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Sample records for alternative diagnostic strategies

  1. Alternative diagnostic strategies for coronary artery disease in women: demonstration of the usefulness and efficiency of probability analysis

    International Nuclear Information System (INIS)

    Melin, J.A.; Wijns, W.; Vanbutsele, R.J.; Robert, A.; De Coster, P.; Brasseur, L.A.; Beckers, C.; Detry, J.M.

    1985-01-01

    Alternative strategies using conditional probability analysis for the diagnosis of coronary artery disease (CAD) were examined in 93 infarct-free women presenting with chest pain. Another group of 42 consecutive female patients was prospectively analyzed. For this latter group, the physician had access to the pretest and posttest probability of CAD before coronary angiography. These 135 women all underwent stress electrocardiographic, thallium scintigraphic, and coronary angiographic examination. The pretest and posttest probabilities of coronary disease were derived from a computerized Bayesian algorithm. Probability estimates were calculated by the four following hypothetical strategies: SO, in which history, including risk factors, was considered; S1, in which history and stress electrocardiographic results were considered; S2, in which history and stress electrocardiographic and stress thallium scintigraphic results were considered; and S3, in which history and stress electrocardiographic results were used, but in which stress scintigraphic results were considered only if the poststress probability of CAD was between 10% and 90%, i.e., if a sufficient level of diagnostic certainty could not be obtained with the electrocardiographic results alone. The strategies were compared with respect to accuracy with the coronary angiogram as the standard. For both groups of women, S2 and S3 were found to be the most accurate in predicting the presence or absence of coronary disease (p less than .05). However, it was found with use of S3 that more than one-third of the thallium scintigrams could have been avoided without loss of accuracy. It was also found that diagnostic catheterization performed to exclude CAD as a diagnosis could have been avoided in half of the patients without loss of accuracy.(ABSTRACT TRUNCATED AT 250 WORDS)

  2. Diagnostic reasoning strategies and diagnostic success.

    Science.gov (United States)

    Coderre, S; Mandin, H; Harasym, P H; Fick, G H

    2003-08-01

    Cognitive psychology research supports the notion that experts use mental frameworks or "schemes", both to organize knowledge in memory and to solve clinical problems. The central purpose of this study was to determine the relationship between problem-solving strategies and the likelihood of diagnostic success. Think-aloud protocols were collected to determine the diagnostic reasoning used by experts and non-experts when attempting to diagnose clinical presentations in gastroenterology. Using logistic regression analysis, the study found that there is a relationship between diagnostic reasoning strategy and the likelihood of diagnostic success. Compared to hypothetico-deductive reasoning, the odds of diagnostic success were significantly greater when subjects used the diagnostic strategies of pattern recognition and scheme-inductive reasoning. Two other factors emerged as independent determinants of diagnostic success: expertise and clinical presentation. Not surprisingly, experts outperformed novices, while the content area of the clinical cases in each of the four clinical presentations demonstrated varying degrees of difficulty and thus diagnostic success. These findings have significant implications for medical educators. It supports the introduction of "schemes" as a means of enhancing memory organization and improving diagnostic success.

  3. Prostate carcinoma: current diagnostic strategy

    International Nuclear Information System (INIS)

    Schwarzschild, Monica Maria Agata Stiepcich; Ferraz, Maria Lucia Cardoso Gomes; Oliveira, Jose Marcelo Amatuzzi; Andriolo, Adagmar

    2001-01-01

    Prostate cancer is the second cause of cancer death in men in the Western world. Despite progress in the treatment of advanced disease, it is recognized that the only possibility of reduction in prostate cancer death is nearly diagnosis when the disease is localized. In the present study our aim was to review the current strategy for diagnosis of prostate carcinoma. Prostate-specific antigen (PSA) is a valuable tumor marker and has demonstrated effectiveness in detecting prostate carcinoma, monitoring therapeutic efficacy, and disclosing disease recurrence. However, alternative methods are been proposed just as the free to total PSA ratio, PSA density, PSA velocity, which could improve the diagnostic sensibility and the specificity. Image diagnostic methods include transrectal ultra sound, computerized tomography, magnetic resonance image, and bone cintigraphy. The ultra sound is the best approach to guide the prostate biopsy and, together with the magnetic resonance is still useful for loco regional graduation. Computerized tomography as magnetic resonance image can be used for identification of linfonodal involvement. Bone cintigraphy is the best method for the identification of metastatic disease. (author)

  4. Performance of alternative strategies for primary cervical cancer screening in sub-Saharan Africa: systematic review and meta-analysis of diagnostic test accuracy studies

    Science.gov (United States)

    Combescure, Christophe; Fokom-Defo, Victoire; Tebeu, Pierre Marie; Vassilakos, Pierre; Kengne, André Pascal; Petignat, Patrick

    2015-01-01

    Objective To assess and compare the accuracy of visual inspection with acetic acid (VIA), visual inspection with Lugol’s iodine (VILI), and human papillomavirus (HPV) testing as alternative standalone methods for primary cervical cancer screening in sub-Saharan Africa. Design Systematic review and meta-analysis of diagnostic test accuracy studies. Data sources Systematic searches of multiple databases including Medline, Embase, and Scopus for studies published between January 1994 and June 2014. Review methods Inclusion criteria for studies were: alternative methods to cytology used as a standalone test for primary screening; study population not at particular risk of cervical cancer (excluding studies focusing on HIV positive women or women with gynaecological symptoms); women screened by nurses; reference test (colposcopy and directed biopsies) performed at least in women with positive screening results. Two reviewers independently screened studies for eligibility and extracted data for inclusion, and evaluated study quality using the quality assessment of diagnostic accuracy studies 2 (QUADAS-2) checklist. Primary outcomes were absolute accuracy measures (sensitivity and specificity) of screening tests to detect cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Results 15 studies of moderate quality were included (n=61 381 for VIA, n=46 435 for VILI, n=11 322 for HPV testing). Prevalence of CIN2+ did not vary by screening test and ranged from 2.3% (95% confidence interval 1.5% to 3.3%) in VILI studies to 4.9% (2.7% to 7.8%) in HPV testing studies. Positivity rates of VILI, VIA, and HPV testing were 16.5% (9.8% to 24.7%), 16.8% (11.0% to 23.6%), and 25.8% (17.4% to 35.3%), respectively. Pooled sensitivity was higher for VILI (95.1%; 90.1% to 97.7%) than VIA (82.4%; 76.3% to 87.3%) in studies where the reference test was performed in all women (Psub-Saharan Africa, VILI is a simple and affordable alternative to cytology that demonstrates higher

  5. Diagnostic Strategy in APR1400

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dongyoung; Kim, Jonghyun [KEPCO International Nuclear Graduate School, Ulsan (Korea, Republic of)

    2013-05-15

    These features may bring out changes in operator tasks, changing the characteristics of tasks, or creating new tasks. Diagnostic strategy for identifying anomaly may be different especially in APR1400 from that in the analog control room due to the change of human-system interface, i.e. alarm system and display system. Since the first plant of APR1400 is being built at this moment, it is not known what strategies the operators will adopt in diagnosis tasks in the new operating environment. In this light, this paper aims at investigating operator's diagnostic strategies which are appropriate for APR1400. In order to collect data, several different approaches which are complementary are used to identify diagnostic strategies in the digital control room: analysis on audio/video recording of operation, observation in the simulator, and interview with the operators. The result shows that the digital control room introduces new strategies in the diagnosis, compared with the analog control room, and also changed the characteristics of strategies, mostly, by getting more support from the computerized system. This paper investigated how the digitalized control room may influence operator's diagnostic strategies. Several different approaches, i. e., audio/video record, observation of training, and the interview with operators, were used to gather information about the operator's behaviors. As a conclusion, this paper figured out that the digital control room introduces new strategies in the diagnosis, compared with the analog control room, and also changed the characteristics of the strategies, mostly, by getting more support from the computerized system. The operators interviewed also commented that the diagnosis in the APR1400 is quicker, more correct, and easier, compared with the analog control room.

  6. Diagnostic Strategy in APR1400

    International Nuclear Information System (INIS)

    Kim, Dongyoung; Kim, Jonghyun

    2013-01-01

    These features may bring out changes in operator tasks, changing the characteristics of tasks, or creating new tasks. Diagnostic strategy for identifying anomaly may be different especially in APR1400 from that in the analog control room due to the change of human-system interface, i.e. alarm system and display system. Since the first plant of APR1400 is being built at this moment, it is not known what strategies the operators will adopt in diagnosis tasks in the new operating environment. In this light, this paper aims at investigating operator's diagnostic strategies which are appropriate for APR1400. In order to collect data, several different approaches which are complementary are used to identify diagnostic strategies in the digital control room: analysis on audio/video recording of operation, observation in the simulator, and interview with the operators. The result shows that the digital control room introduces new strategies in the diagnosis, compared with the analog control room, and also changed the characteristics of strategies, mostly, by getting more support from the computerized system. This paper investigated how the digitalized control room may influence operator's diagnostic strategies. Several different approaches, i. e., audio/video record, observation of training, and the interview with operators, were used to gather information about the operator's behaviors. As a conclusion, this paper figured out that the digital control room introduces new strategies in the diagnosis, compared with the analog control room, and also changed the characteristics of the strategies, mostly, by getting more support from the computerized system. The operators interviewed also commented that the diagnosis in the APR1400 is quicker, more correct, and easier, compared with the analog control room

  7. Choosing wisely: a model-based analysis evaluating the trade-offs in cancer benefit and diagnostic referrals among alternative HPV testing strategies in Norway.

    Science.gov (United States)

    Burger, Emily A; Pedersen, Kine; Sy, Stephen; Kristiansen, Ivar Sønbø; Kim, Jane J

    2017-09-05

    Forthcoming cervical cancer screening strategies involving human papillomavirus (HPV) testing for women not vaccinated against HPV infections may increase colposcopy referral rates. We quantified health and resource trade-offs associated with alternative HPV-based algorithms to inform decision-makers when choosing between candidate algorithms. We used a mathematical simulation model of HPV-induced cervical carcinogenesis in Norway. We compared the current cytology-based strategy to alternative strategies that varied by the switching age to primary HPV testing (ages 25-34 years), the routine screening frequency (every 3-10 years), and management of HPV-positive, cytology-negative women. Model outcomes included reductions in lifetime cervical cancer risk, relative colposcopy rates, and colposcopy rates per cervical cancer prevented. The age of switching to primary HPV testing and the screening frequency had the largest impacts on cancer risk reductions, which ranged from 90.9% to 96.3% compared to no screening. In contrast, increasing the follow-up intensity of HPV-positive, cytology-negative women provided only minor improvements in cancer benefits, but generally required considerably higher rates of colposcopy referrals compared to current levels, resulting in less efficient cervical cancer prevention. We found that in order to maximise cancer benefits HPV-based screening among unvaccinated women should not be delayed: rather, policy makers should utilise the triage mechanism to control colposcopy referrals.

  8. Update on diagnostic strategies of pulmonary embolism

    International Nuclear Information System (INIS)

    Kauczor, H.U.; Heussel, C.P.; Thelen, M.

    1999-01-01

    Acute pulmonary embolism is a frequent disease with non-specific findings, high mortality, and multiple therapeutic options. A definitive diagnosis must be established by accurate, non-invasive, easily performed, cost-effective, and widely available imaging modalities. Conventional diagnostic strategies have relied on ventilation-perfusion scintigraphy complemented by venous imaging. If the results are inconclusive, pulmonary angiography, which is regarded as the gold standard, is to be performed. Recently, marked improvements in CT and MRI and shortcomings of scintigraphy led to an update of the diagnostic strategy. Spiral CT is successfully employed as a second-line procedure to clarify indeterminate scintigraphic results avoiding pulmonary angiography. It can also be used as a first-line screening tool if service and expertise is provided. Venous imaging is indicated if CT is inconclusive. The MRI technique can be applied as an alternative second-line test if spiral CT is not available or is contraindicated. It has the greatest potential for further developments and refinements. Echocardiography should be used as a first-line bedside examination in critical patients. If inconclusive stabilized patients undergo spiral CT, unstable patients should be referred for pulmonary angiography. Chronic thromboembolic pulmonary hypertension is a rare sequela of acute pulmonary embolism which can be cured surgically. Morphology, complications, and differential diagnoses are better illustrated by spiral CT and MRA, whereas invasive acquisition of hemodynamic data is the sole advantage of angiography. (orig.)

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

    International Nuclear Information System (INIS)

    Dusinska, Maria; Fjellsbo, Lise Maria; Heimstad, Eldbjorg; Harju, Mikael; Bartonova, Alena; Tran, Lang; Juillerat-Jeanneret, Lucienne; Halamoda, Blanka; Marano, Francelyne; Boland, Sonja; Saunders, Margaret; Cartwright, Laura; Carreira, Sara; Thawley, Susan; Whelan, Maurice; Klein, Christoph; Housiadas, Christos; Volkovova, Katarina; Tulinska, Jana; Beno, Milan

    2009-01-01

    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 (www.nanotest-fp7.eu) addresses these requirements in relation to the toxicological profile of NPs used in medical diagnostics.

  10. Alternative diagnostic technique for carpal tunnel syndrome

    International Nuclear Information System (INIS)

    Hayakawa, Katsuhiko; Nakane, Takashi; Kobayashi, Shigeru; Shibata, Kunio

    2002-01-01

    Compressive and entrapment neuropathies are common clinical syndromes characterized by neurologic deficits due to mechanical or dynamic compression of peripheral nerves. However, the definitive diagnosis based on clinical symptoms alone is difficult in many cases, and the electrophysiological diagnostic method is solely used as a supplementary diagnostic method at present. As a new diagnostic method for entrapment neuropathy, the present study investigated the usefulness of gadolinium-enhanced MRI in carpal tunnel syndrome. On enhanced MRI of idiopathic carpal tunnel syndrome, contrast-enhancement in the median nerve was found in 30 of 34 hands (88.2%). Enhanced MRI allows to visualize intraneural edema in the nerve easily on the naked eye. Therefore, this technique supplied useful information for making definitive diagnosis and is promising as a non-invasive diagnostic method for entrapment neuropathy. (author)

  11. Alternative diagnostic technique for carpal tunnel syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Hayakawa, Katsuhiko; Nakane, Takashi [Aiko Orthopaedic Hospital, Nagoya (Japan); Kobayashi, Shigeru; Shibata, Kunio [Fujita Health Univ., Toyoake, Aichi (Japan). School of Medicine

    2002-10-01

    Compressive and entrapment neuropathies are common clinical syndromes characterized by neurologic deficits due to mechanical or dynamic compression of peripheral nerves. However, the definitive diagnosis based on clinical symptoms alone is difficult in many cases, and the electrophysiological diagnostic method is solely used as a supplementary diagnostic method at present. As a new diagnostic method for entrapment neuropathy, the present study investigated the usefulness of gadolinium-enhanced MRI in carpal tunnel syndrome. On enhanced MRI of idiopathic carpal tunnel syndrome, contrast-enhancement in the median nerve was found in 30 of 34 hands (88.2%). Enhanced MRI allows to visualize intraneural edema in the nerve easily on the naked eye. Therefore, this technique supplied useful information for making definitive diagnosis and is promising as a non-invasive diagnostic method for entrapment neuropathy. (author)

  12. Summary: analysis of alternative FBR development strategies

    International Nuclear Information System (INIS)

    Burnham, J.B.

    1981-12-01

    This report summarizes the comparative evaluation of alternative strategies for the development of the commercial fast breeder reactor (FBR) in the United States. For planning purposes, a range of possible FBR development paths called strategies were selected for evaluation. These strategies, designed to be technically and economically feasible, were expressed in terms of the timing and nature of facilities/research and development programs required to reach full power operation of the first commercial FBR. Four of the seven strategies resulted in a large (1457 MWe) FBR as an end point, the other three in a 1000-MWe plant. Probability distributions were calculated for total strategy costs and time to completion. For the seven strategies analyzed, the costs (discounted 1980 dollars) ranged from $1.8 billion to $4.9 billion; the completion times ranged from 24 to 55 years

  13. Alternative IT Sourcing Strategies: Six Views

    Science.gov (United States)

    Mahon, Ed; McPherson, Michael R.; Vaughan, Joseph; Rowe, Theresa; Pickett, Michael P.; Bielec, John A.

    2011-01-01

    IT leaders today must not only provide but also decide: which tools and services should they continue to supply, which are better delivered by others, and perhaps most critically, which methods from among the bewildering array of alternative sourcing strategies will best serve their faculty, staff, and students. In 2009, the EDUCAUSE Center for…

  14. Alternative entrepreneurial options: a policy mitigation strategy ...

    African Journals Online (AJOL)

    This study focused on alternative entrepreneurial options as a mitigation strategy against climate change among part-time farmers in Abia state Nigeria. Some farmers abandoned farming in the face of reoccurring adverse weather conditions to other livelihood sustaining activities. The objectives were to examine the ...

  15. Research requirements for alternative reactor development strategies

    International Nuclear Information System (INIS)

    1979-06-01

    The purpose of this paper is to estimate and compare resource requirements and other fuel cycle quantities for alternative reactor deployment strategies. The paper examines from global and national perspectives the interaction of various fuel cycle alternatives described in the previous U.S. submissions to Working Groups 4, 5, 8 and Subgroup 1A/2A. Nuclear energy forecasts of Subgroup 1A/2A are used in the calculation of uranium demand for each strategy. These uranium demands are then compared to U.S. estimates of annual uranium producibility. Annual rather than cumulative producibility was selected because it does not assume preplanned stockpiling, and is therefore more conservative. The strategies attempt to span a range of nuclear power mixes which could evolve if appropriate commercial and governmental climates develop

  16. Alternative evacuation strategies for nuclear power accidents

    International Nuclear Information System (INIS)

    Hammond, Gregory D.; Bier, Vicki M.

    2015-01-01

    In the U.S., current protective-action strategies to safeguard the public following a nuclear power accident have remained largely unchanged since their implementation in the early 1980s. In the past thirty years, new technologies have been introduced, allowing faster computations, better modeling of predicted radiological consequences, and improved accident mapping using geographic information systems (GIS). Utilizing these new technologies, we evaluate the efficacy of alternative strategies, called adaptive protective action zones (APAZs), that use site-specific and event-specific data to dynamically determine evacuation boundaries with simple heuristics in order to better inform protective action decisions (rather than relying on pre-event regulatory bright lines). Several candidate APAZs were developed and then compared to the Nuclear Regulatory Commission’s keyhole evacuation strategy (and full evacuation of the emergency planning zone). Two of the APAZs were better on average than existing NRC strategies at reducing either the radiological exposure, the population evacuated, or both. These APAZs are especially effective for larger radioactive plumes and at high population sites; one of them is better at reducing radiation exposure, while the other is better at reducing the size of the population evacuated. - Highlights: • Developed framework to compare nuclear power accident evacuation strategies. • Evacuation strategies were compared on basis of radiological and evacuation risk. • Current strategies are adequate for smaller scale nuclear power accidents. • New strategies reduced radiation exposure and evacuation size for larger accidents

  17. Biliary parasites: diagnostic and therapeutic strategies.

    Science.gov (United States)

    Khandelwal, Niraj; Shaw, Joanna; Jain, Mamta K

    2008-04-01

    Parasitic infections of the biliary tract are a common cause of biliary obstruction in endemic areas. This article focuses on primary biliary parasites: Ascaris lumbricoides, Clonorchis sinensis, Opisthorchis viverrini, Opisthorchis felineus, Dicrocoelium dendriticum, Fasciola hepatica, and Fasciola gigantica. Tropical and subtropical countries have the highest incidence and prevalence of these infections. Diagnosis is made primarily through direct microscopic examination of eggs in the stool, duodenal, or bile contents. Radiologic imaging may show intrahepatic ductal dilatation, whereas endoscopic retrograde cholangiopancreatography can be used diagnostically and therapeutically. However, oral treatment is inexpensive and effective for most of these parasites and can prevent untoward consequences. Primary and alternative treatments are available and are reviewed in this article.

  18. Antiphospholipid Syndrome Laboratory Testing and Diagnostic Strategies

    Science.gov (United States)

    Ortel, Thomas L.

    2016-01-01

    The Antiphospholipid Syndrome (APS) is diagnosed in patients with recurrent thromboembolic events and/or pregnancy loss in the presence of persistent laboratory evidence for antiphospholipid antibodies. Diagnostic tests for the detection of antiphospholipid antibodies include laboratory assays that detect anticardiolipin antibodies, lupus anticoagulants, and anti-β2-glycoprotein I antibodies. These assays have their origins beginning more than sixty years ago, with the identification of the biologic false positive test for syphilis, the observation of ‘circulating anticoagulants’ in certain patients with systemic lupus erythematosus, the identification of cardiolipin as a key component in the serologic test for syphilis, and the recognition and characterization of a ‘cofactor’ for antibody binding to phospholipids. Although these assays have been used clinically for many years, there are still problems with the accurate diagnosis of patients with this syndrome. For example, lupus anticoagulant testing can be difficult to interpret in patients receiving anticoagulant therapy, but most patients with a thromboembolic event will already be anticoagulated before the decision to perform the tests has been made. In addition to understanding limitations of the assays, clinicians also need to be aware of which patients should be tested and not obtain testing on patients unlikely to have APS. New tests and diagnostic strategies are in various stages of development and should help improve our ability to accurately diagnose this important clinical disorder. PMID:22473619

  19. Alternative strategies for the British coal industry

    Energy Technology Data Exchange (ETDEWEB)

    Manners, G

    1973-01-01

    The Green Paper, 'Energy Policy - a Consultative Document' (HC-Cmnd--7101) affords a valuable insight into official attitudes towards the future of the British energy market. The present author challenges some of the energy supply and demand forecasts that are presented in the Working Document; in particular, he questions the optimistic market forecasts that continue to dominate official thinking about the coal industry; and he proposes that an alternative strategy is required for the British coal industry, one that involves quite painful choices of an economic, geographical, social and environmental nature.

  20. Instructional Strategies Alternative for Reading Comprehension

    Directory of Open Access Journals (Sweden)

    Yajaira del Valle Cadenas Terán

    2017-05-01

    Full Text Available The purpose of this research is to expose significantly instruccionales strategic alternatives that help improve the process of reading in college students to be trained holistically, able to make critical decisions, thoughtful and successful in the academic field. The strategies implemented educational event isolated to produce no change is necessary, that are planned and executed in the proper context of the need to ensure a certain extent the instructional success. It is also essential that teachers be the first to appropriate it. This study was conducted with a literature review serves as instructional foundation - strategic. In conclusion the importance of instructional strategies in reading comprehension was determined, since they increase communication skills, provide specific or complex experiences and promote meaningful learning.

  1. Exploring alternative assessment strategies in science classrooms

    Directory of Open Access Journals (Sweden)

    Michèle Stears

    2010-01-01

    Full Text Available The knowledge children bring to the classroom or construct in the classroom may find expression in a variety of activities and is often not measurable with the traditional assessment instruments used in science classrooms. Different approaches to assessment are required to accommodate the various ways in which learners construct knowledge in social settings. In our research we attempted to determine the types of outcomes achieved in a Grade 6 classroom where alternative strategies such as interactive assessments were implemented. Analyses of these outcomes show that the learners learned much more than the tests indicate, although what they learnt was not necessarily science. The implications for assessment are clear: strategies that assess knowledge of science concepts, as well as assessment of outcomes other than science outcomes, are required if we wish to gain a holistic understanding of the learning that occurs in science classrooms.

  2. Evaluation of alternative MGDS development strategies

    International Nuclear Information System (INIS)

    Roberds, W.; Miller, I.; Caldwell, D.

    1991-01-01

    A methodology has been developed to explicitly and quantitatively evaluate acceptable alternative repository development strategies, in terms of the degree to which they are likely to satisfy a specified set of system objectives (e.g., minimizing overall costs through closure, time to initial waste receipt and long-term health effects). An open-quotes acceptableclose quotes strategy is one which has a high likelihood of satisfying specified system functions and requirements. Simple but comprehensive system models have been developed to estimate the relevant consequences of any strategy, explicitly considering system uncertainties and contingencies, including the possibility of finding the site to be unsuitable and having to develop a repository elsewhere. Such open-quotes technical assessments,close quotes which are appropriately developed by technical experts, can then be combined with separate open-quotes value judgementsclose quotes regarding preferences and tradeoffs among the consequences, which are appropriately determined by the decision makers/stake holders (rather than by the technical experts) in order to explicitly determine preferences among the acceptable strategies. Implementation of the methodology has been demonstrated by example

  3. Alternative models of DSM-5 PTSD: Examining diagnostic implications.

    Science.gov (United States)

    Murphy, Siobhan; Hansen, Maj; Elklit, Ask; Yong Chen, Yoke; Raudzah Ghazali, Siti; Shevlin, Mark

    2018-04-01

    The factor structure of DSM-5 posttraumatic stress disorder (PTSD) has been extensively debated with evidence supporting the recently proposed seven-factor Hybrid model. However, despite myriad studies examining PTSD symptom structure few have assessed the diagnostic implications of these proposed models. This study aimed to generate PTSD prevalence estimates derived from the 7 alternative factor models and assess whether pre-established risk factors associated with PTSD (e.g., transportation accidents and sexual victimisation) produce consistent risk estimates. Seven alternative models were estimated within a confirmatory factor analytic framework using the PTSD Checklist for DSM-5 (PCL-5). Data were analysed from a Malaysian adolescent community sample (n = 481) of which 61.7% were female, with a mean age of 17.03 years. The results indicated that all models provided satisfactory model fit with statistical superiority for the Externalising Behaviours and seven-factor Hybrid models. The PTSD prevalence estimates varied substantially ranging from 21.8% for the DSM-5 model to 10.0% for the Hybrid model. Estimates of risk associated with PTSD were inconsistent across the alternative models, with substantial variation emerging for sexual victimisation. These findings have important implications for research and practice and highlight that more research attention is needed to examine the diagnostic implications emerging from the alternative models of PTSD. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Dental and dental hygiene students' diagnostic accuracy in oral radiology: effect of diagnostic strategy and instructional method.

    Science.gov (United States)

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

    2014-09-01

    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.

  5. Colorectal cancer: diagnostic and therapeutic strategies

    International Nuclear Information System (INIS)

    Vaillant, J.C.

    1996-01-01

    Technical advances that has been achieved during the past two decades have not dramatically improved the 35 % five-year rate observed in patients with colorectal cancer. These tumours remain one of the most challenging problems in public health policies in western countries. Screening applies to some subgroups of high-risk individuals and the general population aged over 50. In order to improve their efficacy, such screening programs imply large-scale information campaigns and a strong cooperation with the general physicians. The diagnosis is strongly suggested by any recent modification of bowel habits ad by rectal bleeding. It has to be confirmed by rectal examination and by colonoscopy which allows sampling to the tumour. Loco-regional and distant metastatic tumour spread must be assessed precisely before any therapeutic strategy is decided. Surgery, which resects the tumour en bloc with the corresponding lymphatic territories, is the only treatment that can achieve long term cure. In localized tumours, surgery alone can provide patients with 5-years survival rates close to 95 %. On the other hand, surgery alone is not sufficient to cure patients with advances cancers. In recent years, several adjuvant therapeutic modalities have been shown to improve the results of surgery in these cases (rectal cancer: pre-operative radiotherapy or post-operative radio-chemotherapy, colon cancer with nodal metastases: post-operative chemotherapy). There is a hope that a better use of our diagnostic and therapeutic armementarium would be able to avoid or to cure up to 75 % of the colorectal cancers we are dealing with. (author)

  6. 24 CFR 248.223 - Alternative State strategy.

    Science.gov (United States)

    2010-04-01

    ... 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 income...

  7. Alternative Strategies for Pricing Home Work Time.

    Science.gov (United States)

    Zick, Cathleen D.; Bryant, W. Keith

    1983-01-01

    Discusses techniques for measuring the value of home work time. Estimates obtained using the reservation wage technique are contrasted with market alternative estimates derived with the same data set. Findings suggest that the market alternative cost method understates the true value of a woman's home time to the household. (JOW)

  8. Epidemiology of and Diagnostic Strategies for Toxoplasmosis

    Science.gov (United States)

    Dardé, Marie-Laure

    2012-01-01

    Summary: The apicomplexan parasite Toxoplasma gondii was discovered a little over 100 years ago, but knowledge of its biological life cycle and its medical importance has grown in the last 40 years. This obligate intracellular parasite was identified early as a pathogen responsible for congenital infection, but its clinical expression and the importance of reactivations of infections in immunocompromised patients were recognized later, in the era of organ transplantation and HIV infection. Recent knowledge of host cell-parasite interactions and of parasite virulence has brought new insights into the comprehension of the pathophysiology of infection. In this review, we focus on epidemiological and diagnostic aspects, putting them in perspective with current knowledge of parasite genotypes. In particular, we provide critical information on diagnostic methods according to the patient's background and discuss the implementation of screening tools for congenital toxoplasmosis according to health policies. PMID:22491772

  9. Neurocysticercosis: Diagnostic problems & current therapeutic strategies

    Directory of Open Access Journals (Sweden)

    Vedantam Rajshekhar

    2016-01-01

    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.

  10. Neurocysticercosis: Diagnostic problems & current therapeutic strategies

    Science.gov (United States)

    Rajshekhar, Vedantam

    2016-01-01

    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

  11. Characterization of alternative FBR development strategies

    International Nuclear Information System (INIS)

    Boegel, A.J.; Clausen, M.J.

    1981-08-01

    Near-term decisions regarding the nature and place of the FBR development program must be made. This study is part of a larger program designed to provide the Department of Energy (DOE) with imformation that can be used to make strategic programmatic decisions. The focus of this report is the description of alternative approaches for developing the FBR and the quantification of the duration and cost of each alternative. The time frames of the alternative approaches are investigated in companion reports (White 1981 and Fraley 1981). The results of these analyses will be described in a summary report

  12. Chromatin conformation capture strategies in molecular diagnostics

    NARCIS (Netherlands)

    de Vree, Pauline J.P.

    2015-01-01

    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

  13. Array-based sensing using nanoparticles: an alternative approach for cancer diagnostics.

    Science.gov (United States)

    Le, Ngoc D B; Yazdani, Mahdieh; Rotello, Vincent M

    2014-07-01

    Array-based sensing using nanoparticles (NPs) provides an attractive alternative to specific biomarker-focused strategies for cancer diagnosis. The physical and chemical properties of NPs provide both the recognition and transduction capabilities required for biosensing. Array-based sensors utilize a combined response from the interactions between sensors and analytes to generate a distinct pattern (fingerprint) for each analyte. These interactions can be the result of either the combination of multiple specific biomarker recognition (specific binding) or multiple selective binding responses, known as chemical nose sensing. The versatility of the latter array-based sensing using NPs can facilitate the development of new personalized diagnostic methodologies in cancer diagnostics, a necessary evolution in the current healthcare system to better provide personalized treatments. This review will describe the basic principle of array-based sensors, along with providing examples of both invasive and noninvasive samples used in cancer diagnosis.

  14. randomised trial of alternative malaria chemoprophylaxis strategies

    African Journals Online (AJOL)

    hi-tech

    2000-02-02

    Feb 2, 2000 ... randomisation produced comparable intervention and comparison groups with balanced characteristics. Specific results of the baseline studies are presented in the companion paper. ... strategies for protecting pregnant women against malaria. ..... from malaria vaccine trial conducted among Tanzanian.

  15. An Alternative Front End Analysis Strategy for Complex Systems

    Science.gov (United States)

    2014-12-01

    missile ( ABM ) system . Patriot is employed in the field through a battalion echelon organizational structure. The line battery is the basic building...Research Report 1981 An Alternative Front End Analysis Strategy for Complex Systems M. Glenn Cobb U.S. Army Research Institute...NUMBER W5J9CQ11D0003 An Alternative Front End Analysis Strategy for Complex Systems 5b. PROGRAM ELEMENT NUMBER 633007 6

  16. Evaluating alternative gait strategies using evolutionary robotics.

    Science.gov (United States)

    Sellers, William I; Dennis, Louise A; W -J, Wang; Crompton, Robin H

    2004-05-01

    Evolutionary robotics is a branch of artificial intelligence concerned with the automatic generation of autonomous robots. Usually the form of the robot is predefined and various computational techniques are used to control the machine's behaviour. One aspect is the spontaneous generation of walking in legged robots and this can be used to investigate the mechanical requirements for efficient walking in bipeds. This paper demonstrates a bipedal simulator that spontaneously generates walking and running gaits. The model can be customized to represent a range of hominoid morphologies and used to predict performance parameters such as preferred speed and metabolic energy cost. Because it does not require any motion capture data it is particularly suitable for investigating locomotion in fossil animals. The predictions for modern humans are highly accurate in terms of energy cost for a given speed and thus the values predicted for other bipeds are likely to be good estimates. To illustrate this the cost of transport is calculated for Australopithecus afarensis. The model allows the degree of maximum extension at the knee to be varied causing the model to adopt walking gaits varying from chimpanzee-like to human-like. The energy costs associated with these gait choices can thus be calculated and this information used to evaluate possible locomotor strategies in early hominids.

  17. Conventional and molecular diagnostic strategies for prosthetic joint infections.

    Science.gov (United States)

    Esteban, Jaime; Sorlí, Luisa; Alentorn-Geli, Eduard; Puig, Lluís; Horcajada, Juan P

    2014-01-01

    An accurate diagnosis of prosthetic joint infection (PJI) is the mainstay for an optimized clinical management. This review analyzes different diagnostic strategies of PJI, with special emphasis on molecular diagnostic tools and their current and future applications. Until now, the culture of periprosthetic tissues has been considered the gold standard for the diagnosis of PJI. However, sonication of the implant increases the sensitivity of those cultures and is being increasingly adopted by many centers. Molecular diagnostic methods compared with intraoperative tissue culture, especially if combined with sonication, have a higher sensitivity, a faster turnaround time and are not influenced by previous antimicrobial therapy. However, they still lack a system for detection of antimicrobial susceptibility, which is crucial for an optimized and less toxic therapy of PJI. More studies are needed to assess the clinical value of these methods and their cost-effectiveness.

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

    Science.gov (United States)

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

    2015-01-01

    Prosthetic valve obstruction (PVO) is a rare but feared complication of mechanical valve replacement. Diagnostic 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. PMID:26730292

  19. Telemetry with an Optical Fiber Revisited: An Alternative Strategy

    Science.gov (United States)

    Kraftmakher, Yaakov

    2014-01-01

    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…

  20. Reconstruction of the Anterior Cruciate Ligament : Alternative Strategies

    OpenAIRE

    van Eijk, F.

    2009-01-01

    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 engineering.

  1. Reconstruction of the Anterior Cruciate Ligament : Alternative Strategies

    NARCIS (Netherlands)

    van Eijk, F.

    2009-01-01

    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

  2. Supporting Alternative Strategies for Learning Chemical Applications of Group Theory

    Science.gov (United States)

    Southam, Daniel C.; Lewis, Jennifer E.

    2013-01-01

    A group theory course for chemists was taught entirely with process oriented guided inquiry learning (POGIL) to facilitate alternative strategies for learning. Students completed a test of one aspect of visuospatial aptitude to determine their individual approaches to solving spatial tasks, and were sorted into groups for analysis on the basis of…

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

    DEFF Research Database (Denmark)

    Isaacs, Steven Howard

    1996-01-01

    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, and the dissol...

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

    Science.gov (United States)

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

    2016-06-01

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  6. Modeling of novel diagnostic strategies for active tuberculosis - a systematic review: current practices and recommendations.

    Directory of Open Access Journals (Sweden)

    Alice Zwerling

    Full Text Available The field of diagnostics for active tuberculosis (TB is rapidly developing. TB diagnostic modeling can help to inform policy makers and support complicated decisions on diagnostic strategy, with important budgetary implications. Demand for TB diagnostic modeling is likely to increase, and an evaluation of current practice is important. We aimed to systematically review all studies employing mathematical modeling to evaluate cost-effectiveness or epidemiological impact of novel diagnostic strategies for active TB.Pubmed, personal libraries and reference lists were searched to identify eligible papers. We extracted data on a wide variety of model structure, parameter choices, sensitivity analyses and study conclusions, which were discussed during a meeting of content experts.From 5619 records a total of 36 papers were included in the analysis. Sixteen papers included population impact/transmission modeling, 5 were health systems models, and 24 included estimates of cost-effectiveness. Transmission and health systems models included specific structure to explore the importance of the diagnostic pathway (n = 4, key determinants of diagnostic delay (n = 5, operational context (n = 5, and the pre-diagnostic infectious period (n = 1. The majority of models implemented sensitivity analysis, although only 18 studies described multi-way sensitivity analysis of more than 2 parameters simultaneously. Among the models used to make cost-effectiveness estimates, most frequent diagnostic assays studied included Xpert MTB/RIF (n = 7, and alternative nucleic acid amplification tests (NAATs (n = 4. Most (n = 16 of the cost-effectiveness models compared new assays to an existing baseline and generated an incremental cost-effectiveness ratio (ICER.Although models have addressed a small number of important issues, many decisions regarding implementation of TB diagnostics are being made without the full benefits of insight from mathematical

  7. A diagnostic tree model for polytomous responses with multiple strategies.

    Science.gov (United States)

    Ma, Wenchao

    2018-04-23

    Constructed-response items have been shown to be appropriate for cognitively diagnostic assessments because students' problem-solving procedures can be observed, providing direct evidence for making inferences about their proficiency. However, multiple strategies used by students make item scoring and psychometric analyses challenging. This study introduces the so-called two-digit scoring scheme into diagnostic assessments to record both students' partial credits and their strategies. This study also proposes a diagnostic tree model (DTM) by integrating the cognitive diagnosis models with the tree model to analyse the items scored using the two-digit rubrics. Both convergent and divergent tree structures are considered to accommodate various scoring rules. The MMLE/EM algorithm is used for item parameter estimation of the DTM, and has been shown to provide good parameter recovery under varied conditions in a simulation study. A set of data from TIMSS 2007 mathematics assessment is analysed to illustrate the use of the two-digit scoring scheme and the DTM. © 2018 The British Psychological Society.

  8. Rational design of diagnostic and vaccination strategies for tuberculosis

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    Stojimirović Biljana B.

    2004-01-01

    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.

  10. Tank waste pretreatment issues, alternatives and strategies for resolution

    International Nuclear Information System (INIS)

    Miller, W.C.; Appel, J.; Barton, W.B.; Orme, R.M.; Holton, L.K. Jr.

    1993-02-01

    The US Department of Energy (DOE) has established the Tank Waste Remediation System (TWRS) to safely manage and dispose of the Hanford Site tank waste. The overall strategy for disposing of tank waste is evolving and initial recommendations on a course of action are expected in March, 1993. Pretreatment of these wastes may be required for one or both of the following reasons: (1) resolution of tank safety issues, and (2) preparation of low level and high level waste fractions for disposal. Pretreatment is faced with several issues that must be addressed by the deployment strategies that are being formulated. These issues are identified. There is also a discussion of several pretreatment deployment strategies and how these strategies address the issues. Finally, the technology alternatives that are being considered for the pretreatment function are briefly discussed

  11. Implications of caries diagnostic strategies for clinical management decisions

    DEFF Research Database (Denmark)

    Baelum, Vibeke; Hintze, Hanne; Wenzel, Ann

    2012-01-01

    -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......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...... and cavitated lesions while the radiographic examination determined lesion depth. Direct inspection of the surfaces following tooth separation for the presence of cavitated or noncavitated lesions was the validation method. The true-positive rate (i.e. the sensitivity) and the false-positive rate (i.e. 1...

  12. Alternative strategies for electricity supply from RENEL's power plants

    International Nuclear Information System (INIS)

    Vladescu, A.; Popescu, M.; Breazu, F.; Valcereanu, G.; Oprea, G.; Velcescu, O.; Popovici, D.

    1996-01-01

    The transition to the market economy imposes the refurbishment and rehabilitation of the energy sector. This development must be based on the principles of economic efficiency having in view both the conditions of environmental protection and the energy demand and supply. This paper will describe some alternative strategies for electricity supply, taking into account the forecast of electricity demand integrated into total energy demand, as well as the environmental protection regulations. (author). 1 fig., 4 refs

  13. Alternative strategy for steady growth towards high quality translation networks

    Energy Technology Data Exchange (ETDEWEB)

    Witkam, A P.M.

    1983-01-01

    This paper points out a rather new and largely unexplored direction. In machine translation (MT), but also in data-base enquiry, advanced word processing and natural language programming systems, the analysis of the source text is the crucial process, responsible for parsing and disambiguation. For this purpose, conventional MT systems initially relied on only grammar and dictionary, the grammar being limited to morphology and syntax. The author points to artificial intelligence as an alternative strategy, leading to knowledge based translation. 12 references.

  14. Alternate Strategies for Conversion of Waste Plastic to Fuels

    OpenAIRE

    Neha Patni; Pallav Shah; Shruti Agarwal; Piyush Singhal

    2013-01-01

    The present rate of economic growth is unsustainable without saving of fossil energy like crude oil, natural gas, or coal. There are many alternatives to fossil energy such as biomass, hydropower, and wind energy. Also, suitable waste management strategy is another important aspect. Development and modernization have brought about a huge increase in the production of all kinds of commodities, which indirectly generate waste. Plastics have been one of the materials because of their wide range ...

  15. Diagnostic strategies using myoglobin measurement in myocardial infarction.

    Science.gov (United States)

    Plebani, M; Zaninotto, M

    1998-04-06

    Myoglobin, a low molecular-weight heme protein (17800 D) present in both cardiac and skeletal muscle, is an old test with new perspectives. Advantages and disadvantages of myoglobin determination are well known. Myoglobin is the earliest known, commercially available, biochemical marker of acute myocardial infarction (AMI) and its rapid kinetics make it an early, good marker of reperfusion. However, since myoglobin is present in both skeletal and cardiac muscle, any damage to these muscle types results in its release into blood. Serum myoglobin levels are falsely elevated in conditions unrelated to AMI as skeletal muscle and neuromuscular disorders, renal failure, intramuscular injection, strenuous exercise, and after several toxins and drugs intake. New strategies for myoglobin measurement may resolve this limitation. These strategies include both the combined measurement of myoglobin and a skeletal specific marker (carbonic anhydrase III) or a cardiac specific marker (troponin I), as well as the myoglobin evaluation on serial samples. In particular, the diagnostic algorithm based on the combined measurement of myoglobin and troponin I, assuring a satisfactory analytical turnaround time, significantly improves the diagnostic efficiency of laboratory assessment of suspected AMI patients, allowing the successive monitoring of coronary reperfusion.

  16. Evidence for an alternation strategy in time-place learning.

    Science.gov (United States)

    Pizzo, Matthew J; Crystal, Jonathon D

    2004-11-30

    Many different conclusions concerning what type of mechanism rats use to solve a daily time-place task have emerged in the literature. The purpose of this study was to test three competing explanations of time-place discrimination. Rats (n = 10) were tested twice daily in a T-maze, separated by approximately 7 h. Food was available at one location in the morning and another location in the afternoon. After the rats learned to visit each location at the appropriate time, tests were omitted to evaluate whether the rats were utilizing time-of-day (i.e., a circadian oscillator) or an alternation strategy (i.e., visiting a correct location is a cue to visit the next location). Performance on this test was significantly lower than chance, ruling out the use of time-of-day. A phase advance of the light cycle was conducted to test the alternation strategy and timing with respect to the light cycle (i.e., an interval timer). There was no difference between probe and baseline performance. These results suggest that the rats used an alternation strategy to meet the temporal and spatial contingencies in the time-place task.

  17. Some Convergence Strategies for the Alternating Generalized Projection Method

    Directory of Open Access Journals (Sweden)

    Maricarmen Andrade

    2013-11-01

    Full Text Available In this paper we extend the application of the alternating projection algorithm to solve the problem of finding a point in the intersection of $n$ sets ($n\\geq2$, which are not all of them convex sets. Here we term such method as alternating generalized projection (AGP method. In particular, we are interested in addressing the problem of avoiding the so-called trap points, which may prevent an algorithm to obtain a feasible solution in two or more sets not all convex. Some strategies that allow us to reach the feasible solution are established and conjectured. Finally, we present simple numerical results that illustrate the efficiency of the iterative methods considered.

  18. Towards an alternative testing strategy for nanomaterials used in nanomedicine

    DEFF Research Database (Denmark)

    Dusinska, M; Boland, S; Saunders, M

    2015-01-01

    In spite of recent advances in describing the health outcomes of exposure to nanoparticles (NPs), it still remains unclear how exactly NPs interact with their cellular targets. Size, surface, mass, geometry, and composition may all play a beneficial role as well as causing toxicity. Concerns...... towards alternative testing strategies for hazard and risk assessment of nanomaterials, highlighting the adaptation of standard methods demanded by the special physicochemical features of nanomaterials and bioavailability studies. The work has assessed a broad range of toxicity tests, cell models and NP...... types and concentrations taking into account the inherent impact of NP properties and the effects of changes in experimental conditions using well-characterized NPs. The results of the studies have been used to generate recommendations for a suitable and robust testing strategy which can be applied...

  19. Comparative cost analysis -- computed tomography vs. alternative diagnostic procedures, 1977-1980

    International Nuclear Information System (INIS)

    Gempel, P.A.; Harris, G.H.; Evans, R.G.

    1977-12-01

    In comparing the total national cost of utilizing computed tomography (CT) for medically indicated diagnoses with that of conventional x-ray, ultrasonography, nuclear medicine, and exploratory surgery, this investigation concludes that there was little, if any, added net cost from CT use in 1977 or will there be in 1980. Computed tomography, generally recognized as a reliable and useful diagnostic modality, has the potential to reduce net costs provided that an optimal number of units can be made available to physicians and patients to achieve projected reductions in alternative procedures. This study examines the actual cost impact of CT on both cranial and body diagnostic procedures. For abdominal and mediastinal disorders, CT scanning is just beginning to emerge as a diagnostic modality. As such, clinical experience is somewhat limited and the authors assume that no significant reduction in conventional procedures took place in 1977. It is estimated that the approximately 375,000 CT body procedures performed in 1977 represent only a 5 percent cost increase over use of other diagnostic modalities. It is projected that 2,400,000 CT body procedures will be performed in 1980 and, depending on assumptions used, total body diagnostic costs will increase only slightly or be reduced. Thirty-one tables appear throughout the text presenting cost data broken down by types of diagnostic procedures used and projections by years. Appendixes present technical cost components for diagnostic procedures, the comparative efficacy of CT as revealed in abstracts of published literature, selected medical diagnoses, and references

  20. Reference materials for molecular diagnostics: Current achievements and future strategies.

    Science.gov (United States)

    Jing, Rongrong; Wang, Huimin; Ju, Shaoqing; Cui, Ming

    2018-06-01

    Molecular diagnoses have become more widespread in many areas of laboratory medicine where qualitative or quantitative approaches are used to detect nucleic acids. The increasing number of assay methods and the targets for molecular diagnostics contribute to variability in the test results among clinical laboratories. Thus, reference materials (RMs) are required to enhance the comparability of results. This review focuses on the definition of RMs as well as the production and characteristics of higher order RMs from different organizations and their future strategies. We describe the recent progress in RMs, including the definition of RMs by the Joint Committee for Guides in Metrology, as well as the production and characteristics of higher order RMs by international official bodies. There is an urgent need for RMs in nucleic acid testing, especially higher order RMs. To advance the harmonization and standardization of clinical nucleic acid detection, cooperation between the above organizations is proposed and different approaches to higher order RMs development are also needed. Copyright © 2018 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  1. Long-term alternative energy R and D strategies

    International Nuclear Information System (INIS)

    1981-01-01

    Within the coming decades a transition must be initiated from oil and gas to 'unlimited' primary energy sources, i.e., nuclear and solar energy. Ever more expensive fossil energy forms will have to provide for an intermediary solution to the growing global energy demand. While a rather clear-cut picture of the energy problem has emerged on the global level, a straightforward translation to the national or even to the company level is not available. The current study contract between the European Economic Community and the International Institute for Applied Systems Analysis (IIASA) is a first exercice designed to transfer the global results to the intermediary level of the ''Subregion'' of the European Community. In operational terms the contract aims at identifying long-term (up to 2030) alternative energy R and D strategies for twelve European countries that would be consistent with the global scenarios, identified by IIASA

  2. Strategy alternatives for homeland air and cruise missile defense.

    Science.gov (United States)

    Murphy, Eric M; Payne, Michael D; Vanderwoude, Glenn W

    2010-10-01

    Air and cruise missile defense of the U.S. homeland is characterized by a requirement to protect a large number of critical assets nonuniformly dispersed over a vast area with relatively few defensive systems. In this article, we explore strategy alternatives to make the best use of existing defense resources and suggest this approach as a means of reducing risk while mitigating the cost of developing and acquiring new systems. We frame the issue as an attacker-defender problem with simultaneous moves. First, we outline and examine the relatively simple problem of defending comparatively few locations with two surveillance systems. Second, we present our analysis and findings for a more realistic scenario that includes a representative list of U.S. critical assets. Third, we investigate sensitivity to defensive strategic choices in the more realistic scenario. As part of this investigation, we describe two complementary computational methods that, under certain circumstances, allow one to reduce large computational problems to a more manageable size. Finally, we demonstrate that strategic choices can be an important supplement to material solutions and can, in some cases, be a more cost-effective alternative. © 2010 Society for Risk Analysis.

  3. Alternative energy supply strategies for Pakistan and their economic implications

    International Nuclear Information System (INIS)

    Jalal, A.I.; Khan, A.M.; Khan, S.B.

    1984-01-01

    Pakistan is beset with serious energy supply difficulties arising from a fast growing demand for commercial energy, a poor energy resource base and the high cost of imported energy. The commercial energy requirements are expected to rise from 22.4 million tonnes of coal equivalent (tce) in 1980 to 80 million tce by the year 2000 and to about 200 million tce by 2020, while the country's proven fossil-fuel reserves are only 440 million tce and cannot cope with the demand for long. Pakistan is already dependent on imported energy for 90% of its oil requirements or 30% of the total commercial energy, and is spending 5.5% of its gross domestic product (GDP) on energy imports. The paper analyses the economic implications of a few alternative energy supply strategies. These strategies correspond to two different rates of petroleum exploration and development activity, a high and a low average size of new petroleum finds, and the large-scale use of nuclear power starting in 1990 or after the year 2000. It is found that in the most favourable case (high level of petroleum drilling activity with a high success rate and nuclear power use starting in 1990) Pakistan would be able to achieve self-sufficiency in oil by 2010 and in the total energy supply shortly after 2020. The energy sector's investment requirement will, however, increase gradually from 3% of GDP now to almost 6% of GDP by 2020. (author)

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

    Science.gov (United States)

    Doshi, Shivang; Ray, David; Stein, Karen; Zhang, Jie; Koduru, Prasad; Fogt, Franz; Wellman, Axel; Wat, Ricky; Mathews, Charles

    2016-01-06

    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.

  5. Coming close to the ideal alternative: The concordant-ranks strategy

    Directory of Open Access Journals (Sweden)

    Neda Kerimi

    2011-04-01

    Full Text Available We present the Concordant-Ranks (CR strategy that decision makers use to quickly find an alternative that is proximate to an ideal alternative in a multi-attribute decision space. CR implies that decision makers prefer alternatives that exhibit concordant ranks between attribute values and attribute weights. We show that, in situations where the alternatives are equal in multi-attribute utility (MAU, minimization of the weighted Euclidean distance (WED to an ideal alternative implies the choice of a CR alternative. In two experiments, participants chose among, as well as evaluated, alternatives that were constructed to be equal in MAU. In Experiment 1, four alternatives were designed in such a way that the choice of each alternative would be consistent with one particular choice strategy, one of which was the CR strategy. In Experiment 2, participants were presented with a CR alternative and a number of arbitrary alternatives. In both experiments, participants tended to choose the CR alternative. The CR alternative was on average evaluated as more attractive than other alternatives. In addition, measures of WED, between given alternatives and the ideal alternative, by and large agreed with the preference order for choices and attractiveness evaluations of the different types of alternatives. These findings indicate that both choices and attractiveness evaluations are guided by proximity of alternatives to an ideal alternative.

  6. Strategies to Enhance Online Learning Teams. Team Assessment and Diagnostics Instrument and Agent-based Modeling

    Science.gov (United States)

    2010-08-12

    Strategies to Enhance Online Learning Teams Team Assessment and Diagnostics Instrument and Agent-based Modeling Tristan E. Johnson, Ph.D. Learning ...REPORT DATE AUG 2010 2. REPORT TYPE 3. DATES COVERED 00-00-2010 to 00-00-2010 4. TITLE AND SUBTITLE Strategies to Enhance Online Learning ...TeamsTeam Strategies to Enhance Online Learning Teams: Team Assessment and Diagnostics Instrument and Agent-based Modeling 5a. CONTRACT NUMBER 5b. GRANT

  7. Low-Dose CT for Evaluation of Suspected Urolithiasis: Diagnostic Yield for Assessment of Alternative Diagnoses.

    Science.gov (United States)

    Weinrich, Julius Matthias; Bannas, Peter; Regier, Marc; Keller, Sarah; Kluth, Luis; Adam, Gerhard; Henes, Frank Oliver

    2018-03-01

    The purpose of this study is to assess the diagnostic yield of low-dose (LD) CT for alternative diagnoses in patients with suspected urolithiasis. In this retrospective study, we included 776 consecutive patients who underwent unenhanced abdominal CT for evaluation of suspected urolithiasis. All examinations were performed with an LD CT protocol; images were reconstructed using iterative reconstruction. The leading LD CT diagnosis was recorded for each patient and compared with the final clinical diagnosis, which served as the reference standard. The mean (± SD) effective dose of CT was 1.9 ± 0.6 mSv. The frequency of urolithiasis was 82.5% (640/776). LD CT reached a sensitivity of 94.1% (602/640), a specificity of 100.0% (136/136), and an accuracy of 95.1% (738/776) for the detection of urolithiasis. In 93 of 136 patients (68.4%) without urolithiasis, alternative diagnoses were established as the final clinical diagnoses. Alternative diagnoses were most commonly located in the genitourinary (n = 53) and gastrointestinal (n = 18) tracts. LD CT correctly provided alternative diagnoses for 57 patients (61.3%) and was false-negative for five patients (5.4%). The most common clinical alternative diagnoses were urinary tract infections (n = 22). Seven diagnoses missed at LD CT were located outside the FOV. For 43 of all 776 patients (5.5%), neither LD CT nor clinical workup could establish a final diagnosis. The sensitivity, specificity, and accuracy of LD CT for the detection of alternative diagnoses were 91.9% (57/62), 95.6% (43/45), and 93.5% (100/107), respectively. LD CT enables the diagnosis of most alternative diagnoses in the setting of suspected urolithiasis. The most frequent alternative diagnoses missed by LD CT are urinary tract infections or diagnoses located outside the FOV of the abdominopelvic CT scan.

  8. Blood transfusion risks and alternative strategies in pediatric patients.

    Science.gov (United States)

    Lavoie, Josée

    2011-01-01

    Although the safety of the blood supply has been greatly improved, there still remain both infectious and noninfectious risks to the patient. The incidence of noninfectious transfusion reactions is greater than that of infectious complications. Furthermore, the mortality associated with noninfectious risks is significantly higher. In fact, noninfectious risks account for 87-100% of fatal complications of transfusions. It is concerning to note that the majority of pediatric reports relate to human error such as overtransfusion and lack of knowledge of special requirements in the neonatal age group. The second most frequent category is acute transfusion reactions, majority of which are allergic in nature. It is estimated that the incidence of adverse outcome is 18:100,000 red blood cells issued for children aged less than 18 years and 37:100,000 for infants. The comparable adult incidence is 13:100,000. In order to decrease the risks associated with transfusion of blood products, various blood-conservation strategies can be utilized. Modalities such as acute normovolemic hemodilution, hypervolemic hemodilution, deliberate hypotension, antifibrinolytics, intraoperative blood salvage, and autologous blood donation are discussed and the pediatric literature is reviewed. A discussion of transfusion triggers, and algorithms as well as current research into alternatives to blood transfusions concludes this review. © 2010 Blackwell Publishing Ltd.

  9. Effective and less invasive diagnostic strategy for gastrointestinal GVHD

    Science.gov (United States)

    Endo, Katsuya; Fujishima, Fumiyoshi; Kuroha, Masatake; Moroi, Rintaro; Onodera, Motoyuki; Naito, Takeo; Kanazawa, Yoshitake; Kimura, Tomoya; Shiga, Hisashi; Kakuta, Yoichi; Kinouchi, Yoshitaka; Shimosegawa, Tooru

    2018-01-01

    %, and 88.9 %, respectively. Conclusion  Orange peel appearance, spotty redness, small mucosal sloughing, and diffuse mucosal defect are the characteristic colonoscopic findings useful for diagnosis of gastrointestinal GVHD. These findings are frequently observed in the rectosigmoid portion. The histological detection rates for crypt cell apoptosis from these findings are high. Identifying the four characteristic findings on rectosigmoidoscopy and taking biopsies from these areas could be essential for the diagnostic strategy for gastrointestinal GVHD. PMID:29507868

  10. 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

    2013-01-01

    . No cases of inflammatory bowel disease, colorectal cancer, or celiac disease were found. CONCLUSIONS: In diagnosing IBS in primary care, use of a positive diagnostic strategy is noninferior to using a strategy of exclusion with regard to the patients' HRQOL. Our findings support the current guideline......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...... year between groups (on the basis of the Short Form 36 health survey, physical component summary, and noninferiority margin of 3 points). Secondary outcomes were change in gastrointestinal symptoms, satisfaction with management, and use of resources. Findings of diagnostic misclassification were...

  11. Efficient strategies to find diagnostic test accuracy studies in kidney journals.

    Science.gov (United States)

    Rogerson, Thomas E; Ladhani, Maleeka; Mitchell, Ruth; Craig, Jonathan C; Webster, Angela C

    2015-08-01

    Nephrologists looking for quick answers to diagnostic clinical questions in MEDLINE can use a range of published search strategies or Clinical Query limits to improve the precision of their searches. We aimed to evaluate existing search strategies for finding diagnostic test accuracy studies in nephrology journals. We assessed the accuracy of 14 search strategies for retrieving diagnostic test accuracy studies from three nephrology journals indexed in MEDLINE. Two investigators hand searched the same journals to create a reference set of diagnostic test accuracy studies to compare search strategy results against. We identified 103 diagnostic test accuracy studies, accounting for 2.1% of all studies published. The most specific search strategy was the Narrow Clinical Queries limit (sensitivity: 0.20, 95% CI 0.13-0.29; specificity: 0.99, 95% CI 0.99-0.99). Using the Narrow Clinical Queries limit, a searcher would need to screen three (95% CI 2-6) articles to find one diagnostic study. The most sensitive search strategy was van der Weijden 1999 Extended (sensitivity: 0.95; 95% CI 0.89-0.98; specificity 0.55, 95% CI 0.53-0.56) but required a searcher to screen 24 (95% CI 23-26) articles to find one diagnostic study. Bachmann 2002 was the best balanced search strategy, which was sensitive (0.88, 95% CI 0.81-0.94), but also specific (0.74, 95% CI 0.73-0.75), with a number needed to screen of 15 (95% CI 14-17). Diagnostic studies are infrequently published in nephrology journals. The addition of a strategy for diagnostic studies to a subject search strategy in MEDLINE may reduce the records needed to screen while preserving adequate search sensitivity for routine clinical use. © 2015 Asian Pacific Society of Nephrology.

  12. The effect of information types on diagnostic strategies in the information aid

    International Nuclear Information System (INIS)

    Kim, Jong Hyun; Seong, Poong Hyun

    2007-01-01

    Through experiments, this paper investigates the compatibility of information types with the diagnostic strategy in information aid. Compatibility with operator strategies is an important requirement for information aiding systems in nuclear power plants (NPPs). This paper used three typical types of information aids for MCR operators to investigate the effect of the aids on diagnostic strategies: 'alarm (A),' 'hypothesis on faults (H),' and 'hypothesis on faults and expected symptoms (HS).' The experimental results indicate that the effectiveness of information aid types can vary, dependent on the strategies subjects employ. The results also show that the HS aid improved the diagnosis performance in the hypothesis-and-test strategy

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

    Science.gov (United States)

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

    2016-01-01

    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

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

    Directory of Open Access Journals (Sweden)

    Godshall William T

    2006-12-01

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

    Directory of Open Access Journals (Sweden)

    Shivang Doshi

    2016-01-01

    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.

  16. Comparing Alternative U.S. Counterterrorism Strategies: Can Assumption-Based Planning Help Elevate the Debate?

    National Research Council Canada - National Science Library

    Lempert, Robert J; Trujillo, Horacio R; Aaron, David; Dewar, James A; Berry, Sandra H; Popper, Steven W

    2008-01-01

    .... Frequently, both expert decisionmakers and lay citizens have trouble assessing alternative strategies to address such issues because of the emotions they engender and of the deep uncertainty involved...

  17. Acquiring, Representing, and Evaluating a Competence Model of Diagnostic Strategy.

    Science.gov (United States)

    Clancey, William J.

    This paper describes NEOMYCIN, a computer program that models one physician's diagnostic reasoning within a limited area of medicine. NEOMYCIN's knowledge base and reasoning procedure constitute a model of how human knowledge is organized and how it is used in diagnosis. The hypothesis is tested that such a procedure can be used to simulate both…

  18. Diagnostic strategies for urinary tract infections in French general practice.

    Science.gov (United States)

    Kinouani, S; de Lary de Latour, H; Joseph, J-P; Letrilliart, L

    2017-10-01

    We aimed to describe the diagnostic management procedures for detection of urinary tract infections in general practice and their correlated factors. We analyzed data from the ECOGEN study on urinary tract infections, collected in France between November 2011 and April 2012. This national cross-sectional study was carried out in general practices. Data was coded according to the International Classification of Primary Care. A total of 340 consultations or home visits were held for urinary tract infections. The five most frequent diagnostic procedures were (in descending order) clinical examination (67.6%), urine cytobacteriological examination (UCBE) (47.9%), urine dipstick test (15.6%), blood test (8.5%), and imaging (6.5%). No urine dipstick test or UCBE was performed in 43% of cases. Factors correlated with diagnostic procedures were age and gender of patients, annual number of consultations held by family physicians, and duration of consultation. Family physicians did not comply with guidelines on diagnostic management for detection of urinary tract infections. We hypothesized that this non-compliance could be due to the family physicians' environment and characteristics, and to clinical practice guidelines. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  19. Effectiveness of alternative management strategies in meeting conservation objectives

    Science.gov (United States)

    Richards S. Holthausen; Carolyn Hull Sieg

    2007-01-01

    This chapter evaluates how well various management strategies meet a variety of conservation objectives, summarizes their effectiveness in meeting objectives for rare or little-known (RLK) species, and proposes ways to combine strategies to meet overall conservation objectives. We address two broad categories of management strategies. Species approaches result in...

  20. Sequencing-based breast cancer diagnostics as an alternative to routine biomarkers.

    Science.gov (United States)

    Rantalainen, Mattias; Klevebring, Daniel; Lindberg, Johan; Ivansson, Emma; Rosin, Gustaf; Kis, Lorand; Celebioglu, Fuat; Fredriksson, Irma; Czene, Kamila; Frisell, Jan; Hartman, Johan; Bergh, Jonas; Grönberg, Henrik

    2016-11-30

    Sequencing-based breast cancer diagnostics have the potential to replace routine biomarkers and provide molecular characterization that enable personalized precision medicine. Here we investigate the concordance between sequencing-based and routine diagnostic biomarkers and to what extent tumor sequencing contributes clinically actionable information. We applied DNA- and RNA-sequencing to characterize tumors from 307 breast cancer patients with replication in up to 739 patients. We developed models to predict status of routine biomarkers (ER, HER2,Ki-67, histological grade) from sequencing data. Non-routine biomarkers, including mutations in BRCA1, BRCA2 and ERBB2(HER2), and additional clinically actionable somatic alterations were also investigated. Concordance with routine diagnostic biomarkers was high for ER status (AUC = 0.95;AUC(replication) = 0.97) and HER2 status (AUC = 0.97;AUC(replication) = 0.92). The transcriptomic grade model enabled classification of histological grade 1 and histological grade 3 tumors with high accuracy (AUC = 0.98;AUC(replication) = 0.94). Clinically actionable mutations in BRCA1, BRCA2 and ERBB2(HER2) were detected in 5.5% of patients, while 53% had genomic alterations matching ongoing or concluded breast cancer studies. Sequencing-based molecular profiling can be applied as an alternative to histopathology to determine ER and HER2 status, in addition to providing improved tumor grading and clinically actionable mutations and molecular subtypes. Our results suggest that sequencing-based breast cancer diagnostics in a near future can replace routine biomarkers.

  1. Simulating the Effects of Alternative Forest Management Strategies on Landscape Structure

    Science.gov (United States)

    Eric J. Gustafson; Thomas Crow

    1996-01-01

    Quantitative, spatial tools are needed to assess the long-term spatial consequences of alternative management strategies for land use planning and resource management. We constructed a timber harvest allocation model (HARVEST) that provides a visual and quantitative means to predict the spatial pattern of forest openings produced by alternative harvest strategies....

  2. Molecular diagnostics clinical utility strategy: a six-part framework.

    Science.gov (United States)

    Frueh, Felix W; Quinn, Bruce

    2014-09-01

    The clinical utility of a molecular test rises proportional to a favorable regulatory risk/benefit assessment, and clinical utility is the driver of payer coverage decisions. Although a great deal has been written about clinical utility, debates still center on its 'definition.' We argue that the definition (an impact on clinical outcomes) is self-evident, and improved communications should focus on sequential steps in building and proving an adequate level of confidence for the diagnostic test's clinical value proposition. We propose a six-part framework to facilitate communications between test developers and health technology evaluators, relevant to both regulatory and payer decisions.

  3. Integrative Strategy for Effective Teaching of Alternating Circuits in ...

    African Journals Online (AJOL)

    One of the reasons advanced for the low enrolment and achievement of students in Physics at both secondary and post-secondary schools is poor teaching strategies used by teachers of Physics particularly in teaching Physics concepts classified by students as being difficult. In this paper, integrative strategy for effective ...

  4. Optimal diagnostic strategy for infantile cholestasis in pediatric surgery

    International Nuclear Information System (INIS)

    Kato, Hisataka; Fumino, Shigehisa; Furukawa, Taizo; Ono, Shigeru; Kimura, Osamu; Deguchi, Eiichi; Iwai, Naomi

    2011-01-01

    The initial goal in treatment for infantile cholestasis is to exclude surgical cholestasis, especially biliary atresia (BA). In this study, we retrospectively reviewed the diagnostic course of infantile cholestasis. Between 2000 and 2009, a total of 44 infants with cholestasis were referred to our department. The median age at admission was 54 days (range: 0-143 days). The medical charts of these infants were reviewed. The initial diagnostic approach was ultrasonography followed by the qualitative detection of bilirubin in stool. The 35 infants with acholic stool and/or a small or absent gallbladder on ultrasonography were subsequently examined by hepatobiliary scintigraphy (HBS). Twenty-nine infants with negative scintigraphy findings underwent intraoperative cholangiography (lOC), and BA was finally confirmed in 24 of 44. A choledochal cyst was noted in 2, Alagille syndrome in 2, cytomegalovirus infection in 2, panhypopituitarism in 2, multiple hemangiomas of the liver in 1, and cholecystolithiasis in 1. The remaining 10 infants were diagnosed as having neonatal hepatitis. The sensitivity and specificity of HBS for BA were 100% and 54.5%, respectively. HBS is a useful modality for detection of BA with a sensitivity of 100%. The indication for IOC should depend on these scan results. (author)

  5. Diagnostic imaging in oncology: New challenges and changing strategies

    International Nuclear Information System (INIS)

    Castellino, Ronald A.; Schwartz, Lawrence H.

    1997-01-01

    Diagnostic radiology and nuclear medicine studies, both imaging and therapeutic, play important roles in screening, staging, monitoring of treatment, and in long term surveillance of oncologic patients. Frequently, information from these studies, as well as from ancillary data (such as the clinical examination and laboratory studies) overlap, and it is sometimes unclear which tests and examinations to perform. Current changes in the delivery and funding of health care are prompting all specialties to evaluate their patterns of care. Some of the important questions to be addressed in medical imaging include: Which studies are pertinent at initial staging, e.g., those that impact patient management, serve as important baselines for comparison with subsequent studies, etc? How sensitive and specific are these studies, e.g., when can they obviate the need for more invasive confirmatory exams? What are the critical questions in monitoring response to therapy, e.g., the significance of the 'post treatment residual mass' and ways to elucidate its etiology? Which tests should be performed in surveillance for disease relapse, and how frequently should they be done? Purpose/Objective: To develop a set of guidelines for developing rational approaches for utilizing diagnostic imaging studies

  6. Diagnostic imaging in oncology: New challenges and changing strategies

    International Nuclear Information System (INIS)

    Castellino, Ronald; Schwartz, Lawrence H.

    1996-01-01

    Purpose/Objective: To develop a set of guidelines for developing rational approaches for utilizing diagnostic imaging studies. Diagnostic radiology and nuclear medicine studies, both imaging and therapeutic, play important roles in screening, staging, monitoring of treatment, and in long term surveillance of oncologic patients. Frequently, information from these studies, as well as from ancillary data (such as the clinical examination and laboratory studies) overlap, and it is sometimes unclear which tests and examinations to perform. Current changes in the delivery and funding of health care are prompting all specialties to evaluate their patterns of care. Some of the important questions to be addressed in medical imaging include: Which studies are pertinent at initial staging, e.g., those that impact patient management, serve as important baselines for comparison with subsequent studies, etc? How sensitive and specific are these studies, e.g., when can they obviate the need for more invasive confirmatory exams? What are the critical questions in monitoring response to therapy, e.g., the significance of the 'post treatment residual mass' and ways to elucidate its etiology? Which tests should be performed in surveillance for disease relapse, and how frequently should they be done?

  7. Pulmonary embolism. Clinical relevance, requirements for diagnostic and therapeutic strategies

    International Nuclear Information System (INIS)

    Nowak, F.G.; Halbfass, P.; Hoffmann, E.

    2007-01-01

    In the population the annual incidence of pulmonary embolism amounts to 1.3-2.8 per 1000 at the age of 65-89 years. Mortality reaches about 17% within the first 3 months. Acute pulmonary embolism is characterized by an increase in pulmonary arterial pressure and an impairment of the pulmonary gas exchange. Elevation of the right cardiac pressure up to right heart decompensation may follow. In addition, hypoxemia, hyperventilation, dead space ventilation, right to left shunting, bronchoconstriction, and vasoconstriction may occur. Clinical examination, ECG, laboratory findings such as elevated D-dimer, blood gas analysis, ultrasound examination of the veins of the lower extremities, and transthoracic echocardiography are acutely available diagnostic methods of an emergency department. In addition, extensive diagnostic procedures like pulmonary scintigraphy and pulmonary angiography may be required. The aim is to get a definite diagnosis as quickly as possible to direct therapy. In acute pulmonary embolism with cardiac shock, monitoring and stabilization of the circulatory function as well as an appropriate anticoagulant therapy are essential. In some cases surgery or a local fibrinolytic intervention is indicated. (orig.) [de

  8. 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

    2009-01-01

    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.

  9. Efficient molecular diagnostic strategy for ABCC6 in pseudoxanthoma elasticum

    NARCIS (Netherlands)

    Hu, Xiaofeng; Plomp, Astrid; Gorgels, Theo; Brink, Jacoline Ten; Loves, Willem; Mannens, Marcel; de Jong, Paulus T. V. M.; Bergen, Arthur A. B.

    2004-01-01

    Pseudoxanthoma elasticum (PXE) is a hereditary disorder of connective tissue with skin, cardiovascular, and visual involvement. In familial cases, PXE usually segregates in an autosomal recessive fashion. The aim of this manuscript is to describe an efficient strategy for DNA diagnosis of PXE. The

  10. Understanding Celiac Disease From Genetics to the Future Diagnostic Strategies

    Directory of Open Access Journals (Sweden)

    Carolina Salazar

    2017-07-01

    Full Text Available Celiac disease (CD is an autoimmune disorder characterized by the permanent inflammation of the small bowel, triggered by the ingestion of gluten. It is associated with a number of symptoms, the most common being gastrointestinal. The prevalence of this illness worldwide is 1%. One of the main problems of CD is its difficulty to be diagnosed due to the various presentations of the disease. Besides, in many cases, CD is asymptomatic. Celiac disease is a multifactorial disease, HLA-DQ2 and HLA-DQ8 haplotypes are predisposition factors. Nowadays, molecular markers are being studied as diagnostic tools. In this review, we explore CD from its basic concept, manifestations, types, current and future methods of diagnosis, and associated disorders. Before addressing the therapeutic approaches, we also provide a brief overview of CD genetics and treatment.

  11. Gestational Diabetes Mellitus: a review of current diagnostic strategies concepts

    Directory of Open Access Journals (Sweden)

    Juan Sebastián Frías-Ordoñez

    2016-10-01

    Full Text Available Gestational diabetes mellitus (GDM is a state of carbohydrate intolerance that is first recognized during pregnancy. The initial criteria for diagnosis were established more than 50 years ago by O’Sullivan & Mahan, and since then, some modifications have been made. Currently, diagnosis considers two methods: the onestep approach, consisting of an oral glucose tolerance test (OGTT for 2 hours with 75g of glucose, and the two-step approach, which involves an initial screening test with 50g of glucose and OGTT with 100g of glucose if screening is positive. Both diagnostic approaches have been justified by expert consensus; however, an absolute concept about the method to be applied has not been established yet. To select a method, the clinician must take into account various factors. This paper proposes a historical overview and the presentation of the current status of GDM diagnosis.

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

    Directory of Open Access Journals (Sweden)

    Aparicio, Miriam Teresita

    2010-12-01

    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.

  13. Strategies for adding adaptive learning mechanisms to rule-based diagnostic expert systems

    Science.gov (United States)

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

    1988-01-01

    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.

  14. Alternative Dispute Resolution: A Business (and) Communication Strategy.

    Science.gov (United States)

    Netzley, Michael

    2001-01-01

    Investigates Alternative Dispute Resolution (ADR) and its potential as a topic for business communication practice and research. Explores what ADR is; how mediation and ADR are used in business; how mediation and ADR are similar to and different from negotiating; and two or three essential learning points or skills to teach business students about…

  15. Unit Pricing and Alternatives: Developing an Individualized Shopping Strategy.

    Science.gov (United States)

    Cude, Brenda; Walker, Rosemary

    1985-01-01

    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)

  16. Alternative Strategies for Funding a General Dentistry Residency Program.

    Science.gov (United States)

    Kralewski, John E.; Wiggins, Carla

    1987-01-01

    Three alternative program funding approaches used in other professions are examined: (1) the reorientation of selected dental schools toward graduate education, (2) emphasizing and marketing the service aspects of the programs, and (3) developing education programs as in-house training for large organizations. (MSE)

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

    NARCIS (Netherlands)

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

    2014-01-01

    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

  18. Comparative Analytical Utility of DNA Derived from Alternative Human Specimens for Molecular Autopsy and Diagnostics

    Science.gov (United States)

    Klassen, Tara L.; von Rüden, Eva-Lotta; Drabek, Janice; Noebels, Jeffrey L.; Goldman, Alica M.

    2013-01-01

    Genetic testing and research have increased the demand for high-quality DNA that has traditionally been obtained by venipuncture. However, venous blood collection may prove difficult in special populations and when large-scale specimen collection or exchange is prerequisite for international collaborative investigations. Guthrie/FTA card–based blood spots, buccal scrapes, and finger nail clippings are DNA-containing specimens that are uniquely accessible and thus attractive as alternative tissue sources (ATS). The literature details a variety of protocols for extraction of nucleic acids from a singular ATS type, but their utility has not been systematically analyzed in comparison with conventional sources such as venous blood. Additionally, the efficacy of each protocol is often equated with the overall nucleic acid yield but not with the analytical performance of the DNA during mutation detection. Together with a critical in-depth literature review of published extraction methods, we developed and evaluated an all-inclusive approach for serial, systematic, and direct comparison of DNA utility from multiple biological samples. Our results point to the often underappreciated value of these alternative tissue sources and highlight ways to maximize the ATS-derived DNA for optimal quantity, quality, and utility as a function of extraction method. Our comparative analysis clarifies the value of ATS in genomic analysis projects for population-based screening, diagnostics, molecular autopsy, medico-legal investigations, or multi-organ surveys of suspected mosaicisms. PMID:22796560

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

    Directory of Open Access Journals (Sweden)

    Shigang Zhang

    2015-10-01

    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.

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

    Science.gov (United States)

    Zhang, Shigang; Song, Lijun; Zhang, Wei; Hu, Zheng; Yang, Yongmin

    2015-01-01

    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. PMID:26457709

  1. Fitting N-mixture models to count data with unmodeled heterogeneity: Bias, diagnostics, and alternative approaches

    Science.gov (United States)

    Duarte, Adam; Adams, Michael J.; Peterson, James T.

    2018-01-01

    Monitoring animal populations is central to wildlife and fisheries management, and the use of N-mixture models toward these efforts has markedly increased in recent years. Nevertheless, relatively little work has evaluated estimator performance when basic assumptions are violated. Moreover, diagnostics to identify when bias in parameter estimates from N-mixture models is likely is largely unexplored. We simulated count data sets using 837 combinations of detection probability, number of sample units, number of survey occasions, and type and extent of heterogeneity in abundance or detectability. We fit Poisson N-mixture models to these data, quantified the bias associated with each combination, and evaluated if the parametric bootstrap goodness-of-fit (GOF) test can be used to indicate bias in parameter estimates. We also explored if assumption violations can be diagnosed prior to fitting N-mixture models. In doing so, we propose a new model diagnostic, which we term the quasi-coefficient of variation (QCV). N-mixture models performed well when assumptions were met and detection probabilities were moderate (i.e., ≥0.3), and the performance of the estimator improved with increasing survey occasions and sample units. However, the magnitude of bias in estimated mean abundance with even slight amounts of unmodeled heterogeneity was substantial. The parametric bootstrap GOF test did not perform well as a diagnostic for bias in parameter estimates when detectability and sample sizes were low. The results indicate the QCV is useful to diagnose potential bias and that potential bias associated with unidirectional trends in abundance or detectability can be diagnosed using Poisson regression. This study represents the most thorough assessment to date of assumption violations and diagnostics when fitting N-mixture models using the most commonly implemented error distribution. Unbiased estimates of population state variables are needed to properly inform management decision

  2. Flipped Classroom as an Alternative Strategy for Teaching Stoichiometry

    OpenAIRE

    Norrie E. Gayeta

    2017-01-01

    This study aimed to compare the effectiveness of flipped classroom and traditional classroom instruction in measuring conceptual change and to determine if flipped classroom instruction would be an alternative method of teaching to traditional lecture method. This study covered the level of conceptual understanding of students on stoichiometry and the type of conceptual change before and after exposure to flipped and traditional classroom environment. Qualitative and quantitative ...

  3. Diagnostic strategy for occult hepatitis B virus infection

    Science.gov (United States)

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

    2011-01-01

    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. PMID:21472120

  4. 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)

    2002-09-01

    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.)

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

    International Nuclear Information System (INIS)

    Marincek, B.

    2002-01-01

    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.)

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

    Directory of Open Access Journals (Sweden)

    Carolina Prevaldi

    2009-02-01

    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.

  7. Economic Impact Assessment of Alternative Climate Policy Strategies

    International Nuclear Information System (INIS)

    Kemfert, C.

    2001-10-01

    This paper investigates the world economic implications of climate change policy strategies, especially the evaluation of impacts by an implementation of Clean Development Mechanisms, Joint Implementation and Emissions trading with a world integrated assessment model. Of special interest in this context are the welfare spill over and competitiveness effects that result from diverse climate policy strategies. In particular, this study elaborates and compares multi gas policy strategies and explores the impacts of the inclusion of sinks. Because of the recent decision of an isolated climate policy strategy by the United States of America, we examine the economic impacts of all world regions by a non cooperative and free rider position of the USA. It turns out that Clean Development Mechanisms and Joint Implementation show evidence of improvement in the economic development in the host countries and increase the share of new applied technologies. The decomposition of welfare effects demonstrates that the competitiveness effect including the spill over effects from trade have the strongest importance because of the intense trade relations between countries. Climatic effects have a significant impact within the next 50 years, cause considerable welfare losses to world regions and will intensify if some highly responsible nations like the USA do not reduce their emissions

  8. Nonequilibrium relaxation method – An alternative simulation strategy

    Indian Academy of Sciences (India)

    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 ...

  9. How does a change in the control room design affect diagnostic strategies in nuclear power plants?

    International Nuclear Information System (INIS)

    Kim, Dong Young; Kim, Jonghyun

    2014-01-01

    Recently, main control rooms have been considerably changed by modern computer techniques. Some of the features that distinguish digital control rooms from conventional, analog rooms in nuclear power plants include advanced alarm systems, graphic information display systems, computerized procedure systems, and soft control. These features can bring changes in operator tasks, changing the characteristics of tasks or creating new tasks for operators. It is especially expected that these features may bring out changes in the operator's diagnostic tasks and strategies in a digital control room as compared with an analog control room. This study investigates the differences in the operator's diagnostic tasks and strategies in analog and digital control rooms. This study also attempts to evaluate how new systems in a digital control room affect diagnostic strategies. Three different approaches, which are complementary, are used to identify diagnostic strategies in the digital control room and in the analog control room: (1) observation in the simulator, (2) interview with operators, and (3) a literature review. The results show that the digital control room introduces new diagnosis strategies compared with the analog control room while also changing the characteristics of the strategies, mostly by gaining more support from the computerized system. (author)

  10. Strategies for Optimizing the Diagnostic Predictive Value of Clostridium difficile Molecular Diagnostics.

    Science.gov (United States)

    Kociolek, Larry K

    2017-05-01

    Because nucleic acid amplification tests (NAATs) do not distinguish Clostridium difficile infection (CDI) and asymptomatic C. difficile carriage, the diagnostic predictive value of NAATs is limited when used in patients with a low probability of CDI. In this issue of the Journal of Clinical Microbiology , Truong et al. (J. Clin. Microbiol., 55:1276-1284, 2017, https://doi.org/10.1128/JCM.02319-16) report significant reductions in hospital-onset CDI and oral vancomycin utilization at their institution following implementation of a novel intervention that leveraged their clinical bioinformatics resources to prevent C. difficile testing of stools from patients without clinically significant diarrhea and in patients with recent laxative use. Copyright © 2017 American Society for Microbiology.

  11. The clinical inadequacy of the DSM-5 classification of somatic symptom and related disorders: an alternative trans-diagnostic model.

    Science.gov (United States)

    Cosci, Fiammetta; Fava, Giovanni A

    2016-08-01

    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.

  12. A one-versus-all class binarization strategy for bearing diagnostics of concurrent defects.

    Science.gov (United States)

    Ng, Selina S Y; Tse, Peter W; Tsui, Kwok L

    2014-01-13

    In bearing diagnostics using a data-driven modeling approach, a concern is the need for data from all possible scenarios to build a practical model for all operating conditions. This paper is a study on bearing diagnostics with the concurrent occurrence of multiple defect types. The authors are not aware of any work in the literature that studies this practical problem. A strategy based on one-versus-all (OVA) class binarization is proposed to improve fault diagnostics accuracy while reducing the number of scenarios for data collection, by predicting concurrent defects from training data of normal and single defects. The proposed OVA diagnostic approach is evaluated with empirical analysis using support vector machine (SVM) and C4.5 decision tree, two popular classification algorithms frequently applied to system health diagnostics and prognostics. Statistical features are extracted from the time domain and the frequency domain. Prediction performance of the proposed strategy is compared with that of a simple multi-class classification, as well as that of random guess and worst-case classification. We have verified the potential of the proposed OVA diagnostic strategy in performance improvements for single-defect diagnosis and predictions of BPFO plus BPFI concurrent defects using two laboratory-collected vibration data sets.

  13. A One-Versus-All Class Binarization Strategy for Bearing Diagnostics of Concurrent Defects

    Directory of Open Access Journals (Sweden)

    Selina S. Y. Ng

    2014-01-01

    Full Text Available In bearing diagnostics using a data-driven modeling approach, a concern is the need for data from all possible scenarios to build a practical model for all operating conditions. This paper is a study on bearing diagnostics with the concurrent occurrence of multiple defect types. The authors are not aware of any work in the literature that studies this practical problem. A strategy based on one-versus-all (OVA class binarization is proposed to improve fault diagnostics accuracy while reducing the number of scenarios for data collection, by predicting concurrent defects from training data of normal and single defects. The proposed OVA diagnostic approach is evaluated with empirical analysis using support vector machine (SVM and C4.5 decision tree, two popular classification algorithms frequently applied to system health diagnostics and prognostics. Statistical features are extracted from the time domain and the frequency domain. Prediction performance of the proposed strategy is compared with that of a simple multi-class classification, as well as that of random guess and worst-case classification. We have verified the potential of the proposed OVA diagnostic strategy in performance improvements for single-defect diagnosis and predictions of BPFO plus BPFI concurrent defects using two laboratory-collected vibration data sets.

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

    DEFF Research Database (Denmark)

    Meyer, Otto A.

    2003-01-01

    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...... uses and of the absence of health problems involved with their use. Thus, the regulatory toxicology is a cocktail of science and pragmatism added a crucial concern for animal welfare. Test methods are most often used in a testing sequence as bricks in a testing strategy. The main key driving forces...

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

    DEFF Research Database (Denmark)

    Vester, Steen

    2013-01-01

    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....

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

    Science.gov (United States)

    Fang, J. M.; Tawil, J.

    1980-12-01

    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 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) Building Energy Performance Standards (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.

  17. Diagnostic approach and management strategy of childhood stroke

    International Nuclear Information System (INIS)

    Salih, Mustafa A.; Abdel-Gader, Abdel-Galil M.

    2006-01-01

    Prompt recognition and early intervention, with pertinent management and medication, may reduce subsequent neurologic deficits in stroke, which constitutes a devastating event in children. This is due to the tasking and demanding consequences including death or residual neurological deficits, which may last for many decades, in over 60% of survivors. Evidence based treatment for children with stroke is still lacking, reflecting scarcity in base line epidemiological data on pediatric stroke, the multitude of underlying risk factors, and ethical and practical challenges incurred in conducting clinical trials. Based on the experience we gained from a combined a combined prospective and retrospective study on childhood stroke (covering 10 years and 7 months and involving a cohort of 104 Saudi children), a diagnostic algorithm, which outlines the approach to a child with suspected stroke/cerebovascular lesion was designed. This algorithm might also be of use for managing other children with stroke from the Arabian Peninsula and Middle East Region with similar demographic, socioeconomic, and ethnic backgrounds. Underlying risk factors which need special attention, include thrombophilia and hypercoagulable states and sickle cell diseases (SCD), which contrary to previous studies from Saudi Arabia, were found to constitute a common risk factor with severe manifestations. Other risk factors include infections (especially neurobrucellosis), cardiac diseases, and hypernatremic dehydration. Recognition of an identifiable syndrome or inherited metabolic cause may unravel an underlying cerebovascular disease. This is particularly important in this region, given the large pool of autosomal recessive diseases and the high rate of consanguinity. In the evaluation of a suspected case of stroke, important imaging modalities include cranial CT, MRI (including diffusion-weighted images), magnetic resonance angiography (MRA), magnetic resonance venography (MRV) and conventional

  18. Strategy for development modes competent performance in teachers qualified alternative

    Directory of Open Access Journals (Sweden)

    Sailí Rodríguez Fuentes

    2017-12-01

    Full Text Available Introduction: the process of professionalization of the teacher is a subject of contemporary conjuncture, which is debated and investigated by researchers from dissimilar edges. Objective: to contribute to the professionalization process of qualified teachers of Technical and Vocational Education through a pedagogical strategy. Materials and methods: The materialist dialectic is used as a general method, allowing the study of the object as a process, the determination of its components, as well as its contradictions. theoretical methods: the historical and logical to delve into the regularities and qualities of reality in the polytechnic centers. Essential empirical methods were used: the documentary analysis that included the professional model; study plans, to obtain authentic and reliable information for research, interviews with students with the purpose of analyzing the manifestations of the professionalization process of the students and the direction of the process by the teachers, the observation of teaching activities allowed to diagnose the object , the demonstration of the problem, as well as the results of the practice of the strategy to be implemented. Results: a pedagogical strategy is designed and implemented to perfect the competent professional performance modes in the qualified professors. Conclusions: it contributed to the improvement of the professionalization process in favor of the competent professional modes of action.

  19. Flipped Classroom as an Alternative Strategy for Teaching Stoichiometry

    Directory of Open Access Journals (Sweden)

    Norrie E. Gayeta

    2017-11-01

    Full Text Available This study aimed to compare the effectiveness of flipped classroom and traditional classroom instruction in measuring conceptual change and to determine if flipped classroom instruction would be an alternative method of teaching to traditional lecture method. This study covered the level of conceptual understanding of students on stoichiometry and the type of conceptual change before and after exposure to flipped and traditional classroom environment. Qualitative and quantitative research methods were used in the study. Respondents were two sections of third year Bachelor of Secondary Education, Biological Science. Frequency, percentage, ranking, mean, standard deviation, Hake factor test, and t-test were the statistical tools applied to answer specific questions. Results showed profound increase towards conceptual change representing a shift from intuitive understanding to correct incomplete understanding level. Thus, change for the better, in theoretical type was determined from pretest to posttest of students exposed to flipped and traditional classroom. Results also indicated that there is no significant difference on students’ conceptual change on stoichiometry exposed to flipped and traditional classroom environment thus, flipped classroom instruction can be used as an alternative teaching method to traditional lecture method in teaching stoichiometry

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

    Directory of Open Access Journals (Sweden)

    Frederic eLamoth

    2015-02-01

    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.

  1. Evaluating alternative offering strategies for wind producers in a pool

    International Nuclear Information System (INIS)

    Rahimiyan, Morteza; Morales, Juan M.; Conejo, Antonio J.

    2011-01-01

    Highlights: → Out-of-sample analysis allows comparing diverse offers using real-world data. → Offering the best production forecast is not optimal for a wind producer. → Stochastic programming offers lead to maximum expected profit. → Offering the best production forecast is not generally optimal for risk control. → Stochastic programming offers lead to the best tradeoff profit versus risk. -- Abstract: As wind power technology matures and reaches break-even cost, wind producers find it increasingly attractive to participate in pool markets instead of being paid feed-in tariffs. The key issue is then how a wind producer should offer in the pool markets to achieve maximum profit while controlling the variability of such profit. This paper compares two families of offering strategies based, respectively, on a naive use of wind production forecasts and on stochastic programming models. These strategies are compared through a comprehensive out-of-sample chronological analysis based on real-world data. A number of relevant conclusions are then duly drawn.

  2. Using a Multi-Tier Diagnostic Test to Explore the Nature of Students' Alternative Conceptions on Reaction Kinetics

    Science.gov (United States)

    Yan, Yaw Kai; Subramaniam, R.

    2018-01-01

    This study focused on grade 12 students' understanding of reaction kinetics. A 4-tier diagnostic instrument was developed for this purpose and administered to 137 students in the main study. Findings showed that reaction kinetics is a difficult topic for these students, with a total of 25 alternative conceptions (ACs) being uncovered. Except for…

  3. Development and Assessment of a Diagnostic Tool to Identify Organic Chemistry Students' Alternative Conceptions Related to Acid Strength

    Science.gov (United States)

    McClary, LaKeisha M.; Bretz, Stacey Lowery

    2012-01-01

    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…

  4. Improving the Functional Diagnostic Process using Dynamic Master Logic Diagram (DMLD) Modeling Strategy

    International Nuclear Information System (INIS)

    Mohamed, A.H.

    2008-01-01

    In recent years, state based functional diagnostic systems have gained a growing attention among the model based diagnostic systems. They have been used to diagnose the new faults of the complex systems. On the other hand, a main point considered against it is its subjective, and the inability of reusing the knowledge gathered from one engineer by others. Different methods have been' suggested to solve these problems. In the same way, the suggested functional diagnostic system introduces the uses of Dynamic Master Logic Diagram (DMLD) modeling strategy for the functional diagnostic systems. DMLD has proven its power as a good modeling strategy. It can model the functions of the system's components in terms of a set of defined primitives for the domain of applications. However, the suggested system can use the DMLD technique to model the small functions of the system according to the defined primitives of its domain. So, the modeling process of the system is relatively invariant from one modeler to another. Also, the functions defined can be reused by other users in the domain for solving different problems. Besides, it can deal with the complex system in a flexible manner. Thus, the proposed system can improve the performance of the state based functional diagnostic systems. It can be applied for a wide area of the complex systems. It has been applied for a fluid system as a case of the real-time systems. The suggested system has proved its success as a powerful practical state based functional diagnostic system

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

    International Nuclear Information System (INIS)

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

    2007-01-01

    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

  6. 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)

    2007-11-15

    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.

  7. [Chest pain in the emergency department : Differential diagnosis and diagnostic strategy].

    Science.gov (United States)

    Köhnlein, T

    2017-01-01

    Chest pain as the leading symptom in emergency patients can have numerous causes and requires an immediate and targeted diagnostic and therapeutic strategy. Clinical scoring systems facilitate risk assessment for individual patients. In the emergency department, critical factors for success are defined professional qualification standards for physicians and nursing staff combined with a well-functioning organization of all technical procedures.

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

    Energy Technology Data Exchange (ETDEWEB)

    Bergeson, C.L.

    1994-09-30

    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.

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

    International Nuclear Information System (INIS)

    Bergeson, C.L.

    1994-01-01

    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

  10. Alternative IT Sourcing Strategies: From the Campus to the Cloud. ECAR Key Findings

    Science.gov (United States)

    Goldstein, Philip J.

    2009-01-01

    This document presents the key findings from the 2009 ECAR (EDUCAUSE Center for Applied Research) study, "Alternative IT Sourcing Strategies: From the Campus to the Cloud," by Philip J. Goldstein. The study explores a multitude of strategies used by colleges and university information technology organizations to deliver the breadth of technologies…

  11. Diagnostics

    DEFF Research Database (Denmark)

    Donné, A.J.H.; Costley, A.E.; Barnsley, R.

    2007-01-01

    of the measurements—time and spatial resolutions, etc—will in some cases be more stringent. Many of the measurements will be used in the real time control of the plasma driving a requirement for very high reliability in the systems (diagnostics) that provide the measurements. The implementation of diagnostic systems...... on ITER is a substantial challenge. Because of the harsh environment (high levels of neutron and gamma fluxes, neutron heating, particle bombardment) diagnostic system selection and design has to cope with a range of phenomena not previously encountered in diagnostic design. Extensive design and R......&D is needed to prepare the systems. In some cases the environmental difficulties are so severe that new diagnostic techniques are required. The starting point in the development of diagnostics for ITER is to define the measurement requirements and develop their justification. It is necessary to include all...

  12. Alternative Testing Strategies for Nanomaterials: State of the Science and Considerations for Risk Analysis.

    Science.gov (United States)

    Shatkin, J A; Ong, K J

    2016-08-01

    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. © 2016 Society for Risk Analysis.

  13. Recurrent unexplained palpitations (RUP) study comparison of implantable loop recorder versus conventional diagnostic strategy.

    Science.gov (United States)

    Giada, Franco; Gulizia, Michele; Francese, Maura; Croci, Francesco; Santangelo, Lucio; Santomauro, Maurizio; Occhetta, Eraldo; Menozzi, Carlo; Raviele, Antonio

    2007-05-15

    The aim of the study was to compare the diagnostic yield and the costs of implantable loop recorder (ILR) with those of the conventional strategy in patients with unexplained palpitations. In patients with unexplained palpitations, especially in those with infrequent symptoms, the conventional strategy, including short-term ambulatory electrocardiogram (ECG) monitoring and electrophysiological study, sometimes fails to establish a diagnosis. We studied 50 patients with infrequent (1 min) palpitations. Before enrollment, patients had a negative initial evaluation, including history, physical examination, and ECG. Patients were randomized either to conventional strategy (24-h Holter recording, a 4-week period of ambulatory ECG monitoring with an external recorder, and electrophysiological study) (n = 24) or to ILR implantation with 1-year monitoring (n = 26). Hospital costs of the 2 strategies were calculated. A diagnosis was obtained in 5 patients in the conventional strategy group, and in 19 subjects in the ILR group (21% vs. 73%, p < 0.001). Despite the higher initial cost, the cost per diagnosis in the ILR group was lower than in the conventional strategy group (euro 3,056 +/- euro 363 vs. euro 6,768 +/- euro 6,672, p = 0.012). In subjects without severe heart disease and with infrequent palpitations, ILR is a safe and more cost-effective diagnostic approach than conventional strategy.

  14. Impulse oscillometry system as an alternative diagnostic method for chronic obstructive pulmonary disease.

    Science.gov (United States)

    Wei, Xia; Shi, Zhihong; Cui, Yajuan; Mi, Jiuyun; Ma, Zhengquan; Ren, Jingting; Li, Jie; Xu, Shudi; Guo, Youmin

    2017-11-01

    We aimed to compare impulse oscillation system (IOS) and traditional pulmonary function tests (PFTs) for the assessment of the severity of chronic obstructive pulmonary disease (COPD), and to assess the use of IOS parameters to identify patients who were forced expiratory volume in 1 second (FEV1)%pred IOS. Diagnostic performance of IOS parameters to determine indication for patients of FEV1%pred operating characteristics (ROC) curve analysis.Out of 215 patients, 18, 83, 78, and 36 patients were classified as grade 1, 2, 3, and 4, respectively, according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity grading. On Spearman correlation analysis, FEV1%pred, MMEF 75%-25%, and residual volume/total lung capacity (RV/TLC) correlated with total respiratory impedance (Z5)%pred, resistance at 5 Hz (R5)-resistance at 20 Hz (R20), R5-R20% R5, R5, R5%pred, frequency response (Fres), reactance area (Ax), and reactance at 5 Hz (X5). On ROC curve analysis, the area under the curve (AUC) of X5 absolute value, Fres, Ax, Z5%pred, R5-R20, and R5-R20% R5 were 0.748, 0.755, 0.760, 0.705, 0.715, and 0.735, respectively, for COPD patients who required inhalational glucocorticoid therapy.IOS parameters showed a good correlation with traditional pulmonary function parameters; reactance parameters showed a stronger correlation than that of the resistance parameters. IOS can be used as an alternative method for pulmonary function assessment in patients with COPD with FEV1%pred < 50% who need inhalational glucocorticoid therapy. ChiCTR-OCH-14004904.

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

    Directory of Open Access Journals (Sweden)

    Gabrielle C Hunter

    2012-01-01

    Full Text Available 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.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.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.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 epidemiology that emerges during screening is key to

  16. A Field Trial of Alternative Targeted Screening Strategies for Chagas Disease in Arequipa, Peru

    Science.gov (United States)

    Hunter, Gabrielle C.; Borrini-Mayorí, Katty; Ancca Juárez, Jenny; Castillo Neyra, Ricardo; Verastegui, Manuela R.; Malaga Chavez, Fernando S.; Cornejo del Carpio, Juan Geny; Córdova Benzaquen, Eleazar; Náquira, César; Gilman, Robert H.; Bern, Caryn; Levy, Michael Z.

    2012-01-01

    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 epidemiology that

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

    Science.gov (United States)

    Gabriel, Adel; Violato, Claudio

    2013-01-01

    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. 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. 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. 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.

  18. Perspectives on diagnostic strategies for hyperglycemia in pregnancy - dealing with the barriers and challenges in China.

    Science.gov (United States)

    Wei, Yumei; Yang, Huixia

    2018-04-18

    Hyperglycemia is one of the most common medical conditions women encounter during pregnancy. Hyperglycemia in pregnancy (HIP) is an issue of increasing concern to both obstetricians and administrators and it brings health issues for both mothers and offspring, not only early complications, but also long-term effects. HIP may either have been pre-gestational diabetes mellitus (pGDM), or gestational diabetes mellitus (GDM). After two-child policy fully carried out in China, the incidence of HIP would be increased further. There are many important issues such as the high prevalence of DM misdiagnosis, the diagnostic criteria of GDM, the strategies of GDM management in China need to deal with. We would focus on the barriers and challenges of diagnostic strategies for hyperglycemia in pregnancy in China. Copyright © 2018. Published by Elsevier B.V.

  19. Application of the Systematic Sensor Selection Strategy for Turbofan Engine Diagnostics

    Science.gov (United States)

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

    2008-01-01

    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.

  20. Muscle diseases with prominent joint contractures: Main entities and diagnostic strategy.

    Science.gov (United States)

    Eymard, B; Ferreiro, A; Ben Yaou, R; Stojkovic, T

    2013-01-01

    Muscle diseases may have various clinical manifestations including muscle weakness, atrophy or hypertrophy and joint contractures. A spectrum of non-muscular manifestations (cardiac, respiratory, cutaneous, central and peripheral nervous system) may be associated. Few of these features are specific. Limb joint contractures or spine rigidity, when prevailing over muscle weakness in ambulant patients, are of high diagnostic value for diagnosis orientation. Within this context, among several disorders, four groups of diseases should systematically come to mind including the collagen VI-related myopathies, the Emery-Dreifuss muscular dystrophies, the SEPN1 and FHL1 related myopathies. More rarely other genetic or acquired myopathies may present with marked contractures. Diagnostic work-up should include a comprehensive assessment including family history, neurological, cardiologic and respiratory evaluations. Paraclinical investigations should minimally include muscle imaging and electromyography. Muscle and skin biopsies as well as protein and molecular analyses usually help to reach a precise diagnosis. We will first describe the main muscle and neuromuscular junction diseases where contractures are typically a prominent symptom of high diagnostic value for diagnosis orientation. In the following chapters, we will present clues for the diagnostic strategy and the main measures to be taken when, at the end of the diagnostic work-up, no definite muscular disease has been identified. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  1. Are value of information methods ready for prime time? An application to alternative treatment strategies for NSTEMI patients.

    Science.gov (United States)

    Kent, Seamus; Briggs, Andrew; Eckermann, Simon; Berry, Colin

    2013-10-01

    The use of value of information methods to inform trial design has been widely advocated but there have been few empirical applications of these methods and there is little evidence they are widely used in decision making. This study considers the usefulness of value of information models in the context of a real clinical decision problem relating to alternative diagnostic strategies for patients with a recent non-ST elevated myocardial infarction. A pretrial economic model is constructed to consider the cost-effectiveness of two competing strategies: coronary angiography alone or in conjunction with fractional flow reserve measurement. A closed-form solution to the expected benefits of information is used with optimal sample size estimated for a range of models reflecting increasingly realistic assumptions and alternative decision contexts. Fractional flow reserve measurement is expected to be cost-effective with an incremental cost-effectiveness ratio of GBP 1,621, however, there is considerable uncertainty in this estimate and consequently a large expected value to reducing this uncertainty via a trial. The recommended sample size is strongly affected by the reality of the assumptions of the expected value of information (EVI) model and the decision context. Value of information models can provide a simple and flexible approach to clinical trial design and are more consistent with the constraints and objectives of the healthcare system than traditional frequentist approaches. However, the variation in sample size estimates demonstrates that it is essential that appropriate model parameters and decision contexts are used in their application.

  2. Baseline energy forecasts and analysis of alternative strategies for airline fuel conservation

    Energy Technology Data Exchange (ETDEWEB)

    1976-01-01

    The objectives of this study were to identify measures to reduce airline fuel consumption and to evaluate the impact of these alternatives on fuel consumption through 1990. To evaluate the impact of fuel conservation strategies, baseline forecasts of airline activity and energy consumption to 1990 were developed. Alternative policy options to reduce fuel consumption were identified and analyzed for three baseline levels of aviation activity within the framework of an aviation activity/energy consumption model. By combining the identified policy options, a strategy was developed to provide incentives for airline fuel conservation. Strategies and policy options were evaluated in terms of their impact on airline fuel conservation and the functioning of the airline industry as well as the associated social, environmental, and economic costs. The need for strategies to conserve airline fuel is based on air transportation's dependence upon petroleum; the current lack of alternative energy sources; the potential for disruption of air service due to crises in fuel availability such as experienced during the OPEC oil embargo; and the overall national goal of energy independence through energy conservation in all consuming sectors. The transition from the current situation to that described by strategies and policy options may require difficult adjustments by the airline industry in the short term. In the long term, however, conservation strategies can enhance the health of the airline industry as well as its fuel efficiency.

  3. Disciplinary Practices in Schools and Principles of Alternatives to Corporal Punishment Strategies

    Science.gov (United States)

    Moyo, George; Khewu, Noncedo P. D.; Bayaga, Anass

    2014-01-01

    The aim of the study was to determine the consistency prevailing between the disciplinary practices in the schools and the principles of the Alternatives-to-Corporal Punishment strategy. The three main research questions that guided the study were to determine (1) How much variance of offences can be explained by disciplinary measures of…

  4. Training Pragmatic Language Skills through Alternate Strategies with a Blind Multiply Handicapped Child.

    Science.gov (United States)

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

    1988-01-01

    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…

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

    Science.gov (United States)

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

    2016-01-01

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

  6. Alternative Teaching Strategies; Helping Behaviorally Troubled Children Achieve. A Guide for Teachers and Psychologists.

    Science.gov (United States)

    Swift, Marshall S.; Spivack, George

    This book provides (1) specific information about overt classroom behaviors that affect or reflect academic success or failure, and (2) information and suggestions about alternative teaching strategies that may be used to increase behavioral effectiveness and subsequent academic achievement. The focus of the book is on specific behaviors, behavior…

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

    NARCIS (Netherlands)

    R.T. Mankowski (Robert Tomasz)

    2015-01-01

    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

  8. A rational analysis of alternating search and reflection strategies in problem solving

    NARCIS (Netherlands)

    Taatgen, N; Shafto, MG; Langley, P

    1997-01-01

    In this paper two approaches to problem solving, search and reflection, are discussed, and combined in two models, both based on rational analysis (Anderson, 1990). The first model is a dynamic growth model, which shows that alternating search and reflection is a rational strategy. The second model

  9. Coupling Cover Crops with Alternative Swine Manure Application Strategies: Manure-15N Tracer Studies

    Science.gov (United States)

    Integration of rye cover crops with alternative liquid swine (Sus scrofa L.) manure application strategies may enhance retention of manure N in corn (Zea mays L.) - soybean [Glycine max (L.) Merr] cropping systems. The objective of this study was to quantify uptake of manure derived-N by a rye (Seca...

  10. Strategies Reported Used by Instructors to Address Student Alternate Conceptions in Chemical Equilibrium

    Science.gov (United States)

    Piquette, Jeff S.; Heikkinen, Henry W.

    2005-01-01

    This study explores general-chemistry instructors' awareness of and ability to identify and address common student learning obstacles in chemical equilibrium. Reported instructor strategies directed at remediating student alternate conceptions were investigated and compared with successful, literature-based conceptual change methods. Fifty-two…

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

    Science.gov (United States)

    Aghaei Hashjin, Asgar; Kringos, Dionne; Ravaghi, Hamid; Manoochehri, Jila; Gorji, Hassan Abolghasem; Klazinga, Niek S.

    2015-01-01

    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

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

    Science.gov (United States)

    Aghaei Hashjin, Asgar; Kringos, Dionne; Ravaghi, Hamid; Manoochehri, Jila; Gorji, Hassan Abolghasem; Klazinga, Niek S

    2015-05-20

    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. A descriptive cross-sectional study was conducted in 2009/2010. Data were collected from 554 DCSS units among 84 hospitals. 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. 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 strategies in practice, and the application of

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

    Directory of Open Access Journals (Sweden)

    Asgar Aghaei Hashjin

    2015-10-01

    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

  14. Baseline energy forecasts and analysis of alternative strategies for airline fuel conservation

    Energy Technology Data Exchange (ETDEWEB)

    1976-07-01

    To evaluate the impact of fuel conservation strategies, baseline forecasts of airline activity and energy consumption to 1990 were developed. Alternative policy options to reduce fuel consumption were identified and analyzed for three baseline levels of aviation activity within the framework of an aviation activity/energy consumption model. By combining the identified policy options, a strategy was developed to provide incentives for airline fuel conservation. Strategies and policy options were evaluated in terms of their impact on airline fuel conservation and the functioning of the airline industry as well as the associated social, environmental, and economic costs. (GRA)

  15. Use of augmentative and alternative communication strategies by family members in the intensive care unit.

    Science.gov (United States)

    Broyles, Lauren M; Tate, Judith A; Happ, Mary Beth

    2012-03-01

    Little is known about communication between patients and their family members during critical illness and mechanical ventilation in the intensive care unit, including use of augmentative and alternative communication tools and strategies. To identify (1) which augmentative and alternative communication tools families use with nonspeaking intensive care patients and how they are used, and (2) what families and nurses say about communication of family members with nonspeaking intensive care patients. A qualitative secondary analysis was conducted of existing data from a clinical trial testing interventions to improve communication between nurses and intensive care patients. Narrative study data (field notes, intervention logs, nurses' interviews) from 127 critically ill adults were reviewed for evidence of family involvement with augmentative and alternative communication tools. Qualitative content analysis was applied for thematic description of family members' and nurses' accounts of patient-family communication. Family involvement with augmentative and alternative communication tools was evident in 44% of the 93 patients who completed the parent study protocol. Spouses or significant others communicated with patients most often. Main themes describing patient-family communication included (1) families being unprepared and unaware, (2) families' perceptions of communication effectiveness, (3) nurses deferring to or guiding patient-family communication, (4) patients' communication characteristics, and (5) families' experience with and interest in augmentative and alternative communication tools. Assessment by skilled bedside clinicians can reveal patients' communication potential and facilitate useful augmentative and alternative communication tools and strategies for patients and their families.

  16. Cost-effectiveness of diagnostic-therapeutic strategies for paediatric visceral leishmaniasis in Morocco.

    Science.gov (United States)

    Alonso, Sergi; Tachfouti, Nabil; Najdi, Adil; Sicuri, Elisa; Picado, Albert

    2017-01-01

    Visceral leishmaniasis (VL) is a neglected parasitic disease with a high fatality rate if left untreated. Endemic in Morocco, as well as in other countries in the Mediterranean basin, VL mainly affects children living in rural areas. In Morocco, the direct observation of Leishmania parasites in bone marrow (BM) aspirates is used to diagnose VL and meglumine antimoniate (SB) is the first line of treatment. Less invasive, more efficacious and safer alternatives exist. In this study we estimate the cost-effectiveness of alternative diagnostic-therapeutic algorithms for paediatric VL in Morocco. A decision tree was used to estimate the cost-effectiveness of using BM or rapid diagnostic tests (RDTs) as diagnostic tools and/or SB or two liposomal amphotericin B (L-AmB) regimens: 6-day and 2-day courses to treat VL. Incremental cost-effectiveness ratios, expressed as cost per death averted, were estimated by comparing costs and effectiveness of the alternative algorithms. A threshold analysis evaluated at which price L-AmB became cost-effective compared with current practices. Implementing RDT and/or L-AmB treatments would be cost-effective in Morocco according to the WHO thresholds. Introducing the 6-day course L-AmB, current second-line treatment, would be highly cost-effective if L-AmB price was below US$100/phial. The 2-day L-AmB treatment, current standard treatment of paediatric VL in France, is highly cost-effective, with L-AmB at its market price (US$165/phial). The results of this study should encourage the implementation of RDT and/or short-course L-AmB treatments for paediatric VL management in Morocco and other North African countries.

  17. Polygyny, mate-guarding, and posthumous fertilization as alternative male mating strategies.

    Science.gov (United States)

    Zamudio, K R; Sinervo, B

    2000-12-19

    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.

  18. The U.S. Marine Corps Combined Action Program (CAP): A Proposed Alternative Strategy for the Vietnam War

    National Research Council Canada - National Science Library

    Williamson, Curtis

    2002-01-01

    .... The CAP offered a viable alternative to the strategy taken in Vietnam, challenging the sustaining infrastructure of the guerrilla, while providing security for the largely agrarian populace. Discussion...

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

    Directory of Open Access Journals (Sweden)

    Z. Poh

    2012-01-01

    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.

  20. Disciplinary practices in schools and principles of alternatives to corporal punishment strategies

    Directory of Open Access Journals (Sweden)

    George Moyo

    2014-01-01

    Full Text Available The aim of the study was to determine the consistency prevailing between the disciplinary practices in the schools and the principles of the Alternatives-to-Corporal Punishment strategy. The three main research questions that guided the study were to determine (1 How much variance of offences can be explained by disciplinary measures of alternative corporal punishment? (2 How well do the different measures of alternative corporal punishment predict offences? (3 Which is the best predictor of offences given a set of alternative measures? Twenty-nine schools participated in the survey andfive schools participated in the case study, so the achieved sample was 34 schools. From the 29 survey schools, one principal and one Life Orientation (LO teacher participated. All in all 58 people participated. The results revealed that 66.60% of the variation in the offence of vandalism was explained by the predictors. When vandalism was predicted it was found that School identification (p = .693, p .05. The results reveal that there was no established consistency between the disciplinary practices in the schools and the principles of the alternatives-to-corporal punishment strategy.

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

    Directory of Open Access Journals (Sweden)

    Raluca Diac Andreea

    2015-09-01

    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.

  2. Subgroup report on alternative technology strategies for the isolation of nuclear waste

    International Nuclear Information System (INIS)

    1978-10-01

    The purpose of this report is to provide information to support programmatic approaches to the disposal of high-level and transuranic-contaminated (TRU) wastes. For this purpose the report describes, in Appendices A through F, the state of knowledge relevant to selected nuclear waste disposal technologies. Within the main report a number of alternative technological strategies that could lead to a disposal facility are specified for illustrative and analytical purposes. These strategies span a wide range of variations of technological emphasis and programmatic diversity. Selected implications of these strategies are analyzed. In addition, subjects such as technical conservatism, retrievability, and intermediate scale facilities, that apply to any strategy, are examined and implications of each are discussed

  3. A systematic review and economic evaluation of diagnostic strategies for Lynch syndrome.

    Science.gov (United States)

    Snowsill, Tristan; Huxley, Nicola; Hoyle, Martin; Jones-Hughes, Tracey; Coelho, Helen; Cooper, Chris; Frayling, Ian; Hyde, Chris

    2014-09-01

    Lynch syndrome (LS) is an inherited autosomal dominant disorder characterised by an increased risk of colorectal cancer (CRC) and other cancers, and caused by mutations in the deoxyribonucleic acid (DNA) mismatch repair genes. To evaluate the accuracy and cost-effectiveness of strategies to identify LS in newly diagnosed early-onset CRC patients (aged strategies for individuals in whom LS is identified. Systematic reviews were conducted of the test accuracy of microsatellite instability (MSI) testing or immunohistochemistry (IHC) in individuals with CRC at risk of LS, and of economic evidence relating to diagnostic strategies for LS. Reviews were carried out in April 2012 (test accuracy); and in February 2012, repeated in February 2013 (economic evaluations). Databases searched included MEDLINE (1946 to April week 3, 2012), EMBASE (1980 to week 17, 2012) and Web of Science (inception to 30 April 2012), and risk of bias for test accuracy was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) quality appraisal tool. A de novo economic model of diagnostic strategies for LS was developed. Inconsistencies in study designs precluded pooling of diagnostic test accuracy results from a previous systematic review and nine subsequent primary studies. These were of mixed quality, with significant methodological concerns identified for most. IHC and MSI can both play a part in diagnosing LS but neither is gold standard. No UK studies evaluated the cost-effectiveness of diagnosing and managing LS, although studies from other countries generally found some strategies to be cost-effective compared with no testing. The de novo model demonstrated that all strategies were cost-effective compared with no testing at a threshold of £20,000 per quality-adjusted life-year (QALY), with the most cost-effective strategy utilising MSI and BRAF testing [incremental cost-effectiveness ratio (ICER) = £5491 per QALY]. The maximum health benefit to the

  4. Cost-effectiveness of alternative management strategies for patients with solitary pulmonary nodules.

    Science.gov (United States)

    Gould, Michael K; Sanders, Gillian D; Barnett, Paul G; Rydzak, Chara E; Maclean, Courtney C; McClellan, Mark B; Owens, Douglas K

    2003-05-06

    Positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) is a potentially useful but expensive test to diagnose solitary pulmonary nodules. To evaluate the cost-effectiveness of strategies for pulmonary nodule diagnosis and to specifically compare strategies that did and did not include FDG-PET. Decision model. Accuracy and complications of diagnostic tests were estimated by using meta-analysis and literature review. Modeled survival was based on data from a large tumor registry. Cost estimates were derived from Medicare reimbursement and other sources. All adult patients with a new, noncalcified pulmonary nodule seen on chest radiograph. Patient lifetime. Societal. 40 clinically plausible combinations of 5 diagnostic interventions, including computed tomography, FDG-PET, transthoracic needle biopsy, surgery, and watchful waiting. Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. The cost-effectiveness of strategies depended critically on the pretest probability of malignancy. For patients with low pretest probability (26%), strategies that used FDG-PET selectively when computed tomography results were possibly malignant cost as little as 20 000 dollars per QALY gained. For patients with high pretest probability (79%), strategies that used FDG-PET selectively when computed tomography results were benign cost as little as 16 000 dollars per QALY gained. For patients with intermediate pretest probability (55%), FDG-PET strategies cost more than 220 000 dollars per QALY gained because they were more costly but only marginally more effective than computed tomography-based strategies. The choice of strategy also depended on the risk for surgical complications, the probability of nondiagnostic needle biopsy, the sensitivity of computed tomography, and patient preferences for time spent in watchful waiting. In probabilistic sensitivity analysis, FDG-PET strategies were cost saving or cost less than 100 000 dollars per QALY

  5. The effect of alternative cost and environmental impact minimisation strategies on radioactive waste disposal strategies

    International Nuclear Information System (INIS)

    Laundy, R.S.; James, A.R.; Groom, M.S.; Dalrymple, G.J.

    1985-06-01

    The study reported here investigates the effects of different cost and environmental impact minimisation strategies for a single waste disposal scenario. Four disposal options are considered. The study examines the environmental impacts from waste storage and transport and the disposal impacts in terms of collective dose, maximum individual dose and individual dose from intrusion. The total cost of disposing of waste takes account of storage, transport and disposal costs to each of the four facilities. Two minimum cost scenarios and seven minimum impact assessments were performed. The results showed clearly that a trade-off has to be made between the environmental impacts from transport and storage of waste. A low objective risk of transport is achieved by directing waste to the engineered trench, assumed to have a central location. This waste is stored until the facility is available in 1995 thus increasing the potential impact from storage. The results also show a trade-off has to be made between minimising the maximum individual dose from disposal and collective dose. The study shows that for relatively little cost large reductions in the impacts can be obtained particularly in short and long-term collective dose and the individual dose from intrusion. (author)

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

    Directory of Open Access Journals (Sweden)

    Blot Christophe

    2014-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Natália Chantal Magalhães da Silva

    2013-12-01

    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.

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

    OpenAIRE

    Driels, Morris; Klegka, John S.

    1991-01-01

    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. The Role of Alternative Testing Strategies in Environmental Risk Assessment of Engineered Nanomaterials

    OpenAIRE

    Hjorth, Rune; Holden, Patricia; Hansen, Steffen Foss; Colman, Ben; Grieger, Khara; Hendren, Christine

    2017-01-01

    Within toxicology there is a pressure to find new test systems and organisms to replace, reduce and refine animal testing. In nanoecotoxicology the need for alternative testing strategies (ATS) is further emphasized as the validity of tests and risk assessment practices developed for dissolved chemicals are challenged. Nonetheless, standardized whole organism animal testing is still considered the gold standard for environmental risk assessment. Advancing risk analysis of engineered nanomater...

  10. CONSUMER DEMAND FOR AND ATTITUDES TOWARD ALTERNATIVE BEEF LABELING STRATEGIES IN FRANCE, GERMANY, AND THE UK

    OpenAIRE

    Roosen, Jutta; Lusk, Jayson L.; Fox, John A.

    2001-01-01

    A wide array of food safety scares and breakdowns have led to loss of consumer confidence in the quality and safety of beef products. To counteract such concerns, firms and regulators have the ability to utilize brands or labels to signal quality. Utilizing a mail survey in France, Germany, and the United Kingdom, we analyzed consumer preferences for alternative beef labeling strategies. Using an ordered probit model and a double bounded logit model, we estimate consumer preferences for alter...

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

    Directory of Open Access Journals (Sweden)

    Bambang Dradjat

    2009-08-01

    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.

  12. Role of Genetics in the Etiology of Autistic Spectrum Disorder: Towards a Hierarchical Diagnostic Strategy.

    Science.gov (United States)

    Robert, Cyrille; Pasquier, Laurent; Cohen, David; Fradin, Mélanie; Canitano, Roberto; Damaj, Léna; Odent, Sylvie; Tordjman, Sylvie

    2017-03-12

    Progress in epidemiological, molecular and clinical genetics with the development of new techniques has improved knowledge on genetic syndromes associated with autism spectrum disorder (ASD). The objective of this article is to show the diversity of genetic disorders associated with ASD (based on an extensive review of single-gene disorders, copy number variants, and other chromosomal disorders), and consequently to propose a hierarchical diagnostic strategy with a stepwise evaluation, helping general practitioners/pediatricians and child psychiatrists to collaborate with geneticists and neuropediatricians, in order to search for genetic disorders associated with ASD. The first step is a clinical investigation involving: (i) a child psychiatric and psychological evaluation confirming autism diagnosis from different observational sources and assessing autism severity; (ii) a neuropediatric evaluation examining neurological symptoms and developmental milestones; and (iii) a genetic evaluation searching for dysmorphic features and malformations. The second step involves laboratory and if necessary neuroimaging and EEG studies oriented by clinical results based on clinical genetic and neuropediatric examinations. The identification of genetic disorders associated with ASD has practical implications for diagnostic strategies, early detection or prevention of co-morbidity, specific treatment and follow up, and genetic counseling.

  13. Role of Genetics in the Etiology of Autistic Spectrum Disorder: Towards a Hierarchical Diagnostic Strategy

    Science.gov (United States)

    Robert, Cyrille; Pasquier, Laurent; Cohen, David; Fradin, Mélanie; Canitano, Roberto; Damaj, Léna; Odent, Sylvie; Tordjman, Sylvie

    2017-01-01

    Progress in epidemiological, molecular and clinical genetics with the development of new techniques has improved knowledge on genetic syndromes associated with autism spectrum disorder (ASD). The objective of this article is to show the diversity of genetic disorders associated with ASD (based on an extensive review of single-gene disorders, copy number variants, and other chromosomal disorders), and consequently to propose a hierarchical diagnostic strategy with a stepwise evaluation, helping general practitioners/pediatricians and child psychiatrists to collaborate with geneticists and neuropediatricians, in order to search for genetic disorders associated with ASD. The first step is a clinical investigation involving: (i) a child psychiatric and psychological evaluation confirming autism diagnosis from different observational sources and assessing autism severity; (ii) a neuropediatric evaluation examining neurological symptoms and developmental milestones; and (iii) a genetic evaluation searching for dysmorphic features and malformations. The second step involves laboratory and if necessary neuroimaging and EEG studies oriented by clinical results based on clinical genetic and neuropediatric examinations. The identification of genetic disorders associated with ASD has practical implications for diagnostic strategies, early detection or prevention of co-morbidity, specific treatment and follow up, and genetic counseling. PMID:28287497

  14. Long-term Cost-Effectiveness of Diagnostic Tests for Assessing Stable Chest Pain: Modeled Analysis of Anatomical and Functional Strategies.

    Science.gov (United States)

    Bertoldi, Eduardo G; Stella, Steffan F; Rohde, Luis E; Polanczyk, Carisi A

    2016-05-01

    Several tests exist for diagnosing coronary artery disease, with varying accuracy and cost. We sought to provide cost-effectiveness information to aid physicians and decision-makers in selecting the most appropriate testing strategy. We used the state-transitions (Markov) model from the Brazilian public health system perspective with a lifetime horizon. Diagnostic strategies were based on exercise electrocardiography (Ex-ECG), stress echocardiography (ECHO), single-photon emission computed tomography (SPECT), computed tomography coronary angiography (CTA), or stress cardiac magnetic resonance imaging (C-MRI) as the initial test. Systematic review provided input data for test accuracy and long-term prognosis. Cost data were derived from the Brazilian public health system. Diagnostic test strategy had a small but measurable impact in quality-adjusted life-years gained. Switching from Ex-ECG to CTA-based strategies improved outcomes at an incremental cost-effectiveness ratio of 3100 international dollars per quality-adjusted life-year. ECHO-based strategies resulted in cost and effectiveness almost identical to CTA, and SPECT-based strategies were dominated because of their much higher cost. Strategies based on stress C-MRI were most effective, but the incremental cost-effectiveness ratio vs CTA was higher than the proposed willingness-to-pay threshold. Invasive strategies were dominant in the high pretest probability setting. Sensitivity analysis showed that results were sensitive to costs of CTA, ECHO, and C-MRI. Coronary CT is cost-effective for the diagnosis of coronary artery disease and should be included in the Brazilian public health system. Stress ECHO has a similar performance and is an acceptable alternative for most patients, but invasive strategies should be reserved for patients at high risk. © 2016 Wiley Periodicals, Inc.

  15. Diagnostic strategy in segmentation defect of the vertebrae: a retrospective study of 73 patients.

    Science.gov (United States)

    Lefebvre, Mathilde; Dieux-Coeslier, Anne; Baujat, Geneviève; Schaefer, Elise; Judith, Saint-Onge; Bazin, Anne; Pinson, Lucile; Attie-Bitach, Tania; Baumann, Clarisse; Fradin, Melanie; Pierquin, Genevieve; Julia, Sophie; Quélin, Chloé; Doray, Bérénice; Berg, Sylvie; Vincent-Delorme, Catherine; Lambert, Laetitia; Bachmann, Nadine; Lacombe, Didier; Isidor, Bertrand; Laurent, Nicole; Joelle, Roume; Blanchet, Patricia; Odent, Sylvie; Kervran, Dominique; Leporrier, Nathalie; Abel, Carine; Segers, Karine; Guiliano, Fabienne; Ginglinger-Fabre, Emmanuelle; Selicorni, Angelo; Goldenberg, Alice; El Chehadeh, Salima; Francannet, Christine; Demeer, Benedicte; Duffourd, Yannis; Thauvin-Robinet, Christel; Verloes, Alain; Cormier-Daire, Valerie; Riviere, Jean Baptiste; Faivre, Laurence; Thevenon, Julien

    2018-02-19

    Segmentation defects of the vertebrae (SDV) are non-specific features found in various syndromes. The molecular bases of SDV are not fully elucidated due to the wide range of phenotypes and classification issues. The genes involved are in the Notch signalling pathway, which is a key system in somitogenesis. Here we report on mutations identified in a diagnosis cohort of SDV. We focused on spondylocostal dysostosis (SCD) and the phenotype of these patients in order to establish a diagnostic strategy when confronted with SDV. We used DNA samples from a cohort of 73 patients and performed targeted sequencing of the five known SCD-causing genes ( DLL3 , MESP2 , LFNG , HES7 and TBX6 ) in the first 48 patients and whole-exome sequencing (WES) in 28 relevant patients. Ten diagnoses, including four biallelic variants in TBX6 , two biallelic variants in LFNG and DLL3 , and one in MESP2 and HES7 , were made with the gene panel, and two diagnoses, including biallelic variants in FLNB and one variant in MEOX1, were made by WES. The diagnostic yield of the gene panel was 10/73 (13.7%) in the global cohort but 8/10 (80%) in the subgroup meeting the SCD criteria; the diagnostic yield of WES was 2/28 (8%). After negative array CGH, targeted sequencing of the five known SCD genes should only be performed in patients who meet the diagnostic criteria of SCD. The low proportion of candidate genes identified by WES in our cohort suggests the need to consider more complex genetic architectures in cases of SDV. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  16. Energy abatement in Chinese industry: Cost evaluation of regulation strategies and allocation alternatives

    International Nuclear Information System (INIS)

    Xia, X.H.; Chen, G.Q.

    2012-01-01

    For Chinese industry, the costs of different energy consumption abatement scenarios are evaluated by the method of directional distance function. These scenarios are based on the combinations of regulation strategies and allocation alternatives—the former are sectors and provinces, and the latter include the five principles of average, intensity share, absolute share, discriminatory absolute and discriminatory intensity. For all the scenarios, the quantitative impacts in terms of output potential loss are calculated and compared. Due to less output potential loss for all the allocation alternatives, the sector regulation strategy is shown to be more effective than the province regulation strategy. It is also demonstrated that, among all the scenarios considered, the sector regulation based on the intensity share principle and the province regulation based on the absolute share principle are the two optimal. The performances of energy abatement allocation of the 11th and 12th Five Year Plans of China are assessed against the simulated scenarios. - Highlights: ► The costs of different energy consumption abatement scenarios are evaluated for Chinese industry. ► The impacts on all entities under all allocation alternatives are calculated and compared. ► The optimal scenarios for the different strategies are identified. ► The performances of the 11th and 12th Five Year Plans are assessed.

  17. The Effect of Question Format and Task Difficulty on Reasoning Strategies and Diagnostic Performance in Internal Medicine Residents

    Science.gov (United States)

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

    2008-01-01

    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…

  18. Cost effectiveness of Alternative Helicobacter pylori Eradication Strategies in the Management of Duodenal Ulcer

    Directory of Open Access Journals (Sweden)

    Bernie O'Brien

    1997-01-01

    Full Text Available Published data and techniques for decision analysis were used to construct a model to estimate the cost effectiveness of nine alternative strategies for the management of patients diagnosed with uncomplicated duodenal ulcer. Two strategies of intermittent therapy with either ranitidine or omeprazole, one strategy of continuous maintenance treatment with ranitidine, and six strategies for ulcer healing and eradication of Helicobacter pylori infection were considered. Healing time curves were estimated by using published data, allowing for estimation of expected time for acute healing episodes. The expected number of weeks to heal per patient, in a one-year period, was estimated by combining healing time data with probability of ulcer recurrence. It was found that patients that underwent any of the six H pylori eradication regimens had fewer days with ulcer per year than those who underwent maintenance or intermittent ranitidine. Four eradication regimens had lower costs and better outcomes than ranitidine therapy. In comparing H pylori strategies, the two strategies of omeprazole plus one antibiotic (either amoxicillin or clarithromycin are more costly than omeprazole plus two antibiotics (specifically amoxicillin and metronidazole or clarithromycin and metronidazole and result in similar outcomes. Although omeprazole-based eradication regimens are more costly than ranitidine bismuth triple therapy, they are associated with fewer recurrences of ulcer and days of symptoms. A limitation of the analysis is that it did not incorporate issues of compliance and metronidazole resistance; however, the former concern may be less of an issue as H pylori regimens become simpler and shorter in duration.

  19. Cost-effectiveness of alternative conservation strategies with application to the Pacific leatherback turtle.

    Science.gov (United States)

    Gjertsen, Heidi; Squires, Dale; Dutton, Peter H; Eguchi, Tomoharu

    2014-02-01

    Although holistic conservation addressing all sources of mortality for endangered species or stocks is the preferred conservation strategy, limited budgets require a criterion to prioritize conservation investments. We compared the cost-effectiveness of nesting site and at-sea conservation strategies for Pacific leatherback turtles (Dermochelys coriacea). We sought to determine which conservation strategy or mix of strategies would produce the largest increase in population growth rate per dollar. Alternative strategies included protection of nesters and their eggs at nesting beaches in Indonesia, gear changes, effort restrictions, and caps on turtle takes in the Hawaiian (U.S.A.) longline swordfish fishery, and temporal and area closures in the California (U.S.A.) drift gill net fishery. We used a population model with a biological metric to measure the effects of conservation alternatives. We normalized all effects by cost to prioritize those strategies with the greatest biological effect relative to its economic cost. We used Monte Carlo simulation to address uncertainty in the main variables and to calculate probability distributions for cost-effectiveness measures. Nesting beach protection was the most cost-effective means of achieving increases in leatherback populations. This result creates the possibility of noncompensatory bycatch mitigation, where high-bycatch fisheries invest in protecting nesting beaches. An example of this practice is U.S. processors of longline tuna and California drift gill net fishers that tax themselves to finance low-cost nesting site protection. Under certain conditions, fisheries interventions, such as technologies that reduce leatherback bycatch without substantially decreasing target species catch, can be cost-effective. Reducing bycatch in coastal areas where bycatch is high, particularly adjacent to nesting beaches, may be cost-effective, particularly, if fisheries in the area are small and of little commercial value.

  20. 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

    1999-05-01

    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

  1. Diagnostic test strategies in children at increased risk of inflammatory bowel disease in primary care.

    Directory of Open Access Journals (Sweden)

    Gea A Holtman

    Full Text Available In children with symptoms suggestive of inflammatory bowel disease (IBD who present in primary care, the optimal test strategy for identifying those who require specialist care is unclear. We evaluated the following three test strategies to determine which was optimal for referring children with suspected IBD to specialist care: 1 alarm symptoms alone, 2 alarm symptoms plus c-reactive protein, and 3 alarm symptoms plus fecal calprotectin.A prospective cohort study was conducted, including children with chronic gastrointestinal symptoms referred to pediatric gastroenterology. Outcome was defined as IBD confirmed by endoscopy, or IBD ruled out by either endoscopy or unremarkable clinical 12 month follow-up with no indication for endoscopy. Test strategy probabilities were generated by logistic regression analyses and compared by area under the receiver operating characteristic curves (AUC and decision curves.We included 90 children, of whom 17 (19% had IBD (n = 65 from primary care physicians, n = 25 from general pediatricians. Adding fecal calprotectin to alarm symptoms increased the AUC significantly from 0.80 (0.67-0.92 to 0.97 (0.93-1.00, but adding c-reactive protein to alarm symptoms did not increase the AUC significantly (p > 0.05. Decision curves confirmed these patterns, showing that alarm symptoms combined with fecal calprotectin produced the diagnostic test strategy with the highest net benefit at reasonable threshold probabilities.In primary care, when children are identified as being at high risk for IBD, adding fecal calprotectin testing to alarm symptoms was the optimal strategy for improving risk stratification.

  2. Dental Providers' Perspectives on Diagnosis-Driven Dentistry: Strategies to Enhance Adoption of Dental Diagnostic Terminology.

    Science.gov (United States)

    Obadan-Udoh, Enihomo; Simon, Lisa; Etolue, Jini; Tokede, Oluwabunmi; White, Joel; Spallek, Heiko; Walji, Muhammad; Kalenderian, Elsbeth

    2017-07-13

    The routine use of standardized diagnostic terminologies (DxTMs) in dentistry has long been the subject of academic debate. This paper discusses the strategies suggested by a group of dental stakeholders to enhance the uptake of DxTMs. Through unstructured interviewing at the 'Toward a Diagnosis-Driven Profession' National Conference held on 19 March 2016 in Los Angeles, CA, USA participants were asked how enthusiastic they were about implementing and consistently using DxTMs at their work. They also brainstormed on strategies to improve the widespread use of DxTMs. Their responses are summarized by recursive abstraction and presented in themes. Conference participants were very enthusiastic about using a DxTM in their place of work. Participants enumerated several strategies to make DxTMs more appealing including: the use of mandates, a value proposition for providers, communication and education, and integration with EHRs and existing systems. All groups across the dental healthcare delivery spectrum will need to work together for the success of the widespread and consistent use of DxTMs. Understanding the provider perspective is however the most critical step in achieving this goal, as they are the group who will ultimately be saddled with the critical task of ensuring DxTM use at the point of care.

  3. Dental Providers’ Perspectives on Diagnosis-Driven Dentistry: Strategies to Enhance Adoption of Dental Diagnostic Terminology

    Science.gov (United States)

    Obadan-Udoh, Enihomo; Etolue, Jini; Tokede, Oluwabunmi; White, Joel; Spallek, Heiko; Walji, Muhammad; Kalenderian, Elsbeth

    2017-01-01

    The routine use of standardized diagnostic terminologies (DxTMs) in dentistry has long been the subject of academic debate. This paper discusses the strategies suggested by a group of dental stakeholders to enhance the uptake of DxTMs. Through unstructured interviewing at the ‘Toward a Diagnosis-Driven Profession’ National Conference held on 19 March 2016 in Los Angeles, CA, USA participants were asked how enthusiastic they were about implementing and consistently using DxTMs at their work. They also brainstormed on strategies to improve the widespread use of DxTMs. Their responses are summarized by recursive abstraction and presented in themes. Conference participants were very enthusiastic about using a DxTM in their place of work. Participants enumerated several strategies to make DxTMs more appealing including: the use of mandates, a value proposition for providers, communication and education, and integration with EHRs and existing systems. All groups across the dental healthcare delivery spectrum will need to work together for the success of the widespread and consistent use of DxTMs. Understanding the provider perspective is however the most critical step in achieving this goal, as they are the group who will ultimately be saddled with the critical task of ensuring DxTM use at the point of care. PMID:28703751

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

    Directory of Open Access Journals (Sweden)

    Jorge Amil Dias

    2014-11-01

    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.

  5. Fowl adenovirus serotype 4: Epidemiology, pathogenesis, diagnostic detection, and vaccine strategies.

    Science.gov (United States)

    Li, P H; Zheng, P P; Zhang, T F; Wen, G Y; Shao, H B; Luo, Q P

    2017-08-01

    Fowl adenovirus (FAdV) serotype-4 is highly pathogenic for chickens, especially for broilers aged 3 to 5 wk, and it has emerged as one of the foremost causes of economic losses to the poultry industry in the last 30 years. The liver is a major target organ of FAdV-4 infections, and virus-infected chickens usually show symptoms of hydropericardium syndrome. The virus is very contagious, and it is spread both vertically and horizontally. It can be isolated from infected liver homogenates and detected by several laboratory diagnostic methods (including an agar gel immunodiffusion test, indirect immunofluorescence assays, counterimmunoelectrophoresis, enzyme-linked immunosorbent assays, restriction endonuclease analyses, polymerase chain reaction (PCR), real-time PCR, and high-resolution melting-curve analyses). Although inactivated vaccines have been deployed widely to control the disease, attenuated live vaccines and subunit vaccines also have been developed, and they are more attractive vaccine candidates. This article provides a comprehensive review of FAdV-4, including its epidemiology, pathogenesis, diagnostic detection, and vaccine strategies. © 2017 Poultry Science Association Inc.

  6. The role of utilities in enabling technology innovation: The BC hydro alternative & emerging energy strategy

    Energy Technology Data Exchange (ETDEWEB)

    Tu, Alex; Leclair, Donna; Morrison, Allison

    2010-09-15

    In order for renewable energy to play a dominant role in the global electricity supply mix, emerging renewable energy technologies - such as wave, tidal, enhanced geothermal, and 3rd generation photovoltaic technologies - must prove their technical merits and achieve cost parity with conventional sources of supply. BC Hydro, a government-owned electric utility, launched an Alternative and Emerging Energy Strategy that describes its role as an enabler of technology innovation. This paper describes BC Hydro's goal, objectives and actions to accelerate the commercialization that will yield a diversity of supply options and a growing, local clean-tech cluster.

  7. Evaluating environmental and economic consequences of alternative pest management strategies: results of modeling workshops

    Science.gov (United States)

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

    1983-01-01

    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.

  8. Sex education and family planning services for young adults: alternative urban strategies in Mexico.

    Science.gov (United States)

    Townsend, J W; Diaz de May, E; Sepúlveda, Y; Santos de Garza, Y; Rosenhouse, S

    1987-01-01

    In Mexico, youth face difficulties in obtaining reliable information on sex education and family planning through existing community programs. Two alternative strategies to provide these services are being tested in poor urban areas of Monterrey. In one experimental area, Integrated Youth Centers were established, which provide sex education and family planning services as well as counseling, academic tutoring, and recreational activities. In another area, trained young adults and community counselors work through informal networks to provide sex education and family planning information. Both utilization and the cost of these services are examined in the context of plans for expanding coverage in Mexico-U.S. border areas.

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

    International Nuclear Information System (INIS)

    Schuppen, J. van; Olthof, D.C.; Wilde, J.C.H.; Beenen, L.F.M.; Rijn, R.R. van; Goslings, J.C.

    2014-01-01

    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

  10. Early diagnostic value of survivin and its alternative splice variants in breast cancer

    International Nuclear Information System (INIS)

    Khan, Salma; Bennit, Heather Ferguson; Turay, David; Perez, Mia; Mirshahidi, Saied; Yuan, Yuan; Wall, Nathan R

    2014-01-01

    The inhibitor of apoptosis (IAP) protein Survivin and its splice variants are differentially expressed in breast cancer tissues. Our previous work showed Survivin is released from tumor cells via small membrane-bound vesicles called exosomes. We, therefore, hypothesize that analysis of serum exosomal Survivin and its splice variants may provide a novel biomarker for early diagnosis of breast cancer. We collected sera from forty breast cancer patients and ten control patients who were disease free for 5 years after treatment. In addition, twenty-three paired breast cancer tumor tissues from those same 40 patients were analyzed for splice variants. Serum levels of Survivin were analyzed using ELISA and exosomes were isolated from this serum using the commercially available ExoQuick kit, with subsequent Western blots and immunohistochemistry performed. Survivin levels were significantly higher in all the breast cancer samples compared to controls (p < 0.05) with exosome amounts significantly higher in cancer patient sera compared to controls (p < 0.01). While Survivin and Survivin-∆Ex3 splice variant expression and localization was identical in serum exosomes, differential expression of Survivin-2B protein existed in the exosomes. Similarly, Survivin and Survivin-∆Ex3 proteins were the predominant forms detected in all of the breast cancer tissues evaluated in this study, whereas a more variable expression of Survivin-2B level was found at different cancer stages. In this study we show for the first time that like Survivin, the Survivin splice variants are also exosomally packaged in the breast cancer patients’ sera, mimicking the survivin splice variant pattern that we also report in breast cancer tissues. Differential expression of exosomal-Survivin, particularly Survivin-2B, may serve as a diagnostic and/or prognostic marker, a “liquid biopsy” if you will, in early breast cancer patients. Furthermore, a more thorough understanding of the role of this

  11. Laboratory Evolution to Alternating Substrate Environments Yields Distinct Phenotypic and Genetic Adaptive Strategies

    DEFF Research Database (Denmark)

    Sandberg, Troy E.; Lloyd, Colton J.; Palsson, Bernhard O.

    2017-01-01

    conditions and different adaptation strategies depending on the substrates being switched between; in some environments, a persistent "generalist" strain developed, while in another, two "specialist" subpopulations arose that alternated dominance. Diauxic lag phenotype varied across the generalists...... maintain simple, static culturing environments so as to reduce selection pressure complexity. In this study, we investigated the adaptive strategies underlying evolution to fluctuating environments by evolving Escherichia coli to conditions of frequently switching growth substrate. Characterization...... of evolved strains via a number of different data types revealed the various genetic and phenotypic changes implemented in pursuit of growth optimality and how these differed across the different growth substrates and switching protocols. This work not only helps to establish general principles of adaptation...

  12. Assessment of an alternative postdeployment reintegration strategy with soldiers returning from Iraq.

    Science.gov (United States)

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

    2014-05-01

    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. PsycINFO Database Record (c) 2014 APA, all rights reserved.

  13. Longitudinal exchange: an alternative strategy towards quantification of dynamics parameters in ZZ exchange spectroscopy

    International Nuclear Information System (INIS)

    Kloiber, Karin; Spitzer, Romana; Grutsch, Sarina; Kreutz, Christoph; Tollinger, Martin

    2011-01-01

    Longitudinal exchange experiments facilitate the quantification of the rates of interconversion between the exchanging species, along with their longitudinal relaxation rates, by analyzing the time-dependence of direct correlation and exchange cross peaks. Here we present a simple and robust alternative to this strategy, which is based on the combination of two complementary experiments, one with and one without resolving exchange cross peaks. We show that by combining the two data sets systematic errors that are caused by differential line-broadening of the exchanging species are avoided and reliable quantification of kinetic and relaxation parameters in the presence of additional conformational exchange on the ms–μs time scale is possible. The strategy is applied to a bistable DNA oligomer that displays different line-broadening in the two exchanging species.

  14. The effect of question format and task difficulty on reasoning strategies and diagnostic performance in Internal Medicine residents.

    Science.gov (United States)

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

    2008-11-01

    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 diagnostic success. Study participants were 13 Internal Medicine residents at the University of Calgary. Each was given eight problem-solving questions in four clinical presentations and were randomized to groups that differed only in the question format, such that a question presented as short answer (SA) to the first group was presented as extended matching (EM) to the second group. There were equal numbers of SA/EM questions and straightforward/difficult tasks. Participants performed think-aloud during diagnostic reasoning. Data were analyzed using multiple logistic regression. Question format was associated with reasoning strategies; hypothetico-deductive reasoning being used more frequently on EM questions and scheme-inductive reasoning on SA questions. For SA question, non-analytic reasoning alone was used more frequently to answer straightforward cases than difficult cases, whereas for EM questions no such association was observed. EM format and straightforward task increased the odds of diagnostic success, whereas hypothetico-deductive reasoning was associated with reduced odds of success. Question format and task difficulty both influence diagnostic reasoning strategies and studies that examine the effect of reasoning strategies on diagnostic success should control for these effects. Further studies are needed to investigate the effect of reasoning strategies on performance of different groups of learners.

  15. Economical analysis of an alternative strategy for CO2 mitigation based on nuclear power

    International Nuclear Information System (INIS)

    Alonso, Gustavo; Valle, Edmundo del

    2013-01-01

    Many countries are pursuing greenhouse gas (GHG) mitigation policies resulting in the increase of use of renewable sources in the electricity sector to mitigate CO 2 emissions. Nuclear energy is a non-emitting CO 2 source that could be used as part of that policy. However, its main drawback is the high investment required for its deployment. On the other hand, wind power is the clean source preferred option to mitigate CO 2 emissions. However, due to its intermittence backup power is needed, in most of the cases it must be provided with combined cycle thermal plants using natural gas. This study performs an economical comparison of a hypothetical implementation of a nuclear strategy to meet the same CO 2 emissions reduction goal that has been obtained by the actual Spaniard strategy (2005–2010) based on wind power. The investment required in both strategies is assessed under different investment scenarios and electricity production conditions for nuclear power. Also, the cost of electricity generation is compared for both strategies. - Highlights: ► Wind power electricity cost including its backup in Spain is assessed. ► Nuclear power is proposed as an alternative to produce the same CO 2 reduction. ► Nuclear power requires less installed capacity deployment. ► Investment to produce the same CO 2 reduction is smaller using nuclear power. ► Electricity generating cost is less expensive using the nuclear option

  16. Alternative futures: Fields, boundaries, and divergent professionalisation strategies within the Chiropractic profession.

    Science.gov (United States)

    Brosnan, Caragh

    2017-10-01

    Sociological studies of the complementary and alternative medicine (CAM) occupations have documented the professionalisation strategies these groups use to establish boundaries between themselves and their competitors, including seeking educational accreditation and statutory regulation/licensure. Chiropractic has been particularly successful at professionalising and in Australia and the UK it is taught within public universities. Recent events have threatened chiropractic's university foothold, however, showing that professionalisation needs to be understood as an ongoing process of negotiation. Based on interviews with chiropractors in Australia and the UK, this paper examines the professionalisation strategies deployed by chiropractors within and outside of the university. Highly divergent strategies are identified across different sectors of the profession, relating to defining the chiropractic paradigm, directing education and constructing professional identity. In each domain, chiropractic academics tended to prioritise building the evidence base and becoming more aligned with medicine and other allied health professions. Although some practitioners supported this agenda, others strove to preserve chiropractic's vitalistic philosophy and professional distinction. Following Bourdieu, these intra-professional struggles are interpreted as occurring within a field in which chiropractors compete for different forms of capital, pulled by two opposing poles. The differing orientations and strategies pursued at the two poles of the field point to a number of possible futures for this CAM profession, including a potential split within the profession itself. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Sykes Alma

    2011-10-01

    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

  18. Age-adjusted D-dimer cut-off in the diagnostic strategy for deep vein thrombosis

    DEFF Research Database (Denmark)

    Nybo, Mads; Hvas, Anne-Mette

    2017-01-01

    BACKGROUND: Studies have indicated that use of an age-adjusted D-dimer cut-off value for patients above 50 years increases utility of the diagnostic strategy for pulmonary embolism. Evidence for the same approach regarding diagnosis of deep vein thrombosis (DVT) is, however, unclear. MATERIALS...... AND METHODS: A systematic literature review was conducted following the PRISMA Statement guideline to gather the existing knowledge on the use of an age-adjusted D-dimer cut-off in the diagnostic strategy for DVT. Studies were extracted from Medline and the Cochrane Library. The search period ended...

  19. Different letter-processing strategies in diagnostic subgroups of developmental dyslexia.

    Science.gov (United States)

    Lachmann, Thomas; van Leeuwen, Cees

    2008-07-01

    Normally reading adults (N = 15) and primary school children (N = 24) and two diagnostic subgroups of children with developmental dyslexia (N = 21)-all native German speakers-performed a successive same-different task with pairs of letters and nonletters (pseudoletters or geometrical shapes). The first item of a pair was always presented on its own, and the second either on its own or surrounded by a congruent or incongruent nontarget shape. Adults showed congruence effects with nonletters but not with letters, and children with both types of stimuli. Frequent-word reading-impaired dyslexics (N = 11) in addition showed dramatically slower overall reaction times. Nonword reading-impaired dyslexics (N = 10) showed congruence effects with nonletters but negative congruence effects with letters. The results support the notion that normal readers have established a special visual processing strategy for letters. Processing speed rather than reading expertise seems crucial for this strategy to emerge. The contrasting effects between subgroups of dyslexics reveal specific underlying deficits.

  20. 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)

    2014-08-15

    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.)

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

    International Nuclear Information System (INIS)

    Koning, Jeffrey L.; Naheedy, John H.; Kruk, Peter G.

    2014-01-01

    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.)

  2. Perspectives and strategies of alternative methods used in the risk assessment of personal care products.

    Science.gov (United States)

    Quantin, P; Thélu, A; Catoire, S; Ficheux, H

    2015-11-01

    Risk assessment for personal care products requires the use of alternative methods since animal testing is now totally banned. Some of these methods are effective and have been validated by the "European Union Reference Laboratory for alternatives to animal testing"; but there is still a need for development and implementation of methods for specific endpoints. In this review, we have focused on dermal risk assessment because it is the prime route of absorption and main target organ for personal care products. Within this field, various areas must be assessed: irritation, sensitisation and toxicokinetic. Personal care product behaviour after use by the consumer and potential effects on the environment are also discussed. The purpose of this review is to show evolution and the prospects of alternative methods for safety dermal assessment. Assessment strategies must be adapted to the different chemical classes of substances studied but also to the way in which they are used. Finally, experimental and theoretical technical parameters that may impact on measured effects have been identified and discussed. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

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

    Science.gov (United States)

    Hurtado-Gonzales, Jorge L; Uy, J Albert C

    2010-12-23

    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. 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. 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 males exhibiting clear differences in their levels of

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

    Directory of Open Access Journals (Sweden)

    Uy J Albert C

    2010-12-01

    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

  5. The rock-paper-scissors game and the evolution of alternative male strategies

    Science.gov (United States)

    Sinervo, B.; Lively, C. M.

    1996-03-01

    MANY species exhibit colour polymorphisms associated with alternative male reproductive strategies, including territorial males and 'sneaker males' that behave and look like females1-3. The prevalence of multiple morphs is a challenge to evolutionary theory because a single strategy should prevail unless morphs have exactly equal fitness4,5 or a fitness advantage when rare6,7. We report here the application of an evolutionary stable strategy model to a three-morph mating system in the side-blotched lizard. Using parameter estimates from field data, the model predicted oscillations in morph frequency, and the frequencies of the three male morphs were found to oscillate over a six-year period in the field. The fitnesses of each morph relative to other morphs were non-transitive in that each morph could invade another morph when rare, but was itself invadable by another morph when common. Concordance between frequency-dependent selection and the among-year changes in morph fitnesses suggest that male interactions drive a dynamic 'rock-paper-scissors' game7.

  6. Resource acquisition policy: Multiple account evaluation of electricity resource alternatives [and] resource acquisition strategy

    International Nuclear Information System (INIS)

    1994-06-01

    British Columbia Hydro has been directed by the provincial government to develop evaluation procedures to rank electricity resource alternatives in terms of their social benefits and costs, and to acquire resources on the basis of need. The current state of development of social costing at BC Hydro is detailed along with its application to the multiple account evaluation of resources. In this evaluation, BC Hydro's corporate costs, customer cost, transfer payments to the province, direct costs incurred by provincial or regional governments or other Crown agences, direct environmental impact costs from air emissions and land/water use, community and social impact costs, and economic development impacts are taken into account. The BC Hydro resource acquisition strategy is also described as it was developed in response to provincial policy on electricity supply from independent power producers. This strategy includes a determination of need, a decision to acquire need-determined resources either by itself or from a private sector developer, and decisions to acquire resources in advance of need for reasons such as economic opportunity, long-term strategies, or load displacement. Background information is included on calculation of air emissions costs. An illustrative example is provided of the multiple account evaluation of several types of resource projects. 1 fig., 5 tabs

  7. Development of alternative sulfur dioxide control strategies for a metropolitan area and its environs, utilizing a modified climatological dispersion model

    Science.gov (United States)

    K. J. Skipka; D. B. Smith

    1977-01-01

    Alternative control strategies were developed for achieving compliance with ambient air quality standards in Portland, Maine, and its environs, using a modified climatological dispersion model (CDM) and manipulating the sulfur content of the fuel oil consumed in four concentric zones. Strategies were evaluated for their impact on ambient air quality, economics, and...

  8. Diagnostic strategy and timing of intervention in infected necrotizing pancreatitis: an international expert survey and case vignette study

    NARCIS (Netherlands)

    van Grinsven, J. (Janneke); S. van Brunschot (Sandra); P. Fockens (Paul); J. van Grinsven (Janneke); O.J. Bakker (Olaf ); van Santvoort, H.C. (Hjalmar C.); T.L. Bollen (Thomas); M.A. Boermeester (Marja); C.H.J. van Eijck (Casper); M.G. Besselink (Marc); M.J. Bruno (Marco); C.H. Dejong (Cees); K.D. Horvath (Karen); van Eijck, C.H. (Casper H.); H. van Goor (Harry); H.G. Gooszen (Hein); Horvath, K.D. (Karen D.); K.P. van Lienden (Krijn); Abdelhafez, M.; Andersson, R.; Andren-Sandberg, A.; Ashley, S.; M.C. van Baal (Mark); Baron, T.; C. Bassi (Claudio); Bradley, E.; M.W. Buchler (M.); V.C. Cappendijk; Carter, R.; Charnley, R.; Coelho, D.; Connor, S.; Dellinger, P.; C. Dervenis (Christos); J. Devière (J.); Doctor, N.; Dudeja, V.; En-qiang, M.; Escourrou, J.; Fagenholz, P.; Farkas, G.; Forsmark, C.; Freeman, M.; P.C. Freeny (Patrick); French, J.; H. Friess; Gardner, T.; Goetzinger, P.; J.W. Haveman; S. Hofker (Sijbrand); Imrie, C.; Isaji, S.; Isenmann, R.; E. Klar (Ernst); J.S. Laméris (Johan ); M. Lerch (M.); P. Lévy (Philippe); Lillemoe, K.; Löhr, M.; J. Mayerle (Julia); Mayumi, T.; Mittal, A.; Moessner, J.; Morgan, D.; K.J. Mortele (Koenraad); Nealon, W.; J.P. Neoptolemos (John); V.B. Nieuwenhuijs (Vincent); Nordback, I.; Olah, A.; K. Oppong (K.); Padbury, R.; Papachristou, G.; Parks, R.; J.-W. Poley (Jan-Werner); Radenkovic, D.; Raraty, M.; Rau, B.; V. Rebours (Vinciane); Rische, S.; Runzi, M.; Sainani, N.; Sarr, M.; Schaapherder, S.; S. Seewald (Stefan); Seifert, H.; Shimosegawa, T.; Silverman, S.; Singh, V.; Siriwardena, A.; Steinberg, W.; Sutton, R.; Takeda, K.; R. Timmer (Robin); Vege, S.; R.P. Voermans (Rogier); J.J. De Waele (Jan J.); Wang, C. (Ch.); Warshaw, A.; J. Werner (Jens Martin); B.L. Weusten (Bas); Whitcomb, D.; Wig, J.; Windsor, J.; Zyromski, N.

    2016-01-01

    textabstractBackground The optimal diagnostic strategy and timing of intervention in infected necrotizing pancreatitis is subject to debate. We performed a survey on these topics amongst a group of international expert pancreatologists. Methods An online survey including case vignettes was sent to

  9. Decision making about healthcare-related tests and diagnostic test strategies. Paper 2: a review of methodological and practical challenges

    NARCIS (Netherlands)

    Mustafa, Reem A.; Wiercioch, Wojtek; Cheung, Adrienne; Prediger, Barbara; Brozek, Jan; Bossuyt, Patrick; Garg, Amit X.; Lelgemann, Monika; Büehler, Diedrich; Schünemann, Holger J.

    2017-01-01

    Objectives: In this first of a series of five articles, we provide an overview of how and why healthcare-related tests and diagnostic strategies are currently applied. We also describe how our findings can be integrated with existing frameworks for making decisions that guide the use of

  10. Fragment-based drug discovery as alternative strategy to the drug development for neglected diseases.

    Science.gov (United States)

    Mello, Juliana da Fonseca Rezende E; Gomes, Renan Augusto; Vital-Fujii, Drielli Gomes; Ferreira, Glaucio Monteiro; Trossini, Gustavo Henrique Goulart

    2017-12-01

    Neglected diseases (NDs) affect large populations and almost whole continents, representing 12% of the global health burden. In contrast, the treatment available today is limited and sometimes ineffective. Under this scenery, the Fragment-Based Drug Discovery emerged as one of the most promising alternatives to the traditional methods of drug development. This method allows achieving new lead compounds with smaller size of fragment libraries. Even with the wide Fragment-Based Drug Discovery success resulting in new effective therapeutic agents against different diseases, until this moment few studies have been applied this approach for NDs area. In this article, we discuss the basic Fragment-Based Drug Discovery process, brief successful ideas of general applications and show a landscape of its use in NDs, encouraging the implementation of this strategy as an interesting way to optimize the development of new drugs to NDs. © 2017 John Wiley & Sons A/S.

  11. An alternate HIV preventive strategy: sex scripts in media for women of color.

    Science.gov (United States)

    Medina, Catherine; Rios, Diana I

    2011-01-01

    New cases of HIV/AIDS among women of color in the United States highlight the continuing need for the public and private sectors to develop alternate preventive strategies. The author discusses the conceptual basis for using television sex scripts to incorporate women of color relational needs (trust, romance, sexual pressure) to promote HIV risk-reduction messages through a process of association with the television storyline. Sex scripts are a source of implicit knowledge about how to behave in situations that involve sexual intimacy. The article suggests that sexual scripts prevention messages build on the agency of women through the use of power theory-that is supporting woman's self-power by participating in sexual behavioral change. Implications for sexual equality in media programming are discussed.

  12. Cultural adaptation of preschool PATHS (Promoting Alternative Thinking Strategies) curriculum for Pakistani children.

    Science.gov (United States)

    Inam, Ayesha; Tariq, Pervaiz N; Zaman, Sahira

    2015-06-01

    Cultural adaptation of evidence-based programmes has gained importance primarily owing to its perceived impact on the established effectiveness of a programme. To date, many researchers have proposed different frameworks for systematic adaptation process. This article presents the cultural adaptation of preschool Promoting Alternative Thinking Strategies (PATHS) curriculum for Pakistani children using the heuristic framework of adaptation (Barrera & Castro, 2006). The study was completed in four steps: information gathering, preliminary adaptation design, preliminary adaptation test and adaptation refinement. Feedbacks on programme content suggested universality of the core programme components. Suggested changes were mostly surface structure: language, presentation of materials, conceptual equivalence of concepts, training needs of implementation staff and frequency of programme delivery. In-depth analysis was done to acquire cultural equivalence. Pilot testing of the outcome measures showed strong internal consistency. The results were further discussed with reference to similar work undertaken in other cultures. © 2014 International Union of Psychological Science.

  13. 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: liuyanhui9@gmail.com [Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu (China)

    2014-03-01

    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)

  14. Guidelines and algorithms: strategies for standardization of referral criteria in diagnostic radiology

    International Nuclear Information System (INIS)

    Kainberger, Franz; Pokieser, Peter; Imhof, Herwig; Czembirek, Heinrich; Fruehwald, Franz

    2002-01-01

    Guidelines can be regarded as special forms of algorithms and have been shown to be useful tools for supporting medical decision making. With the Council Directive 97/43/Euratom recommendations concerning referral criteria for medical exposure have to be implemented into national law of all EU member states. The time- and cost-consuming efforts of developing, implementing, and updating such guidelines are balanced by the acceptance in clinical practice and eventual better health outcomes. Clearly defined objectives with special attention drawn on national and regional differences among potential users, support from organisations with expertise in evidence-based medicine, separated development of the evidence component and the recommendations component, and large-scale strategies for distribution and implementation are necessary. Editors as well as users of guidelines for referral criteria have to be aware which expectations can be met and which cannot be fulfilled with this instrument; thus, dealing with guidelines requires a new form of ''diagnostic reasoning'' based on medical ethics. (orig.)

  15. Central vestibular dysfunction in an otorhinolaryngological vestibular unit: incidence and diagnostic strategy.

    Science.gov (United States)

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

    2014-07-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Mostafa, Badr E.

    2014-03-01

    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.

  17. Antimicrobial Resistance: Its Surveillance, Impact, and Alternative Management Strategies in Dairy Animals

    Science.gov (United States)

    Sharma, Chetan; Rokana, Namita; Chandra, Mudit; Singh, Brij Pal; Gulhane, Rohini Devidas; Gill, Jatinder Paul Singh; Ray, Pallab; Puniya, Anil Kumar; Panwar, Harsh

    2018-01-01

    Antimicrobial resistance (AMR), one among the most common priority areas identified by both national and international agencies, is mushrooming as a silent pandemic. The advancement in public health care through introduction of antibiotics against infectious agents is now being threatened by global development of multidrug-resistant strains. These strains are product of both continuous evolution and un-checked antimicrobial usage (AMU). Though antibiotic application in livestock has largely contributed toward health and productivity, it has also played significant role in evolution of resistant strains. Although, a significant emphasis has been given to AMR in humans, trends in animals, on other hand, are not much emphasized. Dairy farming involves surplus use of antibiotics as prophylactic and growth promoting agents. This non-therapeutic application of antibiotics, their dosage, and withdrawal period needs to be re-evaluated and rationally defined. A dairy animal also poses a serious risk of transmission of resistant strains to humans and environment. Outlining the scope of the problem is necessary for formulating and monitoring an active response to AMR. Effective and commendably connected surveillance programs at multidisciplinary level can contribute to better understand and minimize the emergence of resistance. Besides, it requires a renewed emphasis on investments into research for finding alternate, safe, cost effective, and innovative strategies, parallel to discovery of new antibiotics. Nevertheless, numerous direct or indirect novel approaches based on host–microbial interaction and molecular mechanisms of pathogens are also being developed and corroborated by researchers to combat the threat of resistance. This review places a concerted effort to club the current outline of AMU and AMR in dairy animals; ongoing global surveillance and monitoring programs; its impact at animal human interface; and strategies for combating resistance with an extensive

  18. Antimicrobial Resistance: Its Surveillance, Impact, and Alternative Management Strategies in Dairy Animals.

    Science.gov (United States)

    Sharma, Chetan; Rokana, Namita; Chandra, Mudit; Singh, Brij Pal; Gulhane, Rohini Devidas; Gill, Jatinder Paul Singh; Ray, Pallab; Puniya, Anil Kumar; Panwar, Harsh

    2017-01-01

    Antimicrobial resistance (AMR), one among the most common priority areas identified by both national and international agencies, is mushrooming as a silent pandemic. The advancement in public health care through introduction of antibiotics against infectious agents is now being threatened by global development of multidrug-resistant strains. These strains are product of both continuous evolution and un-checked antimicrobial usage (AMU). Though antibiotic application in livestock has largely contributed toward health and productivity, it has also played significant role in evolution of resistant strains. Although, a significant emphasis has been given to AMR in humans, trends in animals, on other hand, are not much emphasized. Dairy farming involves surplus use of antibiotics as prophylactic and growth promoting agents. This non-therapeutic application of antibiotics, their dosage, and withdrawal period needs to be re-evaluated and rationally defined. A dairy animal also poses a serious risk of transmission of resistant strains to humans and environment. Outlining the scope of the problem is necessary for formulating and monitoring an active response to AMR. Effective and commendably connected surveillance programs at multidisciplinary level can contribute to better understand and minimize the emergence of resistance. Besides, it requires a renewed emphasis on investments into research for finding alternate, safe, cost effective, and innovative strategies, parallel to discovery of new antibiotics. Nevertheless, numerous direct or indirect novel approaches based on host-microbial interaction and molecular mechanisms of pathogens are also being developed and corroborated by researchers to combat the threat of resistance. This review places a concerted effort to club the current outline of AMU and AMR in dairy animals; ongoing global surveillance and monitoring programs; its impact at animal human interface; and strategies for combating resistance with an extensive

  19. Dimorphic ejaculates and sperm release strategies associated with alternative mating behaviors in the squid.

    Science.gov (United States)

    Apostólico, Lígia H; Marian, José E A R

    2017-11-01

    Sperm competition is a powerful postcopulatory selective force influencing male adaptations associated with increasing fertilization success, and it is usually related to the evolution of different strategies of ejaculate expenditure between individuals. Ejaculates may also be influenced by additional selective pressures associated with sperm competition, such as timing between insemination and fertilization, female reproductive tract morphology, and fertilization environment. Also, males that adopt alternative mating tactics may face distinct sperm competition pressures, which may lead to the evolution of intraspecific diversity in ejaculates. In loliginid squids, males with alternative reproductive tactics (sneakers and consorts) differ not only in mating behavior, but also transfer spermatophores into two distinct sites within the female. Here, we compared structure and functioning of spermatophores between sneakers and consorts in the squid Doryteuthis plei applying microscopy techniques and in vitro experiments. Sneakers and consorts exhibit differences in spermatophore structure that lead to distinct spermatophoric reactions and spermatangium morphologies. Moreover, in sneakers, sperm release lasts longer and their sperm show an aggregative behavior not detected in consorts. Slow sperm release may be a strategy to guarantee longer sperm provision, given the wide interval between sneaker mating and egg release. For consorts, in turn, intense and quick sperm discharge may be advantageous, as timing between mating and egg-laying is relatively short. Within the complex squid mating system, factors such as (i) different fertilization sites and (ii) interval between mating and egg release may also influence sperm competition, and ultimately shape the evolution of divergent ejaculates between dimorphic males. © 2017 Wiley Periodicals, Inc.

  20. Africa energy future: Alternative scenarios and their implications for sustainable development strategies

    International Nuclear Information System (INIS)

    Ouedraogo, Nadia S.

    2017-01-01

    The long-term forecasting of energy supply and demand is of prime importance in Africa due to the steady increase in energy requirements, the non-availability of sufficient resources, the high dependence on fossil-fuels to meet these requirements, and the global concerns over the energy-induced environmental issues. This paper is concerned with modelling possible future paths for Africa's energy future and the related emissions. Future energy demand is forecasted based on socio-economic variables such as gross domestic product, income per capita, population, and urbanisation. The Long-range Energy Alternative Planning System (LEAP) modelling framework is employed to analyse and project energy demand and the related emissions under alternative strategies for the period of 2010–2040. Results of scenarios including business-as-usual (BAU) policies, moderate energy access and accelerate energy access policies, renewable energies promotion and energy efficiency policies and their environmental implications are provided. The study provides some policy insights and identifies synergies and trade-offs relating to the potential for energy policies to promote universal energy access, enable a transition to renewable energy, and mitigate climate change for a sustainable development. - Highlights: • Possible future paths for Africa's energy future and the related emissions are modelled. • Scenarios using an adaptation of Schwartz's scenario approach, under LEAP are developed. • Under the current energy policies, the universal access to modern energy will not be met by 2030. • Policies to accelerate the changes in energy structure are required for sustainable development. • Investing in Energy efficient strategies has emerged as one of the best solution.

  1. Antimicrobial Resistance: Its Surveillance, Impact, and Alternative Management Strategies in Dairy Animals

    Directory of Open Access Journals (Sweden)

    Chetan Sharma

    2018-01-01

    Full Text Available Antimicrobial resistance (AMR, one among the most common priority areas identified by both national and international agencies, is mushrooming as a silent pandemic. The advancement in public health care through introduction of antibiotics against infectious agents is now being threatened by global development of multidrug-resistant strains. These strains are product of both continuous evolution and un-checked antimicrobial usage (AMU. Though antibiotic application in livestock has largely contributed toward health and productivity, it has also played significant role in evolution of resistant strains. Although, a significant emphasis has been given to AMR in humans, trends in animals, on other hand, are not much emphasized. Dairy farming involves surplus use of antibiotics as prophylactic and growth promoting agents. This non-therapeutic application of antibiotics, their dosage, and withdrawal period needs to be re-evaluated and rationally defined. A dairy animal also poses a serious risk of transmission of resistant strains to humans and environment. Outlining the scope of the problem is necessary for formulating and monitoring an active response to AMR. Effective and commendably connected surveillance programs at multidisciplinary level can contribute to better understand and minimize the emergence of resistance. Besides, it requires a renewed emphasis on investments into research for finding alternate, safe, cost effective, and innovative strategies, parallel to discovery of new antibiotics. Nevertheless, numerous direct or indirect novel approaches based on host–microbial interaction and molecular mechanisms of pathogens are also being developed and corroborated by researchers to combat the threat of resistance. This review places a concerted effort to club the current outline of AMU and AMR in dairy animals; ongoing global surveillance and monitoring programs; its impact at animal human interface; and strategies for combating resistance

  2. Punk as a Strategy for Body Politicization in the Ljubljana Alternative Scene of the 1980s

    Directory of Open Access Journals (Sweden)

    Jasmina Založnik

    2017-10-01

    Full Text Available The paper focuses on the notion of punk understood as a political position and as a strategy by the actors of the Ljubljana alternative scene in the 1980s. With exposing the minor, invisible and hidden subjectivities the actors and agents of the scene created a ground for experimentation with subjectivities, but also for shaking the Yugoslav Grand National narrative of ‘brotherhood and unity’. I am emphasizing mainly the notion of the body with and through the code of sex and sexuality, being still a base and the core investment of the government. No matter that the discourse has been radically changed, the procedures and protocols of power investments in their core have not. This is an additional reason and a need to recall the past and tackle the bodies that have appeared as unwanted, as ‘not right and not quiet’ identities in the past in order to evaluate and compare the position of the marginalized and suppressed today. Additionally, I am claiming that only with creating different genealogies can we fight against growing ‘intellectual redundancy’ and the continuous process of erasure of the subjectivities, which we are confronting today.   Article received: June 2, 2017; Article accepted: June 12, 2017; Published online: October 15, 2017; Original scholarly paper How to cite this article: Založnik, Jasmina. "Punk as a Strategy for Body Politicization in the Ljubljana Alternative Scene of the 1980s." AM Journal of Art and Media Studies 14 (2017: 145-156. doi: 10.25038/am.v0i14.217

  3. The alternative strategies of the development of the nuclear power industry in the 21st century

    Science.gov (United States)

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

    2014-05-01

    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.

  4. Drifting behaviour as an alternative reproductive strategy for social insect workers

    Science.gov (United States)

    Blacher, Pierre; Yagound, Boris; Lecoutey, Emmanuel; Devienne, Paul; Chameron, Stéphane; Châline, Nicolas

    2013-01-01

    Restricted reproduction is traditionally posited as the defining feature of eusocial insect workers. The discovery of worker reproduction in foreign colonies challenges this view and suggests that workers’ potential to pursue selfish interests may be higher than previously believed. However, whether such reproductive behaviour truly relies on a reproductive decision is still unknown. Workers’ reproductive decisions thus need to be investigated to assess the extent of workers’ reproductive options. Here, we show in the bumblebee Bombus terrestris that drifting is a distinct strategy by which fertile workers circumvent competition in their nest and reproduce in foreign colonies. By monitoring workers’ movements between colonies, we show that drifting is a remarkably dynamic behaviour, widely expressed by both fertile and infertile workers. We demonstrate that a high fertility is, however, central in determining the propensity of workers to enter foreign colonies as well as their subsequent reproduction in host colonies. Moreover, our study shows that the drifting of fertile workers reflects complex decision-making processes associated with in-nest reproductive competition. This novel finding therefore adds to our modern conception of cooperation by showing the previously overlooked importance of alternative strategies which enable workers to assert their reproductive interests. PMID:24068358

  5. Database Objects vs Files: Evaluation of alternative strategies for managing large remote sensing data

    Science.gov (United States)

    Baru, Chaitan; Nandigam, Viswanath; Krishnan, Sriram

    2010-05-01

    Increasingly, the geoscience user community expects modern IT capabilities to be available in service of their research and education activities, including the ability to easily access and process large remote sensing datasets via online portals such as GEON (www.geongrid.org) and OpenTopography (opentopography.org). However, serving such datasets via online data portals presents a number of challenges. In this talk, we will evaluate the pros and cons of alternative storage strategies for management and processing of such datasets using binary large object implementations (BLOBs) in database systems versus implementation in Hadoop files using the Hadoop Distributed File System (HDFS). The storage and I/O requirements for providing online access to large datasets dictate the need for declustering data across multiple disks, for capacity as well as bandwidth and response time performance. This requires partitioning larger files into a set of smaller files, and is accompanied by the concomitant requirement for managing large numbers of file. Storing these sub-files as blobs in a shared-nothing database implemented across a cluster provides the advantage that all the distributed storage management is done by the DBMS. Furthermore, subsetting and processing routines can be implemented as user-defined functions (UDFs) on these blobs and would run in parallel across the set of nodes in the cluster. On the other hand, there are both storage overheads and constraints, and software licensing dependencies created by such an implementation. Another approach is to store the files in an external filesystem with pointers to them from within database tables. The filesystem may be a regular UNIX filesystem, a parallel filesystem, or HDFS. In the HDFS case, HDFS would provide the file management capability, while the subsetting and processing routines would be implemented as Hadoop programs using the MapReduce model. Hadoop and its related software libraries are freely available

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

    Science.gov (United States)

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

    2017-03-01

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

  7. Workshop on acceleration of the validation and regulatory acceptance of alternative methods and implementation of testing strategies

    DEFF Research Database (Denmark)

    Piersma, A. H.; Burgdorf, T.; Louekari, K.

    2018-01-01

    concerning the regulatory acceptance and implementation of alternative test methods and testing strategies, with the aim to develop feasible solutions. Classical validation of alternative methods usually involves one to one comparison with the gold standard animal study. This approach suffers from...... the reductionist nature of an alternative test as compared to the animal study as well as from the animal study being considered as the gold standard. Modern approaches combine individual alternatives into testing strategies, for which integrated and defined approaches are emerging at OECD. Furthermore, progress......-focused hazard and risk assessment of chemicals requires an open mind towards stepping away from the animal study as the gold standard and defining human biologically based regulatory requirements for human hazard and risk assessment....

  8. 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: fvicini@beaumont.edu [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States)

    2011-11-15

    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.

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

    International Nuclear Information System (INIS)

    Shah, Chirag; Vicini, Frank A.

    2011-01-01

    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.

  10. An efficient and comprehensive strategy for genetic diagnostics of polycystic kidney disease.

    Directory of Open Access Journals (Sweden)

    Tobias Eisenberger

    Full Text Available Renal cysts are clinically and genetically heterogeneous conditions. Autosomal dominant polycystic kidney disease (ADPKD is the most frequent life-threatening genetic disease and mainly caused by mutations in PKD1. The presence of six PKD1 pseudogenes and tremendous allelic heterogeneity make molecular genetic testing challenging requiring laborious locus-specific amplification. Increasing evidence suggests a major role for PKD1 in early and severe cases of ADPKD and some patients with a recessive form. Furthermore it is becoming obvious that clinical manifestations can be mimicked by mutations in a number of other genes with the necessity for broader genetic testing. We established and validated a sequence capture based NGS testing approach for all genes known for cystic and polycystic kidney disease including PKD1. Thereby, we demonstrate that the applied standard mapping algorithm specifically aligns reads to the PKD1 locus and overcomes the complication of unspecific capture of pseudogenes. Employing careful and experienced assessment of NGS data, the method is shown to be very specific and equally sensitive as established methods. An additional advantage over conventional Sanger sequencing is the detection of copy number variations (CNVs. Sophisticated bioinformatic read simulation increased the high analytical depth of the validation study and further demonstrated the strength of the approach. We further raise some awareness of limitations and pitfalls of common NGS workflows when applied in complex regions like PKD1 demonstrating that quality of NGS needs more than high coverage of the target region. By this, we propose a time- and cost-efficient diagnostic strategy for comprehensive molecular genetic testing of polycystic kidney disease which is highly automatable and will be of particular value when therapeutic options for PKD emerge and genetic testing is needed for larger numbers of patients.

  11. An efficient and comprehensive strategy for genetic diagnostics of polycystic kidney disease.

    Science.gov (United States)

    Eisenberger, Tobias; Decker, Christian; Hiersche, Milan; Hamann, Ruben C; Decker, Eva; Neuber, Steffen; Frank, Valeska; Bolz, Hanno J; Fehrenbach, Henry; Pape, Lars; Toenshoff, Burkhard; Mache, Christoph; Latta, Kay; Bergmann, Carsten

    2015-01-01

    Renal cysts are clinically and genetically heterogeneous conditions. Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent life-threatening genetic disease and mainly caused by mutations in PKD1. The presence of six PKD1 pseudogenes and tremendous allelic heterogeneity make molecular genetic testing challenging requiring laborious locus-specific amplification. Increasing evidence suggests a major role for PKD1 in early and severe cases of ADPKD and some patients with a recessive form. Furthermore it is becoming obvious that clinical manifestations can be mimicked by mutations in a number of other genes with the necessity for broader genetic testing. We established and validated a sequence capture based NGS testing approach for all genes known for cystic and polycystic kidney disease including PKD1. Thereby, we demonstrate that the applied standard mapping algorithm specifically aligns reads to the PKD1 locus and overcomes the complication of unspecific capture of pseudogenes. Employing careful and experienced assessment of NGS data, the method is shown to be very specific and equally sensitive as established methods. An additional advantage over conventional Sanger sequencing is the detection of copy number variations (CNVs). Sophisticated bioinformatic read simulation increased the high analytical depth of the validation study and further demonstrated the strength of the approach. We further raise some awareness of limitations and pitfalls of common NGS workflows when applied in complex regions like PKD1 demonstrating that quality of NGS needs more than high coverage of the target region. By this, we propose a time- and cost-efficient diagnostic strategy for comprehensive molecular genetic testing of polycystic kidney disease which is highly automatable and will be of particular value when therapeutic options for PKD emerge and genetic testing is needed for larger numbers of patients.

  12. Diagnostic imaging strategy for MDCT- or MRI-detected breast lesions: use of targeted sonography

    International Nuclear Information System (INIS)

    Nakano, Satoko; Ohtsuka, Masahiko; Mibu, Akemi; Karikomi, Masato; Sakata, Hitomi; Yamamoto, Masahiro

    2012-01-01

    Leading-edge technology such as magnetic resonance imaging (MRI) or computed tomography (CT) often reveals mammographically and ultrasonographically occult lesions. MRI is a well-documented, effective tool to evaluate these lesions; however, the detection rate of targeted sonography varies for MRI detected lesions, and its significance is not well established in diagnostic strategy of MRI detected lesions. We assessed the utility of targeted sonography for multidetector-row CT (MDCT)- or MRI-detected lesions in practice. We retrospectively reviewed 695 patients with newly diagnosed breast cancer who were candidates for breast conserving surgery and underwent MDCT or MRI in our hospital between January 2004 and March 2011. Targeted sonography was performed in all MDCT- or MRI-detected lesions followed by imaging-guided biopsy. Patient background, histopathology features and the sizes of the lesions were compared among benign, malignant and follow-up groups. Of the 695 patients, 61 lesions in 56 patients were detected by MDCT or MRI. The MDCT- or MRI-detected lesions were identified by targeted sonography in 58 out of 61 lesions (95.1%). Patients with pathological diagnoses were significantly older and more likely to be postmenopausal than the follow-up patients. Pathological diagnosis proved to be benign in 20 cases and malignant in 25. The remaining 16 lesions have been followed up. Lesion size and shape were not significantly different among the benign, malignant and follow-up groups. Approximately 95% of MDCT- or MRI-detected lesions were identified by targeted sonography, and nearly half of these lesions were pathologically proven malignancies in this study. Targeted sonography is a useful modality for MDCT- or MRI-detected breast lesions

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

    NARCIS (Netherlands)

    Aghaei Hashjin, Asgar; Kringos, Dionne; Ravaghi, Hamid; Manoochehri, Jila; Gorji, Hassan Abolghasem; Klazinga, Niek S.

    2015-01-01

    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

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

    Science.gov (United States)

    Alonso, Wladimir J.; Rabaa, Maia A.; Giglio, Ricardo; Miller, Mark A.; Schuck-Paim, Cynthia

    2015-01-01

    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. PMID:26509976

  15. 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

    2013-04-01

    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

  16. A cost-effectiveness analysis of the diagnostic strategies for differentiating focal nodular hyperplasia from hepatocellular adenoma

    Energy Technology Data Exchange (ETDEWEB)

    Suh, Chong Hyun [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Liver Center, Asan Medical Center, Seoul (Korea, Republic of); Namwon Medical Center, Department of Radiology, Namwon-si (Korea, Republic of); Kim, Kyung Won [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Liver Center, Asan Medical Center, Seoul (Korea, Republic of); Harvard Medical School, Department of Imaging, Dana-Farber Cancer Institute, Brigham and Women' s Hospital, Boston, MA (United States); Park, Seong Ho [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Liver Center, Asan Medical Center, Seoul (Korea, Republic of); Shin, Sangjin; Ahn, Jeonghoon [National Evidence-based Healthcare Collaborating Agency, Division of Healthcare Technology Assessment Research, Department of Economic Evaluation, Seoul (Korea, Republic of); Pyo, Junhee [Utrecht University, Collaborating Center for Pharmaceutical Policy and Regulation, Department of Pharmaceutical Science, Utrecht (Netherlands); Shinagare, Atul B.; Krajewski, Katherine M.; Ramaiya, Nikhil H. [Harvard Medical School, Department of Imaging, Dana-Farber Cancer Institute, Brigham and Women' s Hospital, Boston, MA (United States)

    2018-01-15

    We evaluated the cost-effectiveness of a gadoxetic acid-enhanced MRI (EOB-MRI) strategy compared with conventional MRI strategy and biopsy to differentiate focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA). A decision tree model was constructed to compare the cost-effectiveness of EOB-MRI, conventional MRI with extracellular contrast agents, and biopsy as the initial diagnostic modality in patients with incidentally detected focal liver lesions suspected of being FNH or HCA. We analysed the cost and effectiveness, i.e. probability of successful diagnosis of each strategy. Costs were based on utilisation rates and Medicare reimbursements in the USA and South Korea. In the base case analysis of our decision tree model, the effectiveness of the three strategies was similar. The cost of the EOB-MRI strategy ($1283 in USA, $813 in South Korea) was lowest compared with the biopsy strategy ($1725 in USA, $847 in South Korea) and the conventional MRI strategy ($1750 in USA, $962 in South Korea). One-way, two-way and probabilistic sensitivity analysis showed unchanged results over an acceptable range. EOB-MRI strategy is the most cost-effective strategy for differentiating FNH from HCA in patients with incidentally detected focal liver lesions in a non-cirrhotic liver. (orig.)

  17. A cost-effectiveness analysis of the diagnostic strategies for differentiating focal nodular hyperplasia from hepatocellular adenoma

    International Nuclear Information System (INIS)

    Suh, Chong Hyun; Kim, Kyung Won; Park, Seong Ho; Shin, Sangjin; Ahn, Jeonghoon; Pyo, Junhee; Shinagare, Atul B.; Krajewski, Katherine M.; Ramaiya, Nikhil H.

    2018-01-01

    We evaluated the cost-effectiveness of a gadoxetic acid-enhanced MRI (EOB-MRI) strategy compared with conventional MRI strategy and biopsy to differentiate focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA). A decision tree model was constructed to compare the cost-effectiveness of EOB-MRI, conventional MRI with extracellular contrast agents, and biopsy as the initial diagnostic modality in patients with incidentally detected focal liver lesions suspected of being FNH or HCA. We analysed the cost and effectiveness, i.e. probability of successful diagnosis of each strategy. Costs were based on utilisation rates and Medicare reimbursements in the USA and South Korea. In the base case analysis of our decision tree model, the effectiveness of the three strategies was similar. The cost of the EOB-MRI strategy ($1283 in USA, $813 in South Korea) was lowest compared with the biopsy strategy ($1725 in USA, $847 in South Korea) and the conventional MRI strategy ($1750 in USA, $962 in South Korea). One-way, two-way and probabilistic sensitivity analysis showed unchanged results over an acceptable range. EOB-MRI strategy is the most cost-effective strategy for differentiating FNH from HCA in patients with incidentally detected focal liver lesions in a non-cirrhotic liver. (orig.)

  18. Air Quality and Population Exposure in Urban Areas: Potential Co-Benefits of Alternative Strategies

    Science.gov (United States)

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

    2014-12-01

    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

  19. European specialist porphyria laboratories: diagnostic strategies, analytical quality, clinical interpretation, and reporting as assessed by an external quality assurance program.

    Science.gov (United States)

    Aarsand, Aasne K; Villanger, Jørild H; Støle, Egil; Deybach, Jean-Charles; Marsden, Joanne; To-Figueras, Jordi; Badminton, Mike; Elder, George H; Sandberg, Sverre

    2011-11-01

    The porphyrias are a group of rare metabolic disorders whose diagnosis depends on identification of specific patterns of porphyrin precursor and porphyrin accumulation in urine, blood, and feces. Diagnostic tests for porphyria are performed by specialized laboratories in many countries. Data regarding the analytical and diagnostic performance of these laboratories are scarce. We distributed 5 sets of multispecimen samples from different porphyria patients accompanied by clinical case histories to 18-21 European specialist porphyria laboratories/centers as part of a European Porphyria Network organized external analytical and postanalytical quality assessment (EQA) program. The laboratories stated which analyses they would normally have performed given the case histories and reported results of all porphyria-related analyses available, interpretative comments, and diagnoses. Reported diagnostic strategies initially showed considerable diversity, but the number of laboratories applying adequate diagnostic strategies increased during the study period. We found an average interlaboratory CV of 50% (range 12%-152%) for analytes in absolute concentrations. Result normalization by forming ratios to the upper reference limits did not reduce this variation. Sixty-five percent of reported results were within biological variation-based analytical quality specifications. Clinical interpretation of the obtained analytical results was accurate, and most laboratories established the correct diagnosis in all distributions. Based on a case-based EQA scheme, variations were apparent in analytical and diagnostic performance between European specialist porphyria laboratories. Our findings reinforce the use of EQA schemes as an essential tool to assess both analytical and diagnostic processes and thereby to improve patient care in rare diseases.

  20. An environmental cost-benefit analysis of alternative green roofing strategies

    Science.gov (United States)

    Richardson, M.; William, R. K.; Goodwell, A. E.; Le, P. V.; Kumar, P.; Stillwell, A. S.

    2016-12-01

    Green roofs and cool roofs are alternative roofing strategies that mitigate urban heat island effects and improve building energy performance. Green roofs consist of soil and vegetation layers that provide runoff reduction, thermal insulation, and potential natural habitat, but can require regular maintenance. Cool roofs involve a reflective layer that reflects more sunlight than traditional roofing materials, but require additional insulation during winter months. This study evaluates several roofing strategies in terms of energy performance, urban heat island mitigation, water consumption, and economic cost. We use MLCan, a multi-layer canopy model, to simulate irrigated and non-irrigated green roof cases with shallow and deep soil depths during the spring and early summer of 2012, a drought period in central Illinois. Due to the dry conditions studied, periodic irrigation is implemented in the model to evaluate its effect on evapotranspiration. We simulate traditional and cool roof scenarios by altering surface albedo and omitting vegetation and soil layers. We find that both green roofs and cool roofs significantly reduce surface temperature compared to the traditional roof simulation. Cool roof temperatures always remain below air temperature and, similar to traditional roofs, require low maintenance. Green roofs remain close to air temperature and also provide thermal insulation, runoff reduction, and carbon uptake, but might require irrigation during dry periods. Due to the longer lifetime of a green roof compared to cool and traditional roofs, we find that green roofs realize the highest long term cost savings under simulated conditions. However, using longer-life traditional roof materials (which have a higher upfront cost) can help decrease this price differential, making cool roofs the most affordable option due to the higher maintenance costs associated with green roofs

  1. Magnetopriming - an alternate strategy for crop stress management of field crops

    International Nuclear Information System (INIS)

    Anand, Anjali

    2014-01-01

    Abiotic stresses are major deterrent to sustainable crop production worldwide. Seed germination and early seedling growth are considered as the most critical stages of plant growth under stress conditions. Maximising stress tolerance of crop species by breeding is an integral part of development of strategies for improving sustainable food production under stressed environment but the unprecedented rate at which stress is increasing vis-a-vis the time taken for development of a tolerant variety, necessitates exploring alternate strategies of crop stress management. Seed priming has emerged as a promising crop stress management technique that increases the speed of germination thus ensuring synchronized field emergence of the crop. Magnetopriming (exposure of seeds to magnetic field) is a non invasive physical stimulant used for improving seedling vigour that helps in establishment of crop stand under stress. In our experiments on maize; chickpea and wheat under water deficit and salinity, respectively, improved seed water absorption characteristics resulted in faster hydration of enzymes (amylases, protease and dehydrogenase) leading to early germination and enhanced vigour of seedlings under stress. Increased levels of hydrogen peroxide in faster germinating - magnetoprimed seeds, under both the growing conditions, suggested its role in oxidative signaling during seed germination process. An 'oxidative window' for reactive oxygen species ensured that faster germination rate in magnetoprimed seeds led to vigourous seedlings. Improved root system integrated with higher photosynthetic efficiency and efficient partitioning of Na + increased yield from magnetoprimed seeds under salinity in controlled experiments. Magnetopriming can be effectively used as a pre-sowing treatment for mitigating adverse effects of water deficit and salinity at seed germination and early seedling growth. Unlike other conventional priming techniques it avoids seed hydration and

  2. Maximum likelihood estimation of signal detection model parameters for the assessment of two-stage diagnostic strategies.

    Science.gov (United States)

    Lirio, R B; Dondériz, I C; Pérez Abalo, M C

    1992-08-01

    The methodology of Receiver Operating Characteristic curves based on the signal detection model is extended to evaluate the accuracy of two-stage diagnostic strategies. A computer program is developed for the maximum likelihood estimation of parameters that characterize the sensitivity and specificity of two-stage classifiers according to this extended methodology. Its use is briefly illustrated with data collected in a two-stage screening for auditory defects.

  3. The Future of Public Health Informatics: Alternative Scenarios and Recommended Strategies

    Science.gov (United States)

    Edmunds, Margo; Thorpe, Lorna; Sepulveda, Martin; Bezold, Clem; Ross, David A.

    2014-01-01

    Background: In October 2013, the Public Health Informatics Institute (PHII) and Institute for Alternative Futures (IAF) convened a multidisciplinary group of experts to evaluate forces shaping public health informatics (PHI) in the United States, with the aim of identifying upcoming challenges and opportunities. The PHI workshop was funded by the Robert Wood Johnson Foundation as part of its larger strategic planning process for public health and primary care. Workshop Context: During the two-day workshop, nine experts from the public and private sectors analyzed and discussed the implications of four scenarios regarding the United States economy, health care system, information technology (IT) sector, and their potential impacts on public health in the next 10 years, by 2023. Workshop participants considered the potential role of the public health sector in addressing population health challenges in each scenario, and then identified specific informatics goals and strategies needed for the sector to succeed in this role. Recommendations and Conclusion: Participants developed recommendations for the public health informatics field and for public health overall in the coming decade. These included the need to rely more heavily on intersectoral collaborations across public and private sectors, to improve data infrastructure and workforce capacity at all levels of the public health enterprise, to expand the evidence base regarding effectiveness of informatics-based public health initiatives, and to communicate strategically with elected officials and other key stakeholders regarding the potential for informatics-based solutions to have an impact on population health. PMID:25848630

  4. 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.

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

    Science.gov (United States)

    Mulry, Kristina R; Hanson, Bryan A; Dudle, Dana A

    2015-01-01

    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.

  6. Effect of Alternative Irrigation Strategies on Yield and Quality of Fiesta Raisin Grapes Grown in California

    Directory of Open Access Journals (Sweden)

    Isabel Abrisqueta

    2018-04-01

    Full Text Available Traditionally, grapes are fully irrigated, but alternative irrigation strategies to reduce applied irrigation water may be necessary in the future as occurrences of drought increase. This study was conducted in the San Joaquin Valley (SJV of California from 2012 to 2014. Three irrigation treatments were used to study the effects on the yield and quality of Fiesta grapes. The treatments included: grower irrigation (GI weekly irrigation lasting for approximately 65 h; sustained deficit (SD equal to 80% of the GI treatment; and regulated deficit (RD equal to 50% of the GI until fruit set when it was increased to 80% of the GI through harvest and reduced to 50% of the GI after harvest. Average water use across treatments was ≈489 mm. Average yield across all treatments was 7.9 t ha−1, 9.1 t ha−1 and 11.8 t ha−1 in 2012, 2013, and 2014, respectively. Yield was sustained in SD and RD, with up to a 20% reduction in applied water use compared to GI. There were no differences in raisin quality and grade among any of the treatments in any year. The percentage of substandard grapes decreased from an average of 12.6% in 2012 to 3.6% in 2013 and 2014. Growers may use a sustained deficit approach during periods of limited water availability to minimize the effect on yield.

  7. Alternative strategies: A means for saving money and time on the Yucca Mountain Project

    International Nuclear Information System (INIS)

    Wilder, D.G.

    1993-01-01

    The United States Department of Energy (DOE) is undertaking studies to determine the suitability of Yucca Mountain (YM) as a potential site for disposal of high level nuclear waste. Yucca Mountain is located in an arid environment. Many processes that could contribute to mobilization of radionuclides are either absent or minimized in a dry site. Therefore, Yucca Mountain should have the potential of being a veryfavorable site for disposal of waste. The determination of suitability has no precedence, and the characterization of an and site is complex, requiring intensive studies to determine suitability. The studies undertaken by the Yucca Mountain Site Characterization Project (YMP) are very costly. By a process called performance allocation, the YMP determined strategies to satisfy regulations or meet performance while minimizing costs and schedules. Those involved recognized that allocations should be reviewed as additional information became available. The allocation has not been reviewed nor revised since the initial allocation in the Site Characterization Plan (SCP). The purpose of this paper is to outline alternative allocations that the author feels should be considered based on the additional information that is available at this time

  8. Alternative Strategies to Reduce Maternal Mortality in India: A Cost-Effectiveness Analysis

    Science.gov (United States)

    Goldie, Sue J.; Sweet, Steve; Carvalho, Natalie; Natchu, Uma Chandra Mouli; Hu, Delphine

    2010-01-01

    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 (∼23%–35%) without including strategies that ensured reliable access to intrapartum and emergency obstetrical care (EmOC). An integrated and stepwise approach was identified that would ultimately

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

    Directory of Open Access Journals (Sweden)

    Sue J Goldie

    2010-04-01

    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

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

    Science.gov (United States)

    Goldie, Sue J; Sweet, Steve; Carvalho, Natalie; Natchu, Uma Chandra Mouli; Hu, Delphine

    2010-04-20

    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. 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 identified that would ultimately prevent four of five

  11. A wide variation in diagnostic and therapeutic strategies in chronic pancreatitis: a dutch national survey.

    NARCIS (Netherlands)

    Esch, A.A.J. van; Ahmed Ali, U.; Goor, H. van; Bruno, M.J.; Drenth, J.P.H.

    2012-01-01

    CONTEXT: Optimal diagnostic and treatment modalities in chronic pancreatitis are controversial due to lack of evidence. OBJECTIVE: To evaluate current clinical practice, we conducted a survey with the primary objective to evaluate decisions regarding the diagnosis, management and screening in

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

    NARCIS (Netherlands)

    Holtman, Geeske Atje

    2016-01-01

    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

  13. Use of time and materials and cost reimbursement subcontracts for remedial actions under the alternative remedial contracting strategy contracts. Directive

    International Nuclear Information System (INIS)

    1992-01-01

    The directive is intended to establish agency guidance on the use of time and materials and cost reimbursement contracts for remedial actions in general and to provide specific instruction regarding the use of these approaches in subcontracting under the Alternative Remedial Contracting Strategy (ARCS) contracts

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

    Science.gov (United States)

    Cloyd, Raymond A

    2015-04-09

    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.

  15. 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

    2015-04-01

    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.

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

    Science.gov (United States)

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

    2014-10-01

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

  17. Bouldering: an alternative strategy to long-vertical climbing in root-climbing hortensias.

    Science.gov (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

    2014-10-06

    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. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

  18. Economic Comparison of an Empirical Versus Diagnostic-Driven Strategy for Treating Invasive Fungal Disease in Immunocompromised Patients.

    Science.gov (United States)

    Barnes, Rosemary; Earnshaw, Stephanie; Herbrecht, Raoul; Morrissey, Orla; Slavin, Monica; Bow, Eric; McDade, Cheryl; Charbonneau, Claudie; Weinstein, David; Kantecki, Michal; Schlamm, Haran; Maertens, Johan

    2015-06-01

    Patients with persistent or recurrent neutropenic fevers at risk of invasive fungal disease (IFD) are treated empirically with antifungal therapy (AFT). Early treatment using a diagnostic-driven (DD) strategy may reduce clinical and economic burdens. We compared costs and outcomes of both strategies from a UK perspective. An empirical strategy with conventional amphotericin B deoxycholate (C-AmB), liposomal amphotericin B (L-AmB), or caspofungin was compared with a DD strategy (initiated based on positive ELISA results for galactomannan antigen) and/or positive results for Aspergillus species on polymerase chain reaction assay) using C-AmB, voriconazole, or L-AmB in a decision-analytic model. Rates of IFD incidence, overall mortality, and IFD-related mortality in adults expected to be neutropenic for ≥10 days were obtained. The empirical strategy was assumed to identify 30% of IFD and targeted AFT to improve survival by a hazard ratio of 0.589. AFT-specific adverse events were obtained from a summary of product characteristics. Resource use was obtained, and costs were estimated by using standard UK costing sources. All costs are presented in 2012 British pounds sterling. Total costs were 32% lower for the DD strategy (£1561.29) versus the empirical strategy (£2301.93) due to a reduced incidence of adverse events and decreased use of AFT. Administration of AFT was reduced by 41% (DD strategy, 74 of 1000; empirical strategy, 125 of 1000), with similar survival rates. This study suggests that a DD strategy is likely to be cost-saving versus empirical treatment for immunocompromised patients with persistent or recurrent neutropenic fevers. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  19. A diagnostic of the strategy employed for communicating nuclear related information to Brazilian communities around uranium mining areas

    International Nuclear Information System (INIS)

    Ferrari Dias, Fabiana; Tirollo Taddei, Maria H.

    2008-01-01

    This paper presents a diagnostic of the strategy used by the Brazilian uranium mining industry to communicate nuclear related information to communities around a mining area. The uranium mining industry in Brazil, which is run by the government, has been concerned with communication issues for quite some time. The need to communicate became more apparent after new mining operations started in the Northern region of Brazil. The fact that the government does not have a clear communication guideline made the operators of the uranium mining industry aware of the increasing demand for establishment of a good relationship with several types of Stake holders as well as employment of personnel with experience in dealing with them. A diagnostic of the current communication situation in Brazil and an analysis of the approaches over the past years was done through interviews with employees of the mining industry and review of institutional communication materials. The results were discussed during a Consultant's Meeting organized by the IAEA 's Seibersdorf Laboratory in October 2007. The output of the meeting included an overview of modern communication strategies used by different countries and a suggestion for new uranium mining operations in developing or under developed countries. The strategy for communicating nuclear related information to Brazilian communities varied according to the influence of different Stake holder groups. One initiative worth mentioning was the creation of a Mobile Nuclear Information Thematic Room, which was installed in several locations. This project was seen as one of the main tools to relate to community. Many Stake holders were identified during the diagnostic phase in preparation for the IAEA 's meeting on communication strategy: children, NGOs (Non Government Organizations), local churches, media and internal Stake holders, among others. An initial evaluation showed that the perception of a neighbouring community regarding an uranium

  20. Decision making about healthcare-related tests and diagnostic test strategies. Paper 2: a review of methodological and practical challenges.

    Science.gov (United States)

    Mustafa, Reem A; Wiercioch, Wojtek; Cheung, Adrienne; Prediger, Barbara; Brozek, Jan; Bossuyt, Patrick; Garg, Amit X; Lelgemann, Monika; Büehler, Diedrich; Schünemann, Holger J

    2017-12-01

    In this first of a series of five articles, we provide an overview of how and why healthcare-related tests and diagnostic strategies are currently applied. We also describe how our findings can be integrated with existing frameworks for making decisions that guide the use of healthcare-related tests and diagnostic strategies. We searched MEDLINE, references of identified articles, chapters in relevant textbooks, and identified articles citing classic literature on this topic. We provide updated frameworks for the potential roles and applications of tests with suggested definitions and practical examples. We also discuss study designs that are commonly used to assess tests' performance and the effects of tests on people's health. These designs include diagnostic randomized controlled trials and retrospective validation. We describe the utility of these and other currently suggested designs, which questions they can answer and which ones they cannot. In addition, we summarize the challenges unique to decision-making resulting from the use of tests. This overview highlights current challenges in the application of tests in decision-making in healthcare, provides clarifications, and informs the proposed solutions. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Search strategies to identify diagnostic accuracy studies in MEDLINE and EMBASE

    NARCIS (Netherlands)

    Beynon, Rebecca; Leeflang, Mariska M. G.; McDonald, Steve; Eisinga, Anne; Mitchell, Ruth L.; Whiting, Penny; Glanville, Julie M.

    2013-01-01

    A systematic and extensive search for as many eligible studies as possible is essential in any systematic review. When searching for diagnostic test accuracy (DTA) studies in bibliographic databases, it is recommended that terms for disease (target condition) are combined with terms for the

  2. Cost-effectiveness analysis of various strategies in the diagnostic management of pulmonary embolism

    NARCIS (Netherlands)

    Oudkerk, M.; van Beek, E. J.; van Putten, W. L.; Büller, H. R.

    1993-01-01

    Since the clinical diagnosis of pulmonary embolism is unreliable, various objective diagnostic methods (or combinations thereof) are advocated. Pulmonary angiography is the accepted reference method but is considered less suitable for initial screening due to its invasive nature. Therefore, at least

  3. Complementary and Alternative Medicine Strategies for Therapeutic Gut Microbiota Modulation in Inflammatory Bowel Disease and their Next-Generation Approaches.

    Science.gov (United States)

    Basson, Abigail R; Lam, Minh; Cominelli, Fabio

    2017-12-01

    The human gut microbiome exerts a major impact on human health and disease, and therapeutic gut microbiota modulation is now a well-advocated strategy in the management of many diseases, including inflammatory bowel disease (IBD). Scientific and clinical evidence in support of complementary and alternative medicine, in targeting intestinal dysbiosis among patients with IBD, or other disorders, has increased dramatically over the past years. Delivery of "artificial" stool replacements for fecal microbiota transplantation (FMT) could provide an effective, safer alternative to that of human donor stool. Nevertheless, optimum timing of FMT administration in IBD remains unexplored, and future investigations are essential. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Part I. Alternative fuel-cycle and deployment strategies: their influence on long-term energy supply and resource usage

    International Nuclear Information System (INIS)

    Till, C.E.; Chang, Y.I.; Rudolph, R.R.

    1980-01-01

    This report examines the implications of alternative fast breeder fuel cycles and deployment strategies on long-term energy supply and uranium resource utilization. An international-aggregate treatment for nuclear energy demand and resource base assumptions was adopted where specific assumptions were necessary for system analyses, but the primary emphasis was placed on understanding the general relationships between energy demand, uranium resource and breeder deployment option. The fast breeder deployment options studied include the reference Pu/U cycle as well as alternative cycles with varying degrees of thorium utilization

  5. International differences in health care costs in Europe and the United States: Do these affect the cost-effectiveness of diagnostic strategies for pulmonary embolism?

    International Nuclear Information System (INIS)

    Erkel, A.R. van; Pattynama, P.M.T.; Hout, W.B. van den

    1999-01-01

    The aim of this study was to assess whether potential differences in costs for diagnostic procedures and treatment of pulmonary embolism (PE) among European and U. S. hospitals alter the optimal cost-effective diagnostic strategy for PE. A standardized questionnaire was used to obtain cost data for the diagnosis and treatment of PE in participating European and U. S. hospitals. Costs for diagnostic tests and treatment of PE were then calculated in a standardized manner for all participating hospitals, from the hospital perspective. Costs were used in an existing cost-effectiveness analysis (CEA) model to determine the most cost-effective diagnostic strategy in participating hospitals. There were considerable differences in costs for diagnostic and therapeutic procedures for PE among the participating centers. These differences, however, did not affect the most cost-effective strategy based on incremental cost-effectiveness. In all hospitals the most cost-effective strategy appeared to be ultrasound followed by helical CT. International differences in cost of diagnostic and therapeutic procedures certainly exist and should be considered before applying a published CEA. Nevertheless, despite these cost differences, the diagnostic strategy for PE of ultrasound followed by helical CT appears most cost-effective. (orig.)

  6. Unenhanced breast MRI (STIR, T2-weighted TSE, DWIBS): An accurate and alternative strategy for detecting and differentiating breast lesions.

    Science.gov (United States)

    Telegrafo, Michele; Rella, Leonarda; Stabile Ianora, Amato Antonio; Angelelli, Giuseppe; Moschetta, Marco

    2015-10-01

    To assess the role of STIR, T2-weighted TSE and DWIBS sequences for detecting and characterizing breast lesions and to compare unenhanced (UE)-MRI results with contrast-enhanced (CE)-MRI and histological findings, having the latter as the reference standard. Two hundred eighty consecutive patients (age range, 27-73 years; mean age±standard deviation (SD), 48.8±9.8years) underwent MR examination with a diagnostic protocol including STIR, T2-weighted TSE, THRIVE and DWIBS sequences. Two radiologists blinded to both dynamic sequences and histological findings evaluated in consensus STIR, T2-weighted TSE and DWIBS sequences and after two weeks CE-MRI images searching for breast lesions. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for UE-MRI and CE-MRI were calculated. UE-MRI results were also compared with CE- MRI. UE-MRI sequences obtained sensitivity, specificity, diagnostic accuracy, PPV and NPV values of 94%, 79%, 86%, 79% and 94%, respectively. CE-MRI sequences obtained sensitivity, specificity, diagnostic accuracy, PPV and NPV values of 98%, 83%, 90%, 84% and 98%, respectively. No statistically significant difference between UE-MRI and CE-MRI was found. Breast UE-MRI could represent an accurate diagnostic tool and a valid alternative to CE-MRI for evaluating breast lesions. STIR and DWIBS sequences allow to detect breast lesions while T2-weighted TSE sequences and ADC values could be useful for lesion characterization. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. What Do You Know about Alternative Energy? Development and Use of a Diagnostic Instrument for Upper Secondary School Science

    Science.gov (United States)

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

    2015-01-01

    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…

  8. Diagnostic test strategies in children at increased risk of inflammatory bowel disease in primary care

    NARCIS (Netherlands)

    Holtman, Gea A.; Lisman-van Leeuwen, Yvonne; Kollen, Boudewijn J.; Norbruis, Obbe F.; Escher, Johanna C.; Walhout, Laurence C.; Kindermann, Angelika; de Rijke, Yolanda B.; van Rheenen, Patrick F.; Berger, Marjolein Y.

    2017-01-01

    In children with symptoms suggestive of inflammatory bowel disease (IBD) who present in primary care, the optimal test strategy for identifying those who require specialist care is unclear. We evaluated the following three test strategies to determine which was optimal for referring children with

  9. Diagnostic test strategies in children at increased risk of inflammatory bowel disease in primary care

    NARCIS (Netherlands)

    Holtman, Gea A.; Lisman-van Leeuwen, Yvonne; Kollen, Boudewijn J.; Norbruis, Obbe F.; Escher, Johanna C.; Walhout, Laurence C.; Kindermann, Angelika; de Rijke, Yolanda B.; van Rheenen, Patrick F.; Berger, Marjolein Y.

    2017-01-01

    Background: In children with symptoms suggestive of inflammatory bowel disease (IBD) who present in primary care, the optimal test strategy for identifying those who require specialist care is unclear. We evaluated the following three test strategies to determine which was optimal for referring

  10. Diagnostic test strategies in children at increased risk of inflammatory bowel disease in primary care

    NARCIS (Netherlands)

    G.A. Holtman (Gea A); Y. Lisman-van Leeuwen (Yvonne); B.J. Kollen (Boudewijn ); O.F. Norbruis (Obbe); J.C. Escher (Johanna); L.C. Walhout (Laurence); A. Kindermann; Y.B. de Rijke (Yolanda); P.F. van Rheenen (Patrick); M.Y. Berger (Marjolein)

    2017-01-01

    textabstractBackground: In children with symptoms suggestive of inflammatory bowel disease (IBD) who present in primary care, the optimal test strategy for identifying those who require specialist care is unclear. We evaluated the following three test strategies to determine which was optimal for

  11. Dilution testing using rapid diagnostic tests in a HIV diagnostic algorithm: a novel alternative for confirmation testing in resource limited settings.

    Science.gov (United States)

    Shanks, Leslie; Siddiqui, M Ruby; Abebe, Almaz; Piriou, Erwan; Pearce, Neil; Ariti, Cono; Masiga, Johnson; Muluneh, Libsework; Wazome, Joseph; Ritmeijer, Koert; Klarkowski, Derryck

    2015-05-14

    Current WHO testing guidelines for resource limited settings diagnose HIV on the basis of screening tests without a confirmation test due to cost constraints. This leads to a potential risk of false positive HIV diagnosis. In this paper, we evaluate the dilution test, a novel method for confirmation testing, which is simple, rapid, and low cost. The principle of the dilution test is to alter the sensitivity of a rapid diagnostic test (RDT) by dilution of the sample, in order to screen out the cross reacting antibodies responsible for falsely positive RDT results. Participants were recruited from two testing centres in Ethiopia where a tiebreaker algorithm using 3 different RDTs in series is used to diagnose HIV. All samples positive on the initial screening RDT and every 10th negative sample underwent testing with the gold standard and dilution test. Dilution testing was performed using Determine™ rapid diagnostic test at 6 different dilutions. Results were compared to the gold standard of Western Blot; where Western Blot was indeterminate, PCR testing determined the final result. 2895 samples were recruited to the study. 247 were positive for a prevalence of 8.5 % (247/2895). A total of 495 samples underwent dilution testing. The RDT diagnostic algorithm misclassified 18 samples as positive. Dilution at the level of 1/160 was able to correctly identify all these 18 false positives, but at a cost of a single false negative result (sensitivity 99.6 %, 95 % CI 97.8-100; specificity 100 %, 95 % CI: 98.5-100). Concordance between the gold standard and the 1/160 dilution strength was 99.8 %. This study provides proof of concept for a new, low cost method of confirming HIV diagnosis in resource-limited settings. It has potential for use as a supplementary test in a confirmatory algorithm, whereby double positive RDT results undergo dilution testing, with positive results confirming HIV infection. Negative results require nucleic acid testing to rule out false

  12. IDegLira Versus Alternative Intensification Strategies in Patients with Type 2 Diabetes Inadequately Controlled on Basal Insulin Therapy

    DEFF Research Database (Denmark)

    Freemantle, Nick; Mamdani, Muhammad; Vilsbøll, Tina

    2015-01-01

    INTRODUCTION: IDegLira is a once-daily combination of insulin degludec (IDeg) and liraglutide. Trials directly comparing IDegLira with alternative strategies for intensifying basal insulin are ongoing. While awaiting results, this analysis compared indirectly how different strategies affected......Lira versus up-titrated IGlar. The supplementary analysis yielded similar results to the main analysis. Results with IDegLira were similar to those for the 'GLP-1RA add-on' arm. CONCLUSION: These results suggest that IDegLira may be more effective, with lower hypoglycemia rates and less weight gain, than up...

  13. Strategies in Ebola virus disease (EVD) diagnostics at the point of care.

    Science.gov (United States)

    Coarsey, Chad T; Esiobu, Nwadiuto; Narayanan, Ramswamy; Pavlovic, Mirjana; Shafiee, Hadi; Asghar, Waseem

    2017-11-01

    Ebola virus disease (EVD) is a devastating, highly infectious illness with a high mortality rate. The disease is endemic to regions of Central and West Africa, where there is limited laboratory infrastructure and trained staff. The recent 2014 West African EVD outbreak has been unprecedented in case numbers and fatalities, and has proven that such regional outbreaks can become a potential threat to global public health, as it became the source for the subsequent transmission events in Spain and the USA. The urgent need for rapid and affordable means of detecting Ebola is crucial to control the spread of EVD and prevent devastating fatalities. Current diagnostic techniques include molecular diagnostics and other serological and antigen detection assays; which can be time-consuming, laboratory-based, often require trained personnel and specialized equipment. In this review, we discuss the various Ebola detection techniques currently in use, and highlight the potential future directions pertinent to the development and adoption of novel point-of-care diagnostic tools. Finally, a case is made for the need to develop novel microfluidic technologies and versatile rapid detection platforms for early detection of EVD.

  14. Instantaneous wave-free ratio as an alternative to fractional flow reserve in assessment of moderate coronary stenoses: A meta-analysis of diagnostic accuracy studies.

    Science.gov (United States)

    Maini, Rohit; Moscona, John; Katigbak, Paul; Fernandez, Camilo; Sidhu, Gursukhmandeep; Saleh, Qusai; Irimpen, Anand; Samson, Rohan; LeJemtel, Thierry

    2017-12-27

    Fractional flow reserve (FFR) remains underutilized due to practical concerns related to the need for hyperemic agents. These concerns have prompted the study of instantaneous wave-free ratio (iFR), a vasodilator-free index of coronary stenosis. Non-inferior cardiovascular outcomes have been demonstrated in two recent randomized clinic trials. We performed this meta-analysis to provide a necessary update of the diagnostic accuracy of iFR referenced to FFR based on the addition of eight more recent studies and 3727 more lesions. We searched the PubMed, EMBASE, Central, ProQuest, and Web of Science databases for full text articles published through May 31, 2017 to identify studies addressing the diagnostic accuracy of iFR referenced to FFR≤0.80. The following keywords were used: "instantaneous wave-free ratio" OR "iFR" AND "fractional flow reserve" OR "FFR." In total, 16 studies comprising 5756 lesions were identified. Pooled diagnostic accuracy estimates of iFR versus FFR≤0.80 were: sensitivity, 0.78 (95% CI, 0.76-0.79); specificity, 0.83 (0.81-0.84); positive likelihood ratio, 4.54 (3.85-5.35); negative likelihood ratio, 0.28 (0.24-0.32); diagnostic odds ratio, 17.38 (14.16-21.34); area under the summary receiver-operating characteristic curve, 0.87; and an overall diagnostic accuracy of 0.81 (0.78-0.84). In conclusion, iFR showed excellent agreement with FFR as a resting index of coronary stenosis severity without the undesired effects and cost of hyperemic agents. When considering along with its clinical outcome data and ease of application, the diagnostic accuracy of iFR supports its use as a suitable alternative to FFR for physiology-guided revascularization of moderate coronary stenoses. We performed a meta-analysis of the diagnostic accuracy of iFR referenced to FFR. iFR showed excellent agreement with FFR as a resting index of coronary stenosis severity without the undesired effects and cost of hyperemic agents. This supports its use as a suitable

  15. Routing strategies for efficient deployment of alternative fuel vehicles for freight delivery.

    Science.gov (United States)

    2017-02-01

    With increasing concerns on environmental issues, recent research on Vehicle Routing Problems : (VRP) has added new factors such as greenhouse gas emissions and alternative fuel vehicles into : the models. In this report, we consider one such promisi...

  16. Alternative powertrain strategies and fleet turnover in the 21st century.

    Science.gov (United States)

    2010-08-01

    The changes taking place in the global automotive industry related to alternative : powertrains and fuels are affecting each country or region differently. Each country or : region has its own policies in place to monitor and manage vehicle fuel cons...

  17. Augmentative and alternative communication in daily clinical practice: strategies and tools for management of severe communication disorders.

    Science.gov (United States)

    Frankoff, Denise J; Hatfield, Brooke

    2011-01-01

    Research indicates that augmentative and alternative communication (AAC) approaches can be used effectively by patients and their caregivers to improve communication skills. This article highlights strategies and tools for re-establishing communication competence by considering the complexity and diversity of communication interactions in an effort to maximize natural speech and language skills via a range of technologies that are implemented across the continuum of care rather than as a last resort.

  18. Conservation in the residential sector: two alternatives as strategies for ordering the market

    International Nuclear Information System (INIS)

    Lins, M.E.

    1990-01-01

    This work purposes an economic flow analysis in order to be driven conservation strategies by the electric sector. Two strategies for three conservation measures are considered here in the residential sector. The results obtained increase the reliability of an action plan to be elaborated for the electric energy conservation in the residential sector. (author)

  19. The process evaluation of two alternative participatory ergonomics intervention strategies for construction companies.

    Science.gov (United States)

    Visser, Steven; van der Molen, Henk F; Sluiter, Judith K; Frings-Dresen, Monique H W

    2018-03-26

    To gain insight into the process of applying two guidance strategies - face-to-face (F2F) or e-guidance strategy (EC) - of a Participatory Ergonomics (PE) intervention and whether differences between these guidance strategies occur, 12 construction companies were randomly assigned to a strategy. The process evaluation contained reach, dose delivered, dose received, precision, competence, satisfaction and behavioural change of individual workers. Data were assessed by logbooks, and questionnaires and interviews at baseline and/or after six months. Reach was low (1%). Dose delivered (F2F: 63%; EC: 44%), received (F2F: 42%; EC: 16%) were not sufficient. The precision and competence were sufficient for both strategies and satisfaction was strongly affected by dose received. For behavioural change, knowledge (F2F) and culture (EC) changed positively within companies. Neither strategy was delivered as intended. Compliance to the intervention was low, especially for EC. Starting with a face-to-face meeting might lead to higher compliance, especially in the EC group. Practitioner Summary: This study showed that compliance to a face-to-face and an e-guidance strategy is low. To improve the compliance, it is advised to start with a face-to-face meeting to see which parts of the intervention are needed and which guidance strategy can be used for these parts. ISRCTN73075751.

  20. Statistical Significance of the Contribution of Variables to the PCA Solution: An Alternative Permutation Strategy

    Science.gov (United States)

    Linting, Marielle; van Os, Bart Jan; Meulman, Jacqueline J.

    2011-01-01

    In this paper, the statistical significance of the contribution of variables to the principal components in principal components analysis (PCA) is assessed nonparametrically by the use of permutation tests. We compare a new strategy to a strategy used in previous research consisting of permuting the columns (variables) of a data matrix…

  1. Evaluating alternative management strategies for bigeye tuna, Thunnus obesus, in the Indian Ocean

    Directory of Open Access Journals (Sweden)

    Yuhe Tong

    2013-09-01

    Full Text Available Bigeye tuna (Thunnus obesus support a large commercial fishery in the Indian Ocean. However, explicit management strategies and harvest control rules are yet to be developed for the management of this fishery. We used a stochastic age-structured production model as an operating model to evaluate several potential management strategies under different assumptions of stock productivity. Five management strategies—constant fishing mortality, constant catch, quasi-constant catch, constant escapement, and status-dependent strategies—were evaluated and compared using the performance indicators including average catch, average spawning stock biomass, variation in catch, average fishing mortality and lowest biomass during the time period considered in the simulation. This study shows that (1 for the constant catch strategy, an annual catch of 90000 t would result in a low risk of stock being overfished while obtaining a stable catch; (2 for the constant fishing mortality strategy fishing mortality of 0.3 per year could yield a higher catch, but might have a high probability (64% of stock dropping below the spawning stock biomass (SSB that could achieve maximum sustainable yield (SSBmsy; and (3 for the quasi-constant catch strategy an annual catch of 110000 t was sustainable if the current SSB was higher than SSBmsy. Constant escapement and status-dependent strategies were robust with respect to different levels of virgin recruitment and steepness. This study suggests that it is important to incorporate uncertainties associated with key life history, fisheries and management processes in evaluating management strategies.

  2. Optimization of Classification Strategies of Acetowhite Temporal Patterns towards Improving Diagnostic Performance of Colposcopy

    Directory of Open Access Journals (Sweden)

    Karina Gutiérrez-Fragoso

    2017-01-01

    Full Text Available Efforts have been being made to improve the diagnostic performance of colposcopy, trying to help better diagnose cervical cancer, particularly in developing countries. However, improvements in a number of areas are still necessary, such as the time it takes to process the full digital image of the cervix, the performance of the computing systems used to identify different kinds of tissues, and biopsy sampling. In this paper, we explore three different, well-known automatic classification methods (k-Nearest Neighbors, Naïve Bayes, and C4.5, in addition to different data models that take full advantage of this information and improve the diagnostic performance of colposcopy based on acetowhite temporal patterns. Based on the ROC and PRC area scores, the k-Nearest Neighbors and discrete PLA representation performed better than other methods. The values of sensitivity, specificity, and accuracy reached using this method were 60% (95% CI 50–70, 79% (95% CI 71–86, and 70% (95% CI 60–80, respectively. The acetowhitening phenomenon is not exclusive to high-grade lesions, and we have found acetowhite temporal patterns of epithelial changes that are not precancerous lesions but that are similar to positive ones. These findings need to be considered when developing more robust computing systems in the future.

  3. Teaching science for conceptual change: Toward a proposed taxonomy of diagnostic teaching strategies to gauge students' personal science conceptions

    Science.gov (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

  4. Efficiency of alternative MCMC strategies illustrated using the reaction norm model

    DEFF Research Database (Denmark)

    Shariati, Mohammad Mahdi; Sørensen, D.

    2008-01-01

    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...... in the low correlation scenario where SG was the best strategy. The two LH proposals could not compete with any of the Gibbs sampling algorithms. In this study it was not possible to find an MCMC strategy that performs optimally across the range of target distributions and across all possible values...

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

    International Nuclear Information System (INIS)

    Ruess, Lynne; O'Connor, Stephen C.; Mikita, Cecilia P.; Creamer, Kevin M.

    2002-01-01

    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 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.)

  6. A simulation model to estimate the cost and effectiveness of alternative dialysis initiation strategies.

    Science.gov (United States)

    Lee, Chris P; Chertow, Glenn M; Zenios, Stefanos A

    2006-01-01

    Patients with end-stage renal disease (ESRD) require dialysis to maintain survival. The optimal timing of dialysis initiation in terms of cost-effectiveness has not been established. We developed a simulation model of individuals progressing towards ESRD and requiring dialysis. It can be used to analyze dialysis strategies and scenarios. It was embedded in an optimization frame worked to derive improved strategies. Actual (historical) and simulated survival curves and hospitalization rates were virtually indistinguishable. The model overestimated transplantation costs (10%) but it was related to confounding by Medicare coverage. To assess the model's robustness, we examined several dialysis strategies while input parameters were perturbed. Under all 38 scenarios, relative rankings remained unchanged. An improved policy for a hypothetical patient was derived using an optimization algorithm. The model produces reliable results and is robust. It enables the cost-effectiveness analysis of dialysis strategies.

  7. A Comparison of Alternative Strategies for Cost-Effective Water Quality Management in Lakes

    Science.gov (United States)

    Kramer, Daniel Boyd; Polasky, Stephen; Starfield, Anthony; Palik, Brian; Westphal, Lynne; Snyder, Stephanie; Jakes, Pamela; Hudson, Rachel; Gustafson, Eric

    2006-09-01

    Roughly 45% of the assessed lakes in the United States are impaired for one or more reasons. Eutrophication due to excess phosphorus loading is common in many impaired lakes. Various strategies are available to lake residents for addressing declining lake water quality, including septic system upgrades and establishing riparian buffers. This study examines 25 lakes to determine whether septic upgrades or riparian buffers are a more cost-effective strategy to meet a phosphorus reduction target. We find that riparian buffers are the more cost-effective strategy in every case but one. Large transaction costs associated with the negotiation and monitoring of riparian buffers, however, may be prohibiting lake residents from implementing the most cost-effective strategy.

  8. A Diagnostic Technique for Formulating Market Strategies in Higher Education Based on Relative Competitive Position.

    Science.gov (United States)

    Dolinsky, Arthur L.; Quazi, Hesan A.

    1994-01-01

    Importance-performance analysis, a marketing research technique using analysis of consumer attitudes toward salient product or service attributes, is found useful for colleges and universities in developing marketing strategies, particularly when competition is considered as an important dimension. Data are drawn from a survey of 252 students at 1…

  9. Pyramiding, alternating or mixing: comparative performances of deployment strategies of nematode resistance genes to promote plant resistance efficiency and durability.

    Science.gov (United States)

    Djian-Caporalino, Caroline; Palloix, Alain; Fazari, Ariane; Marteu, Nathalie; Barbary, Arnaud; Abad, Pierre; Sage-Palloix, Anne-Marie; Mateille, Thierry; Risso, Sabine; Lanza, Roger; Taussig, Catherine; Castagnone-Sereno, Philippe

    2014-02-22

    Resistant cultivars are key elements for pathogen control and pesticide reduction, but their repeated use may lead to the emergence of virulent pathogen populations, able to overcome the resistance. Increased research efforts, mainly based on theoretical studies, explore spatio-temporal deployment strategies of resistance genes in order to maximize their durability. We evaluated experimentally three of these strategies to control root-knot nematodes: cultivar mixtures, alternating and pyramiding resistance genes, under controlled and field conditions over a 3-years period, assessing the efficiency and the durability of resistance in a protected crop rotation system with pepper as summer crop and lettuce as winter crop. The choice of the resistance gene and the genetic background in which it is introgressed, affected the frequency of resistance breakdown. The pyramiding of two different resistance genes in one genotype suppressed the emergence of virulent isolates. Alternating different resistance genes in rotation was also efficient to decrease virulent populations in fields due to the specificity of the virulence and the trapping effect of resistant plants. Mixing resistant cultivars together appeared as a less efficient strategy to control nematodes. This work provides experimental evidence that, in a cropping system with seasonal sequences of vegetable species, pyramiding or alternating resistance genes benefit yields in the long-term by increasing the durability of resistant cultivars and improving the long-term control of a soil-borne pest. To our knowledge, this result is the first one obtained for a plant-nematode interaction, which helps demonstrate the general applicability of such strategies for breeding and sustainable management of resistant cultivars against pathogens.

  10. Single-Case Research Design: An Alternative Strategy for Evidence-Based Practice

    Science.gov (United States)

    Stapleton, Drue; Hawkins, Andrew

    2015-01-01

    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…

  11. 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.

    2008-01-01

    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

  12. Assessing Tuition and Student Aid Strategies: Using Price-Response Measures to Simulate Pricing Alternatives.

    Science.gov (United States)

    St. John, Edward P.

    1994-01-01

    A study used price-response measures from recent national studies to assess college and university pricing (tuition and student aid) alternatives in diverse institutional settings. It is concluded that such analyses are feasible. Analysis indicated limits to "Robin Hood" pricing patterns are predominant in private colleges. Consideration…

  13. 78 FR 68076 - Request for Information on Alternative Skin Sensitization Test Methods and Testing Strategies and...

    Science.gov (United States)

    2013-11-13

    ... Laboratory for Alternatives to Animal Testing (EURL ECVAM), and by the industry organization Cosmetics Europe... products. Pesticides and other marketed chemicals, including cosmetic ingredients, are routinely tested for... sensitization. NICEATM collaboration with industry scientists to develop an open-source Bayesian network as an...

  14. Alternative intrapopulation life-history strategies and their trade-offs in an African annual fish

    Czech Academy of Sciences Publication Activity Database

    Polačik, Matej; Blažek, Radim; Řežucha, Radomil; Vrtílek, Milan; Terzibasi Tozzini, E.; Reichard, Martin

    2014-01-01

    Roč. 27, č. 5 (2014), s. 854-865 ISSN 1010-061X R&D Projects: GA ČR GPP505/11/P646 Institutional support: RVO:68081766 Keywords : phenotypic plasticity * periodic habitat * senescence rate * polyphenism * lifespan * alternative embryonic pathway Subject RIV: EG - Zoology Impact factor: 3.232, year: 2014

  15. [Diagnostic and Treatment Strategies in Morel-Lavallee Lesions in the Spinal Column and Pelvis].

    Science.gov (United States)

    Becker, Christopher A; Kammerlander, Christian; Greiner, Axel; Sommer, Fabian; Linhart, Christoph; Böcker, Wolfgang; Rubenbauer, Bianka; Weidert, Simon

    2018-04-12

    The Morel-Lavallée lesion is one of the concomitant soft tissue lesions of pelvic fractures. Its role in spine fractures and its treatment in combination with osteosynthesis of pelvic or spine fractures have not yet been determined. The aim of this study was to analyse the best diagnostic and treatment options of both spine and pelvic fractures combined with Morel-Lavallée lesions (MLL). An analysis of the literature was performed via PubMed and Medline. This revealed a total of 197 studies and case reports. After analysing the literature, 19 studies/case reports met our inclusion criteria. There are several diagnostic options for MLL, including ultrasound, computed tomography or MRI. In spinal and pelvic lesions, ultrasound is capable of detecting MLL. Some authors tend to perform open debridement of the MLL, whereas others recommend percutanous treatment. Open debridement and vacuum-assisted closure are recommended in late diagnosed MLL, where primary suture of the soft tissue is impossible. Fracture fixation should be performed simultaneously to treatment of the MLL. Broad-spectrum cephalosporins combined with an aminoglycoside or piperacilline/tazobactam should be initiated. Radical debridement and drainage are recommended, especially when MLL is diagnosed late. Repeated ultrasound examinations should be performed of the surrounding soft tissue of the fracture. When MLL is diagnosed within 2 days, percutanous fracture and MLL treatment should be performed. After more than 2 days, both fracture and MLL should be treated with open debridement, open fracture fixation and primary suture if possible. Georg Thieme Verlag KG Stuttgart · New York.

  16. Distribution of mast cell subtypes in interstitial cystitis: implications for novel diagnostic and therapeutic strategies?

    Science.gov (United States)

    Malik, Shabana T; Birch, Brian R; Voegeli, David; Fader, Mandy; Foria, Vipul; Cooper, Alan J; Walls, Andrew F; Lwaleed, Bashir A

    2018-05-15

    To identify the presence and geographical distribution of mast cell (MC) subtypes: MC T (tryptase positive-chymase negative) and MC TC (tryptase positive-chymase positive) in bladder tissue. Bladder tissue was obtained from patients with painful bladder syndrome/interstitial cystitis (n=14) and normal histology from University Hospital Southampton tissue bank. Sequential tissue slices were immunohistochemically stained for MC subtypes using anti-MC tryptase (for MC T and MC TC ) and anti-MC chymase (for MC TC ). Stained sections were photographed, and positively stained MCs were quantified using ImageJ. Data were analysed using descriptive statistics and individual paired t-tests. There was a significant difference in the density of MCs between each layer of the disease bladder, with the greatest accumulation within the detrusor (p<0.001). There was a significant increase in MC TC subtype in the lamina (p=0.009) in painful bladder syndrome/interstitial cystitis. Our results suggest that mastocytosis is present within all layers of disease bladder, especially the muscle layer. The varying increase in MC subtypes in the lamina and mucosa may explain the variability in painful bladder syndrome/interstitial cystitis symptoms. A high influx of MC TC in the mucosa of individuals who also had ulceration noted within their diagnostic notes may be of the Hunner's ulcer subclassification. These findings suggest a relationship between the pathogenesis of MC subtypes and the clinical presentation of painful bladder syndrome/interstitial cystitis. A cohort study would further elucidate the diagnostic and/or therapeutic potential of MCs in patients with painful bladder syndrome/interstitial cystitis. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  17. Project Cerberus: tobacco industry strategy to create an alternative to the Framework Convention on Tobacco Control.

    Science.gov (United States)

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

    2008-09-01

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    None

    1977-06-01

    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)

  19. High impact of FDG-PET/CT in diagnostic strategies for ovarian cancer

    International Nuclear Information System (INIS)

    Zytoon, Ashraf Anas; Murakami, Koji; Eid, Hazem; El-Gammal, Mahmoud

    2013-01-01

    Background: Ovarian cancer has the highest mortality of all gynecologic malignancies. FDG-PET/CT was proven to be accurate for identification of primary ovarian tumors, regional lymph nodes, and distant metastases. Purpose: To evaluate ovarian masses at FDG-PET/CT in correlation with histopathologic findings. Material and Methods: Ninety-eight patients underwent whole body FDG-PET/CT examination. Eighty-six patients with primary ovarian cancer and 12 patients with metastatic disease to the ovaries were included. Results: PET/CT imaging was true-positive in 87/94 patients with malignant tumors. In 4/4 patients with benign tumors, PET/CT results were true-negative, with sensitivity of 92.6%, specificity 100%, total test accuracy 92.9%. Fifty-seven patients were diagnosed as stage IV ovarian cancer with distant metastasis. Conclusion: The anatomical/functional examination by FDG-PET/CT was proven to be valuable in increasing the diagnostic accuracy that can help improve patient management

  20. The depressed patient in a biological world: on philosophical and diagnostic strategies.

    Science.gov (United States)

    Korf, Jakob; Bosker, Fokko

    2013-06-01

    We questioned: what kind of relationships between mental and neurobiological levels of complexity is or could become useful in the psychiatric practice? The concept of mind and associated mood states defended here is that they are physically emergent, subjective, qualitative, unified features of the brain. We compared our neurobiological assessment also to psychoanalytical practice (first person's perspective). Applied to recent work on major depressive disorder (MDD), our ideas are among other supported by clinical and experimental studies on sleep deprivation, deep brain stimulation and epidemiological assessments of time-to-recovery. We suggest that depression is a transient state of the brain, that is mutually exclusive to the state of pleasure (in the Freudian context), rather than a disorder or disease with a characteristic time course (like many reversible somatic diseases). MDD can best be described with stochastic transition models, which is discussed in the context of a presumed brain serotonin dysfunction in depression. Our ideas invite a reconsideration of some concepts underlying current diagnostic and therapeutic approaches in the clinical practice. © 2013 John Wiley & Sons Ltd.

  1. A Culturally Responsive Alternative to "Drill and Kill" Literacy Strategies: Deep Roots, Civil Rights

    Science.gov (United States)

    Peterson, Deborah S.

    2014-01-01

    This article describes two approaches to improving literacy in a high poverty, diverse urban high school. One curriculum program, "Striving Readers," included a prescribed course of study for students reading below grade level along with schoolwide strategies. This approach did not improve targeted students' reading scores or motivation…

  2. A Comparison of Alternative Strategies for Cost-Effective Water Quality Management in Lakes

    Science.gov (United States)

    Daniel Boyd Kramer; Stephen Polasky; Anthony Starfield; Brian Palik; Lynn Westphal; Stephanie Snyder; Pamela Jakes; Rachel Hudson; Eric Gustafson

    2006-01-01

    Roughly 45% of the assessed lakes in the United States are impaired for one or more reasons. Eutrophication due to excess phosphorus loading is common in many impaired lakes. Various strategies are available to lake residents for addressing declining lake water quality, including septic system upgrades and establishing riparian buffers. This study examines 25 lakes to...

  3. Note-Taking with Computers: Exploring Alternative Strategies for Improved Recall

    Science.gov (United States)

    Bui, Dung C.; Myerson, Joel; Hale, Sandra

    2013-01-01

    Three experiments examined note-taking strategies and their relation to recall. In Experiment 1, participants were instructed either to take organized lecture notes or to try and transcribe the lecture, and they either took their notes by hand or typed them into a computer. Those instructed to transcribe the lecture using a computer showed the…

  4. Intracranial aneurysms: optimized diagnostic tools call for thorough interdisciplinary treatment strategies.

    Science.gov (United States)

    Mueller, Oliver M; Schlamann, Marc; Mueller, Daniela; Sandalcioglu, I Erol; Forsting, Michael; Sure, Ulrich

    2011-09-01

    Intracranial aneurysms (IAs) require deliberately selected treatment strategies as they are incrementally found prior to rupture and deleterious subarachnoid haemorrhage (SAH). Multiple and recurrent aneurysms necessitate both neurointerventionalists and neurosurgeons to optimize aneurysmal occlusion in an interdisciplinary effort. The present study was conducted to condense essential strategies from a single neurovascular centre with regard to the lessons learned. Medical charts of 321 consecutive patients treated for IAs at our centre from September 2008 until December 2010 were retrospectively analysed for clinical presentation of the aneurysms, multiplicity and treatment pathways. In addition, a selective Medline search was performed. A total of 321 patients with 492 aneurysms underwent occlusion of their symptomatic aneurysm: 132 (41.1%) individuals were treated surgically, 189 (58.2%) interventionally; 138 patients presented with a SAH, of these 44.2% were clipped and 55.8% were coiled. Aneurysms of the middle cerebral artery were primarily occluded surgically (88), whereas most of the aneurysms of the internal carotid artery and anterior communicating artery (114) were treated endovascularly. Multiple aneurysms (range 2-5 aneurysms/individual) were diagnosed in 98 patients (30.2%). During the study period 12 patients with recurrent aneurysms were allocated to another treatment modality (previously clip to coil and vice versa). Our data show that successful interdisciplinary occlusion of IAs is based on both neurosurgical and neurointerventional therapy. In particular, multiple and recurrent aneurysms require tailored individual approaches to aneurysmal occlusion. This is achieved by a consequent interdisciplinary pondering of the optimal strategy to occlude IAs in order to prevent SAH.

  5. A diagnostic strategy for pulmonary embolism based on standardised pretest probability and perfusion lung scanning: a management study

    International Nuclear Information System (INIS)

    Miniati, Massimo; Monti, Simonetta; Bauleo, Carolina; Scoscia, Elvio; Tonelli, Lucia; Dainelli, Alba; Catapano, Giosue; Formichi, Bruno; Di Ricco, Giorgio; Prediletto, Renato; Carrozzi, Laura; Marini, Carlo

    2003-01-01

    Pulmonary embolism remains a challenging diagnostic problem. We developed a simple diagnostic strategy based on combination of assessment of the pretest probability with perfusion lung scan results to reduce the need for pulmonary angiography. We studied 390 consecutive patients (78% in-patients) with suspected pulmonary embolism. The pretest probability was rated low ( 10%, ≤50%), moderately high (>50%, ≤90%) or high (>90%) according to a structured clinical model. Perfusion lung scans were independently assigned to one of four categories: normal; near-normal; abnormal, suggestive of pulmonary embolism (wedge-shaped perfusion defects); abnormal, not suggestive of pulmonary embolism (perfusion defects other than wedge shaped). Pulmonary embolism was diagnosed in patients with abnormal scans suggestive of pulmonary embolism and moderately high or high pretest probability. Patients with normal or near-normal scans and those with abnormal scans not suggestive of pulmonary embolism and low pretest probability were deemed not to have pulmonary embolism. All other patients were allocated to pulmonary angiography. Patients in whom pulmonary embolism was excluded were left untreated. All patients were followed up for 1 year. Pulmonary embolism was diagnosed non-invasively in 132 patients (34%), and excluded in 191 (49%). Pulmonary angiography was required in 67 patients (17%). The prevalence of pulmonary embolism was 41% (n=160). Patients in whom pulmonary embolism was excluded had a thrombo-embolic risk of 0.4% (95% confidence interval: 0.0%-2.8%). Our strategy permitted a non-invasive diagnosis or exclusion of pulmonary embolism in 83% of the cases (95% confidence interval: 79%-86%), and appeared to be safe. (orig.)

  6. Elicitors as alternative strategy to pesticides in grapevine? Current knowledge on their mode of action from controlled conditions to vineyard.

    Science.gov (United States)

    Delaunois, Bertrand; Farace, Giovanni; Jeandet, Philippe; Clément, Christophe; Baillieul, Fabienne; Dorey, Stéphan; Cordelier, Sylvain

    2014-04-01

    Development and optimisation of alternative strategies to reduce the use of classic chemical inputs for protection against diseases in vineyard is becoming a necessity. Among these strategies, one of the most promising consists in the stimulation and/or potentiation of the grapevine defence responses by the means of elicitors. Elicitors are highly diverse molecules both in nature and origins. This review aims at providing an overview of the current knowledge on these molecules and will highlight their potential efficacy from the laboratory in controlled conditions to vineyards. Recent findings and concepts (especially on plant innate immunity) and the new terminology (microbe-associated molecular patterns, effectors, etc.) are also discussed in this context. Other objectives of this review are to highlight the difficulty of transferring elicitors use and results from the controlled conditions to the vineyard, to determine their practical and effective use in viticulture and to propose ideas for improving their efficacy in non-controlled conditions.

  7. Diagnostic strategies to reveal covert infections with intestinal helminths in dogs.

    Science.gov (United States)

    Adolph, Chris; Barnett, Sharon; Beall, Melissa; Drake, Jason; Elsemore, David; Thomas, Jennifer; Little, Susan

    2017-11-30

    Intestinal helminths are common in dogs in the United States, particularly non-treated dogs in animal shelters, but surveys by fecal flotation may underestimate their prevalence. To determine the prevalence of intestinal helminths and evaluate the ability of fecal flotation and detection of nematode antigen to identify those infections, contents of the entire gastrointestinal tract of 97 adult (>1year) dogs previously identified for humane euthanasia at two animal control shelters in northeastern Oklahoma, USA, were screened. All helminths recovered were washed in saline and fixed prior to enumeration and identification to genus and species. Fecal samples from each dog were examined by passive sodium nitrate (SG 1.33) and centrifugal sugar solution (SG 1.25) flotation. Fecal antigen detection assays were used to confirm the presence of nematode antigen in frozen fecal samples from 92 dogs. Necropsy examination revealed Ancylostoma caninum in 45/97 (46.4%), Toxocara canis in 11/97 (11.3%), Trichuris vulpis in 38/97 (39.2%), Dipylidium caninum in 48/97 (49.5%), and Taenia sp. in 7/97 (7.2%) dogs. Passive fecal flotation identified 38/45 (84.4%) A. caninum, 6/11 (54.5%) T. canis, 26/38 (68.4%) T. vulpis, 2/48 (4.2%) D. caninum, and 1/7 (14.3%) Taenia sp. infections, while centrifugal flotation combined with antigen detection assays identified A. caninum in 97.7% (43/44), T. canis in 77.8% (7/9), and T. vulpis in 83.3% (30/36) of infected dogs based on necropsy recovery of nematodes. Taken together, these data indicate that detection of nematode antigen is a useful adjunct to microscopic examination of fecal samples for parasite eggs, and that this approach can improve diagnostic sensitivity for intestinal nematode infections in dogs. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Salivary cortisol as a tool for physiological studies and diagnostic strategies

    Directory of Open Access Journals (Sweden)

    Castro M.

    2000-01-01

    Full Text Available Salivary cortisol is an index of plasma free cortisol and is obtained by a noninvasive procedure. We have been using salivary cortisol as a tool for physiological and diagnostic studies, among them the emergence of circadian rhythm in preterm and term infants. The salivary cortisol circadian rhythm in term and premature infants was established between 8 and 12 postnatal weeks. In the preterm infants the emergence of circadian rhythm was parallel to the onset of sleep rhythm. We also studied the use of salivary cortisol for screening for Cushing's syndrome (CS in control and obese outpatients based on circadian rhythm and the overnight 1 mg dexamethasone (DEX suppression test. Salivary cortisol was suppressed to less than 100 ng/dl after 1 mg DEX in control and obese patients. A single salivary cortisol measurement at 23:00 h and again after 1 mg DEX above the 90th percentile of the obese group values had sensitivity and specificity of 93 and 93% (23:00 h, and 91 and 94% (after DEX, respectively. The sensitivity improved to 100% when we combined both parameters. We also studied 11 CS children and 21 age-matched primary obese children for whom salivary cortisol sensitivity and specificity were 100/95% (23:00 h, and 100/95% (1 mg DEX, respectively. Similar to adults, sensitivity and specificity of 100% were obtained by combining 23:00 h and 1 mg DEX. The measurement of salivary cortisol is a useful tool for physiological studies and for the diagnosis of CS in children and adults on an outpatient basis.

  9. The Henry-Saltwater Intrusion Benchmark – Alternatives in Multiphysics Formulations and Solution Strategies

    Directory of Open Access Journals (Sweden)

    E Holzbecher

    2016-03-01

    Full Text Available In a classical paper Henry set up a conceptual model for simulating saltwater intrusion into coastal aquifers. Up to now the problem has been taken up by software developers and modellers as a benchmark for codes simulating coupled flow and transport in porous media. The Henry test case has been treated using different numerical methods based on various formulations of differential equations. We compare several of these approaches using multiphysics software. We model the problem using Finite Elements, utilizing the primitive variables and the streamfunction approach, both with and without using the Oberbeck-Boussinesq assumption. We compare directly coupled solvers with segregated solver strategies. Changing finite element orders and mesh refinement, we find that models based on the streamfunction converge 2-4 times faster than runs based on primitive variables. Concerning the solution strategy, we find an advantage of Picard iterations compared to monolithic Newton iterations.

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

    DEFF Research Database (Denmark)

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

    2017-01-01

    of culture-expanded skeletal myogenic cells stimulates repair of both acute and 2 - 4-week-old anal sphincter injuries. The results from a small clinical trial with ten patients and a case report support the preclinical findings. Animal studies have also demonstrated that local injections of mesenchymal stem...... cells stimulate repair of sphincter injuries, and a complex bioengineering strategy for creation and implantation of an intrinsically innervated internal anal sphincter construct has been successfully developed in a series of animal studies. CONCLUSION: Cellular therapies with myogenic cells...... and mesenchymal stem cells and the use of bioengineering technology to create an anal sphincter are new potential strategies to treat anal incontinence caused by anal sphincter defects, but the clinical evidence is extremely limited. The use of culture-expanded autologous skeletal myogenic cells has been most...

  11. Collective place branding - an alternative strategy for territorial development compared to geographical indications?

    OpenAIRE

    Donner, Mechthild

    2016-01-01

    Geographical Indications (GIs) protecting the origin of specific food products are expanding worldwide and promoted as first order tool for agricultural and local development in developing countries. At the same time, collective place brands are adopted by public and private sectors in Europe as novel strategy to jointly valorise and promote a package of place-specific (food) products and (tourism) services, which supports a distinctive territorial identity or a territorial project.We here pr...

  12. The development of an alternative rebalancing strategy for a pension fund / Jeandré Francois Swanepoel

    OpenAIRE

    Swanepoel, Jeandré Francois

    2006-01-01

    Portfolio managers typically have two choices: let the portfolio drift with the markets or give direction to the portfolio by rebalancing according to a target allocation. Simply allowing the portfolio to drift with the markets without rebalancing is no longer appropriate. This leaves portfolio managers with the second option of giving direction to the portfolio according to a target allocation. 'This can be achieved by implementing an existing rebalancing strategy. Portfolio ...

  13. 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

    2007-01-01

    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...... a discrepancy in 22% of the patients, resulting in a lower or higher number of grafts than pre-operatively estimated. The difference in shift rates between the three sites, left anterior descending, left circumflex, and right coronary artery, was significant (P=0.014). Patency rates were highest when only...... 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...

  14. Biosensor-based diagnostics of contaminated groundwater: assessment and remediation strategy

    International Nuclear Information System (INIS)

    Bhattacharyya, Jessica; Read, David; Amos, Sean; Dooley, Stephen; Killham, Kenneth; Paton, Graeme I.

    2005-01-01

    Shallow groundwater beneath a former airfield site in southern England has been heavily contaminated with a wide range of chlorinated solvents. The feasibility of using bacterial biosensors to complement chemical analysis and enable cost-effective, and focussed sampling has been assessed as part of a site evaluation programme. Five different biosensors, three metabolic (Vibrio fischeri, Pseudomonas fluorescens 10568 and Escherichia coli HB101) and two catabolic (Pseudomonas putida TVA8 and E. coli DH5α), were employed to identify areas where the availability and toxicity of pollutants is of most immediate environmental concern. The biosensors used showed different sensitivities to each other and to the groundwater samples tested. There was generally a good agreement with chemical analyses. The potential efficacy of remediation strategies was explored by coupling sample manipulation to biosensor tests. Manipulation involved sparging and charcoal treatment procedures to simulate remediative engineering solutions. Sparging was sufficient at most locations. - Luminescent bacteria complement chemical analysis and support remediation technology

  15. Management strategies to curb rhino poaching: Alternative options using a cost benefit approach

    Directory of Open Access Journals (Sweden)

    Sam M. Ferreira

    2014-05-01

    Full Text Available The combination of increasing demand and high black market prices for rhino horn in Asian markets has fueled an escalation in rhino poaching since 2007, particularly in South Africa. This situation has in turn resulted in greatly increased rhino protection costs, loss in confidence by the private sector in rhinos, loss of revenue to conservation authorities and reduced rhino population growth rates. Within current CITES processes, management responses to threats posed by poaching to rhino persistence fall within a mixture of reactive responses of increased protection and law enforcement and some pro-active responses such as demand reduction tactics, along with a parallel call for opening a legal trade in horn. These rhino management strategies carry different risks and benefits in meeting several conservation objectives. An expert-based risk-benefit analysis of five different rhino management strategies was undertaken to assess their potential for delivering upon agreed rhino conservation objectives. The outcomes indicated that benefits may exceed risks for those strategies that in some or other format legally provided horn for meeting demand. Expert risk-benefit approaches are suggested to offer a rational, inclusive and consensus generating means of addressing complex issues such as rhino poaching and augmenting the information used within the CITES decision-making processes.

  16. Global restriction of using antibiotic growth promoters and alternative strategies in poultry production.

    Science.gov (United States)

    Salim, Hossan Md; Huque, Khan Shahidul; Kamaruddin, Kazi M; Beg, M D Anwarul Haque

    2018-03-01

    A growing global concern of antibiotic use in poultry diets due to its potential adverse effects on birds and human health, food safety and the environment has led to a complete ban or restricted use in some countries, and, at the same time, expanding options for the use of alternative feed additives. Multiple, rather than a single additive may replace antibiotic growth promoters (AGPs) in poultry. Blending of feeding additives and hygienic farm management, vaccination and biosecurity may help achieve good intestinal health, stabilise enteric ecosystems and result in sustainable and cost effective production performance of birds. Moreover, controlling unsolicited ingredients at the production level must have the support of different markets responsible for the supply of safe and quality poultry products for consumers. This requires the further increase and diversification of value added poultry products and the expansion of their markets through strategic planning and gradual limitation of live bird markets. More research is warranted in order to explore suitable, reliable and cost effective alternatives to AGPs for commercial use, and strategic poultry value chain development.

  17. Cost-Effectiveness of Alternative Blood-Screening Strategies for West Nile Virus in the United States.

    Directory of Open Access Journals (Sweden)

    2006-01-01

    Full Text Available BACKGROUND: West Nile virus (WNV is endemic in the US, varying seasonally and by geographic region. WNV can be transmitted by blood transfusion, and mandatory screening of blood for WNV was recently introduced throughout the US. Guidelines for selecting cost-effective strategies for screening blood for WNV do not exist. METHODS AND FINDINGS: We conducted a cost-effectiveness analysis for screening blood for WNV using a computer-based mathematical model, and using data from prospective studies, retrospective studies, and published literature. For three geographic areas with varying WNV-transmission intensity and length of transmission season, the model was used to estimate lifetime costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios associated with alternative screening strategies in a target population of blood-transfusion recipients. We compared the status quo (baseline screening using a donor questionnaire to several strategies which differed by nucleic acid testing of either pooled or individual samples, universal versus targeted screening of donations designated for immunocompromised patients, and seasonal versus year-long screening. In low-transmission areas with short WNV seasons, screening by questionnaire alone was the most cost-effective strategy. In areas with high levels of WNV transmission, seasonal screening of individual samples and restricting screening to blood donations designated for immunocompromised recipients was the most cost-effective strategy. Seasonal screening of the entire recipient pool added minimal clinical benefit, with incremental cost-effectiveness ratios exceeding US$1.7 million per quality-adjusted life-year gained. Year-round screening offered no additional benefit compared to seasonal screening in any of the transmission settings. CONCLUSIONS: In areas with high levels of WNV transmission, seasonal screening of individual samples and restricting screening to blood donations

  18. Cost-effectiveness of alternative blood-screening strategies for West Nile Virus in the United States.

    Directory of Open Access Journals (Sweden)

    Caroline T Korves

    2006-02-01

    Full Text Available West Nile virus (WNV is endemic in the US, varying seasonally and by geographic region. WNV can be transmitted by blood transfusion, and mandatory screening of blood for WNV was recently introduced throughout the US. Guidelines for selecting cost-effective strategies for screening blood for WNV do not exist.We conducted a cost-effectiveness analysis for screening blood for WNV using a computer-based mathematical model, and using data from prospective studies, retrospective studies, and published literature. For three geographic areas with varying WNV-transmission intensity and length of transmission season, the model was used to estimate lifetime costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios associated with alternative screening strategies in a target population of blood-transfusion recipients. We compared the status quo (baseline screening using a donor questionnaire to several strategies which differed by nucleic acid testing of either pooled or individual samples, universal versus targeted screening of donations designated for immunocompromised patients, and seasonal versus year-long screening. In low-transmission areas with short WNV seasons, screening by questionnaire alone was the most cost-effective strategy. In areas with high levels of WNV transmission, seasonal screening of individual samples and restricting screening to blood donations designated for immunocompromised recipients was the most cost-effective strategy. Seasonal screening of the entire recipient pool added minimal clinical benefit, with incremental cost-effectiveness ratios exceeding USD 1.7 million per quality-adjusted life-year gained. Year-round screening offered no additional benefit compared to seasonal screening in any of the transmission settings.In areas with high levels of WNV transmission, seasonal screening of individual samples and restricting screening to blood donations designated for immunocompromised recipients is cost

  19. 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.

    Science.gov (United States)

    Mussap, Michele

    2014-01-01

    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. © 2013.

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

    Directory of Open Access Journals (Sweden)

    Spagnolo F

    2015-01-01

    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

  1. Targeting the upstream transcriptional activator of PD-L1 as an alternative strategy in melanoma therapy.

    Science.gov (United States)

    Zhu, Bo; Tang, Liming; Chen, Shuyang; Yin, Chengqian; Peng, Shiguang; Li, Xin; Liu, Tongzheng; Liu, Wei; Han, Changpeng; Stawski, Lukasz; Xu, Zhi-Xiang; Zhou, Guangbiao; Chen, Xiang; Gao, Xiumei; Goding, Colin R; Xu, Nan; Cui, Rutao; Cao, Peng

    2018-05-22

    Programmed cell death ligand 1 (PD-L1) interacts with programmed cell death protein-1 (PD-1) as an immune checkpoint. Reactivating the immune response by inhibiting PD-L1 using therapeutic antibodies provides substantial clinical benefits in many, though not all, melanoma patients. However, transcriptional suppression of PD-L1 expression as an alternative therapeutic anti-melanoma strategy has not been exploited. Here we provide biochemical evidence demonstrating that ultraviolet radiation (UVR) induction of PD-L1 in skin is directly controlled by nuclear factor E2-related transcription factor 2 (NRF2). Depletion of NRF2 significantly induces tumor infiltration by both CD8 + and CD4 + T cells to suppress melanoma progression, and combining NRF2 inhibition with anti-PD-1 treatment enhanced its anti-tumor function. Our studies identify a critical and targetable PD-L1 upstream regulator and provide an alternative strategy to inhibit the PD-1/PD-L1 signaling in melanoma treatment.

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

    International Nuclear Information System (INIS)

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

    2001-01-01

    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

  3. Environmental assessment of alternative municipal solid waste management strategies. A Spanish case study.

    Science.gov (United States)

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

    2010-11-01

    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. Copyright © 2010 Elsevier Ltd. All rights reserved.

  4. Biosolids management strategies: an evaluation of energy production as an alternative to land application.

    Science.gov (United States)

    Egan, Maureen

    2013-07-01

    Currently, more than half of the biosolids produced within the USA are land applied. Land application of biosolids introduces organic contaminants into the environment. There are potential ecological and human health risks associated with land application of biosolids. Biosolids may be used as a renewable energy source. Nutrients may be recovered from biosolids used for energy generation for use as fertilizer. The by-products of biosolids energy generation may be used beneficially in construction materials. It is recommended that energy generation replace land application as the leading biosolids management strategy.

  5. Nine Days to Oder: An Alternate NATO Strategy for Central Region, Europe.

    Science.gov (United States)

    1980-06-01

    Encyclopedia of Military History, p. 261. 2. Basil Liddell Hart, The Sword and the Pen, p. 319. 3. Ibid., p. 318. 3 CHAPTER II SOVIET STRATEGY AND PACT...luf N. 172nd mte le Aba TIP FAk Sea. * nless indiated othrid.se, all forces PCSECUS in PRO. 40 LI It will be of interest that two mechanized divisions...1952. Liddell Hart, B. H. StrAteav. New York: Praeger, 1967. Liddell Hart, Basil . The Sword and the Pen. New York: Crowell, 1976. Peltier, Louis C

  6. A strategy for molecular diagnostics of Fanconi anemia in Brazilian patients.

    Science.gov (United States)

    Pilonetto, Daniela V; Pereira, Noemi F; Bonfim, Carmem M S; Ribeiro, Lisandro L; Bitencourt, Marco A; Kerkhoven, Lianne; Floor, Karijn; Ameziane, Najim; Joenje, Hans; Gille, Johan J P; Pasquini, Ricardo

    2017-07-01

    Fanconi anemia (FA) is a predominantly autosomal recessive disease with wide genetic heterogeneity resulting from mutations in several DNA repair pathway genes. To date, 21 genetic subtypes have been identified. We aimed to identify the FA genetic subtypes in the Brazilian population and to develop a strategy for molecular diagnosis applicable to routine clinical use. We screened 255 patients from Hospital de Clínicas, Universidade Federal do Paraná for 11 common FA gene mutations. Further analysis by multiplex ligation-dependent probe amplification (MLPA) for FANCA and Sanger sequencing of all coding exons of FANCA , -C , and - G was performed in cases who harbored a single gene mutation. We identified biallelic mutations in 128/255 patients (50.2%): 89, 11, and 28 carried FANCA , FANCC , and FANCG mutations, respectively. Of these, 71 harbored homozygous mutations, whereas 57 had compound heterozygous mutations. In 4/57 heterozygous patients, both mutations were identified by the initial screening, in 51/57 additional analyses was required for classification, and in 2/57 the second mutation remained unidentified. We found 52 different mutations of which 22 were novel. The proposed method allowed genetic subtyping of 126/255 (49.4%) patients at a significantly reduced time and cost, which makes molecular diagnosis of FA Brazilian patients feasible.

  7. 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

    1999-12-01

    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.

  8. Invasive Candidiasis in Various Patient Populations: Incorporating Non-Culture Diagnostic Tests into Rational Management Strategies

    Science.gov (United States)

    Clancy, Cornelius J.; Shields, Ryan K.; Nguyen, M. Hong

    2016-01-01

    Mortality rates due to invasive candidiasis remain unacceptably high, in part because the poor sensitivity and slow turn-around time of cultures delay the initiation of antifungal treatment. β-d-glucan (Fungitell) and polymerase chain reaction (PCR)-based (T2Candida) assays are FDA-approved adjuncts to cultures for diagnosing invasive candidiasis, but their clinical roles are unclear. We propose a Bayesian framework for interpreting non-culture test results and developing rational patient management strategies, which considers test performance and types of invasive candidiasis that are most common in various patient populations. β-d-glucan sensitivity/specificity for candidemia and intra-abdominal candidiasis is ~80%/80% and ~60%/75%, respectively. In settings with 1%–10% likelihood of candidemia, anticipated β-d-glucan positive and negative predictive values are ~4%–31% and ≥97%, respectively. Corresponding values in settings with 3%–30% likelihood of intra-abdominal candidiasis are ~7%–51% and ~78%–98%. β-d-glucan is predicted to be useful in guiding antifungal treatment for wide ranges of populations at-risk for candidemia (incidence ~5%–40%) or intra-abdominal candidiasis (~7%–20%). Validated PCR-based assays should broaden windows to include populations at lower-risk for candidemia (incidence ≥~2%) and higher-risk for intra-abdominal candidiasis (up to ~40%). In the management of individual patients, non-culture tests may also have value outside of these windows. The proposals we put forth are not definitive treatment guidelines, but rather represent starting points for clinical trial design and debate by the infectious diseases community. The principles presented here will be applicable to other assays as they enter the clinic, and to existing assays as more data become available from different populations. PMID:29376927

  9. Invasive Candidiasis in Various Patient Populations: Incorporating Non-Culture Diagnostic Tests into Rational Management Strategies

    Directory of Open Access Journals (Sweden)

    Cornelius J. Clancy

    2016-02-01

    Full Text Available Mortality rates due to invasive candidiasis remain unacceptably high, in part because the poor sensitivity and slow turn-around time of cultures delay the initiation of antifungal treatment. β-d-glucan (Fungitell and polymerase chain reaction (PCR-based (T2Candida assays are FDA-approved adjuncts to cultures for diagnosing invasive candidiasis, but their clinical roles are unclear. We propose a Bayesian framework for interpreting non-culture test results and developing rational patient management strategies, which considers test performance and types of invasive candidiasis that are most common in various patient populations. β-d-glucan sensitivity/specificity for candidemia and intra-abdominal candidiasis is ~80%/80% and ~60%/75%, respectively. In settings with 1%–10% likelihood of candidemia, anticipated β-d-glucan positive and negative predictive values are ~4%–31% and ≥97%, respectively. Corresponding values in settings with 3%–30% likelihood of intra-abdominal candidiasis are ~7%–51% and ~78%–98%. β-d-glucan is predicted to be useful in guiding antifungal treatment for wide ranges of populations at-risk for candidemia (incidence ~5%–40% or intra-abdominal candidiasis (~7%–20%. Validated PCR-based assays should broaden windows to include populations at lower-risk for candidemia (incidence ≥~2% and higher-risk for intra-abdominal candidiasis (up to ~40%. In the management of individual patients, non-culture tests may also have value outside of these windows. The proposals we put forth are not definitive treatment guidelines, but rather represent starting points for clinical trial design and debate by the infectious diseases community. The principles presented here will be applicable to other assays as they enter the clinic, and to existing assays as more data become available from different populations.

  10. Alternating current electrical stimulation enhanced chemotherapy: a novel strategy to bypass multidrug resistance in tumor cells

    International Nuclear Information System (INIS)

    Janigro, Damir; Perju, Catalin; Fazio, Vincent; Hallene, Kerri; Dini, Gabriele; Agarwal, Mukesh K; Cucullo, Luca

    2006-01-01

    Tumor burden can be pharmacologically controlled by inhibiting cell division and by direct, specific toxicity to the cancerous tissue. Unfortunately, tumors often develop intrinsic pharmacoresistance mediated by specialized drug extrusion mechanisms such as P-glycoprotein. As a consequence, malignant cells may become insensitive to various anti-cancer drugs. Recent studies have shown that low intensity very low frequency electrical stimulation by alternating current (AC) reduces the proliferation of different tumor cell lines by a mechanism affecting potassium channels while at intermediate frequencies interfere with cytoskeletal mechanisms of cell division. The aim of the present study is to test the hypothesis that permeability of several MDR1 over-expressing tumor cell lines to the chemotherapic agent doxorubicin is enhanced by low frequency, low intensity AC stimulation. We grew human and rodent cells (C6, HT-1080, H-1299, SKOV-3 and PC-3) which over-expressed MDR1 in 24-well Petri dishes equipped with an array of stainless steel electrodes connected to a computer via a programmable I/O board. We used a dedicated program to generate and monitor the electrical stimulation protocol. Parallel cultures were exposed for 3 hours to increasing concentrations (1, 2, 4, and 8 μM) of doxorubicin following stimulation to 50 Hz AC (7.5 μA) or MDR1 inhibitor XR9576. Cell viability was assessed by determination of adenylate kinase (AK) release. The relationship between MDR1 expression and the intracellular accumulation of doxorubicin as well as the cellular distribution of MDR1 was investigated by computerized image analysis immunohistochemistry and Western blot techniques. By the use of a variety of tumor cell lines, we show that low frequency, low intensity AC stimulation enhances chemotherapeutic efficacy. This effect was due to an altered expression of intrinsic cellular drug resistance mechanisms. Immunohistochemical, Western blot and fluorescence analysis revealed

  11. Diagnosing the impact of alternative calibration strategies on coupled hydrologic models

    Science.gov (United States)

    Smith, T. J.; Perera, C.; Corrigan, C.

    2017-12-01

    Hydrologic models represent a significant tool for understanding, predicting, and responding to the impacts of water on society and society on water resources and, as such, are used extensively in water resources planning and management. Given this important role, the validity and fidelity of hydrologic models is imperative. While extensive focus has been paid to improving hydrologic models through better process representation, better parameter estimation, and better uncertainty quantification, significant challenges remain. In this study, we explore a number of competing model calibration scenarios for simple, coupled snowmelt-runoff models to better understand the sensitivity / variability of parameterizations and its impact on model performance, robustness, fidelity, and transferability. Our analysis highlights the sensitivity of coupled snowmelt-runoff model parameterizations to alterations in calibration approach, underscores the concept of information content in hydrologic modeling, and provides insight into potential strategies for improving model robustness / fidelity.

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

    Directory of Open Access Journals (Sweden)

    José Couto Marques

    2013-10-01

    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.

  13. Inducing the Alternative Oxidase Forms Part of the Molecular Strategy of Anoxic Survival in Freshwater Bivalves

    Directory of Open Access Journals (Sweden)

    Maria S. Yusseppone

    2018-02-01

    Full Text Available Hypoxia in freshwater ecosystems is spreading as a consequence of global change, including pollution and eutrophication. In the Patagonian Andes, a decline in precipitation causes reduced lake water volumes and stagnant conditions that limit oxygen transport and exacerbate hypoxia below the upper mixed layer. We analyzed the molecular and biochemical response of the North Patagonian bivalve Diplodon chilensis after 10 days of experimental anoxia (<0.2 mg O2/L, hypoxia (2 mg O2/L, and normoxia (9 mg O2/L. Specifically, we investigated the expression of an alternative oxidase (AOX pathway assumed to shortcut the regular mitochondrial electron transport system (ETS during metabolic rate depression (MRD in hypoxia-tolerant invertebrates. Whereas, the AOX system was strongly upregulated during anoxia in gills, ETS activities and energy mobilization decreased [less transcription of glycogen phosphorylase (GlyP and succinate dehydrogenase (SDH in gills and mantle]. Accumulation of succinate and induction of malate dehydrogenase (MDH activity could indicate activation of anaerobic mitochondrial pathways to support anoxic survival in D. chilensis. Oxidative stress [protein carbonylation, glutathione peroxidase (GPx expression] and apoptotic intensity (caspase 3/7 activity decreased, whereas an unfolded protein response (HSP90 was induced under anoxia. This is the first clear evidence of the concerted regulation of the AOX and ETS genes in a hypoxia-tolerant freshwater bivalve and yet another example that exposure to hypoxia and anoxia is not necessarily accompanied by oxidative stress in hypoxia-tolerant mollusks.

  14. Influence of Nanotoxicity on Human Health and Environment: The Alternative Strategies.

    Science.gov (United States)

    Viswanath, Buddolla; Kim, Sanghyo

    Currently, nanotechnology revolutionizing both scientific and industrial community due to their applications in the fields of medicine, environmental protection, energy, and space exploration. Despite of the evident benefits of nanoparticles, there are still open questions about the influence of these nanoparticles on human health and environment. This is one of the critical issues that have to be addressed in the near future, before massive production of nanomaterials. Manufactured nanoparticles, which are finding ever-increasing applications in industry and consumer products fall into the category of emerging contaminants with ecological and toxicological effects on populations, communities and ecosystems. The existing experimental knowledge gave evidence that inhaled nanoparticles are less efficiently separated than larger particles by the macrophage clearance mechanisms and these nanoparticles are known to translocate through the lymphatic, circulatory and nervous systems to many tissues and organs, including the brain. In this review we highlight adverse impacts of nanoparticles on human and the environment with special emphasis on green nanoscience as a sustainable alternative.

  15. Inducing the Alternative Oxidase Forms Part of the Molecular Strategy of Anoxic Survival in Freshwater Bivalves

    Science.gov (United States)

    Yusseppone, Maria S.; Rocchetta, Iara; Sabatini, Sebastian E.; Luquet, Carlos M.; Ríos de Molina, Maria del Carmen; Held, Christoph; Abele, Doris

    2018-01-01

    Hypoxia in freshwater ecosystems is spreading as a consequence of global change, including pollution and eutrophication. In the Patagonian Andes, a decline in precipitation causes reduced lake water volumes and stagnant conditions that limit oxygen transport and exacerbate hypoxia below the upper mixed layer. We analyzed the molecular and biochemical response of the North Patagonian bivalve Diplodon chilensis after 10 days of experimental anoxia (<0.2 mg O2/L), hypoxia (2 mg O2/L), and normoxia (9 mg O2/L). Specifically, we investigated the expression of an alternative oxidase (AOX) pathway assumed to shortcut the regular mitochondrial electron transport system (ETS) during metabolic rate depression (MRD) in hypoxia-tolerant invertebrates. Whereas, the AOX system was strongly upregulated during anoxia in gills, ETS activities and energy mobilization decreased [less transcription of glycogen phosphorylase (GlyP) and succinate dehydrogenase (SDH) in gills and mantle]. Accumulation of succinate and induction of malate dehydrogenase (MDH) activity could indicate activation of anaerobic mitochondrial pathways to support anoxic survival in D. chilensis. Oxidative stress [protein carbonylation, glutathione peroxidase (GPx) expression] and apoptotic intensity (caspase 3/7 activity) decreased, whereas an unfolded protein response (HSP90) was induced under anoxia. This is the first clear evidence of the concerted regulation of the AOX and ETS genes in a hypoxia-tolerant freshwater bivalve and yet another example that exposure to hypoxia and anoxia is not necessarily accompanied by oxidative stress in hypoxia-tolerant mollusks. PMID:29527172

  16. Clinical utility of the DSM-5 alternative model for borderline personality disorder: Differential diagnostic accuracy of the BFI, SCID-II-PQ, and PID-5.

    Science.gov (United States)

    Fowler, J Christopher; Madan, Alok; Allen, Jon G; Patriquin, Michelle; Sharp, Carla; Oldham, John M; Frueh, B Christopher

    2018-01-01

    With the publication of DSM 5 alternative model for personality disorders it is critical to assess the components of the model against evidence-based models such as the five factor model and the DSM-IV-TR categorical model. This study explored the relative clinical utility of these models in screening for borderline personality disorder (BPD). Receiver operator characteristics and diagnostic efficiency statistics were calculated for three personality measures to ascertain the relative diagnostic efficiency of each measure. A total of 1653 adult inpatients at a specialist psychiatric hospital completed SCID-II interviews. Sample 1 (n=653) completed the SCID-II interviews, SCID-II Questionnaire (SCID-II-PQ) and the Big Five Inventory (BFI), while Sample 2 (n=1,000) completed the SCID-II interviews, Personality Inventory for DSM5 (PID-5) and the BFI. BFI measure evidenced moderate accuracy for two composites: High Neuroticism+ low agreeableness composite (AUC=0.72, SE=0.01, ptrait constellation for diagnosing BPD. Limitations of the study include the single inpatient setting and use of two discrete samples to assess PID-5 and SCID-II-PQ. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Exploration of alternate catalytic mechanisms and optimization strategies for retroaldolase design.

    Science.gov (United States)

    Bjelic, Sinisa; Kipnis, Yakov; Wang, Ling; Pianowski, Zbigniew; Vorobiev, Sergey; Su, Min; Seetharaman, Jayaraman; Xiao, Rong; Kornhaber, Gregory; Hunt, John F; Tong, Liang; Hilvert, Donald; Baker, David

    2014-01-09

    Designed retroaldolases have utilized a nucleophilic lysine to promote carbon-carbon bond cleavage of β-hydroxy-ketones via a covalent Schiff base intermediate. Previous computational designs have incorporated a water molecule to facilitate formation and breakdown of the carbinolamine intermediate to give the Schiff base and to function as a general acid/base. Here we investigate an alternative active-site design in which the catalytic water molecule was replaced by the side chain of a glutamic acid. Five out of seven designs expressed solubly and exhibited catalytic efficiencies similar to previously designed retroaldolases for the conversion of 4-hydroxy-4-(6-methoxy-2-naphthyl)-2-butanone to 6-methoxy-2-naphthaldehyde and acetone. After one round of site-directed saturation mutagenesis, improved variants of the two best designs, RA114 and RA117, exhibited among the highest kcat (>10(-3)s(-1)) and kcat/KM (11-25M(-1)s(-1)) values observed for retroaldolase designs prior to comprehensive directed evolution. In both cases, the >10(5)-fold rate accelerations that were achieved are within 1-3 orders of magnitude of the rate enhancements reported for the best catalysts for related reactions, including catalytic antibodies (kcat/kuncat=10(6) to 10(8)) and an extensively evolved computational design (kcat/kuncat>10(7)). The catalytic sites, revealed by X-ray structures of optimized versions of the two active designs, are in close agreement with the design models except for the catalytic lysine in RA114. We further improved the variants by computational remodeling of the loops and yeast display selection for reactivity of the catalytic lysine with a diketone probe, obtaining an additional order of magnitude enhancement in activity with both approaches. © 2013.

  18. Predicting thermally stressful events in rivers with a strategy to evaluate management alternatives

    Science.gov (United States)

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

    2016-01-01

    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.

  19. Comparative life cycle assessment of alternative strategies for energy recovery from used cooking oil.

    Science.gov (United States)

    Lombardi, Lidia; Mendecka, Barbara; Carnevale, Ennio

    2018-06-15

    The separate collection of Used Cooking Oil (UCO) is gaining popularity through several countries in Europe. An appropriate management of UCO waste stream leads to substantial benefits. In this study, we analyse two different possibilities of UCO energy reuse: the direct feed to a reciprocating internal combustion engine (ICE) for cogeneration purpose, and the processing to generate biodiesel. Concerning biodiesel production, we analyse four among conventional and innovative technologies, characterised by different type and amount of used chemicals, heat and electricity consumptions and yields. We perform a systematic evaluation of environmental benefits and drawbacks by applying life cycle assessment (LCA) analysis to compare the alternatives. For the impact assessment, two methods are selected: the Global Warming Potential (GWP) and Cumulative Exergy Consumption (CExC). Results related only to the processing phases (i.e. not including yet the avoided effects) show that the recovery of UCO in cogeneration plant has in general lower values in terms of environmental impacts than its employment in biodiesel production. When products and co-products substitution are included, the savings obtained by the substitution of conventional diesel production, in the biodiesel cases, are significantly higher than the avoided effects for electricity and heat in the cogeneration case. In particular, by using the UCO in the biodiesel production processes, the savings vary from 41.6 to 54.6 GJ ex per tUCO, and from 2270 to 2860 kg CO 2eq per tUCO for CExC and GWP, respectively. A particular focus is put on sensitivity and uncertainty analyses. Overall, high uncertainty of final results for process impacts is observed, especially for the supercritical methanol process. Low uncertainty values are evaluated for the avoided effects. Including the uncertain character of the impacts, cogeneration scenario and NaOH catalysed process of biodiesel production result to be the most suitable

  20. Revisiting the two-layer hypothesis: coexistence of alternative functional rooting strategies in savannas.

    Science.gov (United States)

    Holdo, Ricardo M

    2013-01-01

    The two-layer hypothesis of tree-grass coexistence posits that trees and grasses differ in rooting depth, with grasses exploiting soil moisture in shallow layers while trees have exclusive access to deep water. The lack of clear differences in maximum rooting depth between these two functional groups, however, has caused this model to fall out of favor. The alternative model, the demographic bottleneck hypothesis, suggests that trees and grasses occupy overlapping rooting niches, and that stochastic events such as fires and droughts result in episodic tree mortality at various life stages, thus preventing trees from otherwise displacing grasses, at least in mesic savannas. Two potential problems with this view are: 1) we lack data on functional rooting profiles in trees and grasses, and these profiles are not necessarily reflected by differences in maximum or physical rooting depth, and 2) subtle, difficult-to-detect differences in rooting profiles between the two functional groups may be sufficient to result in coexistence in many situations. To tackle this question, I coupled a plant uptake model with a soil moisture dynamics model to explore the environmental conditions under which functional rooting profiles with equal rooting depth but different depth distributions (i.e., shapes) can coexist when competing for water. I show that, as long as rainfall inputs are stochastic, coexistence based on rooting differences is viable under a wide range of conditions, even when these differences are subtle. The results also indicate that coexistence mechanisms based on rooting niche differentiation are more viable under some climatic and edaphic conditions than others. This suggests that the two-layer model is both viable and stochastic in nature, and that a full understanding of tree-grass coexistence and dynamics may require incorporating fine-scale rooting differences between these functional groups and realistic stochastic climate drivers into future models.

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

    Directory of Open Access Journals (Sweden)

    Maria Zafiropoulou

    2016-12-01

    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.

  2. Review: Pichia pastoris represents an alternative for human glycoprotein production for therapeutic use. Fermentation strategies

    Directory of Open Access Journals (Sweden)

    Henry Córdoba Ruiz

    2003-07-01

    Full Text Available Producing human proteins in lower organisms' cells using recombinant technology represents a very promising approach for treating many diseases produced by a particular protein deficiency, including close to 40 lysosomal storage diseases. Although E. coli has been the first host successfully employed in expressing human recombinant proteins, it has some limitations owing to its inability to perform some post-traductional steps such as glycosylation. The yeast Saccharomyces cerevisiae (S. cerevisiae has thusbeen initially considered and used. However, S. cerevisiae glycosylates proteins in a very different way to human cells producing highly antigenic proteins and thus some other non-conventional yeasts such as Pichia pastoris have been used recently. Human protein expression is not assodated with growth in this system; growth may occur at high cell concentrations, increasing heterologous protein productivity and yield. The system employs a very efficient, methanol-induced promoter which may be used as sole carbon and energy source. Post-traductional modifications seem more similar to human cells than those produced by other non-mammalian systems used in producing human glycoproteins; they do not secrete large amounts of endogenous proteins, simplifying expressed protein purification. This review presents some strategies for producing heterologous proteins in high density cultures using P. pastoris as an expression system.

  3. An analysis of alternative New Technical Strategy flowsheets for tank waste remediation system

    International Nuclear Information System (INIS)

    Booker, C.P.

    1994-01-01

    The Hanford Tank remediation plans have gone through a few revisions for the best waste processing system. Some designs have been complex while others have been fairly simple. One of the key means in understanding and selecting among the various proposed systems is a discrete events modeling of the system. This modeling provides insight into (1) The total required size of the system; (2) The amount of material, such as reagents and other added materials that must be supplied; (3) The final mass of waste that must be stored; and (4) Areas within the system where a small change can greatly effect the total system. Discrete events modeling also provides the means by which various proposed systems may be compared. It is the framework in which variations within a particular system may be explored and compared to other instantiations. This study examines the current New Technical Strategy flowsheet system with discrete event modeling. Some of the possible variations within that system are examined and compared. Further, an previously proposed, more complex system is examined

  4. Multiple intelligences and alternative teaching strategies: The effects on student academic achievement, conceptual understanding, and attitude

    Science.gov (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

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

    Science.gov (United States)

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

    2010-08-01

    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.

  6. Dispersal and life history strategies in epiphyte metacommunities: alternative solutions to survival in patchy, dynamic landscapes.

    Science.gov (United States)

    Löbel, Swantje; Rydin, Håkan

    2009-09-01

    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

  7. 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.

    2001-02-01

    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)

  8. Draft Programmatic Environmental Impact Statement for alternative strategies for the long-term management and use of depleted uranium hexafluoride. Volume 1: Main text

    International Nuclear Information System (INIS)

    1997-12-01

    This PEIS assesses the potential impacts of alternative management of alternative management strategies for depleted uranium hexafluoride (UF 6 ) currently stored at three DOE sites: Paducah site near Paducah, Kentucky; Portsmouth site near Portsmouth, Ohio; and K-25 site on the Oak Ridge Reservation, Oak Ridge, Tennessee. The alternatives analyzed in the PEIS include no action, long-term storage as UF 6 , long-term storage as uranium oxide, use as uranium oxide, use as uranium metal, and disposal. The preferred alternative for the long-term management of depleted UF 6 is to use the entire inventory of material

  9. Draft Programmatic Environmental Impact Statement for alternative strategies for the long-term management and use of depleted uranium hexafluoride. Volume 2: Appendices

    International Nuclear Information System (INIS)

    1997-12-01

    This PEIS assesses the potential impacts of alternative management of alternative management strategies for depleted uranium hexafluoride (UF 6 ) currently stored at three DOE sites: Paducah site near Paducah, Kentucky; Portsmouth site near Portsmouth, Ohio; and K-25 site on the Oak Ridge Reservation, Oak Ridge, Tennessee. The alternatives analyzed in the PEIS include no action, long-term storage as UF 6 , long-term storage as uranium oxide, use as uranium oxide, use as uranium metal, and disposal. The preferred alternative for the long-term management of depleted UF 6 is to use the entire inventory of material. This volume contains the appendices to volume I

  10. THE STRATEGY OF INCREASING THE COMPETITIVENESS OF ROMANIAN AUTOMOBILE INDUSTRY BY TRANSITION TO ALTERNATIVE ENERGY IN INTERNATIONALIZATION CONDITIONS

    Directory of Open Access Journals (Sweden)

    ALINA HAGIU,

    2014-10-01

    Full Text Available The increasing complexity and the increase of the variability grade of the business environment in general, and of the international business environment especially, represented determinant elements of the awareness of strategic issues of international competitiveness of firms and of the intensifying efforts to resolve the many different aspects of it. This paper is addressed to all those interested in the interesting and important issue of competitiveness in general and of the automotive industry competitiveness in particular. We stopped to the car industry as the automotive industry in Romania is one of the industries that have a high added value and a significant share of GDP. A role no less important had the fact that in the case of the automotive industry there are clear opportunities to improve competitiveness in the international market by focusing not only on low cost segments but also pointing to other market segments. The economic crisis has made Dacia sales to exports increase considerably, but the data show that with alleviate of the economic crisis the success of Dacia will begin to decrease. So it turns out that Dacia is a crisis car, and as the crisis will end, the manufacturer must rethink its strategy if it wants to maintain or increase sales. In the present paper we stoped to the transition to alternative energy sources strategy in the functioning of automobiles as a possible way to increase the competitiveness of Romanian automotive industry because all indicates are that alternative sources are the future and we should adapt trends better sooner rather than later.

  11. THE STRATEGY OF INCREASING THE COMPETITIVENESS OF ROMANIAN AUTOMOBILE INDUSTRY BY TRANSITION TO ALTERNATIVE ENERGY IN INTERNATIONALIZATION CONDITIONS

    Directory of Open Access Journals (Sweden)

    ALINA HAGIU

    2014-10-01

    Full Text Available The increasing complexity and the increase of the variability grade of the business environment in general, and of the international business environment especially, represented determinant elements of the awareness of strategic issues of international competitiveness of firms and of the intensifying efforts to resolve the many different aspects of it. This paper is addressed to all those interested in the interesting and important issue of competitiveness in general and of the automotive industry competitiveness in particular. We stopped to the car industry as the automotive industry in Romania is one of the industries that have a high added value and a significant share of GDP. A role no less important had the fact that in the case of the automotive industry there are clear opportunities to improve competitiveness in the international market by focusing not only on low cost segments but also pointing to other market segments. The economic crisis has made Dacia sales to exports increase considerably, but the data show that with alleviate of the economic crisis the success of Dacia will begin to decrease. So it turns out that Dacia is a crisis car, and as the crisis will end, the manufacturer must rethink its strategy if it wants to maintain or increase sales. In the present paper we stoped to the transition to alternative energy sources strategy in the functioning of automobiles as a possible way to increase the competitiveness of Romanian automotive industry because all indicates are that alternative sources are the future and we should adapt trends better sooner rather than later

  12. 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

    2015-12-01

    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.

  13. Diagnostic strategies in osteomyelitis

    International Nuclear Information System (INIS)

    Wheat, J.

    1985-01-01

    Technetium- 99 pyrophosphate bone scanning often identifies patients with osteomyelitis before roentgenographic findings appear. However, recent studies have shown that 99 Tc bone scanning often gives false-negative results, especially in neonates. The accuracy of computed tomographic scanning and indium-111 leukocyte scanning for diagnosis of early osteomyelitis has not been established. 99 Tc bone scanning often gives false-positive results in patients with other conditions leading to bone injury and repair, such as trauma or recent surgery, further limiting the usefulness of this imaging procedure. Newer imaging techniques have not been adequately evaluated to establish their specificity. Because of their high cost and unproved accuracy, these new imaging procedures should not be routinely applied until their usefulness has been established. Bone biopsy remains the procedure of choice for establishing the diagnosis in patients suspected clinically to have osteomyelitis with negative findings on roentgenography and 99 Tc bone scanning. Although Staphylococcus aureus is the leading cause of osteomyelitis, other pathogens cause 30 to 40 percent of cases. Aspiration or biopsy of the involved bone is usually required to choose appropriate antibiotic therapy. Bone biopsy is essential in chronic osteomyelitis, since cultures of sinus drainage are unreliable. Osteomyelitis in diabetics with foot infection and in association with decubitus ulcers presents special problems. Radionuclide scanning often give false-positive results in these patients. Proper diagnosis usually requires careful assessment of clinical and roentgenographic findings. 33 references

  14. The Qualitative-Quantitative Analysis and the Study of Personnel's Awareness of the Management Strategies of the Wastes of Medical Diagnostic Laboratories of Rasht, in 2009

    Directory of Open Access Journals (Sweden)

    Nabizadeh R.

    2012-01-01

    Full Text Available Background and Objectives: Waste produced by health and treatment centers (hospitals including medical diagnostic laboratories is one of the sources of municipal waste production. Waste produced by medical diagnostic laboratories due to the existence of pathogens and infectious materials by high importance is one of the environmental issues. This survey has been done on the qualitative-quantitative analytical bases, and the investigation has focused on the management strategies of the waste material of medical diagnostic laboratories of Rasht, Iran in 2009. Methods: In this descriptive study, samples were collected from 19 medical diagnostic laboratories of Rasht in 3 consecutive days (Monday, Tuesday and Wednesday every week, after filling the questionnaire and interviewing with the managers. Then, the samples were separated manually, and divided into 46 different constituents and weighed. Next, the constituents were classified based on characteristics and potentiality of being hazardous.Results: The total amount of annual waste production by the medical diagnostic laboratories of Rasht is 25785.143kg. In this study, the share of manufacturing conventional waste (domestic type wastes, especially infectious, chemical, pharmaceutical, and radioactive wastes were 1.16%, 95.34%, 1.42% and 2.08%, respectively. The highest and lowest amount of waste production relates to plastic materials and wood which are 48.37 and 0.43%, respectively. In this study sharp cutting things were calculated to be 10.52%. Furthermore, 84 percent of the managers of the medical diagnostic laboratories had not had enough information of the circulars and instructions on the enforceable management strategies of the medical wastes.Conclusion: Concerning the management of the medical waste production in the medical diagnostic laboratories, it is suggested that the managers and the personnel be trained on the separation, collection, and disinfection techniques and final disposal

  15. Can PSA Reflex Algorithm be a valid alternative to other PSA-based prostate cancer screening strategies?

    Science.gov (United States)

    Caldarelli, G; Troiano, G; Rosadini, D; Nante, N

    2017-01-01

    The available laboratory tests for the differential diagnosis of prostate cancer, are represented by the total PSA, the free PSA, and the free/total PSA ratio. In Italy most of doctors tend to request both total and free PSA for their patients even in cases where the total PSA doesn't justify the further request of free PSA, with a consequent growth of the costs for the National Health System. The aim of our study was to predict the saving in Euro (due to reagents) and reduction in free PSA tests, applying the "PSA Reflex" algorithm. We calculated the number of total PSA and free PSA exams performed in 2014 in the Hospital of Grosseto and, simulating the application of the "PSA Reflex" algorithm in the same year, we calculated the decrease in the number of free PSA requests and we tried to predict the Euro savings in reagents, obtained from this reduction. In 2014 in the Hospital of Grosseto 25,955 total PSA tests have been performed: 3,631 (14%) resulted greater than 10 ng / ml; 7,686 (29.6%) between 2 and 10 ng / ml; 14,638 (56.4%) lower than 2 ng / ml. The performed free PSA tests were 16904. Simulating the use of "PSA Reflex" algorithm, the free PSA tests would be performed only in cases with total PSA values between 2 and 10 ng / mL with a saving of 54.5% of free PSA exams and of 8,971 euros, only for reagents. Our study showed that the "PSA Reflex" algorithm is a valid alternative leading to a reduction of the costs. The estimated intralaboratory savings, due to the reagents, seem to be modest, however, they are followed by the additional savings due to the other diagnostic processes for prostate cancers.

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

    Science.gov (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

    2016-08-01

    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. © 2016 Society for Risk Analysis.

  17. 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: carmen.palermo@unifg.it; Natale, Anna; Quinto, Maurizio; Centonze, Diego

    2015-01-07

    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.

  18. 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.

    Science.gov (United States)

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

    2013-01-01

    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. © 2012 Blackwell Publishing Ltd.

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

    Science.gov (United States)

    Sousa, Catarina O; Barela, José A; Prado-Medeiros, Christiane L; Salvini, Tania F; Barela, Ana M F

    2009-12-01

    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. 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. 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. 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 assistance.

  20. 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

    2009-12-01

    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

  1. New strategy to identify radicals in a time evolving EPR data set by multivariate curve resolution-alternating least squares

    Energy Technology Data Exchange (ETDEWEB)

    Fadel, Maya Abou [LASIR CNRS UMR 8516, Université Lille 1, Sciences et Technologies, 59655 Villeneuve d' Ascq Cedex (France); Juan, Anna de [Chemometrics Group, Section of Analytical Chemistry, Universitat de Barcelona, Diagonal 645, 08028 Barcelona (Spain); Vezin, Hervé [LASIR CNRS UMR 8516, Université Lille 1, Sciences et Technologies, 59655 Villeneuve d' Ascq Cedex (France); Duponchel, Ludovic, E-mail: ludovic.duponchel@univ-lille1.fr [LASIR CNRS UMR 8516, Université Lille 1, Sciences et Technologies, 59655 Villeneuve d' Ascq Cedex (France)

    2016-12-01

    Electron paramagnetic resonance (EPR) spectroscopy is a powerful technique that is able to characterize radicals formed in kinetic reactions. However, spectral characterization of individual chemical species is often limited or even unmanageable due to the severe kinetic and spectral overlap among species in kinetic processes. Therefore, we applied, for the first time, multivariate curve resolution-alternating least squares (MCR-ALS) method to EPR time evolving data sets to model and characterize the different constituents in a kinetic reaction. Here we demonstrate the advantage of multivariate analysis in the investigation of radicals formed along the kinetic process of hydroxycoumarin in alkaline medium. Multiset analysis of several EPR-monitored kinetic experiments performed in different conditions revealed the individual paramagnetic centres as well as their kinetic profiles. The results obtained by MCR-ALS method demonstrate its prominent potential in analysis of EPR time evolved spectra. - Highlights: • A new strategy to identify radicals in a time evolving EPR data set. • Extraction of pure EPR spectral signatures and corresponding kinetic profiles. • The proposed method does not require any prior knowledge of the chemical system. • A multiset analysis in order to decrease rotational ambiguity.

  2. A comparative physics study of alternative long-term strategies for closure of the nuclear fuel cycle

    International Nuclear Information System (INIS)

    Cometto, M.; Wydler, P.; Chawla, R.

    2004-01-01

    The appropriate management of radioactive waste arising from the nuclear fuel cycle is considered to be a key issue in the development of future, more sustainable nuclear energy systems. In this context, the partitioning and transmutation of actinides could play an important role through the achievement of very significant reductions in the actinide content and radiotoxicity of the high-level waste requiring geological disposal. The current paper reports on the results of a detailed physics study carried out to compare the pros and cons of alternative strategies for closure of the nuclear fuel cycle. Different long-term 'steady-state' scenarios have been considered, involving the deployment, to varying degrees, of light water reactors (LWRs) and advanced fast-spectrum systems. The same nuclear data and calculation methods have been used throughout, so that a consistent and reliable comparison of the relative performance of the three basic fuel cycle options (once-through, plutonium recycle, and recycling of all actinides) has been made possible. In addition, with transmutation having been considered employing both critical and accelerator-driven fast-spectrum systems, the study has provided an evaluation of the advantages and disadvantages of these two different advanced system types

  3. Alternative nutritional strategies in protists: symposium introduction and a review of freshwater protists that combine photosynthesis and heterotrophy.

    Science.gov (United States)

    Sanders, Robert W

    2011-01-01

    The alternative nutritional strategies in protists that were addressed during the symposium by that name at the 2010 annual meeting of the International Society of Protistologists and here in contributed papers, include a range of mechanisms that combine photosynthesis with heterotrophy in a single organism. Often called mixotrophy, these multiple trophic level combinations occur across a broad range of organisms and environments. Consequently, there is great variability in the physiological abilities and relative importance of phototrophy vs. phagotrophy and/or osmotrophy in mixotrophic protists. Recently, research papers addressing ecological questions about mixotrophy in marine systems have been more numerous than those that deal with freshwater systems, a trend that is probably partly due to a realization that many harmful algal blooms in coastal marine systems involve mixotrophic protists. After an introduction to the symposium presentations, recent studies of mixotrophy in freshwater systems are reviewed to encourage continuing research on their importance to inland waters. © 2011 The Author(s). Journal of Eukaryotic Microbiology© 2011 International Society of Protistologists.

  4. The cost-effectiveness of alternative vaccination strategies for polyvalent meningococcal vaccines in Burkina Faso: A transmission dynamic modeling study.

    Science.gov (United States)

    Yaesoubi, Reza; Trotter, Caroline; Colijn, Caroline; Yaesoubi, Maziar; Colombini, Anaïs; Resch, Stephen; Kristiansen, Paul A; LaForce, F Marc; Cohen, Ted

    2018-01-01

    The introduction of a conjugate vaccine for serogroup A Neisseria meningitidis has dramatically reduced disease in the African meningitis belt. In this context, important questions remain about the performance of different vaccine policies that target remaining serogroups. Here, we estimate the health impact and cost associated with several alternative vaccination policies in Burkina Faso. We developed and calibrated a mathematical model of meningococcal transmission to project the disability-adjusted life years (DALYs) averted and costs associated with the current Base policy (serogroup A conjugate vaccination at 9 months, as part of the Expanded Program on Immunization [EPI], plus district-specific reactive vaccination campaigns using polyvalent meningococcal polysaccharide [PMP] vaccine in response to outbreaks) and three alternative policies: (1) Base Prime: novel polyvalent meningococcal conjugate (PMC) vaccine replaces the serogroup A conjugate in EPI and is also used in reactive campaigns; (2) Prevention 1: PMC used in EPI and in a nationwide catch-up campaign for 1-18-year-olds; and (3) Prevention 2: Prevention 1, except the nationwide campaign includes individuals up to 29 years old. Over a 30-year simulation period, Prevention 2 would avert 78% of the meningococcal cases (95% prediction interval: 63%-90%) expected under the Base policy if serogroup A is not replaced by remaining serogroups after elimination, and would avert 87% (77%-93%) of meningococcal cases if complete strain replacement occurs. Compared to the Base policy and at the PMC vaccine price of US$4 per dose, strategies that use PMC vaccine (i.e., Base Prime and Preventions 1 and 2) are expected to be cost saving if strain replacement occurs, and would cost US$51 (-US$236, US$490), US$188 (-US$97, US$626), and US$246 (-US$53, US$703) per DALY averted, respectively, if strain replacement does not occur. An important potential limitation of our study is the simplifying assumption that all

  5. Designing alternative strategies for the European industry according to its strength and weaknesses and taking into consideration the opportunities and threats of the PV market

    International Nuclear Information System (INIS)

    Viaud, M.; Despotou, E.; Latour, M.; Cameron, M.; Weiss, I.; Baumann, J.; Stierstorfer, J.; Gisler, R.

    2004-01-01

    The objectives were to generate a variety of strategies to identify alternative ways that the PV Sector can use its specific strengths to capitalize on opportunities or to avoid threats and to overcome its weaknesses. The so-called SWOT analysis provides a matrix illustrating how businesses can match the external opportunities and threats facing the sector with its internal strengths and weaknesses to yield in possible strategic alternatives. This method lends itself to brainstorming to create alternative strategies and actions, which might not otherwise be considered. In two working group meetings with participants from the PV industry, research and other stakeholders the SWOT were performed to result into implications for the PV sector. Through workshops the results will be discussed within an expert group and priorities for the future activities will be defined. The project is co-financed through the 6. Framework Programme of the EC. (authors)

  6. Augmented telomerase activity, reduced telomere length and the presence of alternative lengthening of telomere in renal cell carcinoma: plausible predictive and diagnostic markers.

    Science.gov (United States)

    Pal, Deeksha; Sharma, Ujjawal; Khajuria, Ragini; Singh, Shrawan Kumar; Kakkar, Nandita; Prasad, Rajendra

    2015-05-15

    In this study, we analyzed 100 cases of renal cell carcinoma (RCC) for telomerase activity, telomere length and alternative lengthening of telomeres (ALT) using the TRAP assay, TeloTTAGGG assay kit and immunohistochemical analysis of ALT associated promyelocytic leukemia (PML) bodies respectively. A significantly higher (P=0.000) telomerase activity was observed in 81 cases of RCC which was correlated with clinicopathological features of tumor for instance, stage (P=0.008) and grades (P=0.000) but not with the subtypes of RCC (P = 0.355). Notwithstanding, no correlation was found between telomerase activity and subtypes of RCC. Strikingly, the telomere length was found to be significantly shorter in RCC (P=0.000) to that of corresponding normal renal tissues and it is well correlated with grades (P=0.016) but not with stages (P=0.202) and subtypes (P=0.669) of RCC. In this study, telomere length was also negatively correlated with the age of patients (r(2)=0.528; P=0.000) which supports the notion that it could be used as a marker for biological aging. ALT associated PML bodies containing PML protein was found in telomerase negative cases of RCC. It suggests the presence of an ALT pathway mechanism to maintain the telomere length in telomerase negative RCC tissues which was associated with high stages of RCC, suggesting a prevalent mechanism for telomere maintenance in high stages. In conclusion, the telomerase activity and telomere length can be used as a diagnostic as well as a predictive marker in RCC. The prevalence of ALT mechanism in high stages of RCC is warranted for the development of anti-ALT inhibitors along with telomerase inhibitor against RCC as a therapeutic approach. Copyright © 2015 Elsevier B.V. All rights reserved.

  7. 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

    2006-09-01

    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.

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

    Science.gov (United States)

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

    2014-12-01

    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.

  9. Assessment of off-design performance of a small-scale combined cooling and power system using an alternative operating strategy for gas turbine

    International Nuclear Information System (INIS)

    Han, Wei; Chen, Qiang; Lin, Ru-mou; Jin, Hong-guang

    2015-01-01

    Highlights: • We develop an off-design model for a CCP system driven by gas turbine. • An alternative operating strategy is proposed to improve the system performance. • Off-design performance of the combined cooling and power system (CCP) is enhanced. • Effects of both the different operating strategy are analyzed and compared. • Performance enhancement mechanism of the proposed operating strategy is presented. - Abstract: A small-scale combined cooling and power (CCP) system usually serves district air conditioning apart from power generation purposes. The typical system consists of a gas turbine and an exhaust gas-fired absorption refrigerator. The surplus heat of the gas turbine is recovered to generate cooling energy. In this way, the CCP system has a high overall efficiency at the design point. However, the CCP system usually runs under off-design conditions because the users’ demand varies frequently. The operating strategy of the gas turbine will affect the thermodynamic performance of itself and the entire CCP system. The operating strategies for gas turbines include the reducing turbine inlet temperature (TIT) and the compressor inlet air throttling (IAT). A CCP system, consisting of an OPRA gas turbine and a double effects absorption refrigerator, is investigated to identify the effects of different operating strategies. The CCP system is simulated based on the partial-load model of gas turbine and absorption refrigerator. The off-design performance of the CCP system is compared under different operating strategies. The results show that the IAT strategy is the better one. At 50% rated power output of the gas turbine, the IAT operating strategy can increase overall system efficiency by 10% compared with the TIT strategy. In general, the IAT operating strategy is suited for other gas turbines. However, the benefits of IAT should be investigated in the future, when different gas turbine is adopted. This study may provide a new operating

  10. COMPAS: a European project on the ''comparison of alternative waste management strategies for long-lived radioactive wastes''. Scope, working methods and conclusions

    International Nuclear Information System (INIS)

    Dutton, L.M.C.; Hillis, Z.K.; Roehlig, K.J.

    2004-01-01

    The paper presents the content and major findings of a project on the ''COMParison of Alternative waste management Strategies for long-lived radioactive wastes'' (COMPAS) carried out within the 5 th framework programme of the European commission. Under the leadership of NNC (UK), the project was carried out by individuals representing waste management organisations from 15 European countries. After having compiled information on the nature and amount of long-lived radioactive waste to be managed, issues influencing the selection of waste management strategies and options, presently adopted national strategies as well as options for the future were addressed. Conclusions concerning key issues for the success or otherwise of strategies and management solutions were drawn. (orig.)

  11. A strategy for establishing diagnostic and related services to dairy farmers in developing countries based on radioimmunoassay of progesterone in milk

    International Nuclear Information System (INIS)

    Galloway, D.B.; Perera, B.M.A.O.; Manar, S.

    2001-01-01

    The radioimmunoassay (RIA) for progesterone in milk samples collected from cattle has been used for monitoring ovarian activity, diagnosis of pregnancy and non-pregnancy, assessment of the accuracy of oestrus detection and for surveying efficiency of artificial insemination services. The establishment of a service to dairy farmers in developing countries based on this technique has not been previously reported but there are clear potential benefits in such a service. A strategy was therefore developed for the establishment of diagnostic and related services to dairy farmers in Morocco on a pilot basis, using RIA of progesterone in milk for possible adoption as a model for other developing countries. (author)

  12. Retrofitting a spent fuel pool spray system for alternative cooling as a strategy for beyond design basis events

    Energy Technology Data Exchange (ETDEWEB)

    Hartmann, Christoph; Vujic, Zoran [Westinghouse Electric Germany GmbH, Mannheim (Germany)

    2017-06-15

    Due to requirements for nuclear power plants to withstand beyond design basis accidents, including events such as happened in 2011 in the Fukushima Daiichi Nuclear Power Plant in Japan, alternative cooling of spent fuel is needed. Alternative spent fuel cooling can be provided by a retrofitted spent fuel pool spray system based on the AP1000 plant design. As part of Krsko Nuclear Power Plant's Safety Upgrade Program, Krsko Nuclear Power Plant decided on, and Westinghouse successfully designed a retrofit of the AP1000 {sup registered} plant spent fuel pool spray system to provide alternative spent fuel cooling.

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

    International Nuclear Information System (INIS)

    Watson, F.V.

    1982-01-01

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

  14. Final programmatic environmental impact statement for alternative strategies for the long-term management and use of depleted uranium hexafluoride. Summary

    International Nuclear Information System (INIS)

    1999-04-01

    This PEIS assesses the potential impacts of alternative management strategies for depleted uranium hexafluoride (UF 6 ) currently stored at three DOE sites: Paducah site near Paducah, Kentucky, Portsmouth site near Portsmouth, Ohio; and K-25 site on the Oak Ridge Reservation, Oak Ridge, Tennessee. The alternatives analyzed in the PEIS include no action, long-term storage as UF 6 , long-term storage as uranium oxide, use as uranium oxide, use as uranium metal, and disposal. DOE's preferred alternative is to begin conversion of the depleted UF 6 inventory as soon as possible, either to uranium oxide, uranium metal, or a combination of both, while allowing for use of as much of this inventory as possible

  15. Final programmatic environmental impact statement for alternative strategies for the long-term management and use of depleted uranium hexafluoride. Volume 1: Main text

    International Nuclear Information System (INIS)

    1999-04-01

    This PEIS assesses the potential impacts of alternative management strategies for depleted uranium hexafluoride (UF 6 ) currently stored at three DOE sites: Paducah site near Paducah, Kentucky, Portsmouth site near Portsmouth, Ohio; and K-25 site on the Oak Ridge Reservation, Oak Ridge, Tennessee. The alternatives analyzed in the PEIS include no action, long-term storage as UF 6 , long-term storage as uranium oxide, use as uranium oxide, use as uranium metal, and disposal. DOE's preferred alternative is to begin conversion of the depleted UF 6 inventory as soon as possible, either to uranium oxide, uranium metal, or a combination of both, while allowing for use of as much of this inventory as possible

  16. Final programmatic environmental impact statement for alternative strategies for the long-term management and use of depleted uranium hexafluoride. Volume 2: Appendices

    International Nuclear Information System (INIS)

    1999-04-01

    This PEIS assesses the potential impacts of alternative management strategies for depleted uranium hexafluoride (UF 6 ) currently stored at three DOE sites: Paducah site near Paducah, Kentucky, Portsmouth site near Portsmouth, Ohio; and K-25 site on the Oak Ridge Reservation, Oak Ridge, Tennessee. The alternatives analyzed in the PEIS include no action, long-term storage as UF 6 , long-term storage as uranium oxide, use as uranium oxide, use as uranium metal, and disposal. DOE's preferred alternative is to begin conversion of the depleted UF 6 inventory as soon as possible, either to uranium oxide, uranium metal, or a combination of both, while allowing for use of as much of this inventory as possible. This volume contains Appendices A--O

  17. Evaluation of alternative strategies to MERV 16-based air filtration systems for reduction of the risk of airborne spread of porcine reproductive and respiratory syndrome virus.

    Science.gov (United States)

    Dee, Scott; Pitkin, Andrea; Deen, John

    2009-07-02

    Porcine reproductive and respiratory syndrome (PRRS) is a re-emerging disease of pigs and a growing threat to the global swine industry. For sustainable disease control it is critical to prevent the airborne spread of the etiologic agent, PRRS virus, between pig populations. The application of MERV 16-based air filtration systems to swine facilities in an effort to reduce this risk has been proposed; however, due to the cost and air flow restrictions of such systems the need for alternative strategies has arisen. Therefore, the objective of this study was to evaluate 3 groups of alternative biosecurity strategies for reducing the risk of the airborne spread of PRRSV. Strategies evaluated included mechanical filters, antimicrobial filters and a disinfectant-EVAP (evaporative cooling) system. Results from this study indicate that while alternatives to MERV 16-based biosecurity protocols for protecting farms from the airborne spread of PRRSV are available, further information on their efficacy in the field is needed before conclusions can be drawn.

  18. Alternatives to imprisonment in Scotland: policy, strategy and practice / Mesures alternatives à l’incarcération en Écosse : politique, stratégie et pratique

    Directory of Open Access Journals (Sweden)

    Freeman Ruth

    2016-12-01

    Full Text Available La gamma delle iniziative introdotta dal governo scozzese e dalle agenzie partner, nazionali e locali, ha lo scopo di ridurre il ricorso alla detenzione di breve durata, di promuovere una risposta più efficace nei confronti delle cause del crimine e di ridurre la recidiva. Queste iniziative indicano che il governo ed i suoi partner riconoscono che, anche se di cruciale importanza, le misure in comunità da sole saranno inefficaci. Sono state previste anche altre risposte che focalizzano chiaramente l’attenzione sulla prevenzione, sulla riduzione delle disuguaglianze e sulle problematiche connesse all'infanzia e associate alla recidiva in età adulta. Viene prestata particolare attenzione all'importanza della tipologie di condanne disponibili e alle agenzie che lavorano in modo collaborativo e responsabile nella comunità, al fine di concentrarsi su obiettivi condivisi. Resta da verificare se, dopo anni di continuo aumento della popolazione carceraria, queste diverse misure possono dimostrare di avere un impatto sia sul ricorso alla custodia in carcere sia sui tassi di recidiva. Tuttavia, in conformità con la ricerca, in merito a ciò che funziona per ridurre il crimine e a quello che potrebbe ridurre il ricorso alla carcerazione, sembra che l'approccio si mostri complessivamente promettente. Les différentes initiatives mises en ɶuvre par le gouvernement écossais et par les agences partenaires nationales et locales ont pour but de réduire le recours à l'emprisonnement de courte durée, de promouvoir une réponse plus efficace aux causes de la criminalité et de réduire la récidive. Elles indiquent que le gouvernement et les partenaires reconnaissent que, bien qu’elles soient extrêmement importantes, les solutions communautaires alternatives à l’incarcération seules s’avéreront inefficaces. D’autres réponses, clairement axées sur la prévention, sur la réduction des inégalités et sur des questions liées à l

  19. Planning schistosomiasis control: investigation of alternative sampling strategies for Schistosoma mansoni to target mass drug administration of praziquantel in East Africa.

    Science.gov (United States)

    Sturrock, Hugh J W; Gething, Pete W; Ashton, Ruth A; Kolaczinski, Jan H; Kabatereine, Narcis B; Brooker, Simon

    2011-09-01

    In schistosomiasis control, there is a need to geographically target treatment to populations at high risk of morbidity. This paper evaluates alternative sampling strategies for surveys of Schistosoma mansoni to target mass drug administration in Kenya and Ethiopia. Two main designs are considered: lot quality assurance sampling (LQAS) of children from all schools; and a geostatistical design that samples a subset of schools and uses semi-variogram analysis and spatial interpolation to predict prevalence in the remaining unsurveyed schools. Computerized simulations are used to investigate the performance of sampling strategies in correctly classifying schools according to treatment needs and their cost-effectiveness in identifying high prevalence schools. LQAS performs better than geostatistical sampling in correctly classifying schools, but at a cost with a higher cost per high prevalence school correctly classified. It is suggested that the optimal surveying strategy for S. mansoni needs to take into account the goals of the control programme and the financial and drug resources available.

  20. Is case-based learning an effective teaching strategy to challenge students' alternative conceptions regarding chemical kinetics?

    Science.gov (United States)

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

    2012-07-01

    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.

  1. The Quality of Quantity: Mini-UAVS As An Alternative UAV Acquisition Strategy at the Army Brigade Level

    National Research Council Canada - National Science Library

    Weed, Shawn

    2002-01-01

    This monograph asks should the U.S. Army alter its current UAV acquisition strategy for maneuver brigades from one in which limited numbers of high capability systems are acquired, in favor of another that fields a large quantity...

  2. Optimality of the barrier strategy in de Finetti's dividend problem for spectrally negative Lévy processes: An alternative approach

    Science.gov (United States)

    Yin, Chuancun; Wang, Chunwei

    2009-11-01

    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.

  3. The Performance Of Alternative Interest Rate Risk Measures And Immunization Strategies Under A Heath-Jarrow-Morton Framework

    OpenAIRE

    Agca, Senay

    2002-01-01

    The Heath-Jarrow-Morton (HJM) model represents the latest in powerful arbitrage-free technology for modeling the term structure and managing interest rate risk. Yet risk management strategies in the form of immunization portfolios using duration, convexity, and M-square are still widely used in bond portfolio management today. This study addresses the question of how traditional risk measures and immunization strategies perform when the term structure evolves in the HJM manner. Using Monte Ca...

  4. 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

    2014-12-01

    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.

  5. A Methodological Alternative to Media Comparison Studies: Linking Information Utilization Strategies and Instructional Approach in Hypermedia Learning

    OpenAIRE

    Catrambone, Richard; Gerjets, Peter; Scheiter, Katharina; Vollmann, Brigitte

    2006-01-01

    Literature reviews on hypermedia learning have yet failed to show consistent positive effects of learner-controlled nonlinear information access. We argue that a possible reason for this lack of evidence in favor of hypermedia learning results from the fact that not sufficient attention is paid to the strategies of information utilization learners deploy. The few studies that do analyze these strategies fail to link them to an instructional approach, which hampers a deeper interpretation of s...

  6. Evaluation of alternative groundwater-management strategies for the Bureau of Reclamation Klamath Project, Oregon and California

    Science.gov (United States)

    Wagner, Brian J.; Gannett, Marshall W.

    2014-01-01

    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

  7. Contribution of diagnostic tests for the etiological assessment of uveitis, data from the ULISSE study (Uveitis: Clinical and medicoeconomic evaluation of a standardized strategy of the etiological diagnosis).

    Science.gov (United States)

    Grumet, Pierre; Kodjikian, Laurent; de Parisot, Audrey; Errera, Marie-Hélène; Sedira, Neila; Heron, Emmanuel; Pérard, Laurent; Cornut, Pierre-Loïc; Schneider, Christelle; Rivière, Sophie; Ollé, Priscille; Pugnet, Grégory; Cathébras, Pascal; Manoli, Pierre; Bodaghi, Bahram; Saadoun, David; Baillif, Stéphanie; Tieulie, Nathalie; Andre, Marc; Chiambaretta, Frédéric; Bonin, Nicolas; Bielefeld, Philip; Bron, Alain; Mouriaux, Frédéric; Bienvenu, Boris; Vicente, Stéphanie; Bin, Sylvie; Labetoulle, Marc; Broussolle, Christiane; Jamilloux, Yvan; Decullier, Evelyne; Sève, Pascal

    2018-04-01

    ULISSE is the only study that prospectively assessed the efficiency of a standardized strategy, compared to an open strategy for the etiologic diagnosis of uveitis. Our aim was to evaluate the diagnostic yield of the tests prescribed in the ULISSE study to clarify their relevance. ULISSE is a non-inferiority, prospective, multicenter and cluster randomized study. The standardized strategy is a two-steps strategy: in the first step, common standard tests were performed, and in the second step, tests were guided by the clinical and anatomic type of uveitis. We reported the relevance of the diagnostic tests used in the standardized strategy, as well as the profitability of the tests that were prescribed to more than twenty patients in each group. Based on diagnostic criteria, either an ophthalmologist, or an internist, established the profitability of a test by considering whether the test lead to a diagnosis or not. Among the 676 patients included (standardized 303; open 373), a diagnosis was made for 152 (50.4%) in the standardized group and 203 (54.4%) in the open group. The most common entities were HLA-B27 associated uveitis (22%), spondyloarthritis (11%), sarcoidosis (18%), tuberculosis (10.7%) and herpes virus infections (8.5%). Among the first step's systematic tests, tuberculin skin test was the most contributive investigation (17.1%), followed by chest X-ray (8.4%), C reactive protein and ESR (6.6% and 5.1%), complete blood count (2.2%) and VDRL (2.0%). The second step's most often contributive tests were: HLA B27 (56.3%), chest-CT (30.3%) and angiotensin converting enzyme (ACE) (16.5%). HLA B27 and ACE were significantly more contributive in the standardized group than in the open group. Immunological tests were never contributive. Among the free investigations, or among the investigations guided by clinical or paraclinical findings, the most often contributive tests were: Quantiferon® (24%), electrophoresis of serum protein (7.8%) and sacroiliac imagery

  8. The PM&R Journal Implements a Social Media Strategy to Disseminate Research and Track Alternative Metrics in Physical Medicine and Rehabilitation.

    Science.gov (United States)

    Niehaus, William N; Silver, Julie K; Katz, Matthew S

    2017-12-16

    Implementation science is an evolving part of translating evidence into clinical practice and public health policy. This report describes how a social media strategy for the journal PM&R using metrics, including alternative metrics, contributes to the dissemination of research and other information in the field of physical medicine and rehabilitation. The primary goal of the strategy was to disseminate information about rehabilitation medicine, including but not limited to new research published in the journal, to health care professionals. Several different types of metrics were studied, including alternative metrics that are increasingly being used to demonstrate impact in academic medicine. A secondary goal was to encourage diversity and inclusion of the physiatric workforce-enhancing the reputations of all physiatrists by highlighting their research, lectures, awards, and other accomplishments with attention to those who may be underrepresented. A third goal was to educate the public so that they are more aware of the field and how to access care. This report describes the early results following initiation of PM&R's coordinated social media strategy. Through a network of social media efforts that are strategically integrated, physiatrists and their associated institutions have an opportunity to advance their research and clinical agendas, support the diverse physiatric workforce, and educate the public about the field to enhance patient awareness and access to care. Copyright © 2018 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  9. Terrorism and Counter-Terrorism Strategies in a Globalised World : alternative perceptiveness of terrorist emergence theory and policing strategies confrontation with human rights

    OpenAIRE

    Kikkas, Margit

    2015-01-01

    Globalisation and development in technology have advanced terrorism to reach a broader target audience. Especially focussing at the international co-operation strategies and combined social networks, terrorist activities have an direct- and indirect effect on private households, international commerce and local governments. Security institutions and state organisations use various combinations of counter- terrorism measures, that are mostly social-, political-, or financial in nature. Neverth...

  10. PERFORMANCE OF SELECTED PRE-HARVEST AND POST-HARVEST CORN AND SOYBEAN MARKETING STRATEGIES VS. ALTERNATIVE MARKET BENCHMARKS

    OpenAIRE

    Blue, E. Neal; Wisner, Robert N.; Baldwin, E. Dean

    2004-01-01

    This study was undertaken to update earlier work by the authors that analyzed selected preharvest pricing strategies utilizing options markets to establish a price floor for part of the crop in the spring, with additional pricing done by use of short hedges in early summer. The timing of implementing these strategies was moved back to late February if the previous year's U.S. crop was a weather-induced short crop. A weather-induced short crop as opposed to a government program induced short c...

  11. Physical and biological responses to an alternative removal strategy of a moderate-sized dam in Washington, USA.

    Science.gov (United States)

    Shannon Claeson; B. Coffin

    2015-01-01

    Dam removal is an increasingly practised river restoration technique, and ecological responses vary with watershed, dam and reservoir properties, and removal strategies. Moderate-sized dams, like Hemlock Dam (7.9m tall and 56m wide), are large enough that removal effects could be significant, but small enough that mitigation may be possible through a modified dam...

  12. Social supports and prevention strategies as adjuncts and alternatives to sedation and anesthesia for people with special needs.

    Science.gov (United States)

    Glassman, Paul; Miller, Christine

    2009-01-01

    People with special needs are assuming a more prominent place in our society. The number of people living in communities with medical, physical, and psychological conditions is increasing dramatically. In spite of the advances that people with special needs have made in recognition of their right to live in society and access services open to other people, their oral health is still significantly poorer than that of other groups. There are a number of modalities that can complement or replace pharmacological interventions and allow individuals to have dental treatment in a dental office or clinic. These include behavioral or psychological interventions and social support and prevention strategies. Social supports include care management and integration of oral health services with general health and social service systems. Preventive programs using modern "medical model" oral health prevention strategies also have the potential to reduce the burden of disease among people with special needs and therefore reduce the need for dental procedures. A social support system using community-based Dental Hygienists acting as Dental Coordinators, is described along with outcomes demonstrating improved oral health for people with special needs living in community residential care facilities. Combined social support systems and community prevention strategies have the potential to reduce the need for pharmacological interventions in order to maintain oral health in populations of people with special needs. Social supports and modern preventive strategies must be included in the range of options available in communities in order to improve and maintain oral health for people with special needs.

  13. A comparison of the suitability of patient dosimetry methods for establishing diagnostic dose reference levels and optimisation strategies

    International Nuclear Information System (INIS)

    Gfirtner, Hans; Moores, B. Michael; Stieve, Friedrich E.

    2008-01-01

    For 50 adult patients referred for chest radiography, air kerma at the diaphragm KD, dose area product and entrance skin dose were measured. The air kerma at the diaphragm and the dose area product were determined using Diamentor M4KDK(PTW) which allows measuring air kerma and dose area product simultaneously. For the measurement of entrance skin dose TLDs are used. A 50% variation in dose, incident dose as well as entrance skin dose, was registered for the same patient thickness. The recommendation of ICRP to perform the measurements for DRLs at 'representative patients' and that of the CEC to use 'standard-sized patients' seem to make little sense in the case of chest radiography. It could be demonstrated, that the dose area product is the least appropriate dose quantity for patient measurements and to define dose reference levels. For some radiological examinations like chest, pelvis and lumbar spine the dose area product is even sex dependent. Incident dose and entrance surface dose are of equal quality for patient dose measurements in diagnostic radiography. (author)

  14. Risk-related 18F-FDG PET/CT and new diagnostic strategies in patients with solitary pulmonary nodule: the ITALIAN multicenter trial.

    Science.gov (United States)

    Spadafora, Marco; Pace, Leonardo; Evangelista, Laura; Mansi, Luigi; Del Prete, Francesco; Saladini, Giorgio; Miletto, Paolo; Fanti, Stefano; Del Vecchio, Silvana; Guerra, Luca; Pepe, Giovanna; Peluso, Giuseppina; Nicolai, Emanuele; Storto, Giovanni; Ferdeghini, Marco; Giordano, Alessandro; Farsad, Mohsen; Schillaci, Orazio; Gridelli, Cesare; Cuocolo, Alberto

    2018-05-05

    Diagnosis of solitary pulmonary nodule (SPN) is an important public health issue and 18 F-FDG PET/CT has proven to be more effective than CT alone. Pre-test risk stratification and clinical presentation of SPN could affect the diagnostic strategy. A relevant issue is whether thoracic segmental (s)-PET/CT could be implemented in patients with SPN. This retrospective multicenter study compared the results of FDG whole-body (wb)-PET/CT to those of s-PET/CT. 18 F-FDG PET/CT of 502 patients, stratified for pre-test cancer risk, were retrospectively analyzed. The thoracic part of wb-PET/CT, considered s-PET/CT, was compared to wb-PET/CT. Clinical and PET/CT variables were investigated for SPN characterization as well as for identification of patients in whom s-PET/CT could be performed. Histopathology or follow-up data were used as a reference. In the study population, 36% had malignant, 35% benign, and 29% indeterminate SPN. 18 F-FDG uptake indicative of thoracic and extra-thoracic lesions was detectable in 13% and 3% of the patients. All patients with extra-thoracic metastases (n = 13) had thoracic lymph node involvement and highest 18 F-FDG uptake at level of SPN (negative predictive value 100%). Compared to wb-PET/CT, s-PET/CT could save about 2/3 of 18 F-FDG dose, radiation exposure or scan-time, without affecting the clinical impact of PET/CT. Pre-test probability of malignancy can guide the diagnostic strategy of 18 FDG-PET/CT in patients with SPN. In subjects with low-intermediate pretest probability s-PET/CT imaging might be planned in advance, while in those at high risk and with thoracic lymph node involvement a wb-PET/CT is necessary.

  15. Laboratory diagnostics in dog-mediated rabies: an overview of performance and a proposed strategy for various settings.

    Science.gov (United States)

    Duong, Veasna; Tarantola, Arnaud; Ong, Sivuth; Mey, Channa; Choeung, Rithy; Ly, Sowath; Bourhy, Hervé; Dussart, Philippe; Buchy, Philippe

    2016-05-01

    The diagnosis of dog-mediated rabies in humans and animals has greatly benefited from technical advances in the laboratory setting. Approaches to diagnosis now include the detection of rabies virus (RABV), RABV RNA, or RABV antigens. These assays are important tools in the current efforts aimed at the global elimination of dog-mediated rabies. The assays available for use in laboratories are reviewed herein, as well as their strengths and weaknesses, which vary with the types of sample analyzed. Depending on the setting, however, the public health objectives and use of RABV diagnosis in the field will also vary. In non-endemic settings, the detection of all introduced or emergent animal or human cases justifies exhaustive testing. In dog RABV-endemic settings, such as rural areas of developing countries where most cases occur, the availability of or access to testing may be severely constrained. Thus, these issues are also discussed along with a proposed strategy to prioritize testing while access to rabies testing in the resource-poor, highly endemic setting is improved. As the epidemiological situation of rabies in a country evolves, the strategy should shift from that of an endemic setting to one more suitable for a decreased rabies incidence following the implementation of efficient control measures and when nearing the target of dog-mediated rabies elimination. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  16. Distinguishing hypertrophic cardiomyopathy from athlete's heart physiological remodelling: clinical significance, diagnostic strategies and implications for preparticipation screening.

    Science.gov (United States)

    Maron, B J

    2009-09-01

    Sudden cardiac death in young competitive athletes is an important public health problem, although a relatively low-event-rate phenomenon. The single most common cardiovascular cause of these unexpected catastrophes is hypertrophic cardiomyopathy (HCM), accounting for about one-third of cases. Since the phenotypic expression of HCM is variable, and not uncommonly includes patients with mild and localised left ventricular hypertrophy, the differential diagnosis with physiological remodelling of athlete's heart not uncommonly arises. This review discusses those non-invasive strategies that are useful in distinguishing the benign consequences of systematic athletic training from pathological left ventricular hypertrophy with the potential for sudden cardiac death. Preparticipation screening in healthy general athlete populations may raise the suspicion of HCM, and ultimately lead to definitive diagnosis. However, recently controversy has arisen regarding the most effective and practical strategy for the screening of athletes. European investigators have promoted routine 12-lead ECGs as part of a national mandatory programme distinct from the customary practice in the US which is limited to history and physical examinations. Consensus criteria and recommendations for eligibility and disqualification of athletes with HCM (and other cardiovascular abnormalities) have proved useful to the practising community.

  17. Cost-effectiveness and public health impact of alternative influenza vaccination strategies in high-risk adults.

    Science.gov (United States)

    Raviotta, Jonathan M; Smith, Kenneth J; DePasse, Jay; Brown, Shawn T; Shim, Eunha; Nowalk, Mary Patricia; Wateska, Angela; France, Glenson S; Zimmerman, Richard K

    2017-10-09

    High-dose trivalent inactivated influenza vaccine (HD-IIV3) or recombinant trivalent influenza vaccine (RIV) may increase influenza vaccine effectiveness (VE) in adults with conditions that place them at high risk for influenza complications. This analysis models the public health impact and cost-effectiveness (CE) of these vaccines for 50-64year-olds. Markov model CE analysis compared 5 strategies in 50-64year-olds: no vaccination; only standard-dose IIV3 offered (SD-IIV3 only), only quadrivalent influenza vaccine offered (SD-IIV4 only); high-risk patients receiving HD-IIV3, others receiving SD-IIV3 (HD-IIV3 & SD-IIV3); and high-risk patients receiving HD-IIV3, others receiving SD-IIV4 (HD-IIV3 & SD-IIV4). In a secondary analysis, RIV replaced HD-IIV3. Parameters were obtained from U.S. databases, the medical literature and extrapolations from VE estimates. Effectiveness was measured as 3%/year discounted quality adjusted life year (QALY) losses avoided. The least expensive strategy was SD-IIV3 only, with total costs of $99.84/person. The SD-IIV4 only strategy cost an additional $0.91/person, or $37,700/QALY gained. The HD-IIV3 & SD-IIV4 strategy cost $1.06 more than SD-IIV4 only, or $71,500/QALY gained. No vaccination and HD-IIV3 & SD-IIV3 strategies were dominated. Results were sensitive to influenza incidence, vaccine cost, standard-dose VE in the entire population and high-dose VE in high-risk patients. The CE of RIV for high-risk patients was dependent on as yet unknown parameter values. Based on available data, using high-dose influenza vaccine or RIV in middle-aged, high-risk patients may be an economically favorable vaccination strategy with public health benefits. Clinical trials of these vaccines in this population may be warranted. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Playing the Metadata Game: Technologies and Strategies Used by Climate Diagnostics Center for Cataloging and Distributing Climate Data.

    Science.gov (United States)

    Schweitzer, R. H.

    2001-05-01

    The Climate Diagnostics Center maintains a collection of gridded climate data primarily for use by local researchers. Because this data is available on fast digital storage and because it has been converted to netCDF using a standard metadata convention (called COARDS), we recognize that this data collection is also useful to the community at large. At CDC we try to use technology and metadata standards to reduce our costs associated with making these data available to the public. The World Wide Web has been an excellent technology platform for meeting that goal. Specifically we have developed Web-based user interfaces that allow users to search, plot and download subsets from the data collection. We have also been exploring use of the Pacific Marine Environment Laboratory's Live Access Server (LAS) as an engine for this task. This would result in further savings by allowing us to concentrate on customizing the LAS where needed, rather that developing and maintaining our own system. One such customization currently under development is the use of Java Servlets and JavaServer pages in conjunction with a metadata database to produce a hierarchical user interface to LAS. In addition to these Web-based user interfaces all of our data are available via the Distributed Oceanographic Data System (DODS). This allows other sites using LAS and individuals using DODS-enabled clients to use our data as if it were a local file. All of these technology systems are driven by metadata. When we began to create netCDF files, we collaborated with several other agencies to develop a netCDF convention (COARDS) for metadata. At CDC we have extended that convention to incorporate additional metadata elements to make the netCDF files as self-describing as possible. Part of the local metadata is a set of controlled names for the variable, level in the atmosphere and ocean, statistic and data set for each netCDF file. To allow searching and easy reorganization of these metadata, we loaded

  19. 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.

  20. New alternatives for reference evapotranspiration estimation in West Africa using limited weather data and ancillary data supply strategies.

    Science.gov (United States)

    Landeras, Gorka; Bekoe, Emmanuel; Ampofo, Joseph; Logah, Frederick; Diop, Mbaye; Cisse, Madiama; Shiri, Jalal

    2018-05-01

    Accurate estimation of reference evapotranspiration ( ET 0 ) is essential for the computation of crop water requirements, irrigation scheduling, and water resources management. In this context, having a battery of alternative local calibrated ET 0 estimation methods is of great interest for any irrigation advisory service. The development of irrigation advisory services will be a major breakthrough for West African agriculture. In the case of many West African countries, the high number of meteorological inputs required by the Penman-Monteith equation has been indicated as constraining. The present paper investigates for the first time in Ghana, the estimation ability of artificial intelligence-based models (Artificial Neural Networks (ANNs) and Gene Expression Programing (GEPs)), and ancillary/external approaches for modeling reference evapotranspiration ( ET 0 ) using limited weather data. According to the results of this study, GEPs have emerged as a very interesting alternative for ET 0 estimation at all the locations of Ghana which have been evaluated in this study under different scenarios of meteorological data availability. The adoption of ancillary/external approaches has been also successful, moreover in the southern locations. The interesting results obtained in this study using GEPs and some ancillary approaches could be a reference for future studies about ET 0 estimation in West Africa.

  1. 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

    2011-12-01

    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

  2. Review of Mycobacteriumavium subsp. paratuberculosis antigen candidates with diagnostic potential

    DEFF Research Database (Denmark)

    Mikkelsen, Heidi; Aagaard, Claus; Nielsen, Søren Saxmose

    2011-01-01

    antigens, heat shock antigens and hypothetical antigens. Strategies for evaluation of novel antigen candidates are discussed critically. Relatively few of the described antigens were evaluated for their use in CMI based diagnostic assays and so far, no obvious candidate has been identified...... to development of antibodies and shedding of detectable amounts of MAP. At present, available diagnostic assays are limited by the lack of MAP specific antigens included in these assays resulting in poor specificity. The objective of this review is to provide a systematic overview of diagnostic MAP antigen...... faeces; however, these diagnostic tools are often not applicable until years after infection. Detection of MAP specific cell-mediated immune (CMI) responses can serve as an alternative and be implemented in a diagnostic tool. CMI responses can be measured at an early stage of infection, prior...

  3. 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.

    2012-12-15

    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.

  4. Performance, profitability and greenhouse gas emissions of alternative finishing strategies for Holstein-Friesian bulls and steers.

    Science.gov (United States)

    Murphy, B; Crosson, P; Kelly, A K; Prendiville, R

    2018-02-06

    Modifying finishing strategies within established production systems has the potential to increase beef output and farm profit while reducing greenhouse gas (GHG) emissions. Thus, the objectives of this study were to investigate the effects of finishing duration on animal performance of Holstein-Friesian (HF) bulls and steers and evaluate the profitability and GHG emissions of these finishing strategies. A total of 90 HF calves were assigned to a complete randomised block design; three bull and three steer finishing strategies. Calves were rotationally grazed in a paddock system for the first season at pasture, housed and offered grass silage ad libitum plus 1.5 kg DM of concentrate per head daily for the first winter and returned to pasture for a second season. Bulls were slaughtered at 19 months of age and either finished indoors on concentrates ad libitum for 100 days (19AL), finished at pasture supplemented with 5 kg DM of concentrate per head daily for 100 (19SP) or 150 days (19LP). Steers were slaughtered at 21 months of age and finished at pasture, supplemented with 5 kg DM of concentrate per head daily for 60 (21SP) and 110 days (21LP) or slaughtered at 24 months of age and finished indoors over the second winter on grass silage ad libitum plus 5 kg DM of concentrate per head daily (24MO). The Grange Dairy Beef Systems Model and the Beef Systems Greenhouse Gas Emissions Model were used to evaluate profitability and GHG emissions, respectively. Average daily gain during the finishing period (Pprofit.

  5. Compensatory motor control after stroke: an alternative joint strategy for object-dependent shaping of hand posture.

    Science.gov (United States)

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

    2010-06-01

    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

  6. Diagnostic accuracy of semi-automatic quantitative metrics as an alternative to expert reading of CT myocardial perfusion in the CORE320 study.

    Science.gov (United States)

    Ostovaneh, Mohammad R; Vavere, Andrea L; Mehra, Vishal C; Kofoed, Klaus F; Matheson, Matthew B; Arbab-Zadeh, Armin; Fujisawa, Yasuko; Schuijf, Joanne D; Rochitte, Carlos E; Scholte, Arthur J; Kitagawa, Kakuya; Dewey, Marc; Cox, Christopher; DiCarli, Marcelo F; George, Richard T; Lima, Joao A C

    2018-04-03

    To determine the diagnostic accuracy of semi-automatic quantitative metrics compared to expert reading for interpretation of computed tomography perfusion (CTP) imaging. The CORE320 multicenter diagnostic accuracy clinical study enrolled patients between 45 and 85 years of age who were clinically referred for invasive coronary angiography (ICA). Computed tomography angiography (CTA), CTP, single photon emission computed tomography (SPECT), and ICA images were interpreted manually in blinded core laboratories by two experienced readers. Additionally, eight quantitative CTP metrics as continuous values were computed semi-automatically from myocardial and blood attenuation and were combined using logistic regression to derive a final quantitative CTP metric score. For the reference standard, hemodynamically significant coronary artery disease (CAD) was defined as a quantitative ICA stenosis of 50% or greater and a corresponding perfusion defect by SPECT. Diagnostic accuracy was determined by area under the receiver operating characteristic curve (AUC). Of the total 377 included patients, 66% were male, median age was 62 (IQR: 56, 68) years, and 27% had prior myocardial infarction. In patient based analysis, the AUC (95% CI) for combined CTA-CTP expert reading and combined CTA-CTP semi-automatic quantitative metrics was 0.87(0.84-0.91) and 0.86 (0.83-0.9), respectively. In vessel based analyses the AUC's were 0.85 (0.82-0.88) and 0.84 (0.81-0.87), respectively. No significant difference in AUC was found between combined CTA-CTP expert reading and CTA-CTP semi-automatic quantitative metrics in patient based or vessel based analyses(p > 0.05 for all). Combined CTA-CTP semi-automatic quantitative metrics is as accurate as CTA-CTP expert reading to detect hemodynamically significant CAD. Copyright © 2018 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  7. Natural gas as an alternative to crude oil in automotive fuel chains well-to-wheel analysis and transition strategy development

    International Nuclear Information System (INIS)

    Hekkert, M.P.; Hendriks, F.H.J.F.; Faaij, A.P.C.; Neelis, M.L.

    2005-01-01

    Road transport produces significant amounts of CO 2 by using crude oil as primary energy source. A reduction of CO 2 emissions can be achieved by implementing alternative fuel chains. This article studies CO 2 emissions and energy efficiencies by means of a well to wheel analysis of alternative automotive fuel chains, using natural gas (NG) as an alternative primary energy source to replace crude oil. The results indicate that NG-based hydrogen applied in fuel cell vehicles (FCVs) lead to largest CO 2 emission reductions (up to 40% compared to current practice). However, large implementation barriers for this option are foreseen, both technically and in terms of network change. Two different transition strategies are discussed to gradually make the transition to these preferred fuel chains. Important transition technologies that are the backbone of these routes are traditional engine technology fuelled by compressed NG and a FCV fuelled by gasoline. The first is preferred in terms of carbon emissions. The results furthermore indicate that an innovation in the conventional chain, the diesel hybrid vehicle, is more efficient than many NG-based chains. This option scores well in terms of carbon emissions and implementation barriers and is a very strong option for the future

  8. Final programmatic environmental impact statement for alternative strategies for the long-term management and use of depleted uranium hexafluoride. Volume 3: Responses to public comments

    International Nuclear Information System (INIS)

    1999-04-01

    This PEIS assesses the potential impacts of alternative management strategies for depleted uranium hexafluoride (UF 6 ) currently stored at three DOE sites: Paducah site near Paducah, Kentucky, Portsmouth site near Portsmouth, Ohio; and K-25 site on the Oak Ridge Reservation, Oak Ridge, Tennessee. The alternatives analyzed in the PEIS include no action, long-term storage as UF 6 , long-term storage as uranium oxide, use as uranium oxide, use as uranium metal, and disposal. DOE's preferred alternative is to begin conversion of the depleted UF 6 inventory as soon as possible, either to uranium oxide, uranium metal, or a combination of both, while allowing for use of as much of this inventory as possible. This volume of the Final PEIS contains the comments and DOE's responses to comments received during the comment period. Chapter 2 contains photocopies of written submissions received by DOE on the Draft PEIS; DOE's responses to those comments are listed in Chapter 3. Chapter 4 provides the oral comments received at the public hearings and DOE's responses. Chapter 5 provides indices to comments and responses arranged by commentor name and by comment number

  9. Diagnostic strategies using physical examination are minimally useful in defining carpal tunnel syndrome in population-based research studies.

    Science.gov (United States)

    Descatha, A; Dale, A-M; Franzblau, A; Coomes, J; Evanoff, B

    2010-02-01

    We evaluated the utility of physical examination manoeuvres in the prediction of carpal tunnel syndrome (CTS) in a population-based research study. We studied a cohort of 1108 newly employed workers in several industries. Each worker completed a symptom questionnaire, a structured physical examination and nerve conduction study. For each hand, our CTS case definition required both median nerve conduction abnormality and symptoms classified as "classic" or "probable" on a hand diagram. We calculated the positive predictive values and likelihood ratios for physical examination manoeuvres in subjects with and without symptoms. The prevalence of CTS in our cohort was 1.2% for the right hand and 1.0% for the left hand. The likelihood ratios of a positive test for physical provocative tests ranged from 2.0 to 3.3, and those of a negative test from 0.3 to 0.9. The post-test probability of positive testing was study found that physical examination, alone or in combination with symptoms, was not predictive of CTS in a working population. We suggest using specific symptoms as a first-level screening tool, and nerve conduction study as a confirmatory test, as a case definition strategy in research settings.

  10. Comparison of dobutamine-stress magnetic resonance imaging and dipyridamole-Tl-201-SPECT as alternative strategies for the detection of coronary artery disease in patients not suitable for stress-echocardiography

    International Nuclear Information System (INIS)

    Schmidt, M.; Theissen, P.; Voth, E.; Schicha, H.; Jochims, M.; Baer, F.M.; Crnac, J.; Schneider, C.A.; Erdmann, E.

    2001-01-01

    Aim: During the past decade stress-echocardiography has gained increasing popularity for detection of myocardial ischemia in patients with coronary artery disease. However, about 10% to 15% of the patients submitted for stress-echocardiography do not have an adequate acoustic window. The purpose of this study was to compare high-dose dobutamine-stress magnetic resonance imaging (dobutamine-MRI) with dipyridamole-Tl-201-SPECT (dipyridamole-SPECT) as alternative strategies for detection of myocardial ischemia in patients with inadequate image quality by stress-echocardiography. Patients and Methods: Of 296 patients which were consecutively submitted to stress-echo-cardiography 45 patients (15%) had two or more segments that could not be evaluated according to the 16-segment-model of the American Society of Echocardiography. They underwent dobutamine-MRI and dipyridamole-SPECT studies, which were evaluated using a 28-segment modell. Myocardial segments were attributed to perfusion territories of the coronary arteries. The results of ischemia detection were compared to the results of coronary angiography (stenosis ≥50%). Results: In comparison to coronary angiography dobutamine-MRI yielded a sensitivity of 87%, a specificity of 86%, a positive predictive value of 93%, a negative predictive value of 75% and a diagnostic accuracy of 86%. For dipyridamole-SPECT results were 90%, 86%, 93%, 80% and 89%, respectively. These values were not significantly different. Conclusions: In patients not suitable for stress-echocardiography, both dobutamine-MRI and dipyridamole-SPECT are reliable strategies for detection of myocardial ischemia. Selection is dependent on the patient criteria, technical considerations, local logistics and experience of the observer. (orig.) [de

  11. The impact of spent fuel reprocessing facilities deployment rate on transuranics inventory in alternative fuel cycle strategies

    International Nuclear Information System (INIS)

    Aquien, A.; Kazimi, M.; Hejzlar, P.

    2007-01-01

    The depletion rate of transuranic inventories from spent fuel depends on both the deployment of advanced reactors that can be loaded with recycled transuranics, and on the deployment of the facilities that separate and reprocess spent fuel. In addition to tracking the mass allocation of TRU in the system and calculating a system cost, the fuel cycle simulation tool CAFCA includes a flexible recycling plant deployment model. This study analyses the impact of different recycling deployment schemes for various fuel cycle strategies in the US over the next hundred years under the assumption of a demand for nuclear energy growing at a rate of 2,4%. Recycling strategies explored in this study fall under two categories: recycling in thermal light water reactors using combined non-fertile and UO 2 fuel (CONFU) and recycling in fast reactors (either fertile-free actinide burner reactors, or self-sustaining gas-cooled fast reactors). Preliminary results show that the earlier deployment of recycling in the thermal reactors will limit the stored levels of TRU below those of fast reactors. However, the avoided accumulation of spent fuel interim storage depends on the deployment rate of the recycling facilities. In addition, by the end of the mid century, the TRU in cooling storage will exceed that in interim storage. (authors)

  12. Depression screening in stroke: a comparison of alternative measures with the structured diagnostic interview for the diagnostic and statistical manual of mental disorders, fourth edition (major depressive episode) as criterion standard.

    Science.gov (United States)

    Turner, Alyna; Hambridge, John; White, Jennifer; Carter, Gregory; Clover, Kerrie; Nelson, Louise; Hackett, Maree

    2012-04-01

    Screening tools for depression and psychological distress commonly used in medical settings have not been well validated in stroke populations. We aimed to determine the accuracy of common screening tools for depression or distress in detecting caseness for a major depressive episode compared with a clinician-administered structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders Fourth Edition as the gold standard. Seventy-two participants ≥3 weeks poststroke underwent a diagnostic interview for major depressive episode and completed the Patient Health Questionnaire-2 and -9, Hospital Anxiety and Depression Scale, Beck Depression Inventory-II, Distress Thermometer, and Kessler-10. Internal consistency, sensitivity, specificity, likelihood ratios, and posttest probabilities were calculated. Each measure was validated against the gold standard using receiver operating characteristic curves with comparison of the area under the curve for all measures. Internal consistency ranged from acceptable to excellent for all measures (Cronbach α=0.78-0.94). Areas under the curve (95% CI) for the Patient Health Questionnaire-2, Patient Health Questionnaire-9, Hospital Anxiety and Depression Scale depression and total score, Beck Depression Inventory-II, and Kessler-10 ranged from 0.80 (0.69-0.89) for the Kessler-10 to 0.89 (0.79-0.95) for the Beck Depression Inventory-II with no significant differences between measures. The Distress Thermometer had an area under the curve (95% CI) of 0.73 (0.61-0.83), significantly smaller than the Beck Depression Inventory-II (P<0.05). Apart from the Distress Thermometer, selected scales performed adequately in a stroke population with no significant difference between measures. The Patient Health Questionnaire-2 would be the most useful single screen given free availability and the shortest number of items.

  13. A one-year economic evaluation of six alternative strategies in the management of uninvestigated upper gastrointestinal symptoms in Canadian primary care.

    Science.gov (United States)

    Barkun, Alan N; Crott, Ralph; Fallone, Carlo A; Kennedy, Wendy A; Lachaine, Jean; Levinton, Carey; Armstrong, David; Chiba, Naoki; Thomson, Alan; Veldhuyzen van Zanten, Sander; Sinclair, Paul; Escobedo, Sergio; Chakraborty, Bijan; Smyth, Sandra; White, Robert; Kalra, Helen; Nevin, Krista

    2010-08-01

    The cost-effectiveness of initial strategies in managing Canadian patients with uninvestigated upper gastrointestinalsymptoms remains controversial. To assess the cost-effectiveness of six management approaches to uninvestigated upper gastrointestinal symptoms in the Canadian setting. The present study analyzed data from four randomized trials assessing homogeneous and complementary populations of Canadian patients with uninvestigated upper gastrointestinal symptoms with comparable outcomes. Symptom-free months, qualityadjusted life-years (QALYs) and direct costs in Canadian dollars of two management approaches based on the Canadian Dyspepsia Working Group (CanDys) Clinical Management Tool, and four additional strategies (two empirical antisecretory agents, and two prompt endoscopy) were examined and compared. Prevalence data, probabilities, utilities and costs were included in a Markov model, while sensitivity analysis used Monte Carlo simulations. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves were determined. Empirical omeprazole cost $226 per QALY ($49 per symptom-free month) per patient. CanDys omeprazole and endoscopy approaches were more effective than empirical omeprazole, but more costly. Alternatives using H2-receptor antagonists were less effective than those using a proton pump inhibitor. No significant differences were found for most incremental cost-effectiveness ratios. As willingness to pay (WTP) thresholds rose from $226 to $24,000 per QALY, empirical antisecretory approaches were less likely to be the most costeffective choice, with CanDys omeprazole progressively becoming a more likely option. For WTP values ranging from $24,000 to $70,000 per QALY, the most clinically relevant range, CanDys omeprazole was the most cost-effective strategy (32% to 46% of the time), with prompt endoscopy-proton pump inhibitor favoured at higher WTP values. Although no strategy was the indisputable cost effective option, Can

  14. Prevalence of gestational diabetes mellitus based on various screening strategies in western Kenya: a prospective comparison of point of care diagnostic methods.

    Science.gov (United States)

    Pastakia, Sonak D; Njuguna, Benson; Onyango, Beryl Ajwang'; Washington, Sierra; Christoffersen-Deb, Astrid; Kosgei, Wycliffe K; Saravanan, Ponnusamy

    2017-07-14

    Early diagnosis of gestational diabetes mellitus (GDM) is crucial to prevent short term delivery risks and long term effects such as cardiovascular and metabolic diseases in the mother and infant. Diagnosing GDM in Sub-Saharan Africa (SSA) however, remains sub-optimal due to associated logistical and cost barriers for resource-constrained populations. A cost-effective strategy to screen for GDM in such settings are therefore urgently required. We conducted this study to determine the prevalence of gestational diabetes mellitus (GDM) and assess utility of various GDM point of care (POC) screening strategies in a resource-constrained setting. Eligible women aged ≥18 years, and between 24 and 32 weeks of a singleton pregnancy, prospectively underwent testing over two days. On day 1, a POC 1-h 50 g glucose challenge test (GCT) and a POC glycated hemoglobin (HbA1c) was assessed. On day 2, fasting blood glucose, 1-h and 2-h 75 g oral glucose tolerance test (OGTT) were determined using both venous and POC tests, along with a venous HbA1c. The International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria was used to diagnose GDM. GDM prevalence was reported with 95% confidence interval (CI). Specificity, sensitivity, positive predictive value, and negative predictive value of the various POC testing strategies were determined using IADPSG testing as the standard reference. Six hundred-sixteen eligible women completed testing procedures. GDM was diagnosed in 18 women, a prevalence of 2.9% (95% CI, 1.57% - 4.23%). Compared to IADPSG testing, POC IADPSG had a sensitivity and specificity of 55.6% and 90.6% respectively while that of POC 1-h 50 g GCT (using a diagnostic cut-off of ≥7.2 mmol/L [129.6 mg/dL]) was 55.6% and 63.9%. All other POC tests assessed showed poor sensitivity. POC screening strategies though feasible, showed poor sensitivity for GDM detection in our resource-constrained population of low GDM prevalence. Studies to identify

  15. 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

    2014-08-01

    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.

  16. Alternative treatment strategies for neuropathic pain: Role of Indian medicinal plants and compounds of plant origin-A review.

    Science.gov (United States)

    Singh, Hasandeep; Bhushan, Sakshi; Arora, Rohit; Singh Buttar, Harpal; Arora, Saroj; Singh, Balbir

    2017-08-01

    Neuropathic pain is a complex, chronic pain state accompanied by tissue injury and nerve damage. This important health issue constitutes a challenge for the modern medicine worldwide. The management of neuropathic pain remains a major clinical challenge, pertaining to an inadequate understanding of pathophysiological mechanisms of neuropathic pain. Various classes of drugs have been reported effective for the management of neuropathic pain viz. opiates, tricyclic antidepressants, and antiepileptic agents. However, association of adverse effects with these drugs hinders their confident prescription in people with neuropathic pain. Recently, various medicinal plants have been reported effective for the management of neuropathic pain. So, it may be prudent to look beyond synthetic drugs pertaining to their unprecedented pharmacotherapeutic effects with lesser adverse effects. The extensive literature review has been carried out from databases such as Science direct, Scifinder, Wiley online library, PubMed, Research gate, Google scholar and Chemical Abstracts. The list of Traditional Indian Medicinal plants (TIMPs) and isolated compounds have been compiled which have been reported effective as an alternative therapy for the management of neuropathic pain. This helps the researchers to discover some novel therapeutic agents against neuropathic pain. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

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

    Science.gov (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

    2014-05-15

    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. Copyright © 2014 Elsevier B.V. All rights reserved.

  18. Modeling the fiscal costs and benefits of alternative treatment strategies in the United Kingdom for chronic hepatitis C.

    Science.gov (United States)

    Connolly, Mark P; Kotsopoulos, Nikos; Ustianowski, Andrew

    2018-01-01

    Hepatitis C (HCV) infection causes substantial direct health costs, but also impacts broader societal and governmental costs, such as tax revenue and social protection benefits. This study investigated the broader fiscal costs and benefits of curative interventions for chronic Hepatitis C (CHC) that allow individuals to avoid long-term HCV attributed health conditions. A prospective cohort model, assessing the long-term fiscal consequences of policy decisions, was developed for HCV infected individuals, following the generational accounting analytic framework that combines age-specific lifetime gross taxes paid and governmental transfers received (i.e. healthcare and social support costs). The analysis assessed the burden of a theoretical cohort of untreated HCV infected patients with the alternative of treating these patients with a highly efficacious curative intervention (ledipasvir/sofosbuvir [LDV/SOF]). It also compared treating patients at all fibrosis stages (Stages F0-F4) compared to late treatment (Stage F4). Based on projected lifetime work activity and taxes paid, the treated cohort paid an additional £5,900 per patient compared to the untreated cohort. Lifetime government disability costs of £97,555 and £125,359 per patient for treated cohort vs no treatment cohort were estimated, respectively. Lifetime direct healthcare costs in the treated cohort were £32,235, compared to non-treated cohort of £26,424, with an incremental healthcare costs increase of £5,901 per patient. The benefit cost ratio (BCR) of total government benefits and savings relative to government treatment costs (including LDV/SOF) ranged from 1.8-5.6. Treating patients early resulted in 77% less disability costs, 43% lower healthcare costs, and 33% higher tax revenue. The ability to cure Hepatitis C offers considerable fiscal benefits beyond direct medical costs and savings attributed to reduced disability costs, public allowances, and improved tax revenue. Changes in parameters

  19. Cost-effectiveness of alternate strategies for childhood immunization against meningococcal disease with monovalent and quadrivalent conjugate vaccines in Canada.

    Directory of Open Access Journals (Sweden)

    Thomas E Delea

    Full Text Available Public health programs to prevent invasive meningococcal disease (IMD with monovalent serogroup C meningococcal conjugate vaccine (MCV-C and quadrivalent meningococcal conjugate vaccines (MCV-4 in infancy and adolescence vary across Canadian provinces. This study evaluated the cost-effectiveness of various vaccination strategies against IMD using current and anticipated future pricing and recent epidemiology.A cohort model was developed to estimate the clinical burden and costs (CAN$2014 of IMD in the Canadian population over a 100-year time horizon for three strategies: (1 MCV-C in infants and adolescents (MCV-C/C; (2 MCV-C in infants and MCV-4 in adolescents (MCV-C/4; and (3 MCV-4 in infants (2 doses and adolescents (MCV-4/4. The source for IMD incidence was Canadian surveillance data. The effectiveness of MCV-C was based on published literature. The effectiveness of MCV-4 against all vaccination regimens was assumed to be the same as for MCV-C regimens against serogroup C. Herd effects were estimated by calibration to estimates reported in prior analyses. Costs were from published sources. Vaccines prices were projected to decline over time reflecting historical procurement trends.Over the modeling horizon there are a projected 11,438 IMD cases and 1,195 IMD deaths with MCV-C/C; expected total costs are $597.5 million. MCV-C/4 is projected to reduce cases of IMD by 1,826 (16% and IMD deaths by 161 (13%. Vaccination costs are increased by $32 million but direct and indirect IMD costs are projected to be reduced by $46 million. MCV-C/4 is therefore dominant vs. MCV-C/C in the base case. Cost-effectiveness of MCV-4/4 was $111,286 per QALY gained versus MCV-C/4 (2575/206 IMD cases/deaths prevented; incremental costs $68 million.If historical trends in Canadian vaccines prices continue, use of MCV-4 instead of MCV-C in adolescents may be cost-effective. From an economic perspective, switching to MCV-4 as the adolescent booster should be considered.

  20. Cost-effectiveness of alternate strategies for childhood immunization against meningococcal disease with monovalent and quadrivalent conjugate vaccines in Canada.

    Science.gov (United States)

    Delea, Thomas E; Weycker, Derek; Atwood, Mark; Neame, Dion; Alvarez, Fabián P; Forget, Evelyn; Langley, Joanne M; Chit, Ayman

    2017-01-01

    Public health programs to prevent invasive meningococcal disease (IMD) with monovalent serogroup C meningococcal conjugate vaccine (MCV-C) and quadrivalent meningococcal conjugate vaccines (MCV-4) in infancy and adolescence vary across Canadian provinces. This study evaluated the cost-effectiveness of various vaccination strategies against IMD using current and anticipated future pricing and recent epidemiology. A cohort model was developed to estimate the clinical burden and costs (CAN$2014) of IMD in the Canadian population over a 100-year time horizon for three strategies: (1) MCV-C in infants and adolescents (MCV-C/C); (2) MCV-C in infants and MCV-4 in adolescents (MCV-C/4); and (3) MCV-4 in infants (2 doses) and adolescents (MCV-4/4). The source for IMD incidence was Canadian surveillance data. The effectiveness of MCV-C was based on published literature. The effectiveness of MCV-4 against all vaccination regimens was assumed to be the same as for MCV-C regimens against serogroup C. Herd effects were estimated by calibration to estimates reported in prior analyses. Costs were from published sources. Vaccines prices were projected to decline over time reflecting historical procurement trends. Over the modeling horizon there are a projected 11,438 IMD cases and 1,195 IMD deaths with MCV-C/C; expected total costs are $597.5 million. MCV-C/4 is projected to reduce cases of IMD by 1,826 (16%) and IMD deaths by 161 (13%). Vaccination costs are increased by $32 million but direct and indirect IMD costs are projected to be reduced by $46 million. MCV-C/4 is therefore dominant vs. MCV-C/C in the base case. Cost-effectiveness of MCV-4/4 was $111,286 per QALY gained versus MCV-C/4 (2575/206 IMD cases/deaths prevented; incremental costs $68 million). If historical trends in Canadian vaccines prices continue, use of MCV-4 instead of MCV-C in adolescents may be cost-effective. From an economic perspective, switching to MCV-4 as the adolescent booster should be considered.

  1. Assessing the water quality response to an alternative sewage disposal strategy at bathing sites on the east coast of Ireland.

    Science.gov (United States)

    Bedri, Zeinab; O'Sullivan, John J; Deering, Louise A; Demeter, Katalin; Masterson, Bartholomew; Meijer, Wim G; O'Hare, Gregory

    2015-02-15

    A three-dimensional model is used to assess the bathing water quality of Bray and Killiney bathing sites in Ireland following changes to the sewage management system. The model, firstly calibrated to hydrodynamic and water quality data from the period prior to the upgrade of the Wastewater Treatment Works (WwTW), was then used to simulate Escherichia coli (E. coli) distributions for discharge scenarios of the periods prior to and following the upgrade of the WwTW under dry and wet weather conditions. E. coli distributions under dry weather conditions demonstrate that the upgrade in the WwTW has remarkably improved the bathing water quality to a Blue Flag status. The new discharge strategy is expected to drastically reduce the rainfall-related incidents in which environmental limits of the Bathing Water Directive are breached. However, exceedances to these limits may still occur under wet weather conditions at Bray bathing site due to storm overflows that may still be discharged through two sea outfalls offshore of Bray bathing site. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. An alternative option for "resect and discard" strategy, using magnifying narrow-band imaging: a prospective "proof-of-principle" study.

    Science.gov (United States)

    Takeuchi, Yoji; Hanafusa, Masao; Kanzaki, Hiromitsu; Ohta, Takashi; Hanaoka, Noboru; Yamamoto, Sachiko; Higashino, Koji; Tomita, Yasuhiko; Uedo, Noriya; Ishihara, Ryu; Iishi, Hiroyasu

    2015-10-01

    The "resect and discard" strategy is beneficial for cost savings on screening and surveillance colonoscopy, but it has the risk to discard lesions with advanced histology or small invasive cancer (small advanced lesion; SALs). The aim of this study was to prove the principle of new "resect and discard" strategy with consideration for SALs using magnifying narrow-band imaging (M-NBI). Patients undergoing colonoscopy at a tertiary center were involved in this prospective trial. For each detected polyp <10 mm, optical diagnosis (OD) and virtual management ("leave in situ", "discard" or "send for pathology") were independently made using non-magnifying NBI (N-NBI) and M-NBI, and next surveillance interval were predicted. Histological and optical diagnosis results of all polyps were compared. While the management could be decided in 82% of polyps smaller than 10 mm, 24/31 (77%) SALs including two small invasive cancers were not discarded based on OD using M-NBI. The sensitivity [90% confidence interval (CI)] of M-NBI for SALs was 0.77 (0.61-0.89). The risk for discarding SALs using N-NBI was significantly higher than that using M-NBI (53 vs. 23%, p = 0.02). The diagnostic accuracy (95% CI) of M-NBI in distinguishing neoplastic from non-neoplastic lesions [0.88 (0.86-0.90)] was significantly better than that of N-NBI [0.84 (0.82-0.87)] (p = 0.005). The results of our study indicated that our "resect and discard" strategy using M-NBI could work to reduce the risk for discarding SALs including small invasive cancer (UMIN-CTR, UMIN000003740).

  3. Lifetime attributable risk as an alternative to effective dose to describe the risk of cancer for patients in diagnostic and therapeutic nuclear medicine

    Science.gov (United States)

    Andersson, Martin; Eckerman, Keith; Mattsson, Sören

    2017-12-01

    The aim of this study is to implement lifetime attributable risk (LAR) predictions of cancer for patients of various age and gender, undergoing diagnostic investigations or treatments in nuclear medicine and to compare the outcome with a population risk estimate using effective dose and the International Commission on Radiological Protection risk coefficients. The radiation induced risk of cancer occurrence (incidence) or death from four nuclear medicine procedures are estimated for both male and female between 0 and 120 years. Estimations of cancer risk are performed using recommended administered activities for two diagnostic (18F-FDG and 99mTc-phosphonate complex) and two therapeutic (131I-iodide and 223Ra-dichloride) radiopharmaceuticals to illustrate the use of cancer risk estimations in nuclear medicine. For 18F-FDG, the cancer incidence for a male of 5, 25, 50 and 75 years at exposure is 0.0021, 0.0010, 0.0008 and 0.0003, respectively. For 99mTc phosphonates complex the corresponding values are 0.000 59, 0.000 34, 0.000 27 and 0.000 13, respectively. For an 131I-iodide treatment with 3.7 GBq and 1% uptake 24 h after administration, the cancer incidence for a male of 25, 50 and 75 years at exposure is 0.041, 0.029 and 0.012, respectively. For 223Ra-dichloride with an administration of 21.9 MBq the cancer incidence for a male of 25, 50 and 75 years is 0.31, 0.21 and 0.09, respectively. The LAR estimations are more suitable in health care situations involving individual patients or specific groups of patients than the health detriment based on effective dose, which represents a population average. The detriment consideration in effective dose adjusts the cancer incidence for suffering of non-lethal cancers while LAR predicts morbidity (incidence) or mortality (cancer). The advantages of these LARs are that they are gender and age specific, allowing risk estimations for specific patients or subgroups thus better representing individuals in health care

  4. Costs and outcomes associated with alternative discharge strategies following joint replacement surgery: analysis of an observational study using a propensity score.

    Science.gov (United States)

    Coyte, P C; Young, W; Croxford, R

    2000-11-01

    We estimated the impact of alternative discharge strategies, following joint replacement (JR) surgery, on acute care readmission rates and the total cost of a continuum of care. Following surgery, patients were discharged to one of four destinations. Propensity scores were used to adjust costs and outcomes for potential bias in the assignment of discharge destinations. We demonstrated that the use of rehabilitation hospitals may lower readmission rates, but at a prohibitive incremental cost of each saved readmission, that patients discharged with home care had longer acute care stays than other patients, that the provision of home care services increased health system costs, and that acute care readmission rates were greatest among patients discharged with home care. Our study should be seen as one important stepping stone towards a full economic evaluation of the continuum of care for patients.

  5. 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)

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

    2015-01-01

    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......) were organized in cooperatives raising slow-growing broilers in free-range systems. The third group was linked to a broiler company in the state of Sao Paulo producing antibiotic-free (AF) broilers in intensive systems. Individual assessments were performed through surveys with semi......-structured questions. Nutrient supply was heavily dependent on maize and soy. Free-range broilers were normally raised with access to outdoor areas in permanent paddocks with very little vegetation available. In the three sites, the finishing period of broilers was the production stage with higher feed supplementation....... 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...

  6. Diagnostic and therapeutic strategy in Menière's disease. Guidelines of the French Otorhinolaryngology-Head and Neck Surgery Society (SFORL).

    Science.gov (United States)

    Nevoux, J; Franco-Vidal, V; Bouccara, D; Parietti-Winkler, C; Uziel, A; Chays, A; Dubernard, X; Couloigner, V; Darrouzet, V; Mom, T

    2017-12-01

    The authors present the guidelines of the French Otorhinolaryngology-Head and Neck Surgery Society (Société française d'oto-rhino-laryngologie et de chirurgie de la face et du cou: SFORL) for diagnostic and therapeutic strategy in Menière's disease. A work group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, then read over by an editorial group independent of the work group. The guidelines were graded according to the literature analysis and recommendations grading guide published by the French National Agency for Accreditation and Evaluation in Health (January 2000). Menière's disease is diagnosed in the presence of the association of four classical clinical items and after eliminating differential diagnoses on MRI. In case of partial presentation, objective audiovestibular tests are recommended. Therapy comprises medical treatment and surgery, either conservative or sacrificing vestibular function. Medical treatment is based on lifestyle improvement, betahistine, diuretics or transtympanic injection of corticosteroids or gentamicin. The main surgical treatments, in order of increasing aggressiveness, are endolymphatic sac surgery, vestibular neurotomy and labyrinthectomy. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  7. A retrospective analysis of in vivo eye irritation, skin irritation and skin sensitisation studies with agrochemical formulations: Setting the scene for development of alternative strategies.

    Science.gov (United States)

    Corvaro, M; Gehen, S; Andrews, K; Chatfield, R; Macleod, F; Mehta, J

    2017-10-01

    Analysis of the prevalence of health effects in large scale databases is key in defining testing strategies within the context of Integrated Approaches on Testing and Assessment (IATA), and is relevant to drive policy changes in existing regulatory toxicology frameworks towards non-animal approaches. A retrospective analysis of existing results from in vivo skin irritation, eye irritation, and skin sensitisation studies on a database of 223 agrochemical formulations is herein published. For skin or eye effects, high prevalence of mild to non-irritant formulations (i.e. per GHS, CLP or EPA classification) would generally suggest a bottom-up approach. Severity of erythema or corneal opacity, for skinor eye effects respectively, were the key drivers for classification, consistent with existing literature. The reciprocal predictivity of skin versus eye irritation and the good negative predictivity of the GHS additivity calculation approach (>85%) provided valuable non-testing evidence for irritation endpoints. For dermal sensitisation, concordance on data from three different methods confirmed the high false negative rate for the Buehler method in this product class. These results have been reviewed together with existing literature on the use of in vitro alternatives for agrochemical formulations, to propose improvements to current regulatory strategies and to identify further research needs. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Nordic working group for medical x-ray diagnostics: Diagnostic reference levels within xray diagnostics - experiences in the Nordic countries

    International Nuclear Information System (INIS)

    Leitz, W.; Groen, P.; Servomaa, A.; Einarsson, G.; Olerud, H.

    2003-01-01

    Medical x-ray diagnostics is one of the few applications of ionising radiation where people are irradiated on purpose. The strategy for radiation protection is also different compared to that in other areas that have the zero-alternative as its ultimate goal, meaning that no human beings at all are exposed in these practices. The focus in x-ray diagnostics concerning radiation protection is justification and optimisation. Optimisation implies that the examination is performed in such a way that the radiation dose is as small as possible without jeopardising the diagnostic security. X- ray diagnostics is a complex method where many technical parameters and methodology factors together are interacting in the determination of radiation dose and image quality. The optimisation process is not a simple and uncomplicated procedure, this difficulty is reflected in many international and national surveys showing a large spread of patient doses for one and the same type of examination. The concept diagnostic reference levels (DRL) has been introduced as a tool for reducing this wide distribution that is obviously indicating a lack of optimisation, and for cutting the highest radiation doses. In this presentation the concept for DRL and the experience gained in the Nordic countries with DRL are described. (orig.)

  9. Unexpectedly high leprosy seroprevalence detected using a random surveillance strategy in midwestern Brazil: A comparison of ELISA and a rapid diagnostic test.

    Science.gov (United States)

    Frade, Marco Andrey C; de Paula, Natália A; Gomes, Ciro M; Vernal, Sebastian; Bernardes Filho, Fred; Lugão, Helena B; de Abreu, Marilda M M; Botini, Patrícia; Duthie, Malcolm S; Spencer, John S; Soares, Rosa Castália F R; Foss, Norma T

    2017-02-01

    Leprosy diagnosis is mainly based on clinical evaluation, although this approach is difficult, especially for untrained physicians. We conducted a temporary campaign to detect previously unknown leprosy cases in midwestern Brazil and to compare the performance of different serological tests. A mobile clinic was stationed at the main bus terminal in Brasília, Brazil. Volunteers were quizzed and given a clinical exam to allow categorization as either patients, known contacts of patients or non-contacts, and blood was collected to determine anti-PGL-I and anti-LID-1 antibody titers by ELISA and by the NDO-LID rapid test. New cases of leprosy and the impact of performing this broad random surveillance strategy were evaluated. Accuracy values and concordance between the test results were evaluated among all groups. Four hundred thirty-four individuals were evaluated, and 44 (10.1%) were diagnosed with leprosy. Borderline forms were the most frequent presentation. Both tests presented higher positivity in those individuals with multibacillary disease. Serological tests demonstrated specificities arround 70% for anti-PGL-1 and anti-LID ELISA; and arround 40% for NDO-LID. Sensitivities ranged from 48 to 62%. A substantial agreement between NDO-LID and ELISA with concomitant positive results was found within leprosy patients (Kappa index = 0.79 CI95% 0.36-1.22). The unexpectedly high leprosy prevalence in this population indicates ongoing community-based exposure to Mycobacterium leprae antigens and high rates of subclinical infection. All tests showed low specificity and sensitivity values and therefore cannot be considered for use as stand-alone diagnostics. Rather, considering their positivity among MB patients and non-patients, these tests can be considered effective tools for screening and identifying individuals at high risk who might benefit from regular monitoring.

  10. 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

    2016-08-01

    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.

  11. Korean Unification. Alternative Economics Strategies.

    Science.gov (United States)

    1995-09-01

    marketing the products, for example, panda toys for China. Samsung easily sold 10,000 pairs of jeans assembled in the north and planned to increase...goods were: Coffee 4.76 Chocolate 4.33 Men’s jeans 2.25 Pantyhose 5.28 Bedroom furniture 2.41 Kitchen range 2.09 Washing machine 3.16 Color...expensive for the ROK government.68 For other grain crops, e.g., corn, wheat, and millet , the south is a major importer and price levels can be expected to

  12. Investigating alternatives to the fish early-life stage test: a strategy for discovering and annotating adverse outcome pathways for early fish development.

    Science.gov (United States)

    Villeneuve, Daniel; Volz, David C; Embry, Michelle R; Ankley, Gerald T; Belanger, Scott E; Léonard, Marc; Schirmer, Kristin; Tanguay, Robert; Truong, Lisa; Wehmas, Leah

    2014-01-01

    The fish early-life stage (FELS) test (Organisation for Economic Co-operation and Development [OECD] test guideline 210) is the primary test used internationally to estimate chronic fish toxicity in support of ecological risk assessments and chemical management programs. As part of an ongoing effort to develop efficient and cost-effective alternatives to the FELS test, there is a need to identify and describe potential adverse outcome pathways (AOPs) relevant to FELS toxicity. To support this endeavor, the authors outline and illustrate an overall strategy for the discovery and annotation of FELS AOPs. Key events represented by major developmental landmarks were organized into a preliminary conceptual model of fish development. Using swim bladder inflation as an example, a weight-of-evidence-based approach was used to support linkage of key molecular initiating events to adverse phenotypic outcomes and reduced young-of-year survival. Based on an iterative approach, the feasibility of using key events as the foundation for expanding a network of plausible linkages and AOP knowledge was explored and, in the process, important knowledge gaps were identified. Given the scope and scale of the task, prioritization of AOP development was recommended and key research objectives were defined relative to factors such as current animal-use restrictions in the European Union and increased demands for fish toxicity data in chemical management programs globally. The example and strategy described are intended to guide collective efforts to define FELS-related AOPs and develop resource-efficient predictive assays that address the toxicological domain of the OECD 210 test. © 2013 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

  13. Exploring Alternative Radiolabeling Strategies for Sialic Acid-Binding Immunoglobulin-Like Lectin 9 Peptide: [68Ga]Ga- and [18F]AlF-NOTA-Siglec-9

    Directory of Open Access Journals (Sweden)

    Olli Moisio

    2018-01-01

    Full Text Available Amino acid residues 283–297 from sialic acid-binding immunoglobulin-like lectin 9 (Siglec-9 form a cyclic peptide ligand targeting vascular adhesion protein-1 (VAP-1. VAP-1 is associated with the transfer of leukocytes from blood to tissues upon inflammation. Therefore, analogs of Siglec-9 peptide are good candidates for visualizing inflammation non-invasively using positron emission tomography (PET. Gallium-68-labeled 1,4,7,10-tetraazacyclododecane-N,N′,N″,N‴-tetraacetic acid (DOTA-conjugated Siglec-9 has been evaluated extensively for this purpose. Here, we explored two alternative strategies for radiolabeling Siglec-9 peptide using a 1,4,7-triazacyclononane-triacetic acid (NOTA-chelator to bind [68Ga]Ga or [18F]AlF. The radioligands were evaluated by in vivo PET imaging and ex vivo γ-counting of turpentine-induced sterile skin/muscle inflammation in Sprague-Dawley rats. Both tracers showed clear accumulation in the inflamed tissues. The whole-body biodistribution patterns of the tracers were similar.

  14. 1968 Prototype Diagnostic Test.

    Science.gov (United States)

    Veterans Administration Hospital, Bedford, MA.

    This true-false diagnostic test was used for pretesting of employees at a Veterans Administration Hospital. The test is comprised of 20 items. An alternate test--Classification Questionnaire--was used for testing after remedial training. (For related document, see TM 002 334.) (DB)

  15. Effect of Different Alternate Irrigation Strategies using Saline and Non-Saline Water on Corn Yield, Salinity and Moisture Distribution in Soil Profile

    Directory of Open Access Journals (Sweden)

    Ali Reza Kiani

    2017-01-01

    Full Text Available Introduction: Lack of water and deterioration in the quality of soil and water resources are considered to be the prime cause of reduced crop yield in arid and semi-arid regions ‘More crop per drop’ by trickle irrigation, deficit irrigation, and uncommon water are the best strategies for mitigating water crises. Different irrigation management strategies are needed to increase production in different areas. In areas where sufficient water is available, a full irrigation strategy could be a suitable option, while in areas where water is limited, deficit irrigation would be an appropriate method, and finally in areas where water resources are saline, management strategies for achieving sustainable production as well as economic yields would be suitable. Maize is the third most important grain crop in the world following wheat and rice and it is the main source of nutrition for humans and animals. Because of the importance of maize in the world, increasing maize production under environmental stresses is a big challenge for agricultural scientists. Different methods of irrigation and the use of saline water that had satisfactory results for increasing agricultural production have been studied by several investigators . The main objective of this study was to establish an efficient use of limited water resources as well as to explore the possibility of replacing saline water with fresh water using different management techniques. Materials and Methods: A field experiment was conducted over two maize cropping seasons (2012–2013 in northern Iran (Gorgan Agricultural Research Station to compare different alternate irrigation scenarios using saline water on corn yield, salinity and soil moisture distribution in a randomized complete block design with three replications. Treatments were: T1 and T2 = 100 and 50 % of crop water requirement with non-saline water, respectively; T3 and T4 = variable and fixed full irrigation with saline and non

  16. Cost-effectiveness of alternative strategies for the initial medical management of non-ST elevation acute coronary syndrome: systematic review and decision-analytical modelling.

    Science.gov (United States)

    Robinson, M; Palmer, S; Sculpher, M; Philips, Z; Ginnelly, L; Bowens, A; Golder, S; Alfakih, K; Bakhai, A; Packham, C; Cooper, N; Abrams, K; Eastwood, A; Pearman, A; Flather, M; Gray, D; Hall, A

    2005-07-01

    To identify and prioritise key areas of clinical uncertainty regarding the medical management of non-ST elevation acute coronary syndrome (ACS) in current UK practice. Electronic databases. Consultations with clinical advisors. Postal survey of cardiologists. Potential areas of important uncertainty were identified and 'decision problems' prioritised. A systematic literature review was carried out using standard methods. The constructed decision model consisted of a short-term phase that applied the results of the systematic review and a long-term phase that included relevant information from a UK observational study to extrapolate estimated costs and effects. Sensitivity analyses were undertaken to examine the dependence of the results on baseline parameters, using alternative data sources. Expected value of information analysis was undertaken to estimate the expected value of perfect information associated with the decision problem. This provided an upper bound on the monetary value associated with additional research in the area. Seven current areas of clinical uncertainty (decision problems) in the drug treatment of unstable angina patients were identified. The agents concerned were clopidogrel, low molecular weight heparin, hirudin and intravenous glycoprotein antagonists (GPAs). Twelve published clinical guidelines for unstable angina or non-ST elevation ACS were identified, but few contained recommendations about the specified decision problems. The postal survey of clinicians showed that the greatest disagreement existed for the use of small molecule GPAs, and the greatest uncertainty existed for decisions relating to the use of abciximab (a large molecule GPA). Overall, decision problems concerning the GPA class of drugs were considered to be the highest priority for further study. Selected papers describing the clinical efficacy of treatment were divided into three groups, each representing an alternative strategy. The strategy involving the use of GPAs

  17. Alternative security

    International Nuclear Information System (INIS)

    Weston, B.H.

    1990-01-01

    This book contains the following chapters: The Military and Alternative Security: New Missions for Stable Conventional Security; Technology and Alternative Security: A Cherished Myth Expires; Law and Alternative Security: Toward a Just World Peace; Politics and Alternative Security: Toward a More Democratic, Therefore More Peaceful, World; Economics and Alternative Security: Toward a Peacekeeping International Economy; Psychology and Alternative Security: Needs, Perceptions, and Misperceptions; Religion and Alternative Security: A Prophetic Vision; and Toward Post-Nuclear Global Security: An Overview

  18. Diagnostic imaging of the hand

    Energy Technology Data Exchange (ETDEWEB)

    Schmitt, Rainer [Hospital for Cardiovascular Diseases, Bad Neustadt an der Saale (Germany). Dept. of Radiology; Lanz, Ulrich [Perlach Hospital, Munich (Germany). Dept. of Hand Surgery

    2008-07-01

    With its complex anatomy and specialized biomechanics, the human hand has always presented physicians with a unique challenge when it comes to diagnosing and treating the diseases that afflict it. And while recent decades have seen a rapid increase in the number of therapeutic options, many diseases and injuries of the hand are still commonly misinterpreted. In diagnostic imaging of the hand, an interdisciplinary team, comprisingspecialists in radiology, surgery, and rheumatology, presents a comprehensive,reliable guide to this topographically intricate area. Highlights include: - More than 1000 high-quality illustrations - All state-of-the-art imaging modalities-including multidetector CT, with 2D displays and 3D reconstructions, and contrast-enhanced MRI with multi-channel, phased-array coils - An overview of all currently used methods of examination - A detailed presentation of the anatomic and functional foundations necessary for diagnosis - Full coverage of all disorders of the hand - Systematic treatment of each disease's definition, pathogenesis, and clinical symptoms, according to a graduated diagnostic plan - Easy-to-use format, featuring crisp images and line drawings seamlessly integrated with concise text, summary tables, and handy checklists - A heavily cross-referenced appendix of differential diagnosis tables - Emphasis on interdisciplinary consultation throughout designed to help both radiologists and clinicians develop the most efficient and effective strategies for evaluating and treating patients, Diagnostic imaging of the hand will leave specialists of all levels with a fresh appreciation for - and a richer understanding of - the expanding array of cutting-edge alternatives for diagnosing and treating disorders of the hand. (orig.)

  19. Diagnostic imaging of the hand

    International Nuclear Information System (INIS)

    Schmitt, Rainer; Lanz, Ulrich

    2008-01-01

    With its complex anatomy and specialized biomechanics, the human hand has always presented physicians with a unique challenge when it comes to diagnosing and treating the diseases that afflict it. And while recent decades have seen a rapid increase in the number of therapeutic options, many diseases and injuries of the hand are still commonly misinterpreted. In diagnostic imaging of the hand, an interdisciplinary team, comprisingspecialists in radiology, surgery, and rheumatology, presents a comprehensive,reliable guide to this topographically intricate area. Highlights include: - More than 1000 high-quality illustrations - All state-of-the-art imaging modalities-including multidetector CT, with 2D displays and 3D reconstructions, and contrast-enhanced MRI with multi-channel, phased-array coils - An overview of all currently used methods of examination - A detailed presentation of the anatomic and functional foundations necessary for diagnosis - Full coverage of all disorders of the hand - Systematic treatment of each disease's definition, pathogenesis, and clinical symptoms, according to a graduated diagnostic plan - Easy-to-use format, featuring crisp images and line drawings seamlessly integrated with concise text, summary tables, and handy checklists - A heavily cross-referenced appendix of differential diagnosis tables - Emphasis on interdisciplinary consultation throughout designed to help both radiologists and clinicians develop the most efficient and effective strategies for evaluating and treating patients, Diagnostic imaging of the hand will leave specialists of all levels with a fresh appreciation for - and a richer understanding of - the expanding array of cutting-edge alternatives for diagnosing and treating disorders of the hand. (orig.)

  20. Alternative additives; Alternative additiver

    Energy Technology Data Exchange (ETDEWEB)

    2007-08-15

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

  1. 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

    2001-03-01

    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

  2. Economic evaluation of diagnostic localization following biochemical prostate cancer recurrence.

    Science.gov (United States)

    Barocas, Daniel A; Bensink, Mark E; Berry, Kristin; Musa, Zahra; Bodnar, Carolyn; Dann, Robert; Ramsey, Scott D

    2014-10-01

    The aim of this study was to assess potential cost-effectiveness of using a prostate cancer specific functional imaging technology capable of identifying residual localized disease versus small volume metastatic disease for asymptomatic men with low but detectable prostate specific antigen (PSA) elevation following radical prostatectomy. Markov modeling was used to estimate the incremental impact on healthcare system costs (2012 USD) and quality-adjusted life-years (QALYs) of two alternative strategies: (i) using the new diagnostic to guide therapy versus (ii) current usual care-using a combination of computed tomography, magnetic resonance imaging, and bone scan to guide therapy. Costs were based on estimates from literature and Medicare reimbursement. Prostate cancer progression, survival, utilities, and background risk of all-cause mortality were obtained from literature. Base-case diagnostic sensitivity (75 percent), specificity (90 percent), and cost (USD 2,500) were provided by our industry partner GE Healthcare. The new diagnostic strategy provided an average gain of 1.83 (95 percent uncertainty interval [UI]: 1.24-2.64) QALYs with added costs of USD 15,595 (95 percent UI: USD -6,330-44,402) over 35 years. The resulting incremental cost-effectiveness ratio was USD 8,516/QALY (95 percent UI: USD -2,947-22,372). RESULTS were most influenced by the utility discounting rate and test performance characteristics; however, the new diagnostic provided clinical benefits over a wide range of sensitivity and specificity. This analysis suggests a diagnostic technology capable of identifying whether men with biochemical recurrence after radical prostatectomy have localized versus metastatic disease would be a cost-effective alternative to current standard work-up. The results support additional investment in development and validation of such a diagnostic.

  3. 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

    2009-01-01

    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.

  4. Molecular Diagnostics

    OpenAIRE

    Choe, Hyonmin; Deirmengian, Carl A.; Hickok, Noreen J.; Morrison, Tiffany N.; Tuan, Rocky S.

    2015-01-01

    Orthopaedic infections are complex conditions that require immediate diagnosis and accurate identification of the causative organisms to facilitate appropriate management. Conventional methodologies for diagnosis of these infections sometimes lack accuracy or sufficient rapidity. Current molecular diagnostics are an emerging area of bench-to-bedside research in orthopaedic infections. Examples of promising molecular diagnostics include measurement of a specific biomarker in the synovial fluid...

  5. An Analysis of Alternatives for Reducing Outpatient Military Health Care Costs for Active Duty Members and their Families: Implementing a Recommended Savings Strategy Using Defense Acquisition Principles

    National Research Council Canada - National Science Library

    Jaime, Richardo; Rupert, Joshua W

    2007-01-01

    .... In efforts to reduce or contain the costs of the military health care system, this project will propose two cost savings alternatives for providing outpatient care to active duty personnel and their dependents...

  6. A multi-species modelling approach to examine the impact of alternative climate change adaptation strategies on range shifting ability in a fragmented landscape

    OpenAIRE

    Synes, Nicholas W.; Watts, Kevin; Palmer, Stephen C.F.; Bocedi, Greta; Bartoń, Kamil A.; Osborne, Patrick E.; Travis, Justin M.J.

    2015-01-01

    An individual-based model of animal dispersal and population dynamics was used to test the effects of different climate change adaptation strategies on species range shifting ability, namely the improvement of existing habitat, restoration of low quality habitat and creation of new habitat. These strategies were implemented on a landscape typical of fragmentation in the United Kingdom using spatial rules to differentiate between the allocation of strategies adjacent to or away from existing h...

  7. Molecular diagnostics in endodontics

    OpenAIRE

    Rechenberg, Dan-Krister; Zehnder, Matthias

    2014-01-01

    Recent systematic reviews have substantiated the fact that current testing methods to assess the inflammatory state of the pulp and the periapical tissues are of limited value. Consequently, it may be time to search for alternative routes in endodontic diagnostics. Molecular assessment methods could be the future. However, in the field of endodontics, the research in that direction is only about to evolve. Because pulpal and periradicular diseases are related to opportunistic infections, diag...

  8. Companion diagnostics

    DEFF Research Database (Denmark)

    Jørgensen, Jan Trøst; Hersom, Maria

    2016-01-01

    of disease mechanisms, things are slowly changing. Within the last few years, we have seen an increasing number of predictive biomarker assays being developed to guide the use of targeted cancer drugs. This type of assay is called companion diagnostics and is developed in parallel to the drug using the drug-diagnostic...... co-development model. The development of companion diagnostics is a relatively new discipline and in this review, different aspects will be discussed including clinical and regulatory issues. Furthermore, examples of drugs, such as the ALK and PD-1/PD-L1 inhibitors, that have been approved recently....... Despite having discussed personalized medicine for more than a decade, we still see that most drug prescriptions for severe chronic diseases are largely based on 'trial and error' and not on solid biomarker data. However, with the advance of molecular diagnostics and a subsequent increased understanding...

  9. Alternative Strategies to Achieve Cardiovascular Mortality Goals in China and India: A Microsimulation of Target- Versus Risk-Based Blood Pressure Treatment.

    Science.gov (United States)

    Basu, Sanjay; Yudkin, John S; Sussman, Jeremy B; Millett, Christopher; Hayward, Rodney A

    2016-03-01

    The World Health Organization aims to reduce mortality from chronic diseases including cardiovascular disease (CVD) by 25% by 2025. High blood pressure is a leading CVD risk factor. We sought to compare 3 strategies for treating blood pressure in China and India: a treat-to-target (TTT) strategy emphasizing lowering blood pressure to a target, a benefit-based tailored treatment (BTT) strategy emphasizing lowering CVD risk, or a hybrid strategy currently recommended by the World Health Organization. We developed a microsimulation model of adults aged 30 to 70 years in China and in India to compare the 2 treatment approaches across a 10-year policy-planning horizon. In the model, a BTT strategy treating adults with a 10-year CVD event risk of ≥ 10% used similar financial resources but averted ≈ 5 million more disability-adjusted life-years in both China and India than a TTT approach based on current US guidelines. The hybrid strategy in the current World Health Organization guidelines produced no substantial benefits over TTT. BTT was more cost-effective at $205 to $272/disability-adjusted life-year averted, which was $142 to $182 less per disability-adjusted life-year than TTT or hybrid strategies. The comparative effectiveness of BTT was robust to uncertainties in CVD risk estimation and to variations in the age range analyzed, the BTT treatment threshold, or rates of treatment access, adherence, or concurrent statin therapy. In model-based analyses, a simple BTT strategy was more effective and cost-effective than TTT or hybrid strategies in reducing mortality. © 2016 American Heart Association, Inc.

  10. Alternative Remedies

    Science.gov (United States)

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

  11. Alternative Fuels

    Science.gov (United States)

    Alternative fuels include gaseous fuels such as hydrogen, natural gas, and propane; alcohols such as ethanol, methanol, and butanol; vegetable and waste-derived oils; and electricity. Overview of alternative fuels is here.

  12. Alternating Hemiplegia

    Science.gov (United States)

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

  13. Chasing down the triple-negative myeloproliferative neoplasms: Implications for molecular diagnostics.

    Science.gov (United States)

    Langabeer, Stephen E

    2016-01-01

    The majority of patients with classical myeloproliferative neoplasms (MPN) of polycythemia vera, essential thrombocythemia, and primary myelofibrosis harbor distinct disease-driving mutations within the JAK2 , CALR , or MPL genes. The term triple-negative has been recently applied to those MPN without evidence of these consistent mutations, prompting whole or targeted exome sequencing approaches to determine the driver mutational status of this subgroup. These strategies have identified numerous novel mutations that occur in alternative exons of both JAK2 and MPL , the majority of which result in functional activation. Current molecular diagnostic approaches may possess insufficient coverage to detect these alternative mutations, prompting further consideration of targeted exon sequencing into routine diagnostic practice. How to incorporate these illuminating findings into the expanding molecular diagnostic algorithm for MPN requires continual attention.

  14. Travel demand management : a toolbox of strategies to reduce single\\0x2010occupant vehicle trips and increase alternate mode usage in Arizona.

    Science.gov (United States)

    2012-02-01

    The report provides a suite of recommended strategies to reduce single-occupant vehicle traffic in the urban : areas of Phoenix and Tucson, Arizona, which are presented as a travel demand management toolbox. The : toolbox includes supporting research...

  15. Metabolomics for laboratory diagnostics.

    Science.gov (United States)

    Bujak, Renata; Struck-Lewicka, Wiktoria; Markuszewski, Michał J; Kaliszan, Roman

    2015-09-10

    Metabolomics is an emerging approach in a systems biology field. Due to continuous development in advanced analytical techniques and in bioinformatics, metabolomics has been extensively applied as a novel, holistic diagnostic tool in clinical and biomedical studies. Metabolome's measurement, as a chemical reflection of a current phenotype of a particular biological system, is nowadays frequently implemented to understand pathophysiological processes involved in disease progression as well as to search for new diagnostic or prognostic biomarkers of various organism's disorders. In this review, we discussed the research strategies and analytical platforms commonly applied in the metabolomics studies. The applications of the metabolomics in laboratory diagnostics in the last 5 years were also reviewed according to the type of biological sample used in the metabolome's analysis. We also discussed some limitations and further improvements which should be considered taking in mind potential applications of metabolomic research and practice. Copyright © 2014 Elsevier B.V. All rights reserved.

  16. Cognitive aspect of diagnostic errors.

    Science.gov (United States)

    Phua, Dong Haur; Tan, Nigel C K

    2013-01-01

    Diagnostic errors can result in tangible harm to patients. Despite our advances in medicine, the mental processes required to make a diagnosis exhibits shortcomings, causing diagnostic errors. Cognitive factors are found to be an important cause of diagnostic errors. With new understanding from psychology and social sciences, clinical medicine is now beginning to appreciate that our clinical reasoning can take the form of analytical reasoning or heuristics. Different factors like cognitive biases and affective influences can also impel unwary clinicians to make diagnostic errors. Various strategies have been proposed to reduce the effect of cognitive biases and affective influences when clinicians make diagnoses; however evidence for the efficacy of these methods is still sparse. This paper aims to introduce the reader to the cognitive aspect of diagnostic errors, in the hope that clinicians can use this knowledge to improve diagnostic accuracy and patient outcomes.

  17. An AOP-based alternative testing strategy to predict the impact of thyroid hormone disruption on swim bladder inflation in zebrafish (poster)

    Science.gov (United States)

    Within the field of chemical safety assessment, there is a desire to replace costly whole organism testing with more efficient and cost-effective alternatives based on in vitro test systems. Disruption of thyroid hormone signaling via inhibition of enzymes called deiodinases is o...

  18. An AOP-based alternative testing strategy to predict the impact of thyroid hormone disruption on swim bladder inflation in zebrafish

    Science.gov (United States)

    Within the field of chemical safety assessment, there is a desire to replace costly whole organism testing with more efficient and cost-effective alternatives based on in vitro test systems. Disruption of thyroid hormone signaling via inhibition of enzymes called deiodinases is o...

  19. Alternative Pre-mRNA Splicing in Mammals and Teleost Fish: A Effective Strategy for the Regulation of Immune Responses Against Pathogen Infection.

    Science.gov (United States)

    Chang, Ming Xian; Zhang, Jie

    2017-07-15

    Pre-mRNA splicing is the process by which introns are removed and the protein coding elements assembled into mature mRNAs. Alternative pre-mRNA splicing provides an important source of transcriptome and proteome complexity through selectively joining different coding elements to form mRNAs, which encode proteins with similar or distinct functions. In mammals, previous studies have shown the role of alternative splicing in regulating the function of the immune system, especially in the regulation of T-cell activation and function. As lower vertebrates, teleost fish mainly rely on a large family of pattern recognition receptors (PRRs) to recognize pathogen-associated molecular patterns (PAMPs) from various invading pathogens. In this review, we summarize recent advances in our understanding of alternative splicing of piscine PRRs including peptidoglycan recognition proteins (PGRPs), nucleotide binding and oligomerization domain (NOD)-like receptors (NLRs), retinoic acid-inducible gene-I (RIG-I)-like receptors (RLRs) and their downstream signaling molecules, compared to splicing in mammals. We also discuss what is known and unknown about the function of splicing isoforms in the innate immune responses against pathogens infection in mammals and teleost fish. Finally, we highlight the consequences of alternative splicing in the innate immune system and give our view of important directions for future studies.

  20. Alternatives to the Fish Early Life-Stage Test: A Research Strategy for Discovering and Annotating Adverse Outcome Pathways During Fish Development

    Science.gov (United States)

    The OECD 210 fish early life]stage (FELS) test is the primary guideline test used to estimate chronic fish toxicity, as well as support ecological risk assessments and chemical management programs around the world. As a step toward developing alternatives to the FELS test, a HES...

  1. Plasma Diagnostics

    Energy Technology Data Exchange (ETDEWEB)

    Zaveryaev, V [Kurchatov Institute, Moscow (Russian Federation); others, and

    2012-09-15

    The success in achieving peaceful fusion power depends on the ability to control a high temperature plasma, which is an object with unique properties, possibly the most complicated object created by humans. Over years of fusion research a new branch of science has been created, namely plasma diagnostics, which involves knowledge of almost all fields of physics, from electromagnetism to nuclear physics, and up-to-date progress in engineering and technology (materials, electronics, mathematical methods of data treatment). Historically, work on controlled fusion started with pulsed systems and accordingly the methods of plasma parameter measurement were first developed for short lived and dense plasmas. Magnetically confined hot plasmas require the creation of special experimental techniques for diagnostics. The diagnostic set is the most scientifically intensive part of a plasma device. During many years of research operation some scientific tasks have been solved while new ones arose. New tasks often require significant changes in the diagnostic system, which is thus a very flexible part of plasma machines. Diagnostic systems are designed to solve several tasks. As an example here are the diagnostic tasks for the International Thermonuclear Experimental Reactor - ITER: (1) Measurements for machine protection and basic control; (2) Measurements for advanced control; (3) Additional measurements for performance evaluation and physics. Every new plasma machine is a further step along the path to the main goal - controlled fusion - and nobody knows in advance what new phenomena will be met on the way. So in the planning of diagnostic construction we should keep in mind further system upgrading to meet possible new scientific and technical challenges. (author)

  2. Molecular Diagnostics of ?-Thalassemia

    OpenAIRE

    Atanasovska, B; Bozhinovski, G; Chakalova, L; Kocheva, S; Karanfilski, O; Plaseska-Karanfiska, D

    2012-01-01

    A high-quality hemoglobinopathy diagnosis is based on the results of a number of tests including assays for molecular identification of causative mutations. We describe the current diagnostic strategy for the identification of ?-thalassemias and hemoglobin (Hb) variants at the International Reference Laboratory for Haemoglobinopathies, Research Centre for Genetic Engineering and Biotechnology (RCGEB) ?Georgi D. Efremov,? Skopje, Republic of Macedonia. Our overall approach and most of the meth...

  3. Diagnostic development

    International Nuclear Information System (INIS)

    Barnett, C.F.; Brisson, D.A.; Greco, S.E.

    1978-01-01

    During the past year the far-infrared or submillimeter diagnostic research program resulted in three major developments: (1) an optically pumped 0.385-μm D 2 O-laser oscillator-amplifier system was operated at a power level of 1 MW with a line width of less than 50 MHz; (2) a conical Pyrex submillimeter laser beam dump with a retention efficiency greater than 10 4 was developed for the ion temperature Thompson scattering experiment; and (3) a new diagnostic technique was developed that makes use of the Faraday rotation of a modulated submillimeter laser beam to determine plasma current profile. Measurements of the asymmetric distortion of the H/sub α/ (6563 A) spectral line profile show that the effective toroidal drift velocity, dv/sub two vertical bars i/dT/sub i/, may be used as an indicator of plasma quality and as a complement to other ion temperature diagnostics

  4. Alternative routes to the leader male role in a multi-level society: follower vs. solitary male strategies and outcomes in hamadryas baboons.

    Science.gov (United States)

    Pines, Mathew; Saunders, Julian; Swedell, Larissa

    2011-07-01

    The nested one-male units (OMUs) of the hamadryas baboon are part of a complex social system in which "leader" males achieve near exclusive mating access by forcibly herding females into permanent consortships. Within this multi-level social system (troops, bands, clans and OMUs) are two types of prereproductive males--the follower and solitary male--whose different trajectories converge on the leader role. Here we compare OMU formation strategies of followers, who associate with a particular OMU and may have social access to females, with those of solitary males, who move freely within the band and do not associate regularly with OMUs. Data were derived from 42 OMU formations (16 by followers and 26 by solitary males) occurring over 8 years in a hamadryas baboon band at the Filoha site in Ethiopia. "Initial units" (IUs) with sexually immature females (IU strategy) were formed by 44% of followers and 46% of solitary males. The remaining followers took over mature females when their leader was deposed (challenge strategy) or disappeared (opportunistic strategy), or via a seemingly peaceful transfer (inheritance strategy). Solitary males took over mature females from other clans and bands, but mainly from old, injured or vanished leaders within their clan (via both the challenge and opportunistic strategies). Former followers of an OMU were more successful at taking over females from those OMUs than any other category of male. Despite this advantage enjoyed by ex-follower leaders, ex-solitary leaders were equally capable of increasing their OMU size at a comparable rate in their first 2 years as a leader. These results demonstrate the potential for males to employ both multiple roles (follower vs. solitary male) and multiple routes (IU, inheritance, challenge, opportunistic) to acquire females and become a leader male in a mating system characterized by female defense polygyny in a competitive arena. © 2011 Wiley-Liss, Inc.

  5. Diagnostic dilemma

    DEFF Research Database (Denmark)

    Feldt-Rasmussen, Ulla; Dobrovolny, Robert; Nazarenko, Irina

    2011-01-01

    Fabry disease, an X-linked lysosomal storage disorder, results from the deficient activity of a-galactosidase A (a-Gal A). In affected males, the clinical diagnosis is confirmed by the markedly decreased a-Gal A activity. However, in female heterozygotes, the a-Gal A activity can range from low t...... on enzyme replacement therapy. Thus, gene dosage analyses can detect large deletions (>50bp) in suspect heterozygotes for X-linked and autosomal dominant diseases that are "sequencing cryptic," resolving molecular diagnostic dilemmas....... to normal due to random X-chromosomal inactivation, and diagnostic confirmation requires identification of the family's a-Gal A gene mutation. In a young female who had occasional acroparesthesias, corneal opacities, and 15 to 50% of the lower limit of normal leukocyte a-Gal A activity, a-Gal A sequencing...... in two expert laboratories did not identify a confirmatory mutation, presenting a diagnostic dilemma. A renal biopsy proved diagnostic and renewed efforts to detect an a-Gal A mutation. Subsequent gene dosage analyses identified a large a-Gal A deletion confirming her heterozygosity, and she was started...

  6. A distributed computational search strategy for the identification of diagnostics targets: application to finding aptamer targets for methicillin-resistant staphylococci.

    Science.gov (United States)

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

    2014-06-30

    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.

  7. Screening, early detection, education, and trends for melanoma: current status (2007-2013) and future directions: Part I. Epidemiology, high-risk groups, clinical strategies, and diagnostic technology.

    Science.gov (United States)

    Mayer, Jonathan E; Swetter, Susan M; Fu, Teresa; Geller, Alan C

    2014-10-01

    While most cancers have shown both decreased incidence and mortality over the past several decades, the incidence of melanoma has continued to grow, and mortality has only recently stabilized in the United States and in many other countries. Certain populations, such as men >60 years of age and lower socioeconomic status groups, face a greater burden from disease. For any given stage and across all ages, men have shown worse melanoma survival than women, and low socioeconomic status groups have increased levels of mortality. Novel risk factors can help identify populations at greatest risk for melanoma and can aid in targeted early detection. Risk assessment tools have been created to identify high-risk patients based on various factors, and these tools can reduce the number of patients needed to screen for melanoma detection. Diagnostic techniques, such as dermatoscopy and total body photography, and new technologies, such as multispectral imaging, may increase the accuracy and reliability of early melanoma detection. Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  8. A distributed computational search strategy for the identification of diagnostics targets: Application to finding aptamer targets for methicillin-resistant staphylococci

    Directory of Open Access Journals (Sweden)

    Flanagan Keith

    2014-06-01

    Full Text Available 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.

  9. The marketing strategies of electricity and natural gas providers in France. Which perspectives for alternate operators in front of EDF and GDF Suez?

    International Nuclear Information System (INIS)

    2012-10-01

    This article presents the content of a market study which aimed at gathering and analysing figures regarding electricity and natural gas (production, consumption, tariffs, gross prices, etc.), at assessing the market shares of the main providers and their commercial position, at understanding the impact of the Nome law and of the gas price problematic on providers and consumers, and at assessing the capacity of alternate operators to challenge the positions held by EDF and GDF Suez. Besides EDF and GDF Suez, the following providers are analysed: Alpiq, Electricite de Strasbourg, Enel France, ENI, E.ON France, Gas Natural Fenosa, Poweo Direct Energie, Soregies, Tegaz

  10. Alternative wastewatersystems

    DEFF Research Database (Denmark)

    Dyck-Madsen, Søren; Hoffmann, Birgitte; Gabriel, Søren

    1999-01-01

    The report:-  Communicates experiences from Swedish buildings from the establishment and running of alternative wastewater systems. Communicates pictures of alternative buildings and wastewater systems in Sweden. Gives a short evaluation of the performance and the sustainability of the systems....

  11. The alternative Pharaoh approach: stingless bees mummify beetle parasites alive

    Science.gov (United States)

    Greco, Mark K.; Hoffmann, Dorothee; Dollin, Anne; Duncan, Michael; Spooner-Hart, Robert; Neumann, Peter

    2010-03-01

    Workers from social insect colonies use different defence strategies to combat invaders. Nevertheless, some parasitic species are able to bypass colony defences. In particular, some beetle nest invaders cannot be killed or removed by workers of social bees, thus creating the need for alternative social defence strategies to ensure colony survival. Here we show, using diagnostic radioentomology, that stingless bee workers ( Trigona carbonaria) immediately mummify invading adult small hive beetles ( Aethina tumida) alive by coating them with a mixture of resin, wax and mud, thereby preventing severe damage to the colony. In sharp contrast to the responses of honeybee and bumblebee colonies, the rapid live mummification strategy of T. carbonaria effectively prevents beetle advancements and removes their ability to reproduce. The convergent evolution of mummification in stingless bees and encapsulation in honeybees is another striking example of co-evolution between insect societies and their parasites.

  12. 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.

    Science.gov (United States)

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

    2016-01-01

    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

  13. Secondary influences and ectopic causes of canine hip dysplasia. Critical constructive thoughts to hip dysplasia diagnostics and to current breeding strategies

    International Nuclear Information System (INIS)

    Schawalder, P.; Spreng, D.; Dietschi, E.; Dolf, G.; Gaillard, C.

    1996-01-01

    This article questions the stagnation of breeding results by hip dysplasia screening and its current etiology. The ''Coxa Valga Antetorta'', anteversion of the hip joint and ''soft tissue displasia'' are discussed besides a multitude of primary diseases leading to growth deformities and other diseases in the hip. Ectopic primary causes like malformation of the spine leading to a secondary ''dysplatic'' osteoarthritis of the hip (functional secondary dysplasia) are also discussed in this article. Recent and very promising breeding strategies (estimation of the breeding value) in the battle against hip dysplasia are presented. Biochemical, immunological and structural aspects are presented as a not totally utopic perspecitive. Molecular genetic markers for hip dysplasia will offer in the near future a possibility to detect carriers ct the disease by a blood sample ion before clinical manifestation

  14. Creutzfeldt-Jakob Disease as a Cause of Cognitive Decline and Seizures in the Elderly: Diagnostic Pointers and Strategy for Investigation

    Directory of Open Access Journals (Sweden)

    R. Williams

    2011-01-01

    Full Text Available Cognitive decline affects one in twenty people over the age of 65. There is often a paucity of clues as to the underlying pathology, and while the diagnosis will usually prove to be either Alzheimer’s disease or vascular dementia, there may be clinical features suggesting rarer alternatives. This case of a 71-year-old lady with a 3-month history of progressive cognitive decline illustrates clinical features suggestive of Creutzfeltd-Jakob disease such as rapid decline in conscious level and myoclonic jerking. Diagnosis was confirmed by 3 means: (1 Electroencephalogram demonstrating periodic sharp wave complexes, (2 MRI brain showing cortical ribboning and high signal in the caudate nucleus, and (3 presence of protein S100 and protein14-3-3 in the cerebrospinal fluid. Postmortem brain histology confirmed a typical spongiform encephalopathy. Establishing an underlying aetiology is dementia is important not only for prognostic reasons but in order to detect potentially reversible causes. In cases of an atypical dementing illness our proposed investigations may assist in confirming or excluding underlying Creutzfeltd-Jakob disease.

  15. [Diagnostic laparoscopy in acute abdomen].

    Science.gov (United States)

    Keller, R; Kleemann, M; Hildebrand, P; Roblick, U J; Bruch, H-P

    2006-11-01

    Acute abdomen is not a disease in itself but a description of a complex of symptoms combined with severe abdominal pain developed within a time frame of less than 24 h. All strategies for the management of acute abdomen underline the need for an interdisciplinary approach to diagnosis and therapy. This requires focused and intelligent use of efficient diagnostic procedures. Diagnostic laparoscopy may be a key to solving the diagnostic dilemma of unspecific acute abdomen. Furthermore, it allows not only direct inspection of the abdominal cavity but also surgical intervention, if needed. In particular the rate of negative laparotomies can be reduced.

  16. How alternative are alternative fuels?

    OpenAIRE

    Soffritti, Tiziana; Danielis, Romeo

    1998-01-01

    Could alternative fuel vehicles contribute to a substantial reduction of air pollution? Is there a market for alternative fuel vehicles? Could a market be created via a pollution tax? The article answers these questions on the basis of the available estimates.

  17. Alternative detox.

    Science.gov (United States)

    Ernst, E

    2012-01-01

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

  18. Microfluidic technology for molecular diagnostics.

    Science.gov (United States)

    Robinson, Tom; Dittrich, Petra S

    2013-01-01

    Molecular diagnostics have helped to improve the lives of millions of patients worldwide by allowing clinicians to diagnose patients earlier as well as providing better ongoing therapies. Point-of-care (POC) testing can bring these laboratory-based techniques to the patient in a home setting or to remote settings in the developing world. However, despite substantial progress in the field, there still remain many challenges. Progress in molecular diagnostics has benefitted greatly from microfluidic technology. This chapter aims to summarise the more recent advances in microfluidic-based molecular diagnostics. Sections include an introduction to microfluidic technology, the challenges of molecular diagnostics, how microfluidic advances are working to solve these issues, some alternative design approaches, and detection within these systems.

  19. US Strategy for Cyberspace

    National Research Council Canada - National Science Library

    Veazie, Arnold

    2003-01-01

    .... This strategic research paper analyzes the President's National Strategy to Secure Cyberspace to determine whether it effectively provides solutions for securing cyberspace. It concludes by proposing an alternative strategy for securing cyberspace.

  20. 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

    2016-08-01

    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

  1. Alternative affinity tools: more attractive than antibodies?

    NARCIS (Netherlands)

    Ruigrok, V.J.B.; Levisson, M.; Eppink, M.H.M.; Smidt, H.; Oost, van der J.

    2011-01-01

    Antibodies are the most successful affinity tools used today, in both fundamental and applied research (diagnostics, purification and therapeutics). Nonetheless, antibodies do have their limitations, including high production costs and low stability. Alternative affinity tools based on nucleic acids

  2. FEL components and diagnostics

    International Nuclear Information System (INIS)

    Carr, R.

    1997-01-01

    FEL hardware includes undulators, alignment systems, electron beam diagnostics, and mechanical and vacuum systems. While most FEL close-quote s employ conventional undulators, there is some interest in novel types, particularly where conventional designs cannot be used, as at very short periods and high fields. For these areas, superconducting technology is indicated. The most serious issue facing long FEL undulators is that of alignment; mechanical techniques may not be accurate enough, and beam-based strategies must be considered. To maintain alignment and control the electron trajectory, beam position monitors with micron precision are required. Beam size monitors are also required to assure control of emittance. The talks given in the working group sessions touch on undulators, alignment, and electron beam diagnostics, and they are summarized here. copyright 1997 American Institute of Physics

  3. 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

    2009-01-01

    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....

  4. 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).

    Science.gov (United States)

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

    2013-01-30

    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. Copyright © 2012 Elsevier B.V. All rights reserved.

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

    Science.gov (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

    2015-10-19

    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? 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. Study protocols have been reviewed and approved by the ethics committees of the Kenya Medical Research Institute and National Ethics Review Committee, and London School of Hygiene and Tropical Medicine. The study has a

  6. 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

    2012-07-01

    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

  7. Newer diagnostic approaches to intestinal protozoa.

    Science.gov (United States)

    van Lieshout, Lisette; Verweij, Jaco J

    2010-10-01

    To update the reader on the latest developments in the laboratory diagnosis of intestinal protozoa. Correct identification of a diarrhoea causing pathogens is essential for the choice of treatment in an individual patient as well as to map the aetiology of diarrhoea in a variety of patient populations. Classical diagnosis of diarrhoea causing protozoa by microscopic examination of a stool sample lacks both sensitivity and specificity. Alternative diagnostic platforms are discussed. Recent literature on the diagnosis of intestinal protozoa has focused mainly on nucleic acid-based assays, in particular the specific detection of parasite DNA in stool samples using real-time PCR. In addition, the trend has been moving from single pathogen detection to a multiplex approach, allowing simultaneous identification of multiple parasites. Different combinations of targets can be used within a routine diagnostic setting, depending on the patient population, such as children, immunocompromised individuals and those who have been travelling to tropical regions. Large-scale monitoring and evaluation of control strategies become feasible due to automation and high-throughput facilities. Improved technology also has become available for differentiating protozoa subspecies, which facilitates outbreak investigations and extensive research in molecular epidemiology.

  8. 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

    1985-03-01

    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.

  9. Thyroid diagnostics

    International Nuclear Information System (INIS)

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

    1985-01-01

    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. (orig./MG) [de

  10. Ambient diagnostics

    CERN Document Server

    Cai, Yang

    2014-01-01

    Part I. FundamentalsIntroductionWhat is Ambient Diagnostics?Diagnostic ModelsMultimedia IntelligenceCrowd SourcingSoft SensorsScience of SimplicityPersonal DiagnosesBasic AlgorithmsBasic ToolsSummaryProblemsTransformationEarly Discoveries of Heartbeat PatternsTransforms, Features, and AttributesSequential FeaturesSpatiotemporal FeaturesShape FeaturesImagery FeaturesFrequency Domain FeaturesMulti-Resolution FeaturesSummaryProblemsPattern RecognitionSimilarities and DistancesClustering MethodsClassification MethodsClassifier Accuracy MeasuresSummaryProblemsPart II. Multimedia IntelligenceSound RecognitionMicrophone AppsModern Acoustic Transducers (Microphones)Frequency Response CharacteristicsDigital Audio File FormatsHeart Sound SensingLung Sound SensingSnore MeterSpectrogram (STFT)Ambient Sound AnalysisSound RecognitionRecognizing Asthma SoundPeak ShiftFeature CompressionRegroupingNoise IssuesFuture ApplicationsSummaryProblemsColor SensorsColor SensingHuman Color VisionColor SensorsColor Matching ExperimentsC...

  11. Economic feasibility of hydrogen enrichment for reducing NOx emissions from landfill gas power generation alternatives: A comparison of the levelized cost of electricity with present strategies

    International Nuclear Information System (INIS)

    Kornbluth, Kurt; Greenwood, Jason; Jordan, Eddie; McCaffrey, Zach; Erickson, Paul A.

    2012-01-01

    Based on recent research showing that hydrogen enrichment can lower NO x emissions from landfill gas combustion below future NO x emission control standards imposed by both federal and California state regulations, an investigation was performed to compare the levelized cost of electricity of this technology with other options. In this cost study, a lean-burn reciprocating engine with no after-treatment was the baseline case to compare six other landfill gas-to-energy projects. These cases include a lean burn engine with selective catalytic reduction after treatment, a lean-burn microturbine, and four variations on an ultra-lean-burn engine utilizing hydrogen enrichment with each case using a different method of hydrogen production. Only hydrogen enrichment with an in-stream autothermal fuel reformer was shown to be potentially cost-competitive with current strategies for reaching the NO x reduction target in IC engines. - Highlights: ► Levelized cost of electricity for hydrogen enriched combustion was compared. ► Various ultra-lean-burn engines and microturbines with hydrogen were analyzed. ► Combustion with an autothermal fuel reformer was potentially cost-competitive.

  12. Strategy Development in Organisations

    DEFF Research Database (Denmark)

    Sørensen, Lene

    1999-01-01

    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......" 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....

  13. Evaluation of alternative planting strategies to reduce wheat stem sawfly (Hymenoptera: Cephidae) damage to spring wheat in the northern Great Plains.

    Science.gov (United States)

    Beres, B L; Cárcamo, H A; Bremer, E

    2009-12-01

    Wheat, Triticum aestivum L., producers are often reluctant to use solid-stemmed wheat cultivars resistant to wheat stem sawfly, Cephus cinctus Norton (Hymenoptera: Cephidae), due to concerns regarding yield, efficacy or market opportunities. We evaluated the impact of several planting strategies on wheat yield and quality and wheat stem sawfly infestation at two locations over a three-year period. Experimental units consisted of large plots (50 by 200 m) located on commercial farms adjacent to wheat stem sawfly-infested fields. Compared with a monoculture of a hollow-stemmed cultivar ('AC Barrie'), planting a monoculture of a solid-stemmed cultivar ('AC Eatonia') increased yield by an average of 16% (0.4 mg ha(-1)) and increased the grade of wheat by one unit at the two most heavily infested site-years. Planting a 1:1 blend of AC Eatonia and AC Barrie increased yield by an average of 11%, whereas planting 20- or 40-m plot margins to AC Eatonia increased yield by an average of 8%. High wheat stem sawfly pressure limited the effectiveness of using resistant cultivars in field margins because plants were often infested beyond the plot margin, with uniform infestation down the length of the plots at the two most heavily infested site-years. The effectiveness of AC Eatonia to reduce wheat stem sawfly survivorship was modest in this study, probably due to weather-related factors influencing pith expression and to the high abundance of wheat stem sawfly. Greater benefits from planting field margins to resistant cultivars or planting a blend of resistant and susceptible cultivars might be achievable under lower wheat stem sawfly pressure.