WorldWideScience

Sample records for alternative treatment strategies

  1. 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...

  2. 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.

  3. 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.

  4. Alternative Menopause Treatments

    Science.gov (United States)

    ... menopausal symptoms. These include estrogen—still the most effective treatment for many menopausal symptoms—non-estrogen prescription drugs, and complementary and alternative medicine (CAM). What is CAM? CAM refers to practices ...

  5. 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...

  6. Nitrogen Control Through Decentralized Wastewater Treatment: Process Performance and Alternative Management Strategies

    Science.gov (United States)

    Decentralized or onsite wastewater treatment (OWT) systems have long been implicated in being a major source of N inputs to surface and ground waters and numerous regulatory bodies have promulgated strict total N (TN) effluent standards in N-sensitive areas. These standards, howe...

  7. An Alternative Treatment Strategy for Complicated Chronic Wounds: Negative Pressure Therapy over Mesh Skin Graft

    Directory of Open Access Journals (Sweden)

    Michele Maruccia

    2017-01-01

    Full Text Available Extensive skin defect represents a real problem and major challenge in plastic and reconstructive surgery. On one hand, skin grafts offer a practical method to deal with skin defects despite their unsuitability for several complicated wounds. On the other hand, negative pressure wound therapy (NPWT, applied before skin grafting, promotes granulation tissue growth. The aim of the study is to evaluate the improvement in wound healing given by the merger of these two different approaches. We treated 23 patients for large wounds of multiple factors. Of these, 15 were treated with the application of V.A.C.® Therapy (KCI Medical S.r.l., Milan, Italy, in combination with skin grafts after a prior unsuccessful treatment of 4 weeks with mesh skin grafts and dressings. Another 8 were treated with only mesh skin graft. Pain reduction and wound area reduction were found statistically significant (p<0.0009, p<0.0001. Infection was resolved in almost all patients. According to our study, the use of the negative pressure wound therapy over mesh skin grafts is significantly effective especially in wounds resistant to conventional therapies, thereby improving the rate of skin graft take.

  8. 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.

  9. 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

  10. Alternative Cancer Treatments: 10 Options to Consider

    Science.gov (United States)

    Alternative cancer treatments: 10 options to consider Alternative cancer treatments can't cure your cancer, but they may provide some ... that may help them, including complementary and alternative cancer treatments. If cancer makes you feel as if you ...

  11. 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.

  12. Boundaries matter: Greenhouse gas emission reductions from alternative waste treatment strategies for California’s municipal solid waste

    DEFF Research Database (Denmark)

    Vergara, Sintana E.; Damgaard, Anders; Horvathc, Arpad

    2011-01-01

    How waste is managed – whether as a nuisance to be disposed of, or as a resource to be reused – directly affects local and global environmental quality. This analysis explores the GHG benefits of five treatment options for residual municipal solid waste (MSW) in California: Business As Usual...... landfills. Using two different waste LCA models, EASEWASTE (a Danish model) and WARM (a U.S. model), we find that improved biogenic waste management through anaerobic digestion and waste reduction can lead to life-cycle GHG savings when compared to Business As Usual. The magnitude of the benefits depends...... strongly on a number of model assumptions: the type of electricity displaced by waste-derived energy, how biogenic carbon is counted as a contributor to atmospheric carbon stocks, and the landfill gas collection rate. Assuming that natural gas is displaced by waste-derived energy, that 64% of landfill gas...

  13. 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

  14. 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…

  15. 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 ...

  16. 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

  17. 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

  18. 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.

  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 treatment methods in ENT].

    Science.gov (United States)

    Friese, K H

    1997-08-01

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

  4. Testimony on Drug Treatment Alternatives to Incarceration

    National Research Council Canada - National Science Library

    Iguchi, Martin

    2000-01-01

    ... treatment within the criminal justice system. Players in that policy game focused, as we are doing today, on the need to provide criminal offenders with drug abuse treatment as an alternative to incarceration...

  5. Use of alternative treatment in pediatric oncology

    NARCIS (Netherlands)

    Grootenhuis, M. A.; Last, B. F.; de Graaf-Nijkerk, J. H.; van der Wel, M.

    1998-01-01

    The use of alternative treatment along with conventional cancer therapy is very popular. However, little is known about the use of alternative treatment in pediatric oncology. A study to determine which medical and demographic characteristics distinguish users from nonusers was conducted in a

  6. Necessary alternatives: patients’ views of asthma treatment

    Directory of Open Access Journals (Sweden)

    Helen Kopnina

    2010-06-01

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

  7. 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...

  8. 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

  9. Treatment strategies in mastocytosis

    DEFF Research Database (Denmark)

    Siebenhaar, Frank; Akin, Cem; Bindslev-Jensen, Carsten

    2014-01-01

    Treatment recommendations for mastocytosis are based mostly on expert opinion rather than evidence obtained from controlled clinical trials. In this article, treatment options for mastocytosis are presented, with a focus on the control of mediator-related symptoms in patients with indolent disease....

  10. 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)

  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. Alternative methods of ophthalmic treatment in Russia.

    Science.gov (United States)

    Vader, L

    1994-04-01

    Russian ophthalmic nurses and physicians are using alternative methods of treatment to supplement traditional eye care. As acupuncture and iridology become more popular in the United States, ophthalmic nurses need to be more knowledgeable about these treatments and the implications for patients.

  13. Treatment strategies for acromegaly

    NARCIS (Netherlands)

    Roelfsema, Ferdinand; Biermasz, Nienke R.; Romijn, Johannes A.; Pereira, Alberto M.

    2005-01-01

    Acromegaly is a chronic debilitating disorder caused by a growth hormone (GH)-producing pituitary adenoma. Active acromegaly is associated with a two- to fourfold increased mortality risk, mainly from cardiovascular disease. Transsphenoidal surgery is considered as the treatment of choice because of

  14. Newer antiatherosclerosis treatment strategies.

    Science.gov (United States)

    Aggarwal, Amitesh; Singh, Safal

    2011-01-01

    Atherosclerosis has been a target of much clinical and molecular research. As a result of this extensive research, it is amply clear that atherogenesis is a multifactorial process involving an interplay of metabolic, immune and inflammatory mechanisms. Antiatherosclerotic strategies are today aiming for a multipronged approach targeting each arm of this multifactorial process. The newer agents under development can be divided into three broad categories: anti-inflammatory agents, modulators of intermediary metabolism and antiatherosclerosis vaccines. Potential targets for anti-inflammatory agents include inhibition of conversion of low-density lipoprotein (LDL) to oxidised LDL, blocking or downregulation of cell adhesion molecules, chemokine modulation and macrophage receptor blockade. Beyond inhibition of plaque formation, efforts are also ongoing to develop agents which stabilise the plaque by increasing its fibrous content and inhibiting its disruption. So far as research in the sphere of intermediary metabolism is concerned, the focus is now primarily on raising high-density lipoprotein and promoting reverse cholesterol transport; potential targets include cholesteryl ester transfer protein, liver X-receptor, lecithin cholesterol acyltransferase and high-density lipoprotein mimetics. Acyl-coenzymeA: cholesterol acyltransferase is another enzyme whose selective and differential inhibition is under active investigation. The concept of immunisation against a non-communicable disease such as atherosclerosis is still in its nascent stages. However, with increasing evidence to suggest the role of antigen-specific T-cell-mediated immunity in atherogenesis, this approach is potentially promising. Possible antigens under evaluation include oxidised LDL and its subparticles, heat-shock proteins and cholesteryl ester transfer protein. With cardiovascular disease being the single leading cause of death worldwide, the development of a safe and successful antiatherosclerosis

  15. Obesity Treatment Strategies

    Directory of Open Access Journals (Sweden)

    Simona Ianosi Edith

    2015-12-01

    Full Text Available Obesity is a disease with severe health consequences and increased risk of mortality. The most commonly used criteria to assess the presence and the severity of obesity are body mass index, waist circumference, waist-to-height ratio and the presence of the health conditions caused or worsened by obesity. Worldwide obesity has more than doubled in the last 4 decades. Obesity is the second of the leading preventable causes of death worldwide (after smoking. Obesity has a plurifactorial pathogenesis. The central perturbation consists in the imbalance between calories intake and calories consumption (by inappropriate diet and sedentary lifestyle. Identification of all the ethiological factors is important for treatment and prophylaxis. Weight loss benefits are multiple and important: improvement in glicemic control and in plasma lipid levels, blood presure control, obstructiv sleep apneea reduction, improvement in management of daily activities and profesional performances, increase quality of life, reduction in mortality. Overweight or obese patient will complete a diagnostic and a treatment program. Treatment of obesity claims a targeted multidimensional therapy: weight and lifestyle management, diet, sustained physical activity in daily life, exercise, decrease life stressors, smoking cessation, drug therapy, bariatric surgery psichological, familial and social suport. Weight loss program must be carefully planned, adapted to the patient’s abilities and comorbidities and supervised by a nutritionist and a physiotherapist.

  16. Treatment strategies for transuranic wastes

    International Nuclear Information System (INIS)

    Schneider, K.J.; Swanson, J.L.; Ross, W.A.; Allen, R.P.; Yasutake, K.M.

    1986-01-01

    This paper presents an analysis of treatment options or strategies for transuranic wastes expected to be generated at a commercial nuclear fuel reprocessing plant. Six potential options were analyzed, ranging from no treatment to maximum volume reduction and high quality waste forms. Economics for the total management of these (treatment, transportation, disposal) indicate life-cycle savings for extensive treatment are as high as $1.7 billion for 70,000 MTU. Evaluations of the waste processing and waste forms support the selection of a number of the extensive waste treatments. It is concluded that there are significant incentives for extensive treatment of transuranic wastes

  17. Treatment strategies for transuranic wastes

    International Nuclear Information System (INIS)

    Schneider, K.J.; Ross, W.A.; Swanson, J.L.; Allen, R.P.; Yasutake, K.M.

    1986-01-01

    This paper presents an analysis of treatment options or strategies for transuranic wastes expected to be generated at a commercial nuclear fuel reprocessing plant. Six potential options were analyzed, ranging from no treatment to maximum volume reduction and high quality waste forms. Economics for the total management of these wastes (treatment, transportation, disposal) indicate life-cycle savings for extensive treatment are as high as $1.7 billion for 70,000 MTU. Evaluations of the waste processing and waste forms support the selection of a number of the extensive waste treatments. It is concluded that there are significant incentives for extensive treatment of transuranic wastes

  18. 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.

  19. Bacteriocins: exploring alternatives to antibiotics in mastitis treatment

    Directory of Open Access Journals (Sweden)

    Reneé Pieterse

    2010-10-01

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

  20. Bacteriocins - exploring alternatives to antibiotics in mastitis treatment.

    Science.gov (United States)

    Pieterse, Reneé; Todorov, Svetoslav D

    2010-07-01

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

  1. Bacteriocins – Exploring Alternatives to Antibiotics in Mastitis Treatment

    Science.gov (United States)

    Pieterse, Reneé; Todorov, Svetoslav D.

    2010-01-01

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

  2. Treatment Strategies for Chronic Cases

    Directory of Open Access Journals (Sweden)

    Susan M Lord

    2003-01-01

    Full Text Available The treatment of chronic somatic pain, including pain referred to the head, neck, shoulder girdle and upper limb from somatic structures, is addressed. Levels of evidence for the various treatments that have been prescribed for chronic whiplash associated disorders are considered. The challenge to find a treatment strategy for chronic pain after whiplash that completely relieves the condition and prevents its sequelae is reviewed.

  3. 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

  4. 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.

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

    Science.gov (United States)

    Foxman, Betsy; Buxton, Miatta

    2013-04-01

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

  6. Noninvasive treatment alternative for intractable startle epilepsy

    Directory of Open Access Journals (Sweden)

    Sylvia Klinkenberg

    2014-01-01

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

  7. Treatment Strategies in Childhood Craniopharyngioma

    Directory of Open Access Journals (Sweden)

    Stephanie ePuget

    2012-06-01

    Full Text Available The surgical management of craniopharyngioma in children has been one of the most controversial topics in pediatric neurosurgery. In theory, based on its benign histology total surgical excision could provide a cure. However, the therapeutic goals for pediatric craniopharyngioma are not only the cure of the disease but also the preservation of function. It has been widely established that in some particular cases total excision could leads to inacceptable damages, especially those linked to hypothalamic functions. During the last 15 years, we observed worldwide a growing advocacy for less-invasive pediatric craniopharyngioma resection supported by international consensus conferences. The state-of-the-art in the surgical management of some craniopharyngioma is now turning to multi-modality treatment strategies (combination surgery and radiotherapy aiming to limit morbidiy. Recent literature and our own experience helped to develop risk-adapted treatment strategies at initial diagnosis, respecting hypothalamic structures to provide optimal quality of life for these children. Following new algorithms of treatment, preliminary results with intention to spare the hypothalamus seem to be encouraging but the long-term clinical outcome in terms of post irradiation complications and relapse management is currently unknown.

  8. Treatment Alternatives to Negotiate Peri-Implantitis

    Directory of Open Access Journals (Sweden)

    Eli E. Machtei

    2014-01-01

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

  9. 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…

  10. 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.

  11. 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

  12. 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…

  13. 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...

  14. Complementary and alternative treatment of musculoskeletal pain.

    Science.gov (United States)

    Grazio, Simeon; Balen, Diana

    2011-12-01

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

  15. Treatment alternatives for non-fuel-bearing hardware

    International Nuclear Information System (INIS)

    Ross, W.A.; Clark, L.L.; Oma, K.H.

    1987-01-01

    This evaluation compared four alternatives for the treatment or processing of non-fuel bearing hardware (NFBH) to reduce its volume and prepare it for disposal. These treatment alternatives are: shredding; shredding and low pressure compaction; shredding and supercompaction; and melting. These alternatives are compared on the basis of system costs, waste form characteristics, and process considerations. The study recommends that melting and supercompaction alternatives be further considered and that additional testing be conducted for these two alternatives

  16. 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

  17. Alternative treatment of symptomatic pancreatic fistula.

    Science.gov (United States)

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

    2015-06-01

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

  18. 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

  19. 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.

  20. 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 ...

  1. 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.

  2. Lawsonia inermis - an alternative treatment for hyperthyroidism?

    Science.gov (United States)

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

    2014-01-01

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

  3. 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.

  4. 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...

  5. [Oligometastasized colorectal cancer-modern treatment strategies].

    Science.gov (United States)

    Binnebösel, M; Lambertz, A; Dejong, K; Neumann, U P

    2018-06-05

    The prognosis of colorectal cancer in UICC stage IV has been improved in the last decades by improvements in interdisciplinary treatment. Treatment strategies for oligometastasized colorectal cancer are developing more and more into an individualized treatment. An overview of the current literature of modern treatment concepts in oligometastasized colorectal cancer UICC stage IV is given. Surgery still has the supreme mandate in resectable colorectal liver metastases, as neoadjuvant and adjuvant treatment strategies to not provide any benefits for these patients. In marginal or non-resectable stages systemic treatment is superior in these patients depending on the prognostic parameters. Also in curative settings local treatment options should be considered as a reasonable additive tool. An interesting treatment approach for isolated liver metastases and non-resectable colorectal cancer is liver transplantation. Irrespective of new developments in treatment strategies for metastasized colorectal cancer, resection of colorectal liver metastases remains the gold standard whenever possible.

  6. 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

  7. Diabetes Prevention and Treatment Strategies

    OpenAIRE

    Backholer, Kathryn; Peeters, Anna; Herman, William H.; Shaw, Jonathan E.; Liew, Danny; Ademi, Zanfina; Magliano, Dianna J.

    2013-01-01

    OBJECTIVE Effective interventions to prevent, delay, or remit diabetes are currently available. However, their impact on the prevalence of diabetes at the population level is unknown. This study aimed to estimate the impact of a range of diabetes interventions on the population prevalence of diabetes for Australian adults between 2010 and 2025. RESEARCH DESIGN AND METHODS We used the Australian Diabetes Projection Model to estimate the impact of a population-wide strategy, high-risk preventio...

  8. 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.

  9. 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)

  10. Irradiation as an alternative post harvest treatment

    Energy Technology Data Exchange (ETDEWEB)

    Satin, M. [Agricultural Industries and Post-harvest Management Service, FAO, Rome (Italy); Loaharanu, P. [Head, Food Preservation Section, Joint FAO/ IAEA Division of Nuclear Techniques in Food and Agriculture, Wagramerstr. 5, A-1400, Vienna (Austria)

    1997-12-31

    This current world population has significantly added to the pressures placed upon our finite resources and our resulting ability to feed ourselves. In order to cope with current and future demands, the two established lines of action, that is, reduced population growth and expansion of agricultural production, must be supplemented with the parallel activity of reducing food losses during and after harvest. For developing countries in particular, enormous post-harvest losses result from spillage, contamination, pests and physiological deterioration during storage. Studies in these countries indicate that post-harvest losses are enormous and amount to tens of millions of tons per year valued at billions of dollars. Programs to reduce post-harvest losses, if applied properly, can result in realistic yield increases between 10 and 30%, which can be directly converted into increased consumption for humans. Post-harvest losses vary greatly and are a function of the crop variety, pest combinations in the environment, climate, the system of harvesting, storage, handling, marketing, and even the social and cultural environment. Pests are among the most criticals of these factors. Because of the disastrous potential consequences of such pests, quarantine regulations prohibit the entrance of plants or products which might hide the unwanted pest from countries where it is known to exist. Quarantine treatments are can be chemical, physical or ionizing radiation treatment. Numerous investigations on the use of ionizing radiation for the disinfestation of fresh plant materials indicate that rather low dosages will control fruit-fly problems, thus making it well suited for quarantine treatment. The effectiveness of the irradiation as a broad spectrum quarantine treatment of fresh fruits and vegetables was recognized by the several plant protection organizations around the world. Currently, some 40 countries have approved one or more irradiated food items or groups of food

  11. Irradiation as an alternative post harvest treatment

    Energy Technology Data Exchange (ETDEWEB)

    Satin, M [Agricultural Industries and Post-harvest Management Service, FAO, Rome (Italy); Loaharanu, P [Head, Food Preservation Section, Joint FAO/ IAEA Division of Nuclear Techniques in Food and Agriculture, Wagramerstr. 5, A-1400, Vienna (Austria)

    1998-12-31

    This current world population has significantly added to the pressures placed upon our finite resources and our resulting ability to feed ourselves. In order to cope with current and future demands, the two established lines of action, that is, reduced population growth and expansion of agricultural production, must be supplemented with the parallel activity of reducing food losses during and after harvest. For developing countries in particular, enormous post-harvest losses result from spillage, contamination, pests and physiological deterioration during storage. Studies in these countries indicate that post-harvest losses are enormous and amount to tens of millions of tons per year valued at billions of dollars. Programs to reduce post-harvest losses, if applied properly, can result in realistic yield increases between 10 and 30%, which can be directly converted into increased consumption for humans. Post-harvest losses vary greatly and are a function of the crop variety, pest combinations in the environment, climate, the system of harvesting, storage, handling, marketing, and even the social and cultural environment. Pests are among the most criticals of these factors. Because of the disastrous potential consequences of such pests, quarantine regulations prohibit the entrance of plants or products which might hide the unwanted pest from countries where it is known to exist. Quarantine treatments are can be chemical, physical or ionizing radiation treatment. Numerous investigations on the use of ionizing radiation for the disinfestation of fresh plant materials indicate that rather low dosages will control fruit-fly problems, thus making it well suited for quarantine treatment. The effectiveness of the irradiation as a broad spectrum quarantine treatment of fresh fruits and vegetables was recognized by the several plant protection organizations around the world. Currently, some 40 countries have approved one or more irradiated food items or groups of food

  12. Irradiation as an alternative post harvest treatment

    International Nuclear Information System (INIS)

    Satin, M.; Loaharanu, P.

    1997-01-01

    This current world population has significantly added to the pressures placed upon our finite resources and our resulting ability to feed ourselves. In order to cope with current and future demands, the two established lines of action, that is, reduced population growth and expansion of agricultural production, must be supplemented with the parallel activity of reducing food losses during and after harvest. For developing countries in particular, enormous post-harvest losses result from spillage, contamination, pests and physiological deterioration during storage. Studies in these countries indicate that post-harvest losses are enormous and amount to tens of millions of tons per year valued at billions of dollars. Programs to reduce post-harvest losses, if applied properly, can result in realistic yield increases between 10 and 30%, which can be directly converted into increased consumption for humans. Post-harvest losses vary greatly and are a function of the crop variety, pest combinations in the environment, climate, the system of harvesting, storage, handling, marketing, and even the social and cultural environment. Pests are among the most criticals of these factors. Because of the disastrous potential consequences of such pests, quarantine regulations prohibit the entrance of plants or products which might hide the unwanted pest from countries where it is known to exist. Quarantine treatments are can be chemical, physical or ionizing radiation treatment. Numerous investigations on the use of ionizing radiation for the disinfestation of fresh plant materials indicate that rather low dosages will control fruit-fly problems, thus making it well suited for quarantine treatment. The effectiveness of the irradiation as a broad spectrum quarantine treatment of fresh fruits and vegetables was recognized by the several plant protection organizations around the world. Currently, some 40 countries have approved one or more irradiated food items or groups of food

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

    Science.gov (United States)

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

  14. Proven Alternatives for Aboveground Treatment of Arsenic in Groundwater

    Science.gov (United States)

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

  15. Synthesis of wood treatment alternatives for timber railroad structures.

    Science.gov (United States)

    2011-12-01

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

  16. An alternative treatment for anastomotic leakage after oesophageal resection

    DEFF Research Database (Denmark)

    Damm, P; Hoffmann, J.

    1988-01-01

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

  17. 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.

  18. Alternative donor transplantation--"mixing and matching": the role of combined cord blood and haplo-identical donor transplantation (haplo-cord SCT) as a treatment strategy for patients lacking standard donors?

    Science.gov (United States)

    Liu, Hongtao; van Besien, Koen

    2015-03-01

    In the past decade, haplo-cord stem cell transplantation (SCT) using myeloablative or reduced intensive conditioning regimens has been shown to result in reliable and fast engraftment of neutrophils and platelets comparable to HLA-matched donors and much faster than after cord stem cell transplant. Haplo-cord SCT also has a low incidence of early non-relapse mortality, low incidences of acute and chronic graft-vs-host disease (GVHD), and excellent graft-vs-leukemia (GVL) effects. Favorable long-term outcomes for high-risk patients with hematologic malignancies have been reported, including older patients. Haplo-cord SCT will likely overcome the limitations of cell dose during cord stem cell selection and might significantly expand the use of cord stem cell transplant in the adult population. The comparable survival outcomes of matched related donor (MRD), matched unrelated donor (MUD), and haplo-cord stem cell transplant strongly argue that haplo-cord SCT should be considered as effective alternative stem cell transplant for high-risk patients lacking standard donors. Further improvement in supportive care and incorporation of a better understanding of the human fetal immune development into the haplo-cord SCT are required to further improve this strategy.

  19. 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.

  20. Erosion resistance comparison of alternative surface treatments

    Science.gov (United States)

    Česánek, Z.; Schubert, J.; Houdková, Š.

    2017-05-01

    Erosion is a process characterized by the particle separation and the damage of component functional surfaces. Thermal spraying technology HP/HVOF (High Pressure / High Velocity Oxygen Fuel) is commonly used for protection of component surfaces against erosive wear. Alloy as well as cermet based coatings meet the requirements for high erosion resistance. Wear resistance is in many cases the determining property of required component functioning. The application suitability of coating materials is particularly influenced by different hardness. This paper therefore presents an erosion resistance comparison of alloy and cermet based coatings. The coatings were applied on steel substrates and were subjected to the erosive test using the device for evaluation of material erosion resistance working on the principle of centrifugal erodent flow. Abrasive sand Al2O3 with grain size 212-250 μm was selected as an erosive material. For this purpose, the specimens were prepared by thermal spraying technology HP/HVOF using commercially available powders Stellite 6, NiCrBSi, Cr3C2-25%NiCr, Cr3C2-25%CoNiCrAlY, Hastelloy C-276 and experimental coating TiMoCN-29% Ni. Erosion resistance of evaluated coatings was compared with erosive resistance of 1.4923 high alloyed steel without nitridation and in nitrided state and further with surface treatment using technology PVD. According to the evaluation, the resulting erosive resistance depends not only on the selected erodent and surface protection, but also on the erodent impact angle.

  1. 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

  2. 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...

  3. 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.

  4. 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...

  5. 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.

  6. 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

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

    Science.gov (United States)

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

    2004-01-01

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

  8. 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....

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

    Science.gov (United States)

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

    2000-09-01

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

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

    NARCIS (Netherlands)

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

    2012-01-01

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

  11. 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 ...

  12. Closed Fuel Cycle Waste Treatment Strategy

    Energy Technology Data Exchange (ETDEWEB)

    Vienna, J. D. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Collins, E. D. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Crum, J. V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Ebert, W. L. [Argonne National Lab. (ANL), Argonne, IL (United States); Frank, S. M. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Garn, T. G. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Gombert, D. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Jones, R. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Jubin, R. T. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Maio, V. C. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Marra, J. C. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Matyas, J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Nenoff, T. M. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Riley, B. J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Sevigny, G. J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Soelberg, N. R. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Strachan, D. M. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Thallapally, P. K. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Westsik, J. H. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2015-02-01

    This study is aimed at evaluating the existing waste management approaches for nuclear fuel cycle facilities in comparison to the objectives of implementing an advanced fuel cycle in the U.S. under current legal, regulatory, and logistical constructs. The study begins with the Global Nuclear Energy Partnership (GNEP) Integrated Waste Management Strategy (IWMS) (Gombert et al. 2008) as a general strategy and associated Waste Treatment Baseline Study (WTBS) (Gombert et al. 2007). The tenets of the IWMS are equally valid to the current waste management study. However, the flowsheet details have changed significantly from those considered under GNEP. In addition, significant additional waste management technology development has occurred since the GNEP waste management studies were performed. This study updates the information found in the WTBS, summarizes the results of more recent technology development efforts, and describes waste management approaches as they apply to a representative full recycle reprocessing flowsheet. Many of the waste management technologies discussed also apply to other potential flowsheets that involve reprocessing. These applications are occasionally discussed where the data are more readily available. The report summarizes the waste arising from aqueous reprocessing of a typical light-water reactor (LWR) fuel to separate actinides for use in fabricating metal sodium fast reactor (SFR) fuel and from electrochemical reprocessing of the metal SFR fuel to separate actinides for recycle back into the SFR in the form of metal fuel. The primary streams considered and the recommended waste forms include; Tritium in low-water cement in high integrity containers (HICs); Iodine-129: As a reference case, a glass composite material (GCM) formed by the encapsulation of the silver Mordenite (AgZ) getter material in a low-temperature glass is assumed. A number of alternatives with distinct advantages are also considered including a fused silica waste form

  13. 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.

  14. 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)

  15. Sodium-Bearing Waste Treatment Alternatives Implementation Study

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-07-01

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

  16. 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.

  17. Assessment of alternatives to correct inventory difference statistical treatment deficiencies

    International Nuclear Information System (INIS)

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

    1983-11-01

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

  18. 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…

  19. 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)

  20. 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)

  1. 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.

  2. 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

  3. 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 ...

  4. 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

  5. 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 ...

  6. Strategies of temozolomide in future glioblastoma treatment

    Directory of Open Access Journals (Sweden)

    Lee CY

    2017-01-01

    Full Text Available Chooi Yeng Lee School of Pharmacy, Monash University Malaysia, Selangor, Malaysia Abstract: Glioblastoma multiforme (GBM may be one of the most challenging brain tumors to treat, as patients generally do not live more than 2 years. This review aimed to give a timely review of potential future treatments for GBM by looking at the latest strategies, involving mainly the use of temozolomide (TMZ. Although these studies were carried out either in vitro or in rodents, the findings collectively suggested that we are moving toward developing a more efficacious therapy for GBM patients. Nanoparticles preparation was, by far, the most extensively studied strategy for targeted brain delivery. Therefore, the first section of this review presents a treatment strategy using TMZ-loaded nanocarriers, which encompassed nanoparticles, nanoliposomes, and nanosponges. Besides nanocarriers, new complexes that were formed between TMZ and another chemical agent or molecule have shown increased cytotoxicity and antitumor activity. Another approach was by reducing GBM cell resistance to TMZ, and this was achieved either through the suppression of metabolic change occurring in the cells, inhibition of the DNA repair protein, or up-regulation of the protein that mediates autophagy. Finally, the review collates a list of substances that have demonstrated the ability to suppress tumor cell growth. Keywords: cellular resistance, glioblastoma multiforme, nanoparticles, targeted delivery, temozolomide

  7. Multistrain models predict sequential multidrug treatment strategies to result in less antimicrobial resistance than combination treatment

    DEFF Research Database (Denmark)

    Ahmad, Amais; Zachariasen, Camilla; Christiansen, Lasse Engbo

    2016-01-01

    Background: Combination treatment is increasingly used to fight infections caused by bacteria resistant to two or more antimicrobials. While multiple studies have evaluated treatment strategies to minimize the emergence of resistant strains for single antimicrobial treatment, fewer studies have...... the sensitive fraction of the commensal flora.Growth parameters for competing bacterial strains were estimated from the combined in vitro pharmacodynamic effect of two antimicrobials using the relationship between concentration and net bacterial growth rate. Predictions of in vivo bacterial growth were...... (how frequently antibiotics are alternated in a sequential treatment) of the two drugs was dependent upon the order in which the two drugs were used.Conclusion: Sequential treatment was more effective in preventing the growth of resistant strains when compared to the combination treatment. The cycling...

  8. Complementary and alternative treatments for chronic pelvic pain.

    Science.gov (United States)

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

    2013-02-01

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

  9. Sustainable strategies for treatment of bacterial infections

    DEFF Research Database (Denmark)

    Molin, Søren

    2014-01-01

    Resistance to antibiotics and the consequential failures of treatment based on antibiotics makes microbial infections a major threat to human health. This problem combined with rapidly increasing life-style disease problems challenge our healtcare system as well as the pharma industry, and if we do...... not in a foreseeable future develop novel approaches and strategies to combat bacterial infections, many people will be at risk of dying from even trivial infections for which we until recently had highly effective antibiotics. We have for a number of years investigated chronic bacterial lung infections in patients...... suffering from cystic fibrosis. These infections are optimal model scenarios for studies of antibiotic resistance development and microbial adaptation, and we suggest that this information should be useful when designing new anti-microbial strategies. In this respect it will be important to choose...

  10. Amblyopia treatment strategies and new drug therapies.

    Science.gov (United States)

    Pescosolido, Nicola; Stefanucci, Alessio; Buomprisco, Giuseppe; Fazio, Stefano

    2014-01-01

    Amblyopia is a unilateral or bilateral reduction of visual acuity secondary to abnormal visual experience during early childhood. It is one of the most common causes of vision loss and monocular blindness and is commonly associated with strabismus, anisometropia, and visual deprivation (in particular congenital cataract and ptosis). It is clinically defined as a two-line difference of best-corrected visual acuity between the eyes. The purpose of this study was to understand the neural mechanisms of amblyopia and summarize the current therapeutic strategies. In particular, the authors focused on the concept of brain plasticity and its implication for new treatment strategies for children and adults with amblyopia. Copyright 2014, SLACK Incorporated.

  11. 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...

  12. 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....

  13. 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.

  14. 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.

  15. 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

  16. [Treatment strategy and planning for pilon fractures].

    Science.gov (United States)

    Mittlmeier, Thomas; Wichelhaus, Alice

    2017-08-01

    Pilon fractures are mainly severe and prognostically serious injuries with a high rate of relevant soft tissue involvement. The adequate decision making and choice of treatment in the early phase of trauma are of paramount importance for the final outcome. This essentially encompasses the management of the soft tissue damage, the surgical planning and the differentiated selection of procedures. Most concepts of staged treatment nowadays offer a wide range of options which are integrated into expert-based algorithms. The aim of the present analysis was to display the strategy variations for the treatment of pilon fractures taking into account the advantages and disadvantages of the corresponding treatment concepts. A staged procedure including primary closed reduction employing ligamentotaxis and fixation of the joints of the hindfoot via tibiocalcaneal metatarsal fixation offers a safe basis for consecutive imaging and the selection of specific approaches for definitive reconstruction. A simultaneous reconstruction and fixation of the fibula during the primary intervention are generally not recommended in order to avoid any limitations for subsequent reconstructive procedures. A time frame for definitive reconstruction covers a period of up to 3 weeks after trauma and allows a detailed planning considering the individual dynamics of the soft tissue situation and any logistic requirements. For the choice of the definitive treatment concept a wide range of procedures and implants are available. There are also valid concepts for primary treatment of defined fracture constellations while primary arthrodesis represents a solution in cases of major destruction of the joint surface. Knowledge of the multiple procedural variations for pilon fracture treatment creates the basis to optimize the treatment modalities and to take into account individual parameters of the fracture.

  17. Communication strategies to improve HIV treatment adherence.

    Science.gov (United States)

    Rochon, Donna; Ross, Michael W; Looney, Carol; Nepal, Vishnu P; Price, Andrea J; Giordano, Thomas P

    2011-01-01

    Although antiretroviral therapy has increased the survival of HIV-positive patients, traditional approaches to improving medication adherence have failed consistently. Acknowledging the role of communication in health behavior, we conducted a qualitative study to learn about patients' HIV treatment adherence experiences and to identify which communication strategies might influence adherence. Findings indicate that five constructs--cultural beliefs/language, stigma, cues to action, self-efficacy, and mood state--are potentially modifiable by improved communication. Results will be used to create a direct marketing campaign targeted to HIV-infected patients. Copyright © Taylor & Francis Group, LLC

  18. 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.

  19. 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.

  20. Effective treatment strategies against Ebola virus

    Directory of Open Access Journals (Sweden)

    Amina Yaqoob

    2015-08-01

    Full Text Available Ebola virus (EBOV, a member of order Mononegavirales is most famous for causing the endemics of hemorrhagic fever in different countries of the world. Various effective treatment for EBOV are available presently but different clinical trials and experimental studies on animal models are ongoing for this purpose. Results from different studies showed that selective vaccines and therapeutic drugs have potential to interfere the viral life events within host cell in order to inhibit its replication. Various pre-clinical trials in this regard are proved successful on non-human primates (NHPs and found to be significant in inhibiting EBOV infections. It is the need of hour to develop effective vaccines against Ebola virus to combat this problem as soon as possible. The present article is a brief review on potential treatment strategies against Ebola virus.

  1. SCIENTIFIC BASED OF ACUPUNCTURE AS ALTERNATIVE TREATMENT OF DIABETES MELLITUS

    Directory of Open Access Journals (Sweden)

    Koosnadi Saputra

    2012-11-01

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

  2. 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.

  3. Endovascular Treatment Strategies in Aortoiliac Occlusion

    International Nuclear Information System (INIS)

    Ozkan, Ugur; Oguzkurt, Levent; Tercan, Fahri; Gumus, Burcak

    2009-01-01

    The aim of this study was to report our experience in endovascular treatment of total aortoiliac occlusion. Five patients who underwent endovascular recanalization procedures including manual aspiration thrombectomy, balloon angioplasty, and stent placement for total aortoiliac occlusion in a 4-year period were reviewed retrospectively. The mean age of patients was 51 years (range, 43 to 58 years). All patients had abdominal aorta and bilateral common iliac artery occlusion with or without external iliac artery occlusion. All patients either had a contraindication to surgery or refused it. Initial technical success was obtained in four of five (80%) patients. Endovascular techniques were successful in four patients who had good distal runoff and short-segment aortoiliac occlusion, but failed in a patient who had the worst distal runoff and long-segment aortoiliac occlusion. We observed two major complications, one of which was bilateral rupture of the common iliac arteries treated with covered stent placement. Another patient had extension of intra-aortic thrombus into the iliac stent after primary stenting. This was successfully treated with manual aspiration thrombectomy. Aortic and iliac stents remained patent during the follow-up period (median, 18 months; range, 3 to 26 months) in four patients. Primary patency rates at 6, 12, and 24 months were all 80%. In conclusion, endovascular treatment can be an alternative for aortoiliac occlusion in selected patients. Short- to midterm follow-up so far is satisfactory. Removal of intra-aortic thrombus with manual aspiration thrombectomy before balloon angioplasty and/or stenting is possible and a good alternative to thrombolysis.

  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. 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. 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…

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

    Science.gov (United States)

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

    2014-06-01

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

  9. The irradiation as alternative treatment for laboratory wastes

    International Nuclear Information System (INIS)

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

    2005-01-01

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

  10. 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.

  11. Tank waste remediation system optimized processing strategy with an altered treatment scheme

    International Nuclear Information System (INIS)

    Slaathaug, E.J.

    1996-03-01

    This report provides an alternative strategy evolved from the current Hanford Site Tank Waste Remediation System (TWRS) programmatic baseline for accomplishing the treatment and disposal of the Hanford Site tank wastes. This optimized processing strategy with an altered treatment scheme performs the major elements of the TWRS Program, but modifies the deployment of selected treatment technologies to reduce the program cost. The present program for development of waste retrieval, pretreatment, and vitrification technologies continues, but the optimized processing strategy reuses a single facility to accomplish the separations/low-activity waste (LAW) vitrification and the high-level waste (HLW) vitrification processes sequentially, thereby eliminating the need for a separate HLW vitrification facility

  12. Treatment strategy for ruptured abdominal aortic aneurysms.

    Science.gov (United States)

    Davidovic, L

    2014-07-01

    Rupture is the most serious and lethal complication of the abdominal aortic aneurysm. Despite all improvements during the past 50 years, ruptured abdominal aortic aneurysms are still associated with very high mortality. Namely, including patients who die before reaching the hospital, the mortality rate due to abdominal aortic aneurysm rupture is 90%. On the other hand, during the last twenty years, the number of abdominal aortic aneurysms significantly increased. One of the reasons is the fact that in majority of countries the general population is older nowadays. Due to this, the number of degenerative AAA is increasing. This is also the case for patients with abdominal aortic aneurysm rupture. Age must not be the reason of a treatment refusal. Optimal therapeutic option ought to be found. The following article is based on literature analysis including current guidelines but also on my Clinics significant experience. Furthermore, this article show cases options for vascular medicine in undeveloped countries that can not apply endovascular procedures at a sufficient level and to a sufficient extent. At this moment the following is evident. Thirty-day-mortality after repair of ruptured abdominal aortic aneurysms is significantly lower in high-volume hospitals. Due to different reasons all ruptured abdominal aortic aneurysms are not suitable for EVAR. Open repair of ruptured abdominal aortic aneurysm should be performed by experienced open vascular surgeons. This could also be said for the treatment of endovascular complications that require open surgical conversion. There is no ideal procedure for the treatment of AAA. Each has its own advantages and disadvantages, its own limits and complications, as well as indications and contraindications. Future reductions in mortality of ruptured abdominal aortic aneurysms will depend on implementation of population-based screening; on strategies to prevent postoperative organ injury and also on new medical technology

  13. Invasive strategy for treatment of myocardial infarction.

    Science.gov (United States)

    Höfling, B; von Pölnitz, A

    1990-01-01

    The classical approach to the treatment of acute myocardial infarction (MI) has been one of stabilization and complication management. In an effort to optimize treatment, the initiation of the cardiac care unit and the use of antiarrhythmic therapy have succeeded in lowering the mortality rate substantially. More modern concepts are aimed at limiting infarct size and preserving myocardial function. These aims can be achieved medically using intravenous (i.v.) thrombolysis or invasively either with intracoronary (i.c.) thrombolysis, percutaneous transluminal coronary angioplasty (PTCA), or bypass surgery. Although i.c. thrombolysis is more effective than the i.v. route, the necessity for acute coronary catheterization makes it incompatible and difficult for routine use, and thus is usually reserved for cases in which i.v. lysis has failed. Intravenous thrombolysis is becoming the standard approach to MI, and the remaining questions are those of which drug and dosage are optimal and how to approach the patient after thrombolysis. In this regard, we favor a symptom-guided approach, as shown by the TIMI-IIA and European cooperative studies. In patients with ongoing ischemia postlysis, heart catheterization is indicated and a decision regarding PTCA or surgery is then made, depending on anatomy. In patients remaining stable after acute lysis, a predischarge stress may help in selecting patients requiring catheterization. As an alternative invasive approach to acute MI, PTCA may be the quickest and most effective method to recanalize a vessel, but, again, logistical problems make it incompatible in the acute setting. The same is true for bypass surgery, and although extensive improvements have been made in intraoperative myocardial preservation so that a 2% mortality is achievable, it is reserved for patients with extensive ischemia and anatomy unsuitable for PTCA (extensive multivessel or left main disease).

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

    Directory of Open Access Journals (Sweden)

    Ralevski E

    2014-03-01

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

  15. Kinesiotaping as an alternative treatment method for carpal tunnel syndrome.

    Science.gov (United States)

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

    2016-06-23

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

  16. Vegetable coagulants as alternative for treatment of wastewater in Mexico

    Directory of Open Access Journals (Sweden)

    Servando López-León

    2017-11-01

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

  17. Pollution Impact and Alternative Treatment for Produced Water

    Directory of Open Access Journals (Sweden)

    Hedar Yusran

    2018-01-01

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

  18. Pollution Impact and Alternative Treatment for Produced Water

    Science.gov (United States)

    Hedar, Yusran; Budiyono

    2018-02-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  20. 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.

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

    Science.gov (United States)

    Karavida, N; Notopoulos, A

    2010-01-01

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

  2. 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…

  3. 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…

  4. 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…

  5. 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

  6. 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

  7. 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...

  8. 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…

  9. 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)

  10. 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.

  11. Comparison of alternatives for the treatment of non-fuel-bearing hardware

    International Nuclear Information System (INIS)

    Ross, W.A.; Clark, L.L.; Oma, K.H.

    1987-01-01

    This evaluation compares four alternatives for the treatment or processing of non-fuel-bearing hardware (NFBH) to reduce its volume and prepare it for disposal. These treatment alternatives are: shredding; shredding and low-pressure compaction; shredding and supercompaction; and melting. The alternatives are compared on the bases of system costs, waste form characteristics, and process considerations. The two alternatives with high volume reduction are estimated to save $400 million to $500 million compared with the shredding-only alternative. The study recommends that melting and supercompaction alternatives be considered further and that additional testing be conducted for these two alternatives

  12. 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

  13. 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.

  14. Investigation of treatment strategy for advanced cancer according to treatment of pancreatic cancer

    Directory of Open Access Journals (Sweden)

    XU Kecheng

    2013-10-01

    Full Text Available The majority of pancreatic cancer diagnoses are made at the advanced stage and when metastasis has already occurred, and the 1- and 5-year survival rates are extremely low. Cemcitabine remains the most frequently applied treatment option, yet the most effective chemotherapeutic agents and combinations with multiple agents and/or radiotherapy only marginally improve patient survival and may even establish an environment conducive to cancer cells with stem cell-like characteristics. An alternative treatment modality, cryoablation, is available and has been applied at our institute to patients with unresectable pancreatic cancer since 2001. In this article, we present our collective experience with patient outcome using cryoablation, alone or combined with other treatment modalities such as brachytherapy (125iodine seed implantation. The overall outcomes have been encouraging, suggesting that comprehensive therapy including cryoablation may prolong the survival of patients with advanced or metastatic pancreatic cancer, and we are achieving particular success with a novel combination of percutaneous cryoablation, cancer microvascular intervention with 125iodine seed implantation, and combined immunotherapy (3C applied using an individualized patient strategy (P. The 1- through 10-year survival rates of 145 patients treated with the so-called “3C+P model” are presented in support of this new strategy as a promising new treatment for advanced and metastatic cancer

  15. 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...

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

    Science.gov (United States)

    Dubern, Béatrice; Tounian, Patrice

    2014-06-01

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

  17. Alternative concepts for treatment and disposal of Hanford site high-level waste in tanks

    Energy Technology Data Exchange (ETDEWEB)

    Claghorn, R.D.; Powell, W.J.

    1994-12-01

    Some innovative approaches have recently been proposed that may have significant schedule, cost, or environmental advantages which could improve the current HLW program strategy. Three general categories of alternative concepts are now under consideration: (1) process/product alternatives, (2) facility layout options, and (3) contracting strategies. This report compares the alternate approaches to the current program baseline to illustrate their potential significance and to identify the risks associated with each approach.

  18. Alternative concepts for treatment and disposal of Hanford site high-level waste in tanks

    International Nuclear Information System (INIS)

    Claghorn, R.D.; Powell, W.J.

    1994-12-01

    Some innovative approaches have recently been proposed that may have significant schedule, cost, or environmental advantages which could improve the current HLW program strategy. Three general categories of alternative concepts are now under consideration: (1) process/product alternatives, (2) facility layout options, and (3) contracting strategies. This report compares the alternate approaches to the current program baseline to illustrate their potential significance and to identify the risks associated with each approach

  19. Current Research Therapeutic Strategies for Alzheimer’s Disease Treatment

    Directory of Open Access Journals (Sweden)

    Jaume Folch

    2016-01-01

    Full Text Available Alzheimer’s disease (AD currently presents one of the biggest healthcare issues in the developed countries. There is no effective treatment capable of slowing down disease progression. In recent years the main focus of research on novel pharmacotherapies was based on the amyloidogenic hypothesis of AD, which posits that the beta amyloid (Aβ peptide is chiefly responsible for cognitive impairment and neuronal death. The goal of such treatments is (a to reduce Aβ production through the inhibition of β and γ secretase enzymes and (b to promote dissolution of existing cerebral Aβ plaques. However, this approach has proven to be only modestly effective. Recent studies suggest an alternative strategy centred on the inhibition of the downstream Aβ signalling, particularly at the synapse. Aβ oligomers may cause aberrant N-methyl-D-aspartate receptor (NMDAR activation postsynaptically by forming complexes with the cell-surface prion protein (PrPC. PrPC is enriched at the neuronal postsynaptic density, where it interacts with Fyn tyrosine kinase. Fyn activation occurs when Aβ is bound to PrPC-Fyn complex. Fyn causes tyrosine phosphorylation of the NR2B subunit of metabotropic glutamate receptor 5 (mGluR5. Fyn kinase blockers masitinib and saracatinib have proven to be efficacious in treating AD symptoms in experimental mouse models of the disease.

  20. Various Strategies for Pain-Free Root Canal Treatment

    Science.gov (United States)

    Parirokh, Masoud; V. Abbott, Paul

    2014-01-01

    Introduction: Achieving successful anesthesia and performing pain-free root canal treatment are important aims in dentistry. This is not always achievable and therefore, practitioners are constantly seeking newer techniques, equipments, and anesthetic solutions for this very purpose. The aim of this review is to introduce strategies to achieve profound anesthesia particularly in difficult cases. Materials and Methods: A review of the literature was performed by electronic and hand searching methods for anesthetic agents, techniques, and equipment. The highest level of evidence based investigations with rigorous methods and materials were selected for discussion. Results: Numerous studies investigated to pain management during root canal treatment; however, there is still no single technique that will predictably provide profound pulp anesthesia. One of the most challenging issues in endodontic practice is achieving a profound anesthesia for teeth with irreversible pulpitis especially in mandibular posterior region. Conclusion: According to most investigations, achieving a successful anesthesia is not always possible with a single technique and practitioners should be aware of all possible alternatives for profound anesthesia. PMID:24396370

  1. 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.

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

    OpenAIRE

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

    1980-01-01

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

  3. Present and New Treatment Strategies in the Management of Glaucoma

    DEFF Research Database (Denmark)

    Kolko, Miriam

    2015-01-01

    risk factor for progression of the disease. However, it is clear that a significant number of glaucoma patients show disease progression despite of pressure lowering treatments. Much attention has been given to the development of neuroprotective treatment strategies, but the identification of such has...... of RGCs. In this matter, recent approaches aim to rescue RGCs and regenerate axons in order to restore visual function in glaucoma. The present review seeks to provide an overview of the present and new treatment strategies in the management of glaucoma. The treatment strategies are divided into current...

  4. An alternative methodology for the mathematical treatment of GPS positioning

    Directory of Open Access Journals (Sweden)

    Aly M. El-naggar

    2011-12-01

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

  5. 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

  6. Targeting Gonadotropins: An Alternative Option for Alzheimer Disease Treatment

    Directory of Open Access Journals (Sweden)

    Gemma Casadesus

    2006-01-01

    Full Text Available Recent evidence indicates that, alongside oxidative stress, dysregulation of the cell cycle in neurons susceptible to degeneration in Alzheimer disease may play a crucial role in the initiation of the disease. As such, the role of reproductive hormones, which are closely associated with the cell cycle both during development and after birth, may be of key import. While estrogen has been the primary focus, the protective effects of hormone replacement therapy on cognition and dementia only during a “crucial period” led us to expand the study of hormonal influences to other members of the hypothalamic pituitary axis. Specifically, in this review, we focus on luteinizing hormone, which is not only increased in the sera of patients with Alzheimer disease but, like estrogen, is modulated by hormone replacement therapy and also influences cognitive behavior and pathogenic processing in animal models of the disease. Targeting gonadotropins may be a useful treatment strategy for disease targeting multiple pleiotropic downstream consequences.

  7. 40 CFR 268.49 - Alternative LDR treatment standards for contaminated soil.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 26 2010-07-01 2010-07-01 false Alternative LDR treatment standards for contaminated soil. 268.49 Section 268.49 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) LAND DISPOSAL RESTRICTIONS Treatment Standards § 268.49 Alternative LDR treatment standards for contaminated...

  8. 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)

  9. 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.

  10. 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.

  11. 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

  12. 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

  13. 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

  14. 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...

  15. 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...

  16. 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...

  17. 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.

  18. Integration of alternative feedstreams for biomass treatment and utilization

    Science.gov (United States)

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

    2011-03-22

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

  19. Alternative Splicing as a Target for Cancer Treatment.

    Science.gov (United States)

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

    2018-02-11

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

  20. 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.

  1. New treatment strategies for hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Andersen, R.; Jemec, G. B.E.

    2016-01-01

    and pathogenesis are only partially understood at present. Recent research has, however, identified possible targets for specific intervention using biologicals. In addition, classical clinically driven developments of new treatments continue to evolve, leading to several interesting new therapies for HS patients...... included. A total of 365 papers were identified, 79 of which were retained for analysis following exclusions. The following treatments are discussed in detail: infliximab, adalimumab, ustekinumab, anakinra, alitretinoin, metformin and Vitamin D. HS is a disease with a considerable morbidity and a great...

  2. 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.

  3. Treatment strategies for tics in Tourette syndrome

    Science.gov (United States)

    Eddy, Clare M.; Rickards, Hugh E.; Cavanna, Andrea E.

    2011-01-01

    Tourette syndrome (TS) is a chronic neurodevelopmental disorder characterized by tics: repetitive, involuntary movements and vocalizations. These symptoms can have a significant impact on patients’ daily functioning across many domains. Tics tend to be most severe in child and adolescent sufferers, so their presence has the potential to impact a period of life that is both critical for learning and is often associated with the experience of greater social tension and self-consciousness than adulthood. Furthermore, control over tics that lead to physical impairment or self-injurious behaviour is of vital importance in maintaining health and quality of life. There are numerous complicating factors in the prescription of treatment for tics, due to both the side effects associated with alleviating agents and patient characteristics, such as age and comorbid conditions. This review summarizes literature pertaining to the efficacy and safety of both traditionally prescribed and more modern medications. We also discuss the merits of behavioural and surgical techniques and highlight newer emerging treatments. Although treatment response is to some extent variable, there are a number of agents that are clearly useful as first-line treatments for TS. Other interventions may be of most benefit to patients exhibiting refractory tics or more specific symptom profiles. PMID:21339906

  4. Maximizing cost-effectiveness by adjusting treatment strategy according to glaucoma severity

    Science.gov (United States)

    Guedes, Ricardo Augusto Paletta; Guedes, Vanessa Maria Paletta; Gomes, Carlos Eduardo de Mello; Chaoubah, Alfredo

    2016-01-01

    Abstract Background: The aim of this study is to determine the most cost-effective strategy for the treatment of primary open-angle glaucoma (POAG) in Brazil, from the payer's perspective (Brazilian Public Health System) in the setting of the Glaucoma Referral Centers. Methods: Study design was a cost-effectiveness analysis of different treatment strategies for POAG. We developed 3 Markov models (one for each glaucoma stage: early, moderate and advanced), using a hypothetical cohort of POAG patients, from the perspective of the Brazilian Public Health System (SUS) and a horizon of the average life expectancy of the Brazilian population. Different strategies were tested according to disease severity. For early glaucoma, we compared observation, laser and medications. For moderate glaucoma, medications, laser and surgery. For advanced glaucoma, medications and surgery. Main outcome measures were ICER (incremental cost-effectiveness ratio), medical direct costs and QALY (quality-adjusted life year). Results: In early glaucoma, both laser and medical treatment were cost-effective (ICERs of initial laser and initial medical treatment over observation only, were R$ 2,811.39/QALY and R$ 3,450.47/QALY). Compared to observation strategy, the two alternatives have provided significant gains in quality of life. In moderate glaucoma population, medical treatment presented the highest costs among treatment strategies. Both laser and surgery were highly cost-effective in this group. For advanced glaucoma, both tested strategies were cost-effective. Starting age had a great impact on results in all studied groups. Initiating glaucoma therapy using laser or surgery were more cost-effective, the younger the patient. Conclusion: All tested treatment strategies for glaucoma provided real gains in quality of life and were cost-effective. However, according to the disease severity, not all strategies provided the same cost-effectiveness profile. Based on our findings, there should be a

  5. 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.

  6. Therapeutic strategies in the treatment of periodontitis

    Directory of Open Access Journals (Sweden)

    Liljana Bogdanovska

    2012-04-01

    Full Text Available Periodontitis is a chronic inflammatory process which affects the tooth - supporting structures of the teeth. The disease is initiated by subgingival periopathogenic bacteria in susceptible periodontal sites. The host immune response towards periodontal pathogens helps to sustain periodontal disease and eventual alveolar bone loss. Although scaling and root planing is the standard treatment modality for periodontitis, it suffers from several drawbacks such as the inability to reach the base of deep pockets and doesn’t arrest migration of periodontal pathogens from other sites in the oral cavity. In order to overcome the limitations of scaling and root planning, adjunctive chemotherapeutics and host modulatory agents to the treatment are used. These therapeutic agents show substantial beneficial effects when compared to scaling and root planning alone. This review will cover an update on chemotherapeutic and past and future host immune modulatory agents used adjunctively to treat and manage periodontal diseases.

  7. SECONDARY WASTE MANAGEMENT STRATEGY FOR EARLY LOW ACTIVITY WASTE TREATMENT

    Energy Technology Data Exchange (ETDEWEB)

    TW, CRAWFORD

    2008-07-17

    This study evaluates parameters relevant to River Protection Project secondary waste streams generated during Early Low Activity Waste operations and recommends a strategy for secondary waste management that considers groundwater impact, cost, and programmatic risk. The recommended strategy for managing River Protection Project secondary waste is focused on improvements in the Effiuent Treatment Facility. Baseline plans to build a Solidification Treatment Unit adjacent to Effluent Treatment Facility should be enhanced to improve solid waste performance and mitigate corrosion of tanks and piping supporting the Effiuent Treatment Facility evaporator. This approach provides a life-cycle benefit to solid waste performance and reduction of groundwater contaminants.

  8. HDT mixtures treatment strategies by gas chromatography

    Energy Technology Data Exchange (ETDEWEB)

    Laquerbe, C.; Contreras, S.; Demoment, J. [Commissariat a l' Energie Atomique - CEA/Valduc, F-21121 Is sur Tille (France)

    2008-07-15

    Gas phase chromatographic processes are of interest for the separation of hydrogen isotopes from an HDT mixture. For a certain quantity, they are very competitive and present several benefits. Nevertheless no active packing material allows to have simultaneously good enrichment performances for tritium production and high decontamination capabilities for HD gases. The influence of the packing material is first described in this article. Then two specific processes (TCAP and Reverse Chromatography), each well adapted to perform one target, are presented. Finally, the problematic to propose an optimized treatment scheme associating these two processes is formulated. (authors)

  9. HDT mixtures treatment strategies by gas chromatography

    International Nuclear Information System (INIS)

    Laquerbe, C.; Contreras, S.; Demoment, J.

    2008-01-01

    Gas phase chromatographic processes are of interest for the separation of hydrogen isotopes from an HDT mixture. For a certain quantity, they are very competitive and present several benefits. Nevertheless no active packing material allows to have simultaneously good enrichment performances for tritium production and high decontamination capabilities for HD gases. The influence of the packing material is first described in this article. Then two specific processes (TCAP and Reverse Chromatography), each well adapted to perform one target, are presented. Finally, the problematic to propose an optimized treatment scheme associating these two processes is formulated. (authors)

  10. Nanotechnology-based water treatment strategies.

    Science.gov (United States)

    Kumar, Sandeep; Ahlawat, Wandit; Bhanjana, Gaurav; Heydarifard, Solmaz; Nazhad, Mousa M; Dilbaghi, Neeraj

    2014-02-01

    The most important component for living beings on the earth is access to clean and safe drinking water. Globally, water scarcity is pervasive even in water-rich areas as immense pressure has been created by the burgeoning human population, industrialization, civilization, environmental changes and agricultural activities. The problem of access to safe water is inevitable and requires tremendous research to devise new, cheaper technologies for purification of water, while taking into account energy requirements and environmental impact. This review highlights nanotechnology-based water treatment technologies being developed and used to improve desalination of sea and brackish water, safe reuse of wastewater, disinfection and decontamination of water, i.e., biosorption and nanoadsorption for contaminant removal, nanophotocatalysis for chemical degradation of contaminants, nanosensors for contaminant detection, different membrane technologies including reverse osmosis, nanofiltration, ultrafiltration, electro-dialysis etc. This review also deals with the fate and transport of engineered nanomaterials in water and wastewater treatment systems along with the risks associated with nanomaterials.

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

    Directory of Open Access Journals (Sweden)

    Philip A. Fisher

    2012-07-01

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

  12. Immunotherapeutic Strategies for Alzheimer's Disease Treatment

    Directory of Open Access Journals (Sweden)

    Beka Solomon

    2009-01-01

    Full Text Available Naturally occurring antibodies against amyloid-β peptides have been found in human cerebrospinal fluid and in the plasma of healthy individuals, but were significantly lower in Alzheimer's disease (AD patients, suggesting that AD may be an immunodeficient disorder. The performance of anti-amyloid-β antibodies in transgenic mice models of AD showed that they are delivered to the central nervous system, preventing and dissolving amyloid-β plaques. Moreover, these antibodies protected the mice from learning and age-related memory deficits. Active and/or passive immunization against the amyloid-β peptide has been proposed as a method for preventing and/or treating AD. Immunotherapy represents fascinating ways to test the amyloid hypothesis and offers genuine opportunities for AD treatment, but requires careful antigen and antibody selection to maximize efficacy and minimize adverse events.

  13. Molecular mechanisms of depression: perspectives on new treatment strategies.

    Science.gov (United States)

    Lang, Undine E; Borgwardt, Stefan

    2013-01-01

    observed by ketamine, which acts via the glutamatergic system. Hence, GABA, AMPA, EAAT, NMDA- and metabotropic glutamate receptors (mGluR1 to mGluR8) have gained interest in depression recently. Alternative, causative or also easy available treatment strategies beyond serotonin and noradrenaline reuptake inhibition might be a major topic of future psychiatric care. In this review, an attempt is made to overview concepts of the disease and search for perspectives on antidepressant treatment strategies beyond approved medications. Copyright © 2013 S. Karger AG, Basel.

  14. Molecular Mechanisms of Depression: Perspectives on New Treatment Strategies

    Directory of Open Access Journals (Sweden)

    Undine E. Lang

    2013-05-01

    effect has also been observed by ketamine, which acts via the glutamatergic system. Hence, GABA, AMPA, EAAT, NMDA- and metabotropic glutamate receptors (mGluR1 to mGluR8 have gained interest in depression recently. Alternative, causative or also easy available treatment strategies beyond serotonin and noradrenaline reuptake inhibition might be a major topic of future psychiatric care. In this review, an attempt is made to overview concepts of the disease and search for perspectives on antidepressant treatment strategies beyond approved medications.

  15. Delayed onset muscle soreness : treatment strategies and performance factors.

    Science.gov (United States)

    Cheung, Karoline; Hume, Patria; Maxwell, Linda

    2003-01-01

    Delayed onset muscle soreness (DOMS) is a familiar experience for the elite or novice athlete. Symptoms can range from muscle tenderness to severe debilitating pain. The mechanisms, treatment strategies, and impact on athletic performance remain uncertain, despite the high incidence of DOMS. DOMS is most prevalent at the beginning of the sporting season when athletes are returning to training following a period of reduced activity. DOMS is also common when athletes are first introduced to certain types of activities regardless of the time of year. Eccentric activities induce micro-injury at a greater frequency and severity than other types of muscle actions. The intensity and duration of exercise are also important factors in DOMS onset. Up to six hypothesised theories have been proposed for the mechanism of DOMS, namely: lactic acid, muscle spasm, connective tissue damage, muscle damage, inflammation and the enzyme efflux theories. However, an integration of two or more theories is likely to explain muscle soreness. DOMS can affect athletic performance by causing a reduction in joint range of motion, shock attenuation and peak torque. Alterations in muscle sequencing and recruitment patterns may also occur, causing unaccustomed stress to be placed on muscle ligaments and tendons. These compensatory mechanisms may increase the risk of further injury if a premature return to sport is attempted.A number of treatment strategies have been introduced to help alleviate the severity of DOMS and to restore the maximal function of the muscles as rapidly as possible. Nonsteroidal anti-inflammatory drugs have demonstrated dosage-dependent effects that may also be influenced by the time of administration. Similarly, massage has shown varying results that may be attributed to the time of massage application and the type of massage technique used. Cryotherapy, stretching, homeopathy, ultrasound and electrical current modalities have demonstrated no effect on the alleviation of

  16. 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.

  17. 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.

  18. 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.

  19. Strategies for Prevention and Treatment of Trichomonas vaginalis Infections.

    Science.gov (United States)

    Bouchemal, Kawthar; Bories, Christian; Loiseau, Philippe M

    2017-07-01

    The last estimated annual incidence of Trichomonas vaginalis worldwide exceeds that of chlamydia and gonorrhea combined. This critical review updates the state of the art on advances in T. vaginalis diagnostics and strategies for treatment and prevention of trichomoniasis. In particular, new data on treatment outcomes for topical administration of formulations are reviewed and discussed. Copyright © 2017 American Society for Microbiology.

  20. Emerging drugs and alternative possibilities in the treatment of tuberculosis

    NARCIS (Netherlands)

    Hofman, S.; Segers, M.M.; Ghimire, S.; Bolhuis, M.S.; Sturkenboom, M.G.; Soolingen, D. van; Alffenaar, J.W.

    2016-01-01

    INTRODUCTION: Tuberculosis (TB) remains a global health problem. Drug resistance, treatment duration, complexity, and adverse drug reactions associated with anti-TB regimens are associated with treatment failure, prolonged infectiousness and relapse. With the current set of anti-TB drugs the goal to

  1. Emerging drugs and alternative possibilities in the treatment of tuberculosis

    NARCIS (Netherlands)

    Hofman, S.; Segers, M. M.; Ghimire, S.; Bolhuis, M. S.; Sturkenboom, M. G. G.; Van Soolingen, D.; Alffenaar, J. W. C.

    2016-01-01

    Introduction: Tuberculosis (TB) remains a global health problem. Drug resistance, treatment duration, complexity, and adverse drug reactions associated with anti-TB regimens are associated with treatment failure, prolonged infectiousness and relapse. With the current set of anti-TB drugs the goal to

  2. 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...

  3. 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.

  4. 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.

  5. 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.

  6. 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

  7. 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.

  8. Diagnostic and treatment strategies in mucopolysaccharidosis VI

    Directory of Open Access Journals (Sweden)

    Vairo F

    2015-10-01

    . Specific treatment with enzyme replacement has been available since 2005. It is safe and effective, bringing measurable benefits and increased survival to patients. As several evidences indicate that early initiation of therapy may lead to a better outcome, newborn screening is being considered for this condition, and it is already in place in selected areas where the incidence of MPS VI is increased. However, as enzyme replacement therapy is not curative, associated therapies should be considered, and research on innovative therapies continues. The management of affected patients by a multidisciplinary team with experience in MPS diseases is highly recommended.Keywords: mucopolysaccharidosis VI, Maroteaux–Lamy syndrome, dermatan sulfate, arylsulfatase b, enzyme replacement therapy, lysosomal storage diseases

  9. Proven Alternatives for Aboveground Treatment of Arsenic in Groundwater

    Science.gov (United States)

    2002-10-01

    issue paper does not address three technologies that have been used to treat water containing arsenic: • Biological treatment • Phytoremediation ...arsenic in water, and no aboveground treatments of groundwater conducted at full scale were found. Phytoremediation and electrokinetics are not...Roundtable. September 1998. http://www.frtr.gov/costperf.htm. 1.16 U.S. EPA. Office of Research and Development. Arsenic & Mercury - Workshop on Removal

  10. Thermotherapy. An alternative for the treatment of American cutaneous leishmaniasis.

    OpenAIRE

    López, Liliana; Robayo, Martha; Vargas, Margarita; Vélez, Iván D

    2012-01-01

    Abstract Background Pentavalent antimonials (Sb5) and miltefosine are the first-line drugs for treating cutaneous leishmaniasis in Colombia; however, toxicity and treatment duration negatively impact compliance and cost, justifying an active search for better therapeutic options. We compared the efficacy and safety of thermotherapy and meglumine antimoniate for the treatment of cutaneous leishmaniasis in Colombia. Method An open randomized Phase III clinical trial was performed in five milita...

  11. Thermotherapy. An alternative for the treatment of American cutaneous leishmaniasis.

    Directory of Open Access Journals (Sweden)

    López Liliana

    2012-05-01

    Full Text Available Abstract Background Pentavalent antimonials (Sb5 and miltefosine are the first-line drugs for treating cutaneous leishmaniasis in Colombia; however, toxicity and treatment duration negatively impact compliance and cost, justifying an active search for better therapeutic options. We compared the efficacy and safety of thermotherapy and meglumine antimoniate for the treatment of cutaneous leishmaniasis in Colombia. Method An open randomized Phase III clinical trial was performed in five military health centres. located in northwestern, central and southern Colombia. Volunteers with parasitological positive diagnosis (Giemsa-stained smears of cutaneous leishmaniasis were included. A single thermotherapy session involving the application of 50°C at the center and active edge of each lesion. Meglumine antimoniate was administered intramuscularly at a dose of 20 mg Sb5/kg weight/day for 20 days. Results Both groups were comparable. The efficacy of thermotherapy was 64% (86/134 patients by protocol and 58% (86/149 by intention-to-treat. For the meglumine antimoniate group, efficacy by protocol was 85% (103/121 patients and 72% (103/143 by intention-to-treat, The efficacy between the treatments was statistically significant (p 0.01 and Leishmania species responsible for infection. The side effects of meglumine antimoniate included myalgia, arthralgia, headache and fever. Regarding thermotherapy, the only side effect was pain at the lesion area four days after the initiation of treatment. Conclusion Although the efficacy rate of meglumine antimoniate was greater than that of thermotherapy for the treatment of cutaneous leishmaniasis, the side effects were also greater. Those factors, added to the increased costs, the treatment adherence problems and the progressive lack of therapeutic response, make us consider thermotherapy as a first line treatment for cutaneous leishmaniasis. Registered ClinicalTrials.gov NCT00471705

  12. Thermotherapy. An alternative for the treatment of American cutaneous leishmaniasis.

    Science.gov (United States)

    López, Liliana; Robayo, Martha; Vargas, Margarita; Vélez, Iván D

    2012-05-17

    Pentavalent antimonials (Sb5) and miltefosine are the first-line drugs for treating cutaneous leishmaniasis in Colombia; however, toxicity and treatment duration negatively impact compliance and cost, justifying an active search for better therapeutic options. We compared the efficacy and safety of thermotherapy and meglumine antimoniate for the treatment of cutaneous leishmaniasis in Colombia. An open randomized Phase III clinical trial was performed in five military health centres. located in northwestern, central and southern Colombia. Volunteers with parasitological positive diagnosis (Giemsa-stained smears) of cutaneous leishmaniasis were included. A single thermotherapy session involving the application of 50°C at the center and active edge of each lesion. Meglumine antimoniate was administered intramuscularly at a dose of 20 mg Sb5/kg weight/day for 20 days. Both groups were comparable. The efficacy of thermotherapy was 64% (86/134 patients) by protocol and 58% (86/149) by intention-to-treat. For the meglumine antimoniate group, efficacy by protocol was 85% (103/121 patients) and 72% (103/143) by intention-to-treat, The efficacy between the treatments was statistically significant (p 0.01 and effects of meglumine antimoniate included myalgia, arthralgia, headache and fever. Regarding thermotherapy, the only side effect was pain at the lesion area four days after the initiation of treatment. Although the efficacy rate of meglumine antimoniate was greater than that of thermotherapy for the treatment of cutaneous leishmaniasis, the side effects were also greater. Those factors, added to the increased costs, the treatment adherence problems and the progressive lack of therapeutic response, make us consider thermotherapy as a first line treatment for cutaneous leishmaniasis.

  13. 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.

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

    International Nuclear Information System (INIS)

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

    1986-07-01

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

  15. Regenerative strategies for the treatment of knee joint disabilities

    CERN Document Server

    Reis, Rui

    2017-01-01

    This book presents regenerative strategies for the treatment of knee joint disabilities. The book is composed of four main sections totaling 19 chapters which review the current knowledge on the clinical management and preclinical regenerative strategies. It examines the role of different natural-based biomaterials as scaffolds and implants for addressing different tissue lesions in the knee joint. Section one provides an updated and comprehensive discussion on articular cartilage tissue regeneration. Section two focuses on the important contributions for bone and osteochondral tissue engineering. Section three overview the recent advances on meniscus repair/regeneration strategies. Finally, section four further discusses the current strategies for treatment of ligament lesions. Each chapter is prepared by world know expert on their fields, so we do firmly believe that the proposed book will be a reference in the area of biomaterials for regenerative medicine.

  16. Thermoeconomic analysis applied to an alternative wastewater treatment

    Energy Technology Data Exchange (ETDEWEB)

    Lamas, Wendell de Queiroz [University of Taubate, Post-graduate Programme in Mechanical Engineering, Department of Mechanical Engineering, Sp (Brazil); Sao Paulo State University, Faculty of Engineering, Campus of Guaratingueta, Postgraduate Programme in Mechanical Engineering, Sp (Brazil); Silveira, Jose Luz; Mattos dos Reis, Luiz Octavio [Sao Paulo State University, Faculty of Engineering, Campus of Guaratingueta, Postgraduate Programme in Mechanical Engineering, Sp (Brazil); Oscare Giacaglia, Giorgio Eugenio [University of Taubate, Post-graduate Programme in Mechanical Engineering, Department of Mechanical Engineering, Sp (Brazil)

    2010-10-15

    This work develops a methodology for the determination of costs associated to products generated in a small wastewater treatment station. The methodology begins with plant units identification, relating their fluid and thermodynamics features to each point indicated in its process diagram. Following, a functional diagram and a formulation are developed in exergetic basis, describing all equations for these points, which are the constraints for optimisation and are used to determine costs associated to products generated in a Small Wastewater Treatment Station - SWTS. The methodology is applied to a hypothetical system based on SWTS plants and presents consistent results when compared to values based on previous experiments and evaluations. (author)

  17. Matlab Tools: An Alternative to Planning Systems in Brachytherapy Treatments

    International Nuclear Information System (INIS)

    Herrera, Higmar; Rodriguez, Mercedes; Rodriguez, Miguel

    2006-01-01

    This work proposes the use of the Matlab environment to obtain the treatment dose based on the reported data by Krishnaswamy and Liu et al. The comparison with reported measurements is showed for the Amersham source model. For the 3M source model, measurements with TLDs and a Monte Carlo simulation are compared to the data obtained by Matlab. The difference for the Amersham model is well under the 15% recommended by the IAEA and for the 3M model, although the difference is greater, the results are consistent. The good agreement to the reported data allows the Matlab calculations to be used in daily brachytherapy treatments

  18. Current and emerging somatic treatment strategies in psychotic major depression.

    Science.gov (United States)

    Dannon, Pinhas N; Lowengrub, Katherine; Gonopolski, Yehudit; Kotler, Moshe

    2006-01-01

    Psychotic major depressive disorder (MDD) is a mood disorder characterized by severe affective and neurovegetative symptoms together with the presence of delusions and/or hallucinations. It is a common disorder seen in a quarter of consecutively admitted depressed patients and is often associated with severe symptomatology, increased suicide risk, poor acute response to antidepressants and poor acute and long-term treatment outcome. It is possible that poor response in psychotic depression is caused by the fact that we have yet to identify the most efficacious treatment protocol for psychotic MDD. Multiple studies have shown that modifications in the treatment paradigm may increase treatment efficacy in psychotic MDD. It has been generally accepted that, during the acute treatment phase, antidepressant-antipsychotic drug combination therapy is more effective than either treatment alone, although this strategy has recently been challenged. The question of the optimal duration of pharmacotherapy in order to prevent relapse and improve long-term (i.e., 5-year) outcome is a focus of current investigation. This article will review currently recommended treatment strategies for the acute, continuation and maintenance phases of therapy. In particular, it will address the role of newer-generation antidepressants, the role of second-generation antipsychotics, the use of mood stabilizers and indications for electroconvulsive therapy. Other possible treatment strategies such as transcranial magnetic stimulation, vagus nerve stimulation, deep-brain stimulation and glucocorticoid receptor antagonists will be discussed. Current recommendations for the prevention of relapse and improvement of long-term outcome will be reviewed.

  19. Treatment strategies for the infertile polycystic ovary syndrome patient.

    Science.gov (United States)

    Tannus, Samer; Burke, Yechiel Z; Kol, Shahar

    2015-11-01

    Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. Infertility is a prevalent presenting feature of PCOS, and approximately 75% of these women suffer infertility due to anovulation. Lifestyle modification is considered the first-line treatment and is associated with improved endocrine profile. Clomiphene citrate (CC) should be considered as the first line pharmacologic therapy for ovulation induction. In women who are CC resistant, second-line treatment should be considered, as adding metformin, laparoscopic ovarian drilling or treatment with gonadotropins. In CC treatment failure, Letrozole could be an alternative or treatment with gonadotropins. IVF is considered the third-line treatment; the 'short', antagonist-based protocol is the preferred option for PCOS patients, as it is associated with lower risk of developing ovarian hyperstimulation syndrome (specifically by using a gonadotropin--releasing hormone agonist as ovulation trigger), but with comparable outcomes as the long protocol.

  20. An alternative non-invasive treatment for Peyronie's disease

    Directory of Open Access Journals (Sweden)

    Joaquim A. Claro

    2004-06-01

    Full Text Available OBJECTIVE: Surgical correction of the deformity and plaque caused by Peyronie's disease has some important disadvantages and extracorporeal shockwave therapy (ESWT emerged as a new promising therapy. We evaluated prospectively the efficacy and safety of the association of high dose vitamin E and ESWT as a non-invasive treatment for the disease. MATERIALS AND METHODS: Twenty-five patients 42 to 68 years old (mean = 54 presenting penile deviation and sexual distress caused by Peyronie's disease were treated in a non-invasive manner. The time of penile deviation ranged from 16 to 52 months (mean = 30. All patients had previous unsuccessful treatment for Peyronie's disease. The angulation's deformity of the penis was assessed by photography at home. The patients received vitamin E (l.200 mg daily during 3 months and underwent 3 to 6 sessions (mean = 3 of ESWT (3,000 to 4,000 shockwaves at a power level of l to 2 at 1-week intervals. RESULTS: From 25 patients treated, 16 (64% reported an improvement in penile angulation, with a mean reduction of 21 degrees (10 to 40. Eight patients reported improvement in their spontaneous erections. Overall, the patients presented only minimal bruising at the site of treatment and skin hematoma. Four patients presented urethral bleeding. The mean angulation after treatment in the control group was 48.67 degrees (30 - 70 and in the study group was 24.42 degrees (0 - 70, statistically significant. CONCLUSION: Considering the common complications and the unsatisfactory outcome of the surgical correction for Peyronie's disease, the association of high dose vitamin E and ESWT represents a good option for a non-invasive, effective and safe treatment of the penile deformity.

  1. Strategies for diagnosis and treatment of suspected leptospirosis: a cost-benefit analysis.

    Directory of Open Access Journals (Sweden)

    Yupin Suputtamongkol

    Full Text Available BACKGROUND: Symptoms and signs of leptospirosis are non-specific. Several diagnostic tests for leptospirosis are available and in some instances are being used prior to treatment of leptospirosis-suspected patients. There is therefore a need to evaluate the cost-effectiveness of the different treatment strategies in order to avoid misuse of scarce resources and ensure best possible health outcomes for patients. METHODS: The study population was adult patients, presented with uncomplicated acute febrile illness, without an obvious focus of infection or malaria or typical dengue infection. We compared the cost and effectiveness of 5 management strategies: 1 no patients tested or given antibiotic treatment; 2 all patients given empirical doxycycline treatment; patients given doxycycline when a patient is tested positive for leptospirosis using: 3 lateral flow; 4 MCAT; 5 latex test. The framework used is a cost-benefit analysis, accounting for all direct medical costs in diagnosing and treating patients suspected of leptospirosis. Outcomes are measured in length of fever after treatment which is then converted to productivity losses to capture the full economic costs. FINDINGS: Empirical doxycycline treatment was the most efficient strategy, being both the least costly alternative and the one that resulted in the shortest duration of fever. The limited sensitivity of all three diagnostic tests implied that their use to guide treatment was not cost-effective. The most influential parameter driving these results was the cost of treating patients with complications for patients who did not receive adequate treatment as a result of incorrect diagnosis or a strategy of no-antibiotic-treatment. CONCLUSIONS: Clinicians should continue treating suspected cases of leptospirosis on an empirical basis. This conclusion holds true as long as policy makers are not prioritizing the reduction of use of antibiotics, in which case the use of the latex test would be

  2. 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

  3. 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

  4. Prostate IMRT fractionation strategies. Two-phase treatment versus simultaneous integrated boost

    International Nuclear Information System (INIS)

    Stavrev, P.; Hristov, D.

    2003-01-01

    Background. The purpose of the study was to investigate the radiobiological effect of the number of fractions, position uncertainties and clonogen spread (microscopic disease) on two different inverse treatment planning alternatives: (a) 2-phase strategy; (b) simultaneous integrated boost (SIB). Material and methods. The tumour control probability (TCP) and normal tissue complication probability (NTCP) were calculated for the 2-phase strategy, which has well defined fractionation scheme and compared to the TCP and NTCP for the SIB strategy calculated as a function of the number of fractions. For a 7-beam IMRT prostate treatment, we have performed inverse treatment planning for the two different strategies following the above method. Results. When the position uncertainties and clonogen spread were accounted for in the TCP calculation a drop as large as 10% was found. A drop of 5-7% in the TCP was obtained for the SIB strategy, if delivered in the same number of fractions as the 2-phased one. Conclusions. The potential of inverse planning to design tight conformal dose distributions is fully revealed in the SIB optimization process. The optimized SIB superior dose distributions require modification of the delivered dose per fraction and therefore careful selection of the fractionation regime. Hence physically optimized SIB treatments may not always lead to better tumour control and tissue sparing. (author)

  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. 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.

  7. 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

  8. Complementary and alternative medicine treatments for low back pain.

    Science.gov (United States)

    Marlowe, Dan

    2012-09-01

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

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

    Science.gov (United States)

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

    2010-01-01

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

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

    Science.gov (United States)

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

    2017-07-01

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

  11. 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...

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

    Science.gov (United States)

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

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

    NARCIS (Netherlands)

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

    2009-01-01

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

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

    Science.gov (United States)

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

  15. Obtaining membranes for alternative treatment hydrogels of cutaneous leishmaniasis

    International Nuclear Information System (INIS)

    Oliveira, Maria Jose Alves de

    2013-01-01

    Polymeric Hydrogels formed by crosslinked polymeric chains were obtained by ionizing radiation process according to Rosiak technique. In the last 40 years the use of hydrogels has been investigated for various applications as curatives. In this work hydrogel membranes were synthesized with poly (N-2-pyrrolidone) (PVP), poly (vinyl alcohol) (PVA), chitosan and laponita clay for use as a vehicle for controlled glucantime release on the surface of skin tissues injured by leishmaniasis. Leishmaniasis is a disease caused by a protozoan parasite of the genus Leishmania transmitted by the bite of phlebotomies sandfly. The traditional treatment of patients infected by these parasites is done with pentavalent antimony in injectable form. However, these antimonates are highly toxic and cause side effects in these patients. In addition, patients with heart and kidney disease can not use this treatment. In treatment with drug delivery hydrogel membrane applied on the surface of leishmaniasis injured tissues the drug is released directly to the wound in a controlled manner, reducing the side effects. Membranes prepared in this study were characterized by X-ray diffraction (XRD), thermogravimetric analysis (TG), swelling, gel fraction, infrared spectroscopy (FTIR), scanning electron microscopy (SEM) and atomic force microscopy (AFM). The characterizations of cytotoxicity and drug release were made 'in vitro' and 'in vivo' with functional test according to ethical protocol of the Division of Infectious and Parasitic Diseases at the Hospital of Clinics, Sao Paulo University-School of Medicine, University. The 'in vivo' test of these membranes proved to be effective in controlled release of drugs directly into leishmaniasis damaged tissues. Results of 'in vivo' tests using PVP/PVAl / clay 1,5% and glucantime membrane showed remarkable contribution to wound reduction and cure in clinical therapy. (author)

  16. [Calcitonin as an alternative treatment for root resorption].

    Science.gov (United States)

    Pierce, A; Berg, J O; Lindskog, S

    1989-01-01

    Inflammatory root resorption is a common finding following trauma and will cause eventual destruction of the tooth root if left untreated. This study examined the effects of intrapulpal application of calcitonin, a hormone known to inhibit osteoclastic bone resorption, on experimental inflammatory root resorption induced in monkeys. Results were histologically evaluated using a morphometric technique and revealed that calcitonin was an effective medicament for the treatment of inflammatory root resorption. It was concluded that this hormone could be a useful therapeutic adjunct in difficult cases of external root resorption.

  17. 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.

  18. 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.

  19. Is exercise an alternative treatment for chronic insomnia?

    Directory of Open Access Journals (Sweden)

    Giselle Soares Passos

    Full Text Available The purposes of this systematic/critical review are: 1 to identify studies on the effects of exercise on chronic insomnia and sleep complaints in middle-aged and older adults and to compare the results of exercise with those obtained with hypnotic medications and 2 to discuss potential mechanisms by which exercise could promote sleep in insomniac patients. We identified studies from 1983 through 2011 using MEDLINE, SCOPUS and Web of Science. For systematic analyses, only studies assessing the chronic effects of exercise on sleep in people with sleep complaints or chronic insomnia were considered. We used the following keywords when searching for articles: insomnia, sleep, sleep complaints, exercise and physical activity. For a critical review, studies were selected on the effects of exercise and possible mechanisms that may explain the effects of exercise on insomnia. We identified five studies that met our inclusion criteria for systematic review. Exercise training is effective at decreasing sleep complaints and insomnia. Aerobic exercise has been more extensively studied, and its effects are similar to those observed after hypnotic medication use. Mechanisms are proposed to explain the effects of exercise on insomnia. There is additional documented evidence on the antidepressant and anti-anxiety effects of exercise. Exercise is effective to decrease sleep complaints and to treat chronic insomnia. Exercise presented similar results when compared with hypnotics; however, prospective studies comparing the effects of exercise with medical and non-medical treatments are warranted before including exercise as a first-line treatment for chronic insomnia are necessary.

  20. 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

  1. 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

  2. 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.

  3. 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.

  4. 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

  5. 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

  6. Benchmarking of Control Strategies for Wastewater Treatment Plants

    DEFF Research Database (Denmark)

    Wastewater treatment plants are large non-linear systems subject to large perturbations in wastewater flow rate, load and composition. Nevertheless these plants have to be operated continuously, meeting stricter and stricter regulations. Many control strategies have been proposed in the literature...

  7. Plant-wide Control Strategy for Improving Produced Water Treatment

    DEFF Research Database (Denmark)

    Yang, Zhenyu; Pedersen, Simon; Løhndorf, Petar Durdevic

    2016-01-01

    This work focuses on investigation and development of an innovative Produced Water Treatment (PWT) technology for offshore oil & gas production by employing the model-based plant-wide control strategy. The key contributions lie in two folds: (i) the advanced anti-slug analysis and control...

  8. Coping Strategies of Women Seeking Infertility Treatment in ...

    African Journals Online (AJOL)

    Infertility is a health problem faced by an estimated 15% of women of childbearing age in Ghana. This study explores the coping strategies adopted by 615 women seeking infertility treatment in southern Ghana. Both closed and open-ended questions were used through a survey conducted using face-to-face interviews in ...

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

    Directory of Open Access Journals (Sweden)

    A. Boudewyns

    2007-12-01

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

  10. 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.

  11. 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.

  12. 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

  13. Cognitive Impairment in Bipolar Disorder: Treatment and Prevention Strategies.

    Science.gov (United States)

    Solé, Brisa; Jiménez, Esther; Torrent, Carla; Reinares, Maria; Bonnin, Caterina Del Mar; Torres, Imma; Varo, Cristina; Grande, Iria; Valls, Elia; Salagre, Estela; Sanchez-Moreno, Jose; Martinez-Aran, Anabel; Carvalho, André F; Vieta, Eduard

    2017-08-01

    Over the last decade, there has been a growing appreciation of the importance of identifying and treating cognitive impairment associated with bipolar disorder, since it persists in remission periods. Evidence indicates that neurocognitive dysfunction may significantly influence patients' psychosocial outcomes. An ever-increasing body of research seeks to achieve a better understanding of potential moderators contributing to cognitive impairment in bipolar disorder in order to develop prevention strategies and effective treatments. This review provides an overview of the available data from studies examining treatments for cognitive dysfunction in bipolar disorder as well as potential novel treatments, from both pharmacological and psychological perspectives. All these data encourage the development of further studies to find effective strategies to prevent and treat cognitive impairment associated with bipolar disorder. These efforts may ultimately lead to an improvement of psychosocial functioning in these patients. © The Author 2017. Published by Oxford University Press on behalf of CINP.

  14. Cognitive Impairment in Bipolar Disorder: Treatment and Prevention Strategies

    Science.gov (United States)

    Solé, Brisa; Jiménez, Esther; Torrent, Carla; Reinares, Maria; Bonnin, Caterina del Mar; Torres, Imma; Varo, Cristina; Grande, Iria; Valls, Elia; Salagre, Estela; Sanchez-Moreno, Jose; Martinez-Aran, Anabel; Carvalho, André F

    2017-01-01

    Abstract Over the last decade, there has been a growing appreciation of the importance of identifying and treating cognitive impairment associated with bipolar disorder, since it persists in remission periods. Evidence indicates that neurocognitive dysfunction may significantly influence patients’ psychosocial outcomes. An ever-increasing body of research seeks to achieve a better understanding of potential moderators contributing to cognitive impairment in bipolar disorder in order to develop prevention strategies and effective treatments. This review provides an overview of the available data from studies examining treatments for cognitive dysfunction in bipolar disorder as well as potential novel treatments, from both pharmacological and psychological perspectives. All these data encourage the development of further studies to find effective strategies to prevent and treat cognitive impairment associated with bipolar disorder. These efforts may ultimately lead to an improvement of psychosocial functioning in these patients. PMID:28498954

  15. 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

  16. Strategies to Combat Antibiotic Resistance in the Wastewater Treatment Plants

    Directory of Open Access Journals (Sweden)

    Fateme Barancheshme

    2018-01-01

    Full Text Available The main goal of this manuscript is to review different treatment strategies and mechanisms for combating the antibiotic resistant bacteria (ARB and antibiotic resistant genes (ARGs in the wastewater environment. The high amount of antibiotics is released into the wastewater that may promote selection of ARB and ARGs which find their way into natural environments. Emerging microbial pathogens and increasing antibiotic resistance among them is a global public health issue. The propagation and spread of ARB and ARGs in the environment may result in an increase of antibiotic resistant microbial pathogens which is a worldwide environmental and public health concern. A proper treatment of wastewater is essential before its discharge into rivers, lake, or sewage system to prevent the spread of ARB and ARGs into the environment. This review discusses various treatment options applied for combating the spread of ARB and ARGs in wastewater treatment plants (WWTPs. It was reported that low-energy anaerobic–aerobic treatment reactors, constructed wetlands, and disinfection processes have shown good removal efficiencies. Nanomaterials and biochar combined with other treatment methods and coagulation process are very recent strategies regarding ARB and ARGs removal and need more investigation and research. Based on current studies a wide-ranging removal efficiency of ARGs can be achieved depending on the type of genes present and treatment processes used, still, there are gaps that need to be further investigated. In order to find solutions to control dissemination of antibiotic resistance in the environment, it is important to (1 study innovative strategies in large scale and over a long time to reach an actual evaluation, (2 develop risk assessment studies to precisely understand occurrence and abundance of ARB/ARGs so that their potential risks to human health can be determined, and (3 consider operating and environmental factors that affect the

  17. 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.

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

    International Nuclear Information System (INIS)

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

    1990-01-01

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

  19. SLUDGE TREATMENT PROJECT PHASE 1 SLUDGE STORAGE OPTIONS. ASSESSMENT OF T PLANT VERSUS ALTERNATE STORAGE FACILITY

    International Nuclear Information System (INIS)

    Rutherford, W.W.; Geuther, W.J.; Strankman, M.R.; Conrad, E.A.; Rhoadarmer, D.D.; Black, D.M.; Pottmeyer, J.A.

    2009-01-01

    The CH2M HILL Plateau Remediation Company (CHPRC) has recommended to the U.S. Department of Energy (DOE) a two phase approach for removal and storage (Phase 1) and treatment and packaging for offsite shipment (Phase 2) of the sludge currently stored within the 105-K West Basin. This two phased strategy enables early removal of sludge from the 105-K West Basin by 2015, allowing remediation of historical unplanned releases of waste and closure of the 100-K Area. In Phase 1, the sludge currently stored in the Engineered Containers and Settler Tanks within the 105-K West Basin will be transferred into sludge transport and storage containers (STSCs). The STSCs will be transported to an interim storage facility. In Phase 2, sludge will be processed (treated) to meet shipping and disposal requirements and the sludge will be packaged for final disposal at a geologic repository. The purpose of this study is to evaluate two alternatives for interim Phase 1 storage of K Basin sludge. The cost, schedule, and risks for sludge storage at a newly-constructed Alternate Storage Facility (ASF) are compared to those at T Plant, which has been used previously for sludge storage. Based on the results of the assessment, T Plant is recommended for Phase 1 interim storage of sludge. Key elements that support this recommendation are the following: (1) T Plant has a proven process for storing sludge; (2) T Plant storage can be implemented at a lower incremental cost than the ASF; and (3) T Plant storage has a more favorable schedule profile, which provides more float, than the ASF. Underpinning the recommendation of T Plant for sludge storage is the assumption that T Plant has a durable, extended mission independent of the K Basin sludge interim storage mission. If this assumption cannot be validated and the operating costs of T Plant are borne by the Sludge Treatment Project, the conclusions and recommendations of this study would change. The following decision-making strategy, which is

  20. SLUDGE TREATMENT PROJECT PHASE 1 SLUDGE STORAGE OPTIONS ASSESSMENT OF T PLANT VERSUS ALTERNATE STORAGE FACILITY

    Energy Technology Data Exchange (ETDEWEB)

    RUTHERFORD WW; GEUTHER WJ; STRANKMAN MR; CONRAD EA; RHOADARMER DD; BLACK DM; POTTMEYER JA

    2009-04-29

    The CH2M HILL Plateau Remediation Company (CHPRC) has recommended to the U.S. Department of Energy (DOE) a two phase approach for removal and storage (Phase 1) and treatment and packaging for offsite shipment (Phase 2) of the sludge currently stored within the 105-K West Basin. This two phased strategy enables early removal of sludge from the 105-K West Basin by 2015, allowing remediation of historical unplanned releases of waste and closure of the 100-K Area. In Phase 1, the sludge currently stored in the Engineered Containers and Settler Tanks within the 105-K West Basin will be transferred into sludge transport and storage containers (STSCs). The STSCs will be transported to an interim storage facility. In Phase 2, sludge will be processed (treated) to meet shipping and disposal requirements and the sludge will be packaged for final disposal at a geologic repository. The purpose of this study is to evaluate two alternatives for interim Phase 1 storage of K Basin sludge. The cost, schedule, and risks for sludge storage at a newly-constructed Alternate Storage Facility (ASF) are compared to those at T Plant, which has been used previously for sludge storage. Based on the results of the assessment, T Plant is recommended for Phase 1 interim storage of sludge. Key elements that support this recommendation are the following: (1) T Plant has a proven process for storing sludge; (2) T Plant storage can be implemented at a lower incremental cost than the ASF; and (3) T Plant storage has a more favorable schedule profile, which provides more float, than the ASF. Underpinning the recommendation of T Plant for sludge storage is the assumption that T Plant has a durable, extended mission independent of the K Basin sludge interim storage mission. If this assumption cannot be validated and the operating costs of T Plant are borne by the Sludge Treatment Project, the conclusions and recommendations of this study would change. The following decision-making strategy, which is

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2017-03-15

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

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

    International Nuclear Information System (INIS)

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

    2017-01-01

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

  3. Effects of ecological restoration alternative treatments on nonnative plant species establishment

    Science.gov (United States)

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

    2008-01-01

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

  4. Strategies and techniques to enhance constructed wetland performance for sustainable wastewater treatment.

    Science.gov (United States)

    Wu, Haiming; Fan, Jinlin; Zhang, Jian; Ngo, Huu Hao; Guo, Wenshan; Liang, Shuang; Hu, Zhen; Liu, Hai

    2015-10-01

    Constructed wetlands (CWs) have been used as an alternative to conventional technologies for wastewater treatment for more than five decades. Recently, the use of various modified CWs to improve treatment performance has also been reported in the literature. However, the available knowledge on various CW technologies considering the intensified and reliable removal of pollutants is still limited. Hence, this paper aims to provide an overview of the current development of CW strategies and techniques for enhanced wastewater treatment. Basic information on configurations and characteristics of different innovations was summarized. Then, overall treatment performance of those systems and their shortcomings were further discussed. Lastly, future perspectives were also identified for specialists to design more effective and sustainable CWs. This information is used to inspire some novel intensifying methodologies, and benefit the successful applications of potential CW technologies.

  5. Environmental assessment of alternative treatment schemes for energy and nutrient recovery from livestock manure.

    Science.gov (United States)

    Pedizzi, C; Noya, I; Sarli, J; González-García, S; Lema, J M; Moreira, M T; Carballa, M

    2018-04-20

    The application of livestock manure on agricultural land is being restricted due to its significant content of phosphorus (P) and nitrogen (N), leading to eutrophication. At the same time, the growing demand for N and P mineral fertilizers is increasing their production costs and causing the depletion of natural phosphate rock deposits. In the present work, seven technologically feasible treatment schemes for energy (biogas) and nutrient recovery (e.g., struvite precipitation) and/or removal (e.g., partial nitritation/anammox) were evaluated from an environmental perspective. In general, while approaches based solely on energy recovery and use of digestate as fertilizer are commonly limited by community regulations, strategies pursuing the generation of high-quality struvite are not environmentally sound alternatives. In contrast, schemes that include further solid/liquid separation of the digestate improved the environmental profile, and their combination with an additional N-removal stage would lead to the most environmental-friendly framework. However, the preferred scenario was identified to be highly dependent on the particular conditions of each site, integrating environmental, social and economic criteria. Copyright © 2018 Elsevier Ltd. All rights reserved.

  6. 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....

  7. Multimodality treatment strategies have changed prognosis of peritoneal metastases

    Science.gov (United States)

    Lungoci, Corneliu; Mironiuc, Aurel Ion; Muntean, Valentin; Oniu, Traian; Leebmann, Hubert; Mayr, Max; Piso, Pompiliu

    2016-01-01

    For a long time, treatment of peritoneal metastases (PM) was mostly palliative and thus, this status was link with “terminal status/despair”. The current multimodal treatment strategy, consisting of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), has been strenuously achieved over time, but seems to be the best treatment option for PM patients. As we reviewed the literature data, we could emphasize some milestones and also, controversies in the history of proposed multimodal treatment and thus, outline the philosophy of this approach, which seems to be an unusual one indeed. Initially marked by nihilism and fear, but benefiting from a remarkable joint effort of human and material resources (multi-center and -institutional research), over a period of 30 years, CRS and HIPEC found their place in the treatment of PM. The next 4 years were dedicated to the refinement of the multimodal treatment, by launching research pathways. In selected patients, with requires training, it demonstrated a significant survival results (similar to the Hepatic Metastases treatment), with acceptable risks and costs. The main debates regarding CRS and HIPEC treatment were based on the oncologists’ perspective and the small number of randomized clinical trials. It is important to statement the PM patient has the right to be informed of the existence of CRS and HIPEC, as a real treatment resource, the decision being made by multidisciplinary teams. PMID:26798438

  8. Strategies for maximizing clinical effectiveness in the treatment of schizophrenia.

    Science.gov (United States)

    Tandon, Rajiv; Targum, Steven D; Nasrallah, Henry A; Ross, Ruth

    2006-11-01

    The ultimate clinical objective in the treatment of schizophrenia is to enable affected individuals to lead maximally productive and personally meaningful lives. As with other chronic diseases that lack a definitive cure, the individual's service/recovery plan must include treatment interventions directed towards decreasing manifestations of the illness, rehabilitative services directed towards enhancing adaptive skills, and social support mobilization aimed at optimizing function and quality of life. In this review, we provide a conceptual framework for considering approaches for maximizing the effectiveness of the array of treatments and other services towards promoting recovery of persons with schizophrenia. We discuss pharmacological, psychological, and social strategies that decrease the burden of the disease of schizophrenia on affected individuals and their families while adding the least possible burden of treatment. In view of the multitude of treatments necessary to optimize outcomes for individuals with schizophrenia, effective coordination of these services is essential. In addition to providing best possible clinical assessment and pharmacological treatment, the psychiatrist must function as an effective leader of the treatment team. To do so, however, the psychiatrist must be knowledgeable about the range of available services, must have skills in clinical-administrative leadership, and must accept the responsibility of coordinating the planning and delivery of this multidimensional array of treatments and services. Finally, the effectiveness of providing optimal individualized treatment/rehabilitation is best gauged by measuring progress on multiple effectiveness domains. Approaches for efficient and reliable assessment are discussed.

  9. 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

  10. 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

  11. 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

  12. [Cotard's syndrome. Different treatment strategies according to subclassification].

    Science.gov (United States)

    Madani, Y; Sabbe, B G C

    2007-01-01

    After performing an exploratory factor analysis, Berrios & Luque (1995) identified three subcategories in the Cotard's syndrome: Cotard type I, Cotard type II and Cotard type psychotic depression. The article, which is based on two case studies and an examination of the relevant literature since 1995, explores whether there are different treatment strategies for Cotard type I and the Cotard type psychotic depression. For the Cotard type psychotic depression, electroconvulsive therapy proves to be an effective method of treatment. For Cotard type I, antipsychotic therapy seems to be sufficient.

  13. Assessment and treatment strategies for rotator cuff tears

    Science.gov (United States)

    Al-Hakim, Wisam; Noorani, Ali

    2014-01-01

    Tears of the rotator cuff are common and becoming an increasingly frequent problem. There is a vast amount of literature on the merits and limitations of the various methods of clinical and radiological assessment of rotator cuff tears. This is also the case with regard to treatment strategies. Certain popular beliefs and principles practiced widely and the basis upon which they are derived may be prone to inaccuracy. We provide an overview of the historical management of rotator cuff tears, as well as an explanation for how and why rotator cuff tears should be managed, and propose a structured methodology for their assessment and treatment. PMID:27582960

  14. Cost-effectiveness analysis of optimal strategy for tumor treatment

    International Nuclear Information System (INIS)

    Pang, Liuyong; Zhao, Zhong; Song, Xinyu

    2016-01-01

    We propose and analyze an antitumor model with combined immunotherapy and chemotherapy. Firstly, we explore the treatment effects of single immunotherapy and single chemotherapy, respectively. Results indicate that neither immunotherapy nor chemotherapy alone are adequate to cure a tumor. Hence, we apply optimal theory to investigate how the combination of immunotherapy and chemotherapy should be implemented, for a certain time period, in order to reduce the number of tumor cells, while minimizing the implementation cost of the treatment strategy. Secondly, we establish the existence of the optimality system and use Pontryagin’s Maximum Principle to characterize the optimal levels of the two treatment measures. Furthermore, we calculate the incremental cost-effectiveness ratios to analyze the cost-effectiveness of all possible combinations of the two treatment measures. Finally, numerical results show that the combination of immunotherapy and chemotherapy is the most cost-effective strategy for tumor treatment, and able to eliminate the entire tumor with size 4.470 × 10"8 in a year.

  15. New strategies for local treatment of vaginal infections.

    Science.gov (United States)

    Palmeira-de-Oliveira, Rita; Palmeira-de-Oliveira, Ana; Martinez-de-Oliveira, José

    2015-09-15

    Vaginal infections are extremely prevalent, particularly among women of reproductive age. Although they do not result in high mortality rates, these infections are associated with high levels of anxiety and reduction of quality of life. In most cases, topical treatment of vaginal infections has been shown to be at least as effective as oral treatment, resulting in higher local drug concentrations, with fewer drug interactions and adverse effects. Furthermore, the emergence of microbial resistance to chemotherapeutics and the difficulties in managing infection recurrences sustain the need for more effective local treatments. However, conventional dosage forms have been associated with low retention in the vagina and discomfort. Formulation strategies such as the development of bioadhesive, thermogelling systems and microtechnological or nanotechnological approaches have been proposed to improve delivery of traditional drugs, and other treatment modalities such as new drugs, plant extracts, and probiotics are being studied. This article reviews the recent strategies studied to improve the treatment and prevention of the commonest vaginal infections-namely, vaginal bacteriosis, aerobic vaginitis, vulvovaginal candidosis, and trichomoniasis-through the intravaginal route. Copyright © 2015 Elsevier B.V. All rights reserved.

  16. 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

  17. Land Disposal Restrictions Treatment Standards: Compliance Strategies for Four Types of Mixed Wastes

    International Nuclear Information System (INIS)

    Fortune, W.B.; Ranek, N.L.

    2006-01-01

    This paper describes the unique challenges involved in achieving compliance with the Resource Conservation and Recovery Act (Public Law 94-580) Land Disposal Restrictions (LDR) treatment standards for four types of mixed wastes generated throughout the U.S. Department of Energy (DOE) complex: (1) radioactively contaminated lead acid batteries; (2) radioactively contaminated cadmium-, mercury-, and silver-containing batteries; (3) mercury-bearing mixed wastes; and (4) radioactive lead solids. For each of these mixed waste types, the paper identifies the strategy pursued by DOE's Office of Pollution Prevention and Resource Conservation Policy and Guidance (EH-43) in coordination with other DOE elements and the U.S. Environmental Protection Agency (EPA) to meet the compliance challenge. Specifically, a regulatory interpretation was obtained from EPA agreeing that the LDR treatment standard for wastes in the D008 'Radioactive Lead Solids' sub-category applies to radioactively contaminated lead acid batteries. For cadmium-, mercury-, and silver-containing batteries, generically applicable treatability variances were obtained from EPA approving macro-encapsulation as the alternative LDR treatment standard for all three battery types. Joint DOE/EPA technology demonstrations were pursued for mercury-bearing mixed wastes in an effort to justify revising the LDR treatment standards, which focus on thermal recovery of mercury for reuse. Because the demonstrations failed to produce enough supporting data for a rulemaking, however, EPA has recommended site-specific treatability variances for particular mercury-bearing mixed waste streams. Finally, DOE has filed an application for a determination of equivalent treatment requesting approval of container-based macro-encapsulation technologies as an alternative LDR treatment standard for radioactive lead solids. Information is provided concerning the length of time required to implement each of these strategies, and suggestions for

  18. Multistrain models predict sequential multidrug treatment strategies to result in less antimicrobial resistance than combination treatment

    DEFF Research Database (Denmark)

    Ahmad, Amais; Zachariasen, Camilla; Christiansen, Lasse Engbo

    2016-01-01

    generated by a mathematical model of the competitive growth of multiple strains of Escherichia coli.Results: Simulation studies showed that sequential use of tetracycline and ampicillin reduced the level of double resistance, when compared to the combination treatment. The effect of the cycling frequency...... frequency did not play a role in suppressing the growth of resistant strains, but the specific order of the two antimicrobials did. Predictions made from the study could be used to redesign multidrug treatment strategies not only for intramuscular treatment in pigs, but also for other dosing routes.......Background: Combination treatment is increasingly used to fight infections caused by bacteria resistant to two or more antimicrobials. While multiple studies have evaluated treatment strategies to minimize the emergence of resistant strains for single antimicrobial treatment, fewer studies have...

  19. 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

  20. 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.

  1. 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.

  2. 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

  3. 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

  4. 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

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

    Science.gov (United States)

    Kim, David D; Basu, Anirban

    2017-11-01

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

  6. Treatment strategy for a multidrug-resistant Klebsiella UTI.

    Science.gov (United States)

    Fleming, Erin; Heil, Emily L; Hynicka, Lauren M

    2014-01-01

    To describe the management strategy for a multidrug-resistant (MDR) Klebsiella urinary tract infection (UTI). A 69-year-old Caucasian woman with a past medical history of recurrent UTIs and a right-lung transplant presented with fever to 101.4°F, chills, malaise, and cloudy, foul-smelling urine for approximately 1 week. She was found to have a MDR Klebsiella UTI that was sensitive to tigecycline and cefepime. To further evaluate the degree of resistance Etest minimum inhibitory concentrations were requested for cefepime, amikacin, meropenem, and ertapenem. The patient received a 14-day course of amikacin, which resulted in resolution of her symptoms. One month later, the patient's UTI symptoms returned. The urine culture again grew MDR Klebsiella, sensitive only to tigecycline. Fosfomycin was initiated and resulted in limited resolution of her symptoms. Colistin was started, however, therapy was discontinued on day 5 secondary to the development of acute kidney injury. Despite the short course of therapy, the patient's symptoms resolved. The case presented lends itself well to numerous discussion items that are important to consider when determining optimal treatment for MDR Gram-negative bacilli (GNBs). Susceptibility testing is an important tool for optimizing antibiotic therapy, however, automated systems may overestimate the susceptibility profile for a MDR GNB. Treatment strategies evaluated to treat MDR GNB, include combination therapy with a carbepenem and synergy using polymyxin. We have described the management strategy for a MDR Klebsiella UTI, the consequences of the initial management strategy, and potential strategies to manage these types of infections in future patients.

  7. 4D Proton treatment planning strategy for mobile lung tumors

    International Nuclear Information System (INIS)

    Kang Yixiu; Zhang Xiaodong; Chang, Joe Y.; Wang He; Wei Xiong; Liao Zhongxing; Komaki, Ritsuko; Cox, James D.; Balter, Peter A.; Liu, Helen; Zhu, X. Ronald; Mohan, Radhe; Dong Lei

    2007-01-01

    Purpose: To investigate strategies for designing compensator-based 3D proton treatment plans for mobile lung tumors using four-dimensional computed tomography (4DCT) images. Methods and Materials: Four-dimensional CT sets for 10 lung cancer patients were used in this study. The internal gross tumor volume (IGTV) was obtained by combining the tumor volumes at different phases of the respiratory cycle. For each patient, we evaluated four planning strategies based on the following dose calculations: (1) the average (AVE) CT; (2) the free-breathing (FB) CT; (3) the maximum intensity projection (MIP) CT; and (4) the AVE CT in which the CT voxel values inside the IGTV were replaced by a constant density (AVE R IGTV). For each strategy, the resulting cumulative dose distribution in a respiratory cycle was determined using a deformable image registration method. Results: There were dosimetric differences between the apparent dose distribution, calculated on a single CT dataset, and the motion-corrected 4D dose distribution, calculated by combining dose distributions delivered to each phase of the 4DCT. The AVE R IGTV plan using a 1-cm smearing parameter had the best overall target coverage and critical structure sparing. The MIP plan approach resulted in an unnecessarily large treatment volume. The AVE and FB plans using 1-cm smearing did not provide adequate 4D target coverage in all patients. By using a larger smearing value, adequate 4D target coverage could be achieved; however, critical organ doses were increased. Conclusion: The AVE R IGTV approach is an effective strategy for designing proton treatment plans for mobile lung tumors

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

    International Nuclear Information System (INIS)

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

    1986-09-01

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

  9. 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

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

    Directory of Open Access Journals (Sweden)

    Jacob Ablin

    2013-01-01

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

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

    Science.gov (United States)

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

    2013-01-01

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

  12. Attention Deficit Hyperactive Disorder: Alternative Treatment Plans for School Age Children Diagnosed with ADHD.

    Science.gov (United States)

    Carbonell, Claudia L.

    This literature review of attention deficit hyperactivity disorder (ADHD) reviews the diagnosis and treatment options for children diagnosed with ADHD. It describes the complexity of ADHD, its symptoms, treatments, and implications on a child's social and academic development as well as strategies for assisting such children. Individual sections…

  13. Modeling Test and Treatment Strategies for Presymptomatic Alzheimer Disease

    Science.gov (United States)

    Burke, James F.; Langa, Kenneth M.; Hayward, Rodney A.; Albin, Roger L.

    2014-01-01

    Objectives In this study, we developed a model of presymptomatic treatment of Alzheimer disease (AD) after a screening diagnostic evaluation and explored the circumstances required for an AD prevention treatment to produce aggregate net population benefit. Methods Monte Carlo simulation methods were used to estimate outcomes in a simulated population derived from data on AD incidence and mortality. A wide variety of treatment parameters were explored. Net population benefit was estimated in aggregated QALYs. Sensitivity analyses were performed by individually varying the primary parameters. Findings In the base-case scenario, treatment effects were uniformly positive, and net benefits increased with increasing age at screening. A highly efficacious treatment (i.e. relative risk 0.6) modeled in the base-case is estimated to save 20 QALYs per 1000 patients screened and 221 QALYs per 1000 patients treated. Conclusions Highly efficacious presymptomatic screen and treat strategies for AD are likely to produce substantial aggregate population benefits that are likely greater than the benefits of aspirin in primary prevention of moderate risk cardiovascular disease (28 QALYS per 1000 patients treated), even in the context of an imperfect treatment delivery environment. PMID:25474698

  14. Thymic epithelial tumours: from basic principles to individualised treatment strategies

    Directory of Open Access Journals (Sweden)

    Nicolas Girard

    2013-03-01

    Full Text Available Thymic epithelial tumours represent a wide range of anatomical, clinical, histological and molecular malignant entities that may be aggressive and difficult to treat. The histopathological classification distinguishes thymomas from thymic carcinomas. Thymomas may be associated with autoimmune disorders. The management of thymic epithelial tumours is a paradigm of co-operation between clinicians, surgeons and pathologists, from establishing the diagnosis to organising the multimodal therapeutic strategy. Surgery is the mainstay of the curative-intent treatment, as complete resection represents the most significantly favourable prognostic factor on overall survival. In case of invasion of intra-thoracic structures and/or dissemination to the pleura and the pericardium, precluding complete resection to be achieved, primary chemotherapy has been used to reduce the tumour burden, possibly allowing subsequent surgery and/or radiotherapy. Novel strategies are needed, especially for refractory, recurrent tumours and thymic carcinomas, which carry a poor prognosis. Personalised approaches are currently being developed, as potentially “druggable” molecular targets are emerging from recent integrated genomic analyses. Along with the large variety of questions relative to the treatment strategy, thymic epithelial tumours represent a model of therapeutic implementation and achievement in orphan thoracic oncology, showing how the advent of new results induces new questions, as well as diversifies further clinical research directions and international collaborative initiatives.

  15. Up to date knowledge on different treatment strategies for phenylketonuria

    Science.gov (United States)

    Bélanger-Quintana, Amaya; Burlina, Alberto; Harding, Cary O.; Muntau, Ania C.

    2015-01-01

    Dietary management for phenylketonuria was established over half a century ago, and has rendered an immense success in the prevention of the severe mental retardation associated with the accumulation of phenylalanine. However, the strict low-phenylalanine diet has several shortcomings, not the least of which is the burden it imposes on the patients and their families consequently frequent dietary non-compliance. Imperfect neurological outcome of patients in comparison to non-PKU individuals and nutritional deficiencies associated to the PKU diet are other important reasons to seek alternative therapies. In the last decade there has been an impressive effort in the investigation of other ways to treat PKU that might improve the outcome and quality of life of these patients. These studies have lead to the commercialization of sapropterin dihydrochloride, but there are still many questions regarding which patients to challenge with sapropterin what is the best challenge protocol and what could be the implications of this treatment in the long-term. Current human trials of PEGylated phenylalanine ammonia lyase are underway, which might render an alternative to diet for those patients non-responsive to sapropterin dihydrochloride. Preclinical investigation of gene and cell therapies for PKU is ongoing. In this manuscript, we will review the current knowledge on novel pharmacologic approaches to the treatment of phenylketonuria. PMID:21967857

  16. Multi-criteria evaluation of wastewater treatment plant control strategies under uncertainty.

    Science.gov (United States)

    Flores-Alsina, Xavier; Rodríguez-Roda, Ignasi; Sin, Gürkan; Gernaey, Krist V

    2008-11-01

    The evaluation of activated sludge control strategies in wastewater treatment plants (WWTP) via mathematical modelling is a complex activity because several objectives; e.g. economic, environmental, technical and legal; must be taken into account at the same time, i.e. the evaluation of the alternatives is a multi-criteria problem. Activated sludge models are not well characterized and some of the parameters can present uncertainty, e.g. the influent fractions arriving to the facility and the effect of either temperature or toxic compounds on the kinetic parameters, having a strong influence in the model predictions used during the evaluation of the alternatives and affecting the resulting rank of preferences. Using a simplified version of the IWA Benchmark Simulation Model No. 2 as a case study, this article shows the variations in the decision making when the uncertainty in activated sludge model (ASM) parameters is either included or not during the evaluation of WWTP control strategies. This paper comprises two main sections. Firstly, there is the evaluation of six WWTP control strategies using multi-criteria decision analysis setting the ASM parameters at their default value. In the following section, the uncertainty is introduced, i.e. input uncertainty, which is characterized by probability distribution functions based on the available process knowledge. Next, Monte Carlo simulations are run to propagate input through the model and affect the different outcomes. Thus (i) the variation in the overall degree of satisfaction of the control objectives for the generated WWTP control strategies is quantified, (ii) the contributions of environmental, legal, technical and economic objectives to the existing variance are identified and finally (iii) the influence of the relative importance of the control objectives during the selection of alternatives is analyzed. The results show that the control strategies with an external carbon source reduce the output uncertainty

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-04-01

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

  18. Treatability studies of alternative wastewaters for Metal Finishing Effluent Treatment Facility

    International Nuclear Information System (INIS)

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

    1994-01-01

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

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

    Science.gov (United States)

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

    2016-04-01

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

  20. Nitrate control strategies in an activated sludge wastewater treatment process

    Energy Technology Data Exchange (ETDEWEB)

    Shen, Wenhao; Tao, Erpan; Chen, Xiaoquan; Liu, Dawei [South China University of Technology, Guangzhou (China); Liu, Hongbin [Kyung Hee University, Yongin (Korea, Republic of)

    2014-03-15

    We studied nitrate control strategies in an activated sludge wastewater treatment process (WWTP) based on the activated sludge model. Two control strategies, back propagation for proportional-integral-derivative (BP-PID) and adaptive-network based fuzzy inference systems (ANFIS), are applied in the WWTP. The simulation results show that the simple local constant setpoint control has poor control effects on the nitrate concentration control. However, the ANFIS (4*1) controller, which considers not only the local constant setpoint control of the nitrate concentration, but also three important indices in the effluent--ammonia concentration, total suspended sludge concentration and total nitrogen concentration--demonstrates good control performance. The results also prove that ANFIS (4*1) controller has better control performance than that of the controllers PI, BP-PID and ANFIS (2*1), and that the ANFIS (4*1) controller is effective in improving the effluent quality and maintaining the stability of the effluent quality.

  1. 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.

  2. 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.

  3. Our Approach to Toxic Epidermal Necrolysis and Review of Current Treatment Alternatives

    Directory of Open Access Journals (Sweden)

    Fatih Uygur

    2008-09-01

    Full Text Available Toxic epidermal necrolysis (TEN is a clinical entity which has a 30 to 40 % mortality rate, with necrolysis affecting the entire epidermis. Antibiotics, nonsteroidal anti-inflammatory drugs and anticonvulsants are offender drugs in TEN etiology. A standard treatment protocol with proven efficacy is still lacking. In this study, current treatment practice and our treatment strategy for TEN is discussed and eight patients treated in our clinic between the years 2001 and 2008 are reviewed.

  4. 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.

  5. Friction Surface Treatment Selection: Aggregate Properties, Surface Characteristics, Alternative Treatments, and Safety Effects

    Science.gov (United States)

    2017-07-01

    This study aimed to evaluate the long term performance of the selected surface friction treatments, including high friction surface treatment (HFST) using calcined bauxite and steel slag, and conventional friction surfacing, in particular pavement pr...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-06-15

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

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

    Science.gov (United States)

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

    2017-05-01

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

  8. Evidence-based evaluation of treatment strategy for multiple sclerosis

    Directory of Open Access Journals (Sweden)

    LI Meng-qiu

    2012-04-01

    Full Text Available Objective To formulate the best treatment plan for multiple sclerosis (MS patients by evaluating the therapeutic efficacy and side effect of various evidence-based programs. Methods Key words were defined as multiple sclerosis, immunomodulatory therapy and therapy, etc. We searched MEDLINE, Cochrane Library, Wanfang data bases for Scientific Journals in China and National Knowledge Infrastructure for Chinese Scientific Journals Database. Additionally, we applied manual searching and screened out conference paper and academic dissertation, etc, from various references. After that we obtained and evaluated by Jadad scales on systematic reviews, randomized controlled trials, controlled clinical trials and observational study cases about glucocorticoids, plasmapheresis, intravenous immunoglobulin, IFN-β, glatiramer acetate, mitoxantrone, natalizumab, fingolimod. Results After screening, all seventeen selected resources included systematic reviews 6 articles, randomized controlled trials 7 articles, controlled clinical trials 2 articles, observational study cases 2 articles, among which fifteen articles were proved to be high quality (according to Jadad scoring system, five score 4, six score 5, four score 7, two chapters were judged to be low quality scoring 3. Finally, we summerize that: 1 The first choice of treatment for acute relapses is glucocorticoids and we suggest that plasmapheresis or intravenous immunoglobulin may be tried as an alternative therapy in acute MS relapse, especially in case of contraindications to intravenous methylprednisolone. 2 Immunomodulatory or immunosuppressive treatment (IFN-β, glatiramer acetate, mitoxantrone, natalizumab can be an option to prevent new relapses and progression of disability. 3 Fingolimod is an oral treatment for multiple sclerosis to improve treatment adherence. Conclusion Using evidence-based medicine methods can provide us best clinical evidence on MS treatment.

  9. Oligometastatic non-small-cell lung cancer: current treatment strategies

    Directory of Open Access Journals (Sweden)

    Richard PJ

    2016-11-01

    Full Text Available Patrick J Richard, Ramesh Rengan Department of Radiation Oncology, University of Washington, Seattle, WA, USA Abstract: The oligometastatic disease theory was initially described in 1995 by Hellman and Weichselbaum. Since then, much work has been performed to investigate its existence in many solid tumors. This has led to subclassifications of stage IV cancer, which could redefine our treatment approaches and the therapeutic outcomes for this historically “incurable” entity. With a high incidence of stage IV disease, non-small-cell lung cancer (NSCLC remains a difficult cancer to treat and cure. Recent work has proven the existence of an oligometastatic state in NSCLC in terms of properly selecting patients who may benefit from aggressive therapy and experience long-term overall survival. This review discusses the current treatment approaches used in oligometastatic NSCLC and provides the evidence and rationale for each approach. The prognostic factors of many trials are discussed, which can be used to properly select patients for aggressive treatment regimens. Future advances in both molecular profiling of NSCLC to find targetable mutations and investigating patient selection may increase the number of patients diagnosed with oligometastatic NSCLC. As this disease entity increases, it is of utmost importance for oncologists treating NSCLC to be aware of the current treatment strategies that exist and the potential advantages/disadvantages of each. Keywords: oligometastatic, non-small-cell lung cancer, oligoprogressive, treatment

  10. Energy Efficiency Strategies for Municipal Wastewater Treatment Facilities

    Energy Technology Data Exchange (ETDEWEB)

    Daw, J.; Hallett, K.; DeWolfe, J.; Venner, I.

    2012-01-01

    Water and wastewater systems are significant energy consumers with an estimated 3%-4% of total U.S. electricity consumption used for the movement and treatment of water and wastewater. Water-energy issues are of growing importance in the context of water shortages, higher energy and material costs, and a changing climate. In this economic environment, it is in the best interest for utilities to find efficiencies, both in water and energy use. Performing energy audits at water and wastewater treatment facilities is one way community energy managers can identify opportunities to save money, energy, and water. In this paper the importance of energy use in wastewater facilities is illustrated by a case study of a process energy audit performed for Crested Butte, Colorado's wastewater treatment plant. The energy audit identified opportunities for significant energy savings by looking at power intensive unit processes such as influent pumping, aeration, ultraviolet disinfection, and solids handling. This case study presents best practices that can be readily adopted by facility managers in their pursuit of energy and financial savings in water and wastewater treatment. This paper is intended to improve community energy managers understanding of the role that the water and wastewater sector plays in a community's total energy consumption. The energy efficiency strategies described provide information on energy savings opportunities, which can be used as a basis for discussing energy management goals with water and wastewater treatment facility managers.

  11. [The clinical features and surgical treatment strategies of cervical kyphosis].

    Science.gov (United States)

    Fang, Jia-hu; Jia, Lian-shun; Zhou, Xu-hui; Song, Li-jun; Cai, Wei-hua; Li, Xiang

    2010-10-15

    To analyze the clinical characteristics and the surgical treatment strategy of cervical kyphosis. From March 2006 to October 2009, 31 cases of cervical kyphosis were treated. According to the clinical features and imaging findings, different treatment methods were used. There were 9 patients in operation group, including 4 male and 5 female patients, aged from 17 to 72 years (average age of 35 years). Among them, 5 cases were idiopathic kyphosis and 4 cases were caused by laminectomy or other reasons. There were 22 patients in conservative treatment group, including 11 male and 11 female patients, aged from 14 to 40 years (average age of 29 years), who were all idiopathic cervical kyphosis. Before and 1 week after operation, clinical assessment were taken for the patients in operation group using Spinal Cord Injuries Classification Standard of American Spinal Injury Association (AISA). During the periodic review, the anteroposterior, normal sagittal films of cervical spine were taken. At 1 week and every 6 months after operation, MRI films were also taken. These films were studied to evaluate the effects of the operations. In the conservative group, assessment of treatment results by studying anteroposterior and normal lateral views of cervical spine were were taken every month. The clinical characteristics and the surgical treatment strategies of these patients were analyzed. In operation group, 9 cases were followed up for 6 to 18 months, all patients did not failed in internal fixation and fusion. AISA neurological score and neurological function significantly improved. Three days after operation the average Cobb angle was -1.29 ° (preoperative 54.24 °). In conservative group, the average Cobb angle was -5.41 ° (before treatment 11.20 °) 4 months after the treatment. The symptoms of neck shoulder and back pain disappeared, and all patients were followed up for 3 to 24 months, with no recurrence of symptoms. In the early period of cervical kyphosis, adopt

  12. Treatment strategy for trigeminal neuralgia: a thirty years experience.

    Science.gov (United States)

    Broggi, Giovanni; Ferroli, Paolo; Franzini, Angelo

    2008-05-01

    Trigeminal neuralgia is an invalidating disease when become drug-resistant. The only possible treatment is surgery with different modalities, percutaneous, open surgery or radiosurgery. The thirty years experience at the Fondazione Istituto Neurologico C. Besta, Milano, Italy suggests that these surgical strategies are successful in pain control in short and long term period in more than 90% of cases, with a low rate of side effects and high improvement of quality of life. The type of surgery should be tailored on the particular patient considering age, general physical condition, neuroradiological assessment in which MRI with dedicated sequences are mandatory, and also patient's attitude.

  13. Long range personalized cancer treatment strategies incorporating evolutionary dynamics.

    Science.gov (United States)

    Yeang, Chen-Hsiang; Beckman, Robert A

    2016-10-22

    Current cancer precision medicine strategies match therapies to static consensus molecular properties of an individual's cancer, thus determining the next therapeutic maneuver. These strategies typically maintain a constant treatment while the cancer is not worsening. However, cancers feature complicated sub-clonal structure and dynamic evolution. We have recently shown, in a comprehensive simulation of two non-cross resistant therapies across a broad parameter space representing realistic tumors, that substantial improvement in cure rates and median survival can be obtained utilizing dynamic precision medicine strategies. These dynamic strategies explicitly consider intratumoral heterogeneity and evolutionary dynamics, including predicted future drug resistance states, and reevaluate optimal therapy every 45 days. However, the optimization is performed in single 45 day steps ("single-step optimization"). Herein we evaluate analogous strategies that think multiple therapeutic maneuvers ahead, considering potential outcomes at 5 steps ahead ("multi-step optimization") or 40 steps ahead ("adaptive long term optimization (ALTO)") when recommending the optimal therapy in each 45 day block, in simulations involving both 2 and 3 non-cross resistant therapies. We also evaluate an ALTO approach for situations where simultaneous combination therapy is not feasible ("Adaptive long term optimization: serial monotherapy only (ALTO-SMO)"). Simulations utilize populations of 764,000 and 1,700,000 virtual patients for 2 and 3 drug cases, respectively. Each virtual patient represents a unique clinical presentation including sizes of major and minor tumor subclones, growth rates, evolution rates, and drug sensitivities. While multi-step optimization and ALTO provide no significant average survival benefit, cure rates are significantly increased by ALTO. Furthermore, in the subset of individual virtual patients demonstrating clinically significant difference in outcome between

  14. [Effective treatment strategy in elderly breast cancer patients].

    Science.gov (United States)

    Boér, Katalin

    2005-01-02

    High frequency of cancer in older people and the improvements in life expectancy do not allow older age to be a barrier to treatment. The age is one of the risk factors for breast cancer development, one third of all cases occur in women older than 70 years. To provide an overview of the available information on the main issues in the field of surgery, radiotherapy and medical approaches to the treatment of breast cancer in the elderly. The author discusses the treatment of breast cancer in the elderly, based on the data of literature. The assessment of any patient is the first step in the treatment process, performance status is more important than age. In older women a correct evaluation includes not only the basic medical history and the cancer staging, but also a detailed assessment of health and environment that may interfere with the therapeutic approach of the patient. Age is not a limitation for surgery, without any comorbidity it is safe, and operative mortality is low. The body self-image is important for most old women, they also wish to keep their breasts, so a conservative surgery and adjuvant radiotherapy should be offered to all, as long as the stage permits it. The selection of patients who are candidates for axillary dissection is based on selective lymph sentinel node technique which provides an optimal nodal staging with a minimal morbidity. The results of radiotherapy are as good as in younger patients, elderly women tolerate radiotherapy well. The inability to travel to the radiation facility is often the reason for omitting the radiation treatment and to choose a modified mastectomy. A promising alternative to the standard radiation treatment is the concept of intraoperative radiotherapy. Breast cancer in the elderly women is more likely to be well differentiated tumour, containing oestrogen and progesterone receptors. Based on these favourable prognostic factors, endocrine therapy is the standard treatment in adjuvant and metastatic setting

  15. Strategies for prevention and treatment of staphylococcal biofilms

    DEFF Research Database (Denmark)

    Meyer, Rikke Louise

    Biofilm formation by bacteria that colonize biomedical implants cause infections that cannot be eradicated by antibiotic therapy. Bacteria in biofilms are tolerant to every antibiotic known today, and this tolerance is partly due to their low metabolic activity, the occurrence of persister cells...... in biofilms. Innovative biomaterials may at best delay biofilm formation and an important question in this context is to understand how the material can contribute to more successful antibiotic treatment by not providing the cues that trigger the onset of antibiotic tolerance in the attached bacteria...... treatments that more effectively tackle biofilm infections. We have explored how the combination of antibiotic therapy with matrix-targeting enzymes can enhance the efficacy of antibiotics. The matrix composition is highly variable among different bacterial species, and this strategy will not produce a one...

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

    Science.gov (United States)

    Opher, Tamar; Friedler, Eran

    2016-11-01

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

  17. Treatment strategies for childhood noninfectious chronic uveitis: an update.

    Science.gov (United States)

    Cantarini, Luca; Simonini, Gabriele; Frediani, Bruno; Pagnini, Ilaria; Galeazzi, Mauro; Cimaz, Rolando

    2012-01-01

    Uveitis is an inflammatory disorder involving inflammation of the uveal tract. It is classified as anterior, intermediate, posterior or panuveitis, depending on the part of eye affected by the inflammatory process. In children, noninfectious, chronic uveitis is a relatively uncommon but serious disease, with the potential for significant long-term complications and possible blindness. Although frequently associated with an underlying systemic disease, for example, juvenile idiopathic arthritis, a significant number of cases in children show no associated signs or symptoms and are labeled as idiopathic. We reviewed the available literature. Taking into account this evidence, an anti-inflammatory therapy based on an immunomodulatory approach seems a reasonable strategy for noninfectious chronic uveitis, in children as well as in adults. Due to a lack of controlled studies regarding uveitis in children, immunosuppressive strategy is supported only at evidence level III. Our aim is to review the currently available medical strategies for the treatment of childhood sight-threatening chronic uveitis. Uveitis in children can be severe. Methotrexate is the drug of choice for recalcitrant cases, and biologic therapies can be useful in selected situations.

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

    Science.gov (United States)

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

    2009-01-01

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

  19. Treatment in chronic migraine: choice of reabilitation strategies

    Directory of Open Access Journals (Sweden)

    Ioana STANESCU

    2015-12-01

    started with topiramate, because the drug has the highest level of evidence in treating CM; Onabotulinumtoxin A reduced the number headache days, headache severity, headache-related disability and improved functioning and quality of life. Additionally, complementary and alternative medicine treatments are available in CM prophylaxis, such as biobehavioral techniques (relaxation training, thermal biofeedback, electromyography feedback and cognitive-behavioral therapy. Invasive and non-invasive neurostimulation techniques have been studied in the treatment and prevention of various types of headaches, including chronic migraine. New treatment options for acute attacks and for prevention include calcitonin gene-related peptide (CGRP antagonists and antibodies.

  20. Noninfectious uveitis: strategies to optimize treatment compliance and adherence

    Directory of Open Access Journals (Sweden)

    Dolz-Marco R

    2015-08-01

    Full Text Available Rosa Dolz-Marco,1 Roberto Gallego-Pinazo,1 Manuel Díaz-Llopis,2 Emmett T Cunningham Jr,3–6 J Fernando Arévalo7,8 1Unit of Macula, Department of Ophthalmology, University and Polytechnic Hospital La Fe, 2Faculty of Medicine, University of Valencia, Spain; 3Department of Ophthalmology, California Pacific Medical Center, San Francisco, 4Department of Ophthalmology, Stanford University School of Medicine, Stanford, 5The Francis I Proctor Foundation, University of California San Francisco Medical Center, 6West Coast Retina Medical Group, San Francisco, CA, USA; 7Vitreoretina Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 8Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Noninfectious uveitis includes a heterogenous group of sight-threatening ocular and systemic disorders. Significant progress has been made in the treatment of noninfectious uveitis in recent years, particularly with regard to the effective use of corticosteroids and non-corticosteroid immunosuppressive drugs, including biologic agents. All of these therapeutic approaches are limited, however, by any given patient’s ability to comply with and adhere to their prescribed treatment. In fact, compliance and adherence are among the most important patient-related determinants of treatment success. We discuss strategies to optimize compliance and adherence. Keywords: noninfectious uveitis, intraocular inflammation, immunosuppressive treatment, adherence, compliance, therapeutic failure

  1. Advances in Risk Classification and Treatment Strategies for Neuroblastoma

    Science.gov (United States)

    Pinto, Navin R.; Applebaum, Mark A.; Volchenboum, Samuel L.; Matthay, Katherine K.; London, Wendy B.; Ambros, Peter F.; Nakagawara, Akira; Berthold, Frank; Schleiermacher, Gudrun; Park, Julie R.; Valteau-Couanet, Dominique; Pearson, Andrew D.J.

    2015-01-01

    Risk-based treatment approaches for neuroblastoma have been ongoing for decades. However, the criteria used to define risk in various institutional and cooperative groups were disparate, limiting the ability to compare clinical trial results. To mitigate this problem and enhance collaborative research, homogenous pretreatment patient cohorts have been defined by the International Neuroblastoma Risk Group classification system. During the past 30 years, increasingly intensive, multimodality approaches have been developed to treat patients who are classified as high risk, whereas patients with low- or intermediate-risk neuroblastoma have received reduced therapy. This treatment approach has resulted in improved outcome, although survival for high-risk patients remains poor, emphasizing the need for more effective treatments. Increased knowledge regarding the biology and genetic basis of neuroblastoma has led to the discovery of druggable targets and promising, new therapeutic approaches. Collaborative efforts of institutions and international cooperative groups have led to advances in our understanding of neuroblastoma biology, refinements in risk classification, and stratified treatment strategies, resulting in improved outcome. International collaboration will be even more critical when evaluating therapies designed to treat small cohorts of patients with rare actionable mutations. PMID:26304901

  2. Osteoarthritis: detection, pathophysiology, and current/future treatment strategies.

    Science.gov (United States)

    Sovani, Sujata; Grogan, Shawn P

    2013-01-01

    Osteoarthritis (OA) is a disease of the joint, and age is the major risk factor for its development. Clinical manifestation of OA includes joint pain, stiffness, and loss of mobility. Currently, no pharmacological treatments are available to treat this specific joint disease; only symptom-modifying drugs are available. Improvement in imaging technology, identification of biomarkers, and increased understanding of the molecular basis of OA will aid in detecting the early stages of disease. Yet the development of interventional strategies remains elusive and will be critical for effective prevention of OA-associated joint destruction. The potential of cell-based therapies may be applicable in improving joint function in mild to more advanced cases of OA. Ongoing studies to understand the basis of this disease will eventually lead to prevention and treatment strategies and will also be a key in reducing the social and economic burden of this disease. Nurses are advised to provide an integrative approach of disease assessment and management in OA patients' care with a focus on education and implementation. Knowledge and understanding of OA and how this affects the individual patient form the basis for such an integrative approach to all-round patient care and disease management.

  3. Targeting oncogenic Myc as a strategy for cancer treatment.

    Science.gov (United States)

    Chen, Hui; Liu, Hudan; Qing, Guoliang

    2018-01-01

    The MYC family oncogene is deregulated in >50% of human cancers, and this deregulation is frequently associated with poor prognosis and unfavorable patient survival. Myc has a central role in almost every aspect of the oncogenic process, orchestrating proliferation, apoptosis, differentiation, and metabolism. Although Myc inhibition would be a powerful approach for the treatment of many types of cancers, direct targeting of Myc has been a challenge for decades owing to its "undruggable" protein structure. Hence, alternatives to Myc blockade have been widely explored to achieve desirable anti-tumor effects, including Myc/Max complex disruption, MYC transcription and/or translation inhibition, and Myc destabilization as well as the synthetic lethality associated with Myc overexpression. In this review, we summarize the latest advances in targeting oncogenic Myc, particularly for cancer therapeutic purposes.

  4. 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.

  5. Novel Strategies in the Prevention and Treatment of Urinary Tract Infections

    Science.gov (United States)

    Lüthje, Petra; Brauner, Annelie

    2016-01-01

    Urinary tract infections are one of the most common bacterial infections, especially in women and children, frequently treated with antibiotics. The alarming increase in antibiotic resistance is a global threat to future treatment of infections. Therefore, alternative strategies are urgently needed. The innate immune system plays a fundamental role in protecting the urinary tract from infections. Antimicrobial peptides form an important part of the innate immunity. They are produced by epithelial cells and neutrophils and defend the urinary tract against invading bacteria. Since efficient resistance mechanisms have not evolved among bacterial pathogens, much effort has been put into exploring the role of antimicrobial peptides and possibilities to utilize them in clinical practice. Here, we describe the impact of antimicrobial peptides in the urinary tract and ways to enhance the production by hormones like vitamin D and estrogen. We also discuss the potential of medicinal herbs to be used in the prophylaxis and the treatment of urinary tract infections. PMID:26828523

  6. Alternative Wastewater Treatment: On-Site Bio-treatment Wetlands at the Fernald Preserve Visitors Center

    International Nuclear Information System (INIS)

    Homer, J.; Glassmeyer, C.; Sauer, N.; Powell, J.

    2009-01-01

    This paper describes the design and operation of a constructed on-site bio-treatment wetland at the Fernald Preserve Visitors Center. The use of constructed wetlands for treatment of domestic wastewater at the Fernald Preserve contributed to the award of Leadership in Energy and Environmental Design platinum certification from the U.S. Green Building Council. (authors)

  7. Estimation of dynamic treatment strategies for maintenance therapy of children with acute lymphoblastic leukaemia: an application of history-adjusted marginal structural models

    DEFF Research Database (Denmark)

    Rosthøj, Susanne; Keiding, Niels; Schmiegelow, Kjeld

    2012-01-01

    Childhood acute lymphoblastic leukaemia is treated with long-term intensive chemotherapy. During the latter part of the treatment, the maintenance therapy, the patients receive oral doses of two cytostatics. The doses are tailored to blood counts measured on a weekly basis, and the treatment is t...... of the methods in relation to the formulation of alternative dosing strategies for the maintenance therapy....

  8. Exploring Diversification as A Management Strategy in Substance Use Disorder Treatment Organizations.

    Science.gov (United States)

    Fields, Dail; Riesenmy, Kelly; Roman, Paul M

    2015-10-01

    Implementation of the Affordable Care Act (ACA) creates both environmental uncertainties and opportunities for substance use disorder (SUD) treatment providers. One managerial response to uncertainties and emergent opportunities is strategic diversification of various dimensions of organizational activity. This paper explored organizational outcomes related to diversification of funding sources, services offered, and referral sources in a national sample of 590 SUD treatment organizations. Funding diversification was related to higher average levels of census, organization size, and recent expansion of operations. Service diversification was related to higher average levels of use of medication-assisted treatment (MAT), organization size, and expansion. Referral source diversification was related only to greater average use of MAT. Overall, strategic diversification in the three areas explored was related to positive organizational outcomes. Considering alternative strategies of diversification may help position SUD treatment centers to deliver more innovative treatments such as MAT as well as enhance capacity to satisfy current unmet treatment needs of individuals with behavioral health coverage provided under the ACA. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    International Nuclear Information System (INIS)

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

    2005-01-01

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

  10. 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...

  11. DOE evaluates nine alternative thermal technologies for treatment of mixed waste

    International Nuclear Information System (INIS)

    Anon.

    1995-01-01

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

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

    International Nuclear Information System (INIS)

    1976-05-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    1976-05-01

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

  14. Current knowledge and treatment strategies for grade II gliomas

    International Nuclear Information System (INIS)

    Narita, Yoshitaka

    2013-01-01

    World Health Organization grade II gliomas (GIIGs) include diffuse astrocytoma, oligodendroglioma, and oligoastrocytoma. GIIG is a malignant brain tumor for which the treatment outcome can still be improved. Review of previous clinical trials found the following: GIIG increased in size by 3-5 mm per year when observed or treated with surgery alone; after pathological diagnosis, the survival rate was increased by early aggressive tumor removal at an earlier stage compared to observation alone; although the prognosis after total tumor removal was significantly better than that after partial tumor removal, half of the patients relapsed within 5 years; comparing postoperative early radiotherapy (RT) and non-early RT after relapse, early RT prolonged progression-free survival (PFS) but did not affect overall survival (OS); local RT of 45 to 64.8 Gy did not impact PFS or OS; in patients with residual tumors, RT combined with chemotherapy (procarbazine plus lomustine plus vincristine) prolonged PFS compared with RT alone but did not affect OS; and poor prognostic factors included astrocytoma, non-total tumor removal, age ≥40 years, largest tumor diameter ≥4-6 cm, tumor crossing the midline, and neurological deficit. To improve treatment outcomes, surgery with functional brain mapping or intraoperative magnetic resonance imaging or chemoradiotherapy with temozolomide is important. In this review, current knowledge regarding GIIG is described and treatment strategies are explored. (author)

  15. Recommendations for severe hypertriglyceridemia treatment, are there new strategies?

    Science.gov (United States)

    Filippatos, Theodosios D; Elisaf, Moses S

    2014-01-01

    This review considers drug combinations and newer treatment strategies for patients with severe hypertriglyceridemia. Hypertriglyceridemia is associated with an atherogenic metabolic profile and in most studies with increased cardiovascular disease risk. Patients with severe hypertriglyceridemia also have increased incidence of pancreatitis. All types of severe hypertriglyceridemia are associated with a reduction in lipoprotein lipase activity. Patients with severe hypertriglyceridemia and abdominal pain or pancreatitis should be hospitalized and treated with hypolipidemic drugs and, if needed, with insulin/dextrose infusion or therapeutic apheresis. Fibrates are the first-line treatment in patients with severe hypertriglyceridemia. Omega-3 fatty acids and niacin are very useful drugs for patients with hypertriglyceridemia. Statins in high doses exhibit a significant hypotriglyceridemic activity. Drugs that interfere with chylomicron production such as orlistat are also useful for hypertriglyceridemic patients. In most patients with severe hypertriglyceridemia drug combinations are needed to maintain an acceptable triglyceride concentration. Gene therapy is under development for patients with known genetic abnormalities of triglyceride metabolism. Clinicians should be vigilant for the recognition and prompt treatment of patients with severe hypertriglyceridemia aimed to avoid the serious complication of pancreatitis and to reduce their cardiovascular risk.

  16. 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...

  17. 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...

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

    Science.gov (United States)

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

    2010-07-01

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

  19. 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.

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

    Science.gov (United States)

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

    2018-04-02

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

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

    Science.gov (United States)

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

    2014-01-01

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

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

    International Nuclear Information System (INIS)

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

    2001-01-01

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

  3. Management of Hyposalivation and Xerostomia: Criteria for Treatment Strategies.

    Science.gov (United States)

    Epstein, Joel B; Beier Jensen, Siri

    2015-09-01

    Saliva management in patients with hyposalivation is potentially complex. Future development of oral care products and treatment strategies requires attention to the biology of saliva and the best means of providing a continuum of relief for people with xerostomia--the sensation of dry mouth--and hyposalivation--documented reduction in saliva flow. Improvement in patient care requires that clinicians be aware of approaches to management, desirable qualities of methods and products, and that they seek the development of products that support the functions of saliva and promote comfort and health. In this brief review of the epidemiology of hyposalivation, the biology and functions of saliva are presented in order to guide clinical decision-making to address the needs of patients with dry mouth.

  4. Emerging treatment strategies for trauma-induced coagulopathy.

    Science.gov (United States)

    Sorensen, B; Fries, D

    2012-01-01

    Trauma-induced coagulopathy has a multifactorial aetiology. Coagulopathy is related to blood loss including consumption of clotting factors and platelets and haemodilution. Additionally hyperfibrinolysis, hypothermia, acidosis and metabolic changes affect the coagulation system. This is a review of pathophysiology and new treatment strategies for trauma-induced coagulopathy. Paradigms are actively changing and there is still a shortage of data. The aim of any haemostatic therapy is to control bleeding and minimize blood loss and transfusion requirements. Transfusion of allogeneic blood products as well as trauma-induced coagulopathy cause increased morbidity and mortality. Current opinion is based on present studies and results from small case series, combined with findings from experimental studies in animals, in vitro studies and expert opinions, as opposed to large, randomized, placebo-controlled studies. A summary of new and emerging strategies, including medical infusion and blood products, to beneficially manipulate the coagulation system in the critically injured patient is suggested. Future treatment of trauma-induced coagulopathy may be based on systemic antifibrinolytics, local haemostatics and individualized point-of-care-guided rational use of coagulation factor concentrates such as fibrinogen, prothrombin complex concentrate, recombinant factor VIIa and factor XIII. The authors speculate that timely and rational use of coagulation factor concentrates will be more efficacious and safer than ratio-driven use of transfusion packages of allogeneic blood products. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  5. 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)

  6. 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.

  7. 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…

  8. Comparative LCA of Alternative Scenarios for Waste Treatment: The Case of Food Waste Production by the Mass-Retail Sector

    Directory of Open Access Journals (Sweden)

    Giovanni Mondello

    2017-05-01

    Full Text Available Food waste is one of the most important issues taken into account by the European Union due to its negative environmental, economic and social impacts. The treatment of food waste through recycling processes represents a solution for food waste minimisation. Concerning, in particular, the retail sector, it is necessary to define strategies for retail-oriented sustainable food waste management. The aim of this study is to compare the potential environmental impacts related to five scenarios (landfill, incineration, composting, anaerobic digestion and bioconversion through insects for the disposal/treatment of food waste produced by a mass retail company operating in Messina (Italy through the application of the Life Cycle Assessment method, in order to find the best treatment solution. Results based on the treatment of a functional unit of 1 tonne of food waste show that the bioconversion scenario represents the most preferable solution considering all of the impact categories analysed through the CML 2 baseline 2000 method, except for Global Warming, for which higher environmental performances are connected to the anaerobic digestion scenario. The incineration and the bioconversion scenarios show the highest environmental benefits when the production of alternative energy sources and valuable materials is evaluated through the inclusion of the avoided productions in the analysis.

  9. Modern strategy and prospects in pharmacological treatment of Parkinson's disease

    Directory of Open Access Journals (Sweden)

    А. V. Kutsak

    2017-02-01

    Full Text Available Aim – to analyze scientific literature to summarize data about contemporary views on the pharmacological therapy of Parkinson's disease (PD. PD is a chronic, neurodegenerative steadily progressive disease of the central nervous system, primarily associated with the degeneration of dopamine-producing neurons in the cerebral pulp, manifested by motor and non-motor disorders and leading to permanent disability. The duration of patient’s life with PD, provided with adequate treatment, can be closer to the one of the general population. At the same time, the course of the disease may change with the increase of life expectancy of the patients. And as the result, in the clinical picture, non-motor disorders and motor complications caused by a further degeneration of dopaminergic neurons and adverse reactions of pharmacological therapy, come out in the first place. The apropos and rational correction of which improves the course of the disease and patients' quality of life. Within the age PD frequency in the population is increasing; taking into account the global trend to an increase in the duration of human life, this disease performs even bigger medical and social problem. And the need for further development of pharmacotherapy practices becomes more relevant. This review presents the current recommendations for the pharmacological treatment of PD. The attention is directed to the need for evidence when assessing the effectiveness of any treatment strategy. The data on the ongoing development of pharmaceuticals. Conclusions. At this time the existing therapeutic tactics in the pharmacological therapy of BP, despite the fact that they are quite successful in leveling manifestations of the disease, do not stop the disease, and are in fact symptomatic treatment. All successful clinical development, for the time being, are the emergence of new drugs belonging to the group of BP symptomatic therapy with the best bioavailability and tolerability

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

    Science.gov (United States)

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

    2018-06-01

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

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

    Science.gov (United States)

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

    2012-01-01

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

  12. 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.

  13. Using Chemical Reaction Kinetics to Predict Optimal Antibiotic Treatment Strategies.

    Science.gov (United States)

    Abel Zur Wiesch, Pia; Clarelli, Fabrizio; Cohen, Ted

    2017-01-01

    Identifying optimal dosing of antibiotics has proven challenging-some antibiotics are most effective when they are administered periodically at high doses, while others work best when minimizing concentration fluctuations. Mechanistic explanations for why antibiotics differ in their optimal dosing are lacking, limiting our ability to predict optimal therapy and leading to long and costly experiments. We use mathematical models that describe both bacterial growth and intracellular antibiotic-target binding to investigate the effects of fluctuating antibiotic concentrations on individual bacterial cells and bacterial populations. We show that physicochemical parameters, e.g. the rate of drug transmembrane diffusion and the antibiotic-target complex half-life are sufficient to explain which treatment strategy is most effective. If the drug-target complex dissociates rapidly, the antibiotic must be kept constantly at a concentration that prevents bacterial replication. If antibiotics cross bacterial cell envelopes slowly to reach their target, there is a delay in the onset of action that may be reduced by increasing initial antibiotic concentration. Finally, slow drug-target dissociation and slow diffusion out of cells act to prolong antibiotic effects, thereby allowing for less frequent dosing. Our model can be used as a tool in the rational design of treatment for bacterial infections. It is easily adaptable to other biological systems, e.g. HIV, malaria and cancer, where the effects of physiological fluctuations of drug concentration are also poorly understood.

  14. Hybrid Curcumin Compounds: A New Strategy for Cancer Treatment

    Directory of Open Access Journals (Sweden)

    Marie-Hélène Teiten

    2014-12-01

    Full Text Available Cancer is a multifactorial disease that requires treatments able to target multiple intracellular components and signaling pathways. The natural compound, curcumin, was already described as a promising anticancer agent due to its multipotent properties and huge amount of molecular targets in vitro. Its translation to the clinic is, however, limited by its reduced solubility and bioavailability in patients. In order to overcome these pharmacokinetic deficits of curcumin, several strategies, such as the design of synthetic analogs, the combination with specific adjuvants or nano-formulations, have been developed. By taking into account the risk-benefit profile of drug combinations, as well as the knowledge about curcumin’s structure-activity relationship, a new concept for the combination of curcumin with scaffolds from different natural products or components has emerged. The concept of a hybrid curcumin molecule is based on the incorporation or combination of curcumin with specific antibodies, adjuvants or other natural products already used or not in conventional chemotherapy, in one single molecule. The high diversity of such conjugations enhances the selectivity and inherent biological activities and properties, as well as the efficacy of the parental compound, with particular emphasis on improving the efficacy of curcumin for future clinical treatments.

  15. A review of current treatment strategies for gestational diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Kristi W Kelley

    2015-07-01

    Full Text Available Approximately 90% of diabetes cases in pregnant women are considered gestational diabetes mellitus (GDM. It is well known that uncontrolled glucose results in poor pregnancy outcomes in both the mother and fetus. Worldwide there are many guidelines with recommendations for appropriate management strategies for GDM once lifestyle modifications have been instituted and failed to achieve control. The efficacy and particularly the safety of other treatment modalities for GDM has been the source of much debate in recent years. Studies that have demonstrated the safety and efficacy of both glyburide and metformin in the management of patients with GDM will be reviewed. There is a lack of evidence with other oral and injectable non-insulin agents to control blood glucose in GDM. The role of insulin will be discussed, with emphasis on insulin analogs. Ideal patient characteristics for each treatment modality will be reviewed. In addition, recommendations for postpartum screening of patients will be described as well as recommendations for use of agents to manage subsequent type 2 diabetes in patients who are breastfeeding.

  16. 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...

  17. Group vs. Individual Treatment for Acute Insomnia: A Pilot Study Evaluating a “One-Shot” Treatment Strategy

    Directory of Open Access Journals (Sweden)

    Pam Boullin

    2016-12-01

    Full Text Available Background: Despite undeniable evidence for the efficacy and effectiveness of Cognitive Behaviour Therapy for Insomnia (CBT-I, the potential for its widespread dissemination and implementation has yet to be realised. A suggested reason for this is that traditional CBT-I is considered too burdensome for deployment, in its current form, within the context of where it would be most beneficial—Primary Care. One strategy, aimed to address this, has been to develop briefer versions of CBT-I, whilst another has been to deliver CBT-I in a group format. An alternative has been to attempt to address insomnia during its acute phase with a view to circumventing its progression to chronic insomnia. The aim of the present study was to compare a brief version of CBT-I (one-shot when delivered individually or in groups to those with acute insomnia. Method: Twenty-eight individuals with acute insomnia (i.e., meeting full DSM-5 criteria for insomnia disorder for less than three months self-assigned to either a group or individual treatment arm. Treatment consisted of a single one-hour session accompanied by a self-help pamphlet. Subjects completed measures of insomnia severity, anxiety and depression pre-treatment and at one-month post-treatment. Additionally, daily sleep diaries were compared between pre-treatment and at the one-month follow up. Results: There were no significant between group differences in treatment outcome on any sleep or mood measures although those in the group treatment arm were less adherent than those who received individual treatment. Furthermore, the combined (group and individual treatment arms pre-post test effect size on insomnia symptoms, using the Insomnia Severity Index, was large (d = 2.27. Discussion: It appears that group treatment is as efficacious as individual treatment within the context of a “one shot” intervention for individuals with acute insomnia. The results are discussed with a view to integrating one-shot CBT

  18. Current and emerging treatment strategies for Duchenne muscular dystrophy

    Science.gov (United States)

    Mah, Jean K

    2016-01-01

    Duchenne muscular dystrophy (DMD) is the most common form of muscular dystrophy in childhood. It is caused by mutations of the DMD gene, leading to progressive muscle weakness, loss of independent ambulation by early teens, and premature death due to cardiorespiratory complications. The diagnosis can usually be made after careful review of the history and examination of affected boys presenting with developmental delay, proximal weakness, and elevated serum creatine kinase, plus confirmation by muscle biopsy or genetic testing. Precise characterization of the DMD mutation is important for genetic counseling and individualized treatment. Current standard of care includes the use of corticosteroids to prolong ambulation and to delay the onset of secondary complications. Early use of cardioprotective agents, noninvasive positive pressure ventilation, and other supportive strategies has improved the life expectancy and health-related quality of life for many young adults with DMD. New emerging treatment includes viral-mediated microdystrophin gene replacement, exon skipping to restore the reading frame, and nonsense suppression therapy to allow translation and production of a modified dystrophin protein. Other potential therapeutic targets involve upregulation of compensatory proteins, reduction of the inflammatory cascade, and enhancement of muscle regeneration. So far, data from DMD clinical trials have shown limited success in delaying disease progression; unforeseen obstacles included immune response against the generated mini-dystrophin, inconsistent evidence of dystrophin production in muscle biopsies, and failure to demonstrate a significant improvement in the primary outcome measure, as defined by the 6-minute walk test in some studies. The long-term safety and efficacy of emerging treatments will depend on the selection of appropriate clinical end points and sensitive biomarkers to detect meaningful changes in disease progression. Correction of the underlying

  19. 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.

  20. 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.

  1. 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.

  2. 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…

  3. 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

  4. 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…

  5. 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...

  6. 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

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

    Science.gov (United States)

    Zörgő, Szilvia; Purebl, György; Zana, Ágnes

    2016-04-10

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

  8. 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 ...

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

    Science.gov (United States)

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

    2017-12-01

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

  10. 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.

  11. 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

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

    Science.gov (United States)

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

    2008-08-01

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

  13. Antibiotic susceptibility, heteroresistance, and updated treatment strategies in Helicobacter pylori infection.

    Science.gov (United States)

    Mascellino, Maria Teresa; Porowska, Barbara; De Angelis, Massimiliano; Oliva, Alessandra

    2017-01-01

    In this review, we discuss the problem of antibiotic resistance, heteroresistance, the utility of cultures and antibiotic susceptibility tests in Helicobacter pylori ( Hp ) eradication, as well as the updated treatment strategies for this infection. The prevalence of antibiotic resistance is increasing all over the world, especially for metronidazole and clarithromycin, because of their heavy use in some geographical areas. Heteroresistance (simultaneous presence of both susceptible and resistant strains in different sites of a single stomach) is another important issue, as an isolate could be mistakenly considered susceptible if a single biopsy is used for antimicrobial tests. We also examined literature data regarding eradication success rates of culture-guided and empiric therapies. The empiric therapy and the one based on susceptibility testing, in Hp eradication, may depend on several factors such as concomitant diseases, the number of previous antibiotic treatments, differences in bacterial virulence in individuals with positive or negative cultures, together with local antibiotic resistance patterns in real-world settings. Updated treatment strategies in Hp infection presented in the guidelines of the Toronto Consensus Group (2016) are reported. These suggest to prolong eradication therapy up to 14 days, replacing the old triple therapy with a quadruple therapy based on proton pump inhibitor (PPI), bismuth, metronidazole, and tetracycline for most of the patients, or as an alternative quadruple therapy without bismuth, based on the use of PPI, amoxicillin, metronidazole, and clarithromycin. The new drug vonoprazan, a first-in-class potassium-competitive acid blocker recently approved in Japan, is also considered to be a promising solution for Hp eradication, even for clarithromycin-resistant strains. Furthermore, there is growing interest in finding new therapeutic strategies, such as the development of vaccines or the use of natural resources, including

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

    Science.gov (United States)

    McClymont, Hoda; Gow, Jeff; Perry, Chad

    2014-01-01

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

  15. Strategies in the treatment for intracranial venous sinus thrombosis

    Directory of Open Access Journals (Sweden)

    JIA Qiang

    2013-03-01

    Full Text Available Background Cerebral venous sinus thrombosis (CVST is a special type of cerebrovascular disease with high morbidity and mortality which often has an unpredictable outcome. It is usually misdiagnosed because of different causes and variable clinical manifestations. How to improve the diagnosis and therapy of CVST is always the hotspot in clinic. This article aims to investigate the effective and safe strategies in the treatment for CVST. Methods Clinical data of 52 patients diagnosed with CVST were retrospectively analyzed. These patients were subdivided into mild type and severe type according to the features of symptoms, signs, lumbar puncture pressure and imaging. The patients with mild type were treated with systemic anticoagulant therapy combined with intravenous thrombolysis [continuous intravenous infusion of heparin (12.50-25 × 103 U/d for 7-10 d followed by a continuous infusion of urokinase (0.50-0.75 ×106 U/d for 5-7d]. The patients with severe type were treated with endovascular thrombolysis [injection of urokinase (0.50-1 × 106 U, 0.10 × 106 U/min via carotid or vertebral artery; or intravenous infusion of urokinase 1 ×106 U/d and heparin 25 ×103 U/d for 5-7 d], and superior sagittal sinus cut-open/ intrasinus thrombolysis separately. All the patients took oral warfarin for 6-12 months, and follow-up was performed after operation by the method of magnetic resonance venography (MRV. Results Among the 27 cases of mild type receiving systemic anticoagulant agents and intravenous thrombolysis, 14 were cured; 9 were improved; 4 were ineffective. Among the 22 cases of severe type receiving systemic anticoagulant drugs and endovascular thrombolysis, 18 were cured; 3 were improved; 1 was dead. The left 3 cases with gravis type received superior sagittal sinus cut-open/intrasinus thrombolysis and were cured. The period of follow-up was between 6 months and 60 months (the median time was 36 months, and no recurrence happened. Conclusion

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

    Science.gov (United States)

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

    2017-05-01

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

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

    Science.gov (United States)

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

    2014-10-14

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

  18. 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.

  19. Comparison of treatment strategies for Space Motion Sickness

    Science.gov (United States)

    Davis, J. R.; Jennings, R. T.; Beck, B. G.

    1992-01-01

    Treatment strategies for Space Motion Sickness were compared using the results of postflight oral debriefings. Standardized questionnaires were administered to all crewmembers immediately following Space Shuttle flights by NASA flight surgeons. Cases of Space Motion Sickness were graded as mild, moderate or severe based on published criteria, and medication effectiveness was judged based on subjective reports of symptom relief. Since October 1989, medication effectiveness is reported inflight through Private Medical Conferences with the crew. A symptom matrix was analyzed for 19 crewmembers treated with an oral combination of scopolamine and dextroamphetamine (scopdex) and 15 crewmembers treated with promethazine delivered by intramuscular (IM) or suppository routes. Scopdex has been given preflight as prophaxis for Space Motion Sickness but analysis showed delayed symptom presentation in 9 crewmembers or failed to prevent symptoms in 7. Only three crewmembers who took scopdex had no symptoms inflight. Fourteen out of 15 crewmembers treated with IM promethazine and 6 of 8 treated with promethazine suppositories after symptom development had immediate (within 12 h) symptom relief and required no additional medication. There were no cases of delayed symptom presentation in the crewmembers treated with promethazine. This response is in contrast to untreated crewmembers who typically have slow symptom resolution over 72-96 h. We conclude that promethazine is an effective treatment of Space Motion Sickness symptoms inflight. NASA policy currently recommends treating crewmembers with Space Motion Sickness after symptom development, and no longer recommends prophylaxis with scopdex due to delayed symptom development and apparent variable absorption of oral medications during early flight days.

  20. Radiation treatment of brain tumors: Concepts and strategies

    International Nuclear Information System (INIS)

    Marks, J.E.

    1989-01-01

    Ionizing radiation has demonstrated clinical value for a multitude of CNS tumors. Application of the different physical modalities available has made it possible for the radiotherapist to concentrate the radiation in the region of the tumor with relative sparing of the surrounding normal tissues. Correlation of radiation dose with effect on cranial soft tissues, normal brain, and tumor has shown increasing effect with increasing dose. By using different physical modalities to alter the distribution of radiation dose, it is possible to increase the dose to the tumor and reduce the dose to the normal tissues. Alteration of the volume irradiated and the dose delivered to cranial soft tissues, normal brain, and tumor are strategies that have been effective in improving survival and decreasing complications. The quest for therapeutic gain using hyperbaric oxygen, neutrons, radiation sensitizers, chemotherapeutic agents, and BNCT has met with limited success. Both neoplastic and normal cells are affected simultaneously by all modalities of treatment, including ionizing radiation. Consequently, one is unable to totally depopulate a tumor without irreversibly damaging the normal tissues. In the case of radiation, it is the brain that limits delivery of curative doses, and in the case of chemical additives, it is other organ systems, such as bone marrow, liver, lung, kidneys, and peripheral nerves. Thus, the major obstacle in the treatment of malignant gliomas is our inability to preferentially affect the tumor with the modalities available. Until it is possible to directly target the neoplastic cell without affecting so many of the adjacent normal cells, the quest for therapeutic gain will go unrealized.72 references

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

  2. Diagnosis and treatment strategies of thrombophilic risk factors

    Directory of Open Access Journals (Sweden)

    Murat Albayrak

    2010-09-01

    Full Text Available Thrombophilia is defined as the general name for a group of genetic and acquired situations, arising from defects of hemostasis mechanism and generating tendency to thrombosis. Examples of the acquired risk factors that increase the tendency to thrombosis are venous catheters, sepsis, surgery, hyperlipidemia, congestive heart disease, increased lipoprotein a, old age, antiphospholipid syndrome, nephrotic syndrome, hyperviscosity, chronic myeloproliferative neoplasms, paroxysmal nocturnal hemoglobinuria, heparin induced thrombocytopenia, vasculitis, immobility, obesity, major surgery, trauma, burns, malignancy, pregnancy and oral contraceptive usage. Genetic tendency to venous thromboembolism in early ages, even without any known cause, is named as thrombophilia. Factor V Leiden, prothrombin G20210A, methylenetetrahydrofolate reductase gene mutations, factor VIII elevation, protein C, protein S and antithrombin deficiency parameters are suggested for evaluation, in patient groups suspected of inherited thrombophilia. Detection of inherited thrombophilic factors in selected patient groups is a guide in developing treatment strategies and in establishing prognosis. Due to the genetic heterogeneities, each society should determine their thrombophilic risk pool. Thus, with the determination of the risk factors, unnecessary assessments will be prevented and a cost-effective approach can be developed.

  3. WEEE recovery strategies and the WEEE treatment status in China

    International Nuclear Information System (INIS)

    He Wenzhi; Li Guangming; Ma Xingfa; Wang Hua; Huang Juwen; Xu Min; Huang Chunjie

    2006-01-01

    The electric and electronic equipment has been developed, applied, and consumed world wide at a very high speed. Subsequently, the ever-increasing amount of waste electric and electronic equipment (WEEE) has become a common problem facing the world. In view of the deleterious effects of WEEE on the environment and the valuable materials that can be reused in them, legislations in many countries have focused their attention on the management of WEEE, and new techniques have been developed for the recovery of WEEE. In China, rapid economic growth, coupled with urbanization and growing demand for consumer goods, has increased the consumption of EEE in large quantity, thus made the WEEE manifold rapidly, posing a severe threat to the environment and the sustainable economic growth as well. This article reviewed the implementation of strategies of WEEE treatment and the recovery technologies of WEEE. It presented the current status of WEEE and corresponding responses adopted so far in China. The concept and implementation of scientific development is critical to the sector of electronics, one of the important industrial sectors in China's economy. To achieve this objective, it is significant to recycle WEEE sufficiently to comply with regulations regarding WEEE management, and to implement green design and cleaner production concepts within the electronics industry to comply with the upcoming EU and China legislation in a proactive manner

  4. Decision making in treatment strategy of AVMs. Treatment board system at Tohoku University

    International Nuclear Information System (INIS)

    Jokura, Hidefumi; Yoshimoto, Takashi

    1999-01-01

    Treatment of some large, deep-seated arteriovenous malformations is still a challenge to neurosurgeons. The recent development of non-invasive imaging modalities has increased the chance of finding asymptomatic AVM's, for which evaluation for treatment is more complicated than in symptomatic cases. Currently there are 3 major treatment options for AVM: microsurgical removal, radiosurgery, and intravascular embolization. It is not easy to choose the best single modality or combination of modalities for individual patients, who have different types of onset, neurological deficits, size and location, and social background. After the installation of the Gamma Knife in November 1991, we established an 'AVM Treatment Board.' It comprises vascular neurosurgeons, endovascular neurosurgeons, and radio-neurosurgeons, and meetings are held twice a month. Every AVM case referred to us is presented to the board, and treatment strategy is selected after a discussion among experts who know the advantages and drawbacks of each treatment modality. We describe this board system in detail and emphasize the importance of gathering expertise in decision making. (author)

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

    Science.gov (United States)

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

    2017-06-01

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

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

    Science.gov (United States)

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

    1999-01-01

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

  7. 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…

  8. 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...

  9. 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…

  10. Modelling the consequences of targeted selective treatment strategies on performance and emergence of anthelmintic resistance amongst grazing calves

    Directory of Open Access Journals (Sweden)

    Zoe Berk

    2016-12-01

    Full Text Available The development of anthelmintic resistance by helminths can be slowed by maintaining refugia on pasture or in untreated hosts. Targeted selective treatments (TST may achieve this through the treatment only of individuals that would benefit most from anthelmintic, according to certain criteria. However TST consequences on cattle are uncertain, mainly due to difficulties of comparison between alternative strategies. We developed a mathematical model to compare: 1 the most ‘beneficial’ indicator for treatment selection and 2 the method of selection of calves exposed to Ostertagia ostertagi, i.e. treating a fixed percentage of the population with the lowest (or highest indicator values versus treating individuals who exceed (or are below a given indicator threshold. The indicators evaluated were average daily gain (ADG, faecal egg counts (FEC, plasma pepsinogen, combined FEC and plasma pepsinogen, versus random selection of individuals. Treatment success was assessed in terms of benefit per R (BPR, the ratio of average benefit in weight gain to change in frequency of resistance alleles R (relative to an untreated population. The optimal indicator in terms of BPR for fixed percentages of calves treated was plasma pepsinogen and the worst ADG; in the latter case treatment was applied to some individuals who were not in need of treatment. The reverse was found when calves were treated according to threshold criteria, with ADG being the best target indicator for treatment. This was also the most beneficial strategy overall, with a significantly higher BPR value than any other strategy, but its degree of success depended on the chosen threshold of the indicator. The study shows strong support for TST, with all strategies showing improvements on calves treated selectively, compared with whole-herd treatment at 3, 8, 13 weeks post-turnout. The developed model appeared capable of assessing the consequences of other TST strategies on calf populations.

  11. Treatment strategies in the management of jejunoileal and colonic atresia

    Directory of Open Access Journals (Sweden)

    Chadha Rajiv

    2006-01-01

    Full Text Available BACKGROUND/PURPOSE: The purpose of this prospective study was to review the operative findings, treatment strategies, as well as the results of management of 46 consecutive cases of jejunoileal and colonic atresia, managed over a 2-year period. MATERIALS AND METHODS: There were 42 patients with jejunoileal atresia (JIA and 4 with colonic atresia (CA. The 4 group types were: type I-membranous (n=20, type II- blind ends separated by a fibrous cord (n=6, type IIIa- blind ends with a V-shaped mesenteric defect (n=10, type IIIb- apple-peel atresia (n=4 and type IV- multiple atresias (n=6. Primary surgery for JIA consisted of resection with a single anastomosis (n=37, anastomosis after tapering jejunoplasty (n=3, multiple anastomosis (n=1 and a Bishop-Koop ileostomy (n=1. For CA, resection with primary anastomosis was performed. A single end-to-oblique anastomosis after adequate resection of dilated proximal bowel, was the preferred surgical procedure. In the absence of facilities for administering TPN, early oral/nasogastric (NG tube feeding was encouraged. In patients with anastomotic dysfunction, conservative treatment of the obstruction followed after its resolution by gradually increased NG feeds, was the preferred treatment protocol. RESULTS: Late presentation or diagnosis with hypovolemia, electrolyte imbalance, unconjugated hyperbilirubinemia (n=25 and sepsis (n=6, were significant preoperative findings. After resection and anastomosis, significant shortening of bowel length was seen in 16 patients (34.7%. Postoperative complications included an anastomotic leak (n=3, a perforation proximal to the anastomosis in 1 and anastomotic dysfunction in 5 patients. Full oral or NG tube feeding was possible only by the 13th to 31st postoperative day (POD, after the primary surgery in patients with anastomotic dysfunction and those undergoing reoperation. Overall, 38 patients survived (82.6%. Mortality was highest in patients with type IIIb or type IV

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

    Science.gov (United States)

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

    2017-07-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    RT Hallen; SA Bryan; FV Hoopes

    2000-08-04

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

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

    International Nuclear Information System (INIS)

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

    2000-01-01

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

  15. Alternatives of Treatment and Final Disposition of the Solid Hospital residuals

    International Nuclear Information System (INIS)

    Meza Monge, K.

    1998-01-01

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

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

    Science.gov (United States)

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

    2017-05-01

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

  17. 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.

  18. 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.

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

    Directory of Open Access Journals (Sweden)

    Sabra Ramzi

    2006-03-01

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

  20. 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...

  1. 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 ...

  2. 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.

  3. 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.

  4. 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

  5. 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

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

    Science.gov (United States)

    Pang, Ran; Ali, Abdullah

    2015-12-01

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

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

    International Nuclear Information System (INIS)

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

    1986-09-01

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

  8. Drug repurposing as an alternative for the treatment of recalcitrant bacterial infections

    Directory of Open Access Journals (Sweden)

    Adrian eRangel-Vega

    2015-04-01

    Full Text Available Bacterial infections remain one of the leading causes of death worldwide, and the therapeutic outlook for these infections is worsening, due the rise of antibiotic resistant strains. The pharmaceutical industry has produced few new types of antibiotics in more than a decade. Researchers are taking several approaches towards developing new classes of antibiotics, including (1 focusing on new targets and processes, such as bacterial cell-cell communication that upregulates virulence; (2 designing inhibitors of bacterial resistance, such as blockers of multi-drug efflux pumps; and (3 using alternative antimicrobials such as bacteriophages. In addition, the strategy of finding new uses for existing drugs is beginning to produce results: antibacterial properties have been discovered in existing anticancer, antifungal, anthelmintic, and anti-inflammatory drugs. In this work we discuss the antimicrobial properties of gallium based compounds, 5-fluorouracil, ciclopirox, diflunisal, and some other FDA-approved drugs.

  9. Traditional Chinese Medicine for Refractory Nephrotic Syndrome: Strategies and Promising Treatments

    Science.gov (United States)

    Tu, Yuan-Chao

    2018-01-01

    Refractory nephrotic syndrome (RNS) is an immune-related kidney disease with poor clinical outcomes. Standard treatments include corticosteroids as the initial therapy and other immunosuppressants as second-line options. A substantial proportion of patients with RNS are resistant to or dependent on immunosuppressive drugs and often experience unremitting edema and proteinuria, cycles of remission and relapse, and/or serious adverse events due to long-term immunosuppression. Traditional Chinese medicine has a long history of treating complicated kidney diseases and holds great potential for providing effective treatments for RNS. This review describes the Chinese medical theories relating to the pathogenesis of RNS and discusses the strategies and treatment options using Chinese herbal medicine. Available preclinical and clinical evidence strongly supports the integration of traditional Chinese medicine and Western medicine for improving the outcome of RNS. Herbal medicine such as Astragalus membranaceus, Stephania tetrandra S. Moore, and Tripterygium wilfordii Hook F can serve as the alternative therapy when patients fail to respond to immunosuppression or as the complementary therapy to improve therapeutic efficacy and reduce side effects of immunosuppressive agents. Wuzhi capsules (Schisandra sphenanthera extract) with tacrolimus and tetrandrine with corticosteroids are two herb-drug combinations that have shown great promise and warrant further studies. PMID:29507594

  10. High Risk Aortic Valve Replacement - The Challenges of Multiple Treatment Strategies with an Evolving Technology.

    Science.gov (United States)

    Booth, K; Beattie, R; McBride, M; Manoharan, G; Spence, M; Jones, J M

    2016-01-01

    Deciding on the optimal treatment strategy for high risk aortic valve replacement is challenging. Transcatheter Aortic Valve implantation (TAVI) has been available in our centre as an alternative treatment modality for patients since 2008. We present our early experience of TAVI and SAVR (surgical Aortic Valve Replacement) in high risk patients who required SAVR because TAVI could not be performed. The database for Surgical aortic valve and Transcatheter aortic valve replacement referrals was interrogated to identify relevant patients. Survival to hospital discharge was 95.5% in the forty five patients who had SAVR when TAVI was deemed technically unsuitable. One year survival was 86%. Defining who is appropriate for TAVI or high risk SAVR is challenging and multidisciplinary team discussion has never been more prudent in this field of evolving technology with ever decreasing risks of surgery. The introduction of TAVI at our institution has seen a rise in our surgical caseload by approximately by 25%. Overall, the option of aortic valve intervention is being offered to more patients in general which is a substantial benefit in the treatment of aortic valve disease.

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

    Science.gov (United States)

    Senel, Hatice Gunayer

    2010-01-01

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

  12. Management strategies in the treatment of neonatal and pediatric gastroenteritis

    Directory of Open Access Journals (Sweden)

    Ciccarelli S

    2013-10-01

    Full Text Available Simona Ciccarelli,1 Ilaria Stolfi,1 Giuseppe Caramia2 1Neonatal Intensive Care Unit, Sapienza University of Rome, Rome, Italy; 2Division of Neonatology and Pediatrics, Maternal and Child Hospital "G. Salesi", Ancona, Italy Abstract: Acute gastroenteritis, characterized by the onset of diarrhea with or without vomiting, continues to be a major cause of morbidity and mortality in children in mostly resource-constrained nations. Although generally a mild and self-limiting disease, gastroenteritis is one of the most common causes of hospitalization and is associated with a substantial disease burden. Worldwide, up to 40% of children aged less than 5 years with diarrhea are hospitalized with rotavirus. Also, some microorganisms have been found predominantly in resource-constrained nations, including Shigella spp, Vibrio cholerae, and the protozoan infections. Prevention remains essential, and the rotavirus vaccines have demonstrated good safety and efficacy profiles in large clinical trials. Because dehydration is the major complication associated with gastroenteritis, appropriate fluid management (oral or intravenous is an effective and safe strategy for rehydration. Continuation of breastfeeding is strongly recommended. New treatments such as antiemetics (ondansetron, some antidiarrheal agents (racecadotril, and chemotherapeutic agents are often proposed, but not yet universally recommended. Probiotics, also known as “food supplement,” seem to improve intestinal microbial balance, reducing the duration and the severity of acute infectious diarrhea. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition and the European Society of Paediatric Infectious Diseases guidelines make a stronger recommendation for the use of probiotics for the management of acute gastroenteritis, particularly those with documented efficacy such as Lactobacillus rhamnosus GG, Lactobacillus reuteri, and Saccharomyces boulardii. To date, the

  13. Treatment strategies for inherited optic neuropathies: past, present and future

    Science.gov (United States)

    Yu-Wai-Man, P; Votruba, M; Moore, A T; Chinnery, P F

    2014-01-01

    Bilateral visual loss secondary to inherited optic neuropathies is an important cause of registrable blindness among children and young adults. The two prototypal disorders seen in clinical practice are Leber hereditary optic neuropathy (LHON) and autosomal dominant optic atrophy (DOA). About 90% of LHON cases are due to one of three mitochondrial DNA (mtDNA) point mutations: m.3460G>A, m.11778G>A, and m.14484T>C, which affect critical complex I subunits of the mitochondrial respiratory chain. The majority of patients with DOA harbour pathogenic mutations within OPA1, a nuclear gene that codes for a multifunctional inner mitochondrial membrane protein. Despite their contrasting genetic basis, LHON and DOA share overlapping pathological and clinical features that serve to highlight the striking tissue-specific vulnerability of the retinal ganglion cell (RGC) layer to disturbed mitochondrial function. In addition to severe visual loss secondary to progressive optic nerve degeneration, a subgroup of patients will also develop a more aggressive syndromic phenotype marked by significant neurological deficits. The management of LHON and DOA remains largely supportive, but major advances in our understanding of the mechanisms underpinning RGC loss in these two disorders are paving the way for novel forms of treatment aimed at halting or reversing visual deterioration at different stages of the disease process. In addition to neuroprotective strategies for rescuing RGCs from irreversible cell death, innovative in vitro fertilisation techniques are providing the tantalising prospect of preventing the germline transmission of pathogenic mtDNA mutations, eradicating in so doing the risk of disease in future generations. PMID:24603424

  14. Treatment strategies for inherited optic neuropathies: past, present and future.

    Science.gov (United States)

    Yu-Wai-Man, P; Votruba, M; Moore, A T; Chinnery, P F

    2014-05-01

    Bilateral visual loss secondary to inherited optic neuropathies is an important cause of registrable blindness among children and young adults. The two prototypal disorders seen in clinical practice are Leber hereditary optic neuropathy (LHON) and autosomal dominant optic atrophy (DOA). About 90% of LHON cases are due to one of three mitochondrial DNA (mtDNA) point mutations: m.3460G>A, m.11778G>A, and m.14484T>C, which affect critical complex I subunits of the mitochondrial respiratory chain. The majority of patients with DOA harbour pathogenic mutations within OPA1, a nuclear gene that codes for a multifunctional inner mitochondrial membrane protein. Despite their contrasting genetic basis, LHON and DOA share overlapping pathological and clinical features that serve to highlight the striking tissue-specific vulnerability of the retinal ganglion cell (RGC) layer to disturbed mitochondrial function. In addition to severe visual loss secondary to progressive optic nerve degeneration, a subgroup of patients will also develop a more aggressive syndromic phenotype marked by significant neurological deficits. The management of LHON and DOA remains largely supportive, but major advances in our understanding of the mechanisms underpinning RGC loss in these two disorders are paving the way for novel forms of treatment aimed at halting or reversing visual deterioration at different stages of the disease process. In addition to neuroprotective strategies for rescuing RGCs from irreversible cell death, innovative in vitro fertilisation techniques are providing the tantalising prospect of preventing the germline transmission of pathogenic mtDNA mutations, eradicating in so doing the risk of disease in future generations.

  15. An Antipersister Strategy for Treatment of Chronic Pseudomonas aeruginosa Infections.

    Science.gov (United States)

    Koeva, Martina; Gutu, Alina D; Hebert, Wesley; Wager, Jeffrey D; Yonker, Lael M; O'Toole, George A; Ausubel, Frederick M; Moskowitz, Samuel M; Joseph-McCarthy, Diane

    2017-12-01

    Bacterial persisters are a quasidormant subpopulation of cells that are tolerant to antibiotic treatment. The combination of the aminoglycoside tobramycin with fumarate as an antibacterial potentiator utilizes an antipersister strategy that is aimed at reducing recurrent Pseudomonas aeruginosa infections by enhancing the killing of P. aeruginosa persisters. Stationary-phase cultures of P. aeruginosa were used to generate persister cells. A range of tobramycin concentrations was tested with a range of metabolite concentrations to determine the potentiation effect of the metabolite under a variety of conditions, including a range of pH values and in the presence of azithromycin or cystic fibrosis (CF) patient sputum. In addition, 96-well dish biofilm and colony biofilm assays were performed, and the cytotoxicity of the tobramycin-fumarate combination was determined utilizing a lactate dehydrogenase (LDH) assay. Enhanced killing of up to 6 orders of magnitude of P. aeruginosa persisters over a range of CF isolates, including mucoid and nonmucoid strains, was observed for the tobramycin-fumarate combination compared to killing with tobramycin alone. Furthermore, significant fumarate-mediated potentiation was seen in the presence of azithromycin or CF patient sputum. Fumarate also reduced the cytotoxicity of tobramycin-treated P. aeruginosa to human epithelial airway cells. Finally, in mucoid and nonmucoid CF isolates, complete eradication of P. aeruginosa biofilm was observed in the colony biofilm assay due to fumarate potentiation. These data suggest that a combination of tobramycin with fumarate as an antibacterial potentiator may be an attractive therapeutic for eliminating recurrent P. aeruginosa infections in CF patients through the eradication of bacterial persisters. Copyright © 2017 American Society for Microbiology.

  16. Consensus Recommendations for Treatment Strategies in Indians Using Botulinum Toxin and Hyaluronic Acid Fillers

    Directory of Open Access Journals (Sweden)

    Krishan Mohan Kapoor, MCh, DNB

    2017-12-01

    Conclusions:. These recommendations give physicians treating Indians worldwide a better understanding of their unique facial characteristics and provide treatment strategies to achieve optimal aesthetic outcomes.

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

    Directory of Open Access Journals (Sweden)

    Raquel Pinheiro Reis Souza Ramalho

    2016-03-01

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

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

    Science.gov (United States)

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

    2007-04-02

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

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

    Directory of Open Access Journals (Sweden)

    Siti Choirul Dwi Astuti

    2017-10-01

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

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

    Science.gov (United States)

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

    2005-03-01

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

  1. Strategies for automatic online treatment plan reoptimization using clinical treatment planning system: A planning parameters study

    International Nuclear Information System (INIS)

    Li, Taoran; Wu, Qiuwen; Zhang, You; Vergalasova, Irina; Lee, W. Robert; Yin, Fang-Fang; Wu, Q. Jackie

    2013-01-01

    Purpose: Adaptive radiation therapy for prostate cancer using online reoptimization provides an improved control of interfractional anatomy variations. However, the clinical implementation of online reoptimization is currently limited by the low efficiency of current strategies and the difficulties associated with integration into the current treatment planning system. This study investigates the strategies for performing fast (∼2 min) automatic online reoptimization with a clinical fluence-map-based treatment planning system; and explores the performance with different input parameters settings: dose-volume histogram (DVH) objective settings, starting stage, and iteration number (in the context of real time planning).Methods: Simulated treatments of 10 patients were reoptimized daily for the first week of treatment (5 fractions) using 12 different combinations of optimization strategies. Options for objective settings included guideline-based RTOG objectives, patient-specific objectives based on anatomy on the planning CT, and daily-CBCT anatomy-based objectives adapted from planning CT objectives. Options for starting stages involved starting reoptimization with and without the original plan's fluence map. Options for iteration numbers were 50 and 100. The adapted plans were then analyzed by statistical modeling, and compared both in terms of dosimetry and delivery efficiency.Results: All online reoptimized plans were finished within ∼2 min with excellent coverage and conformity to the daily target. The three input parameters, i.e., DVH objectives, starting stage, and iteration number, contributed to the outcome of optimization nearly independently. Patient-specific objectives generally provided better OAR sparing compared to guideline-based objectives. The benefit in high-dose sparing from incorporating daily anatomy into objective settings was positively correlated with the relative change in OAR volumes from planning CT to daily CBCT. The use of the

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

    Science.gov (United States)

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

    2013-01-01

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

  3. 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

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

    Science.gov (United States)

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

    2010-11-01

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

  7. Ustekinumab as an Alternative Treatment Option for Chronic Pityriasis Rubra Pilaris

    Directory of Open Access Journals (Sweden)

    Mudit Chowdhary

    2015-03-01

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

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

    DEFF Research Database (Denmark)

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

    1997-01-01

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

  9. 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

  10. Office of River Protection (DOE-ORP) Hanford Tank Waste Treatment Alternatives March 2000

    International Nuclear Information System (INIS)

    WODRICH, D.D.

    2000-01-01

    The U.S. Department of Energy (DOE) is currently planning to retrieve, pretreat, immobilize and safely dispose of 53 million gallons of highly radioactive waste currently stored in underground tanks at Hanford Site. The DOE plan is a two-phased approach to privatizing the processing of hazardous and radioactive waste. Phase 1 is a proof-of-concept/commercial demonstration-scale effort whose objectives are to: demonstrate, the technical and business viability of using privatized facilities to treat Hanford tank waste; define and maintain required levels of radiological, nuclear, process and occupational safety; maintain environmental protection and compliance; and substantially reduce life-cycle costs and time required to treat Hanford tank waste. The Phase 1 effort consists of Part A and Part B. On September 25, 1996 (Reference 1), DOE signed a contract with BNFL, Inc. (BNFL) to commence with Phase 1, Part A. In August 1998, BNFL was authorized to proceed with Phase I, Part 6-1, a 24-month design phase that will-provide sufficient engineering and financial maturity to establish fixed-unit prices and financing terms for tank waste processing services in privately-owned and -operated facilities. By August 2000, DOE will decide whether to authorize BNFL to proceed with construction and operation of the proposed processing facilities, or pursue a different path. To support of the decision, DOE is evaluating alternatives to potentially enhance the BNFL tank waste processing contract, as well as, developing an alternate path forward should DOE decide to not continue the BNFL contract. The decision on whether to continue with the current privatization strategy (BNFL contract) or to pursue an alternate can not be made until the evaluation process leading up to the decision on whether to authorize BNFL to proceed with construction and operation (known as the Part 8-2 decision) is completed. The evaluation process includes reviewing and evaluating the information BNFL is

  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. Bioremediation assessment of diesel-biodiesel-contaminated soil using an alternative bioaugmentation strategy.

    Science.gov (United States)

    Colla, Tatiana Simonetto; Andreazza, Robson; Bücker, Francielle; de Souza, Marcela Moreira; Tramontini, Letícia; Prado, Gerônimo Rodrigues; Frazzon, Ana Paula Guedes; Camargo, Flávio Anastácio de Oliveira; Bento, Fátima Menezes

    2014-02-01

    This study investigated the effectiveness of successive bioaugmentation, conventional bioaugmentation, and biostimulation of biodegradation of B10 in soil. In addition, the structure of the soil microbial community was assessed by polymerase chain reaction-denaturing gradient gel electrophoresis. The consortium was inoculated on the initial and the 11th day of incubation for successive bioaugmentation and only on the initial day for bioaugmentation and conventional bioaugmentation. The experiment was conducted for 32 days. The microbial consortium was identified based on sequencing of 16S rRNA gene and consisted as Pseudomonas aeruginosa, Achromobacter xylosoxidans, and Ochrobactrum intermedium. Nutrient introduction (biostimulation) promoted a positive effect on microbial populations. The results indicate that the edaphic community structure and dynamics were different according to the treatments employed. CO2 evolution demonstrated no significant difference in soil microbial activity between biostimulation and bioaugmentation treatments. The total petroleum hydrocarbon (TPH) analysis indicated a biodegradation level of 35.7 and 32.2 % for the biostimulation and successive bioaugmentation treatments, respectively. Successive bioaugmentation displayed positive effects on biodegradation, with a substantial reduction in TPH levels.

  13. 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.

  14. 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.

  15. 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.

  16. 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

  17. Clinical treatment strategies and experimental studies in polytrauma

    NARCIS (Netherlands)

    van Wessem, K.J.P.

    2013-01-01

    This thesis describes the clinical treatment of polytrauma patients and the underlying pathophysiological mechanisms causing injury-induced inflammatory response. Even though the treatment of polytrauma patients has improved over the years, trauma is still the leading cause of death

  18. 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.

  19. 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.

  20. 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

  1. 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.

  2. 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.

  3. Organ preservation in invasive bladder cancer: Brachytherapy, an alternative to cystectomy and combined modality treatment?

    International Nuclear Information System (INIS)

    Pos, Floris; Horenblas, Simon; Dom, Paul; Moonen, Luc; Bartelink, Harry

    2005-01-01

    Purpose: To evaluate our long-term results of bladder preservation with brachytherapy in the treatment of bladder cancer. Methods and materials: Between 1987 and 2000, 108 patients with T1-G3 and T2-T3a stages of bladder cancer were treated with a transurethral resection (TUR) and a course of external beam radiotherapy (30 Gy in 15 fractions) followed by brachytherapy (40 Gy). All tumors were solitary lesions with a diameter ≤5 cm. Median follow-up was 54 months (range, 1-178 months). Results: The 5-year and 10-year overall survival rates were 62% and 50%, respectively. The 5-year and 10-year disease-specific survival rates were 73% and 67%, respectively. The actuarial local control rate was 73% at 5 and 73% at 10 years, respectively. The 5-year and 10-year disease-specific survival rates for patients with a preserved bladder were 68% and 59%, respectively. Of all long-term surviving patients, 90% preserved their native bladders. The treatment was well tolerated. Acute toxicity was mild. Two patients experienced serious late toxicity: 1 patient developed a persisting vesicocutaneous fistula and the other a stricture of the urethra and ureters. Conclusion: For patients with solitary, organ confined invasive bladder cancer ≤5 cm, bladder preservation with brachytherapy is an excellent alternative to radical cystectomy and combined modality treatment

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

    International Nuclear Information System (INIS)

    Suzana Che Sayuti; Abdul Aziz Mohd Azoddein

    2015-01-01

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

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

    Science.gov (United States)

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

    1996-07-01

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

  6. F/H Effluent Treatment Facility filtration upgrade alternative evaluations overview

    Energy Technology Data Exchange (ETDEWEB)

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

    1992-01-01

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

  7. F/H Effluent Treatment Facility filtration upgrade alternative evaluations overview

    Energy Technology Data Exchange (ETDEWEB)

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

    1992-07-01

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

  8. F/H effluent treatment facility filtration upgrade alternative evaluations overview

    International Nuclear Information System (INIS)

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

    1992-01-01

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

  9. 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.

  10. 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

  11. Gamma radiation use as a quarantine treatment alternative for cut flowers

    International Nuclear Information System (INIS)

    Kikuchi, Olivia Kimiko

    1999-01-01

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

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

    Science.gov (United States)

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

    2003-01-01

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

  13. 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 ...

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

    Directory of Open Access Journals (Sweden)

    Rudolf Schicho

    2011-01-01

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

  15. 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

  16. 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

  17. Targeting Strategies for the Combination Treatment of Cancer Using Drug Delivery Systems

    Science.gov (United States)

    Kydd, Janel; Jadia, Rahul; Velpurisiva, Praveena; Gad, Aniket; Paliwal, Shailee; Rai, Prakash

    2017-01-01

    Cancer cells have characteristics of acquired and intrinsic resistances to chemotherapy treatment—due to the hostile tumor microenvironment—that create a significant challenge for effective therapeutic regimens. Multidrug resistance, collateral toxicity to normal cells, and detrimental systemic side effects present significant obstacles, necessitating alternative and safer treatment strategies. Traditional administration of chemotherapeutics has demonstrated minimal success due to the non-specificity of action, uptake and rapid clearance by the immune system, and subsequent metabolic alteration and poor tumor penetration. Nanomedicine can provide a more effective approach to targeting cancer by focusing on the vascular, tissue, and cellular characteristics that are unique to solid tumors. Targeted methods of treatment using nanoparticles can decrease the likelihood of resistant clonal populations of cancerous cells. Dual encapsulation of chemotherapeutic drug allows simultaneous targeting of more than one characteristic of the tumor. Several first-generation, non-targeted nanomedicines have received clinical approval starting with Doxil® in 1995. However, more than two decades later, second-generation or targeted nanomedicines have yet to be approved for treatment despite promising results in pre-clinical studies. This review highlights recent studies using targeted nanoparticles for cancer treatment focusing on approaches that target either the tumor vasculature (referred to as ‘vascular targeting’), the tumor microenvironment (‘tissue targeting’) or the individual cancer cells (‘cellular targeting’). Recent studies combining these different targeting methods are also discussed in this review. Finally, this review summarizes some of the reasons for the lack of clinical success in the field of targeted nanomedicines. PMID:29036899

  18. Targeting Strategies for the Combination Treatment of Cancer Using Drug Delivery Systems

    Directory of Open Access Journals (Sweden)

    Janel Kydd

    2017-10-01

    Full Text Available Cancer cells have characteristics of acquired and intrinsic resistances to chemotherapy treatment—due to the hostile tumor microenvironment—that create a significant challenge for effective therapeutic regimens. Multidrug resistance, collateral toxicity to normal cells, and detrimental systemic side effects present significant obstacles, necessitating alternative and safer treatment strategies. Traditional administration of chemotherapeutics has demonstrated minimal success due to the non-specificity of action, uptake and rapid clearance by the immune system, and subsequent metabolic alteration and poor tumor penetration. Nanomedicine can provide a more effective approach to targeting cancer by focusing on the vascular, tissue, and cellular characteristics that are unique to solid tumors. Targeted methods of treatment using nanoparticles can decrease the likelihood of resistant clonal populations of cancerous cells. Dual encapsulation of chemotherapeutic drug allows simultaneous targeting of more than one characteristic of the tumor. Several first-generation, non-targeted nanomedicines have received clinical approval starting with Doxil® in 1995. However, more than two decades later, second-generation or targeted nanomedicines have yet to be approved for treatment despite promising results in pre-clinical studies. This review highlights recent studies using targeted nanoparticles for cancer treatment focusing on approaches that target either the tumor vasculature (referred to as ‘vascular targeting’, the tumor microenvironment (‘tissue targeting’ or the individual cancer cells (‘cellular targeting’. Recent studies combining these different targeting methods are also discussed in this review. Finally, this review summarizes some of the reasons for the lack of clinical success in the field of targeted nanomedicines.

  19. 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)

  20. 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

  1. 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

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

    Directory of Open Access Journals (Sweden)

    Sang Min Yoon

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

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

    Science.gov (United States)

    Arnold, L E

    2001-06-01

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

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

    Science.gov (United States)

    Kua, Kok Pim; Lee, Shaun Wen Huey

    2017-01-01

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

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

    Science.gov (United States)

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

    2017-03-24

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

  6. Education Strategies Through Simulation For Training In Cardiopulmonary Resuscitation Treatment

    Directory of Open Access Journals (Sweden)

    Regimar Carla Machado

    2017-01-01

    Full Text Available Theoretical and reflective study based on scientific literature and critical analysis of authors related to teaching strategies through simulation for training in cardiopulmonary resuscitation (CPR. Current teaching methodologies CPR involve realistic simulation strategies and simulations in virtual environments, but the first method provides the best results, allowing proactivity of individuals in their teaching-learning process and bringing them the experience of a life threatening situation. It is noteworthy that health professionals need to be able to assist a victim in cardiac arrest, but even  existing effective teaching methodologies to enable them in this subject, is not fully applicable in the Brazilian context of health education.

  7. 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.

  8. 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

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

    Science.gov (United States)

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

    2012-01-01

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

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

    Science.gov (United States)

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

    2012-01-01

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

  11. Antibiotic susceptibility, heteroresistance, and updated treatment strategies in Helicobacter pylori infection

    Directory of Open Access Journals (Sweden)

    Mascellino MT

    2017-07-01

    Full Text Available Maria Teresa Mascellino,1 Barbara Porowska,2 Massimiliano De Angelis,1 Alessandra Oliva1 1Department of Public Health and Infectious Diseases, 2Department of Cardio-Thoracic, Vascular, General Surgery and of Organ Transplants, Policlinico Umberto I, Rome, Italy Abstract: In this review, we discuss the problem of antibiotic resistance, heteroresistance, the utility of cultures and antibiotic susceptibility tests in Helicobacter pylori (Hp eradication, as well as the updated treatment strategies for this infection. The prevalence of antibiotic resistance is increasing all over the world, especially for metronidazole and clarithromycin, because of their heavy use in some geographical areas. Heteroresistance (simultaneous presence of both susceptible and resistant strains in different sites of a single stomach is another important issue, as an isolate could be mistakenly considered susceptible if a single biopsy is used for antimicrobial tests. We also examined literature data regarding eradication success rates of culture-guided and empiric therapies. The empiric therapy and the one based on susceptibility testing, in Hp eradication, may depend on several factors such as concomitant diseases, the number of previous antibiotic treatments, differences in bacterial virulence in individuals with positive or negative cultures, together with local antibiotic resistance patterns in real-world settings. Updated treatment strategies in Hp infection presented in the guidelines of the Toronto Consensus Group (2016 are reported. These suggest to prolong eradication therapy up to 14 days, replacing the old triple therapy with a quadruple therapy based on proton pump inhibitor (PPI, bismuth, metronidazole, and tetracycline for most of the patients, or as an alternative quadruple therapy without bismuth, based on the use of PPI, amoxicillin, metronidazole, and clarithromycin. The new drug vonoprazan, a first-in-class potassium-competitive acid blocker recently

  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. 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

  14. Usefulness of Photodynamic Therapy as a Possible Therapeutic Alternative in the Treatment of Basal Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    Paola Savoia

    2015-09-01

    Full Text Available Basal cell carcinoma (BCC is the most common cancer in individuals with fair skin type (I–II and steadily increasing in incidence (70% of skin malignancy. It is locally invasive but metastasis is usually very rare, with an estimated incidence of 0.0028%–0.55%. Conventional therapy is surgery, especially for the H region of the face and infiltrative lesions; in case of inoperable tumors, radiotherapy is a valid option. Recently, topical photodynamic therapy (PDT has become an effective treatment in the management of superficial and small nodular BCC. PDT is a minimally invasive procedure that involves the administration of a photo-sensibilizing agent followed by irradiation at a pre-defined wavelength; this determines the creation of reactive oxygen species that specifically destroy target cells. The only major side effect is pain, reported by some patients during the irradiation. The high cure rate and excellent cosmetic outcome requires considering this possibility for the management of patients with both sporadic and hereditary BCC. In this article, an extensive review of the recent literature was made, in order to clarify the role of PDT as a possible alternative therapeutic option in the treatment of BCC.

  15. Usefulness of Photodynamic Therapy as a Possible Therapeutic Alternative in the Treatment of Basal Cell Carcinoma

    Science.gov (United States)

    Savoia, Paola; Deboli, Tommaso; Previgliano, Alberto; Broganelli, Paolo

    2015-01-01

    Basal cell carcinoma (BCC) is the most common cancer in individuals with fair skin type (I–II) and steadily increasing in incidence (70% of skin malignancy). It is locally invasive but metastasis is usually very rare, with an estimated incidence of 0.0028%–0.55%. Conventional therapy is surgery, especially for the H region of the face and infiltrative lesions; in case of inoperable tumors, radiotherapy is a valid option. Recently, topical photodynamic therapy (PDT) has become an effective treatment in the management of superficial and small nodular BCC. PDT is a minimally invasive procedure that involves the administration of a photo-sensibilizing agent followed by irradiation at a pre-defined wavelength; this determines the creation of reactive oxygen species that specifically destroy target cells. The only major side effect is pain, reported by some patients during the irradiation. The high cure rate and excellent cosmetic outcome requires considering this possibility for the management of patients with both sporadic and hereditary BCC. In this article, an extensive review of the recent literature was made, in order to clarify the role of PDT as a possible alternative therapeutic option in the treatment of BCC. PMID:26426005

  16. Molecular cloning and functional characterization of a mouse gene upregulated by lipopolysaccharide treatment reveals alternative splicing

    Energy Technology Data Exchange (ETDEWEB)

    Du, Kejun; Chen, Yaoming; Dai, Zongming; Bi, Yuan; Cai, Tongjian [Department of Occupational and Environmental Health, Fourth Military Medical University, Xi' an 710032, Shaanxi Province (China); Hou, Lichao [Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi' an 710032, Shaanxi Province (China); Chai, Yubo; Song, Qinghe; Chen, Sumin [Department of Biochemistry and Molecular Biology, Fourth Military Medical University, Xi' an 710032, Shaanxi Province (China); Luo, Wenjing, E-mail: luowenj@fmmu.edu.cn [Department of Occupational and Environmental Health, Fourth Military Medical University, Xi' an 710032, Shaanxi Province (China); Chen, Jingyuan, E-mail: jy_chen@fmmu.edu.cn [Department of Occupational and Environmental Health, Fourth Military Medical University, Xi' an 710032, Shaanxi Province (China)

    2010-01-01

    Treatment of mouse cells with lipopolysaccharide (LPS) potently initiates an inflammatory response, but the underlying mechanisms are unclear. We therefore sought to characterize cDNA sequences of a new mouse LPS-responsive gene, and to evaluate the effects of MLrg. Full-length cDNAs were obtained from LPS-treated NIH3T3 cells. We report that the MLrg gene produces two alternative splice products (GenBank Accession Nos. (DQ316984) and (DQ320011)), respectively, encoding MLrgW and MLrgS polypeptides. Both proteins contain zinc finger and leucine zipper domains and are thus potential regulators of transcription. Expression of MLrgW and MLrgS were robustly upregulated following LPS treatment, and the proteins were localized predominantly in the nuclear membrane and cytoplasm. In stable transfectants over-expressing MLrgW the proportion of cells in G1 phase was significantly reduced, while in cells over-expressing MLrgS the proportion of cells in G2 was significantly increased; both proteins are thus potential regulators of cell cycle progression. Upregulation of MLrgW and MLrgS may be an important component of the LPS inflammatory pathway and of the host response to infection with GNB.

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

    Directory of Open Access Journals (Sweden)

    Ahmet Sabuncu

    2015-06-01

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

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

    Science.gov (United States)

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

    2016-03-01

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

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

    Science.gov (United States)

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

    2016-05-01

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

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

    Directory of Open Access Journals (Sweden)

    Eduardo Leiva

    2016-11-01

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

  1. Treatment of PVC using an alternative low energy ion bombardment procedure

    Science.gov (United States)

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

    2011-12-01

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

  2. Treatment of PVC using an alternative low energy ion bombardment procedure

    International Nuclear Information System (INIS)

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

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    John Linnegar

    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.

  4. Current strategies for the treatment of aneurysmal bone cysts

    Directory of Open Access Journals (Sweden)

    Panagiotis Tsagozis

    2015-12-01

    Full Text Available Aneurysmal bone cysts are benign bone tumors that usually present in childhood and early adulthood. They usually manifest as expansile osteolytic lesions with a varying potential to be locally aggressive. Since their first description in 1942, a variety of treatment methods has been proposed. Traditionally, these tumors were treated with open surgery. Either intralesional surgical procedures or en bloc excisions have been described. Furthermore, a variety of chemical or physical adjuvants has been utilized in order to reduce the risk for local recurrence after excision. Currently, there is a shift to more minimally invasive procedures in order to avoid the complications of open surgical excision. Good results have been reported during percutaneous surgery, or the use of embolization. Recently, sclerotherapy has emerged as a promising treatment, showing effective consolidation of the lesions and functional results that appear to be superior to the ones of open surgery. Lastly, non-invasive treatment, such as pharmaceutical intervention with denosumab or bisphosphonates has been reported to be effective in the management of the disease. Radiotherapy has also been shown to confer good local control, either alone or in conjunction to other treatment modalities, but is associated with serious adverse effects. Here, we review the current literature on the methods of treatment of aneurysmal bone cysts. The indication for each type of treatment along reported outcome of the intervention, as well as potential complications are systematically presented. Our review aims to increase awareness of the different treatment modalities and facilitate decision-making regarding each individual patient.

  5. Telepsychiatrists' Medication Treatment Strategies in the Children's Attention-Deficit/Hyperactivity Disorder Telemental Health Treatment Study

    Science.gov (United States)

    Tse, Yuet Juhn; Fesinmeyer, Megan D.; Garcia, Jessica; Myers, Kathleen

    2016-01-01

    Abstract Objective: The purpose of this study was to examine the prescribing strategies that telepsychiatrists used to provide pharmacologic treatment in the Children's Attention-Deficit/Hyperactivity Disorder (ADHD) Telemental Health Treatment Study (CATTS). Methods: CATTS was a randomized controlled trial that demonstrated the superiority of a telehealth service delivery model for the treatment of ADHD with combined pharmacotherapy and behavior training (n=111), compared with management in primary care augmented with a telepsychiatry consultation (n=112). A diagnosis of ADHD was established with the Computerized Diagnostic Interview Schedule for Children (CDISC), and comorbidity for oppositional defiant disorder (ODD) and anxiety disorders (AD) was established using the CDISC and the Child Behavior Checklist. Telepsychiatrists used the Texas Children's Medication Algorithm Project (TCMAP) for ADHD to guide pharmacotherapy and the treat-to-target model to encourage their assertive medication management to a predetermined goal of 50% reduction in ADHD-related symptoms. We assessed whether telepsychiatrists' decision making about making medication changes was associated with baseline ADHD symptom severity, comorbidity, and attainment of the treat-to-target goal. Results: Telepsychiatrists showed high fidelity (91%) to their chosen algorithms in medication management. At the end of the trial, the CATTS intervention showed 46.0% attainment of the treat-to-target goal compared with 13.6% for the augmented primary care condition, and significantly greater attainment of the goal by comorbidity status for the ADHD with one and ADHD with two comorbidities groups. Telepsychiatrists' were more likely to decide to make medication adjustments for youth with higher baseline ADHD severity and the presence of disorders comorbid with ADHD. Multiple mixed methods regression analyses controlling for baseline ADHD severity and comorbidity status indicated that the telepsychiatrists

  6. 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)

  7. Fetal alcohol spectrum disorders: experimental treatments and strategies for intervention.

    Science.gov (United States)

    Idrus, Nirelia M; Thomas, Jennifer D

    2011-01-01

    Despite the known damaging effects of prenatal alcohol exposure, women continue to drink during pregnancy, creating a need for effective interventions and treatments for fetal alcohol spectrum disorders (FASD). Experimental models can be useful in identifying potential treatments, and this article describes the spectrum of experimental therapeutics that currently are being investigated, including pharmacological, nutritional, and environmental/behavioral interventions. Some treatments target the underlying mechanisms that contribute to alcohol-induced damage, protecting against alcohol's teratogenic effects, whereas other treatments may enhance central nervous system plasticity either during alcohol exposure or long after alcohol exposure has ceased. The insights gained to date from experimental models offer several candidates for attenuating the deficits associated with FASD.

  8. INTRAPERITONEAL DEXTROSE ADMINISTRATION AS AN ALTERNATIVE EMERGENCY TREATMENT FOR HYPOGLYCEMIC YEARLING CALIFORNIA SEA LIONS (ZALOPHUS CALIFORNIANUS).

    Science.gov (United States)

    Fravel, Vanessa A; Van Bonn, William; Gulland, Frances; Rios, Carlos; Fahlman, Andreas; Graham, James L; Havel, Peter J

    2016-03-01

    The Marine Mammal Center (TMMC) cares for malnourished California sea lion (CSL) (Zalophus californianus) pups and yearlings every year. Hypoglycemia is a common consequence of malnutrition in young CSLs. Administering dextrose during a hypoglycemic crisis is vital to recovery. Traditional veterinary approaches to treat hypoglycemia pose therapeutic challenges in otariids, as vascular access and catheter maintenance can be difficult. The current approach to a hypoglycemic episode at TMMC is to administer dextrose intravenously (i.v.) by medically trained personnel. Intraperitoneal (i.p.) dextrose administration is an attractive alternative to i.v. administration because volunteer staff with basic training can administer treatment instead of waiting for trained staff to treat. This study compares the effects of i.v., i.p., and no dextrose administration on serum glucose and insulin in clinically healthy, euglycemic CSL yearlings. Three groups of animals, consisting of five sea lions each, were treated with 500 mg/kg dextrose using one of the following routes: i.v., i.p., or no dextrose (control). A jugular catheter was placed, and blood samples were collected at times 0, 5, 15, 30, 60, 120, 180, and 240 min after dextrose administration. I.v. dextrose administration resulted in an increase of serum glucose concentrations from a baseline level of approximately 150 mg/dl to a peak of approximately 350 mg/dl. The resulting hyperglycemia persisted for approximately 2 hr and was associated with an attenuated plasma insulin response compared with most terrestrial mammals. Intraperitoneal dextrose administration resulted in increases of serum glucose to approximately 200 mg/dl, which gradually declined to baseline by 2 hr after dextrose administration. These data suggest that the initial treatment of a hypoglycemic crisis in young malnourished CSLs can be accomplished with i.p. dextrose, thus enabling minimally trained volunteer staff to respond immediately to a crisis

  9. Perceived treatment effectiveness, medication compliance, and complementary and alternative medicine use among veterans with bipolar disorder.

    Science.gov (United States)

    Jarman, Christopher N; Perron, Brian E; Kilbourne, Amy M; Teh, Carrie Farmer

    2010-03-01

    Recent research shows a high rate of complementary and alternative medicine (CAM) use among persons with mental disorders, although correlates and patterns of CAM use are relatively unknown. This study tested whether CAM use is associated with perceived effectiveness of conventional treatment (i.e., psychotropic medication and psychotherapy) and medication compliance among persons with bipolar disorder. Patients with bipolar disorder (n = 435) were included as part of a naturalistic cohort study. Measures of CAM utilization, medication compliance, and perceptions of the effectiveness of psychotropic medications and psychotherapy were based on previously established questionnaires. Associations were tested using bivariate and multivariate analyses. Bivariate analyses showed that patients who did not perceive psychotherapy as effective at improving social, family, or job functioning reported greater CAM use. However, medication compliance was not significantly associated with use of CAM. Patients who used oral (e.g., herbal therapies) or cognitive (e.g., meditation) CAM were more likely to report that their medications were not effective at relieving manic or depressive symptoms. Users of cognitive CAM were more likely to report that their medications did not help with social, job, or family functioning, and that they did not prevent recurrences of manic or depressive episodes. None of the bivariate associations remained significant in multivariate analyses. Prior research has suggested that persons who are dissatisfied with treatment for medical conditions are more likely to use CAM therapies. However, the results of this study do not show CAM therapies to be associated with perceived effectiveness of treatments for mental health problems among this sample of persons with serious mental illnesses. This suggests that motivations for CAM use may vary by population and condition. Because few correlates of CAM use among persons with serious mental illnesses are known

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

    Directory of Open Access Journals (Sweden)

    Tarantini Mario

    2007-01-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  12. [Treatment adherence and use of complementary and alternative medicine in patients with inflammatory bowel disease].

    Science.gov (United States)

    Lakatos, László; Czeglédi, Zsófia; Dávid, Gyula; Kispál, Zsófi; Kiss, Lajos S; Palatka, Károly; Kristóf, Tünde; Molnár, Tamás; Salamon, Agnes; Demeter, Pál; Miheller, Pál; Szamosi, Tamás; Banai, János; Papp, Mária; Bene, László; Kovács, Agota; Rácz, István; Lakatos, Péter László

    2010-02-14

    Previous studies have suggested an increasing use of complementary and alternative medicine (CAM) in patients with inflammatory bowel disease (IBD). Furthermore, a significant number of IBD patients fail to comply with treatment. The aim of our study was to evaluate the prevalence of non-adherence the use of CAM in Hungarian patients with IBD. A total of 655 consecutive IBD patients (Crohn's disease [CD]: 344, age: 38.2 + or - 12.9 years; ulcerative colitis [UC]: 311, age: 44.9 + or - 15.3 years) were interviewed during the visit at specialists by self-administered questionnaire including demographic and disease-related data, as well as items analyzing the extent of non-adherence and CAM use. Patients taking more then 80% of each prescribed medicine were classified as adherent. The overall rate of self reported non-adherence (CD: 20.9%, UC: 20.6%) and CAM (CD: 31.7%, UC: 30.9%) use was not different between CD and UC. The most common causes of non-adherence were: forgetfulness (47.8%), too many/unnecessary pills (39.7%), being afraid of side effects (27.9%) and too frequent dosing. Most common forms of CAM were herbal tee (47.3%), homeopathy (14.6%), special diet (12.2%), and acupuncture (5.8%). In CD, disease duration, date of last follow-up visit, educational level and previous surgeries were predicting factors for non-adherence. Alternative medicine use was associated in both diseases with younger age, higher educational level and immunosuppressant use. In addition, CAM use in UC was more common in females and in patients with supportive psychiatric/psychological therapy. Non-adherence and CAM use is common in patients with IBD. Special attention should be paid to explore the identified predictive factors during follow-up visits to improve adherence to therapy and improving patient-doctor relationship.

  13. Interim Control Strategy for the Test Area North/Technical Support Facility Sewage Treatment Facility Disposal Pond - Two-year Update

    International Nuclear Information System (INIS)

    L. V. Street

    2007-01-01

    The Idaho Cleanup Project has prepared this interim control strategy for the U.S. Department of Energy Idaho Operations Office pursuant to DOE Order 5400.5, Chapter 11.3e (1) to support continued discharges to the Test Area North/Technical Support Facility Sewage Treatment Facility Disposal Pond. In compliance with DOE Order 5400.5, a 2-year review of the Interim Control Strategy document has been completed. This submittal documents the required review of the April 2005 Interim Control Strategy. The Idaho Cleanup Project's recommendation is unchanged from the original recommendation. The Interim Control Strategy evaluates three alternatives: (1) re-route the discharge outlet to an uncontaminated area of the TSF-07; (2) construct a new discharge pond; or (3) no action based on justification for continued use. Evaluation of Alternatives 1 and 2 are based on the estimated cost and implementation timeframe weighed against either alternative's minimal increase in protection of workers, the public, and the environment. Evaluation of Alternative 3, continued use of the TSF-07 Disposal Pond under current effluent controls, is based on an analysis of four points: - Record of Decision controls will protect workers and the public - Risk of increased contamination is low - Discharge water will be eliminated in the foreseeable future - Risk of contamination spread is acceptable. The Idaho Cleanup Project recommends Alternative 3, no action other than continued implementation of existing controls and continued deactivation, decontamination, and dismantlement efforts at the Test Area North/Technical Support Facility

  14. A cost comparison of alternative regimens for treatment-refractory partial seizure disorder: an econometric analysis.

    Science.gov (United States)

    Lee, Won Chan; Hoffmann, Marc S; Arcona, Steve; D'Souza, Joseph; Wang, Qin; Pashos, Chris L

    2005-10-01

    Partial seizure disorder is typically treated by monotherapy with antiepileptic drugs (AEDs). However, when the condition is refractory to the initial treatment regimen, patients may be switched to monotherapy with another AED or to combination therapy with the initial AED plus a second AED. The purpose of this study was to examine the economic costs associated with treatment-refractory partial seizure disorder and to compare the costs of 2 alternative approaches: a switch to oxcarbazepine (OXC) monotherapy or the addition to the regimen of another AED (AED add-on). Adult patients with a diagnosis of partial seizure disorder who received initial AED monotherapy between January 1, 2000, and March 31, 2003, were identified from the PharMetrics Patient-Centric Database, a health plan administrative claims database. The medical and pharmacy history of these patients was analyzed from 6 months before a change to either OXC monotherapy or AED add-on therapy through 12 months after the change in treatment. Total health care resource utilization and the associated costs were compared within each cohort before and after the change, as well as between cohorts, with statistical differences tested using Wilcoxon rank sum tests. Multivariate econometric analyses were performed to examine the impact of age, sex, geographic location, Charlson Comorbidity Index, and the presence of specific comorbidities. Demographic and clinical characteristics 102 were similar between the OXC monotherapy cohort (n = 259) and the AED add-on cohort (n = 795). Annual direct treatment costs increased in both groups in the period after the failure of initial monotherapy, increasing from 10,462 US dollars to 11,360 US dollars in the OXC cohort and from 10,137 US dollars to 12,201 US dollars in the AED add on cohort (P < 0.01). Increased pharmacy costs were the primary driver behind cost increases in both cohorts. Patients in the AED add-on cohort were significantly more likely to have an emergency

  15. Complementary and alternative medical therapies for chronic low back pain: What treatments are patients willing to try?

    Science.gov (United States)

    Sherman, Karen J; Cherkin, Daniel C; Connelly, Maureen T; Erro, Janet; Savetsky, Jacqueline B; Davis, Roger B; Eisenberg, David M

    2004-07-19

    Although back pain is the most common reason patients use complementary and alternative medical (CAM) therapies, little is known about the willingness of primary care back pain patients to try these therapies. As part of an effort to refine recruitment strategies for clinical trials, we sought to determine if back pain patients are willing to try acupuncture, chiropractic, massage, meditation, and t'ai chi and to learn about their knowledge of, experience with, and perceptions about each of these therapies. We identified English-speaking patients with diagnoses consistent with chronic low back pain using automated visit data from one health care organization in Boston and another in Seattle. We were able to confirm the eligibility status (i.e., current low back pain that had lasted at least 3 months) of 70% of the patients with such diagnoses and all eligible respondents were interviewed. Except for chiropractic, knowledge about these therapies was low. Chiropractic and massage had been used by the largest fractions of respondents (54% and 38%, respectively), mostly for back pain (45% and 24%, respectively). Among prior users of specific CAM therapies for back pain, massage was rated most helpful. Users of chiropractic reported treatment-related "significant discomfort, pain or harm" more often (23%) than users of other therapies (5-16%). Respondents expected massage would be most helpful (median of 7 on a 0 to 10 scale) and meditation least helpful (median of 3) in relieving their current pain. Most respondents indicated they would be "very likely" to try acupuncture, massage, or chiropractic for their back pain if they did not have to pay out of pocket and their physician thought it was a reasonable treatment option. Most patients with chronic back pain in our sample were interested in trying therapeutic options that lie outside the conventional medical spectrum. This highlights the need for additional studies evaluating their effectiveness and suggests that

  16. Noradrenergic augmentation strategies in the pharmacological treatment of depression and schizophrenia : An experimental study

    OpenAIRE

    Linnér, Love

    2002-01-01

    The pharmacological treatment of depression and schizophrenia, two major psychiatric disorders, is largely based on modulation of central monoaminergic neurotransmission. However, currently available pharmacological treatment alternatives possess a relatively modest clinical efficacy, making them less than optimal. The present series of studies, using in vivo electrophysiological, biochemical and behavioral techniques in rats, aim at the disclosure of mechanisms whereby an ...

  17. GREYWATER TREATMENT SYSTEM IN UNIVERSITI KEBANGSAAN MALAYSIA MOSQUE: UTILIZING FILTER WELLS AS AN ALTERNATIVE SUSTAINABLE INNOVATION

    Directory of Open Access Journals (Sweden)

    Nangkula Utaberta

    2014-09-01

    Full Text Available Water is one of the natural resources that support entire creature’s needs in earth. It was also a key element of sustainable living. The important of water is proved by fact that human body were consists of 80% water which makes daily water needs is definitely important. Same thing was happen on earth which also consists of 71 % water.  Unfortunately,  nowadays qualities  as well  as quantities  of  water is getting  poor caused many environmental decline. Those situation is feel quite irony, first is because in one side human are depending on water badly, and in another side, qualities and quantities water have been decreasing because of their own. This environmental issue, especially water was realized by Universiti Kebangsaan Malaysia (UKM by starting to be a first pioneer in Green & Sustainability Campus in Malaysia.  Although UKM is located in water-rich country, still UKM try to commit to save environment as well as manage its environment aspect. The usage of water in UKM itself is categorized in high level. UKM have around 20.000 students and most of them are dwelling in campus.  For  big  campus  like  this,  UKM  had  one  main  Mosque  which  accommodates  some  daily  worship  of Moslem as the majority one. For activities like ablution, washing and bathing, UKM Mosque had produce quite big  amount  of  grey  water.  Grey  water itself  is residual  water that  still fresh  and can  be recycled for some purposes such as landscape irrigation and cleaning service. One alternative method to treats the grey water is by the usage of filter wells. This paper is trying to analysis and proposes some design of grey water system in UKM mosque in order to save environment. With proper grey water treatment, UKM Mosque will contribute to save water and UKM’s environment. This successful water treatment is also can be an alternative model to apply in another building.

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

    Science.gov (United States)

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

    2017-02-01

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

  19. Strategies to mitigate dissociative and psychotomimetic effects of ketamine in the treatment of major depressive episodes: a narrative review.

    Science.gov (United States)

    Cooper, Matthew D; Rosenblat, Joshua D; Cha, Danielle S; Lee, Yena; Kakar, Ron; McIntyre, Roger S

    2017-09-01

    Objectives Replicated evidence has demonstrated that ketamine exerts rapid-acting and potent antidepressant effects. Notwithstanding, its promise to mitigate depressive symptoms and suicidality in antidepressant-resistant populations, several limitations and safety concerns accompany ketamine including, but not limited to, the potential for abuse and psychotomimetic/dissociative experiences. The focus of the current narrative review is to synthesise available evidence of strategies that may mitigate and fully prevent treatment-emergent psychotomimetic and dissociative effects associated with ketamine administration. Methods PubMed, Google Scholar and ClinicalTrials.gov were searched for relevant articles. Results Potential avenues investigated to minimise psychotomimetic effects associated with ketamine administration include the following: (1) altering dosing and infusion rates; (2) route of administration; (3) enantiomer choice; (4) co-administration with mood stabilisers of antipsychotics; and (5) use of alternative N-methyl-d-aspartate (NMDA)-modulating agents. Emerging evidence indicates that dissociative experiences can be significantly mitigated by using an intranasal route of administration, lower dosages, or use of alternative NMDA-modulating agents, namely lanicemine (AZD6765) and GLYX-13. Conclusions Currently, intranasal administration presents as the most promising strategy to mitigate dissociative and psychotomimetic effects; however, studies of strategies to mitigate the adverse events of ketamine are limited in number and quality and thus further investigation is still needed.

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

    DEFF Research Database (Denmark)

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

    2001-01-01

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