M.; Barber, Cheryl A.; Abrams, William R.; Malamud, Daniel


    The field of "salivary diagnostics" includes studies utilizing samples obtained from a variety of sources within the oral cavity. These samples include; whole unstimulated saliva, stimulated whole saliva, duct saliva collected directly from the parotid, submandibular/sublingual glands or minor salivary glands, swabs of the buccal mucosa, tongue or tonsils, and gingival crevicular fluid. Many publications state "we collected saliva from subjects" without fully describing the process or source of the oral fluid. Factors that need to be documented in any study include the time of day of the collection, the method used to stimulate and collect the fluid, and how much fluid is being collected and for how long. The handling of the oral fluid during and post-collection is also critical and may include addition of protease or nuclease inhibitors, centrifugation, and cold or frozen storage prior to assay. In an effort to create a standard protocol for determining a biomarker's origin we carried out a pilot study collecting oral fluid from 5 different sites in the mouth and monitoring the concentrations of pro- and anti-inflammatory cytokines detected using MesoScaleDiscovery (MSD) electrochemiluminesence assays. Our data suggested that 3 of the cytokines are primarily derived from the submandibular gland, while 7 of the cytokines come from a source other than the major salivary glands such as the minor salivary glands or cells in the oral mucosae. Here we review the literature on monitoring biomarkers in oral samples and stress the need for determining the blood/saliva ratio when a quantitative determination is needed and suggest that the term oral diagnostic be used if the source of an analyte in the oral cavity is unknown.

  10. Diagnostics development plan for ZR.

    Energy Technology Data Exchange (ETDEWEB)

    Hanson, David Lester


    The Z Refurbishment (ZR) Project is a program to upgrade the Z machine at SNL with modern durable pulsed power technology, providing additional shot capacity and improved reliability as well as advanced capabilities for both pulsed x-ray production and high pressure generation. The development of enhanced diagnostic capabilities is an essential requirement for ZR to meet critical mission needs. This report presents a comprehensive plan for diagnostic instrument and infrastructure development for the first few years of ZR operation. The focus of the plan is on: (1) developing diagnostic instruments with high spatial and temporal resolution, capable of low noise operation and survival in the severe EMP, bremsstrahlung, and blast environments of ZR; and (2) providing diagnostic infrastructure improvements, including reduced diagnostic trigger signal jitter, more and flexible diagnostic line-of-sight access, and the capability for efficient exchange of diagnostics with other laboratories. This diagnostic plan is the first step in an extended process to provide enhanced diagnostic capabilities for ZR to meet the diverse programmatic needs of a broad range of defense, energy, and general science programs of an international user community into the next decade.

  11. Evaluation of the appendix during diagnostic laparoscopy, the laparoscopic appendicitis score : a pilot study

    NARCIS (Netherlands)

    Hamminga, Jenneke T. H.; Hofker, H. Sijbrand; Broens, Paul M. A.; Kluin, Philip M.; Heineman, Erik; Haveman, Jan Willem


    Diagnostic laparoscopy is the ultimate diagnostic tool to evaluate the appendix. Still, according to the literature, this strategy results in a negative appendectomy rate of approximately 12-18 % and associated morbidity. Laparoscopic criteria for determining appendicitis are lacking. The goal of th

  12. Learning to Question: Categories of Questioning Used by Preservice Teachers during Diagnostic Mathematics Interviews. (United States)

    Moyer, Patricia S.; Milewicz, Elizabeth


    Examines the questioning strategies used by (n=48) preservice teachers during one-on-one diagnostic mathematics interviews with children. Conducts audiotaped interviews, following analyses, and reflection on the interview. Indicates that using the diagnostic interview format allows preservice teachers to recognize and reflect upon effective…

  13. Cognitive Diagnostic Assessment via Bayesian Evaluation of Informative Diagnostic Hypotheses

    NARCIS (Netherlands)

    Hoitink, Herbert; Beland, Sebastien; Vermeulen, Jorine A.


    There exist diverse approaches that can be used for cognitive diagnostic assessment, such as mastery testing, constrained latent class analysis, rule space methodology, diagnostic cognitive modeling, and person-fit analysis. Each of these approaches can be used within 1 of the 4 psychometric perspec

  14. Cognitive diagnostic assessment via Bayesian evaluation of informative diagnostic hypotheses.

    NARCIS (Netherlands)

    Hoijtink, Herbert; Béland, Sébastien; Vermeulen, Jorine A.


    There exist diverse approaches that can be used for cognitive diagnostic assessment, such as mastery testing, constrained latent class analysis, rule space methodology, diagnostic cognitive modeling, and person-fit analysis. Each of these approaches can be used within 1 of the 4 psychometric perspec

  15. Automation, consolidation, and integration in autoimmune diagnostics. (United States)

    Tozzoli, Renato; D'Aurizio, Federica; Villalta, Danilo; Bizzaro, Nicola


    Over the past two decades, we have witnessed an extraordinary change in autoimmune diagnostics, characterized by the progressive evolution of analytical technologies, the availability of new tests, and the explosive growth of molecular biology and proteomics. Aside from these huge improvements, organizational changes have also occurred which brought about a more modern vision of the autoimmune laboratory. The introduction of automation (for harmonization of testing, reduction of human error, reduction of handling steps, increase of productivity, decrease of turnaround time, improvement of safety), consolidation (combining different analytical technologies or strategies on one instrument or on one group of connected instruments) and integration (linking analytical instruments or group of instruments with pre- and post-analytical devices) opened a new era in immunodiagnostics. In this article, we review the most important changes that have occurred in autoimmune diagnostics and present some models related to the introduction of automation in the autoimmunology laboratory, such as automated indirect immunofluorescence and changes in the two-step strategy for detection of autoantibodies; automated monoplex immunoassays and reduction of turnaround time; and automated multiplex immunoassays for autoantibody profiling.

  16. Diagnostic peptide discovery: prioritization of pathogen diagnostic markers using multiple features.

    Directory of Open Access Journals (Sweden)

    Santiago J Carmona

    Full Text Available The availability of complete pathogen genomes has renewed interest in the development of diagnostics for infectious diseases. Synthetic peptide microarrays provide a rapid, high-throughput platform for immunological testing of potential B-cell epitopes. However, their current capacity prevent the experimental screening of complete "peptidomes". Therefore, computational approaches for prediction and/or prioritization of diagnostically relevant peptides are required. In this work we describe a computational method to assess a defined set of molecular properties for each potential diagnostic target in a reference genome. Properties such as sub-cellular localization or expression level were evaluated for the whole protein. At a higher resolution (short peptides, we assessed a set of local properties, such as repetitive motifs, disorder (structured vs natively unstructured regions, trans-membrane spans, genetic polymorphisms (conserved vs. divergent regions, predicted B-cell epitopes, and sequence similarity against human proteins and other potential cross-reacting species (e.g. other pathogens endemic in overlapping geographical locations. A scoring function based on these different features was developed, and used to rank all peptides from a large eukaryotic pathogen proteome. We applied this method to the identification of candidate diagnostic peptides in the protozoan Trypanosoma cruzi, the causative agent of Chagas disease. We measured the performance of the method by analyzing the enrichment of validated antigens in the high-scoring top of the ranking. Based on this measure, our integrative method outperformed alternative prioritizations based on individual properties (such as B-cell epitope predictors alone. Using this method we ranked [Formula: see text]10 million 12-mer overlapping peptides derived from the complete T. cruzi proteome. Experimental screening of 190 high-scoring peptides allowed the identification of 37 novel epitopes with

  17. Alternative fuels for vehicles; Alternative drivmidler

    Energy Technology Data Exchange (ETDEWEB)


    Up until 2020 and onwards the analysis indicates that especially electricity, biogas and natural gas as propellants is economically attractive compared to conventional gasoline and diesel while other fuels have the same or higher costs for petrol and diesel. Especially biogas and electricity will also offer significant reductions in CO{sub 2} emissions, but also hydrogen, methanol, DME and to a lesser extent the second generation bioethanol and most of the other alternative fuels reduce CO{sub 2} emissions. Use of the traditional food-based first generation biofuels involves, at best, only modest climate benefits if land use changes are counted, and at worst, significant negative climate effects. Natural gas as a propellant involves a moderate climate gain, but may play a role for building infrastructure and market for gaseous fuels in large fleets, thereby contributing to the phasing in of biogas for transport. The electric-based automotive fuels are the most effective due to a high efficiency of the engine and an increasing proportion of wind energy in the electricity supply. The methanol track also has a relatively high efficiency. Among the others, the track based on diesel engines (biodiesel) is more effective than the track based on gasoline/Otto engines (gas and ethanol) as a result of the diesel engine's better efficiency. For the heavy vehicles all the selected alternative fuels to varying degrees reduce emissions of CO{sub 2}, particularly DME based on wood. The only exception to this is - as for passenger cars - the propellant synthetic diesel based on coal. (LN).

  18. [Diagnostic strategy in patients with clinically suspected deep vein thrombosis

    DEFF Research Database (Denmark)

    Mantoni, Margit Yvonne; Kristensen, M.; Brogaard, M.H.;


    . MATERIALS AND METHODS: A total of 508 consecutive patients presenting in the emergency room with suspected DVT had D-dimer and DVT-score performed. Patients with non-elevated D-dimer and a low or moderate DVT score received no treatment. The remainder had ultrasound scanning from the groin to the popliteal...

  19. Hypoglycaemia in anesthesiology practice: Diagnostic, preventive, and management strategies

    Directory of Open Access Journals (Sweden)

    Sanjay Kalra


    Full Text Available Diabetes mellitus has emerged as one of the fastest growing non communicable diseases worldwide. Management of diabetic patients during surgical and critically illness is of paramount challenge to anesthesiologist and intensivist. Among its major acute complications, hypoglycemia has been given lesser attention as compared to other major acute complications; diabetic ketoacidosis and hyperosmolar non ketotic coma. However, newer studies and literary evidence have established the serious concerns of morbidity and mortality, both long- and short-term, related to hypoglycemia. basis. Invariably, diabetic patients are encountered in our daily routine practice of anesthesia. During fasting status as well as the perioperative period, it is hypoglycemia that is of high concern to anesthesiologist. Management has to be based on clinical, pharmacological, social, and psychological basis, so as to completely prevent the complications arising from an acute episode of hypoglycemia. This review aims to highlight various aspects of hypoglycemia and its management both from endocrine and anesthesia perspective.

  20. Diagnostic efficiency and treatment strategy in chronic axonal polyneuropathy

    NARCIS (Netherlands)

    Vrancken, A.F.J.E.


    Polyneuropathy is a common peripheral nerve disorder that often has a well known cause such as diabetes, chronic renal disease, alcohol abuse, vitamin deficiency, hypothyroidism, or use of toxic medication. Elderly people are more often affected, but the differentiation from signs of normal ageing c