Sample records for assessing anticalcification treatments

  1. In Vitro Evaluation Of Anti-calcification And Anti-coagulation On Sulfonated Chitosan And Carrageenan Surfaces


    Campelo; Clayton Souza; Lima; Luana Dias; Rebelo; Luciana Magalhaes; Mantovani; Diego; Beppu; Marisa Masumi; Vieira; Rodrigo Silveira


    In recent years, great effort has been devoted to the development of biomaterials that come into contact with blood. The surfaces of these materials need to be of suitable mechanical strength, and present anti-thrombogenic and anti-calcification properties. Chitosan is a natural polymer that has attracted attention due to its potential to act as a biomaterial. However, chitosan contains amino groups in its structure that may promote thrombogenesis and calcification. A strategy to reduce these...

  2. Assessment and Treatment of Paraphilias. (United States)

    Seligman, Linda; Hardenburg, Stephanie A.


    Provides a description of the category of mental disorders called "paraphilias" and guidelines for assessment of people who present with paraphillic behavior. Includes a review of inventories that can facilitate diagnosis and description of paraphilias. Discusses effective approaches to treatment of these disorders as well as personal and…

  3. The Treatment Effectiveness Assessment (TEA

    Directory of Open Access Journals (Sweden)

    Ling W


    Full Text Available Walter Ling,1 David Farabee,1 Dagmar Liepa,2 Li-Tzy Wu3 1Integrated Substance Abuse Programs, University of California, Los Angeles, CA, 2Valley Care Medical Center, Panorama City, CA, 3Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA We have been surprised and gratified by the readers’ responses to our article, The Treatment Effectiveness Assessment (TEA: an efficient, patient-centered instrument for evaluating progress in recovery from addiction, which was published in December 2012.1 In the six months since that time, we have received numerous questions and observations about the article, and about the TEA instrument. Respondents were clinicians: physicians, counselors, therapists, nurses; as well as administrators and policy makers.  View original paper by Ling W, Farabee D, Liepa D, Wu LT. 

  4. Sustainability assessment of advanced wastewater treatment technologies

    DEFF Research Database (Denmark)

    Høibye, Linda; Clauson-Kaas, Jes; Wenzel, Henrik


    As a consequence of the EU Water Framwork Directive, more focus is now on discharges of hazardous substances from wastewater treatment plants and sewers. Thus, many municipalities in Denmark may have to adopt to future advenced treatment technologies. This paper describes a holistic assessment......, which includes technical, economic and environmental aspects. The technical and economic assessment is performed on 5 advanced treatment technologies: sand filtration, ozone treatment, UV exclusively for disinfection of pathogenic microorganisms, Membrane Bioreactor (MBR), and UV in combination...... and three advanced treatment methods: sand filtration, ozone treatment and MBR. The technical and economic assessment showed that UV solely for disinfection purposes or ozone treatment are the most advantageous advanved treatment methods if the demands are restricted to pathogenic microorganisms. In terms...

  5. Sustainability assessment of advanced wastewater treatment technologies

    DEFF Research Database (Denmark)

    Høibye, Linda; Clauson-Kaas, Jes; Wenzel, Henrik


    As a consequence of the EU Water Framework Directive more focus is now on discharges of hazardous substances from wastewater treatment plants and sewers. Thus, many municipalities in Denmark may have to adopt to future advanced treatment technologies. This paper describes a holistic assessment...... of sustainability, sand filtration is the most advantageous method based on the technical and environmental assessment due to the low energy consumption and high efficiency with regards to removal of heavy metals. Key words | advanced wastewater treatment, life cycle assessment, MBR, ozone treatment, sand......, which includes technical, economical and environmental aspects. The technical and economical assessment is performed on 5 advanced treatment technologies: sand filtration, ozone treatment, UV exclusively for disinfection of pathogenic microorganisms, membrane bioreactor (MBR) and UV in combination...

  6. Eating disorders: assessment and treatment. (United States)

    Johnson, W G; Schlundt, D G


    Anorexia and bulimia are eating disorders affecting a significant number of adolescent and young adult women. The core symptoms of both disorders are similar and include a fear of obesity, body image disturbance, erratic eating patterns, and purging. These symptoms produce significant physical and psychologic complications. Both anorexia and bulimia appear to have a common origin in a fear of obesity and dieting. Anorectics, being "successful" dieters, lose a significant amount of weight; whereas bulimics alternate between binges and purges. Treatment for the eating disorders is gradually evolving as clinical research experience accumulates. For anorexia, hospitalization is indicated when weight falls below 15% of ideal, and most investigators agree that therapy for the core symptoms cannot be undertaken until weight is restored. During the impatient stay, a behavior modification program can effectively organize medical, nutritional, and psychologic support, and offers the quickest and most direct route to weight restoration. The nasogastric tube and total parenteral nutrition are used primarily for those who are severely emaciated or who actively resist standard modes of therapy. Inpatient treatment is most effectively and efficiently rendered in a specialized eating disorder unit. Once weight restoration is progressing, behavior therapy for core symptoms is commenced and continued on an outpatient basis. A variety of behavioral techniques are employed, and they are designed primarily to influence anorectic assumptions and beliefs. Although there may be a brief inpatient stay for initiation of treatment, the bulk of therapy for bulimia occurs on an outpatient basis. The available literature indicates that behavioral techniques and antidepressant medication are effective for the symptoms of bulimia. Early identification of core symptoms of both disorders can lead to an initiation of treatment before the core symptoms become ingrained. A potentially more effective

  7. Assessing observational studies of medical treatments

    Directory of Open Access Journals (Sweden)

    Butani Yogita


    Full Text Available Abstract Background Previous studies have assessed the validity of the observational study design by comparing results of studies using this design to results from randomized controlled trials. The present study examined design features of observational studies that could have influenced these comparisons. Methods To find at least 4 observational studies that evaluated the same treatment, we reviewed meta-analyses comparing observational studies and randomized controlled trials for the assessment of medical treatments. Details critical for interpretation of these studies were abstracted and analyzed qualitatively. Results Individual articles reviewed included 61 observational studies that assessed 10 treatment comparisons evaluated in two studies comparing randomized controlled trials and observational studies. The majority of studies did not report the following information: details of primary and ancillary treatments, outcome definitions, length of follow-up, inclusion/exclusion criteria, patient characteristics relevant to prognosis or treatment response, or assessment of possible confounding. When information was reported, variations in treatment specifics, outcome definition or confounding were identified as possible causes of differences between observational studies and randomized controlled trials, and of heterogeneity in observational studies. Conclusion Reporting of observational studies of medical treatments was often inadequate to compare study designs or allow other meaningful interpretation of results. All observational studies should report details of treatment, outcome assessment, patient characteristics, and confounding assessment.

  8. Behavioral Assessment and Treatment of Pediatric Headache (United States)

    Andrasik, Frank; Schwartz, Mark S.


    Headaches are quite common in children and adolescents, and they appear to persist into adulthood in a sizable number of individuals. Assessment approaches (interview, pain diaries, and general and specific questionnaires) and behavioral treatment interventions (contingency management, relaxation, biofeedback, and cognitive behavior therapy) are…

  9. New Assessments and Treatments in ASD. (United States)

    Choueiri, Roula N; Zimmerman, Andrew W


    The assessment of autism spectrum disorder (ASD) is complex and remains clinical, despite advances in basic research. In this chapter, we review new and updated clinical tools, such as screening and diagnostic tests, and discuss the DSM-5 criteria introduced in 2013. We provide an algorithm to guide clinical evaluation and referrals. We also review non-behavioral treatments and summarize recent research. Current conventional treatment of ASD in children includes intensive behavioral interventions (known as applied behavioral analysis or ABA), rehabilitative services such as speech therapy, occupational therapy, physical therapy, social skills training, and counseling. We present new validated information and provide clinical guidance for the evaluation and treatment of young children and youth with ASD.

  10. Life cycle assessment of electronic waste treatment. (United States)

    Hong, Jinglan; Shi, Wenxiao; Wang, Yutao; Chen, Wei; Li, Xiangzhi


    Life cycle assessment was conducted to estimate the environmental impact of electronic waste (e-waste) treatment. E-waste recycling with an end-life disposal scenario is environmentally beneficial because of the low environmental burden generated from human toxicity, terrestrial ecotoxicity, freshwater ecotoxicity, and marine ecotoxicity categories. Landfill and incineration technologies have a lower and higher environmental burden than the e-waste recycling with an end-life disposal scenario, respectively. The key factors in reducing the overall environmental impact of e-waste recycling are optimizing energy consumption efficiency, reducing wastewater and solid waste effluent, increasing proper e-waste treatment amount, avoiding e-waste disposal to landfill and incineration sites, and clearly defining the duties of all stakeholders (e.g., manufacturers, retailers, recycling companies, and consumers). Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Life cycle assessment of electronic waste treatment

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Jinglan, E-mail: [Shandong Provincial Key Laboratory of Water Pollution Control and Resource Reuse, School of Environmental Science and Engineering, Shandong University, Jinan 250100 (China); Shandong University Climate Change and Health Center, Public Health School, Shandong University, Jinan 250012 (China); Shi, Wenxiao [Shandong Provincial Key Laboratory of Water Pollution Control and Resource Reuse, School of Environmental Science and Engineering, Shandong University, Jinan 250100 (China); Wang, Yutao [School of Life Science, Shandong University, Shanda South Road 27, Jinan 250100 (China); Chen, Wei [Shandong Provincial Key Laboratory of Water Pollution Control and Resource Reuse, School of Environmental Science and Engineering, Shandong University, Jinan 250100 (China); Li, Xiangzhi, E-mail: [School of Medicine, Shandong University, Jinan 250012 (China)


    Highlights: • Life cycle assessment of electronic waste recycling is quantified. • Key factors for reducing the overall environmental impact are indentified. • End-life disposal processes provide significant environmental benefits. • Efficiently reduce the improper disposal amount of e-waste is highly needed. • E-waste incineration can generate significant environmental burden. - Abstract: Life cycle assessment was conducted to estimate the environmental impact of electronic waste (e-waste) treatment. E-waste recycling with an end-life disposal scenario is environmentally beneficial because of the low environmental burden generated from human toxicity, terrestrial ecotoxicity, freshwater ecotoxicity, and marine ecotoxicity categories. Landfill and incineration technologies have a lower and higher environmental burden than the e-waste recycling with an end-life disposal scenario, respectively. The key factors in reducing the overall environmental impact of e-waste recycling are optimizing energy consumption efficiency, reducing wastewater and solid waste effluent, increasing proper e-waste treatment amount, avoiding e-waste disposal to landfill and incineration sites, and clearly defining the duties of all stakeholders (e.g., manufacturers, retailers, recycling companies, and consumers)

  12. Poststroke hypertonicity: upper limb assessment and treatment. (United States)

    Marciniak, Christina


    Hypertonicity is common in patients with upper limb dysfunction following hemiplegic stroke and is associated with greater impairment, worse function, and lower health-related quality of life. In addition to increased rest activity, abnormal patterns of muscle activation, such as spastic co-contraction, may contribute to disability. In the upper limb, flexor muscles are more commonly involved distally, and at the shoulder, spasticity of adductors, flexors, and internal rotators is most often observed. Prior to interventions, a history regarding prior interventions, comorbid diagnoses, and limitations imposed by abnormal tone should be elicited. Commonly used scales to assess hypertonicity include the Modified Ashworth, the Modified Tardieu, the Spasm Frequency, the Disability Assessment, the Fugl-Meyer, and the Motor Assessment Scales. Treatment interventions for upper limb hypertonicity include stretching, splinting, strengthening of antagonist muscles, oral medications, and focal injections (phenol or botulinum toxins). Intrathecal baclofen may also impact upper limb tone. For focal injections, correct identification of muscles contributing to problematic tone is evaluated by eliciting resistance to movement at rest and observation of patterns of tightness as the limb is used functionally. The botulinum toxins have been shown to decrease tone in stroke survivors and improve active and passive functioning. Because secondary changes such as contractures and weakness may occur with prolonged hypertonicity, therapy to improve range of motion, strengthen weakened muscles, and incorporate use of the limb should be considered following focal injections, oral medications, or intrathecal pump placement.

  13. Achilles tendon rupture; assessment of nonoperative treatment

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner


    to be clarified, particularly the role of weight-bearing during early rehabilitation. Also, there is a need for a clinically applicable and accurate measurement to detect patients in risk of developing Achilles tendon elongation. PURPOSE: The aim of this PhD thesis was to evaluate non-operative treatment of acute......BACKGROUND: Acute Achilles tendon rupture is a frequent and potentially disabling injury. Over the past decade a change in treatment of acute Achilles tendon rupture away from operative towards non-operative treatment has taken place. However, the optimal non-operative treatment protocol remains.......3 mm), inter-rater reliability (ICC 0.97, SEM 3.3 mm and MDC 9.3 mm) and validity (measurement error 2%). CONCLUSION: Treatment algorithms across Scandinavia showed considerable variation, though operative treatment and controlled early weight-bearing was the preferred treatment in Denmark, Norway...

  14. California Drug and Alcohol Treatment Assessment (CALDATA-1991-1993) (United States)

    U.S. Department of Health & Human Services — The California Drug and Alcohol Treatment Assessment (CALDATA) was designed to study the costs, benefits, and effectiveness of the state's alcohol and drug treatment...

  15. Re-assessing community-directed treatment

    DEFF Research Database (Denmark)

    Halwindi, H.; Magnussen, Pascal; Siziya, S.


    Cross-sectional surveys with carers, health workers, community drug distributors (CDDs) and neighbourhood health committees were conducted to identify factors associated with utilization of community-directed treatment (ComDT) of soil-transmitted helminths in children aged 12-59 months in Mazabuka...... district, Zambia. The surveys took place in December 2006 and December 2007. In addition child treatment records were reviewed. The factors that were found to be significantly associated (ptreatment of children by the CDDs were: (1) the perception of soil-transmitted helminth infections...... as having significant health importance, (2) the community-based decision to launch and subsequently implement ComDT, (3) the use of the door-to-door method of drug distribution, (4) CDDs being visited by a supervisor, (5) CDDs receiving assistance in mobilizing community members for treatment, (6) CDDs...

  16. Acne vulgaris: pathogenesis, treatment, and needs assessment. (United States)

    Knutsen-Larson, Siri; Dawson, Annelise L; Dunnick, Cory A; Dellavalle, Robert P


    Acne vulgaris is a common skin condition with substantial cutaneous and psychologic disease burden. Studies suggest that the emotional impact of acne is comparable to that experienced by patients with systemic diseases, like diabetes and epilepsy. In conjunction with the considerable personal burden experienced by patients with acne, acne vulgaris also accounts for substantial societal and health care burden. The pathogenesis and existing treatment strategies for acne are complex. This article discusses the epidemiology, pathogenesis, and treatment of acne vulgaris. The burden of disease in the United States and future directions in the management of acne are also addressed. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Achilles tendon rupture; assessment of nonoperative treatment

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner


    to be clarified, particularly the role of weight-bearing during early rehabilitation. Also, there is a need for a clinically applicable and accurate measurement to detect patients in risk of developing Achilles tendon elongation. PURPOSE: The aim of this PhD thesis was to evaluate non-operative treatment of acute...... I found surgery to be the preferred treatment in 83% of departments in Denmark, 92% in Norway, 65% in Sweden, and 30% in Finland (p up except from a better health......-related quality of life in the weight-bearing group (p=0.009). Compared to the unaffected limb, the affected limb had decreased stiffness (77%, p

  18. Virtual Reality Augmentation for Functional Assessment and Treatment of Stuttering (United States)

    Brundage, Shelley B.


    Stuttering characteristics, assessment, and treatment principles present challenges to assessment and treatment that can be addressed with virtual reality (VR) technology. This article describes how VR can be used to assist clinicians in meeting some of these challenges with adults who stutter. A review of current VR research at the Stuttering…

  19. Life Cycle Assessment of Horse Manure Treatment

    Directory of Open Access Journals (Sweden)

    Ola Eriksson


    Full Text Available Horse manure consists of feces, urine, and varying amounts of various bedding materials. The management of horse manure causes environmental problems when emissions occur during the decomposition of organic material, in addition to nutrients not being recycled. The interest in horse manure undergoing anaerobic digestion and thereby producing biogas has increased with an increasing interest in biogas as a renewable fuel. This study aims to highlight the environmental impact of different treatment options for horse manure from a system perspective. The treatment methods investigated are: (1 unmanaged composting; (2 managed composting; (3 large-scale incineration in a waste-fired combined heat and power (CHP plant; (4 drying and small-scale combustion; and (5 liquid anaerobic digestion with thermal pre-treatment. Following significant data uncertainty in the survey, the results are only indicative. No clear conclusions can be drawn regarding any preference in treatment methods, with the exception of their climate impact, for which anaerobic digestion is preferred. The overall conclusion is that more research is needed to ensure the quality of future surveys, thus an overall research effort from horse management to waste management.

  20. Early assessment and treatment of myocardial infarction

    NARCIS (Netherlands)

    Hoog, V.C. de


    Although the detection and treatment of acute myocardial infarction (MI) has dramatically improved the last decades, ischemic heart disease is still a leading cause of death worldwide. Whereas mortality has declined in industrialized countries, it continues to rise in other parts of the world.

  1. Trauma in pregnancy: assessment and treatment. (United States)

    Petrone, P; Asensio, J A


    Women between the ages of 10 and 50 year-old have the potential for pregnancy; therefore this condition must be taken into consideration when a woman is examined in the Emergency Room after sustaining a traumatic event. Pregnancy produces significant physiologic and anatomic changes in every system of the female body. The evaluation of the traumatized pregnant patient, the approach, and the interpretation of the diagnostic tests results must be accompanied by the full knowledge of all changes that take place during pregnancy. In the same context, although the physician treating a pregnant trauma victim must remember that there are two patients, the treatment priorities are the same as for the non-pregnant trauma patient. The best initial treatment for the fetus is the optimum resuscitation of the mother. A thorough exam should take place to discover unique conditions that might be present in any pregnant patient such as blunt or penetrating injury to the uterus, placental abruption, amniotic fluid embolism, isoimmunization, and premature rupture of membranes. The obstetrician should be present at all times and be considered a part of the trauma team in the evaluation and treatment of a pregnant trauma patient.

  2. Social Anxiety and Dating Inhibitions: Assessment and Treatment. (United States)

    Arkowitz, Hal

    Recent research on the behavioral assessment and treatment of social anxiety and inhibition is reviewed. Subjects for the studies were college men and women selected on the basis of heterosexual anxiety and inhibition. The first part of the paper is concerned with assessment. The behavioral assessment procedures developed include: (1) direct…

  3. The assessment and treatment of specific phobias: a review. (United States)

    Grös, Daniel F; Antony, Martin M


    Specific phobia is one of the most common and easily treated mental disorders. In this review, empirically supported assessment and treatment procedures for specific phobia are discussed. Exposure-based treatments in particular are highlighted given their demonstrated effectiveness for this condition. The format and characteristics of exposure-based treatment and predictors of treatment response are outlined to provide recommendations for maximizing outcome. In addition, several other treatments for specific phobia are reviewed and critiqued, including cognitive therapy, virtual reality, eye movement desensitization and reprocessing, applied tension, and pharmacologic treatments. The review concludes with a discussion of future directions for research.

  4. Optimizing stormwater treatment practices a handbook of assessment and maintenance

    CERN Document Server

    Erickson, Andrew J; Gulliver, John S


    Optimizing Stormwater Treatment Practices: A Handbook of Assessment and Maintenance provides the information necessary for developing and operating an effective maintenance program for stormwater treatment. The book offers instructions on how to measure the level of performance of stormwater treatment practices directly and bases proposed maintenance schedules on actual performance and historical maintenance efforts and costs. The inspection methods, which are proven in the field and have been implemented successfully, are necessary as regulatory agencies are demanding evaluations of the performance of stormwater treatment practices. The authors have developed a three-tiered approach that offers readers a standard protocol for how to determine the effectiveness of stormwater treatment practices currently in place. This book also: Provides a standard protocol for how to determine the effectiveness of stormwater treatment practices Assists readers with identifying which assessment techniques to use for stormwa...

  5. A laboratory assessment of various treatment conditions affecting ...

    African Journals Online (AJOL)

    A laboratory assessment of various treatment conditions affecting the ammoniation of wheat straw ... levels of 250 and 375 g/kg wheat straw and treatment periods of 0;. 1; 2; 4; 6 and 8 weeks. Dependent variables .... Individual samples were sealed airtightly in 2 000 ml plastic containers. Subsequently the urea included in ...

  6. Family Treatment Approaches to Alcoholism: Assessing the "Alcoholic Family." (United States)

    Gomberg, Christopher A.; Billings, Andrew G.

    Research and clinical support for the connections between alcohol abuse and the family milieu have generated increased interest in family treatment approaches to alcoholism. In assessing the "alcoholic family," the clinician must consider numerous aspects of family interaction which have been linked to abuse and to treatment outcomes.…

  7. Assessment of the efficacy of desmopressin in treatment of Primary ...

    African Journals Online (AJOL)

    Background: Enuresis is defined as a normal void occurring at an inappropriate social time or place. The treatment approach for enuresis is controversial due to a lack of consensus as to the exact causes of nocturnal enuresis. Aim: Aim was to assess the efficacy of desmopressin therapy in the treatment of Primary

  8. Assessment and Treatment of Co-occurring Eating Disorders in Privately Funded Addiction Treatment Programs (United States)

    Killeen, Therese K.; Greenfield, Shelly F.; Bride, Brian E.; Cohen, Lisa; Gordon, Susan Merle; Roman, Paul M.


    Privately-funded addiction treatment programs were surveyed to increase understanding of assessment and current treatment options for patients with co-occurring substance use and eating disorders. Data were collected from face-to-face interviews with program administrators of a nationally representative sample of 345 private addiction treatment programs. Although the majority of programs reported screening for eating disorders, programs varied in screening instruments used. Sixty-seven percent reported admitting cases of low severity. Twenty-one percent of programs attempt to treat eating disorders. These results highlight the need for education of addiction treatment professionals in assessment, referral and treatment of eating disorders. PMID:21477048

  9. Current approaches for assessment and treatment of women with ...

    African Journals Online (AJOL)

    Context: It has been suggested that women with early miscarriage or ectopic pregnancy are best cared for in dedicated units which offer rapid and definitive ultrasonographic and biochemical assessment at the initial review of the patient. Aims: To describe the current protocols for the assessment and treatment of women ...

  10. Conducting Systematic Outcome Assessment in Private Addictions Treatment Settings

    Directory of Open Access Journals (Sweden)

    Gerard J Connors


    Full Text Available Systematic outcome assessment is central to ascertaining the impact of treatment services and to informing future treatment initiatives. This project was designed to be conducted within the clinical operations of 4 private addictions treatment centers. A structured interview was used to assess patients’ alcohol and other drug use and related variables (on treatment entry and at 1, 3, and 6 months following treatment discharge. The primary outcomes were percentage of days abstinent (PDA from alcohol and drugs, PDA from alcohol, and PDA from other drugs. Collateral reports during follow-up also were gathered. A total of 280 patients (56% men across the 4 programs participated. Percentage of days abstinent for each outcome increased significantly from baseline to the 1-month follow-up assessment, and this change was maintained at the 3- and 6-month follow-up assessments. Collateral reports mirrored the patient follow-up reports. Secondary outcomes of patient ratings of urges/cravings, depression, anxiety, and general life functioning all indicated significant improvement from baseline over the course of the follow-up. The results suggest the feasibility of conducting systematic outcome assessment in freestanding private addictions treatment environments.

  11. Clinical Significance: a Therapeutic Approach Topsychological Assessment in Treatment Planning

    Directory of Open Access Journals (Sweden)

    Afolabi Olusegun Emmanuel


    Full Text Available Psychological assessment has long been reported as a key component of clinical psychology. This paper examines the complexities surrounding the clinical significance of therapeutic approach to treatment planning. To achieve this objective, the paper searched and used the PsycINFO and PubMed databases and the reference sections of chapters and journal articles to analysed, 1 a strong basis for the usage of therapeutic approach to psychological assessment in treatment plans, 2 explained the conceptual meaning of clinical significant change in therapeutic assessment, 3 answered some of the questions regarding practicability and the clinical significance of therapeutic approach to treatment plans, particularly during or before treatment, 4 linked therapeutic assessment to change in clients’ clinical impression, functioning and therapeutic needs 5 analysed the empirically documenting clinically significant change in therapeutic assessment. Finally, the study suggested that though therapeutic assessment is not sufficient for the systematic study of psychotherapy outcome and process, it is still consistent with both the layman and professional expectations regarding treatment outcome and also provides a precise method for classifying clients as ‘changed’ or ‘unchanged’ on the basis of clinical significance criteria.

  12. Clinical outcomes assessment in clinical trials to assess treatment of femoroacetabular impingement

    DEFF Research Database (Denmark)

    Harris-Hayes, Marcie; McDonough, Christine M; Leunig, Michael


    Patient-reported outcome measures are an important component of outcomes assessment in clinical trials to assess the treatment of femoroacetabular impingement (FAI). This review of disease-specific measures and instruments used to assess the generic quality of life and physical activity levels...

  13. Performance assessment techniques for groundwater recovery and treatment systems

    Energy Technology Data Exchange (ETDEWEB)

    Kirkpatrick, G.L. [Environmental Resources Management, Inc., Exton, PA (United States)


    Groundwater recovery and treatment (pump and treat systems) continue to be the most commonly selected remedial technology for groundwater restoration and protection programs at hazardous waste sites and RCRA facilities nationwide. Implementing a typical groundwater recovery and treatment system includes the initial assessment of groundwater quality, characterizing aquifer hydrodynamics, recovery system design, system installation, testing, permitting, and operation and maintenance. This paper focuses on methods used to assess the long-term efficiency of a pump and treat system. Regulatory agencies and industry alike are sensitive to the need for accurate assessment of the performance and success of groundwater recovery systems for contaminant plume abatement and aquifer restoration. Several assessment methods are available to measure the long-term performance of a groundwater recovery system. This paper presents six assessment techniques: degree of compliance with regulatory agency agreement (Consent Order of Record of Decision), hydraulic demonstration of system performance, contaminant mass recovery calculation, system design and performance comparison, statistical evaluation of groundwater quality and preferably, integration of the assessment methods. Applying specific recovery system assessment methods depends upon the type, amount, and quality of data available. Use of an integrated approach is encouraged to evaluate the success of a groundwater recovery and treatment system. The methods presented in this paper are for engineers and corporate management to use when discussing the effectiveness of groundwater remediation systems with their environmental consultant. In addition, an independent (third party) system evaluation is recommended to be sure that a recovery system operates efficiently and with minimum expense.

  14. A Review on Assessment and Treatment for Depression in Malaysia

    Directory of Open Access Journals (Sweden)

    Firdaus Mukhtar


    Full Text Available This paper aimed to review the literature on depression that focused on its assessment and treatment in Malaysia. PsycINFO, Medline, local journals were searched, and 18 published articles were included in this paper. Results indicate that research on depression in Malaysia, particularly validation studies and psychotherapy research, was weak and fragmented, with minimal empirical evidence available. Pharmacotherapy still dominated the treatment for depression, and, in terms of psychotherapy, Cognitive Behavioural Therapy (CBT was recently practiced, but only a few studies have reported on the treatment efficacy of CBT. Major limitations of studies were noted, and, consequently, the problems that are associated with the implementation and future direction of clinical and research on depression in Malaysia were discussed. In short, the contribution of empirical research on the assessment and treatment for depression remained inconsistent and fragmented and urgently in need of further empirical investigation.

  15. Reporting methods of blinding in randomized trials assessing nonpharmacological treatments.

    Directory of Open Access Journals (Sweden)

    Isabelle Boutron


    Full Text Available BACKGROUND: Blinding is a cornerstone of treatment evaluation. Blinding is more difficult to obtain in trials assessing nonpharmacological treatment and frequently relies on "creative" (nonstandard methods. The purpose of this study was to systematically describe the strategies used to obtain blinding in a sample of randomized controlled trials of nonpharmacological treatment. METHODS AND FINDINGS: We systematically searched in Medline and the Cochrane Methodology Register for randomized controlled trials (RCTs assessing nonpharmacological treatment with blinding, published during 2004 in high-impact-factor journals. Data were extracted using a standardized extraction form. We identified 145 articles, with the method of blinding described in 123 of the reports. Methods of blinding of participants and/or health care providers and/or other caregivers concerned mainly use of sham procedures such as simulation of surgical procedures, similar attention-control interventions, or a placebo with a different mode of administration for rehabilitation or psychotherapy. Trials assessing devices reported various placebo interventions such as use of sham prosthesis, identical apparatus (e.g., identical but inactivated machine or use of activated machine with a barrier to block the treatment, or simulation of using a device. Blinding participants to the study hypothesis was also an important method of blinding. The methods reported for blinding outcome assessors relied mainly on centralized assessment of paraclinical examinations, clinical examinations (i.e., use of video, audiotape, photography, or adjudications of clinical events. CONCLUSIONS: This study classifies blinding methods and provides a detailed description of methods that could overcome some barriers of blinding in clinical trials assessing nonpharmacological treatment, and provides information for readers assessing the quality of results of such trials.

  16. [Assessing environmental and economical benefits of integrated sewage treatment systems]. (United States)

    Li, Jin-rong; Zhang, Xiao-hong; Zhang, Hang-bin; Pan, Heng-yu; Liu, Qiang


    Sewage treatment, treated water treatment and sludge treatment are three basic units of an integrated sewage treatment system. This work assessed the influence of reusing or discharge of treated water and sludge landfill or compost on the sustainability of an integrated sewage treatment system using emergy analysis and newly proposed emergy indicators. This system's value included its environmental benefits and the products. Environmental benefits were the differences of the environmental service values before and after sewage treatment. Due to unavailability of data of the exchanged substance and energy in the internal system, products' values were attained by newly proposed substitution values. The results showed that the combination of sewage treatment, treated water reuse and sludge landfill had the strongest competitiveness, while the combination of sewage treatment, treated water reuse and earthworm compost was the most sustainable. Moreover, treated water reuse and earthworm compost were helpful for improving the sustainability of the integrated sewage treatment system. The quality of treated water and local conditions should be also considered when implementing the treated water reuse or discharge. The resources efficiency of earthworm compost unit needed to be further improved. Improved emergy indices were more suitable for integrated sewage treatment systems.

  17. Assessment, management and treatment of acute fingertip injuries. (United States)

    Kearney, Anthony; Canty, Louise


    Fingertip injuries with nail bed trauma can require specialist hand surgery, depending on severity. However, most of these injuries can be managed in well-equipped emergency departments by emergency nurses with an in-depth knowledge and understanding of the anatomy and physiology of the fingernail and surrounding structures, assessment and examination, pain management and treatment. This article describes the surface and underlying anatomy and physiology of the nail, the most common mechanisms of injury, relevant diagnostic investigations, and initial assessment and management. It also discusses treatment options, referral pathways, and patient discharge advice.

  18. Operational energy performance assessment system of municipal wastewater treatment plants. (United States)

    Yang, Lingbo; Zeng, Siyu; Chen, Jining; He, Miao; Yang, Wan


    Based on the statistical analysis of operational energy consumption and its influential factors from data of 599 Chinese WWTPs in 2006, it is noticed that the most influential factors include treatment technology adopted, treated sewage amount, removed pollutants amount, etc. Using the conclusion above, this paper sets up an integrated system of operational energy performance assessment for municipal wastewater treatment plants. Combining with result from on-spot research and model simulation, the calculating method of benchmark value and score of 7 energy efficiency indicators grouped into 3 levels is stated. Applying the assessment system to three plants, its applicability and objectivity are proved and suggestions to improve energy performance are provided.


    Directory of Open Access Journals (Sweden)

    Evelin Witruk


    Full Text Available This article will give an overview of the different methods of assessment and treatment currently used in the field of dyslexia with a special focus on genetic research. Based on the modification and extension of the multilevel model of Valtin (1989, modified by Witruk, 1993b, assessment and treatment methods will be discussed due to their primary objectives. These methods will be described regarding primary causes (biological risk factors, secondary causes (partial performance deficits, primary symptoms (reading and writing problems and secondary symptoms (emotional and behavioural disorders. Keywords: Multilevel model of dyslexia, genetics, magnocellular deficit, partial performance

  20. Life cycle assessment of advanced waste water treatment

    DEFF Research Database (Denmark)

    Larsen, Henrik Fred; Hansen, Peter Augusto

    The EU FP6 NEPTUNE project is related to the EU Water Framework Directive and the main goal is to develop new and optimize existing waste water treatment technologies (WWTT) and sludge handling methods for municipal waste water. Besides nutrients, a special focus area is micropollutants (e....... In total more that 20 different waste water and sludge treatment technologies are to be assessed. This paper will present the preliminary LCA results from running the induced versus avoided impact approach (mainly based on existing LCIA methodology) on one of the advanced treatment technologies, i...

  1. [Stalking: diagnostics, risk assessment, principles of treatment and forensic psychiatric assessment]. (United States)

    Dressing, H


    Stalking is a widespread phenomenon describing a pattern of intrusive and threatening behavior that leads to the victim's perception of being harassed, threatened and frightened. Physical assault and even homicide may sometimes occur in the context of stalking. For psychiatry the following tasks result: (1) diagnosis and classification of stalking cases, (2) risk assessment of stalking cases, (3) counselling and treatment of victims of stalking and, (4) treatment and assessment of stalkers. Empirical findings and instructions are presented for these four areas.

  2. The Caries Assessment Spectrum and Treatment (CAST) instrument: construct validation

    NARCIS (Netherlands)

    Souza, A.L. de; Leal, S.C.; Chaves, S.B.; Bronkhorst, E.M.; Frencken, J.E.F.M.; Creugers, N.H.J.


    The Caries Assessment Spectrum and Treatment (CAST) is a newly developed epidemiological instrument. The aim of this study was to investigate its construct validity. Four calibrated examiners, using CAST codes 0-6, visually examined 109 surfaces of extracted and exfoliated teeth. These teeth were

  3. Assessment of the efficacy of desmopressin in treatment of Primary ...

    African Journals Online (AJOL)

    Farida ElBaz


    Mar 31, 2015 ... ORIGINAL ARTICLE. Assessment of the efficacy of desmopressin in treatment of Primary Monosymptomatic. Nocturnal Enuresis in Egyptian children. Farida ElBaz, Sally Zahra *, Marian Khairy. Child Psychiatry Clinic, Pediatrics Department, Ain Shams University, Cairo, Egypt. Received 21 December 2014; ...

  4. Assessment of dairy wastewater treatment and its potential for ...

    African Journals Online (AJOL)

    The extent of pollution of dairy wastewater treated in a septic tank and its potential for biogas production was investigated. Performance of the existing treatment system was assessed through characterization of both raw and treated effluents. From the analysis parameters likeChemical Oxygen Demand (COD), Biochemical ...

  5. Current approaches for assessment and treatment of women with ...

    African Journals Online (AJOL)


    Nov 1, 2013 ... Aims: To describe the current protocols for the assessment and treatment of women with early miscarriage or ectopic pregnancy as reported by .... SOGON has membership strength of over 2000. The total number of .... of those sampled had formal training in transvaginal sonography. Table 4 shows the ...

  6. School Refusal Behavior: Classification, Assessment, and Treatment Issues. (United States)

    Lee, Marcella I.; Miltenberger, Raymond G.


    Discusses diagnostic and functional classification, assessment, and treatment approaches for school refusal behavior. Diagnostic classification focuses on separation anxiety disorder, specific phobia, social phobia, depression, and truancy. Functional classification focuses on the maintaining consequences of the behavior, such as avoidance of…

  7. Cardiovascular genetic assessment and treatment in middle age to ...

    African Journals Online (AJOL)

    Assessment and treatment of cardiovascular disease (CVD) risk factors as a preventable cause of cognitive decline, morbidity and mortality is an important clinical goal. The apolipoprotein E (Apo E) gene provides a genetic link between CVD and the development of Alzheimer's disease (AD). The E4 allele increases the risk ...

  8. Assessment of antiretroviral treatment outcome in public hospitals ...

    African Journals Online (AJOL)

    Assessment of antiretroviral treatment outcome in public hospitals, South Nations Nationalities and Peoples Region, Ethiopia. ... Kaplan-Meier models were used to estimate mortality and Cox proportional hazards models to identify predictors of mortality. Results: The median age was 30 years and 73.6% were in the age ...

  9. Assessment and treatment of post patent ductus arteriosus ligation syndrome.

    LENUS (Irish Health Repository)

    El-Khuffash, Afif F


    To compare differences in tissue Doppler imaging, global longitudinal strain (GLS), and cardiac troponin T (cTnT) between infants with low (<200 mL\\/kg\\/min) and high (>200 mL\\/kg\\/min) left ventricular (LV) output 1 hour after duct ligation and assess the impact of milrinone treatment on cardiac output and myocardial performance.

  10. Multi-Criteria Sustainability Assessment of Urban Sludge Treatment Technologies

    DEFF Research Database (Denmark)

    An, Da; Xi, Beidou; Ren, Jingzheng


    This study aims at developing a sustainability assessment framework for assessing the technologies for the treatment of urban sewage sludge based on the logarithmic fuzzy preference programming based fuzzy analytic hierarchy process (LFPPFAHP) and extension theory. LFPPFAHP was employed...... to determine the weights of the criteria for sustainability assessment, and extension theory was used to prioritize the alternative technologies for the treatment of urban sewage sludge and grade their sustainability performances. An illustrative case including three technologies (compositing, incineration......, and resource utilization) was studied by the proposed method, and compositing, incineration, and resource utilization are recognized as "Moderately Sustainable", "Not Sustainable", and "Highly Sustainable", respectively. The sustainability sequence in the descending order is resource utilization, compositing...

  11. Neuropathic Pain Following Spinal Cord Injury: Mechanism, Assessment and Treatment

    Directory of Open Access Journals (Sweden)

    Gul Mete Civelek


    Full Text Available Spinal cord injury (SCI is a devastating disease which may cause physical, psychological and social dysfunction. Neuropathic pain (NP after SCI is common, can be seen in varying degrees and is one of the most difficultly treated problems developing after SCI. With the addition of the NP to loss of function after SCI, sleep patterns, moods and daily activities of patients are adversely affected. In order to treat pain effectively, classification of pain after SCI must be done carefully and correctly. According to classification of International Pain Study Group, pain after SCI is divided into two main groups as nociceptive and neuropathic pain. Neuropathic pain is defined as %u201Cpain occuring as a direct result of a disease or lesion directly affecting somato-sensorial system%u201D. NP after SCI can be classified according to anatomical region (above the level of lesion, at the level of lesion, below the level of lesion. Treatment of NP after SCI is often challenging and receiving response to treatment may take long time. Therefore, treatment of NP after SCI should be multifactorial. Treatment options include pharmochologic treatment, application of transcutanous electrical nerve stimulation, psychiatric treatment approaches, and surgical approaches in selected cases. In pharmachologic treatment, first line agents are tricyclic antidepresants, pregabalin and gabapentin. In this review, mechanisms and assessment and treatment of NP after SCI is discussed with the guide of current literature.

  12. Treatments for somnambulism in adults: assessing the evidence. (United States)

    Harris, Melanie; Grunstein, Ronald R


    Somnambulism, or sleepwalking, is a parasomnia of non-rapid eye movement (NREM) sleep where movement behaviours usually confined to wakefulness are displayed during sleep. Generally, if sleepwalking is causing distress or danger in spite of safety measures, medical or psychological treatment is indicated. Clinicians will need to assess the evidence for treatment options. MEDLINE, EMBASE, PsycINFO and the Ovid Evidence-Based Medicine Reviews (EBM) multifile databases were searched. No properly powered rigorous controlled trials were found for treatment of sleepwalking in adults. Seven reports described small trials with some kind of control arm, or retrospective case series which included 30 or more patients. With no high quality evidence to underpin recommendations for treatments of somnambulism, full discussion with patients is advised. Adequately powered, well-designed clinical trials are now needed, and multi-centre collaborations may be required to obtain the sample sizes required.

  13. THMs assessment in Khuzestan rural water treatment plants

    Directory of Open Access Journals (Sweden)

    Mehdi Ahmadi


    Full Text Available Aims: The trihalomethanes (THMs concentration was investigated in some of rural water treatment plants in Khuzestan. Materials and Methods: Fifteen of the water treatment plants with the same drinking water source (Karoon river were selected for analysis of THMs to assess the levels and the relationship between THMs and total organic carbon (TOC, pH, temperature, chlorination dose, and free chlorine residue. Results: THMs ranged from 1.8 to 219 mg/l in winter and 1.7 to 98 in summer, where the level in some treatment plants is higher than the Maximum Concentration Level (MCL. The ratio of total THMs levels was significantly correlated with temperature, pH, chlorination dose, and free chlorine residue, but negative correlation with TOC. Conclusion: Epidemiological studies using total THMs levels should be considered in the analysis of water treatment plant′s results, and regulatory check of this parameter with drinking water guidelines.

  14. Orthodontic treatment modalities: a qualitative assessment of Internet information. (United States)

    Arun, Madahar; Usman, Qureshi; Johal, Ama


    The present study aimed to determine the quality, accuracy, reliability and usability of Internet information, regarding different orthodontic treatment modalities. Google AdWords identified five popular keywords: Cosmetic braces, fixed braces, Removable braces, Quick braces and risks. These were entered in five search engines, with the resultant websites analysed using five validated assessment tools. Intra-examiner reliability was assessed, descriptive and inferential analysis of the data undertaken. Good intra-examiner reliability and consistency was observed. A total of 119 websites were included for analysis, with the keywords cosmetic and fixed braces accounting for 55% of identified websites. Invisalign was the most offered treatment (80%). Specialist orthodontists produced the highest, whilst general dentists advertising short-term options produced the lowest quality scoring websites. LIDA provided the most accurate assessment of quality (mean 62.02, SD 7.48). Regression analysis found a significant relationship between author type and a questions and answer sections with both Discern (P < 0.001) and LIDA (P = 0.002) scores, respectively. Quality of Information regarding orthodontic treatment was variable, with the highest scoring websites were produced by orthodontic specialists and Invisalign the most offered treatment. There is a clear need for valid and reliable websites to better guide patients.

  15. Life Cycle Assessment of Waste Water Treatment Plants in Ireland

    Directory of Open Access Journals (Sweden)

    Greg Mcnamara


      The Urban Wastewater Treatment Directive 91/271/EEC introduced a series of measures for the purpose of protecting the environment from the adverse effects of effluent discharge from wastewater treatment plants.  There are environmental costs associated with attaining the required level of water quality set out in the directive such as greenhouse gas emissions due to energy production, and ecotoxicity from sludge application to land.  The goal of this study is to assess the environmental costs in an Irish context, focusing specifically on the effects of variation in scale and discharge limitation. Life cycle assessment is the analytical tool used to evaluate the environmental impact.  The life cycle impact assessment methodology developed by the Centre of Environmental Science, Leiden University (2010 has been adopted and implemented using GaBi 6.0 life cycle assessment software.  Two plants of varying size and location were chosen for the study. The study found that energy consumption and sludge application to land are the largest contributors to the overall environmental impact associated with the treatment process at both plants.  Economies of scale were observed in energy usage during secondary aeration.   

  16. Therapists' assessment and treatment of internet infidelity cases. (United States)

    Hertlein, Katherine M; Piercy, Fred P


    In this study, we investigated through an Internet survey of 508 practicing marriage and family therapists which treatment decisions varied by gender of the client and background variables of therapists. The subjects responded to several typical Internet infidelity scenarios. We varied the gender of the person initiating the infidelity for half of one sample. We also asked the family therapy participants to respond to how they might assess and treat each presenting problem. They also evaluated problem severity, prognosis of the case, number of sessions necessary for treatment, and the extent to which a therapist would focus individually or relationally. Results indicate that there were differences in how therapists assessed and treated clients based on client gender, therapists' age, therapists' gender, how religious therapists reported they were, and the extent of therapists' personal experience with infidelity.

  17. Ecological Momentary Assessment and Alcohol Use Disorder Treatment


    Morgenstern, Jon; KUERBIS, ALEXIS; Muench, Frederick


    The ability to capture real-time data on human behavior inexpensively, efficiently, and accurately holds promise to transform and broaden our understanding of many areas of health science. One approach to acquiring this type of real-time data is ecological momentary assessment (EMA). This method has been used to collect data in many domains of addiction research, including research on the treatment of alcohol use disorders (AUDs). Empirical evidence supports the hypothesis that use of EMA can...

  18. [Spanish validation of the MacArthur Competence Assessment Tool for Treatment interview to assess patients competence to consent treatment]. (United States)

    Alvarez Marrodán, Ignacio; Baón Pérez, Beatriz; Navío Acosta, Mercedes; López-Antón, Raul; Lobo Escolar, Elena; Ventura Faci, Tirso


    To validate the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) Spanish version, which assesses the mental capacity of patients to consent treatment, by examining 4 areas (Understanding, Appreciation, Reasoning and Expressing a choice). 160 subjects (80 Internal Medicine inpatients, 40 Psychiatric inpatients and 40 healthy controls). MacCAT-T, Mini-Mental Status Examination (MMSE). Feasibility study, reliability and validity calculations (against to gold standard of clinical expert). Mean duration of the MacCAT-T interview was 18min. Inter-rater reliability: Intraclass correlation coefficient for Understanding=0.98, Appreciation=0.97, Reasoning=0.98, Expressing a choice=0.91. Internal consistency (Cronbach's alpha): Understanding=0.87, for Appreciation=0.76, for Reasoning=0.86. Patients considered to be incapable (gold standard) scored lower in all the MacCAT-T areas. Poor performance on the MacCAT-T was related to cognitive impairment assessed by MMSE. Spanish version of the MacCAT-T is feasible, reliable, and valid for assessing the capacity of patients to consent treatment. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  19. Longitudinal nutritional assessment in acute lymphoblastic leukemia during treatment. (United States)

    Higashiyama, Yukie; Kojima, Chiaki; Kubota, Masaru; Nagai, Ayako; Watanabe, Ken-Ichiro; Adachi, Souichi; Usami, Ikuya


    A nutritional assessment of pediatric patients with cancer is important to improve their outcome. The number of longitudinal nutritional studies during treatment, however, is limited. The purpose of this study was to investigate the longitudinal changes in anthropometric measures and serum albumin level during chemotherapy in patients with acute lymphoblastic leukemia (ALL). We retrospectively reviewed the charts of 23 patients (19 boys, four girls) with ALL from April 2007 to March 2010. The median age at diagnosis was 4.5 years. Bodyweight, height, and serum albumin levels were measured at the start and the end point of each chemotherapy phase. At diagnosis, two patients (8.7%) were underweight and five patients (21.7%) were overweight according to body mass index z-score, while five patients were underweight and three (13.0%) were overweight according to Waterlow score. The prevalence of malnourished patients did not change significantly throughout chemotherapy by either assessment. The absolute scores in either assessment were significantly reduced at the sanctuary treatment phase. Low serum albumin (nutritional status under a similar chemotherapeutic regimen as assessed by anthropometric measures and albumin level differed among patients, careful observation of the nutritional status and intervention may be necessary at different phases of chemotherapy. © 2014 Japan Pediatric Society.

  20. Photopneumatic technology in acne treatment and skin rejuvenation: histological assessment. (United States)

    Omi, Tokuya


    Recent reports indicate that a variety of light-based devices have been used for acne treatment and skin rejuvenation. A new technology combining intense pulsed light with negative pressure, photopneumatic technology, has recently attracted interest. The present study assessed acne treatment and skin rejuvenation with this novel approach Subjects and Methods: Acne, 450 nm tip. Five Japanese volunteers (1 male, 4 female; mean age 28.6 yr; skin type III) with mild to moderate/moderate active acne participated. The face was treated with 2 sessions, 2 weeks apart. Biopsies were obtained immediately after the first session and 1 week after the second session, and routinely processed for transmission electron microscopy (TEM). Rejuvenation, profusion tip with topical preparation . In 5 Japanese volunteers (3 male, 2 female; mean age 37.6 yr, skin type III), the volar aspect of both forearms was treated with the 530 nm head at P6 (around 12 J/cm(2)). The left arm was then treated with a pre-infused profusion tip and vacuum only. Four sessions were given, 14-day intervals. Biopsies were taken from both arms 2 weeks after the 2nd session and 3 weeks after the 4th session. One-half of each biopsy was assessed with histo-and immunohistochemistry, and the other with TEM. Acne trial: A combination of physical extraction of comedones, mild photothermal damage of the follicle and damage to identified bacilli was noted post-treatment, with macroscopic improvement of the skin. Rejuvenation with profusion: Significant morphological and immunohistochemical differences were seen between the control and profusion-treated arms at the first assessment. These differences became less significant at the 2nd assessment. Macroscopically and histologically, photopneumatic technology improved acne lesions, suggesting a synergistic effect between the components of the technology. In skin rejuvenation, the profusion therapy accelerated the regenerative process, and could have excellent additional

  1. Clubfoot: The Treatment Outcome Using Quantitative Assessment of Deformity

    Directory of Open Access Journals (Sweden)

    AH Rasit


    Full Text Available Introduction: The recent trend in management of congenital idiopathic clubfoot tends towards conservative treatment. This study reviews the outcomes of treatment in our practice using the quantitative clubfoot assessment of the deformity (QCAD. Methods: Thirty patients (38 cases of clubfoot with congenital idiopathic clubfoot treated at Sarawak General Hospital were followed-up for a mean of 3.6 years. The quantitative assessment consists of limb anthropometric measurement and the Pirani deformity severity score. Results: There were 15 boys and 15 girls, with a mean age of 4.4 years (range, 13m - 8y. Most patients were of the Malay race (67%, followed by Chinese (23% and others (10%. Eight patients suffered from bilateral congenital idiopathic clubfoot (33%, 12 were left unilateral (40% and 10 were right unilateral (27%. Out of the total of 30 patients, 12 were treated conservatively with serial casting and 18 patients were treated surgically after resistance to serial casting at the age of nine months. At follow-up, there were significant differences between the surgical group (2.57 ± 1.45; (0.86 ± 0.36 and conservative group (0.7 ± 0.81; (0.34 ± 0.35 respectively (p < 0.05 regarding the mean difference in mid-leg circumference and foot length discrepancy in patients with unilateral clubfoot. There were no significant difference noted between groups with regards to results of the Pirani score, leg length discrepancy and mean difference of mid-foot circumference. Conclusion: There were significant differences in calf atrophy and foot length discrepancy when comparing surgically treated clubfoot patient compared to conservatively treated patients. Conservative treatment of clubfoot is the preferred method of treatment while surgical treatment may be necessary in more resistant cases.

  2. Assessment and treatment of eating disorders in children and adolescents. (United States)

    Mairs, Rebecca; Nicholls, Dasha


    Feeding and eating disorders (FEDs) are serious mental health disorders that cause impairments in physical health, development, cognition and psychosocial function and can go undetected for months or years. They are characterised by disturbed eating behaviour associated with concerns about weight and shape or by disinterest in food, phobic avoidance or avoidance due to sensory aspects of food. Restrictive forms of FEDs lead to significant weight loss requiring intervention. Without specific knowledge of these conditions, they can evade detection, delaying time to diagnosis and treatment and potentially influencing outcome. This review article focuses on the key factors involved in the psychiatric assessment and treatment of four feeding or eating disorders (EDs): anorexia nervosa, avoidant-restrictive food intake disorder, bulimia nervosa and binge eating disorder. They have been chosen for discussion as they are most likely to be encountered in both a psychiatric and paediatric setting. It emphasises the importance of a family-focused, developmentally appropriate and multidisciplinary approach to care. It does not address aspects of medical assessment and treatment. Other feeding or EDs not included in this article are pica, rumination disorder, other specified feeding and eating disorder and unspecified feeding and eating disorder. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  3. Assessment of Atmospheric Pressure Plasma Treatment for Implant Osseointegration

    Directory of Open Access Journals (Sweden)

    Natalie R. Danna


    Full Text Available This study assessed the osseointegrative effects of atmospheric pressure plasma (APP surface treatment for implants in a canine model. Control surfaces were untreated textured titanium (Ti and calcium phosphate (CaP. Experimental surfaces were their 80-second air-based APP-treated counterparts. Physicochemical characterization was performed to assess topography, surface energy, and chemical composition. One implant from each control and experimental group (four in total was placed in one radius of each of the seven male beagles for three weeks, and one implant from each group was placed in the contralateral radius for six weeks. After sacrifice, bone-to-implant contact (BIC and bone area fraction occupancy (BAFO were assessed. X-ray photoelectron spectroscopy showed decreased surface levels of carbon and increased Ti and oxygen, and calcium and oxygen, posttreatment for Ti and CaP surfaces, respectively. There was a significant (P<0.001 increase in BIC for APP-treated textured Ti surfaces at six weeks but not at three weeks or for CaP surfaces. There were no significant (P=0.57 differences for BAFO between treated and untreated surfaces for either material at either time point. This suggests that air-based APP surface treatment may improve osseointegration of textured Ti surfaces but not CaP surfaces. Studies optimizing APP parameters and applications are warranted.

  4. Assessment of Atmospheric Pressure Plasma Treatment for Implant Osseointegration (United States)

    Danna, Natalie R.; Beutel, Bryan G.; Tovar, Nick; Witek, Lukasz; Marin, Charles; Granato, Rodrigo; Suzuki, Marcelo; Coelho, Paulo G.


    This study assessed the osseointegrative effects of atmospheric pressure plasma (APP) surface treatment for implants in a canine model. Control surfaces were untreated textured titanium (Ti) and calcium phosphate (CaP). Experimental surfaces were their 80-second air-based APP-treated counterparts. Physicochemical characterization was performed to assess topography, surface energy, and chemical composition. One implant from each control and experimental group (four in total) was placed in one radius of each of the seven male beagles for three weeks, and one implant from each group was placed in the contralateral radius for six weeks. After sacrifice, bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO) were assessed. X-ray photoelectron spectroscopy showed decreased surface levels of carbon and increased Ti and oxygen, and calcium and oxygen, posttreatment for Ti and CaP surfaces, respectively. There was a significant (P < 0.001) increase in BIC for APP-treated textured Ti surfaces at six weeks but not at three weeks or for CaP surfaces. There were no significant (P = 0.57) differences for BAFO between treated and untreated surfaces for either material at either time point. This suggests that air-based APP surface treatment may improve osseointegration of textured Ti surfaces but not CaP surfaces. Studies optimizing APP parameters and applications are warranted. PMID:26090443

  5. Implicit Working Memory: Implications for Assessment and Treatment. (United States)

    Joyce, Arthur W


    Working memory (WM) impacts a gamut of cognitive abilities, but implicit WM is typically not considered in assessment or treatment, which may explain the variability of results in reviews of WM training. The role of implicit WM in adaptive behavior is reviewed. All we do is action based. Explicit WM plays a major role when we are required to "think"; that is, when we apply previously learned perception-action linkages in new ways to unique situations. Implicit WM is involved in the automation of behavior, which occurs through interaction with cortical and subcortical systems that guide sensory-motor anticipation and the prediction of reward. This article reviews evidence that implicit WM interacts with cortical-cerebellar and cortical-basal ganglia connections to form perception-action linkages. The cerebellum forms an internal model of cortical WM, corrects the content of this internal model, and then projects the improved representation back to the cortex, where it is retained for future use. The basal ganglia also form an anticipatory system, controlling cortical access to WM by allowing or restricting the information that is released based on the probability of reward. This framework is applied to the assessment and treatment of individuals with WM deficits. The ability to automate behavior can be assessed through repeated trials of existing testing instruments, such as the Trails B and Stroop tasks. Application of skill learning emphasizing automation as an end goal offers a model for the development of new types of WM training.

  6. Technical, economic and environmental assessment of sludge treatment wetlands. (United States)

    Uggetti, Enrica; Ferrer, Ivet; Molist, Jordi; García, Joan


    Sludge treatment wetlands (STW) emerge as a promising sustainable technology with low energy requirements and operational costs. In this study, technical, economic and environmental aspects of STW are investigated and compared with other alternatives for sludge management in small communities (wastewater treatment plant. According to the results, STW with direct land application is the most cost-effective scenario, which is also characterised by the lowest environmental impact. The life cycle assessment highlights that global warming is a significant impact category in all scenarios, which is attributed to fossil fuel and electricity consumption; while greenhouse gas emissions from STW are insignificant. As a conclusion, STW are the most appropriate alternative for decentralised sludge management in small communities. Copyright © 2010 Elsevier Ltd. All rights reserved.

  7. Environmental performance assessment of a company of aluminum surface treatment

    Directory of Open Access Journals (Sweden)

    Susan Catieri Ramalho


    Full Text Available The purpose of this article was to evaluate the environmental performance of a medium-sized company that provides services for surface treatment of aluminum. The treatment is known as anodizing. The research method was qualitative numerical modeling. The environmental performance of the company was organized into five constructs: atmosphere, wastewater, energy and natural resources, solid waste, and legislation and management. Nineteen indicators were chosen to explain the five constructs. Ten employees of the company prioritized the constructs and evaluated the situation of the indicators by means of a scale of assessment. By means of a mathematical model, the general performance of the environmental operation was calculated at 74.5% of the maximum possible. The indicators that most contributed to the performance not to reach 100% were consumption of electricity and water consumption. The construct of worse performance was natural and energy resources. These are the priorities for future environmental improvement actions that the company may promote.

  8. Multidimensional vocal assessment after laser treatment for recurrent respiratory papillomatosis. (United States)

    Kono, Takeyuki; Yabe, Haruna; Uno, Kosuke; Saito, Koichiro; Ogawa, Kaoru


    Recurrent respiratory papillomatosis (RRP) is a benign epithelial tumor that exhibits a high frequency of recurrence. This study assesses the vocal function after laser treatment for RRP, particularly in relation to the frequency of surgery. Retrospective study. Thirty RRP patients who underwent laser surgery that controlled the tumor were included. Preoperative and postoperative Grade, Roughness, Breathiness, Asthenia, and Strain Scale, videostroboscopic findings, aerodynamic and acoustic parameters, and self-assessment questionnaires were measured and compared with an age- and sex-matched control group. Subsequently, to evaluate the association between postoperative voice quality and the number of surgeries, the patients were divided into three groups (group 1: single surgery, group 2: 2-5 surgeries, group3: >6 surgeries), and comparative multidimensional vocal assessments were performed. The mean number of surgeries was 3.4 (range, 1-8). Although all patients exhibited poorer vocal function than the control group preoperatively, they showed improvement in postoperative subjective and objective parameters. However, four patients who underwent one surgery with relatively aggressive ablation exhibited vocal cord scarring and deteriorated objective parameters. All remaining patients showed voice quality that was on par with the control group. Subgroup analysis proved no association between post-therapeutic voice quality and the patient characteristics, including preoperative staging and the number of surgical treatments performed. RRP patients can achieve a close to normal voice with high satisfaction even after recurrent surgical treatment when ablation of a subepithelial lesion using sufficient laser energy is adequate. 3b Laryngoscope, 127:679-684, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  9. Cardiovascular complications of Rheumatoid Arthritis - Assessment, prevention and treatment (United States)

    Kaplan, Mariana J.


    Synopsis Morbidity and mortality rates are higher in individuals with rheumatoid arthritis (RA) than in the general population. Ischemic heart disease and heart failure now represent one of the most common causes of death in RA. Indeed, RA appears to represent an independent risk factor for ischemic heart disease, similar to diabetes mellitus. However, no clear guidelines with regards to cardiovascular disease diagnosis and prevention in RA have been developed. This review highlights recent investigations on the assessment, prevention and treatment of cardiovascular disease in RA. PMID:20510241

  10. Assessing fly ash treatment: Remediation and stabilization of heavy metals

    DEFF Research Database (Denmark)

    Lima, A.T.; Ottosen, Lisbeth M.; Ribeiro, Alexandra B.


    Fly ashes from Municipal Solid Waste (MSW), straw (ST) and co-combustion of wood (CW) are here analyzed with the intent of reusing them. Two techniques are assessed, a remediation technique and a solidification/stabilization one. The removal of heavy metals from fly ashes through...... the electrodialytic process (EDR) has been tried out before. The goal of removing heavy metals has always been the reuse of fly ash, for instance in agricultural fields (BEK). The best removal rates are here summarized and some new results have been added. MSW fly ashes are still too hazardous after treatment to even...

  11. Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches. (United States)

    Melrose, Sherri


    Seasonal affective disorder or SAD is a recurrent major depressive disorder with a seasonal pattern usually beginning in fall and continuing into winter months. A subsyndromal type of SAD, or S-SAD, is commonly known as "winter blues." Less often, SAD causes depression in the spring or early summer. Symptoms center on sad mood and low energy. Those most at risk are female, are younger, live far from the equator, and have family histories of depression, bipolar disorder, or SAD. Screening instruments include the Seasonal Pattern Assessment Questionnaire (SPAQ). Typical treatment includes antidepressant medications, light therapy, Vitamin D, and counselling. This paper provides an overview of SAD.

  12. Assessment, Diagnosis, and Treatment of Binge Eating Disorder. (United States)

    Ambrogne, Janet A


    Binge eating disorder (BED) is the most prevalent eating disorder in the United States, believed to affect an estimated 2.8 million adults. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, BED was recognized as a separate diagnosis. The purpose of the current article is to provide an overview of BED including assessment, diagnosis, and current pharmacological and nonpharmacological treatment options. Implications for nursing are also addressed. [Journal of Psychosocial Nursing and Mental Health Services, 55(8), 32-38.]. Copyright 2017, SLACK Incorporated.

  13. Traumatic brain injury: future assessment tools and treatment prospects

    Directory of Open Access Journals (Sweden)

    Steven R Flanagan


    Full Text Available Steven R Flanagan1, Joshua B Cantor2, Teresa A Ashman21New York University School of Medicine, The Rusk Institute of Rehabilitation, New York, NY, USA; 2Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY, USAAbstract: Traumatic brain injury (TBI is widespread and leads to death and disability in millions of individuals around the world each year. Overall incidence and prevalence of TBI are likely to increase in absolute terms in the future. Tackling the problem of treating TBI successfully will require improvements in the understanding of normal cerebral anatomy, physiology, and function throughout the lifespan, as well as the pathological and recuperative responses that result from trauma. New treatment approaches and combinations will need to be targeted to the heterogeneous needs of TBI populations. This article explores and evaluates the research evidence in areas that will likely lead to a reduction in TBI-related morbidity and improved outcomes. These include emerging assessment instruments and techniques in areas of structural/chemical and functional neuroimaging and neuropsychology, advances in the realms of cell-based therapies and genetics, promising cognitive rehabilitation techniques including cognitive remediation and the use of electronic technologies including assistive devices and virtual reality, and the emerging field of complementary and alternative medicine.Keywords: traumatic brain injury, assessments, treatments

  14. Dysphonia in preterm children: assessing incidence and response to treatment. (United States)

    Reynolds, Victoria; Meldrum, Suzanne; Simmer, Karen; Vijayasekaran, Shyan; French, Noel P


    Mild dysphonia in childhood is surprisingly common, yet moderate to severe dysphonia is rare. The latter has been associated with complex medical conditions and congenital abnormalities. Intubation injury has also been documented as a cause of childhood dysphonia. Children born very preterm may be intubated as part of the intensive care administered in the perinatal and neonatal periods, yet there are few studies investigating dysphonia in this population. This study will be the first to: use an objective acoustic voice assessment in a paediatric study, document the incidence of dysphonia in very preterm children at school age, and conduct a controlled trial of behavioural voice therapy in this population. This study will consist of three phases: assessment of voice quality and its impact on quality of life in up to 200 children born at less than 32 weeks' gestation: assessment of the nature and extent of laryngeal pathology in children with moderate to severe dysphonia; and a non-blinded, randomised controlled trial of behavioural voice therapy in children with moderate to severe dysphonia. This study will be the first to use clinical assessment to examine the voice quality of very preterm children, and to use fibre optic endoscopic evaluation of laryngeal function to determine the nature and extent of any laryngeal pathology in such children. Those participants with significant voice difficulties will be randomised to receive treatment immediately or after the eight week assessment. This study is registered on the Australian New Zealand Clinical Trials Registry (ACTRN12613001015730/ACTRN12613001012763). Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

  15. Patient factors influencing dermal filler complications: prevention, assessment, and treatment

    Directory of Open Access Journals (Sweden)

    De Boulle K


    Full Text Available Koenraad De Boulle,1 Izolda Heydenrych2 On behalf of the Consensus Group 1Aalst Dermatology Group, Aalst, Belgium; 2Cape Town Cosmetic Dermatology Centre, Century City, South Africa Abstract: While rare, complications do occur with the esthetic use of dermal fillers. Careful attention to patient factors and technique can do much to avoid these complications, and a well-informed practitioner can mitigate problems when they do occur. Since cosmetic surgery is usually an elective process, requested by the patient, clinical trials are complex to organize and run. For this reason, an international group of practicing physicians in the field of esthetics came together to share knowledge and to try and produce some informed guidance for their colleagues, considering the literature and also pooling their own extensive clinical experience. This manuscript aims to summarize the crucial aspects of patient selection, including absolute contraindications as well as situations that warrant caution, and also covers important considerations for the pre- and posttreatment periods as well as during the procedure itself. Guidance is given on both immediate and long-term management of adverse reactions. The majority of complications are related to accepting patients inappropriate for treatment or issues of sterility, placement, volume, and injection technique. It is clear that esthetic practitioners need an in-depth knowledge of all aspects of treatment with dermal fillers to achieve optimal outcomes for their patients. Keywords: dermal fillers, complications, prevention, assessment, treatment, patient factors

  16. Environmental assessment of digestate treatment technologies using LCA methodology. (United States)

    Vázquez-Rowe, Ian; Golkowska, Katarzyna; Lebuf, Viooltje; Vaneeckhaute, Céline; Michels, Evi; Meers, Erik; Benetto, Enrico; Koster, Daniel


    The production of biogas from energy crops, organic waste and manure has augmented considerably the amounts of digestate available in Flanders. This has pushed authorities to steadily introduce legislative changes to promote its use as a fertilising agent. There is limited arable land in Flanders, which entails that digestate has to compete with animal manure to be spread. This forces many anaerobic digestion plants to further treat digestate in such a way that it can either be exported or the nitrogen be removed. Nevertheless, the environmental impact of these treatment options is still widely unknown, as well as the influence of these impacts on the sustainability of Flemish anaerobic digestion plants in comparison to other regions where spreading of raw digestate is allowed. Despite important economic aspects that must be considered, the use of Life Cycle Assessment (LCA) is suggested in this study to identify the environmental impacts of spreading digestate directly as compared to four different treatment technologies. Results suggest relevant environmental gains when the digestate mix is treated using the examined conversion technologies prior to spreading, although important trade-offs between impact categories were observed and discussed. The promising results of digestate conversion technologies suggest that further LCA analyses should be performed to delve into, for instance, the appropriateness to shift to nutrient recovery technologies rather than digestate conversion treatments. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Assessment Results of Patellar Fracture Treatment after Tension Band Wiring

    Directory of Open Access Journals (Sweden)

    S. Abdolhossein Mehdinasab


    Full Text Available Background: To assess the results of patellar fracture treatment by tension band wiring. Materials and Methods: This retrospective study was performed to evaluate clinical and radiological results of patellar fracture during past 6 years.Results: Twenty four patients were participated in follow-up. Union was occurred in the mean time of 2.67±0.61 months. Falling down and direct trauma were the most common cause of fracture. Most common complications were thigh muscle atrophy and pin irritation. Excellent and good results in 87.5% and fair results in 12.5% of the patients were seen.Conclusion: Fixation of patellar fractures with tension band wiring was associated with a high rate of union.

  18. Shift work disorder: clinical assessment and treatment strategies. (United States)

    Simon, Richard D


    Shift work disorder (SWD) occurs when individuals are unable to successfully synchronize their internal clocks with a work schedule that requires them to stay awake when it is dark and sleep when it is light. When assessing for SWD, clinicians should take a thorough sleep history and have the patient maintain a sleep diary. Clinicians should also be aware of conditions that commonly occur in conjunction with this illness, including sleep apnea, restless legs syndrome, depressive and anxiety disorders, and chronic fatigue. The primary goal of treatment for SWD is to reduce the rate of circadian misalignment by fostering better sleep when it is desired and improved alertness and functioning when appropriate. Nonpharmacologic strategies (eg, melatonin and light therapy) should be tried before considering medications to promote sleep and/or alertness. © Copyright 2012 Physicians Postgraduate Press, Inc.

  19. Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches

    Directory of Open Access Journals (Sweden)

    Sherri Melrose


    Full Text Available Seasonal affective disorder or SAD is a recurrent major depressive disorder with a seasonal pattern usually beginning in fall and continuing into winter months. A subsyndromal type of SAD, or S-SAD, is commonly known as “winter blues.” Less often, SAD causes depression in the spring or early summer. Symptoms center on sad mood and low energy. Those most at risk are female, are younger, live far from the equator, and have family histories of depression, bipolar disorder, or SAD. Screening instruments include the Seasonal Pattern Assessment Questionnaire (SPAQ. Typical treatment includes antidepressant medications, light therapy, Vitamin D, and counselling. This paper provides an overview of SAD.

  20. Treatment allocation in hepatocellular carcinoma: Assessment of the BCLC algorithm. (United States)

    Richani, Mandy; Kolly, Philippe; Knoepfli, Marina; Herrmann, Evelyn; Zweifel, Martin; von Tengg-Kobligk, Hendrik; Candinas, Daniel; Dufour, Jean-François


    The Barcelona Clinic Liver Cancer (BCLC) staging system is the algorithm most widely used to manage patients with hepatocellular carcinoma (HCC). We aimed to investigate the extent to which the BCLC recommendations effectively guide clinical practice and assess the reasons for any deviation from the recommendations. The first-line treatments assigned to patients included in the prospective Bern HCC cohort were analyzed. Among 223 patients included in the cohort, 116 were not treated according to the BCLC algorithm. Eighty percent of the patients in BCLC stage 0 (very early HCC) and 60% of the patients in BCLC stage A (early HCC) received recommended curative treatment. Only 29% of the BCLC stage B patients (intermediate HCC) and 33% of the BCLC stage C patients (advanced HCC) were treated according to the algorithm. Eighty-nine percent of the BCLC stage D patients (terminal HCC) were treated with best supportive care, as recommended. In 98 patients (44%) the performance status was disregarded in the stage assignment. The management of HCC in clinical practice frequently deviates from the BCLC recommendations. Most of the curative therapy options, which have well-defined selection criteria, were allocated according to the recommendations, while the majority of the palliative therapy options were assigned to patients with tumor stages not aligned with the recommendations. The only parameter which is subjective in the algorithm, the performance status, is also the least respected.

  1. Angioscopic assessment of various percutaneous treatments for arteriosclerosis obliterance (United States)

    Kusaba, Hiroyasu; Watanabe, Kazuo; Shiraishi, Shohzo; Sato, Takashi; Koga, Nobuhiko


    We have evaluated the angioscopic findings before and after various percutaneous techniques to treat 39 lesions in 32 cases of arteriosclerosis obliterans (ASO). We applied a laser (CL50: SLT, Japan), percutaneous transluminal angioplasty (PTA), and atherectomy -- either singly or in combination, with angioscopic luminal observation (angioscope: PF14L & PF18L Olympus, Japan) recorded before and after the treatments. In the case of a complete obstruction, we employed PTA as the first choice. We used a laser prior to PTA when the PTA guide-wire failed to penetrate the lumen. For eccentric and calcified lesions atherectomy was applied. A sufficient enlargement was obtained initially in 37 of the 39 lesions. The angioscopic observations after treatment revealed carbonization (3/5) and attachment of small thrombi (3/5) after using the laser, intimal rupture (3/8), dissection (2/8), flap formation (2/8), and attachment of small thrombi (4/8) after PTA, and attachment of small thrombi (9/19), flap formation (6/19), and dissection (2/19) after atherectomy. We established the efficacy of angioscopic assessment demonstrating beneficial clinical results. The angioscopic findings suggest that attachment of small thrombi may be responsible for a poor prognosis. Additional angioscopic observations with angiography are recommended for improved understanding of the luminal changes.

  2. [Alcohol consumption in patients with psychiatric disorders: assessment and treatment]. (United States)

    Lang, J-P; Bonnewitz, M-L; Kusterer, M; Lalanne-Tongio, L


    Alcohol consumption in France exceeds the European average (12.7L of pure alcohol/habitant/year in 2009 for an average of 12.5 L). This consumption has a major professional, social and health impact on the individuals and their families. The cost of such, estimated in Europe to be of 155.8 billion Euros in 2010, is the highest among the central nervous system diseases in Europe, far higher than that of depression or dementia. Patients suffering from psychiatric disorders are more frequently affected by problems related to alcohol use than the general population. They are also more vulnerable to the immediate and subsequent consequences of their consumption. The alcohol related disorders that are often accompanied by risk taking and other addictive behaviour require a global assessment of the addiction, with and without substance, and of the complications. These have a strong impact on risk taking, compliance with care, and the morbidity of somatic and psychiatric disorders, as well as access to optimal care and the life span of patients suffering from psychiatric disorders. The development of addictology care, with integrative treatment programs, is recommended in response to these public health issues. Nevertheless, specific addictology practices and partners with addictology care structures are still scarcely developed in psychiatry. Firstly, it would be necessary to set up such integrated treatments through the systematisation of an "addictology" checkup on admission, a global assessment of addictive behaviour and cognitive disorders, using pragmatic tools that are user-friendly for the care teams, maintain the reduction in risk taking, and apply prescriptions for addiction to psychotropic treatments, in liaison with the referring general practitioner. As early as possible, accompanied by specific training in addictology for the psychiatrists and the mental health nursing teams, such care could be enhanced by the development of liaison and advanced psychiatric

  3. Neighborhood walkability and hospital treatment costs: A first assessment. (United States)

    Yu, Yan; Davey, Rachel; Cochrane, Tom; Learnihan, Vincent; Hanigan, Ivan C; Bagheri, Nasser


    Health system expenditure is a global concern, with hospital cost a major component. Built environment has been found to affect physical activity and health outcomes. The purpose of the study was a first assessment of the relationship between neighborhood walkability and hospital treatment costs. For 88 neighborhoods in the Australian Capital Territory (ACT), 2011-2013, a total of 30,690 public hospital admissions for the treatment of four diagnostic groups (cancers, endocrine, nutritional and metabolic diseases, circulatory diseases and respiratory diseases) were extracted from the ACT admitted patient care database and analyzed in relation to the Walk Score® index as a measure of walkability. Hospital cost was calculated according to the cost weight of the diagnosis related group assigned to each admission. Linear regressions were used to analyze the associations of walkability with hospital cost per person, admissions per person and cost per admission at the neighborhood level. An inverse association with neighborhood walkability was found for cost per person and admissions per person, but not cost per admission. After adjusting for age, sex and socioeconomic status, a 20-unit increase in walkability was associated with 12.1% (95% CI: 7.1-17.0%) lower cost and 12.5% (8.1-17.0%) fewer admissions. These associations did not vary by neighborhood socioeconomic status. This exploratory analysis suggests the potential for improved population health and reduced hospital cost with greater neighborhood walkability. Further research should replicate the analysis with data from other urban settings, and focus on the behavioral mechanisms underlying the inverse walkability-hospital cost association. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Assessment and treatment relevance in elderly glioblastoma patients. (United States)

    Bauchet, Luc; Zouaoui, Sonia; Darlix, Amélie; Menjot de Champfleur, Nicolas; Ferreira, Ernestine; Fabbro, Michel; Kerr, Christine; Taillandier, Luc


    Glioblastoma (GBM) is the most common malignant primary brain tumor. Its incidence continues to increase in the elderly because the older segment of the population is growing faster than any other age group. Most clinical studies exclude elderly patients, and "standards of care" do not exist for GBM patients aged >70 years. We review epidemiology, tumor biology/molecular factors, prognostic factors (clinical, imaging data, therapeutics), and their assessments as well as classic and specific endpoints plus recent and ongoing clinical trials for elderly GBM patients. This work includes perspectives and personal opinions on this topic. Although there are no standards of care for elderly GBM patients, we can hypothesize that (i) Karnofsky performance status (KPS), probably after steroid treatment, is one of the most important clinical factors for determining our oncological strategy; (ii) resection is superior to biopsy, at least in selected patients (depending on location of the tumor and associated comorbidities); (iii) specific schedules of radiotherapy yield a modest but significant improvement; (iv) temozolomide has an acceptable tolerance, even when KPS patients; and (v) the addition of concomitant temozolomide to radiotherapy has not yet been validated but shows promising results in some studies, yet the optimal schedule of radiotherapy remains to be determined. In the future, specific assessments (geriatric, imaging, biology) and use of new endpoints (quality of life and toxicity measures) will aid clinicians in determining the balance of potential benefits and risks of each oncological strategy. © The Author(s) 2014. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail:

  5. Radiological Risk Assessment for King County Wastewater Treatment Division

    Energy Technology Data Exchange (ETDEWEB)

    Strom, Daniel J.


    Staff of the King County Wastewater Treatment Division (WTD) have concern about the aftermath of a radiological dispersion event (RDE) leading to the introduction of significant quantities of radioactive material into the combined sanitary and storm sewer system in King County, Washington. Radioactive material could come from the use of a radiological dispersion device (RDD). RDDs include "dirty bombs" that are not nuclear detonations but are explosives designed to spread radioactive material (National Council on Radiation Protection and Measurements (NCRP) 2001). Radioactive material also could come from deliberate introduction or dispersion of radioactive material into the environment, including waterways and water supply systems. This document develops plausible and/or likely scenarios, including the identification of likely radioactive materials and quantities of those radioactive materials to be involved. These include 60Co, 90Sr, 137Cs, 192Ir, 226Ra, plutonium, and 241Am. Two broad categories of scenarios are considered. The first category includes events that may be suspected from the outset, such as an explosion of a "dirty bomb" in downtown Seattle. The explosion would most likely be heard, but the type of explosion (e.g., sewer methane gas or RDD) may not be immediately known. Emergency first responders must be able to quickly detect the radioisotopes previously listed, assess the situation, and deploy a response to contain and mitigate (if possible) detrimental effects resulting from the incident. In such scenarios, advance notice of about an hour or two might be available before any contaminated wastewater reaches a treatment plant. The second category includes events that could go initially undetected by emergency personnel. Examples of such a scenario would be the inadvertent or surreptitious introduction of radioactive material into the sewer system. Intact rogue radioactive sources from industrial radiography devices, well-logging apparatus, or

  6. Assessing fly ash treatment: Remediation and stabilization of heavy metals

    KAUST Repository

    Lima, A.T.


    Fly ashes from Municipal Solid Waste (MSW), straw (ST) and co-combustion of wood (CW) are here analyzed with the intent of reusing them. Two techniques are assessed, a remediation technique and a solidification/stabilization one. The removal of heavy metals from fly ashes through the electrodialytic process (EDR) has been tried out before. The goal of removing heavy metals has always been the reuse of fly ash, for instance in agricultural fields (BEK). The best removal rates are here summarized and some new results have been added. MSW fly ashes are still too hazardous after treatment to even consider application to the soil. ST ash is the only residue that gets concentrations low enough to be reused, but its fertilizing value might be questioned. An alternative reuse for the three ashes is here preliminary tested, the combination of fly ash with mortar. Fly ashes have been substituted by cement fraction or aggregate fraction. Surprisingly, better compressive strengths were obtained by replacing the aggregate fraction. CW ashes presented promising results for the substitution of aggregate in mortar and possibly in concrete. © 2010 Elsevier Ltd.

  7. Assessment and Treatment of Personality Disorders: A Behavioral Perspective (United States)

    Nelson-Gray, Rosemery O.; Lootens, Christopher M.; Mitchell, John T.; Robertson, Christopher D.; Hundt, Natalie E.; Kimbrel, Nathan A.


    Personality disorders are complex and highly challenging to treatment providers; yet, for clients with these problems, there exist very few treatment options that have been supported by research. Given the lack of empirically-supported therapies for personality disorders, it can be difficult to make treatment decisions for this population. The…

  8. Exploration of Culturally Proficient Mental Health Assessment and Treatment Practices of Black/African American Clients (United States)

    Glover, Tina Marie


    Changing trends within the mental health system treatment practices demand exploration of the cultural context of assessment and treatment of Black/African Americans. Culturally competent assessments include a realistic integration of historical context. Clinicians counseling Black/African Americans must be prepared to assess and address PTSD,…

  9. Feasibility of Using Virtual Reality to Assess Nicotine Cue Reactivity during Treatment (United States)

    Kaganoff, Eili; Bordnick, Patrick S.; Carter, Brian Lee


    Cue reactivity assessments have been widely used to assess craving and attention to cues among cigarette smokers. Cue reactivity has the potential to offer insights into treatment decisions; however, the use of cue reactivity in treatment studies has been limited. This study assessed the feasibility of using a virtual reality-based cue reactivity…

  10. Performance assessment of aquatic macrophytes for treatment of municipal wastewater


    Shah, Mumtaz,; Hashmi, Hashim Nisar; Ali, Arshad; Ghumman, Abdul Razzaq


    The objective of the study was to evaluate the performance of three different aquatic macrophytes for treatment of municipal wastewater collected from Taxila (Pakistan). A physical model of treatment plant was constructed and was operated for six experimental runs with each species of macrophyte. Every experimental run consist of thirty days period. Regular monitoring of influent and effluent concentrations were made during each experimental run. For the treatment locally available macrophyte...

  11. Radiological Instrumentation Assessment for King County Wastewater Treatment Division

    Energy Technology Data Exchange (ETDEWEB)

    Strom, Daniel J.; McConn, Ronald J.; Brodzinski, Ronald L.


    The King County Wastewater Treatment Division (WTD) have concern about the aftermath of a radiological dispersion event (RDE) leading to the introduction of significant quantities of radioactive material into its combined sanitary and storm sewer system. Radioactive material could come from the use of a radiological dispersion device (RDD). RDDs include "dirty bombs" that are not nuclear detonations but are explosives designed to spread radioactive material. Radioactive material also could come from deliberate introduction or dispersion of radioactive material into the environment, including waterways and water supply systems. Volume 2 of PNNL-15163 assesses the radiological instrumentation needs for detection of radiological or nuclear terrorism, in support of decisions to treat contaminated wastewater or to bypass the West Point Treatment Plant (WPTP), and in support of radiation protection of the workforce, the public, and the infrastructure of the WPTP. Fixed radiation detection instrumentation should be deployed in a defense-in-depth system that provides 1) early warning of significant radioactive material on the way to the WPTP, including identification of the radionuclide(s) and estimates of the soluble concentrations, with a floating detector located in the wet well at the Interbay Pump Station and telemetered via the internet to all authorized locations; 2) monitoring at strategic locations within the plant, including 2a) the pipe beyond the hydraulic ram in the bar screen room; 2b) above the collection funnels in the fine grit facility; 2c) in the sampling tank in the raw sewage pump room; and 2d) downstream of the concentration facilities that produce 6% blended and concentrated biosolids. Engineering challenges exist for these applications. It is necessary to deploy both ultra-sensitive detectors to provide early warning and identification and detectors capable of functioning in high-dose rate environments that are likely under some scenarios, capable

  12. Assessing Tumor Response to Treatment in Patients with Lung Cancer Using Dynamic Contrast-Enhanced CT

    DEFF Research Database (Denmark)

    Strauch, Louise S; Eriksen, Rie Ø; Sandgaard, Michael


    Reviews and Meta-Analyses (PRISMA) guidelines. Only original research articles concerning treatment response in patients with lung cancer assessed with DCE-CT were included. To assess the validity of each study we implemented Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). The initial search...... after treatment. Four out of five studies that measured blood flow post anti-angiogenic treatments found that blood flow was significantly decreased. DCE-CT may be a useful tool in assessing treatment response in patients with lung cancer. It seems that particularly permeability and blood flow...

  13. Assessing Decisional Capacity for Clinical Research or Treatment: A Review of Instruments

    National Research Council Canada - National Science Library

    Saks, Elyn R; Nowrangi, Milap A; Palmer, Barton W; Jeste, Dilip V; Dunn, Laura B


    ...: Electronic medical and legal databases were searched for articles published from 1980 to 2004 describing structured assessments of adults' capacity to consent to clinical treatment or research protocols...

  14. Assessing Treatment Integrity in Alcohol Behavioral Couple Therapy. (United States)

    Hallgren, Kevin A; Crotwell, Shirley M; Muñoz, Rosa E; Gius, Becky K; McCrady, Barbara S; Ladd, Benjamin O; Epstein, Elizabeth E


    Alcohol Behavioral Couple Therapy (ABCT) is an efficacious treatment for alcohol use disorders. Coding treatment integrity can shed light on the active ingredients of ABCT, but there are no published studies of treatment integrity instruments for ABCT. The present study describes the development and initial reliability of the Treatment Integrity Rating System - Couples Version (C-TIRS) for ABCT. The C-TIRS was used to rate 284 first- and mid-treatment ABCT sessions of 188 couples in four randomized clinical trials. Average inter-rater reliability for distinguishing ratings between C-TIRS items was fair-to-good for quantity items (intraclass correlation [ICC] = 0.64) and poor-to-fair for quality items (ICC = 0.41). Five C-TIRS subscales were defined a priori to measure treatment components involving cognitive-behavioral therapy, spouse involvement, couple therapy, common therapeutic factors, and overall adherence to the treatment protocol and had adequate internal reliability (α = 0.74-0.89). Inter-rater reliability was fair to good on seven of ten scales but poor on three scales (ICC range = 0.17-0.72). The C-TIRS was designed to provide information about quantity and quality of the delivery of ABCT components; however, further refinement of the C-TIRS is warranted before it should be used in frontline practice. Clinical implications and recommendations for future research are discussed.

  15. Current concepts in the assessment and treatment of hepatic encephalopathy.

    LENUS (Irish Health Repository)

    Cash, W J


    Hepatic encephalopathy (HE) is defined as a metabolically induced, potentially reversible, functional disturbance of the brain that may occur in acute or chronic liver disease. Standardized nomenclature has been proposed but a standardized approach to the treatment, particularly of persistent, episodic and recurrent encephalopathy associated with liver cirrhosis has not been proposed. This review focuses on the pathogenesis and treatment of HE in patients with cirrhosis. The pathogenesis and treatment of hepatic encephalopathy in fulminant hepatic failure is quite different and is reviewed elsewhere.

  16. Assessment of wastewater treatment plant effluent effects on fish reproduction (United States)

    Wastewater treatment plant (WWTP) effluents are known contributors of chemical mixtures into the environment. Of particular concern are endocrine-disrupting compounds that can affect hypothalamic-pituitary-gonadal axis function in exposed organisms. The present study examined t...

  17. Assessment of spirituality and its relevance to addiction treatment. (United States)

    Galanter, Marc; Dermatis, Helen; Bunt, Gregory; Williams, Caroline; Trujillo, Manuel; Steinke, Paul


    The prominence of Twelve-Step programs has led to increased attention on the putative role of spirituality in recovery from addictive disorders. We developed a 6-item Spirituality Self-Rating Scale designed to reflect a global measure of spiritual orientation to life, and we demonstrated here its internal consistency reliability in substance abusers on treatment and in nonsubstance abusers. This scale and the measures related to recovery from addiction and treatment response were applied in three diverse treatment settings: a general hospital inpatient psychiatry service, a residential therapeutic community, and methadone maintenance programs. Findings on these patient groups were compared to responses given by undergraduate college students, medical students, addiction faculty, and chaplaincy trainees. These suggest that, for certain patients, spiritual orientation is an important aspect of their recovery. Furthermore, the relevance of this issue may be underestimated in the way treatment is framed in a range of clinical facilities.

  18. Assessment of didecyldimethylammonium chloride as a ballast water treatment method

    NARCIS (Netherlands)

    van Slooten, Cees; Buma, Anita; Peperzak, Louis

    Ballast water-mediated transfer of aquatic invasive species is considered a major threat to marine biodiversity, marine industry and human health. A ballast water treatment is needed to comply with International Maritime Organization (IMO) ballast water discharge regulations. Didecyldimethylammonium

  19. Assessment of didecyldimethylammonium chloride as a ballast water treatment method

    NARCIS (Netherlands)

    van Slooten, C.; Peperzak, L.; Buma, A.G.J.


    Ballast water-mediated transfer of aquatic invasive species is considered a major threat to marine biodiversity, marine industry and human health. A ballast water treatment is needed to comply with International Maritime Organization (IMO) ballast water discharge regulations. Didecyldimethylammonium

  20. Assessing physicians' preferences on skin cancer treatment in Europe. (United States)

    Ferrandiz, L; Ruiz-de-Casas, A; Trakatelli, M; de Vries, E; Ulrich, M; Aquilina, S; Saksela, O; Majewski, S; Ranki, A; Proby, C; Magnoni, C; Pitkänen, S; Kalokasidis, K; Siskou, S; Hinrichs, B; Altsitsiadis, E; Stockfleth, E; Moreno-Ramirez, D


    A wide variety of both surgical and nonsurgical therapies is currently available for patients with skin cancer. This part of the EPIDERM (European Prevention Initiative for Dermatological Malignancies) project is aimed at the evaluation of the treatment preferences for skin cancer in eight countries of the European Union. A multicentre hospital-based case-control study was carried out at dermatology departments in Finland, Germany, Greece, Italy, Malta, Poland, Scotland and Spain. Patients with skin cancer (basal cell carcinoma, actinic keratosis, squamous cell carcinoma, cutaneous malignant melanoma and Bowen disease) were consecutively enrolled between July 2008 and July 2010. Information on the study variables (sex, age, country, tumour type, anatomical location and treatment) was obtained from questionnaires designed by the EPIDERM project. In total, 1708 patients with skin cancer were included. Surgery was the first treatment option in 76·5% of the patients (P = 0·001). Actinic keratosis was the only tumour type in which nonsurgical treatment was more frequent than surgery (91·4%). Tumours on the head were less likely to be surgically excised than those at other locations (odds ratio 0·25, P = 0·001). Simple excision or curettage was the most common surgical procedure (65·4%), followed by graft and flaps (22·4%). Cryotherapy was the most common nonsurgical option (52·4%), followed by imiquimod (18·0%), photodynamic therapy (PDT; 12·0%), 5-fluorouracil (5-FU; 5·7%), and diclofenac with hyaluronic acid (4·0%). Surgery remains the first-choice treatment of skin cancer. Regarding nonsurgical treatments, the conservative treatments available (imiquimod, 5-FU, PDT and diclofenac gel) have not yet exceeded the use of ablative options such as cryotherapy despite their accepted benefit of treating field cancerization. © 2012 The Authors. BJD © 2012 British Association of Dermatologists.

  1. Clinical Assessment of Mineral Trioxide Aggregate in the Treatment ...

    African Journals Online (AJOL)


    . Niger J Clin Pract 2017;20:600-5. Objective: This clinical study aimed to assess the effectiveness of mineral trioxide aggregate (MTA) and .... The isolation was performed using a saliva ejector and cotton rolls. Cavities were ...

  2. Assessment of the Evolution of Cancer Treatment Therapies

    Directory of Open Access Journals (Sweden)

    Mónica Valladares


    Full Text Available Cancer therapy has been characterized throughout history by ups and downs, not only due to the ineffectiveness of treatments and side effects, but also by hope and the reality of complete remission and cure in many cases. Within the therapeutic arsenal, alongside surgery in the case of solid tumors, are the antitumor drugs and radiation that have been the treatment of choice in some instances. In recent years, immunotherapy has become an important therapeutic alternative, and is now the first choice in many cases. Nanotechnology has recently arrived on the scene, offering nanostructures as new therapeutic alternatives for controlled drug delivery, for combining imaging and treatment, applying hyperthermia, and providing directed target therapy, among others. These therapies can be applied either alone or in combination with other components (antibodies, peptides, folic acid, etc.. In addition, gene therapy is also offering promising new methods for treatment. Here, we present a review of the evolution of cancer treatments, starting with chemotherapy, surgery, radiation and immunotherapy, and moving on to the most promising cutting-edge therapies (gene therapy and nanomedicine. We offer an historical point of view that covers the arrival of these therapies to clinical practice and the market, and the promises and challenges they present.

  3. Assessment of the Evolution of Cancer Treatment Therapies

    Energy Technology Data Exchange (ETDEWEB)

    Arruebo, Manuel [Instituto de Nanociencia de Aragón (INA), Mariano Esquillor, Edif. I+D, University of Zaragoza, Zaragoza 50018 (Spain); CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza 50018 (Spain); Vilaboa, Nuria [CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza 50018 (Spain); Hospital Universitario La Paz-IdiPAZ, Paseo de la Castellana 261, Madrid 28046 (Spain); Sáez-Gutierrez, Berta; Lambea, Julio; Tres, Alejandro [Instituto de Nanociencia de Aragón (INA), Mariano Esquillor, Edif. I+D, University of Zaragoza, Zaragoza 50018 (Spain); Servicio de Oncología Médica, Hospital Clínico Universitario Lozano Blesa, Avda. San Juan Bosco 50009, Zaragoza (Spain); Instituto Aragonés de Ciencias de la Salud (I-CS), Avda. Gómez Laguna, 25, Zaragoza 50009 (Spain); Valladares, Mónica [Lonza Biologics Porriño, A relva s/n, Porriño (Pontevedra) 36410 (Spain); González-Fernández, África, E-mail: [Immunology Department, Biomedical Research Center (CINBIO), University of Vigo, Campus Lagoas Marcosende, Vigo (Pontevedra) 36310 (Spain)


    Cancer therapy has been characterized throughout history by ups and downs, not only due to the ineffectiveness of treatments and side effects, but also by hope and the reality of complete remission and cure in many cases. Within the therapeutic arsenal, alongside surgery in the case of solid tumors, are the antitumor drugs and radiation that have been the treatment of choice in some instances. In recent years, immunotherapy has become an important therapeutic alternative, and is now the first choice in many cases. Nanotechnology has recently arrived on the scene, offering nanostructures as new therapeutic alternatives for controlled drug delivery, for combining imaging and treatment, applying hyperthermia, and providing directed target therapy, among others. These therapies can be applied either alone or in combination with other components (antibodies, peptides, folic acid, etc.). In addition, gene therapy is also offering promising new methods for treatment. Here, we present a review of the evolution of cancer treatments, starting with chemotherapy, surgery, radiation and immunotherapy, and moving on to the most promising cutting-edge therapies (gene therapy and nanomedicine). We offer an historical point of view that covers the arrival of these therapies to clinical practice and the market, and the promises and challenges they present.

  4. 78 FR 14510 - Notice of Availability of a Treatment Evaluation Document and an Environmental Assessment for... (United States)


    ..., Riverdale, MD 20737- 1238. The treatment evaluation document, environmental assessment, and any comments we... Animal and Plant Health Inspection Service Notice of Availability of a Treatment Evaluation Document and an Environmental Assessment for Pesticide Use in the Imported Fire Ant Program AGENCY: Animal and...

  5. Environmental life cycle assessments for water treatment processes ...

    African Journals Online (AJOL)

    The objective of this study was to generate information on the environmental profile of the life cycle of water, including treatment, distribution and collection and disposal (including recycling), in an urban context. As a case study the eThekwini Municipality (with its main city Durban) in South Africa was used. Another aim of ...

  6. Clinical assessment of mineral trioxide aggregate in the treatment of ...

    African Journals Online (AJOL)

    Four teeth capped with Ca(OH)2 (two each at the end of 6 and 12 months) and one tooth capped with MTA (at the end of 12 months) received endodontic emergency treatment because of symptoms of irreversible pulpitis that were clinically and/or radiographically established. There was no significant difference between the ...

  7. Parental assessment and treatment of food selectivity in natural settings.


    Najdowski, Adel C; Wallace, Michele D; Doney, Janice K; Ghezzi, Patrick M


    This study evaluated the effects of a parent-conducted functional analysis and treatment consisting of differential reinforcement of an alternative behavior, escape extinction, and demand fading on food selectivity in a young child with autism. Increases in food acceptance at home and in a restaurant were obtained.

  8. Focus on Implementation: Assessing and Promoting Treatment Fidelity (United States)

    Collier-Meek, Melissa A.; Fallon, Lindsay M.; Sanetti, Lisa M. H.; Maggin, Daniel M.


    Implementation, or treatment fidelity, is the link between evidence-based interventions and changes in student outcomes. Although higher levels of implementation are generally associated with more efficient improvements in student outcomes, research indicates that many adults struggle to consistently implement student interventions. As school…

  9. Physician Peer Assessments for Compliance with Methadone Maintenance Treatment Guidelines (United States)

    Strike, Carol; Wenghofer, Elizabeth; Gnam, William; Hillier, Wade; Veldhuizen, Scott; Millson, Margaret


    Introduction: Medical associations and licensing bodies face pressure to implement quality assurance programs, but evidence-based models are lacking. To improve the quality of methadone maintenance treatment (MMT), the College of Physicians and Surgeons of Ontario, Canada, conducts an innovative quality assurance program on the basis of peer…

  10. Assessment of the Concentration of Metals in a Sewage Treatment ...

    African Journals Online (AJOL)

    Metal concentration of the water in the sewage treatment pond of the Ahmadu Bello University Zaria, Nigeria, was studied between April and September 2007 using Energy Dispersive X-Ray Fluorescence (ED-XRF) Analysis. The mean concentrations of ten (10) heavy metals observed during the study were as follows: ...

  11. Eating disorders in day treatment aspects of assessment and outcome

    NARCIS (Netherlands)

    Exterkate, C.C.


    Part I gives a general introduction and overview of the research with a naturalistic design that has been done in Amarum. Amarus is a specialized public health centre for the treatment of people with eating disorders where the development of Evidence Based Mental Health (EBMH) and the use of

  12. Assessment and Treatment of Anxiety Disorders in Children and Adolescents (United States)

    Wehry, Anna M.; Beesdo-Baum, Katja; Hennelly, Meghann M.; Connolly, Sucheta D.; Strawn, Jeffrey R.


    Recent advances in the developmental epidemiology, neurobiology and treatment of pediatric anxiety disorders have increased our understanding of these conditions and herald improved outcomes for affected children and adolescents. This article reviews the current epidemiology, longitudinal trajectory, and neurobiology of anxiety disorders in youth. Additionally, we summarize the current evidence for both psychotherapeutic and psychopharmacologic treatments of fear-based anxiety disorders (e.g., generalized, social and separation anxiety disorders) in children and adolescents. Current data suggest that these disorders begin in childhood and adolescence, exhibit homotypic continuity and increase the risk of secondary anxiety and mood disorders. Psychopharmacologic trials involving selective serotonin reuptake inhibitors (SSRIs) and selective serotonin norepinephrine reuptake inhibitors (SSNRIs) are effective in pediatric patients with anxiety disorders and have generally demonstrated moderate effect sizes. Additionally, current data support cognitive-behavioral therapy (CBT) are efficacious in the treatment of these conditions in youth and that combination of CBT + an SSRI may be associated with greater improvement than would be expected with either treatment as monotherapy. PMID:25980507

  13. A comparative life cycle assessment of process water treatment ...

    African Journals Online (AJOL)


    Jul 29, 2011 ... softening and hot lime softening. Hot lime softening (HLS) ... filtration. Raw water. Condensate make up to boilers. Condensate. Make Up. Tank. Brines and Sludge management. Treatment chemicals. Electricity. Emmissions ... Feed water is dosed at 5 mg/ℓ with chlorine gas (0.15 kg/Mℓ. BFW), and sodium ...

  14. assessment of dairy wastewater treatment and its potential for ...

    African Journals Online (AJOL)


    HANNA model HI 839800 hot plates and measured by using .... filtration of suspended solids and organic matter decomposition ..... Gas Composition. The biogas produced from the anaerobic treatment system is usually composed of different gases, including methane as the targeted gas, carbon dioxide, hydrogen sulfide ...

  15. Assessment of the efficacy of desmopressin in treatment of Primary ...

    African Journals Online (AJOL)

    Farida ElBaz


    Mar 31, 2015 ... mal development because it carries emotional stigmata [3]. Treatment of ... IQ ¼ MA/CA Â 100. The Stanford–Binet intelligence scale consists of 15 subsets. ... level for each test was established when 2 consecutive items are passed; the ceiling ... times during school day, and often enough to avoid urgency.

  16. Assessment and Treatment of Selective Mutism with English Language Learners (United States)

    Mayworm, Ashley M.; Dowdy, Erin; Knights, Kezia; Rebelez, Jennica


    Selective mutism (SM) is a type of anxiety disorder that involves the persistent failure to speak in contexts where speech is typically expected (e.g., school), despite speaking in other contexts (e.g., home). Research on the etiology and treatment of SM is limited, as it is a rare disorder and few clinical trials evaluating SM interventions have…

  17. An exploratory pilot study to design and assess the credibility of a sham kinesiology treatment. (United States)

    Hall, Sue; Lewith, George; Brien, Sarah; Little, Paul


    Kinesiology is a complementary therapy assessing subtle change in manual muscle testing results to select individualised treatments. We report the exploratory 2-stage development and pilot of a sham kinesiology treatment for use in a clinical trial to evaluate the specific effects of this intervention. 1. To design, pilot and assess the credibility of a sham kinesiology treatment in a kinesiology-aware population. 2. To pilot the sham kinesiology in a cross-over study of sham versus real kinesiology, and to make an exploratory assessment of its credibility in a kinesiology-naïve population. 1. 10 kinesiology-aware volunteers received a specially designed sham treatment weekly for 5 weeks which was subject to a credibility assessment. 2. 10 kinesiology-naïve patients with low back pain were randomised to receive 4 real and 4 sham treatments in a cross-over design; the treatments were subject to a credibility assessment. 100% of participants found the sham protocol a credible treatment as measured by the credibility questionnaire. 100% of patients having real treatment first did not recognise that the second set of treatments were sham. Small numbers precluded the use of formal statistical tests. In this small sample it appeared feasible to deliver an apparently credible sham kinesiology treatment. This feasibility study has allowed us to develop a sham treatment for use in a larger prospective clinical trial of kinesiology in patients with low back pain. 2008 S. Karger AG, Basel.

  18. Crowdsourced assessment of common genetic contribution to predicting anti-TNF treatment response in rheumatoid arthritis

    NARCIS (Netherlands)

    Sieberts, Solveig K.; Zhu, Fan; García-García, Javier; Stahl, Eli; Pratap, Abhishek; Pandey, Gaurav; Pappas, Dimitrios; Aguilar, Daniel; Anton, Bernat; Bonet, Jaume; Eksi, Ridvan; Fornés, Oriol; Guney, Emre; Li, Hongdong; Marín, Manuel Alejandro; Panwar, Bharat; Planas-Iglesias, Joan; Poglayen, Daniel; Cui, Jing; Falcao, Andre O.; Suver, Christine; Hoff, Bruce; Balagurusamy, Venkat S. K.; Dillenberger, Donna; Neto, Elias Chaibub; Norman, Thea; Aittokallio, Tero; Ammad-Ud-Din, Muhammad; Azencott, Chloe-Agathe; Bellón, Víctor; Boeva, Valentina; Bunte, Kerstin; Chheda, Himanshu; Cheng, Lu; Corander, Jukka; Dumontier, Michel; Goldenberg, Anna; Gopalacharyulu, Peddinti; Hajiloo, Mohsen; Hidru, Daniel; Jaiswal, Alok; Kaski, Samuel; Khalfaoui, Beyrem; Khan, Suleiman Ali; Kramer, Eric R.; Marttinen, Pekka; Mezlini, Aziz M.; Molparia, Bhuvan; Pirinen, Matti; Saarela, Janna; Samwald, Matthias; Stoven, Véronique; Tang, Hao; Tang, Jing; Torkamani, Ali; Vert, Jean-Phillipe; Wang, Bo; Wang, Tao; Wennerberg, Krister; Wineinger, Nathan E.; Xiao, Guanghua; Xie, Yang; Yeung, Rae; Zhan, Xiaowei; Zhao, Cheng; Greenberg, Jeff; Kremer, Joel; Michaud, Kaleb; Barton, Anne; Coenen, Marieke; Mariette, Xavier; Miceli, Corinne; Shadick, Nancy; Weinblatt, Michael; de Vries, Niek; Tak, Paul P.; Gerlag, Danielle; Huizinga, Tom W. J.; Kurreeman, Fina; Allaart, Cornelia F.; Louis Bridges, S.; Criswell, Lindsey; Moreland, Larry; Klareskog, Lars; Saevarsdottir, Saedis; Padyukov, Leonid; Gregersen, Peter K.; Friend, Stephen; Plenge, Robert; Stolovitzky, Gustavo; Oliva, Baldo; Guan, Yuanfang; Mangravite, Lara M.; Bridges, S. Louis; Calaza, Manuel; Elmarakeby, Haitham; Heath, Lenwood S.; Long, Quan; Moore, Jonathan D.; Opiyo, Stephen Obol; Savage, Richard S.; Zhu, Jun


    Rheumatoid arthritis (RA) affects millions world-wide. While anti-TNF treatment is widely used to reduce disease progression, treatment fails in Bone-third of patients. No biomarker currently exists that identifies non-responders before treatment. A rigorous community-based assessment of the utility

  19. How to assess treatment efficacy in Sjogren's syndrome?

    NARCIS (Netherlands)

    Vissink, Arjan; Bootsma, Hendrika; Kroese, Frans G. M.; Kallenberg, Cees G. M.

    Purpose of review This article critically reviews the current views and discusses the future challenges with regard to assessing disease progression and disease activity in Sjogren's syndrome, as a decrease of disease progression and activity is what an effective Sjogren's syndrome therapy aims for.

  20. Cost effectiveness of haemophilia treatment : a cross-national assessment

    NARCIS (Netherlands)

    Lippert, B; Berger, K; Berntorp, E; Giangrande, P; van den Berg, M; Schramm, W; Siebert, U


    The aim of this study was to assess the incremental cost effectiveness of on-demand versus prophylactic haemophilia therapy in Germany, Sweden, the United Kingdom and The Netherlands from the third-party payers' perspective. Using a decision tree model, the cost effectiveness of on-demand versus

  1. Assessment and treatment of planning skills in adolescents with ADHD

    NARCIS (Netherlands)

    Boyer, B.E.


    Planning problems are described to be prominent in the daily lives of adolescents with ADHD (Barkley, 2004) and may cause comorbid conditions and impairments (Safren, 2006). Therefore the central aim of this thesis was to assess planning skills of adolescents with ADHD and to investigate whether

  2. Games for the assessment and treatment of mental health

    NARCIS (Netherlands)

    Mandryk, R.L.; Birk, M.V.; Lobel, A.M.; Rooij, M.M.J.W. van; Granic, I.; Abeele, V. vanden


    The community for research on video games for assessment and intervention for mental health spans multiple disciplines, from cognitive sciences, computer science, and interaction design, to psychology, neurobiology, and medicine. The goal of this workshop is to bring together an international group

  3. Nocturnal enuresis: an approach to assessment and treatment. (United States)

    Bayne, Aaron P; Skoog, Steven J


    On the basis of strong evidence, although primary monosymptomatic nocturnal enuresis (PMNE) is common and most children will outgrow the condition spontaneously, the psychological effect to the child can be significant and represents the main reason for treatment of these children. On the basis of international consensus panels, treatment of PMNE should be targeted toward the specific type of bedwetting patterns the child has, using bladder diary, sleep history, and daytime elimination concerns as a guide (Table 3). On the basis of international consensus panels, it is important for the primary care physician to be able to differentiate children with PMNE from children with nonmonosymptomatic nocturnal enuresis (NMNE) and secondary nocturnal enuresis. On the basis of international consensus panels, children with NMNE should have their underlying voiding or stool problem addressed before initiation of therapy for the nocturnal enuresis. On the basis of strong evidence, both the bedwetting alarm and desmopressin are considered first-line therapy for children with PMNE.

  4. Assessing sex differences on treatment effectiveness from the drug abuse treatment outcome study (DATOS). (United States)

    Acharyya, Suddhasatta; Zhang, Heping


    Men and women entering drug treatment programs are known to differ in demographic characteristics and psychosocial behavioral patterns. To be effective, any such program that caters to individuals from both sexes should identify and address these gender-based variations. Studies have also reported clinical differences in the effect of drugs on men and women addicts. Here, we examine whether the treatment is equally effective on men and women, when several demographic covariates are controlled. We construct a "problem severity index" to categorize individuals based on how acute their problems were at the start of the program. We also examine how the choice of treatment modality affects treatment success. Cumulative logit models were used in our analysis. The choice of treatment modality is sex specific, although sex did not appear to be a significant factor for treatment effectiveness when we controlled for other explanatory variables.

  5. Liquid Effluent Retention Facility/Effluent Treatment Facility Hazards Assessment

    Energy Technology Data Exchange (ETDEWEB)

    Simiele, G.A.


    This document establishes the technical basis in support of Emergency Planning activities for the Liquid Effluent Retention Facility and Effluent Treatment Facility the Hanford Site. The document represents an acceptable interpretation of the implementing guidance document for DOE ORDER 5500.3A. Through this document, the technical basis for the development of facility specific Emergency Action Levels and the Emergency Planning Zone is demonstrated.

  6. Durability assessment of limestone subjected to surface treatments (United States)

    Theodoridou, Magdalini; Charalambous, Cleopatra; Ioannou, Ioannis


    Weathering is inevitable in existing limestone structures due to their exposure to fluctuating and aggressive environmental conditions, such as wetting/drying, and the presence of salts. Therefore, conservation treatments are often deemed necessary in order to prevent or at least delay the progress of deterioration and to strengthen weathered stones. This paper focuses on the effect of an ethanol-based laboratory produced water repellent and three water-based commercial products (water repellent, pure acrylic emulsion mixed with a water repellent with thermal insulation properties and consolidant) on the durability and other properties of three different types of limestone (massive chalk, calcarenite and bioclastic limestone). All test specimens were subjected to micro-destructive cutting tests before/after the application of the aforementioned surface treatments to investigate changes in resistance to cutting on the area close to the treated surface. They were also subjected to two cycles of salt contamination with 20% w/w Na2SO4•10H2O solution by capillary absorption through their bottom face, until 2 mm of pore space was theoretically filled with salt crystals. Drying after salt contamination took place at 70 °C. The results of the micro-destructive cutting tests showed increases in cutting resistance at the topmost area (1-2 mm below the treated surface) of the massive chalk and the calcarenite, but no significant changes in the case of the rather non-homogeneous bioclastic limestone. At the same time, the performance of each surface treatment varied from lithotype to lithotype. The laboratory produced water repellent showed a generally better performance; no signs of damage were detected due to the formation of salt crystals within the pores of the materials, i.e. subflorescence, when applied on the calcarenite and the bioclastic limestone. Very poor performance was observed for all treatments when applied on the massive chalk. This accounted for (i

  7. Assessment of rehabilitation needs in colorectal cancer treatment

    DEFF Research Database (Denmark)

    Wiedenbein, Liza; Kristiansen, Maria; Adamsen, Lis


    Background Systematic assessments of cancer patients' rehabilitation needs are a prerequisite for devising appropriate survivorship programs. Little is known about the fit between needs assessment outlined in national rehabilitation policies and clinical practice. This study aimed to explore...... clinical practices related to identification and documentation of rehabilitation needs among patients with colorectal cancer at Danish hospitals. Material and methods A retrospective clinical audit was conducted utilizing data from patient files randomly selected at surgical and oncology hospital...... departments treating colorectal cancer patients. Forty patients were included, 10 from each department. Semi-structured interviews were carried out among clinical nurse specialists. Audit data was analyzed using descriptive statistics, qualitative data using thematic analysis. Results Documentation...

  8. Delivering occupational therapy hand assessment and treatment sessions via telehealth. (United States)

    Worboys, Tess; Brassington, Melinda; Ward, Elizabeth C; Cornwell, Petrea L


    Introduction Telehealth offers a solution to assist delivery of occupational therapy (OT) services for hand therapy in rural and remote locations. However, there is currently no evidence to validate this service model. The aim of this study was to examine the validity of clinical decisions made during hand therapy sessions conducted via telehealth compared to a traditional clinical model (TCM) assessment, and explore patient and clinician satisfaction. Methods Eighteen patients referred for hand therapy to a rural/remote hospital-based outpatient service were assessed simultaneously via telehealth and a TCM assessment. An allied health assistant supported data collection at the patient end. Hand function was assessed using a range of objective measures, subjective scales and patient reported information. Minimal level of percent exact agreement (PEA) between the telehealth OT (T-OT) and the TCM-OT was set at ≥80%. Results Level of agreement for all objective measures (dynamometer and pinch gauge reading, goniometer flexion and extension, circumference in millimetres) ranged between 82% and 100% PEA. High agreement (>80% PEA) was also obtained for judgements of scar and general limb function, exercise compliance, pain severity and sensitivity location, activities of daily living and global ratings of change (GROC) scores. There was 100% PEA for overall recommendations. Minimal technical issues were experienced. Patient and clinician satisfaction was high. Discussion Clinical decisions made via telehealth were comparable to the TCM and consumers were satisfied with telehealth as a service option. Telehealth offers the potential to improve access to hand therapy services for rural and remote patients.

  9. Assessment and treatment of planning skills in adolescents with ADHD


    Boyer, B. E.


    Planning problems are described to be prominent in the daily lives of adolescents with ADHD (Barkley, 2004) and may cause comorbid conditions and impairments (Safren, 2006). Therefore the central aim of this thesis was to assess planning skills of adolescents with ADHD and to investigate whether these planning skills can be enhanced using cognitive behavioral therapy (CBT). Chapter 2 suggests that even though adolescents with ADHD show planning problems as compared to typically developing (TD...

  10. Assessing the treatment costs and the fertilizing value of the output products in digestate treatment systems. (United States)

    Golkowska, K; Vázquez-Rowe, I; Lebuf, V; Accoe, F; Koster, D


    The objective of this paper was to advance towards finding sustainable solutions to deal with biogas digestate and contribute to faster development of the market for digestate treatment products. The study compares digestate treatment costs through four different treatment plants, estimates the potential fertilizing and humus value (PFHV) of the derived products and allocates the cash flows to show the possible regional benefits. The treatment costs for the pre-dried solid fraction of digestate ranged from €19 to €23/tonne output. These costs may be covered by vending treatment products at a price reaching at least 34-41% of their PFHV (ca €55/tonne). Treatment of raw digestate generates high operating costs (€216-247/tonne output), much higher than the PFHV of the products (ca €35-51/tonne). For such systems either the treatment has to be financially subsidized by the authorities or €13-32/tonne input should be covered by the substrate deliverers as a disposal fee. Nevertheless, a well-prepared investment concept in this field may allow the local binding of up to 80% of total cash flows. Finally, the current difficult market situation of the treatment products can be primarily improved by clearing their legal status at European level.

  11. Circadian rhythm disorders among adolescents: assessment and treatment options. (United States)

    Bartlett, Delwyn J; Biggs, Sarah N; Armstrong, Stuart M


    Delayed sleep phase disorder (DSPD) - a circadian rhythm sleep disorder - is most commonly seen in adolescents. The differential diagnosis between DSPD and conventional psychophysiological insomnia is important for correct therapeutic intervention. Adolescent DSPD sleep duration is commonly 9 hours or more. Depression may be comorbid with DSPD. DSPD has a negative impact on adolescent academic performance. DSPD treatments include bright light therapy, chronotherapeutic regimens, and administration of melatonin as a chronobiotic (as distinct from a soporific). Attention to non-photic and extrinsic factors including healthy sleep parameters is also important to enable better sleep and mood outcomes in adolescents.

  12. Towards Probablistic Assessment of Hypobaric Decompression Sickness Treatment (United States)

    Conkin, J.; Abercromby, A. F.; Feiveson, A. H.; Gernhardt, M. L.; Norcross, J. R.; Ploutz-Snyder, R.; Wessel, J. H., III


    INTRODUCTION: Pressure, oxygen (O2), and time are the pillars to effective treatment of decompression sickness (DCS). The NASA DCS Treatment Model links a decrease in computed bubble volume to the resolution of a symptom. The decrease in volume is realized in two stages: a) during the Boyle's Law compression and b) during subsequent dissolution of the gas phase by the O2 window. METHODS: The cumulative distribution of 154 symptoms that resolved during repressurization was described with a log-logistic density function of pressure difference (deltaP as psid) associated with symptom resolution and two other explanatory variables. The 154 symptoms originated from 119 cases of DCS during 969 exposures in 47 different altitude tests. RESULTS: The probability of symptom resolution [P(symptom resolution)] = 1 / (1+exp(- (ln(deltaP) - 1.682 + 1.089×AMB - 0.00395×SYMPTOM TIME) / 0.633)), where AMB is 1 when the subject ambulated as part of the altitude exposure or else 0 and SYMPTOM TIME is the elapsed time in min from start of the altitude exposure to recognition of a DCS symptom. The P(symptom resolution) was estimated from computed deltaP from the Tissue Bubble Dynamics Model based on the "effective" Boyle's Law change: P2 - P1 (deltaP, psid) = P1×V1/V2 - P1, where V1 is the computed volume of a spherical bubble in a unit volume of tissue at low pressure P1 and V2 is computed volume after a change to a higher pressure P2. V2 continues to decrease through time at P2, at a faster rate if 100% ground level O2 was breathed. The computed deltaP is the effective treatment pressure at any point in time as if the entire ?deltaP was just from Boyle's Law compression. DISCUSSION: Given the low probability of DCS during extravehicular activity and the prompt treatment of a symptom with options through the model it is likely that the symptom and gas phase will resolve with minimum resources and minimal impact on astronaut health, safety, and productivity.

  13. Assessment and treatment of common pediatric sleep disorders (United States)

    Avis, Kristin


    Current evidence indicates that chronically disrupted sleep in children and adolescents can lead to problems in cognitive functioning. Behavioral interventions for pediatric sleep problems (e.g., graduated extinction, parent education, positive bedtime routines), especially in young children, have been shown to produce clinically significant improvements. This review describes a few pertinent conditions of sleep disorders in children and adolescents as well as provides clinically useful approaches to sleep complaints and both pharmacologic and nonpharmacological treatments of some common pediatric sleep disorders. PMID:20622943

  14. The significance of motivation in periodontal treatment: validity and reliability of the motivation assessment scale among patients undergoing periodontal treatment. (United States)

    Pac, A; Oruba, Z; Olszewska-Czyż, I; Chomyszyn-Gajewska, M


    The individual evaluation of patients' motivation should be introduced to the protocol of periodontal treatment, as it could impact positively on effective treatment planning and treatment outcomes. However, a standardised tool measuring the extent of periodontal patients' motivation has not yet been proposed in the literature. Thus, the objective of the present study was to determine the validity and reliability of the Zychlińscy motivation scale adjusted to the needs of periodontology. Cross sectional study. Department of Periodontology and Oral Medicine, Dental University Clinic, Jagiellonian University, Krakow, Poland. 199 adult periodontal patients, aged 20-78. 14-item questionnaire. The items were adopted from the original Zychlińscy motivation assessment scale. Validity and reliability of the proposed motivation assessment instrument. The assessed Cronbach's alpha of 0.79 indicates the scale is a reliable tool. Principal component analysis revealed a model with three factors, which explained half of the total variance. Those factors represented: the patient's attitude towards treatment and oral hygiene practice; previous experiences during treatment; and the influence of external conditions on the patient's attitude towards treatment. The proposed scale proved to be a reliable and accurate tool for the evaluation of periodontal patients' motivation.

  15. Evaluation of orthodontists' perception of treatment need and the peer assessment rating (PAR) index. (United States)

    McGorray, S P; Wheeler, T T; Keeling, S D; Yurkiewicz, L; Taylor, M G; King, G J


    This paper examines the relationship between orthodontists' subjective assessment of treatment need and objective measurements obtained during standardized intra- and extraoral examinations. Logistic regression modeling was used to develop predictive models of treatment need. Data were obtained from 1155 eighth-grade students by four orthodontists who used standardized examination forms to assess demographics, trauma, skeletal relationships, morphologic malocclusion traits, and mandibular function. At the conclusion of the examination, the orthodontist rated the subjective treatment need as none, elective, recommended, soon, or immediate. For some analyses, the categories were collapsed to represent no need and need. The peer assessment rating (PAR) index (American validated version) was computed from the clinical exam findings and scoring of dental models; PAR scores were used to document malocclusion severity and treatment difficulty. Spearman rank correlation coefficients quantified the relationship between PAR scores and need categories. Logistic regression analysis modeled treatment need using components of the PAR index as well as other variables. The components of these models, as well as sensitivity and specificity, were compared with malocclusion severity/treatment difficulty scores obtained from malocclusion assessments using the PAR index. The five subjective treatment need categories and the PAR index scores were significantly correlated (rho = 0.62, porthodontists' subjective assessment of treatment need when that assessment is made in the absence of financial considerations and patient desires.

  16. Probabilistic Assessment of Hypobaric Decompression Sickness Treatment Success (United States)

    Conkin, Johnny; Abercromby, Andrew F. J.; Dervay, Joseph P.; Feiveson, Alan H.; Gernhardt, Michael L.; Norcross, Jason R.; Ploutz-Snyder, Robert; Wessel, James H., III


    The Hypobaric Decompression Sickness (DCS) Treatment Model links a decrease in computed bubble volume from increased pressure (DeltaP), increased oxygen (O2) partial pressure, and passage of time during treatment to the probability of symptom resolution [P(symptom resolution)]. The decrease in offending volume is realized in 2 stages: a) during compression via Boyle's Law and b) during subsequent dissolution of the gas phase via the O2 window. We established an empirical model for the P(symptom resolution) while accounting for multiple symptoms within subjects. The data consisted of 154 cases of hypobaric DCS symptoms along with ancillary information from tests on 56 men and 18 women. Our best estimated model is P(symptom resolution) = 1 / (1+exp(-(ln(Delta P) - 1.510 + 0.795×AMB - 0.00308×Ts) / 0.478)), where (DeltaP) is pressure difference (psid), AMB = 1 if ambulation took place during part of the altitude exposure, otherwise AMB = 0; and where Ts is the elapsed time in mins from start of the altitude exposure to recognition of a DCS symptom. To apply this model in future scenarios, values of DeltaP as inputs to the model would be calculated from the Tissue Bubble Dynamics Model based on the effective treatment pressure: (DeltaP) = P2 - P1 | = P1×V1/V2 - P1, where V1 is the computed volume of a spherical bubble in a unit volume of tissue at low pressure P1 and V2 is computed volume after a change to a higher pressure P2. If 100% ground level O2 (GLO) was breathed in place of air, then V2 continues to decrease through time at P2 at a faster rate. This calculated value of (DeltaP then represents the effective treatment pressure at any point in time. Simulation of a "pain-only" symptom at 203 min into an ambulatory extravehicular activity (EVA) at 4.3 psia on Mars resulted in a P(symptom resolution) of 0.49 (0.36 to 0.62 95% confidence intervals) on immediate return to 8.2 psia in the Multi-Mission Space Exploration Vehicle. The P(symptom resolution) increased

  17. The assessment and treatment of wound pain at dressing change.

    LENUS (Irish Health Repository)

    Bell, Cassandra


    Pain is a common reason for patients with acute or chronic wounds seeking hospital admission, but it appears to be under-treated by health professionals. A quantitative descriptive study was conducted to investigate nurses\\' knowledge with regard to dressing change and wound pain. Data were collected from registered nurses (n=94). Analysis indicated a low level of knowledge with regard to pain assessment and strategies to overcome pain at dressing change, but a good knowledge of factors that contribute to pain at dressing change.

  18. Causes, assessment and treatment of malnutrition in older people. (United States)

    Willis, Helen


    Malnutrition is a growing problem in the UK with as many as 14% of people aged over 65 at risk. It is of particular concern in care homes where more than one third of residents are undernourished. Weight loss is not the only symptom of malnourishment and nurses should examine any changes to a person's health and well-being to identify causes. Regular monitoring of patients' risk of malnutrition through use of screening assessments, such as the Malnutrition Universal Screening Tool, ensures undernourishment is identified early. As the population ages, it is more important than ever that the implications of malnutrition are recognised and addressed.

  19. Impact of response shift on the assessment of treatment effects using the Oral Health Impact Profile. (United States)

    Reissmann, Daniel R; Remmler, Antje; John, Mike T; Schierz, Oliver; Hirsch, Christian


    The assessment of changes in oral health-related quality of life (OHRQoL) is challenging because individuals' concepts and internal standards of OHRQoL may change over time. The aim of this study was to detect response shifts in OHRQoL assessments made using the Oral Health Impact Profile (OHIP). Oral health-related quality of life was assessed in a consecutive sample of 126 patients seeking prosthodontic care. Patients were asked to rate their OHRQoL before treatment started and 1 month after treatment was finished, using the German 49-item version of the OHIP. When rating their OHRQoL after treatment, patients were also asked to rate their pre-treatment OHRQoL without having access to their baseline data. The response shift was calculated as the difference in OHIP summary scores between the initial assessment and the retrospective baseline assessment. The OHIP mean scores decreased from 31.8 at the initial baseline assessment to 24.4 after treatment. The retrospective baseline assessment resulted in an OHIP mean score of 38.1, corresponding to a response shift of 6.3 OHIP points. The effect size (Cohen's d = 0.21) of the response shift was considered small. The response shift phenomenon and its magnitude have important implications for dental practice, where patients and dentists often assess perceived treatment effects retrospectively. © 2012 Eur J Oral Sci.

  20. Pain Assessment and Treatment Decisions for Virtual Human Patients (United States)

    George, Steven Z.; Lok, Benjamin C.; Torres, Calia A.; Chuah, Joon Hao; Robinson, Michael E.


    Abstract Laypeople and healthcare professionals use demographic cues when making pain management decisions. These decisions can negatively affect patient outcomes. This study examined whether laypeople base their pain management decisions in part on pain-related postures and demographic cues. Virtual human (VH) technology was used to research whether sex and race, as well as body posture, influenced pain management decisions. Ninety-seven laypersons examined VH patients exhibiting low back pain related body postures whose demographic cues varied by VH sex and VH race. T tests validated that participants were able to distinguish between high pain related body postures and low pain related body postures. The participants assessed male VH patients to be experiencing more pain than female VH patients. This study suggests that participants use sex as a cue when assessing pain. Participants may perceive VH male patients as experiencing high pain intensity if the participants are willing to counter male stereotypes and acknowledge that the male VH patients display pain behaviors. PMID:23971429

  1. Functional assessment of endoprosthesis in the treatment of bone tumors

    Directory of Open Access Journals (Sweden)

    Denis Kiyoshi Fukumothi

    Full Text Available ABSTRACT OBJECTIVES: Evaluate the functional grade of these patients and to identify the types of complications found that influenced the average life span of endoprostheses the functions of the operated limb. METHODS: We analyzed 14 post-operative cases of endoprosthesis, patients with malignant bone tumors and aggressive benign bone tumors submitted to surgery between 2004 and 2014. The evaluation system used was proposed by Enneking, recommended by the Musculoskeletal Tumor Society (MSTS, in addition to the radiologic evaluation. RESULTS: Endoprosthesis are excellent choices for the treatment of bone tumors with limb preservation in relation to pain, strength, and patient's emotional acceptance. Another factor for good results is the immediate weight-bearing capacity, generating a greater independence. CONCLUSION: The authors conclude that all patients classified the therapy as excellent/good, regardless of the type of prosthesis used, extent of injury, and/or type of tumor resection performed.

  2. Assessment and treatment of pica and destruction of holiday decorations. (United States)

    Mitteer, Daniel R; Romani, Patrick W; Greer, Brian D; Fisher, Wayne W


    Problem behavior exhibited by individuals with autism can be disruptive to family traditions, such as decorating for the holidays. We present data for a 6-year-old girl who engaged in automatically reinforced pica and destruction of holiday decorations. Treatment was evaluated within an ABCDCD reversal design. During baseline (Phases A and B), we observed elevated rates of problem behavior. We implemented differential reinforcement of alternative behavior in Phase C to teach a response to compete with problem behavior. Little change in toy play or problem behavior occurred. In Phase D, we added a facial screen to the differential reinforcement procedures, which resulted in increases in toy play and decreases in problem behavior. Findings are discussed in terms of how interventions for problem behavior can promote alternative behavior while they facilitate household activities and traditions. © Society for the Experimental Analysis of Behavior.

  3. Functional assessment of endoprosthesis in the treatment of bone tumors. (United States)

    Fukumothi, Denis Kiyoshi; Pupo, Hiran; Reganin, Luciano Augusto; Matte, Silvia Raquel Fricke; Lima, Bruno Spagnuolo de; Mattos, Carlos Augusto de


    Evaluate the functional grade of these patients and to identify the types of complications found that influenced the average life span of endoprostheses the functions of the operated limb. We analyzed 14 post-operative cases of endoprosthesis, patients with malignant bone tumors and aggressive benign bone tumors submitted to surgery between 2004 and 2014. The evaluation system used was proposed by Enneking, recommended by the Musculoskeletal Tumor Society (MSTS), in addition to the radiologic evaluation. Endoprosthesis are excellent choices for the treatment of bone tumors with limb preservation in relation to pain, strength, and patient's emotional acceptance. Another factor for good results is the immediate weight-bearing capacity, generating a greater independence. The authors conclude that all patients classified the therapy as excellent/good, regardless of the type of prosthesis used, extent of injury, and/or type of tumor resection performed.

  4. Toward a definition and method of assessment of treatment failure and treatment effectiveness: the case of leflunomide versus methotrexate. (United States)

    Wolfe, Frederick; Michaud, Kaleb; Stephenson, Barbara; Doyle, Joseph


    Time to treatment discontinuation (TTD) is an accepted method of assessing treatment effectiveness in the community, but is susceptible to channeling bias and secular and cohort effects. In addition, TTD does not consider the addition of new disease modifying antirheumatic drugs (DMARD) to insufficiently effective therapies. We expand the definition of treatment failure to include discontinuation or addition of a second DMARD (1) to examine leflunomide (LEF) versus methotrexate (MTX) effectiveness in clinical practice; (2) to obtain an estimate of overall clinical effectiveness; and (3) to identify factors associated with treatment successes and failure. In addition, (4) we test the feasibility of performing a clinical trial using a longitudinal data bank. Using the National Data Bank for Rheumatic Diseases longitudinal data bank, 1431 patients with rheumatoid arthritis (RA) who began taking LEF or MTX as part of their routine medical care were followed from 1998 through 2001. None of the 1431 patients had received either treatment previously. Patients were assessed at 6 month intervals for periods up to 36 months by mailed questionnaires concerning DMARD therapy and demographic and RA severity factors. Kaplan-Meier survivor functions and Cox regression analyses were used to assess treatment failure, defined as time to discontinuation or to the addition of a second DMARD. For 756 patients taking LEF, the failure rate was 55.5 per 100 patient-years, and the median time to failure was 15 (95% CI 13, 17) months. For 675 patients taking MTX the failure rate was 57.3 per 100 patient-years, and the median failure time was 14 (95% CI 12, 18) months. These differences were not statistically significant. The overall rate of discontinuation was 68.7% of the failure rate. Discontinuation was predicted by adverse effects [hazard ratio 1.76 (95% CI 1.51, 2.04)] and by clinical status prior to starting DMARD, and these results were not affected by specific DMARD treatment

  5. Fatigue in chronic kidney disease: Definition, assessment and treatment. (United States)

    Zalai, Dora; Bohra, Miqdad


    Chronic fatigue--an overwhelming subjective feeling of mental or physical exhaustion--impacts patients' everyday functioning and quality of life, delays recovery after hemodialysis, and increases mortality. There are a number of factors that may perpetuate clinically significant fatigue among individuals with chronic kidney disease, including sleep disorders, depression, sedentary lifestyle, anemia, and chronic inflammation. Some of these factors (i.e., anemia and inflammation) are in the forefront of clinical attention, whereas the other contributing factors often remain unrecognized. This article provides a pragmatic overview of the definition, assessment, maintaining factors, and management of fatigue in chronic kidney disease. Given that chronic fatigue is a major determinant of patients' quality of life, nurses can bring about a fundamental improvement in patients' well-being if they recognize the most common fatigue-perpetuating factors and facilitate fatigue management interventions.

  6. Risk assessment for organic trace compounds in wastewater: comparison of conventional and advanced treatment. (United States)

    Schwätter, F; Hannich, C B; Nöthe, T; Oehlmann, J; Fahlenkamp, H


    The elimination of organic trace compounds in municipal wastewater was analysed at three German wastewater treatment plants. Additionally, the effects of advanced treatment, membrane filtration, adsorption and oxidation processes were investigated. To assess the ecotoxicity of effluents, a number of tools were used: substance-specific evaluation, case studies for combined effects and risk assessment on the basis of cumulative parameters. The results of the research projects revealed that aquatic environmental risks can be reduced significantly using advanced treatment technologies for wastewater treatment plants.

  7. Virtual reality treatment and assessments for post-stroke unilateral spatial neglect: A systematic literature review. (United States)

    Ogourtsova, Tatiana; Souza Silva, Wagner; Archambault, Philippe S; Lamontagne, Anouk


    Unilateral spatial neglect (USN) is a highly prevalent post-stroke deficit. Currently, there is no gold standard USN assessment which encompasses the heterogeneity of this disorder and that is sensitive to detect mild deficits. Similarly, there is a limited number of high quality studies suggesting that conventional USN treatments are effective in improving functional outcomes and reducing disability. Virtual reality (VR) provides enhanced methods for USN assessment and treatment. To establish best-practice recommendations with respect to its use, it is necessary to appraise the existing evidence. This systematic review aimed to identify and appraise existing VR-based USN assessments; and to determine whether VR is more effective than conventional therapy. Assessment tools were critically appraised using standard criteria. The methodological quality of the treatment trials was rated by two authors. The level of evidence according to stage of recovery was determined. Findings were compiled into a VR-based USN Assessment and Treatment Toolkit (VR-ATT). Twenty-three studies were identified. The proposed VR tools augmented the conventional assessment strategies. However, most studies lacked analysis of psychometric properties. There is limited evidence that VR is more effective than conventional therapy in improving USN symptoms in patients with stroke. It was concluded that VR-ATT could facilitate identification and decision-making as to the appropriateness of VR-based USN assessments and treatments across the continuum of stroke care, but more evidence is required on treatment effectiveness.

  8. Clinician-Reported Outcome Assessments of Treatment Benefit: Report of the ISPOR Clinical Outcome Assessment Emerging Good Practices Task Force. (United States)

    Powers, John H; Patrick, Donald L; Walton, Marc K; Marquis, Patrick; Cano, Stefan; Hobart, Jeremy; Isaac, Maria; Vamvakas, Spiros; Slagle, Ashley; Molsen, Elizabeth; Burke, Laurie B


    A clinician-reported outcome (ClinRO) assessment is a type of clinical outcome assessment (COA). ClinRO assessments, like all COAs (patient-reported, observer-reported, or performance outcome assessments), are used to 1) measure patients' health status and 2) define end points that can be interpreted as treatment benefits of medical interventions on how patients feel, function, or survive in clinical trials. Like other COAs, ClinRO assessments can be influenced by human choices, judgment, or motivation. A ClinRO assessment is conducted and reported by a trained health care professional and requires specialized professional training to evaluate the patient's health status. This is the second of two reports by the ISPOR Clinical Outcomes Assessment-Emerging Good Practices for Outcomes Research Task Force. The first report provided an overview of COAs including definitions important for an understanding of COA measurement practices. This report focuses specifically on issues related to ClinRO assessments. In this report, we define three types of ClinRO assessments (readings, ratings, and clinician global assessments) and describe emerging good measurement practices in their development and evaluation. The good measurement practices include 1) defining the context of use; 2) identifying the concept of interest measured; 3) defining the intended treatment benefit on how patients feel, function, or survive reflected by the ClinRO assessment and evaluating the relationship between that intended treatment benefit and the concept of interest; 4) documenting content validity; 5) evaluating other measurement properties once content validity is established (including intra- and inter-rater reliability); 6) defining study objectives and end point(s) objectives, and defining study end points and placing study end points within the hierarchy of end points; 7) establishing interpretability in trial results; and 8) evaluating operational considerations for the implementation of

  9. Assessment of indoor airborne contamination in a wastewater treatment plant. (United States)

    Teixeira, Juliana V; Miranda, Sandra; Monteiro, Ricardo A R; Lopes, Filipe V S; Madureira, Joana; Silva, Gabriela V; Pestana, Nazaré; Pinto, Eugénia; Vilar, Vítor J P; Boaventura, Rui A R


    The main objective of this work was to quantify and characterize the major indoor air contaminants present in different stages of a municipal WWTP, including microorganisms (bacteria and fungi), carbon dioxide, carbon monoxide, hydrogen sulfide ammonia, formaldehyde, and volatile organic compounds (VOCs). In general, the total bacteria concentration was found to vary from 60 to >52,560 colony-forming units (CFU)/m(3), and the total fungi concentration ranged from 369 to 14,068 CFU/m(3). Generally, Gram-positive bacteria were observed in higher number than Gram-negative bacteria. CO(2) concentration ranged from 251 to 9,710 ppm, and CO concentration was either not detected or presented a level of 1 ppm. H(2)S concentration ranged from 0.1 to 6.0 ppm. NH(3) concentration was <2 ppm in most samples. Formaldehyde was <0.01 ppm at all sampling sites. The total VOC concentration ranged from 36 to 1,724 μg/m(3). Among the VOCs, toluene presented the highest concentration. Results point to indoor/outdoor ratios higher than one. In general, the highest levels of airborne contaminants were detected at the primary treatment (SEDIPAC 3D), secondary sedimentation, and sludge dehydration. At most sampling sites, the concentrations of airborne contaminants were below the occupational exposure limits (OELs) for all the campaigns. However, a few contaminants were above OELs in some sampling sites.

  10. Water treatment plants assessment at Talkha power plant. (United States)

    El-Sebaie, Olfat D; Abd El-Kerim, Ghazy E; Ramadan, Mohamed H; Abd El-Atey, Magda M; Taha, Sahr Ahmed


    Talkha power plant is the only power plant located in El-Mansoura. It generates electricity using two different methods by steam turbine and gas turbine. Both plants drew water from River Nile (208 m3 /h). The Nile raw water passes through different treatment processes to be suitable for drinking and operational uses. At Talkha power plant, there are two purification plants used for drinking water supply (100 m3/h) and for water demineralization supply (108 m3/h). This study aimed at studying the efficiency of the water purification plants. For drinking water purification plant, the annual River Nile water characterized by slightly alkaline pH (7.4-8), high annual mean values of turbidity (10.06 NTU), Standard Plate Count (SPC) (313.3 CFU/1 ml), total coliform (2717/100 ml), fecal coliform (0-2400/100 ml), and total algae (3 x 10(4) org/I). The dominant group of algae all over the study period was green algae. The blue green algae was abundant in Summer and Autumn seasons. The pH range, and the annual mean values of turbidity, TDS, total hardness, sulfates, chlorides, nitrates, nitrites, fluoride, and residual chlorine for purified water were in compliance with Egyptian drinking water standards. All the SPC recorded values with an annual mean value of 10.13 CFU/1 ml indicated that chlorine dose and contact time were not enough to kill the bacteria. However, they were in compliance with Egyptian decree (should not exceed 50 CFU/1 ml). Although the removal efficiency of the plant for total coliform and blue green algae was high (98.5% and 99.2%, respectively), the limits of the obtained results with an annual mean values of 40/100 ml and 15.6 org/l were not in compliance with the Egyptian decree (should be free from total coliform, fecal coliform and blue green algae). For water demineralization treatment plant, the raw water was characterized by slightly alkaline pH. The annual mean values of conductivity, turbidity, and TDS were 354.6 microS/cm, 10.84 NTU, and 214

  11. Assessment of airborne virus contamination in wastewater treatment plants. (United States)

    Masclaux, Frédéric G; Hotz, Philipp; Gashi, Drita; Savova-Bianchi, Dessislava; Oppliger, Anne


    Occupational exposure to bioaerosols in wastewater treatment plants (WWTP) and its consequence on workers' health are well documented. Most studies were devoted to enumerating and identifying cultivable bacteria and fungi, as well as measuring concentrations of airborne endotoxins, as these are the main health-related factors found in WWTP. Surprisingly, very few studies have investigated the presence and concentrations of airborne virus in WWTP. However, many enteric viruses are present in wastewater and, due to their small size, they should become aerosolized. Two in particular, the norovirus and the adenovirus, are extremely widespread and are the major causes of infectious gastrointestinal diseases reported around the world. The third one, hepatitis E virus, has an emerging status. This study׳s objectives were to detect and quantify the presence and concentrations of 3 different viruses (adenovirus, norovirus and the hepatitis E virus) in air samples from 31 WWTPs by using quantitative polymerase chain reaction (qPCR) during two different seasons and two consecutive years. Adenovirus was present in 100% of summer WWTP samples and 97% of winter samples. The highest airborne concentration measured was 2.27 × 10(6) genome equivalent/m(3) and, on average, these were higher in summer than in winter. Norovirus was detected in only 3 of the 123 air samples, and the hepatitis E virus was not detected. Concentrations of potentially pathogenic viral particles in WWTP air are non-negligible and could partly explain the work-related gastrointestinal symptoms often reported in employees in this sector. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Assessment and treatment of malnutrition in Dutch geriatric practice: consensus through a modified Delphi study.

    NARCIS (Netherlands)

    Asselt, D.Z.B. van; Bokhorst-de van der Schueren, M.A. van; Cammen, T.J.M. van der; Disselhorst, L.G.; Janse, A.; Lonterman-Monasch, S.; Maas, H.A.; Popescu, M.E.; Schölzel-Dorenbos, C.J.M.; Sipers, W.M.; Veldhoven, C.M. van; Wijnen, H.H.M; Olde Rikkert, M.


    OBJECTIVE: scientific evidence regarding the optimal management of malnutrition in geriatric patients is scarce. Our aim was to develop a consensus statement for geriatric hospital practice concerning six elements: (i) definition of malnutrition, (ii) screening and assessment, (iii) treatment and

  13. The assessment of port wine stains in children following multiple pulsed-dye laser treatments. (United States)

    Naran, Sanjay; Gilmore, John; Deleyiannis, Frederic W-B


    The purpose of this study was to compare 3 methods of assessment of pediatric port wine stains (PWSs) following multiple pulsed-dye laser (PDL) treatments; (i) parental evaluation, (ii) objective evaluation utilizing L*a*b* color measurement, and (iii) the visual inspection of serial photographs by blinded observers. Twenty-one children who had received at least 4 prior PDL treatments were prospectively enrolled. Following additional PDL treatment, 72.5% of the parental responses indicated a lighter PWS; 85% said that they would continue with further treatment. According to the assessments by 3 observers, only 33.3% to 61.9% (correlation coefficients: 0.41 and 0.54; P L*a*b* measurements were not significantly correlated with the observers' perceptions. L*a*b* assessment is not a clinically useful method to evaluate PDL response in the PWS previously treated. Relying solely on parental assessment may lead to overtreatment without a demonstrable benefit.

  14. Recent advances in the assessment and treatment of falls in Parkinson's disease

    NARCIS (Netherlands)

    Snijders, A.H.; Nonnekes, J.; Bloem, B.R.


    Falls are among the most incapacitating features of Parkinson's disease. Prevention of falls requires a systematic assessment of all contributing factors (with emphasis on freezing of gait and frontal executive dysfunction), and a multidisciplinary treatment approach tailored to the specific

  15. Assessment and selection of the best treatment alternative for infectious waste by modified Sustainability Assessment of Technologies methodology. (United States)

    Rafiee, Ata; Yaghmaeian, Kamyar; Hoseini, Mohammad; Parmy, Saeid; Mahvi, Amirhosein; Yunesian, Masud; Khaefi, Mehran; Nabizadeh, Ramin


    Improper treatment of infectious waste can cause numerous adverse environmental and health effects such as transmission of diseases through health personnel and other susceptible groups,who come in contact with such wastes. On the other hand, selection of appropriate treatment alternatives in infectious waste management has become a challenging task for public health authorities especially in developing countries. The objective of this paper is to select the best infectious waste treatment alternative by the modified Sustainability Assessment of Technologies (SAT) methodology, developed by the International Environmental Technology Center of the United Nations Environment Program (IETC-UNEP). SAT methodology consists of three main components, including screening, scoping and detailed assessment. In screening, different infectious waste treatment alternatives undergo screening using the finalized environmental and technical criteria. Short-listed treatment options from the previous step, then go through the comprehensive scoping and detailed assessment (2nd and 3rd components) which is more qualitative and quantitative in nature. An empirical case in Tehran, the largest city in Iran, is provided to illustrate the potential of the proposed methodology. According to the final score, "Hydroclave", was the most suitable infectious treatment technology. The ranking order of the treatment alternatives were "Autoclave with a shredder", "Autoclave", "Central Incineration" and "chemical treatment" on the basis of technical, economical, social and environmental aspects and their related criteria. According to the results it could be concluded that the top ranking technologies basically have higher scores in all the aspects. Hence it is easier to arrive at a decision for the final technology selection based on the principles of sustainability.

  16. Multidimensional assessment of perceived treatment-entry pressures among substance abusers. (United States)

    Marlowe, D B; Merikle, E P; Kirby, K C; Festinger, D S; McLellan, A T


    Motivational assessment instruments typically measure clients' attributions about their readiness to change problem behaviors. They do not indicate why a client may be motivated to change, or provide guidance on how to retain an unmotivated client in treatment. The authors interviewed 415 substance abuse clients about their reasons for entering treatment and scored their responses along the dimensions of (a) negative versus positive treatment-entry pressures, (b) internal versus external sources of those pressures, and (c) the life domain from which the pressures emanated. Exploratory cluster analysis yielded 5 types of clients characterized by different profiles of perceived treatment-entry pressures. Cluster membership was predictive of treatment outcomes, and the clusters differed by demographic variables. These data support the discriminative and predictive utility of performing a multidimensional assessment of pressures to enter treatment.

  17. Tools to aid post-wildfire assessment and erosion-mitigation treatment decisions (United States)

    Peter R. Robichaud; Louise E. Ashmun


    A considerable investment in post-fire research over the past decade has improved our understanding of wildfire effects on soil, hydrology, erosion and erosion-mitigation treatment effectiveness. Using this new knowledge, we have developed several tools to assist land managers with post-wildfire assessment and treatment decisions, such as prediction models, research...

  18. Practice Parameter for the Assessment and Treatment of Children and Adolescents with Obsessive-Compulsive Disorder (United States)

    Journal of the American Academy of Child & Adolescent Psychiatry, 2012


    Research in etiology, neurobiology, genetics, clinical correlates, and evidence-based treatments in children and adolescents with obsessive-compulsive disorder indicate a need for the revision of the Practice Parameters for the Assessment and Treatment of Children and Adolescents with Obsessive-Compulsive Disorder first published a decade ago. The…

  19. Recent Developments in the Assessment and Treatment of Pediatric Obsessive-Compulsive Disorder (United States)

    Berman, Noah C.; Abramowitz, Jonathan S.


    Although tremendous strides have recently been made in the development of assessment and treatment methods for pediatric obsessive-compulsive disorder (OCD), more accurate methods for diagnosis, more effective treatments, and more refined instruments for monitoring progress during therapy are still needed. The present commentary highlights the…

  20. A Framework for Assessment and Treatment of Language-Learning Disabled Children with Psychiatric Disorders. (United States)

    Audet, Lisa R.; Hummel, Lauren J.


    The paper defines the population of primary school age language/learning-disabled children with communication disorders and emotional/behavioral disorders. It then discusses the language demands of traditional treatment methods, assessment and diagnostic procedures, approaches to communication intervention, and treatment modalities; and offers a…

  1. Randomized controlled trial assessing a traditional Chinese medicine remedy in the treatment of primary dysmenorrhea

    NARCIS (Netherlands)

    Kennedy, S.; Jin, X.; Yu, H.; Zhong, S.; Magill, P.; Vliet, T. van; Kistemaker, C.; Voors, C.; Pasman, W.


    A proof-of-concept study to assess the safety and efficacy of a traditional Chinese medicine formula as treatment for primary dysmenorrhea showed no statistically significant benefit over placebo. However, some efficacy parameters suggested possible superiority of the active treatment and so a

  2. Epidemiology of Malocclusion and Assessment of Orthodontic Treatment Need for Nepalese Children


    Singh, Varun Pratap; Sharma, Amita


    Objective. To evaluate the prevalence of malocclusion and orthodontic treatment needs among 12- to 15-year-old schoolchildren in eastern Nepal and compare the findings with those of other populations. Methods. Two thousand seventy-four children (1149 males and 925 females) aged between 12 and 15 years were evaluated. Their orthodontic treatment need was assessed using the Index of Orthodontic Treatment Needs (IOTN) (dental health component (DHC)). Angle’s classes of malocclusion were also eva...

  3. Assessment and Treatment of Obsessive-Compulsive Disorder in College Age Students and Adults. (United States)

    Spengler, Paul M.; Jacobi, David M.


    The potential for clinical-judgment errors in assessing obsessive-compulsive disorder (OCD) makes this a good example for illustrating methods of debiasing and hypothesis testing. This article provides information about this frequently misdiagnosed disorder, delineates methods for assessment and treatment of OCD, and discusses implications of…

  4. Cross-Cultural Adaptations of the MacArthur Competence Assessment Tool for Treatment in Iran


    Saber; Tabatabaei; Akasheh; Sehat; Zanjani; Larijani


    Background According to general ethical and legal principles, valid consent must be obtained before starting any procedure. Objectives Due to the lack of a standard tool for assessing patients’ capacity to consent to medical treatment in Iran, the present study was carried out aiming to devise a Persian version of a cross-cultural adaptation of the MacArthur competence assessment tool. Patients...

  5. Moving from Assessment to Treatment of School Refusal Behavior in Youth (United States)

    Kearney, Christopher A.; Chapman, Gillian; Cook, L. Caitlin


    School refusal behavior is a difficult problem faced by many parents, educators, and mental health professionals. A functional model to guide classification, assessment, and treatment of this population has evolved in recent years. In this article, step-by-step recommendations are made for synthesizing assessment information from a particular case…

  6. Resource utilization implications of treatment were able to be assessed from appropriately reported clinical trial data

    NARCIS (Netherlands)

    Poole-Wilson, Philip A.; Kirwan, Bridget-Anne; Voko, Zoltan; de Brouwer, Sophie; Dunselman, Peter H. J. M.; van Dalen, Frederik J.; Lubsen, Jacobus

    Background and Objective: Published clinical trial data rarely allow assessment of the health care resource utilization implications of treatment. We give an example of how these can be assessed given appropriate tabulation of data. Methods: Data from a trial comparing long-acting nifedipine

  7. Predictive validity of the Structured Assessment of Violence Risk in Youth (SAVRY) during residential treatment

    NARCIS (Netherlands)

    Lodewijks, H.P.B.; Doreleijers, T.A.H.; de Ruiter, C.; Borum, R.


    This prospective study examines the predictive validity of the Dutch version of the Structured Assessment of Violence Risk in Youth (SAVRY) by examining relationships between SAVRY scores and various types of disruptive behavior during residential treatment. The SAVRY, a risk assessment instrument,

  8. Attachment based treatments for adolescents: the secure cycle as a framework for assessment, treatment and evaluation. (United States)

    Kobak, Roger; Zajac, Kristyn; Herres, Joanna; Krauthamer Ewing, E Stephanie


    The emergence of attachment-based treatments (ABTs) for adolescents highlights the need to more clearly define and evaluate these treatments in the context of other attachment based treatments for young children and adults. We propose a general framework for defining and evaluating ABTs that describes the cyclical processes that are required to maintain a secure attachment bond. This secure cycle incorporates three components: (1) the child or adult's IWM of the caregiver; (2) emotionally attuned communication; and (3) the caregiver's IWM of the child or adult. We briefly review Bowlby, Ainsworth, and Main's contributions to defining the components of the secure cycle and discuss how this framework can be adapted for understanding the process of change in ABTs. For clinicians working with adolescents, our model can be used to identify how deviations from the secure cycle (attachment injuries, empathic failures and mistuned communication) contribute to family distress and psychopathology. The secure cycle also provides a way of describing the ABT elements that have been used to revise IWMs or improve emotionally attuned communication. For researchers, our model provides a guide for conceptualizing and measuring change in attachment constructs and how change in one component of the interpersonal cycle should generalize to other components.

  9. Conversion Disorder, Functional Neurological Symptom Disorder, and Chronic Pain: Comorbidity, Assessment, and Treatment. (United States)

    Tsui, Patricia; Deptula, Andrew; Yuan, Derek Y


    This paper examines the overlap of conversion disorder with chronic pain conditions, describes ways to assess for conversion disorder, and provides an overview of evidence-based treatments for conversion disorder and chronic pain, with a focus on conversion symptoms. Conversion disorder is a significant problem that warrants further study, given that there are not many well-established guidelines. Accurate and timely assessment should help move treatment in a more fruitful direction and avoid unnecessary medical interventions. Advances in neuroimaging may also help further our understanding of conversion disorder. Creating a supportive environment and a collaborative treatment relationship and improving understanding of conversion symptoms appear to help individuals diagnosed with conversion disorder engage in appropriate treatments. Novel uses of earlier treatments, such as hypnosis and psychodynamic approaches, could potentially be beneficial and require a more vigorous and systematic study. There are treatments that produce significant improvements in functioning and reduction of physical symptoms from conversion disorder even for very severe cases. Hypnotherapy, cognitive behavioral therapy, and inpatient multidisciplinary treatment with intensive physiotherapy for severe cases have the most evidence to support reduction of symptoms. Components of treatment for conversion disorder overlap with treatments for chronic pain and can be used together to produce therapeutic effects for both conditions. Treatment needs to be tailored for each individual's specific symptoms.

  10. Life cycle assessment of a wastewater treatment plant focused on material and energy flows. (United States)

    Wu, Jian-Guang; Meng, Xiang-Yu; Liu, Xiao-Meng; Liu, Xian-Wei; Zheng, Zhi-Xia; Xu, De-Qian; Sheng, Guo-Ping; Yu, Han-Qing


    Life cycle assessment (LCA) was applied to analyze a food-processing wastewater treatment plant and investigate the economic and environmental effects of the plant. With the long-term operational data of this plant, an inventory of relative inputs, e.g., flow rate, chemical oxygen demand (COD), and suspended solids, etc., and outputs of the plant, e.g., effluent COD and suspended solids, methane production, etc., was compiled. The potential environmental effects associated with those inputs and outputs were evaluated, and the results of the inventory analysis and impact assessment phases of the plant were interpreted. One feature of this study was the assessment of the treatment plant based on both energy and material flows. Another feature was the establishment of an assessment model with an integration of plant operating parameters, system recognition and grey relation. The analytical results are helpful for the design and operation of wastewater treatment plants.

  11. Comparative life cycle assessment of wastewater treatment in Denmark including sensitivity and uncertainty analysis

    DEFF Research Database (Denmark)

    Niero, Monia; Pizzol, Massimo; Gundorph Bruun, Henrik


    Wastewater treatment has nowadays multiple functions and produces both clean effluents and sludge, which is increasingly seen as a resource rather than a waste product. Technological as well as management choices influence the performance of wastewater treatment plants (WWTPs) on the multiple...... functions. In this context, Life Cycle Assessment (LCA) can determine what choices provide the best environmental performance. However, the assessment is not straightforward due to the intrinsic space and time-related variability of the wastewater treatment process. These challenges were addressed...... in a comparative LCA of four types of WWTPs, representative of mainstream treatment options in Denmark. The four plant types differ regarding size and treatment technology: aerobic versus anaerobic, chemical vs. combined chemical and biological. Trade-offs in their environmental performance were identified...

  12. Blueprints for the assessment, treatment, and future study of catatonia in autism spectrum disorders. (United States)

    Dhossche, Dirk Marcel; Shah, Amitta; Wing, Lorna


    The blueprints for the assessment, treatment, and future study of catatonia in autism spectrum disorders (ASDs), which are submitted in this chapter aim to increase early recognition and treatment of catatonia in ASDs, show the urgency of controlled treatment trials, and increase collaborative and interdisciplinary research into the co-occurrence of these two enigmatic disorders. Catatonia should be assessed in any patient with ASDs when there is an obvious and marked deterioration in movement, pattern of activities, self-care, and practical skills, compared with previous levels, through a comprehensive diagnostic evaluation of medical and psychiatric symptoms. A formal diagnosis should be ascertained using ASD specific criteria for catatonia that takes into account baseline symptoms like muteness, echophenomena, stereotypy, negativism, or other psychomotor abnormalities. Any underlying medical and neurological conditions should be treated, and culprit medications or other substances that may cause catatonia should be eliminated. Separate treatment blueprints are presented for mild, moderate, and severe catatonia, featuring combinations of a psychological approach developed by Shah and Wing and medical treatments that have shown efficacy in catatonia: lorazepam challenge, lorazepam trial, lorazepam continuation, and bilateral electroconvulsive therapy (ECT). These treatment modalities in themselves are well established. Side effects and complications are known and manageable. Legal, ethical, and practice guidelines governing all treatment aspects should be followed. The treatment blueprints should be viewed as best estimates pending future controlled studies. The blueprint for the future study of catatonia in ASDs describes promising clinical and preclinical research avenues. Longitudinal studies need to assess the possible effect of early recognition and adequate treatment of catatonia in ASDs in order to avoid the impairment associated with chronicity. Effects of

  13. [Opinions and attitudes of clinical staff on systems for the assessment and treatment of children's pain]. (United States)

    Ullan, A M; Fernández, E; Badia, M; Lorente, F; Malmierca, F; Zapatero, I


    Many factors affect the assessment and treatment of pain, among them being the knowledge and attitudes of clinical staff. The goal of this work was to determine the opinions and attitudes of clinical staff from two hospitals on the different aspects of the assessment and treatment of children's pain. A cross-sectional, descriptive study was conducted using a self-administered questionnaire issued to clinical staff. The questionnaire was given to the professionals, doctors, and nursing staff of the paediatric services of two hospitals, and to an incidental sample of paediatric doctors. Of the 146 questionnaires sent out, 105 were completed. Participants indicated that standardised scales and physiological recordings were the least frequently used methods to assess children's pain. Participants considered that pharmacological techniques for the treatment of pain were used more frequently than non-pharmacological techniques, at all ages. Participants acknowledged being significantly more knowledgeable about pharmacological methods to relieve paediatric pain than about non-pharmacological methods. There is margin for improvement in systems for the assessment and treatment of children's pain as regards the more frequent and standardised use of techniques and standardised tools for the assessment of pain, and the greater administration of non-pharmacological strategies for its treatment. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  14. The Effect of A Geriatric Assessment on Treatment Decisions for Patients with Lung Cancer. (United States)

    Schulkes, Karlijn J G; Souwer, Esteban T D; Hamaker, Marije E; Codrington, Henk; van der Sar-van der Brugge, Simone; Lammers, Jan-Willem J; Portielje, Johanneke E A; van Elden, Leontine J R; van den Bos, Frederiek


    Decision-making for older patients with lung cancer can be complex and challenging. A geriatric assessment (GA) may be helpful and is increasingly being used since 2005 when SIOG advised to incorporate this in standard work-up for the elderly with cancer. Our aim was to evaluate the value of a geriatric assessment in decision-making for patients with lung cancer. Between January 2014 and April 2016, data on patients with lung cancer from two teaching hospitals in the Netherlands were entered in a prospective database. Outcome of geriatric assessment, non-oncologic interventions, and suggested adaptations of oncologic treatment proposals were evaluated. 83 patients (median age 79 years) were analyzed with a geriatric assessment, of which 59% were treated with a curative intent. Half of the patients were classified as ECOG PS 0 or 1. The majority of the patients (78%) suffered from geriatric impairments and 43% (n = 35) of the patients suffered from three or more geriatric impairments (out of eight analyzed domains). Nutritional status was most frequently impaired (52%). Previously undiagnosed impairments were identified in 58% of the patients, and non-oncologic interventions were advised for 43%. For 33% of patients, adaptations of the oncologic treatment were proposed. Patients with higher number of geriatric impairments more often were advised a reduced or less intensive treatment (p geriatric assessment uncovers previously unknown health impairments and provides important guidance for tailored treatment decisions in patients with lung cancer. More research on GA-stratified treatment decisions is needed.

  15. Assessment and Treatment of Pain in Adult Intensive Care Unit Patients

    Directory of Open Access Journals (Sweden)

    Jun Mo Park


    Because pain is quite subjective, the accurate assessment of pain is very difficult in the patients with impaired communication ability. The current most valid and reliable behavioral pain scales used to assess pain in adult ICU patients are the Behavioral Pain Scale and the Critical-Care Pain Observation Tool. Once pain has been accurately assessed using these methods, various pharmacologic and non-pharmacologic therapies should be performed by the multidisciplinary care team. Accurate assessment and proper treatment of pain in adult ICU patients will improve patients outcome, which reduces the stress response and decreases the risk of post-traumatic stress disorder.

  16. Assessing the energy and environmental performance of algae-mediated tertiary treatment of estrogenic compounds. (United States)

    Colosi, Lisa M; Resurreccion, Eleazer P; Zhang, Yongli


    This study uses a systems-level modeling approach to illustrate a novel synergy between municipal wastewater treatment and large-scale algaculture for production of bio-energy, whereby algae-mediated tertiary treatment provides efficient removal of unregulated, strongly estrogenic steroid hormones from the secondary effluent. Laboratory results from previously published studies suggested that algae-mediated treatment could deliver roughly 75-85% removal of a model estrogen (17β-estradiol) within typical algae pond residence times. As such, experimental results are integrated into a comprehensive life cycle assessment (LCA) framework, to assess the environmental performance of an algae-based tertiary treatment system relative to three conventional tertiary treatments: ozonation, UV irradiation, and adsorption onto granular activated carbon. Results indicate that the algae-mediated tertiary treatment is superior to the selected benchmarks on the basis of raw energy return on investment (EROI) and normalized energy use per mass of estrogenic toxicity removed. It is the only tertiary treatment system that creates more energy than it consumes, and it delivers acceptable effluent quality for nutrient and coliform concentrations while rendering a significant reduction in estrogenic toxicity. These results highlight the dual water and energy sustainability benefits that accrue from the integration of municipal wastewater treatment and large-scale algae farming.

  17. Analytic approaches for assessing long-term treatment effects. Examples of empirical applications and findings. (United States)

    Hser, Y I; Shen, H; Chou, C P; Messer, S C; Anglin, M D


    Analytic approaches, including the structural equation model (autoregressive panel model), hierarchical linear model, latent growth curve model, survival/event history analysis, latent transition model, and time-series analysis (interrupted time series, multivariate time-series analysis) are discussed for their applicability to data of different structures and their utility in evaluating temporal effects of treatment. Methods are illustrated by presenting applications of the various approaches in previous studies examining temporal patterns of treatment effects. Recent advancements in these longitudinal modeling approaches and the accompanying computer software development offer tremendous flexibility in examining long-term treatment effects through longitudinal data with varying numbers and intervals of assessment and types of measures. A multimethod assessment will contribute to a more complete understanding of the complex phenomena of the long-term courses of substance use and its treatment.

  18. Initial assessment and early treatment options for anorexia nervosa and bulimia nervosa. (United States)

    Powers, P S


    This article presents the essential aspects of assessment of patients with anorexia nervosa or bulimia nervosa. The evaluation of the athlete with a suspected eating disorder is described. The choice of appropriate type and site of treatment is discussed. Throughout the article there is an emphasis on methods that can be useful in assisting the patient to acknowledge his or her illness and participate in treatment. The need to focus simultaneously on psychological and relationship issues and nutritional status is stressed.

  19. Performance assessment framework for groundwater treatment plants in Arid Environments: a case of Buraydah, Saudi Arabia. (United States)

    Haider, Husnain


    In arid environmental regions, such as the Kingdom of Saudi Arabia (KSA), each and every drop of groundwater needs to be efficiently utilized to meet growing water demands. Ground water treatment plants (WTPs) are regularly being monitored by the municipalities to ensure safe water supply. However, analyzing large data to assess the performance of a WTP has always been a daunting task for plant's management. Most of existing performance assessment frameworks were developed for surface WTPs. In this research, an assessment framework using performance-based water quality indices (P WQI ) is developed to facilitate senior management of ground WTPs for effective decision-making. The framework is also implemented on a case study of Buraydah, Qassim, Saudi Arabia. Five most important water quality parameters (WQPs) have been selected to assess the performance of different components of the WTP, including raw water, pre-treatment, ultrafiltration, sand filtration, reverse osmosis, and final product. Depending on the relative importance of WQPs for a specific treatment process, different weighting schemes have been developed for each treatment process using fuzzy analytical hierarchical process (FAHP) to address the possible uncertainties in data and imprecision in expert opinion. Subsequently, fuzzy weighted sum method (FWSM) is employed to develop aggregated P WQI for assessing average monthly performance during the year 2016. Study results show that all the units consistently performed "high," and the plant is meeting drinking water quality standards throughout the year. Hypothetical scenario analysis revealed robustness of the developed framework by showing lacking performance in case failure of different units.

  20. Dual energy CT - a possible new method to assess regression of rectal cancers after neoadjuvant treatment. (United States)

    Al-Najami, Issam; Drue, Henrik C; Steele, Robert; Baatrup, Gunnar


    The measurement of tumor regression after neoadjuvant oncological treatment has gained increasing interest because it has a prognostic value and because it may influence the method of treatment in rectal cancer. The assessment of tumor regression remains difficult and inaccurate with existing methods. Dual Energy Computed Tomography (DECT) enables qualitative tissue differentiation by simultaneous scanning with different levels of energy. We aimed to assess the feasibility of DECT in quantifying tumor response to neoadjuvant therapy in loco-advanced rectal cancer. We enrolled 11 patients with histological and MRI verified loco-advanced rectal adenocarcinoma and followed up on them prospectively. All patients had one DECT scanning before neoadjuvant treatment and one 12 weeks after using the spectral imaging scan mode. DECT analyzing tools were used to determine the average quantitative parameters; effective-Z, water- and iodine-concentration, Dual Energy Index (DEI), and Dual Energy Ratio (DER). These parameters were compared to the regression in the resection specimen as measured by the pathologist. Changes in the quantitative parameters differed significantly after treatment in comparison with pre-treatment, and the results were different in patients with different CRT response rates. DECT might be helpful in the assessment of rectal cancer regression grade after neoadjuvant treatment. © 2017 Wiley Periodicals, Inc.

  1. The Reflux Disease Questionnaire: a measure for assessment of treatment response in clinical trials

    Directory of Open Access Journals (Sweden)

    Junghard Ola


    Full Text Available Abstract Background Critical needs for treatment trials in gastroesophageal reflux disease (GERD include assessing response to treatment, evaluating symptom severity, and translation of symptom questionnaires into multiple languages. We evaluated the previously validated Reflux Disease Questionnaire (RDQ for internal consistency, reliability, responsiveness to change during treatment and the concordance between RDQ and specialty physician assessment of symptom severity, after translation into Swedish and Norwegian. Methods Performance of the RDQ after translation into Swedish and Norwegian was evaluated in 439 patients with presumed GERD in a randomized, double-blind trial of active treatment with a proton pump inhibitor. Results The responsiveness was excellent across three RDQ indicators. Mean change scores in patients on active treatment were large, also reflected in effect sizes that ranged from a low of 1.05 (dyspepsia to a high of 2.05 (heartburn and standardized response means 0.99 (dyspepsia and 1.52 (heartburn. A good positive correlation between physician severity ratings and RDQ scale scores was seen. The internal consistency reliability using alpha coefficients of the scales, regardless of language, ranged from 0.67 to 0.89. Conclusion The results provide strong evidence that the RDQ is amenable to translation and represents a viable instrument for assessing response to treatment, and symptom severity.

  2. A case study of behavioral assessment and treatment of insect phobia.


    Jones, K. M.; Friman, P C


    We assessed the academic performance of a 14-year-old boy with insect phobia in the context of feared stimuli. The dependent measure was math calculation rate across three conditions that varied therapist statements about the presence of crickets and the actual presence of live crickets. Subsequent treatment consisted of graduated exposure and contingent rewards for math problem completion. Assessment results indicated that the boy's performance was consistently low in the presence of live cr...

  3. Assessment of oral health status and treatment needs of Santhal tribes of Dhanbad District, Jharkhand


    Kumar, Gunjan; Tripathi, Ranjan Mani; Dileep, C. L.; Trehan, Megha; Malhotra, Shitanshu; Singh, Pallavi


    Aims and Objectives: India has an assortment of tribal population living in isolated pockets, and the Santhals are numerically predominant in Jharkhand. This study was aimed at assessing the oral health status and treatment needs of Santhals residing in Dhanbad, Jharkhand. Materials and Methods: A cross-sectional survey of 921 Santhals of Topchanchi Block was conducted. A modified World Health Organization (WHO) Oral Health Assessment Form (1997) was utilized and examined according to the WHO...

  4. Efficacy assessment of local doxycycline treatment in periodontal patients using multivariate chemometric approach. (United States)

    Bogdanovska, Liljana; Poceva Panovska, Ana; Nakov, Natalija; Zafirova, Marija; Popovska, Mirjana; Dimitrovska, Aneta; Petkovska, Rumenka


    The aim of our study was application of chemometric algorithms for multivariate data analysis in efficacy assessment of the local periodontal treatment with doxycycline (DOX). Treatment efficacy was evaluated by monitoring inflammatory biomarkers in gingival crevicular fluid (GCF) samples and clinical indices before and after the local treatment as well as by determination of DOX concentration in GCF after the local treatment. The experimental values from these determinations were submitted to several chemometric algorithms: principal component analysis (PCA), partial least square discriminant analysis (PLS-DA) and orthogonal projection to latent structures-discriminant analysis (OPLS-DA). The data structure and the mutual relations of the selected variables were thoroughly investigated by PCA. The PLS-DA model identified variables responsible for discrimination of classes of data, before and after DOX treatment. The OPLS-DA model compared the efficacy of the two commonly used medications in periodontal treatment, chlorhexidine (CHX) and DOX, at the same time providing insight in their mechanism of action. The obtained results indicate that application of multivariate chemometric algorithms can be used as a valuable approach for assessment of treatment efficacy. Copyright © 2016 Elsevier B.V. All rights reserved.

  5. Life cycle assessment case study: Tertiary treatment process options for wastewater reuse. (United States)

    Carré, Erwan; Beigbeder, Joana; Jauzein, Vincent; Junqua, Guillaume; Lopez-Ferber, Miguel


    Tertiary treatment process (including filtration and/or disinfection) is necessary to obtain a water quality suited for high-quality reuse from wastewater treatment. Industrial pilots representing small real-size treatment units were set up downstream of a conventional secondary treatment of a wastewater treatment plant in the South of France and their performance followed for 2 y. Life cycle assessment (LCA) methodology is used to compare the environmental impacts of different treatment processes. Five tertiary treatment trains were studied: 1) sand filtration (SF) + storage followed by ultraviolet (UV) dynamic reactor disinfection (SF-UVD), 2) sand filtration + UV batch reactor disinfection (SF-UVB), 3) ultrafiltration (UF), 4) ultrafiltration and UV batch reactor disinfection (UF-UVB), and 5) microfiltration (MF) and storage followed by dynamic UV disinfection (MF-UVD). The chosen functional unit is "To supply 1 m3 of water with a quality in compliance with the highest standard of the French reuse regulations." The combination of SF with UV disinfection or the use of UF alone was found to be equivalent in terms of environmental impact for most of the midpoint indicators chosen. Combination of UF with UV disinfection was significantly more impacting because the electricity consumption was nearly doubled. This study was conducted on an industrial pilot; it may thus be representative of industrial facilities implemented to treat higher water flows. Integr Environ Assess Manag 2017;13:1113-1121. © 2017 SETAC. © 2017 SETAC.

  6. [Treatment with sodium alginate of gastroesophageal reflux disease in childhood: efficacy and tolerance assessment]. (United States)

    Maestri, L


    Evaluation of efficacy of sodium alginate (Gaviscon) in the treatment of gastroesophageal reflux disease in children 3-12 months old, assessed by 24 hours esophageal continuous pH monitoring. 28 children studied by 24 hours pH esophageal continuous monitoring before starting the treatment with Gaviscon 0.5 ml/Kg/dose four times a day, 20 minutes after meal. After 2 months of treatment, a second pH esophageal monitoring was performed, during therapy. Total number of refluxes, number of refluxes longer than 5 minutes and reflux index before and during treatment were evaluated, by multiple regression method. All pHmetric parameters showed a statistically significative improvement after 60 days of treatment.

  7. Assessing physicians' use of treatment algorithms: Project IMPACTS study design and rationale. (United States)

    Trivedi, Madhukar H; Claassen, Cynthia A; Grannemann, Bruce D; Kashner, T Michael; Carmody, Thomas J; Daly, Ella; Kern, Janet K


    Effective treatments for major depressive disorder have been available for 35 years, yet inadequate pharmacotherapy continues to be widespread leading to suboptimal outcomes. Evidence-based medication algorithms have the potential to bring much-needed improvement in effectiveness of antidepressant treatment in "real-world" clinical settings. Project IMPACTS (Implementation of Algorithms using Computerized Treatment Systems) addresses the critical question of how best to facilitate integration of depression treatment algorithms into routine care. It tests an algorithm implemented through a computerized decision support system using a measurement-based care approach for depression against a paper-and-pencil version of the same algorithm and non-algorithm-based, specialist-delivered usual care. This paper reviews issues related to the Project IMPACTS study rationale, design, and procedures. Patient outcomes include symptom severity, social and work function, and quality of life. The economic impact of treatment is assessed in terms of health care utilization and cost. Data collected on physician behavior include degree of adherence to guidelines and physician attitudes about the perceived utility, ease of use, and self-reported effect of the use of algorithms on workload. Novel features of the design include a two-tiered study enrollment procedure, which initially enroll physicians as subjects, and then following recruitment of physicians, enrollment of subjects takes place based initially on an independent assessment by study staff to determine study eligibility. The study utilizes brief, easy-to-use symptom severity measures that facilitate physician decision making, and it employs a validated, phone-based, follow-up assessment protocol in order to minimize missing data, a problem common in public sector and longitudinal mental health studies. IMPACTS will assess the success of algorithm implementation and subsequent physician adherence using study

  8. Issues and challenges in the assessment, diagnosis and treatment of cardiovascular risk factors: Assessing the needs of cardiologists

    Directory of Open Access Journals (Sweden)

    Dupuis Martin


    Full Text Available Abstract Background This needs assessment, initiated by the Academy for Healthcare Education Inc. in cooperation with AXDEV Group Inc., explored the knowledge, attitudes, behavior, and skills of community-based and academic-affiliated U.S. cardiologists in the area of CV risk assessment, treatment, and management from July 2006 to December 2006. Methods The needs assessment used a multistage, mixed-method approach to collect, analyze, and verify data from two independent sources. The exploratory phase collected data from a representative sampling of U.S. cardiologists by means of qualitative panel meetings, one-on-one interviews, and quantitative questionnaires. In the validation phase, 150 cardiologists from across the United States completed a quantitative online questionnaire. Data were analyzed with standardized statistical methods. Results The needs assessment found that cardiologists have areas of weakness pertaining to their interpersonal skills, which may influence patient-physician communication and patient adherence. Cardiologists appeared to have little familiarity with or lend little credence to the concept of relative CV risk. In daily clinical practice, they faced challenges with regard to optimal patient outcome in areas of patient referral from primary-care providers, CV risk assessment and treatment, and patient monitoring. Community-based and academic-affiliated cardiologists appeared to be only moderately interested in educational interventions that pertain to CV risk-reduction strategies. Conclusion Educational interventions that target cardiologists' interpersonal skills to enhance their efficacy may benefit community-based and academic-affiliated specialists. Other desirable educational initiatives should address gaps in the patient referral process, improve patient knowledge and understanding of their disease, and provide supportive educational tools and materials to enhance patient-physician communication.

  9. Assessment and Management of Treatment-Refractory Obsessive-Compulsive Disorder in Children (United States)

    Bloch, Michael H.; Storch, Eric A.


    OBJECTIVE To review the assessment and treatment of treatment-refractory pediatric obsessive-compulsive disorder (OCD). METHOD A PubMed search was conducted to identify controlled trials in pediatric OCD. Additionally, practice guidelines for the treatment of adults and children were further reviewed for references in treatment-refractory OCD across the lifespan. RESULTS Pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy are effective treatments for pediatric OCD. Evidence suggests that CBT is additionally effective even in pediatric patients with refractory OCD symptoms. Antipsychotic augmentation, raising SSRI dosage, and several glutamate-modulating agents have some evidence of efficacy in adults with treatment-refractory OCD but have not been studied in pediatric populations. CONCLUSION Several pharmacological treatment options exist for children with refractory OCD symptoms. However, little evidence-based data exist to guide treatment for our most challenging pediatric OCD patients. Further research is needed to evaluate the efficacy/side-effect profile of commonly used interventions in treatment-refractory pediatric OCD. PMID:25791142

  10. How Do Psychiatrists Apply the Minimum Clinically Important Difference to Assess Patient Responses to Treatment?

    Directory of Open Access Journals (Sweden)

    Alan J. McMichael BSc


    Full Text Available Symptom report scales are used in clinical practice to monitor patient outcomes. Using them permits the definition of a minimum clinically important difference (MCID beyond which a patient may be judged as having responded to treatment. Despite recommendations that clinicians routinely use MCIDs in clinical practice, statisticians disagree about how MCIDs should be used to evaluate individual patient outcomes and responses to treatment. To address this issue, we asked how clinicians actually use MCIDs to evaluate patient outcomes in response to treatment. Sixty-eight psychiatrists made judgments about whether hypothetical patients had responded to treatment based on their pre- and posttreatment change scores on the widely used Positive and Negative Syndrome Scale. Psychiatrists were provided with the scale’s MCID on which to base their judgments. Our secondary objective was to assess whether knowledge of the patient’s genotype influenced psychiatrists’ responder judgments. Thus, psychiatrists were also informed of whether patients possessed a genotype indicating hyperresponsiveness to treatment. While many psychiatrists appropriately used the MCID, others accepted a far lower posttreatment change as indicative of a response to treatment. When psychiatrists accepted a lower posttreatment change than the MCID, they were less confident in such judgments compared to when a patient’s posttreatment change exceeded the scale’s MCID. Psychiatrists were also less likely to identify patients as responders to treatment if they possessed a hyperresponsiveness genotype. Clinicians should recognize that when judging patient responses to treatment, they often tolerate lower response thresholds than warranted. At least some conflate their judgments with information, such as the patient’s genotype, that is irrelevant to a post hoc response-to-treatment assessment. Consequently, clinicians may be at risk of persisting with treatments that have failed

  11. Acute myeloblastic leukaemia--a model for assessing value for money for new treatment programmes. (United States)

    Lobo, P J; Powles, R L; Hanrahan, A; Reynold, D K


    OBJECTIVE--To measure the effects of changes in treatment of acute myeloblastic leukaemia that may give better value for money. DESIGN--Retrospective analysis of patients' notes to identify items of management costing money; prospective costing of these items. The Medical Research Council acute myeloblastic leukaemia 9 trial was used to identify the amount and distribution of these costs when either one or two courses of induction treatment were required to obtain complete remission. These findings were then extrapolated to four published international controlled trials using similarly intense treatment and in which the number of courses of treatment required for complete remission was stated, to compare British costs for treatment with idarubicin and daunorubicin, both in combination with cytarabine. SETTING--Leukaemia unit, Royal Marsden Hospital, London. SUBJECTS--Data on 10 patients receiving intensive induction treatment for acute myeloblastic leukaemia were used to identify 160 items of cost in four broad groups: general (including accommodation), diagnostic, supportive treatment, and cytotoxic chemotherapy. One newly treated patient was prospectively assessed over one month, including a time and motion study, to cost these items; then costs for 268 patients from the MRC trial receiving moderate induction chemotherapy including daunorubicin were assessed, and costs for treatment of 522 patients in the four international studies comparing daunorubicin with idarubicin were analysed. MAIN OUTCOME MEASURES--Cost effectiveness was measured as the overall cost to obtain complete remission in untreated patients with acute myeloblastic leukaemia after treatment with idarubicin or daunorubicin. RESULTS--The 160 costed items were measured for their sensitivity in varying the total cost of treatment, this being assessed within Britain in other district general and private hospitals to measure the extremes of cost of these items. Overall, idarubicin, although more

  12. Effect of treatment willingness on specialist assessment and treatment uptake for hepatitis C virus infection among people who use drugs: the ETHOS study. (United States)

    Alavi, M; Micallef, M; Fortier, E; Dunlop, A J; Balcomb, A C; Day, C A; Treloar, C; Bath, N; Haber, P S; Dore, G J; Grebely, J


    Among people who inject drugs (PWID) with chronic HCV, the association between HCV treatment willingness and intent, and HCV specialist assessment and treatment were evaluated. The Enhancing Treatment for Hepatitis C in Opioid Substitution Settings (ETHOS) is a prospective observational cohort. Recruitment was through six opioid substitution treatment clinics, two community health centres and one Aboriginal community controlled health organisation in Australia. Analyses were performed using logistic regression. Among 415 participants (mean age 41 years, 71% male), 67% were 'definitely willing' to receive HCV treatment and 70% reported plans to initiate therapy 12 months postenrolment. Those definitely willing to receive HCV treatment were more likely to undergo specialist assessment (64% vs 32%, P < 0.001) and initiate therapy (36% vs 9%, P < 0.001), compared to those with lower treatment willingness. Those with early HCV treatment plans were more likely to undergo specialist assessment (65% vs 27%, P < 0.001) and initiate therapy (36% vs 5%, P < 0.001), compared to those without early plans. In adjusted analyses, HCV treatment willingness independently predicted specialist assessment (aOR 3.06, 95% CI 1.90, 4.94) and treatment uptake (aOR 4.33, 95% CI 2.14, 8.76). In adjusted analysis, having early HCV treatment plans independently predicted specialist assessment (aOR 4.38, 95% CI 2.63, 7.29) and treatment uptake (aOR 9.79, 95% CI 3.70, 25.93). HCV treatment willingness was high and predicted specialist assessment and treatment. Strategies for enhanced HCV care should be developed with an initial focus on people willing to receive treatment and to increase treatment willingness among those less willing. © 2015 John Wiley & Sons Ltd.

  13. Assessment and treatment of insomnia in adult patients with alcohol use disorders. (United States)

    Brower, Kirk J


    Insomnia in patients with alcohol dependence has increasingly become a target of treatment due to its prevalence, persistence, and associations with relapse and suicidal thoughts, as well as randomized controlled studies demonstrating efficacy with behavior therapies and non-addictive medications. This article focuses on assessing and treating insomnia that persists despite 4 or more weeks of sobriety in alcohol-dependent adults. Selecting among the various options for treatment follows a comprehensive assessment of insomnia and its multifactorial causes. In addition to chronic, heavy alcohol consumption and its effects on sleep regulatory systems, contributing factors include premorbid insomnia; co-occurring medical, psychiatric, and other sleep disorders; use of other substances and medications; stress; environmental factors; and inadequate sleep hygiene. The assessment makes use of history, rating scales, and sleep diaries as well as physical, mental status, and laboratory examinations to rule out these factors. Polysomnography is indicated when another sleep disorder is suspected, such as sleep apnea or periodic limb movement disorder, or when insomnia is resistant to treatment. Sobriety remains a necessary, first-line treatment for insomnia, and most patients will have some improvement. If insomnia-specific treatment is needed, then brief behavioral therapies are the treatment of choice, because they have shown long-lasting benefit without worsening of drinking outcomes. Medications work faster, but they generally work only as long as they are taken. Melatonin agonists; sedating antidepressants, anticonvulsants, and antipsychotics; and benzodiazepine receptor agonists each have their benefits and risks, which must be weighed and monitored to optimize outcomes. Some relapse prevention medications may also have sleep-promoting activity. Although it is assumed that treatment for insomnia will help prevent relapse, this has not been firmly established. Therefore

  14. Training Needs for Substance Abuse Treatment and Assessment among Rehabilitation Counselors: California State Project (United States)

    Ong, Lee Za; Lee, Dal-Yob; Cha, Grace; Arokiasamy, Charles


    One hundred rehabilitation counselors in California reported that about 90% of consumers with whom they worked with had substance abuse and cooccurring issues, yet about half rated their graduate training in substance abuse treatment and assessment as poor and their practices as marginally proficient. The correlation analysis revealed that…

  15. Ethical Issues in the Assessment and Treatment of a Rational Suicidal Client. (United States)

    Snipe, Rosetta M.


    Notes that rational client's decision to commit suicide may present complex ethical issues for therapist. Presents and discusses three-month account of therapy with client, from perspective of ethical values and principles upon which assessment and treatment decisions were made, and complex ethical dilemmas encountered as therapist juxtaposed…

  16. Practice Parameter for the Assessment and Treatment of Children and Adolescents with Posttraumatic Stress Disorder (United States)

    Cohen, Judith A.; Bukstein, Oscar; Walter, Heather; Benson, R. Scott; Chrisman, Allan; Farchione, Tiffany R.; Hamilton, John; Keable, Helene; Kinlan, Joan; Schoettle, Ulrich; Siegel, Matthew; Stock, Saundra; Medicus, Jennifer


    This Practice Parameter reviews the evidence from research and clinical experience and highlights significant advances in the assessment and treatment of posttraumatic stress disorder since the previous Parameter was published in 1998. It highlights the importance of early identification of posttraumatic stress disorder, the importance of…

  17. New Methodology in Life Cycle Impact Assessment (LCIA) of waste water treatment

    DEFF Research Database (Denmark)

    Larsen, Henrik Fred; Wenzel, Henrik; Hauschild, Michael

    chose among different waste water treatments? Which ones are most beneficial in a holistic perspective? Here, the life cycle assessment (LCA) approach as a decision supporting tool may help because its goal is to allow quantification and direct comparison of characteristics as diverse as energy...

  18. Assessment of Pharmacological Treatment of Myocardial Infarction by Phosphorus-31 NMR with Surface Coils (United States)

    Nunnally, Ray L.; Bottomley, Paul A.


    Phosphorus-31 nuclear magnetic resonance (NMR) measurements with small surface coils have been used to observe phosphorus metabolism of perfused hearts within localized regions. The method allows for direct, noninvasive, sequential assessment of the altered regional metabolism resulting from myocardial infarction and its response to drug treatment, which cannot be observed by conventional techniques.

  19. Utility of Doppler ultrasonography for diagnosing and assessing treatment effects in liver compartment syndrome. (United States)

    Ando, Yusuke; Ishigami, Masatoshi; Ishizu, Yoji; Kuzuya, Teiji; Honda, Takashi; Hayashi, Kazuhiko; Ishikawa, Tetsuya; Goto, Hidemi; Hirooka, Yoshiki


    Liver compartment syndrome is a life-threatening complication of hepatic subcapsular hematoma; diagnosis and assessment of treatment effects are therefore important. We report a rare case of liver compartment syndrome due to spontaneous hepatic subcapsular hematoma without any underlying conditions, in which Doppler ultrasonography (US) proved useful in both diagnosis and assessment of treatment effects. A 32-year-old woman experienced sudden epigastralgia and was diagnosed with hepatic subcapsular hematoma in the right lobe, based on contrast-enhanced computed tomography. Hepatic arteriography showed active hemorrhage and Doppler US showed retrograde flow in the right portal vein. From these findings, we diagnosed hepatic subcapsular hematoma complicated with liver compartment syndrome, and performed embolization of the bleeding point and percutaneous hematoma drainage. After these medical procedures, normalized antegrade flow in the right portal vein was observed on Doppler US. No underlying conditions contributing to hematoma were identified. In this case, Doppler US was useful for both diagnosis and assessment of treatment effects in liver compartment syndrome. When we examine patients with hepatic subcapsular hematoma, Doppler US should be used to diagnose the presence of liver compartment syndrome and assess treatment effects.

  20. Assessment and Treatment of Socially Phobic Children: A Cross Cultural Comparison (United States)

    Ferrell, Courtney B.; Beidel, Deborah C.; Turner, Samuel M.


    In this study we examined the psychopathology and behavioral treatment of White and African American preadolescent children with social phobia. The comprehensive assessment strategy, including semistructured diagnostic interviews, clinician ratings of impairment, behavioral observations, parental ratings, and self-report inventories, did not…

  1. Attention Deficit Hyperactivity Disorder among Asian American Families: Challenges in Assessment and Treatment (United States)

    Pham, Andy V.


    Studies addressing assessment and treatment of attention deficit hyperactivity disorder (ADHD) have primarily been focused on Caucasian populations, although a growing number of studies have included ethnic minority populations, particularly Hispanic and African American children. Findings regarding the relationship between ADHD diagnosis and race…

  2. Quality indicators for treatment of respiratory tract infections? An assessment by Danish general practitioners

    DEFF Research Database (Denmark)

    Hansen, Malene Plejdrup; Bjerrum, Lars; Gahrn-Hansen, Bente


    Background: In 2008, a set of 41 quality indicators for antibiotic treatment of respiratory tract infections (RTIs) in general practice were developed in an international setting as part of the European project HAPPY AUDIT. Objectives: To investigate Danish general practitioners' (GPs') assessment...

  3. Texas Christian University (TCU) Short Forms for Assessing Client Needs and Functioning in Addiction Treatment (United States)

    Simpson, D. Dwayne; Joe, George W.; Knight, Kevin; Rowan-Szal, Grace A.; Gray, Julie S.


    The TCU Short Forms contain a revised and expanded set of assessments for planning and managing addiction treatment services. They are formatted as brief (one-page) forms to measure client needs and functioning, including drug use severity and history (TCUDS II), criminal thinking and cognitive orientation (CTSForm), motivation and readiness for…

  4. Assessment and Treatment of Tic Behavior: A Review and Case Study. (United States)

    Pray, Bruce, Jr.; And Others


    A discussion of the classification, differential diagnosis, etiology, assessment, and treatment of tic disorders is presented. A case study is included in which a school psychologist utilized behavioral consultation to assist a 9-year-old girl's parent and teacher in implementing a habit reversal program. (Author/LMO)

  5. Effects of Flame Treatment in the Interfacial Energy of Polyethylene Assessed by Contact Mechanics

    NARCIS (Netherlands)

    Song, Jing; Vancso, Gyula J.


    The effects of flame treatment of low-density polyethylene (LDPE) on the work of adhesion (W) and energy release rate (G) were assessed by a custom-built adhesion testing device (ATD). The contact area and the vertical displacement between planar LDPE films and PDMS lenses (untreated and UV/ozone

  6. Clinical Practice Guideline for Physical Therapy Assessment and Treatment in Patients With Nonspecific Neck Pain

    NARCIS (Netherlands)

    Bier, Jasper D; Scholten-Peeters, Wendy G M; Staal, J Bart; Pool, Jan; van Tulder, Maurits W; Beekman, Emmylou; Knoop, Jesper; Meerhoff, Guus; Verhagen, Arianne P


    The Royal Dutch Society for Physical Therapy (KNGF) issued a clinical practice guideline for physical therapists that addresses the assessment and treatment of patients with nonspecific neck pain, including cervical radiculopathy, in Dutch primary care. Recommendations were based on a review of

  7. The world is a scary place? INvestigating Treatments and Assessment for Children after Trauma

    NARCIS (Netherlands)

    Diehle, J.


    This dissertation provides new insights about treatments and assessment for children who experienced traumatic events. We investigated the comparative effectiveness of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR) by means of a

  8. Best Practices for Mental Health in Child Welfare: Screening, Assessment, and Treatment Guidelines (United States)

    Romanelli, Lisa Hunter; Landsverk, John; Levitt, Jessica Mass; Leslie, Laurel K.; Hurley, Maia M.; Bellonci, Christopher; Gries, Leonard T.; Pecora, Peter J.; Jensen, Peter S.


    The Best Practices for Mental Health in Child Welfare Consensus Conference focused on developing guidelines in five key areas (screening and assessment, psychosocial interventions, psychopharmacologic treatment, parent engagement, and youth empowerment) related to children's mental health. This paper provides an overview of issues related to the…

  9. ArcFuels: an ArcMap toolbar for fuel treatment planning and wildfire risk assessment (United States)

    Nicole M. Vaillant; Alan A. Ager


    Fire behavior modeling and geospatial analysis can provide tremendous insight to land managers in defining both the benefits and potential impacts of fuel treatments in the context of land management goals and public expectations. ArcFuels is a streamlined fuel management planning and wildfire risk assessment system that creates a trans-scale (stand to large landscape...

  10. Comparative assessment of the environmental sustainability of existing and emerging perchlorate treatment technologies for drinking water. (United States)

    Choe, Jong Kwon; Mehnert, Michelle H; Guest, Jeremy S; Strathmann, Timothy J; Werth, Charles J


    Environmental impacts of conventional and emerging perchlorate drinking water treatment technologies were assessed using life cycle assessment (LCA). Comparison of two ion exchange (IX) technologies (i.e., nonselective IX with periodic regeneration using brines and perchlorate-selective IX without regeneration) at an existing plant shows that brine is the dominant contributor for nonselective IX, which shows higher impact than perchlorate-selective IX. Resource consumption during the operational phase comprises >80% of the total impacts. Having identified consumables as the driving force behind environmental impacts, the relative environmental sustainability of IX, biological treatment, and catalytic reduction technologies are compared more generally using consumable inputs. The analysis indicates that the environmental impacts of heterotrophic biological treatment are 2-5 times more sensitive to influent conditions (i.e., nitrate/oxygen concentration) and are 3-14 times higher compared to IX. However, autotrophic biological treatment is most environmentally beneficial among all. Catalytic treatment using carbon-supported Re-Pd has a higher (ca. 4600 times) impact than others, but is within 0.9-30 times the impact of IX with a newly developed ligand-complexed Re-Pd catalyst formulation. This suggests catalytic reduction can be competitive with increased activity. Our assessment shows that while IX is an environmentally competitive, emerging technologies also show great promise from an environmental sustainability perspective.

  11. Longitudinal assessment of psychotherapeutic day hospital treatment for elderly patients with depression. (United States)

    Canuto, Alessandra; Meiler-Mititelu, Corina; Herrmann, François R; Delaloye, Christophe; Giannakopoulos, Panteleimon; Weber, Kerstin


    Although previous studies suggested that psychiatric day hospital care is a valuable alternative to inpatient treatment, its effectiveness for elderly patients is disputed. Small number of cases, poor definition of the psychotherapeutic setting, and absence of systematic assessment at different time points may explain the observed discrepancies. We performed an assessment of a psychiatric day hospital treatment combining individual and group psychotherapy in a series of 122 elderly depressed outpatients. The Geriatric Depression Scale, Short Form Survey, as well as a Therapeutic Community Assessment Scale and Group Evaluation Scale were repeated at admission, 3, 6, 12 months and discharge. The day hospital program was based on psychotherapeutic treatment combining individual and group settings. All patients presented with major depression or a depressive episode of bipolar disease. Variables included severity of depressive symptoms, quality of life, adhesion to therapeutic community treatment and progress in groups of psychotherapy, art-therapy, and psychomotricity. There was a significant reduction of depressive symptoms, and improvement in mental quality of life across all time points studied. Adhesion to therapeutic community increased from admission to discharge. This was also the case for the progress in group therapy for all three groups used, yet the evolution of this parameter at intermediate time points was highly variable. Neither demographic characteristics, nor pharmacological treatment or presence of stressful life events predicted the clinical improvement. Psychotherapeutic care program in day hospitals may improve clinical status and quality of life in elderly depressed patients.

  12. Social science to improve fuels management: a synthesis of research on assessing social acceptability of fuels treatments (United States)

    Terry C. Daniel; Michael Valdiserri; Carrie R. Daniel; Pamela Jakes; Pamela Jakes; Susan Barro


    A series of syntheses were commissioned by the USDA Forest Service to aid in fuels mitigation project planning. This synthesis focuses on research for assessing the social acceptability of fuels treatments. The synthesis is structured around six important considerations for any social acceptability assessment: defining the fuels treatments being assessed; representing...

  13. Assessment of immediate pain relief with laser treatment in recurrent aphthous stomatitis. (United States)

    Prasad R, Shesha; Pai, Anuradha


    To compare immediate pain relief, healing time between minor recurrent aphthous ulcers treated with a single session of carbon dioxide (CO2) laser and a placebo. A prospective clinical study was performed on 25 patients with minor recurrent aphthous stomatitis. Pretreatment pain levels were recorded using a numerical rating scale. Ulcers were randomized to either receive treatment or placebo. Pain levels were assessed immediately after treatment and after 24 h. Healing was assessed on days 3 and 4, and once every 2 days thereafter for 2 weeks. Mean pain scores in the laser group were significantly reduced immediately after treatment (0.68 ± 0.6) compared with pretreatment (8.48 ± 0.71; P recurrent aphthous stomatitis (RAS) provides immediate pain relief sustained over 24 h, along with accelerated healing time. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. [Assessment-Based Home Treatment for People with Severe Psychotic Disorders]. (United States)

    Sturm, Dietrich; Arends, Sebastian; Henke, Thomas; Reichmann, Claudia; Janssen, Birgit; Görtz, Philipp


    Although there is growing evidence for clinical effectiveness of crisis resolution teams (also called Home Treatment Teams) for patients with severe psychotic disorders, a lot of studies suffer from poor model fidelity, which leads to an ignorance of specific effective factors. Here we present the implementation of an assessment-based Home Treatment in Germany. Assessment-derived therapeutic tasks are shared between team members by a manualized process. We visited 32 patients almost 600 times in 15 months. The median was 15.5 visits per patient. Adherence to Home Treatment intervention was significantly stronger (unplanned discharge 16 %) compared to prior hospitalization (unplanned discharge 50 %) (Chi-square test, p = 0.003). Applying this model, a detailed definition of specific tasks for team members leads to a high model fidelity and increases patients' compliance to therapy. © Georg Thieme Verlag KG Stuttgart · New York.

  15. An evaluation of alternative household solid waste treatment practices using life cycle inventory assessment mode. (United States)

    Thanh, Nguyen Phuc; Matsui, Yasuhiro


    Waste disposal is an important part of the life cycle of a product and is associated with environmental burdens like any other life-cycle stages. In this study, an integrated assessment for solid waste treatment practices, especially household solid waste, was undertaken to evaluate the impact contribution of household solid waste treatment alternatives towards the sustainable development by using Life Cycle Inventory Assessment method. A case study has been investigated under various possible scenarios, such as (1) landfill without landfill gas recovery, (2) landfill with landfill gas recovery and flaring, (3) landfill with landfill gas recovery and electric generation, (4) composting, and (5) incineration. The evaluation utilized the Life Cycle Inventory Assessment method for multiple assessments based on various aspects, such as greenhouse gas emission/reduction, energy generation/consumption, economic benefit, investment and operating cost, and land use burden. The results showed that incineration was the most efficient alternative for greenhouse gas emission reduction, economic benefit, energy recovery, and land use reduction, although it was identified as the most expensive for investment and operating cost, while composting scenario was also an efficient alternative with quite economic benefit, low investment and operating cost, and high reduction of land use, although it was identified as existing greenhouse gas emission and no energy generation. Furthermore, the aim of this study was also to establish localized assessment methods that waste management agencies, environmental engineers, and environmental policy decision makers can use to quantify and compare the contribution to the impacts from different waste treatment options.

  16. High-frequency ultrasound in carpal tunnel syndrome: assessment of patient eligibility for surgical treatment

    Directory of Open Access Journals (Sweden)

    Katarzyna Kapuścińska


    Full Text Available Carpal tunnel syndrome (CTS is the most common entrapment neuropathy and a frequent cause of sick leaves because of work-related hand overload. That is why an early diagnosis and adequate treatment (conservative or surgical are essential for optimal patient management. Aim: The aim of the study is to assess the usefulness of high-frequency ultrasound in CTS for the assessment of patient eligibility for surgical treatment. Material and methods: The study involved 62 patients (50 women and 12 men, aged 28–70, mean age 55.2 with scheduled surgeries of CTS on the basis of clinical symptoms, physical examination performed by a neurosurgeon and a positive result of EMG testing. The ultrasound examinations of the wrist were performed in all these patients. On the basis of the collected data, the author has performed multiple analyses to confi rm the usefulness of ultrasound imaging in assessing patient eligibility for surgical treatment of CTS. Results: US examinations showed evidence of median nerve compression at the level of the carpal tunnel in all of the examined patients. This was further confi rmed during surgical procedures. The mean value of the cross-sectional area at the proximal part of the pisiform bone was 17.45 mm2 (min. 12 mm2 , max. 31 mm2 . Nerve hypoechogenicity proximal to the nerve compression site was visible in all 62 patients (100%. Increased nerve vascularity on the transverse section was present in 50 patients (80.65%. Conclusions: Ultrasonography with the use of high-frequency transducers is a valuable diagnostic tool both for assessing patient eligibility for surgical treatment of CTS, and in postoperative assessment of the treatment efficacy.

  17. Assessment of efficacy and safety of eslicarbazepine acetate for the treatment of trigeminal neuralgia. (United States)

    Sanchez-Larsen, A; Sopelana-Garay, D; Diaz-Maroto, I; Perona-Moratalla, A B; Gracia-Gil, J; García-Muñozguren, S; Palazón-García, E; Segura, T


    Antiepileptic drugs are the first line treatment for trigeminal neuralgia (TN). Carbamazepine and oxcarbazepine are the most studied with well-known efficacy. Eslicarbazepine acetate is a third-generation antiepileptic drug that has not previously been evaluated for the treatment of TN. We aim to assess the efficacy, tolerability, and safety of eslicarbazepine for TN. Retrospective, open-label, multicentric, intention-to-treat study. We included patients older than 18 years who met the ICHD-3 beta diagnostic criteria for TN. We evaluated the variation of intensity and frequency of pain paroxysms before and after treatment with eslicarbazepine. Secondary objectives assessed were tolerability and safety of eslicarbazepine. Eighteen patients were included, 15 women, mean age 65.2 years-old, mean follow-up 21.1 months. The mean number of drugs tested before eslicarbazepine was 2; ten patients used eslicarbazepine as monotherapy. After the treatment with ESL, the median of pain intensity improved from 9.5 to 2.5 (p eslicarbazepine for this reason. Despite this, 16 patients (88.9%) noticed a good subjective tolerance to eslicarbazepine. The retention rate at 6 months was 77.8% and at 12 months 61.1%. Our study supports the hypothesis that eslicarbazepine acetate is an effective, safe, and well-tolerated treatment for the treatment of TN. Further studies are warranted to corroborate these results. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  18. Identifying energy and carbon footprint optimization potentials of a sludge treatment line with Life Cycle Assessment. (United States)

    Remy, C; Lesjean, B; Waschnewski, J


    This study exemplifies the use of Life Cycle Assessment (LCA) as a tool to quantify the environmental impacts of processes for wastewater treatment. In a case study, the sludge treatment line of a large wastewater treatment plant (WWTP) is analysed in terms of cumulative energy demand and the emission of greenhouse gases (carbon footprint). Sludge treatment consists of anaerobic digestion, dewatering, drying, and disposal of stabilized sludge in mono- or co-incineration in power plants or cement kilns. All relevant forms of energy demand (electricity, heat, chemicals, fossil fuels, transport) and greenhouse gas emissions (fossil CO(2), CH(4), N(2)O) are accounted in the assessment, including the treatment of return liquor from dewatering in the WWTP. Results show that the existing process is positive in energy balance (-162 MJ/PE(COD) * a) and carbon footprint (-11.6 kg CO(2)-eq/PE(COD) * a) by supplying secondary products such as electricity from biogas production or mono-incineration and substituting fossil fuels in co-incineration. However, disposal routes for stabilized sludge differ considerably in their energy and greenhouse gas profiles. In total, LCA proves to be a suitable tool to support future investment decisions with information of environmental relevance on the impact of wastewater treatment, but also urban water systems in general.

  19. Assessment of the efficacy of Aspergillus sp. EL-2 in textile waste water treatment. (United States)

    Gomaa, Ola M; Kareem, Hussein Abd El; Fatahy, Reham


    Fungal biomass has the ability to decolorize a wide variety of dyes successfully through a number of mechanisms. A brown rot isolate, previously identified as Aspergillus sp. EL-2, was used in the aerobic treatment of textile waste water efficiently. In the current work, the treated waste water was tested chemically using more than one combined treatment. Microbial toxicity, phytotoxicity, genotoxicity and cytotoxicity were also studied to assess the toxicity level for each treatment. The obtained data suggest that the contribution of more than one mode of treatment is essential to ensure complete destruction of the by-products. The use of gamma irradiation (25 kGy) after the bioremediation step led to the decrease of the by-products of biodegradation as observed by visible spectrum and Fourier transfer infra red spectroscopy (FT-IR). The toxicity assessment presented variable results indicating the need for more than one toxicity test to confirm the presence or absence of hazardous compounds. Brown rot fungus could be used efficiently in the treatment of textile waste water without the risk of obtaining high carcinogenic or genotoxic compounds, especially if combined treatment is employed.

  20. Assessing and reporting heterogeneity in treatment effects in clinical trials: a proposal

    Directory of Open Access Journals (Sweden)

    Kent David M


    Full Text Available Abstract Mounting evidence suggests that there is frequently considerable variation in the risk of the outcome of interest in clinical trial populations. These differences in risk will often cause clinically important heterogeneity in treatment effects (HTE across the trial population, such that the balance between treatment risks and benefits may differ substantially between large identifiable patient subgroups; the "average" benefit observed in the summary result may even be non-representative of the treatment effect for a typical patient in the trial. Conventional subgroup analyses, which examine whether specific patient characteristics modify the effects of treatment, are usually unable to detect even large variations in treatment benefit (and harm across risk groups because they do not account for the fact that patients have multiple characteristics simultaneously that affect the likelihood of treatment benefit. Based upon recent evidence on optimal statistical approaches to assessing HTE, we propose a framework that prioritizes the analysis and reporting of multivariate risk-based HTE and suggests that other subgroup analyses should be explicitly labeled either as primary subgroup analyses (well-motivated by prior evidence and intended to produce clinically actionable results or secondary (exploratory subgroup analyses (performed to inform future research. A standardized and transparent approach to HTE assessment and reporting could substantially improve clinical trial utility and interpretability.

  1. Bias in retrospective assessment of perceived dental treatment effects when using the Oral Health Impact Profile. (United States)

    Reissmann, Daniel R; Erler, Antje; Hirsch, Christian; Sierwald, Ira; Machuca, Carolina; Schierz, Oliver


    Aim of this exploratory study was to investigate whether a retrospective assessment of oral health-related quality of life (OHRQoL) using the Oral Health Impact Profile (OHIP) is susceptible to bias such as implicit theory of change and cognitive dissonance. In this prospective clinical study, a sample of 126 adult patients (age 17-83 years, 49% women) requiring prosthodontic treatment was consecutively recruited. The OHRQoL was assessed using the 49-item OHIP at baseline and at follow-up. Additionally, patients were asked at follow-up to retrospectively rate their oral health status at baseline (retrospective pretest or then-test) and the change in oral health status using a global transition question. Furthermore, patients' ratings of overall oral health and general health were used as validity criteria for the OHRQoL assessments. Response shift was calculated as the difference between the initial and retrospective baseline assessments. Baseline and retrospective pretest did not differ substantially in terms of internal consistency and convergent validity. Response shift was more pronounced when patients perceived a large change in OHRQoL during treatment. Retrospective pretests were more highly correlated with the baseline than with the follow-up assessment. Findings suggest that retrospective assessments of OHRQoL using the OHIP-49 are susceptible to bias. Cognitive dissonance is more likely to appear as a source of bias than implicit theory of change.

  2. Perspective on the integration of substance user needs assessment and treatment planning. (United States)

    Ford, W E


    In the 1970s and 1980s, several techniques for assessing the needs for substance user treatment were developed. Generally these techniques relied upon the data developed from large-scale data-gathering systems, originally designed to assess the capacity of the substance user treatment system nationwide. The need assessment techniques generally require making estimates of the prevalence of substance use disorders in the population and then applying them to the national utilitization experience. As first attempts often do, these approaches tended to simplify complex problems and tended to rely too heavily on the only available data. The result was that they tended to reify current practice rather than to define best practice. In the 1990s, new challenges face those attempting to assess needs for substance user services. As a result of the last decade's emphasis on cost containment, new concepts have challenged traditional views of needs assessment. This paper will discuss those new concepts and their impact on the needs assessment endeavor. In particular, the impact of the concept of medical necessity will be examined.

  3. Assessment of adherence to visual correction and occlusion therapy in the Infant Aphakia Treatment Study

    Directory of Open Access Journals (Sweden)

    Carolyn Drews-Botsch


    Full Text Available Occlusion therapy throughout early childhood is believed to be efficacious in treating deprivation amblyopia but has not been rigorously assessed in clinical trials. Further, tools to assess adherence to such therapy over an extended period of time are lacking. Using data from the Infant Aphakia Treatment Study, a randomized clinical trial of treatment for unilateral congenital cataract, we examined the use of quarterly 48-h recall interviews and annual 7-day prospective diaries to assess reported hours of patching in 114 children throughout the first 5 years of life. Consistency of data reported was assessed using correlation coefficients and intraclass correlation coefficients. Both interview and diary data showed excellent consistency with Cronbach’s Alpha’s ranging from 0.69 to 0.88 for hours of patching and 0.60 to 0.73 for hours of sleep. However, caregivers reported somewhat more adherence in prospective diaries than retrospective interviews. Completion rates, on the other hand, were substantially higher for telephone interviews than prospective diaries. For example, four years after surgery response rates to telephone interviews exceeded 75% versus completion rates of only 54% for diaries. In situations where occlusion dose monitors cannot be used for assessing adherence to occlusion therapy, such as in infants or over an extended period of time, quantitative assessments of occlusion therapy can be obtained by parental report, either as a series of prospective diaries or a series of recall interviews.

  4. Assessing drinking water treatment systems for safety against cyanotoxin breakthrough using maximum tolerable values. (United States)

    Schmidt, Wido; Bornmann, Katrin; Imhof, Lutz; Mankiewicz, Joanna; Izydorczyk, Katarzyna


    For assessing the safety of drinking water supplies suffering cyanobacterial blooms in their water source, a methodology is proposed which relates the performance of their current treatment train to the quality of the raw water. The approach considers that different treatment trains can remove algal toxins with different efficiency. Maximum Tolerable (MT-) values of the raw water expressed by cell counts or by biovolumes of cyanobacteria were calculated. Three MT-categories were identified by colours; high risk (red), moderate risk (yellow) and no risk (green). Two treatment facilities using a conventional (1) and polishing train (2) were assessed using this methodology. For most of the time during an algal bloom the water quality could be classified as yellow which means short term higher toxin levels in comparison to the guide line in clear water were found. However, the red classification, indicating a high risk for drinking water quality was never reached. The model proposed can be understood as supplement of the common alert level framework, ALF-concept (Chorus and Bartram, Situation Assessment, Planning and Management. London and New York: E & FN Spon. 1999; House et al., Management Strategies for Toxic Blue Green Algae: Literature Review. Australia: CRC for Water Quality and Treatment. 2004).

  5. Assessment of treatment efficacy and sebosuppressive effect of fractional radiofrequency microneedle on acne vulgaris. (United States)

    Lee, Kyung Real; Lee, Eo Gin; Lee, Hee Jung; Yoon, Moon Soo


    A minimally invasive fractional radiofrequency microneedle (FRM) device has been used in skin rejuvenation and acne scars, and a recent pilot study demonstrated the positive therapeutic effect on acne. We evaluated the efficacy of FRM device for acne vulgaris in Asians and conducted objective measurement to assess its effect on sebum production. Twenty Korean patients with acne vulgaris received a single full-face FRM treatment. Outcome assessments included standardized photography, physician's global assessment, patient's satisfaction scores, acne lesion count, and objective measurements of casual sebum level (CSL) and sebum excretion rate (SER). They were evaluated at baseline and 2, 4, 8 weeks after the treatment. After a single FRM treatment, the CSL and the SER showed 30-60% and 70-80% reduction, respectively, at week 2 (P acne severity and acne lesion count also revealed clinical improvement with maximum efficacy at week 2, but returned to the baseline in most patients by week 8. Patients' satisfaction scores (0-4) were above 2 on average, and adverse effects were minimal. This prospective study demonstrated the sebosuppressive effect from a single FRM treatment, but its therapeutic efficacy in acne requires further evaluation. © 2013 Wiley Periodicals, Inc.

  6. Use of patient self-report oral health outcome measures in assessment of dental treatment outcomes. (United States)

    Wright, Wanda G; Jones, Judith A; Spiro, Avron; Rich, Sharron E; Kressin, Nancy R


    To assess the sensitivity of a newly developed brief measure of oral health-related quality of life (OQOL). Self-assessed oral health and OQOL were measured in three groups of patients who had presented for either prophylaxis (n = 32), endodontic care (n = 15), or for a denture (n = 16) in a dental school setting before and after treatment. Main outcome measures included the single-item self-report of oral health (OH-1) and the 6- and 12-item versions of a new OQOL instrument. General linear modeling was used to compute means of self-reported oral health by treatment group. Of the 63 patients who completed the baseline questionnaire, 44 (70 percent) returned questionnaires after treatment. The sample averaged 43 +/- 15 years, 48 percent male and 55 percent with some college education. Ethnic representation included 35 percent White, 33 percent Black, and 32 percent other - mostly Latino. The mean self-reported number of teeth was 20.6. In terms of sensitivity, significant differences were observed between the treatment groups on the items assessing being upset (P sensitive to differences within groups, with a small to borderline magnitude of change.

  7. Totality of outcomes: A different paradigm in assessing interventions for treatment of tuberculosis

    Directory of Open Access Journals (Sweden)

    Grace Montepiedra


    Full Text Available Conventional analytic methods used for tuberculosis (TB outcomes research use standardized outcomes definitions and assess safety and efficacy separately. These methods are subject to important limitations. Conventionally utilized outcome definitions fail to capture important aspects of patients' treatment experience and obscure meaningful differences between patients.Assessing safety and efficacy separately fails to yield an objective risk–benefit comparison to guide clinical practice. We propose to address these issues through an analytic approach based on prioritized outcomes. This approach enables a more comprehensive and integrated assessment of TB interventions. It simultaneously considers a “totality of outcomes”, including clinical benefit, adverse events, and quality of life. These composite outcomes are ranked terms of overall desirability and compared using statistical methods for ordinal outcomes. Here we discuss the application of this approach to TB research, the considerations involved with prioritizing TB treatment outcomes, and the statistical methods involved in comparing prioritized outcomes. Keywords: Tuberculosis, Treatment outcome, Risk–benefit assessment

  8. Life cycle assessment of wastewater treatment options for small and decentralized communities. (United States)

    Machado, A P; Urbano, L; Brito, A G; Janknecht, P; Salas, J J; Nogueira, R


    Sustainability has strong implications on the practice of engineering. Life cycle assessment (LCA) is an appropriate methodology for assessing the sustainability of a wastewater treatment plant design. The present study used a LCA approach for comparing alternative wastewater treatment processes for small and decentralised rural communities. The assessment was focused on two energy-saving systems (constructed wetland and slow rate infiltration) and a conventional one (activated sludge process). The low environmental impact of the energy-saving wastewater treatment plants was demonstrated, the most relevant being the global warming indicator. Options for reduction of life cycle impacts were assessed including materials used in construction and operational lifetime of the systems. A 10% extension of operation lifetime of constructed wetland and slow rate infiltration systems led to a 1% decrease in CO2 emissions, in both systems. The decrease in the abiotic depletion was 5 and 7%, respectively. Also, replacing steel with HDPE in the activated sludge tank resulted in a 1% reduction in CO2 emission and 1% in the abiotic depletion indicator. In the case of the Imhoff tank a 1% reduction in CO2 emissions and 5% in the abiotic depletion indicator were observed when concrete was replaced by HDPE.

  9. Identification and assessment of site treatment plan implementation opportunities for emerging technologies

    Energy Technology Data Exchange (ETDEWEB)

    Bernard, E.A. [Sandia National Labs., Germantown, MD (United States)


    The Department of Energy (DOE), in response to the 1992 Federal Facility Compliance Act, has prepared Site Treatment Plans (STP) for the approximately 2,000 waste streams identified within its mixed waste inventory Concurrently, emerging mixed waste treatment technologies are in final development. This paper defines a three-phase process to identify and assess implementation opportunities for these emerging technologies within the STP. It highlights the first phase, functional matching of expected treatment capabilities with proposed treatment requirements. Matches are based on treatment type, regulated contaminant and waste matrix type, for both capabilities and requirements. Results identify specific waste streams and volumes that could be treated by each emerging technology. A study for Plasma Hearth Process, Delphi DETOX{sup sm}, Supercritical Water Oxidation and Vitrification shows that about 200,000 ml of DOE`s mixed waste inventory can potentially be treated by one or more of these emerging technologies. Actual implementations are small fractions of the treatable inventory. Differences between potential and actual implementations must be minimized to accrue optimum benefit from implementation of emerging or alternative treatment technologies. Functional matching is the first phase in identifying and quantifying benefits, addressing technology system and treatment issues, and providing, in part, the basis for STP implementation decisions. DOE, through EM`s Office of Technology Development, has funded this work.

  10. The accurate assessment and physiotherapeutic treatment of rotator cuff myofascial Pain Syndrome: A case report

    Directory of Open Access Journals (Sweden)

    B. B. Barker


    Full Text Available Management  of  patients  with  rotator  cuff  myofascial  pain syndrome varies  and  successful  intervention  is  dependent  on accurate assessment. The aim of this case report is to show the importance of accurate assessment  and  clinical  reasoning  in  the  physiotherapeutic management  of a  patient  suffering  from  ante-cubital  and  anterior shoulder  pain.  The  patient was  referred  for  physiotherapy  after proving refractory  to  treatment  with  non-steroidal anti-inflammatory medication. The physiotherapist diagnosed a rotator cuff myofascial pain syndrome and treatment proceeded on that basis. Treatment consisted of twitch-obtaining dry needling, myofascial release and exercise therapy.  The result was a change in the harryman rotator cuff functional Assessment Scale score from 22/52 to 43/52 over eight treatments. Strength was regained and subjective pain report on the visual rating scale was improved to 1/10. The case study highlights the importance of accurate assessment and consideration of alternative myofascial sources for pain even in circumstances which initially seem trauma related. Precise diagnosis of the cause - in this case rotator cuff myofascial pain syndrome – will result in effective treatment being administered.

  11. Methods of blinding in reports of randomized controlled trials assessing pharmacologic treatments: a systematic review.

    Directory of Open Access Journals (Sweden)

    Isabelle Boutron


    Full Text Available BACKGROUND: Blinding is a cornerstone of therapeutic evaluation because lack of blinding can bias treatment effect estimates. An inventory of the blinding methods would help trialists conduct high-quality clinical trials and readers appraise the quality of results of published trials. We aimed to systematically classify and describe methods to establish and maintain blinding of patients and health care providers and methods to obtain blinding of outcome assessors in randomized controlled trials of pharmacologic treatments. METHODS AND FINDINGS: We undertook a systematic review of all reports of randomized controlled trials assessing pharmacologic treatments with blinding published in 2004 in high impact-factor journals from Medline and the Cochrane Methodology Register. We used a standardized data collection form to extract data. The blinding methods were classified according to whether they primarily (1 established blinding of patients or health care providers, (2 maintained the blinding of patients or health care providers, and (3 obtained blinding of assessors of the main outcomes. We identified 819 articles, with 472 (58% describing the method of blinding. Methods to establish blinding of patients and/or health care providers concerned mainly treatments provided in identical form, specific methods to mask some characteristics of the treatments (e.g., added flavor or opaque coverage, or use of double dummy procedures or simulation of an injection. Methods to avoid unblinding of patients and/or health care providers involved use of active placebo, centralized assessment of side effects, patients informed only in part about the potential side effects of each treatment, centralized adapted dosage, or provision of sham results of complementary investigations. The methods reported for blinding outcome assessors mainly relied on a centralized assessment of complementary investigations, clinical examination (i.e., use of video, audiotape, or

  12. A mini geriatric assessment helps treatment decision in elderly patients with digestive cancer. A pilot study. (United States)

    Aparicio, Thomas; Girard, Laurence; Bouarioua, Nadia; Patry, Claire; Legrain, Sylvie; Soulé, Jean Claude


    Comprehensive geriatric assessment (CGA) is advocate to improved care of elderly with cancer but is not available in every hospital within a short delay. Therefore, a tool allowing gastroenterologist to detect rapidly specific abnormalities in elderly is needed. the aim of our pilot study was to evaluate feasibility of a mini geriatric assessment (MGA) to adapt the anticancer treatments. MGA was done by a gastroenterologist and was taken into account during the cancer multidisciplinary team meeting for making decision. Then, CGA was realised and suggested adaptation of care. 21 patients over 75 years treated for different digestive cancers were enrolled. The treatments recommended by the cancer multidisciplinary team meeting after the GMA were: standard treatments in 9 (41%); modified in 10 (47%) and best supportive care in 2 (12%) patients. CGA led to an adaptation of the non-oncological treatment in 15 (72%) and of the social care in 8 (38%) patients, but never modified the oncological strategy. MGA could help gastroenterologists for adaptation of anticancer treatment. The characteristics of the patients that should subsequently have a geriatric follow-up remain to be defined. 2010 Elsevier Ireland Ltd. All rights reserved.

  13. Exergy analysis in the assessment of the sustainability of waste gas treatment systems. (United States)

    Dewulf, J; Van Langenhove, H; Dirckx, J


    This study focuses on the sustainability of different technological options for the treatment of waste gases from a waste water treatment plant loaded with volatile organic compounds. The options considered are biofiltration, active carbon adsorption and catalytic and thermal oxidation. The amount of resources and utilities to construct and operate each system have been investigated from the point of view of the Second Law of thermodynamics. The unit in which all resources are treated is Joules of exergy. It was concluded that biofiltration was the most exergetically efficient system. The cumulative exergy consumption of the resources and utilities for construction and operation have been quantified in exergy terms. Further on, the requirements for the abatement of emissions generated by operating the waste gas treatment systems and the amount of renewables have been taken into account in the assessment of the sustainability of the waste gas treatment technologies. Finally, a comparison between exergy analysis and life cycle analysis in assessing the sustainability of the waste gas treatment options, is presented.

  14. Assessing treatment motivation among patients receiving antiretroviral therapy: A multidimensional approach (United States)

    Houston, Eric; McKirnan, David J.; Cervone, Daniel; Johnson, Matthew S.; Sandfort, Theo G.M.


    Using multidimensional scaling analysis (MDS), this study examined how patient conceptualisations of treatment motivation compare with theoretically-based assumptions used in current assessment approaches. Patients undergoing antiretroviral therapy for HIV/AIDS (n = 39) rated for similarity all possible pairings of 23 treatment descriptions, including descriptors of intrinsic, extrinsic, approach, and avoidance motivation. MDS analyses revealed that patient perceptions of intrinsic and extrinsic motivation often differ from those based on definitions derived from common interpretations of self-determination theory. Findings also showed that patients reported motivation for avoiding treatment when they associated their medication regimens with side effects and other negatively-valenced outcomes. The study describes new applications of MDS in assessing how patients perceive the relationship between treatment behaviours and specific forms of motivation, such as intrinsic and extrinsic motivation. In addition, the study suggests how MDS may be used to develop behavioural strategies aimed at helping patients follow their regimens consistently by identifying treatment conceptualisations and contexts that facilitate or impede adherence. PMID:21942538

  15. Assessing treatment motivation among patients receiving antiretroviral therapy: a multidimensional approach. (United States)

    Houston, Eric; McKirnan, David J; Cervone, Daniel; Johnson, Matthew S; Sandfort, Theo G M


    Using multidimensional scaling (MDS) analysis, this study examined how patient conceptualisations of treatment motivation compare with theoretically based assumptions used in current assessment approaches. Patients undergoing antiretroviral therapy for HIV/AIDS (n=39) rated for similarity between all possible pairings of 23 treatment descriptions, including descriptors of intrinsic, extrinsic, approach and avoidance motivation. MDS analyses revealed that patient perceptions of intrinsic and extrinsic motivations often differ from those based on definitions derived from common interpretations of self-determination theory. Findings also showed that patients reported motivation for avoiding treatment when they associated their medication regimens with side effects and other negatively valenced outcomes. The study describes new applications of MDS in assessing how patients perceive the relationship between treatment behaviours and specific forms of motivation, such as intrinsic and extrinsic motivations. In addition, the study suggests how MDS may be used to develop behavioural strategies aimed at helping patients follow their regimens consistently by identifying treatment conceptualisations and contexts that facilitate or impede adherence.

  16. CT pulmonary angiogram for assessing the treatment outcome of acute pulmonary embolism. (United States)

    Zhou, Hai-Ting; Yan, Wen-Ying; Zhao, De-Li; Liang, Hong-Wei; Wang, Guo-Kun; Ling, Zai-Sheng; Zhang, Jin-Ling


    To discuss the value of CT pulmonary angiogram (CTPA) for assessing the treatment outcome of acute pulmonary embolism (APE). CT pulmonary angiogram data and other clinical data were collected for 28 cases diagnosed as APE and analyzed retrospectively. The number and positions of emboli in the pulmonary artery, pulmonary artery obstruction index, right ventricular/left ventricular diameter ratio, main pulmonary artery/ascending aorta diameter ratio and blood oxygen saturation, and pulmonary arterial pressure were compared before and after treatment. Of 28 cases, emboli in the pulmonary artery completely or partially disappeared in 16 and 12 cases, respectively. CPTA indicated that the pulmonary arterial pressure decreased dramatically and the blood oxygen saturation increased after treatment in 26 cases. There were significant differences in the number and positions of pulmonary emboli and in pulmonary artery obstruction index before and after treatment in 28 cases (P  .05). CT pulmonary angiogram proved reliable for assessing the treatment efficacy of APE, providing more clinical information on the patients' status. © 2017, Wiley Periodicals, Inc.

  17. Assessing treatments used to reduce rumination and/or worry: a systematic review. (United States)

    Querstret, Dawn; Cropley, Mark


    Perseverative cognitions such as rumination and worry are key components of mental illnesses such as depression and anxiety. Given the frequent comorbidity of conditions in which rumination and worry are present, it is possible that they are underpinned by the same cognitive process. Furthermore, rumination and worry appear to be part of a causal chain that can lead to long-term health consequences, including cardiovascular disease and other chronic conditions. It is important therefore to understand what interventions may be useful in reducing their incidence. This systematic review aimed to assess treatments used to reduce worry and/or rumination. As we were interested in understanding the current treatment landscape, we limited our search from 2002 to 2012. Nineteen studies were included in the review and were assessed for methodological quality and treatment integrity. Results suggested that mindfulness-based and cognitive behavioural interventions may be effective in the reduction of both rumination and worry; with both Internet-delivered and face-to-face delivered formats useful. More broadly, it appears that treatments in which participants are encouraged to change their thinking style, or to disengage from emotional response to rumination and/or worry (e.g., through mindful techniques), could be helpful. Implications for treatment and avenues for future research are discussed. © 2013.

  18. Quantitative MR imaging in planning and assessing novel cancer treatments Radiotherapy

    CERN Document Server

    Baustert, I C


    Novel treatments in cancer, like conformal radiotherapy and anticancer drugs, require new MRI techniques to assess their benefits and potential. In conformal radiotherapy, MRI can be used to measure the shape and dose of the conformed radiation field in dose sensitive gel test-objects thus validating the predicted dose computed by complex programs. In antiangiogenic drug treatment, the vascular dysfunction of the tumour can be assessed by MRI prior to treatment. Response to treatment may also be monitored by measuring the changes in vascular function. In this thesis, MRI of polyacrylamide gels is investigated as a 3D dosimeter for conformal radiotherapy treatment planning. Quantitative MRI sequences capable of measuring the wide range of T2 values typically expected in gel dosimetry, are identified. Different T2 measurement methods are compared in terms of accuracy, signal to noise ratio and acquisition time. Examples of a complex dose distribution in 2D and 3D are presented and compared to the planned dose p...

  19. Development of substance flow based Life Cycle Assessment tool for sewage sludge treatment and disposal

    DEFF Research Database (Denmark)

    Yoshida, Hiroko; Clavreul, Julie; Scheutz, Charlotte

    Life Cycle Assessment (LCA) is a method to quantify environmental impacts of products or systems. It is often done by correlating material and energy demands with certain input characteristics. An attempt was made to evaluate the robustness of the substance flow based LCA for wastewater and sludge...... treatment processes. Operational data of a conventional wastewater treatment plant over 12 years was collected. A cluster analysis was conducted to determine the relatedness of each input and output characteristic at the whole plant level. The results indicate that the output from the wastewater and sludge...

  20. [Assessment of antibacterial efficacy of ozone therapy in treatment of caries at the white spot stage]. (United States)

    Makeeva, I M; Turkina, A Yu; Margaryan, E G; Paramonov, Yu O; Polyakova, M A

    Effect on cariogenic flora is the key toremineralizing therapy efficacy in treatment of initial caries (at the white spot stage). Ozone in dentistry is used as a highly effective antibacterial agent. Treatment of white spot lesions with the ozone-air mixture leads to significant increase of efficacy in non-invasive treatment of initial caries. clinical and microbiological assessment of antibacterial efficacy of ozone therapy in treatment of caries at the white spot stage. The trial recruited 86 patients for non-invasive treatment of caries at the white spot stage which included the complex of professional oral hygiene, medicamental treatment of white spot lesions with hydrogen peroxide 3% and chlorhexidinedigluconate 0,2%, treatment with the ozone-air mixture and application of hydroxyapatite Са2+. Material for microbiological study was received before the treatment, after the complex of professional oral hygiene and medicamental treatment of white spot lesions conducted as well as after the treatment with the ozone-air mixture. Before the treatment up to 16 kinds of microorganisms on the surface of white spot lesion were detected with the following shares: S. mutans (19.9%), S. salivarius (15.1%), S. epidermidis (8.7%), S. mitis (6.5%), Lactobacillus (6.5%) and different kinds of staphylococci (10.8%). After the complex of professional oral hygiene and medicamental treatment conducted decrease in number of cariogenic microorganisms was indicated as follows: S. mutans - from 1·105 to 1·104, S. salivarius - from 1·107 to 1·106, S. epidermidis - from 1·105 to 1·104, S. mitis - from 1·104 to 1·103, Lactobacillus - from 1·104 tо 1·103. After the treatment of tooth enamel with the ozone-air mixture increase in microorganisms was not observed. The efficacy of ozone on cariogenic microorganisms exceeds significantly the efficacy of 3% hydrogen peroxide and 0,2% chlorhexidinedigluconate. It is strongly advisable to include ozone in protocol of non

  1. From P-Values to Objective Probabilities in Assessing Medical Treatments. (United States)

    Kault, David; Kault, Sam


    The assessment of the effectiveness of a treatment in a clinical trial, depends on calculating p-values. However, p-values are only indirect and partial indicators of a genuine effect. Particularly in situations where publication bias is very likely, assessment using a p-value of 0.05 may not be sufficiently cautious. In other situations it seems reasonable to believe that assessment based on p-values may be unduly conservative. Assessments could be improved by using prior information. This implies using a Bayesian approach to take account of prior probability. However, the use of prior information in the form of expert opinion can allow bias. A method is given here that applies to assessments already included or likely to be included in the Cochrane Collaboration, excluding those reviews concerning new drugs. This method uses prior information and a Bayesian approach, but the prior information comes not from expert opinion but simply from the distribution of effectiveness apparent in a random sample of summary statistics in the Cochrane Collaboration. The method takes certain types of summary statistics and their confidence intervals and with the help of a graph, translates this into probabilities that the treatments being trialled are effective.

  2. From P-Values to Objective Probabilities in Assessing Medical Treatments.

    Directory of Open Access Journals (Sweden)

    David Kault

    Full Text Available The assessment of the effectiveness of a treatment in a clinical trial, depends on calculating p-values. However, p-values are only indirect and partial indicators of a genuine effect. Particularly in situations where publication bias is very likely, assessment using a p-value of 0.05 may not be sufficiently cautious. In other situations it seems reasonable to believe that assessment based on p-values may be unduly conservative. Assessments could be improved by using prior information. This implies using a Bayesian approach to take account of prior probability. However, the use of prior information in the form of expert opinion can allow bias. A method is given here that applies to assessments already included or likely to be included in the Cochrane Collaboration, excluding those reviews concerning new drugs. This method uses prior information and a Bayesian approach, but the prior information comes not from expert opinion but simply from the distribution of effectiveness apparent in a random sample of summary statistics in the Cochrane Collaboration. The method takes certain types of summary statistics and their confidence intervals and with the help of a graph, translates this into probabilities that the treatments being trialled are effective.

  3. Using MRI for the assessment of paraoxon-induced brain damage and efficacy of antidotal treatment. (United States)

    Rosman, Yossi; Eisenkraft, Arik; Krivoy, Amir; Schein, Ophir; Makarovski, Igor; Shrot, Shai; Ramaty, Erez; Shilderman, Eugenia Bloch; Kapon, Joseph; Gilat, Eran; Kadar, Tamar; Maier, Stephan; Daniels, Dianne; Shneor, Ran; Salomon, Sharona; Tamar, Gregori; Last, David; Mardor, Yael


    Organophosphate intoxication induces neural toxicity as demonstrated in histological analysis of poisoned animals. Diffusion-weighted magnetic resonance imaging (DWMRI) enables early noninvasive characterization of biological tissues based on their water diffusion characteristics. Our objectives were to study the application of MRI for assessment of paraoxon-induced brain damage and the efficacy of antidotal treatments. Seventy-six rats were poisoned with paraoxon followed by treatment with atropine and obidoxime. The rats were then divided into five treatment groups consisting of midazolam after 1 or 30 min, scopolamine after 1 or 30 min and a no anticonvulsant treatment group. Five untreated rats served as controls. Animals underwent MRI on days 1, 8, 15, 29 and 50 post poisoning. Histological evaluation was performed on representative rat brains. Acute DWMRI effects, such as enhancement of temporal brain regions, and chronic effects such as ventricular enlargement and brain atrophy, depicted on T₂-weighted MRI, were significantly more prominent in late anticonvulsant treatment groups. There was no significant difference between the neuroprotective effects of midazolam and scopolamine as shown by DWMRI. Early MRI abnormalities were found to correlate significantly with histological analysis of samples obtained 15 days post treatment. In conclusion, our results demonstrate the feasibility of using DWMRI for depiction of early cytotoxic response to paraoxon and T₂-weighted MRI for later changes, thus enabling assessment of early/late brain damage as well as treatment efficacy in rats. The ability to depict these changes early and noninvasively may be applied clinically in the acute phase of organophosphate poisoning. Copyright © 2011 John Wiley & Sons, Ltd.

  4. Virtual reality in the assessment, understanding, and treatment of mental health disorders. (United States)

    Freeman, D; Reeve, S; Robinson, A; Ehlers, A; Clark, D; Spanlang, B; Slater, M


    Mental health problems are inseparable from the environment. With virtual reality (VR), computer-generated interactive environments, individuals can repeatedly experience their problematic situations and be taught, via evidence-based psychological treatments, how to overcome difficulties. VR is moving out of specialist laboratories. Our central aim was to describe the potential of VR in mental health, including a consideration of the first 20 years of applications. A systematic review of empirical studies was conducted. In all, 285 studies were identified, with 86 concerning assessment, 45 theory development, and 154 treatment. The main disorders researched were anxiety (n = 192), schizophrenia (n = 44), substance-related disorders (n = 22) and eating disorders (n = 18). There are pioneering early studies, but the methodological quality of studies was generally low. The gaps in meaningful applications to mental health are extensive. The most established finding is that VR exposure-based treatments can reduce anxiety disorders, but there are numerous research and treatment avenues of promise. VR was found to be a much-misused term, often applied to non-interactive and non-immersive technologies. We conclude that VR has the potential to transform the assessment, understanding and treatment of mental health problems. The treatment possibilities will only be realized if - with the user experience at the heart of design - the best immersive VR technology is combined with targeted translational interventions. The capability of VR to simulate reality could greatly increase access to psychological therapies, while treatment outcomes could be enhanced by the technology's ability to create new realities. VR may merit the level of attention given to neuroimaging.

  5. Life cycle assessment of sewage sludge treatment and its use on land

    DEFF Research Database (Denmark)

    Yoshida, Hiroko

    - ) into the environment were major contributors to almost all of the non-toxic impact categories. Hence, a depiction of the N balance through the target systems, beyond energy and C balance, often included in environmental assessments is vital for accurately evaluating the environmental performance of sewage sludge......Sewage sludge is generated as an end-product of wastewater treatment processes, and its management holds importance in the operation of wastewater treatment plants from both an economic and an environmental point of view. At the same time, the management of sewage sludge is becoming increasingly...... multi-focused, as renewable energy and nutrient recovery have been added to the list beyond sanitation and stabilisation of sewage sludge. In order to organise and quantify environmental benefits and associated burdens, in order to facilitate an informed decision making process, life cycle assessments...

  6. Spinal and sacroiliac assessment and treatment techniques used by osteopathic physicians in the United States (United States)

    Fryer, Gary; Morse, Christopher M; Johnson, Jane C


    Background Osteopathic manipulative medicine texts and educators advocate a range of approaches for physical assessment and treatment, but little is known about their use by osteopathic physicians in the United States. Methods A web-based survey using a 5-point Likert scale was developed and e-mailed to 777 practicing osteopathic physician members of the American Academy of Osteopathy. Responses in the "frequently" and "always" categories were combined for reporting purposes. Friedman tests were used to analyze the reported usage of each item. The effect of gender was analyzed using Mann-Whitney tests. Results One hundred seventy-one osteopathic physicians completed the survey (22%). For the assessment of spinal somatic dysfunction, paraspinal tissue texture (98%), transverse process asymmetry (89%), and tenderness (85%) were most commonly reported. Myofascial release (78%), soft tissue technique (77%), and patient self-stretches (71%) were most commonly used for treatment of the spine. For assessment of pelvic landmark asymmetry, the anterior superior iliac spine (ASIS, 87%), sacral base (82%), posterior superior iliac spine (81%), sacral sulci (78%), iliac crests (77%), and inferior lateral angle of the sacrum (74%) were commonly palpated. For assessment of sacroiliac joint motion, ASIS compression (68%) was most commonly used. Sacroiliac pain provocation tests were also employed although their use was less common than asymmetry or motion tests. Muscle energy (70%), myofascial release (67%), patient self-stretches (66%), osteopathy in the cranial field (59%), muscle strengthening exercises (58%), soft tissue technique (58%), and articulatory technique (53%) were most commonly used for treatment of the pelvis and sacroiliac. The effect of gender was significant for many of the treatment procedures, with females using more soft tissue and muscle energy and males more high-velocity techniques. The majority of respondents document the types of osteopathic

  7. Barriers and facilitators for assessment and treatment of hepatitis C virus infection in the opioid substitution treatment setting: insights from the ETHOS study. (United States)

    Treloar, C; Rance, J; Dore, G J; Grebely, J


    Provision of hepatitis C virus (HCV) assessment and treatment via opioid substitution treatment (OST) clinics has been posed as an effective means of engaging populations with high HCV prevalence. This study explores OST client and health professional reports concerning barriers and facilitators affecting the delivery and uptake of HCV care and treatment within OST settings. In-depth interviews were conducted with 57 clients, 16 staff from four NSW clinics participating in the Australian ETHOS study and three peer workers. Client participants included those who had not had HCV assessment; those who had HCV assessment only; and those who were awaiting or undertaking HCV treatment. A clear difference in decisions about HCV treatment emerged between participant groups. For those who have not been assessed, barriers to engaging with HCV care included the perception that they were physically well, were not experiencing HCV symptoms, had other life priorities and were concerned about the side effects and tolerability of treatment. Those who had engaged with care expressed motivations stemming from seeing friends becoming unwell, wanting to live longer and hearing positive stories of treatment. For those interested in HCV treatment, issues related to both provider and setting were important, such as presence of an engaged clinician, an accessible treatment pathway and availability of support. In this integrated care model, some barriers to HCV care and treatment (particularly those relating to health provider and the system) are minimized. In this setting, HCV treatment remained an unattractive option for a significant number of clients. Providing ways for those without HCV symptoms to be assessed for liver damage may be important to open up alternative conversations about HCV care. Further, the importance of a changing discourse of treatment is apparent from these data and could be enhanced by peer communication that provides information about successful treatment

  8. Occlusal wear following orthodontic treatment assessed by 3D CT scanning. (United States)

    Panos, Periklis G; Tarawneh, Fadi M; Athanasiou, Athanasios E


    To evaluate occlusal wear after comprehensive orthodontic treatment. Consecutive pre- and posttreatment dental casts of 30 patients who had received orthodontic treatment with stainless steel fixed appliances in both dental arches at the postgraduate clinic of Aristotle University of Thessaloniki were digitized by means of a three-dimensional CT scanner. The final sample consisted of 1,256 individual teeth (628 reference-free 3D superimpositions). The data were statistically assessed. Five randomly selected pairs of pre- and posttreatment casts were measured twice; the results were compared by paired t test. The magnitude of the method's error was 0.188 mm(3) (P =.229). After orthodontic treatment, almost all examined teeth had decreased in volume. The mean decrease was 1.03 mm(3) per tooth (P < .001). Treatment duration greater than 30 months was associated with a significant increase in occlusal wear (P < .001). No significant differences were found between extraction and nonextraction treatments, males and females, or different groups of teeth or malocclusions. There seems to be a relationship between orthodontic treatment and occlusal wear, which deserves serious attention and further investigation.

  9. Assessing methods for dealing with treatment switching in randomised controlled trials: a simulation study

    Directory of Open Access Journals (Sweden)

    Latimer Nicholas


    Full Text Available Abstract Background We investigate methods used to analyse the results of clinical trials with survival outcomes in which some patients switch from their allocated treatment to another trial treatment. These included simple methods which are commonly used in medical literature and may be subject to selection bias if patients switching are not typical of the population as a whole. Methods which attempt to adjust the estimated treatment effect, either through adjustment to the hazard ratio or via accelerated failure time models, were also considered. A simulation study was conducted to assess the performance of each method in a number of different scenarios. Results 16 different scenarios were identified which differed by the proportion of patients switching, underlying prognosis of switchers and the size of true treatment effect. 1000 datasets were simulated for each of these and all methods applied. Selection bias was observed in simple methods when the difference in survival between switchers and non-switchers were large. A number of methods, particularly the AFT method of Branson and Whitehead were found to give less biased estimates of the true treatment effect in these situations. Conclusions Simple methods are often not appropriate to deal with treatment switching. Alternative approaches such as the Branson & Whitehead method to adjust for switching should be considered.

  10. Cyanobacterial toxins: removal during drinking water treatment, and human risk assessment. (United States)

    Hitzfeld, B C; Höger, S J; Dietrich, D R


    Cyanobacteria (blue-green algae) produce toxins that may present a hazard for drinking water safety. These toxins (microcystins, nodularins, saxitoxins, anatoxin-a, anatoxin-a(s), cylindrospermopsin) are structurally diverse and their effects range from liver damage, including liver cancer, to neurotoxicity. The occurrence of cyanobacteria and their toxins in water bodies used for the production of drinking water poses a technical challenge for water utility managers. With respect to their removal in water treatment procedures, of the more than 60 microcystin congeners, microcystin-LR (L, L-leucine; R, L-arginine) is the best studied cyanobacterial toxin, whereas information for the other toxins is largely lacking. In response to the growing concern about nonlethal acute and chronic effects of microcystins, the World Health Organization has recently set a new provisional guideline value for microcystin-LR of 1.0 microg/L drinking water. This will lead to further efforts by water suppliers to develop effective treatment procedures to remove these toxins. Of the water treatment procedures discussed in this review, chlorination, possibly micro-/ultrafiltration, but especially ozonation are the most effective in destroying cyanobacteria and in removing microcystins. However, these treatments may not be sufficient during bloom situations or when a high organic load is present, and toxin levels should therefore be monitored during the water treatment process. In order to perform an adequate human risk assessment of microcystin exposure via drinking water, the issue of water treatment byproducts will have to be addressed in the future.

  11. The Facial Aesthetic index: An additional tool for assessing treatment need (United States)

    Sundareswaran, Shobha; Ramakrishnan, Ranjith


    Objectives: Facial Aesthetics, a major consideration in orthodontic diagnosis and treatment planning, may not be judged correctly and completely by simply analyzing dental occlusion or osseous structures. Despite this importance, there is no index to guarantee availability of treatment or prioritize patients based on their soft tissue treatment needs. Individuals having well-aligned teeth but unaesthetic convex profiles do not get included for treatment as per current malocclusion indices. The aim of this investigation is to develop an aesthetic index based on facial profiles which could be used as an additional tool with malocclusion indices. Materials and Methods: A chart showing typical facial profile changes due to underlying malocclusions was generated by soft tissue manipulations of standardized profile photographs of a well-balanced male and female face. A panel of 62 orthodontists judged the profile photographs of 100 patients with different soft tissue patterns for assessing profile variations and treatment need. The index was later tested in a cross-section of school population. Statistical analysis was done using “irr” package of R environment version 2.15.1. Results: The index exhibited very good reliability in determining profile variations (Fleiss kappa 0.866, P Aesthetic index, based on patient's soft tissue profile requirements is proposed, which can complement existing indices to ensure treatment to those in need. PMID:27127752

  12. Framework for feasibility assessment and performance analysis of riverbank filtration systems for water treatment

    KAUST Repository

    Sharma, Saroj K.


    Bank filtration (BF) is an attractive, robust and reliable water treatment technology. It has been used in Europe and USA for a long time; however experience with this technology so far is site specific. There are no guidelines or tools for transfer of this technology to other locations, specifically to developing countries. A four-step methodology was developed at UNESCO-IHE to analyse feasibility and to predict the performance of BF for water treatment. This included (i) hydraulic simulation using MODFLOW; (ii) determination of share of bank filtrate using NASRI BF simulator; (iii) prediction of water quality from a BF system using the water quality guidelines developed and (iv) comparison of the costs of BF systems and existing conventional surface water treatment systems for water treatment. The methodology was then applied to assess feasibility of BF in five cities in Africa. It was found that in most of the cities studied BF is a feasible and attractive option from hydraulic, water quality as well as operational cost considerations. Considerable operational and maintenance costs saving can be achieved and water quality can be further improved by switching from conventional chemical-based surface water treatment to BF or at least by replacing some of the treatment units with BF systems. © IWA Publishing 2012.

  13. Instrumented gait analysis for planning and assessment of treatment in cerebral palsy


    Thomas Raji; Ganesh T; George J; Venugopal K; Macaden A; Poonnoose P; Tharion G; Devasahayam S; Bhattacharji S


    Background: To improve the walking efficiency of children with cerebral palsy, gait must be documented accurately so that the abnormalities can be assessed and the best treatment option can be selected. Methods: Gait was analysed using Selspot kinematic system with a Kistler force plate and the motion analysis ambulatory EMG system connected to a personal computer. Results: Walking speed and stride length had improved in children. Conclusion: Gait analysis can help to accomplish improv...

  14. Spinal and sacroiliac assessment and treatment techniques used by osteopathic physicians in the United States


    Fryer, Gary; Morse, Christopher M; Johnson, Jane C


    Background Osteopathic manipulative medicine texts and educators advocate a range of approaches for physical assessment and treatment, but little is known about their use by osteopathic physicians in the United States. Methods A web-based survey using a 5-point Likert scale was developed and e-mailed to 777 practicing osteopathic physician members of the American Academy of Osteopathy. Responses in the "frequently" and "always" categories were combined for reporting purposes. Friedman tests w...

  15. Computerized acoustic assessment of treatment efficacy of nebulized epinephrine and albuterol in RSV bronchiolitis


    Talmon Gil; Tov Naveh; Shoval Shay; Elias Nael; Beck Raphael; Godfrey Simon; Bentur Lea


    Abstract Aim We evaluated the use of computerized quantification of wheezing and crackles compared to a clinical score in assessing the effect of inhaled albuterol or inhaled epinephrine in infants with RSV bronchiolitis. Methods Computerized lung sounds analysis with quantification of wheezing and crackles and a clinical score were used during a double blind, randomized, controlled nebulized treatment pilot study. Infants were randomized to receive a single dose of 1 mgr nebulized l-epinephr...

  16. Stopwatch-assessed duration of erection: a new measure of the efficacy of erectile dysfunction treatments. (United States)

    Rosenberg, M T; Miner, M M; Barnes, A L; Janning, S W


    Results are reported from the first two adequate trials of the PDE-5 inhibitor vardenafil using a stopwatch to precisely measure erection duration in men with ED. Two randomized, multicenter, double-blind, placebo-controlled trials were conducted: a crossover 4-week treatment in men with ED (ENDURANCE) and a parallel group, 12-week treatment in men with ED and dyslipidemia (the dyslipidemia study). Stopwatch-assessed duration of erection leading to successful intercourse measured by Sexual Encounter Profile question-3 (SEP-3) was the primary end point in ENDURANCE and one of the secondary end points in the dyslipidemia study. Other efficacy end points included responses to SEP-2, SEP-3 and International Index of Erectile Function-Erectile Function (IIEF-EF) domain scores. Adverse events were recorded. Duration of erection (least squares mean ± s.e.) leading to successful intercourse was statistically superior in men receiving vardenafil versus placebo (12.8 ± 1.0 versus 5.5 ± 1.0 min; p<0.001 in ENDURANCE and 10.0 ± 0.8 versus 3.4 ± 0.8; p<0.001 in the dyslipidemia study), with a difference of 7.4 and 6.6 min, respectively, between treatment groups. Results for SEP-2, SEP-3 and IIEF-EF domain scores were consistent across studies and with stopwatch-assessed measures for duration of erection. Vardenafil was well tolerated. Duration of erection leading to successful intercourse is an important indicator of the efficacy of ED treatment. The stopwatch approach offers an alternative, precise and reproducible measure of efficacy. We propose this approach as a potential new paradigm for assessing the efficacy of ED treatments.

  17. Subcutaneous infection model facilitates treatment assessment of secondary Alveolar echinococcosis in mice.

    Directory of Open Access Journals (Sweden)

    Tatiana Küster

    Full Text Available Alveolar echinococcosis (AE in humans is a parasitic disease characterized by severe damage to the liver and occasionally other organs. AE is caused by infection with the metacestode (larval stage of the fox tapeworm Echinococcus multilocularis, usually infecting small rodents as natural intermediate hosts. Conventionally, human AE is chemotherapeutically treated with mebendazole or albendazole. There is, however still the need for improved chemotherapeutical options. Primary in vivo studies on drugs of interest are commonly performed in small laboratory animals such as mice and Mongolian jirds, and in most cases, a secondary infection model is used, whereby E. multilocularis metacestodes are directly injected into the peritoneal cavity or into the liver. Disadvantages of this methodological approach include risk of injury to organs during the inoculation and, most notably, a limitation in the macroscopic (visible assessment of treatment efficacy. Thus, in order to monitor the efficacy of chemotherapeutical treatment, animals have to be euthanized and the parasite tissue dissected. In the present study, mice were infected with E. multilocularis metacestodes through the subcutaneous route and were then subjected to chemotherapy employing albendazole. Serological responses to infection were comparatively assessed in mice infected by the conventional intraperitoneal route. We demonstrate that the subcutaneous infection model for secondary AE facilitates the assessment of the progress of infection and drug treatment in the live animal.

  18. Handover of patient information from the crisis assessment and treatment team to the inpatient psychiatric unit. (United States)

    Waters, Amanda; Sands, Natisha; Keppich-Arnold, Sandra; Henderson, Kathryn


    Handover, or the communication of patient information between clinicians, is a fundamental component of health care. Psychiatric settings are dynamic environments relying on timely and accurate communication to plan care and manage risk. Crisis assessment and treatment teams are the primary interface between community and mental health services in many Australian and international health services, facilitating access to assessment, treatment, and admission to hospital. No previous research has investigated the handover between crisis assessment and treatment teams and inpatient psychiatric units, despite the importance of handover to care planning. The aim of the present study was to identify the nature and types of information transferred during these handovers, and to explore how these guides initial care planning. An observational, exploratory study design was used. A 20-item handover observation tool was used to observe 19 occasions of handover. A prospective audit was undertaken on clinical documentation arising from the admission. Clinical information, including psychiatric history and mental state, were handed over consistently; however, information about consumer preferences was reported less consistently. The present study identified a lack of attention to consumer preferences at handover, despite the current focus on recovery-oriented models for mental health care, and the centrality of respecting consumer preferences within the recovery paradigm. © 2014 Australian College of Mental Health Nurses Inc.

  19. An update on childhood bone health: mineral accrual, assessment and treatment. (United States)

    Sopher, Aviva B; Fennoy, Ilene; Oberfield, Sharon E


    To update the reader's knowledge about the factors that influence bone mineral accrual and to review the advances in the assessment of bone health and treatment of bone disorders. Maternal vitamin D status influences neonatal calcium levels, bone mineral density (BMD) and bone size. In turn, BMD z-score tends to track in childhood. These factors highlight the importance of bone health as early as fetal life. Dual-energy x-ray absorptiometry is the mainstay of clinical bone health assessment in this population because of the availability of appropriate reference data. Recently, more information has become available about the assessment and treatment of bone disease in chronically ill pediatric patients. Bone health must become a health focus starting prenatally in order to maximize peak bone mass and to prevent osteoporosis-related bone disease in adulthood. Vitamin D, calcium and weight-bearing activity are the factors of key importance throughout childhood in achieving optimal bone health as BMD z-score tracks through childhood and into adulthood. Recent updates of the International Society for Clinical Densitometry focus on the appropriate use of dual-energy x-ray absorptiometry in children of all ages, including children with chronic disease, and on the treatment of pediatric bone disease.

  20. Assessing the costs of municipal solid waste treatment technologies in developing Asian countries. (United States)

    Aleluia, João; Ferrão, Paulo


    The management of municipal solid waste (MSW) is one of the main costs incurred by local authorities in developing countries. According to some estimates, these costs can account for up to 50% of city government budgets. It is therefore of importance that policymakers, urban planners and practitioners have an adequate understanding of what these costs consist of, from collection to final waste disposal. This article focuses on a specific stage of the MSW value chain, the treatment of waste, and it aims to identify cost patterns associated with the implementation and operation of waste treatment approaches in developing Asian countries. An analysis of the capital (CAPEX) and operational expenditures (OPEX) of a number of facilities located in countries of the region was conducted based on a database gathering nearly 100 projects and which served as basis for assessing four technology categories: composting, anaerobic digestion (AD), thermal treatment, and the production of refuse-derived fuel (RDF). Among these, it was found that the least costly to invest, asa function of the capacity to process waste, are composting facilities, with an average CAPEX per ton of 21,493 USD 2015 /ton. Conversely, at the upper end featured incineration plants, with an average CAPEX of 81,880 USD 2015 /ton, with this treatment approach ranking by and large as the most capital intensive of the four categories assessed. OPEX figures of the plants, normalized and analyzed in the form of OPEX/ton, were also found to be higher for incineration than for biological treatment methods, although on this component differences amongst the technology groups were less pronounced than those observed for CAPEX. While the results indicated the existence of distinct cost implications for available treatment approaches in the developing Asian context, the analysis also underscored the importance of understanding the local context asa means to properly identify the cost structure of each specific plant

  1. Development of neutron imaging quantitative data treatment to assess conservation products in cultural heritage. (United States)

    Realini, Marco; Colombo, Chiara; Conti, Claudia; Grazzi, Francesco; Perelli Cippo, Enrico; Hovind, Jan


    Distribution, penetration depth and amount of new mineralogical phases formed after the interaction between an inorganic treatment and a matrix are key factors for the evaluation of the conservation treatment behaviour. Nowadays, the conventional analytical methodologies, such as vibrational spectroscopies, scanning electron microscopy and X-ray diffraction, provide only qualitative and spot information. Here, we report, for the first time, the proof of concept of a methodology based on neutron imaging able to achieve quantitative data useful to assess the formation of calcium oxalate in a porous carbonatic stone treated with ammonium oxalate. Starting from the neutron attenuation coefficient of Noto stone-treated specimens, the concentrations of newly formed calcium oxalate and the diffusion coefficient have been calculated for both sound and decayed substrates. These outcomes have been also used for a comparative study between different treatment modalities. Graphical abstract Horizontal slice at 300 mm depth and CaOx molar density profile by NEUTRA output.

  2. Assessment of dissociation in Bosnian treatment-seeking refugees in Denmark

    DEFF Research Database (Denmark)

    Palic, Sabina; Carlsson, Jessica; Armour, Cherie


    Background: Dissociative experiences are common in traumatized individuals, and can sometimes be mistaken for psychosis. It is difficult to identify pathological dissociation in the treatment of traumatized refugees, because there is a lack of systematic clinical descriptions of dissociative...... phenomena in refugees. Furthermore, we are currently unaware of how dissociation measures perform in this clinical group. Aims: To describe the phenomenology of dissociative symptoms in Bosnian treatment-seeking refugees in Denmark. Method: As a part of a larger study, dissociation was assessed...... systematically in 86 Bosnian treatment-seeking refugees using a semi-structured clinical interview (Structured Interview for Disorders of Extreme Stress-dissociation subscale; SIDES-D) and a self-report scale (Dissociative Experiences Scale; DES). Results: The SIDES-D indicated twice as high prevalence...

  3. Assessment and Treatment of Abuse Risk in Opioid Prescribing for Chronic Pain

    Directory of Open Access Journals (Sweden)

    Robert N. Jamison


    Full Text Available Opioid analgesics provide effective treatment for noncancer pain, but many physicians have concerns about adverse effects, tolerance, and addiction. Misuse of opioids is prominent in patients with chronic back pain and early recognition of misuse risk could help physicians offer adequate patient care while implementing appropriate levels of monitoring to reduce aberrant drug-related behaviors. In this review, we discuss opioid abuse and misuse issues that often arise in the treatment of patients with chronic back pain and present an overview of assessment and treatment strategies that can be effective in improving compliance with the use of prescription opioids for pain. Many persons with chronic back pain have significant medical, psychiatric and substance use comorbidities that affect treatment decisions and a comprehensive evaluation that includes a detailed history, physical, and mental health evaluation is essential. Although there is no “gold standard” for opioid misuse risk assessment, several validated measures have been shown to be useful. Controlled substance agreements, regular urine drug screens, and interventions such as motivational counseling have been shown to help improve patient compliance with opioids and to minimize aberrant drug-related behavior. Finally, we discuss the future of abuse-deterrent opioids and other potential strategies for back pain management.

  4. A usability assessment on a virtual reality system for panic disorder treatment (United States)

    Lee, Jaelin; Kawai, Takashi; Yoshida, Nahoko; Izawa, Shuhei; Nomura, Shinobu; Eames, Douglas; Kaiya, Hisanobu


    The authors have developed a virtual reality exposure system that reflects the Japanese culture and environment. Concretely, the system focuses on the subway environment, which is the environment most patients receiving treatment for panic disorder at hospitals in Tokyo, Japan tend to avoid. The system is PC based and features realistic video images and highly interactive functionality. In particular, the system enables instant transformation of the virtual space and allows situations to be freely customized according to the condition and symptoms expressed by each patient. Positive results achieved in therapy assessments aimed at patients with panic disorder accompanying agoraphobia indicate the possibility of indoor treatment. Full utilization of the functionality available requires that the interactive functions be easily operable. Accordingly, there appears to be a need for usability testing aimed at determining whether or not a therapist can operate the system naturally while focusing fully on treatment. In this paper, the configuration of the virtual reality exposure system focusing on the subway environment is outlined. Further, the results of usability tests aimed at assessing how naturally it can be operated while focusing fully on treatment are described.

  5. Biochemical bone markers in the assessment and pamidronate treatment of children and adolescents with osteogenesis imperfecta. (United States)

    Aström, E; Magnusson, P; Eksborg, S; Söderhäll, S


     To assess the role of biochemical bone markers in classification of children with osteogenesis imperfecta (OI), their possible association with vertebral compression fractures in milder forms of OI and their role in monitoring of intravenous pamidronate (APD) treatment.  Serum total alkaline phosphatase (ALP), bone ALP isoforms (in a subgroup), osteocalcin, type I procollagen carboxy-terminal propeptide, carboxy-terminal telopeptide of type I collagen, and urine deoxypyridinoline (DPD) were measured in a cross-sectional study of 130 untreated individuals, 0.25-20.9years (median 6.7), with OI types I, III and IV. Of those, sixty-nine were also assessed longitudinally during monthly APD treatment. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry.  Significant differences in bone markers, however not sufficient for individual clinical use, were found in the larger untreated group but not between subgroups with or without vertebral compressions. All bone markers decreased during treatment for 1.0-12.5years, but with different relative amounts. Changes were not correlated to the improvement in BMD, mobility or pain.   Bone markers are, despite significant differences, not useful for the classification of OI type in the individual child and are not associated with vertebral compressions. Serum ALP and urinary DPD are sensitive in monitoring bisphosphonate treatment. © 2010 The Author(s)/Journal Compilation © 2010 Foundation Acta Paediatrica.

  6. Computerized assessment facilitates disclosure of sensitive HIV risk behaviors among African Americans entering substance abuse treatment. (United States)

    Caldwell, Diana H; Jan, Gryczynski


    Individuals entering substance abuse treatment are at elevated risk for HIV infection, and clinicians must generally rely on patient self-report to gauge their involvement in risk behaviors. Strategies to improve accurate reporting of personally sensitive or stigmatizing risk behaviors are needed. This study compared computerized and face-to-face interview methods in eliciting self-disclosure of HIV risk behaviors among a high-risk sample of urban African Americans entering substance abuse treatment (N = 146). Participants completed a standardized HIV risk behavior screening as a face-to-face interview. Several days later, the same participants completed a computerized self-interview with the same measure, covering the same time frame. Disclosure rates for many sensitive risk behaviors were considerably higher on the computerized interview. Participants had significantly higher odds of disclosure on the computerized interview compared to the face-to-face interview on 2 of 6 drug risk behaviors examined (ORs between 2.75 and 3.15) and 9 of 13 sex risk behaviors examined (ORs between 1.60 and 6.45). The advantage of the computerized interview was most evident for highly stigmatized behaviors, such as unprotected sex with someone other than a spouse or main partner (OR = 3.93; p behavior assessment with African Americans entering substance abuse treatment. Computerized assessment of HIV risk behaviors may be clinically useful in substance abuse treatment and other healthcare venues serving high-risk populations.

  7. Assessing treatment effects in older breast cancer patients: systematic review of observational research methods. (United States)

    de Glas, N A; Kiderlen, M; de Craen, A J M; Hamaker, M E; Portielje, J E A; van de Velde, C J H; Liefers, G J; Bastiaannet, E


    Solid evidence of treatment effects in older women with breast cancer is lacking, as they are generally underrepresented in randomized clinical trials on which guideline recommendations are based. An alternative way to study treatment effects in older patients could be to use data from observational studies. However, using appropriate methods in analyzing observational data is a key condition in order to draw valid conclusions, as directly comparing treatments generally results in biased estimates due to confounding by indication. The aim of this systematic review was to investigate the methods that have been used in observational studies that assessed the effects of breast cancer treatment on survival, breast cancer survival and recurrence in older patients (aged 65 years and older). Studies were identified through systematic review of the literature published between January 1st 2009 and December 13th 2013 in the PubMed database and EMBASe. Finally, 31 studies fulfilled the inclusion criteria. Of these, 22 studies directly compared two treatments. Fifteen out of these 22 studies addressed the problem of confounding by indication, while seven studies did not. Nine studies used some form of instrumental variable analysis. In conclusion, the vast majority of observational studies that investigate treatment effects in older breast cancer patients compared treatments directly. These studies are therefore likely to be biased. Observational research will be essential to improve treatment and outcome of older breast cancer patients, but the use of accurate methods is essential to draw valid conclusions from this type of data. Copyright © 2015 Elsevier Ltd. All rights reserved.


    Directory of Open Access Journals (Sweden)

    S. A. Pribylov


    Full Text Available The aim of this study is to measure the level of the endothelin-1 in blood samples and to assess vasoactive function of the endothelial in asthma patients with different phenotypes and to develop the methods of the objective assess of the ongoing treatment. Materials and methods. 119 asthma patients were separated into several phenotypes: patients with atopic asthma (60 pat; patients with ACOS (35 pat; asthma with obesity (24 pat. In all patients endothelium-dependent vasodilation and plasma level of endothelin-1 were assessed. Results. Endothelial dysfunction revealed in all asthma phenotypes. The highest level of the endothelin-1 shown in ACOS patients. In patients which achieved asthma control during three month of the anti-inflammatory therapy showed decreasing of the endothelin-1 level by 1,5 times in comparison with basic level (0,35 ± 0,06 fmol/ml and 0,64 ± 0,15 fmol/ml respectively, р < 0,01. But in patients with persistent symptoms and/or without lung function improvement the level of the endothelin-1 was not decreased significantly. Conclusions. Change of the functional conditions of the endothelial depend on the time and severity and phenotype of the asthma. The endothelin-1 level and the endothelium-dependent vasodilatation assess on the course of the treatment allow to reveal success of this anti- inflammatory therapy.

  9. The assessment and treatment of prosodic disorders and neurological theories of prosody. (United States)

    Diehl, Joshua J; Paul, Rhea


    In this article, we comment on specific aspects of Peppé (Peppé, 2009). In particular, we address the assessment and treatment of prosody in clinical settings and discuss current theory on neurological models of prosody. We argue that in order for prosodic assessment instruments and treatment programs to be clinical effective, we need assessment instruments that: (1) have a representative normative comparison sample and strong psychometric properties; (2) are based on empirical information regarding the typical sequence of prosodic acquisition and are sensitive to developmental change; (3) meaningfully subcategorize various aspects of prosody; (4) use tasks that have ecological validity; and (5) have clinical properties, such as length and ease of administration, that allow them to become part of standard language assessment batteries. In addition, we argue that current theories of prosody processing in the brain are moving toward network models that involve multiple brain areas and are crucially dependent on cortical communication. The implications of these observations for future research and clinical practice are outlined.

  10. Implicit and Explicit Drug-Related Cognitions during Detoxification Treatment Are Associated with Drug Relapse: An Ecological Momentary Assessment Study (United States)

    Marhe, Reshmi; Waters, Andrew J.; van de Wetering, Ben J. M.; Franken, Ingmar H. A.


    Objective: Relapse is a major problem in drug addiction treatment. Both drug craving and drug-related cognitions (e.g., attentional bias and implicit attitudes to drugs) may contribute to relapse. Using ecological momentary assessments, we examined whether craving and cognitions assessed during drug detoxification treatment were associated with…

  11. Influence of data collection schemes on the Life Cycle Assessment of a municipal wastewater treatment plant

    DEFF Research Database (Denmark)

    Yoshida, Hiroko; Clavreul, Julie; Scheutz, Charlotte


    A Life Cycle Assessment (LCA) of a municipal wastewater treatment plant (WWTP) was conducted to illustrate the effect of an emission inventory data collection scheme on the outcomes of an environmental impact assessment. Due to their burden in respect to data collection, LCAs often rely heavily...... on input data coverage. Due to the threshold on reporting value, the E-PRTR did not capture the impact for particulate matter emission, terrestrial acidification, or terrestrial eutrophication. While the current practice can capture more than 90% of non-carcinogenic human toxicity and marine eutrophication......, and chemicals, which do not need to be disclosed currently under E-PRTR. The incidental release of pollutants was also assessed by employing a scenario-based approach, the results of which demonstrated that these non-routine emissions could increase overall WWTP greenhouse gas emissions by between 113 and 210...

  12. Pain assessment in time to get pain treatment on time – patients’ perspective of time during pain assessment after spine surgery

    DEFF Research Database (Denmark)

    Kaptain, Kirsten; Bregnballe, Vibeke; Dreyer, Pia

    their pain. Furthermore, patients experienced that the nurses kept an eye on them by frequently contact and by being available for questions about pain. Conclusion: Pain experiences changes rapidly and therefore it is important to assess pain in time. Accurate pain assessment is essential to achieve...... an efficient and individual pain treatment on time. Knowl-edge about how time affect patients pain assessment is important for nurses in order to make patients participate in pain assessment....

  13. Musculoskeletal Conditions of the Foot and Ankle: Assessments and Treatment Options (United States)

    Rao, Smita; Riskowski, Jody; Hannan, Marian T.


    Musculoskeletal conditions of the foot and ankle are an important public health challenge due to their increasing incidence combined with their substantial negative impact on patients’ quality of life. Non-pharmacological treatments serve as the first line of treatment and are frequently used for patients with musculoskeletal conditions of the foot and ankle. This review provides a summary of the assessments and non-invasive treatment options based upon available evidence. Recent studies show that individuals with foot and ankle pain have multiple co-existing impairments in alignment, motion, load distribution and muscle performance that may be evident in static and/or dynamic tasks. Additionally, both clinical and epidemiological studies support the inter-dependence between the foot and proximal joints. For instance, aberrant foot structure has been linked to foot osteoarthritis (OA), as well as OA and pain at the knee and hip. Most recently, advances in motion capture technology and plantar load distribution measurement offer opportunities for precise dynamic assessments of the foot and ankle. In individuals with musculoskeletal conditions of the foot and ankle, the chief objectives of treatment are to afford pain relief, restore mechanics (alignment, motion and/or load distribution) and return the patient to their desired level of activity participation. Given that most patients present with multiple impairments, combinational therapies that target foot-specific as well as global impairments have shown promising results. In particular, in individuals with rheumatoid arthritis and other rheumatic diseases, comprehensive rehabilitation strategies including early detection, foot-based interventions (such as orthoses) and wellness-based approaches for physical activity and self-management have been successful. While significant improvements have been made in the last decade to the assessment and treatment of foot and ankle conditions, few randomized clinical

  14. Psychometrics of a new questionnaire to assess glaucoma adherence: the Glaucoma Treatment Compliance Assessment Tool (an American Ophthalmological Society thesis). (United States)

    Mansberger, Steven L; Sheppler, Christina R; McClure, Tina M; Vanalstine, Cory L; Swanson, Ingrid L; Stoumbos, Zoey; Lambert, William E


    To report the psychometrics of the Glaucoma Treatment Compliance Assessment Tool (GTCAT), a new questionnaire designed to assess adherence with glaucoma therapy. We developed the questionnaire according to the constructs of the Health Belief Model. We evaluated the questionnaire using data from a cross-sectional study with focus groups (n = 20) and a prospective observational case series (n=58). Principal components analysis provided assessment of construct validity. We repeated the questionnaire after 3 months for test-retest reliability. We evaluated predictive validity using an electronic dosing monitor as an objective measure of adherence. Focus group participants provided 931 statements related to adherence, of which 88.7% (826/931) could be categorized into the constructs of the Health Belief Model. Perceived barriers accounted for 31% (288/931) of statements, cues-to-action 14% (131/931), susceptibility 12% (116/931), benefits 12% (115/931), severity 10% (91/931), and self-efficacy 9% (85/931). The principal components analysis explained 77% of the variance with five components representing Health Belief Model constructs. Reliability analyses showed acceptable Cronbach's alphas (>.70) for four of the seven components (severity, susceptibility, barriers [eye drop administration], and barriers [discomfort]). Predictive validity was high, with several Health Belief Model questions significantly associated (P <.05) with adherence and a correlation coefficient (R (2)) of .40. Test-retest reliability was 90%. The GTCAT shows excellent repeatability, content, construct, and predictive validity for glaucoma adherence. A multisite trial is needed to determine whether the results can be generalized and whether the questionnaire accurately measures the effect of interventions to increase adherence.

  15. Radiographic assessment of photodynamic therapy as an adjunctive treatment on induced periodontitis in immunosuppressed rats (United States)

    FERNANDES, Leandro Araújo; MARTINS, Thiago Marchi; de ALMEIDA, Juliano Milanezi; THEODORO, Letícia Helena; GARCIA, Valdir Gouveia


    Objective The aim of this study was to assess radiographically the effect of photodynamic therapy (PDT) as an adjunctive treatment to scaling and root planing (SRP) on induced periodontitis in dexamethasone-induced immunosuppressed rats. Material and Methods The animals were divided into 2 groups: ND group (n=60): saline treatment; D group (n=60): dexamethasone treatment. In both ND and D groups, periodontal disease was induced by the placement of a ligature in the left first mandibular molar. After 7 days, ligature was removed and all animals received SRP, being divided according to the following treatments: SRP: saline and PDT: phenothiazinium dye (TBO) plus laser irradiation. Ten animals per treatment were killed at 7, 15 and 30 days. The distance between the cementoenamel junction and the height of the alveolar bone crest in the mesial surface of the mandibular left first molars was determined in millimeters in each radiograph. The radiographic values were analyzed statistically by ANOVA and Tukey's test at a p value periodontitis in dexamethasone-induced immunosuppressed rats. PMID:20857000

  16. [Preoperative workup to assess indication for laparoscopic treatment in gastroesophageal reflux disease]. (United States)

    Pérez-Holanda, S; Urdiales, G L; Fernández, J A; España, L; Rodríguez-Rubio, J; Martínez, M D; Fernández, F; Tojo, S; Fernández-Muñiz, P; Calleja, M; Valverde, D


    antireflux surgery performed by an experienced surgeon is a maintenance option for patients with well-documented gastroesophageal reflux disease (GERD). Well-documented GERD is difficult to find, as GERD is a multifactorial disease in which the gastroesophageal junction, with its special anatomical and functional components, is important. In order to examine patient preoperative workups, and their indication for surgical treatment in GERD, we retrospectively studied patients who underwent a laparoscopic antireflux procedure. preoperative workups in patients from our health care area who underwent a laparoscopic antireflux procedure from December 1997 to February 2007 were retrospectively analyzed. Data related to epidemiological findings, symptoms, morphologic and functional evaluation, medical therapy, and indication for surgical treatment were recorded and statistically analyzed by means of a bivariate test. Differences were significant when the p value was equal to or less than 0.05. 100 patients (50 % female, 51.31 +/- 13.53 years of age) underwent a laparoscopic antireflux surgery after 56.47 +/- 61.33 months with symptoms. Ninety-five percent of patients had an anatomical abnormality. The pH monitoring test diagnosed three quarters of cases. The most frequent indication for GERD treatment was persistent or recurrent esophagitis despite adequate medical treatment (52 cases). based on our preoperative workup, as described, 100 percent of subjects were well documented and diagnosed with GERD (both non-erosive reflux disease and erosive reflux disease), and their indication for laparoscopic treatment was retrospectively assessed in 94% of cases.

  17. Issues in the psychopharmacologic assessment and treatment of the orthodox Jewish patient. (United States)

    Feinberg, S Shalom


    As with members of other cultural and religious groups, patients within the Orthodox Jewish community present with their own distinct clinical psychiatric issues related to their unique beliefs and practices. This article reviews the existing literature and anecdotal experience on the psychopharmacologic assessment and treatment of Orthodox Jewish patients. Specific aspects examined include this group's perceived intense stigma in receiving treatment, the priority this community places on cognitive functioning, and how the influence of Jewish laws on marriage and sexual practices impacts one's treatment decisions. The relevance of Jewish dietary laws, the Sabbath, and the community's interest in alternative treatments are also discussed. The limited ethno-psychopharmacology research related to Orthodox Jewish psychiatric patients is reviewed. We conclude that understanding issues such as these is critical if one is going to work within this cultural system in order to successfully address their mental health issues. However, the dearth of controlled research in this community needs to be addressed to provide more effective treatment.

  18. Prospective assessment of perioperative course in 2648 patients after surgical treatment of benign prostatic obstruction. (United States)

    Bach, Thorsten; Wölbling, Felix; Gross, Andreas J; Netsch, C; Tauber, S; Pottek, Tobias; Wülfing, Christian; Brunken, Claus


    TUR-prostate (TUR-P) is considered the reference method for surgical treatment of benign prostatic obstruction (BPO); Greenlight laser photoselective vaporization (PVP) and thulium laser vapoenucleation (ThuVEP) have also been established as treatments of BPO. Objective of this prospective observation was to compare a large numbers of patients treated in everyday routine. This prospective multicentre data collection assesses morbidity and perioperative course of consecutive men treated with BPO-related transurethral surgery between 2011 and 2014 in a German metropolis area with TUR-P, PVP or ThuVEP. Two thousand six hundred and forty-eight patients have been treated in the time period. All treatment options achieved immediate improvement of voiding parameters. Multivariate analyses proved shorter hospital stay after laser treatments as compared to resection (p BPO is effective and safe independent of the surgical procedure. Volume reduction is most effective in ThuVEP; PVP has the lowest rate of severe complications. Laser treatment is associated with shorter hospital stay. Surgery under ongoing anticoagulation prolonged the post-operative hospital stay.

  19. Assessment of upper airway size after orthopedic treatment for maxillary protrusion or mandibular retrusion. (United States)

    Aksu, Muge; Gorucu-Coskuner, Hande; Taner, Tulin


    The aim of this retrospective study was to find out whether different Class II treatments would affect the airway sizes of patients having maxillary protrusion or mandibular retrusion. The study sample comprised 57 Class II patients whose upper airway sizes were not significantly different at the start of treatment and whose sagittal skeletal jaw relationships showed that they had maxillary protrusion or mandibular retrusion. Twenty-two of them were treated with cervical headgear, 16 with activator, and 19 were selected as a control. Lateral cephalograms at the start of treatment and the end of orthopedic treatment were assessed. The intragroup comparisons were performed by using the paired-samples t test, and intergroup comparisons of the skeletal features and upper airways were performed with 1-way analysis of variance, with the Tukey test as a second step, at P mandibular retrusion group when compared with both maxillary protrusion and control groups. No statistically significant difference between the maxillary protrusion and the mandibular retrusion groups was found regarding the upper airway sizes after cervical headgear or activator treatments, respectively (P > 0.05). The only significant differences observed in airway variables were at the middle airway space of the activator and control groups with an increase of 1.6 ± 2.5 mm and a decrease of 1.5 ± 2.3 mm, respectively. Orthopedic treatment with either cervical headgear or activator did not result in different upper airway changes, but activator treatment resulted in increased middle airway space with regard to the Class II control group. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

  20. Environmental evaluation of transfer and treatment of excess pig slurry by life cycle assessment. (United States)

    Lopez-Ridaura, Santiago; Werf, Hayo van der; Paillat, Jean Marie; Le Bris, Bertrand


    Slurry management is a central topic in the agronomic and environmental analysis of intensive livestock production systems. The objective of this study is to compare the environmental performance of two scenarios of collective slurry management for the disposal of excess nitrogen from animal manure. The scenarios are the transfer of slurry and its injection to crop land, and the treatment of slurry in a collective biological treatment station. The study is based on a real case in the West of France, where a group of farmers is developing a collective plan for the disposal of almost 7000 m(3) of excess pig slurry. The evaluation is carried out by Life Cycle Assessment, where emissions and resource consumption are quantified and aggregated into four environmental impact categories: eutrophication, acidification, climate change, and non-renewable energy use. Ammonia emitted is the most important contributor to acidification and eutrophication, while methane contributes most to climate change. Both ammonia and methane are mostly emitted during the storage of slurry and, in the case of the treatment scenario, also during composting the solid fraction of the slurry. The two management strategies are similar with respect to climate change, whereas eutrophication and acidification are twice as large for treatment relative to transfer. Electricity needed for the treatment process is the main contributor to non-renewable energy use for the treatment scenario, while the transfer scenario represents a net energy saving, as energy saved by the reduction of mineral fertiliser use more than compensates for the energy needed for transport and injection of slurry. The overall environmental performance of transfer is better than that of treatment, as it involves less acidification, eutrophication and non-renewable energy use. The method employed and the results obtained in this study can provide elements for a transparent discussion of the advantages and disadvantages of contrasting

  1. Development and validation of the functional assessment of chronic illness therapy treatment satisfaction (FACIT TS) measures. (United States)

    Peipert, John D; Beaumont, Jennifer L; Bode, Rita; Cella, Dave; Garcia, Sofia F; Hahn, Elizabeth A


    To develop and validate a new functional assessment of chronic illness therapy (FACIT) measure of satisfaction with treatment for chronic illnesses such as cancer and HIV/AIDS. To define domains and generate items, a literature review informed creation of semi-structured interview guides for patients and an international expert panel of clinicians and researchers. Patients and experts also rated 15 areas of satisfaction for relevance. The final list of items underwent further refinement by the original expert panel and a new group of clinical experts. Items were tested in four studies (primarily lung cancer) and data were pooled for analysis. Exploratory and confirmatory factor analyses (CFA), and item response theory modeling were conducted to evaluate dimensionality. Internal consistency reliability and test-retest reliability were both evaluated. Validity was evaluated by correlating the FACIT subscale scores and measures of comparable concepts and by testing the scales' ability to distinguish people according to their overall treatment satisfaction. Two instruments were created: the FACIT TS-general (G), an overall evaluation of current treatment, and the FACIT TS-patient satisfaction (PS), a measure of patient satisfaction. CFA results were not optimal for a five-factor solution for PS. Internal consistency reliability met psychometric standards (≥0.70) for all PS subscales. Construct validity was established for the PS subscales: Physician Communication, Treatment Staff Communication, Technical Competence, Confidence and Trust, and Nurse Communication. The two instruments generated here offer a new way to assess several key dimensions of patient satisfaction with treatment, especially for people with lung cancer.

  2. An objective assessment of botulinum toxin type A injection in the treatment of post-facial palsy synkinesis and hyperkinesis using the synkinesis assessment questionnaire. (United States)

    Neville, Catriona; Venables, Vanessa; Aslet, Margaret; Nduka, Charles; Kannan, Ruben


    This study aimed to provide reliable and valid evidence that botulinum toxin type A (BTX-A) is a successful treatment for facial synkinesis in facial palsy by using the synkinesis assessment questionnaire (SAQ) tool. Fifty-one patients completed questionnaires pre- and post-BTX-A treatment over 103 cycles of treatment. Each patient was individually assessed and then treated according to their presenting symptoms with a dosage in each injection site of between 0.5 and 5 U of BTX-A. A two-tailed paired samples t-test was used to compare the scores for each question before and after treatment. A significant difference was found between all scores before and after treatment at the level of p < 0.05. There was not only an improvement in the mean score in the post-treatment group but also a smaller spread of scores in the post-treatment group than in the pre-treatment group. The study showed that SAQ scores decreased significantly for every question on the SAQ after treatment. This indicates that BTX-A is an effective treatment for synkinesis, adding further weight to current evidence. The study also indicated that BTX-A continues to be effective even after three rounds of treatment, with a significant decrease in overall scores after each treatment cycle. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  3. Economic assessment of sludge handling and environmental impact of sludge treatment in a reed bed system. (United States)

    Nielsen, Steen


    The effect on the environment of the establishment and operation of a sludge treatment reed bed system (STRB) is quite limited compared to mechanical sludge dewatering, with its accompanying use of energy and chemicals. The assessment presented here of the investment, operation and maintenance costs of a typical STRB, and of the related environmental impact, is based on the experiences gained from the operation of a large number of STRB in Denmark. There are differences in the environmental perspectives and costs involved in mechanical sludge dewatering and disposal on agricultural land compared to STRB. The two treatment methods were considered for comparison based on a treatment capacity of 550 tons of dry solids per year and with land application of the biosolids in Denmark. The initial capital cost for STRB is higher than a conventional mechanical system; however, an STRB would provide significant power and operating-cost savings, with a significant saving in the overall cost of the plant over 20-30 years. The assessment focuses on the use of chemicals, energy and greenhouse gas emissions and includes emptying, sludge residue quality and recycling. STRB with direct land application is the most cost-effective scenario and has the lowest environmental impact. A sludge strategy consisting of an STRB will be approximately DKK 536,894-647,636 cheaper per year than the option consisting of a new screw press or decanter.

  4. Case Study: Optimality Theory and the Assessment and Treatment of Phonological Disorders. (United States)

    Barlow, Jessica A


    Recently, the development of the constraint-based framework of optimality theory has been adopted and applied to the assessment and treatment of children with phonological disorders. This paper provides a demonstration of the application of optimality theory to the assessment and treatment of a single child with a phonological disorder. First, a tutorial of the theory is provided. Then, several prototypical error patterns evident in the child's productions are analyzed within the framework. These errors are accounted for by assuming that constraints against marked structure are ranked over constraints that require faithfulness to input forms within the child's grammar. Following that, a demonstration of how optimality theory accounts for different types of variation in the child's productions is provided. These different types of variation are revealing of the true nature of certain error patterns, particularly an apparent pattern of cluster reduction. Finally, the results of the analysis lead to suggestions for treatment that focus on the demotion of markedness constraints below faithfulness constraints.

  5. Hypertension Canada's 2017 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults. (United States)

    Leung, Alexander A; Daskalopoulou, Stella S; Dasgupta, Kaberi; McBrien, Kerry; Butalia, Sonia; Zarnke, Kelly B; Nerenberg, Kara; Harris, Kevin C; Nakhla, Meranda; Cloutier, Lyne; Gelfer, Mark; Lamarre-Cliche, Maxime; Milot, Alain; Bolli, Peter; Tremblay, Guy; McLean, Donna; Tobe, Sheldon W; Ruzicka, Marcel; Burns, Kevin D; Vallée, Michel; Prasad, G V Ramesh; Gryn, Steven E; Feldman, Ross D; Selby, Peter; Pipe, Andrew; Schiffrin, Ernesto L; McFarlane, Philip A; Oh, Paul; Hegele, Robert A; Khara, Milan; Wilson, Thomas W; Penner, S Brian; Burgess, Ellen; Sivapalan, Praveena; Herman, Robert J; Bacon, Simon L; Rabkin, Simon W; Gilbert, Richard E; Campbell, Tavis S; Grover, Steven; Honos, George; Lindsay, Patrice; Hill, Michael D; Coutts, Shelagh B; Gubitz, Gord; Campbell, Norman R C; Moe, Gordon W; Howlett, Jonathan G; Boulanger, Jean-Martin; Prebtani, Ally; Kline, Gregory; Leiter, Lawrence A; Jones, Charlotte; Côté, Anne-Marie; Woo, Vincent; Kaczorowski, Janusz; Trudeau, Luc; Tsuyuki, Ross T; Hiremath, Swapnil; Drouin, Denis; Lavoie, Kim L; Hamet, Pavel; Grégoire, Jean C; Lewanczuk, Richard; Dresser, George K; Sharma, Mukul; Reid, Debra; Lear, Scott A; Moullec, Gregory; Gupta, Milan; Magee, Laura A; Logan, Alexander G; Dionne, Janis; Fournier, Anne; Benoit, Geneviève; Feber, Janusz; Poirier, Luc; Padwal, Raj S; Rabi, Doreen M


    Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension. This year, we introduce 10 new guidelines. Three previous guidelines have been revised and 5 have been removed. Previous age and frailty distinctions have been removed as considerations for when to initiate antihypertensive therapy. In the presence of macrovascular target organ damage, or in those with independent cardiovascular risk factors, antihypertensive therapy should be considered for all individuals with elevated average systolic nonautomated office blood pressure (non-AOBP) readings ≥ 140 mm Hg. For individuals with diastolic hypertension (with or without systolic hypertension), fixed-dose single-pill combinations are now recommended as an initial treatment option. Preference is given to pills containing an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in combination with either a calcium channel blocker or diuretic. Whenever a diuretic is selected as monotherapy, longer-acting agents are preferred. In patients with established ischemic heart disease, caution should be exercised in lowering diastolic non-AOBP to ≤ 60 mm Hg, especially in the presence of left ventricular hypertrophy. After a hemorrhagic stroke, in the first 24 hours, systolic non-AOBP lowering to < 140 mm Hg is not recommended. Finally, guidance is now provided for screening, initial diagnosis, assessment, and treatment of renovascular hypertension arising from fibromuscular dysplasia. The specific evidence and rationale underlying each of these guidelines are discussed. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  6. Assessment and treatment of adolescent sexual offenders: implications of recent research on generalist versus specialist explanations. (United States)

    Pullman, Lesleigh; Seto, Michael C


    Adolescent sex offenders (ASOs) are commonly considered a special kind of juvenile offender, with distinct risk and etiological factors from other adolescent offenders. However, a growing body of research suggests that ASOs are more similar to other adolescent non-sex offenders than they are different (e.g., Awad, Saunders, & Levine, 1984; Elliott, 1994; France & Hudson, 1993). The purpose of the present article is to review recent literature pertaining to the distinction between generalist and specialist adolescent sex offenders (ASOs). This article summarizes the findings from Seto and Lalumière's (2010) meta-analysis on theoretically derived risk and etiological factors for adolescent sexual offending. Based on these findings, recommendations for the assessment and treatment of this population are made. The results of Seto and Lalumière's (2010) meta-analysis suggests the majority of ASOs are generalist offenders who are similar to other adolescent non-sex offenders, while a minority of ASOs are specialist offenders, who have unique risk and etiological factors including childhood sexual abuse/maltreatment and atypical sexual interests. A clear distinction has been shown between generalist ASOs and specialist ASOs. Assessment measures and treatment targets geared toward one of these groups may be less effective with the other group, which means that this distinction is clinically important. It is expected that if treatment is matched to ASO type, sexual and nonsexual recidivism will be reduced and positive changes in other clinically important areas will be evident. Copyright © 2012 Elsevier Ltd. All rights reserved.

  7. Prospective sonographic assessment of uterine artery embolization for the treatment of fibroids. (United States)

    Tranquart, F; Brunereau, L; Cottier, J P; Marret, H; Gallas, S; Lebrun, J L; Body, G; Herbreteau, D; Pourcelot, L


    To evaluate sonographic features following uterine artery embolization and to assess using ultrasound the efficacy of embolization as the primary treatment of fibroids. Fifty-eight women (mean age, 44.5 years; range, 33-65 years) suffering from symptoms due to fibroids (menometrorrhagia, bulk-related symptoms, pelvic pain) were followed-up after uterine artery embolization by ultrasound examination at 3 months, 6 months, 1 year and 2 years with assessment of volume and vascularization of fibroids as well as uterine vascularization. Fifty-eight patients were examined at 3 months, 46 at 6 months, 36 at 1 year and 19 at 2 years. Most patients were improved or free of symptoms at 3 months (90%), 6 months (92%) and 1 year (87%) and all monitored patients were free of symptoms at 2 years. Clinical failure of treatment occurred in only two cases (3%). Progressive significant reduction in fibroid size with reference to the baseline was demonstrated during follow-up from 3 months (-29%) to 24 months (-86%). Absence of intrafibroid vessels was observed in all except three cases as early as 3 months, whereas perifibroid vessels persisted in 21 cases. No changes in uterine vascularization or uterine artery resistance were noted. Uterine artery embolization is a valuable endovascular method for the treatment of fibroids, resulting in marked reduction in fibroid size and disappearance of intrafibroid vessels without reduction in uterine vascularization which is well depicted by sonography.

  8. Metric qualities of the cognitive behavioral assessment for outcome evaluation to estimate psychological treatment effects. (United States)

    Bertolotti, Giorgio; Michielin, Paolo; Vidotto, Giulio; Sanavio, Ezio; Bottesi, Gioia; Bettinardi, Ornella; Zotti, Anna Maria


    Cognitive behavioral assessment for outcome evaluation was developed to evaluate psychological treatment interventions, especially for counseling and psychotherapy. It is made up of 80 items and five scales: anxiety, well-being, perception of positive change, depression, and psychological distress. The aim of the study was to present the metric qualities and to show validity and reliability of the five constructs of the questionnaire both in nonclinical and clinical subjects. Four steps were completed to assess reliability and factor structure: criterion-related and concurrent validity, responsiveness, and convergent-divergent validity. A nonclinical group of 269 subjects was enrolled, as was a clinical group comprising 168 adults undergoing psychotherapy and psychological counseling provided by the Italian public health service. Cronbach's alphas were between 0.80 and 0.91 for the clinical sample and between 0.74 and 0.91 in the nonclinical one. We observed an excellent structural validity for the five interrelated dimensions. The clinical group showed higher scores in the anxiety, depression, and psychological distress scales, as well as lower scores in well-being and perception of positive change scales than those observed in the nonclinical group. Responsiveness was large for the anxiety, well-being, and depression scales; the psychological distress and perception of positive change scales showed a moderate effect. The questionnaire showed excellent psychometric properties, thus demonstrating that the questionnaire is a good evaluative instrument, with which to assess pre- and post-treatment outcomes.

  9. Implications of attachment theory and research for the assessment and treatment of eating disorders. (United States)

    Tasca, Giorgio A; Ritchie, Kerri; Balfour, Louise


    In this paper, we review the research literature on attachment and eating disorders and suggest a framework for assessing and treating attachment functioning in patients with an eating disorder. Treatment outcomes for individuals with eating disorders tend to be moderate. Those with attachment-associated insecurities are likely to be the least to benefit from current symptom-focused therapies. We describe the common attachment categories (secure, avoidant, anxious), and then describe domains of attachment functioning within each category: affect regulation, interpersonal style, coherence of mind, and reflective functioning. We also note the impact of disorganized mental states related to loss or trauma. Assessing these domains of attachment functioning can guide focused interventions in the psychotherapy of eating disorders. Case examples are presented to illustrate assessment, case formulation, and group psychotherapy of eating disorders that are informed by attachment theory. Tailoring treatments to improve attachment functioning for patients with an eating disorder will likely result in better outcomes for those suffering from these particularly burdensome disorders. (c) 2011 APA, all rights reserved.

  10. Assessment of quality of life of children and adolescents with cancer during their treatment. (United States)

    Vlachioti, Efrosini; Matziou, Vasiliki; Perdikaris, Pantelis; Mitsiou, Maria; Stylianou, Christos; Tsoumakas, Konstantinos; Moschovi, Maria


    The purpose of this study was to evaluate the quality of life of children and adolescents with any type of cancer in all phases of their treatment. Fifty-six newly diagnosed patients diagnosed with malignancy and hospitalized in a Pediatric Hematology-Oncology Unit in Athens were included in the study. Minneapolis-Manchester Quality of Life Instrument was used for data collection from July 2010 to December 2012. The assessment of children and adolescents' quality of life who were under treatment was performed in three different stages of treatment. The results of the study showed that the quality of life of children and adolescents with cancer did not change notably during their treatment (F = 0.16, P = 0.86 and F = 0.03, P = 0.97). For the first measurement, at the beginning of the therapy, the score on the scale for quality of life for children and adolescents was 3.44 and 3.88, respectively, in the middle of the treatment 3.36 and 3.89, respectively, and 3.43 and 3.89, respectively, when therapy was completed. Children and adolescents diagnosed with hematologic cancer stated higher quality of life scores (z = -1.61, P = 0.05 and t = 2.64, P = 0.007). Moreover, teenage patients (F = 13.22, P = 0.001) and male patients (t = 2.31, P = 0.02 and t = 2.27, P = 0.02) expressed better quality-of-life scores. According to the results, children and adolescents with any kind of cancer have better quality-of-life scores at the end of their treatment, and when they are supported by their family. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email:

  11. Clinical Practice Guideline for Physical Therapy Assessment and Treatment in Patients With Nonspecific Neck Pain. (United States)

    Bier, Jasper D; Scholten-Peeters, Wendy G M; Staal, J Bart; Pool, Jan; van Tulder, Maurits W; Beekman, Emmylou; Knoop, Jesper; Meerhoff, Guus; Verhagen, Arianne P


    The Royal Dutch Society for Physical Therapy (KNGF) issued a clinical practice guideline for physical therapists that addresses the assessment and treatment of patients with nonspecific neck pain, including cervical radiculopathy, in Dutch primary care. Recommendations were based on a review of published systematic reviews.During the intake, the patient is screened for serious pathologies and corresponding patterns. Patients with cervical radiculopathy can be included or excluded through corresponding signs and symptoms and possibly diagnostic tests (Spurling test, traction/distraction test, and Upper Limb Tension Test). History taking is done to gather information about patients' limitations, course of pain, and prognostic factors (eg, coping style) and answers to health-related questions.In case of a normal recovery (treatment profile A), management should be hands-off, and patients should receive advice from the physical therapist and possibly some simple exercises to supplement "acting as usual."In case of a delayed/deviant recovery (treatment profile B), the physical therapist is advised to use, in addition to the recommendations for treatment profile A, forms of mobilization and/or manipulation in combination with exercise therapy. Other interventions may also be considered. The physical therapist is advised not to use dry needling, low-level laser, electrotherapy, ultrasound, traction, and/or a cervical collar.In case of a delayed/deviant recovery with clear and/or dominant psychosocial prognostic factors (treatment profile C), these factors should first be addressed by the physical therapist, when possible, or the patient should be referred to a specialist, when necessary.In case of neck pain grade III (treatment profile D), the therapy resembles that for profile B, but the use of a cervical collar for pain reduction may be considered. The advice is to use it sparingly: only for a short period per day and only for a few weeks.

  12. Assessing methods for dealing with treatment switching in clinical trials: A follow-up simulation study. (United States)

    Latimer, Nicholas R; Abrams, Keith R; Lambert, Paul C; Morden, James P; Crowther, Michael J


    When patients randomised to the control group of a randomised controlled trial are allowed to switch onto the experimental treatment, intention-to-treat analyses of the treatment effect are confounded because the separation of randomised groups is lost. Previous research has investigated statistical methods that aim to estimate the treatment effect that would have been observed had this treatment switching not occurred and has demonstrated their performance in a limited set of scenarios. Here, we investigate these methods in a new range of realistic scenarios, allowing conclusions to be made based upon a broader evidence base. We simulated randomised controlled trials incorporating prognosis-related treatment switching and investigated the impact of sample size, reduced switching proportions, disease severity, and alternative data-generating models on the performance of adjustment methods, assessed through a comparison of bias, mean squared error, and coverage, related to the estimation of true restricted mean survival in the absence of switching in the control group. Rank preserving structural failure time models, inverse probability of censoring weights, and two-stage methods consistently produced less bias than the intention-to-treat analysis. The switching proportion was confirmed to be a key determinant of bias: sample size and censoring proportion were relatively less important. It is critical to determine the size of the treatment effect in terms of an acceleration factor (rather than a hazard ratio) to provide information on the likely bias associated with rank-preserving structural failure time model adjustments. In general, inverse probability of censoring weight methods are more volatile than other adjustment methods.

  13. Obesity and Surgical Treatment – A Cost-Effectiveness Assessment for Sweden

    Directory of Open Access Journals (Sweden)

    Sixten Borg


    Full Text Available Background:The rising trend in the prevalence of obesity has during the past decades become a major public health concern in many countries, as obesity may lead to comorbidities and death. A frequent used marker for obesity is the Body Mass Index (BMI. The cost of treatment for obesity related diseases has become a heavy burden on national health care budget in many countries. While diet and exercise are the cornerstones of weight management, pharmaco­therapy is often needed to achieve and maintain desired weight loss.  In some cases of extreme obesity, bariatric surgery may be recommended. It is expected to increase by 50% in Sweden.Objective: The overall objective was to develop a cost-effectiveness model using the best available evidence to assess the cost-effectiveness of gastric bypass (GBP surgical treatments for obesity in adult patients, in comparison with conventional treatment (CT, in Sweden from a healthcare perspective. With the model we also seeked to identify the lower cut-off point using BMI criteria, for the surgical intervention to be cost-effective. Methods:A micro-simulation model with an underlying Markov methodology was developed, that simulates individual patients. It simulates the outcomes of the patients in terms of treatment costs, life years, and quality adjusted life years (QALY over his/her remaining lifetime. The costs are presented in SEK in the year 2006 price level (1 SEK ≈ 0.11 EUR ≈ 0.14 USD.Results: We estimated that the incremental cost per QALY gained will not exceed SEK 33,000 per QALY in patients with BMI < 35. In patients with BMI > 35 kg/m2, gastric bypass surgery has lower costs compared to conventional treatment. Conclusion: Gastric bypass surgery is a cost-effective intervention compared to conventional treatment consisting of watchful waiting, diet and exercise.

  14. Use of Q methodology to assess the concerns of adult female individuals seeking orthodontic treatment

    Directory of Open Access Journals (Sweden)

    Yao L


    Full Text Available Linjie Yao,1 Xingqiao Xu,2 Zhenyu Ni,3 Minling Zheng,3 Feiou Lin3 1Department of Pedodontics, 2Department of Oral and Maxillofacial Surgery, 3Department of Orthodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, People’s Republic of China Background: Orthodontic treatment may cause functional restrictions, discomfort, and pain, which may lead to dental anxiety and noncooperation among patients. This study aimed to assess the concerns of adult female patients with respect to such treatment.Patients and methods: We conducted an explorative study using Q methodology among 40 adult female patients with different educational and social backgrounds in Wenzhou, People’s Republic of China. We asked participants to rank a set of 41 statements about seeking orthodontic treatment on an 11-point scale from “agree most” to “disagree most”. The collected data were analyzed using the PQ Method 2.35 program. We extracted significant viewpoints using centroid factor extraction and varimax rotation.Results: We identified major factors based on how the patients ranked statements. Patients in group 1 worried about lack of information about orthodontic treatment, and may have suffered from dental phobia; patients in group 2 were all single women, and they were worried that the braces might lower their chances of finding a partner; patients in group 3 worried about appearance and speech with braces; and patients in group 4 worried about cost, pain, and dental hygiene. The remaining participants who had other viewpoints did not load to any of these four groups.Conclusion: The concerns of adult female individuals seeking orthodontic treatment are complex. A significant feature of this study was using Q methodology to analyze the psychological characteristics of the patients. This study identified four typical characterizations that are associated with each group, and our findings may aid orthodontists in improving doctor

  15. Life cycle assessment of drinking water: comparing conventional water treatment, reverse osmosis and mineral water in glass and plastic bottles


    Garfi, Marianna; Cadena, Erasmo; Sanchez Ramos, David; Ferrer Martí, Ivet


    This study evaluated the environmental impacts caused by drinking water consumption in Barcelona (Spain) using the Life Cycle Assessment (LCA) methodology. Five different scenarios were compared: 1) tap water from conventional drinking water treatment; 2) tap water from conventional drinking water treatment with reverse osmosis at the water treatment plant; 3) tap water from conventional drinking water treatment with domestic reverse osmosis; 4) mineral water in plastic bottles, and 5) minera...

  16. Evaluation of the Treatment of Congenital Penile Curvature Including Psychosexual Assessment. (United States)

    Zachalski, Wojciech; Krajka, Kazimierz; Matuszewski, Marcin


    Penile corporoplasty is a well-established treatment method of congenital penile deviation (CPD). Anatomical results are good with only slight differences between surgical procedures used. The disease however has huge influence on young male quality of life. This issue is not well analyzed in the literature. The aim of the study was to evaluate quality of life of the patients affected with CPD before and after the surgical treatment Study population consisted of 107 patients with CPD referred for surgical management. Patients were evaluated with not only clinical assessment, but also by four questionnaires measuring various aspects of quality of life. They were: Short-Form Medical Outcomes, Sexual Quality of Life Questionnaire for Man, Beck Depression Inventory, and International Index of Erectile Function. Quality of life measurements showed deep decrease in the general quality of life, sexual performance, depression scale, as well as in physical and mental health in men with CPD. All these parameters were restored to normal after the successful surgical treatment with any method. CPD deeply decreases the quality of life of the affected men in many aspects. Surgical treatment is able to repair the anatomical deformity and as well as significantly restore the patients' psychosocial well-being. © 2015 International Society for Sexual Medicine.

  17. Environmental assessment for liquid waste treatment at the Nevada Test Site, Nye County, Nevada

    Energy Technology Data Exchange (ETDEWEB)



    This environmental assessment (EA) examines the potential impacts to the environment from treatment of low-level radioactive liquid and low-level mixed liquid and semi-solid wastes generated at the Nevada Test Site (NTS). The potential impacts of the proposed action and alternative actions are discussed herein in accordance with the National Environmental Policy Act (NEPA) of 1969, as amended in Title 42 U.S.C. (4321), and the US Department of Energy (DOE) policies and procedures set forth in Title 10 Code of Federal Regulations (CFR) Part 1021 and DOE Order 451.1, ``NEPA Compliance Program.`` The potential environmental impacts of the proposed action, construction and operation of a centralized liquid waste treatment facility, were addressed in the Final Environmental Impact Statement for the Nevada Test Site and Off-Site Locations in the State of Nevada. However, DOE is reevaluating the need for a centralized facility and is considering other alternative treatment options. This EA retains a centralized treatment facility as the proposed action but also considers other feasible alternatives.

  18. Psycho-ophthalmology: Contributions of Health psychology to the assessment and treatment of glaucoma. (United States)

    Méndez-Ulrich, Jorge Luis; Sanz, Antoni


    Asymptomatic in its early stages, glaucoma is the second leading cause of blindness worldwide. While psychosocial factors are taken into consideration for a host of diseases such as cancer, heart disease and autoimmune conditions, to date, psychological issues have been ignored in the clinical management of glaucoma. This work reviews the most relevant contributions from a health psychology perspective for the assessment and treatment of glaucoma, which is emerging in the field of psycho-ophthalmology. To provide scientific evidence regarding contributions of psychology to the comprehension of glaucoma, a bibliographic review of three databases (Psicodoc, PsycInfo and Medline) was conducted, spanning the period between 1940 and 2016. This review yielded a total of 66 studies published in the period analysed and identified three areas where health psychology has made substantive contributions to glaucoma screening, monitoring and treatment: the emotional impact on patients suffering from glaucoma, the adherence to treatment and the effects of stress on intraocular pressure. A health psychology approach for research and therapy of glaucoma must focus on the management of the negative affect associated with the diagnosis, the optimisation of treatment adherence and the stress management of the intraocular pressure measurements.

  19. Distribution, fate and risk assessment of antibiotics in sewage treatment plants in Hong Kong, South China. (United States)

    Leung, H W; Minh, T B; Murphy, M B; Lam, James C W; So, M K; Martin, Michael; Lam, Paul K S; Richardson, B J


    Occurrence, removal, consumption and environmental risks of sixteen antibiotics were investigated in several sewage treatment plants (STPs) featuring different treatment levels in Hong Kong, China. Cefalexin, ofloxacin and erythromycin-H(2)O were predominant with concentrations of 1020-5640, 142-7900 and 243-4740 ng/L in influent, respectively; their mass loads were comparable to levels reported in urban regions in China and were at the high end of the range reported for western countries. The target antibiotics behaved differently depending on the treatment level employed at the STPs and relatively higher removal efficiencies (>70%) were observed for cefalexin, cefotaxime, amoxicillin, sulfamethoxazole and chloramphenicol during secondary treatment. ß-lactams were especially susceptible to removal via the activated sludge process while macrolides were recalcitrant (norfloxacin (52%), differed greatly in their removal efficiencies, probably because of disparities in their pK(a) values which resulted in different sorption behaviour in sludge. Overall antibiotic consumption in Hong Kong was back-calculated based on influent mass flows and compared with available prescription and usage data. This model was verified by a good approximation of 82% and 141% to the predicted consumption of total ofloxacin, but a less accurate estimate was obtained for erythromycin usage. Risk assessment indicated that algae are susceptible to the environmental concentrations of amoxicillin as well as the mixture of the nine detected antibiotics in receiving surface waters. Copyright © 2011 Elsevier Ltd. All rights reserved.

  20. Toxicity assessment of water at different stages of treatment using Microtox assay

    Directory of Open Access Journals (Sweden)

    Pogorzelec Marta


    Full Text Available Number of potentially toxic hydrophobic organic contaminants e.g. polycyclic aromatic hydrocarbons, pesticides, polychlorinated biphenyls and dioxins having entered aquatic environment, including potential sources of drinking water. Unfortunately, not all micropollutants can be removed during water treatment processes. What is more, disinfectants can react with some organic compounds already present in the water, and form disinfection by-products which also can be toxic. The aim of this study was to assess toxicity of water at different stages of water treatment and to verify usefulness semipermeable membrane devices in monitoring of drinking water. For this purpose, semipermeable membrane devices (SPMDs were deployed in a surface water treatment plant. To determine the effect of water treatment on the presence of toxic micropollutants, study was conducted for a period of 5 months. Three sampling places were chosen: raw water input, stream of water just before disinfection and treated water output. After sampling dialysis in organic solvent was carried out and extracts were then analyzed with the Microtox acute toxicity test. The study has indicated the utility as well as some limitations of combining SPMDs with bioluminescence assay in the monitoring of biological effects of bioavailable hydrophobic pollutants in drinking water.

  1. Methodology for assessment of low level laser therapy (LLLT) irradiation parameters in muscle inflammation treatment (United States)

    Mantineo, M.; Pinheiro, J. P.; Morgado, A. M.


    Several studies in human and animals show the clinical effectiveness of low level laser therapy (LLLT) in reducing some types of pain, treating inflammation and wound healing. However, more scientific evidence is required to prove the effectiveness of LLLT since many aspects of the cellular and molecular mechanisms triggered by irradiation of injured tissue with laser remain unknown. Here, we present a methodology that can be used to evaluate the effect of different LLLT irradiation parameters on the treatment of muscle inflammation on animals, through the quantification of four cytokines (TNF-α, IL-1β, IL-2 and IL-6) in systemic blood and histological analysis of muscle tissue. We have used this methodology to assess the effect of LLLT parameters (wavelength, dose, power and type of illumination) in the treatment of inflammation induced in the gastrocnemius muscle of Wistar rats. Results obtained for laser dose evaluation with continuous illumination are presented.

  2. Brave New Worlds—Review and Update on Virtual Reality Assessment and Treatment in Psychosis (United States)

    Veling, Wim; Moritz, Steffen; van der Gaag, Mark


    In recent years, virtual reality (VR) research on psychotic disorders has been initiated. Several studies showed that VR can elicit paranoid thoughts about virtual characters (avatars), both in patients with psychotic disorders and healthy individuals. Real life symptoms and VR experiences were correlated, lending further support to its validity. Neurocognitive deficits and difficulties in social behavior were found in schizophrenia patients, not only in abstract tasks but also using naturalistic virtual environments that are more relevant to daily life, such as a city or encounters with avatars. VR treatments are conceivable for most dimensions of psychotic disorders. There is a small but expanding literature on interventions for delusions, hallucinations, neurocognition, social cognition, and social skills; preliminary results are promising. VR applications for assessment and treatment of psychotic disorders are in their infancy, but appear to have a great potential for increasing our understanding of psychosis and expanding the therapeutic toolbox. PMID:25193975

  3. Assessment and treatment of alcoholism and substance-related disorders in the elderly. (United States)

    Menninger, John A


    Substance-related disorders in the elderly remain overlooked and undertreated. Up to 16% of the elderly have alcohol use disorders. With Americans age 65 and older constituting the fastest growing segment of our population, this issue becomes increasingly important. The author reviews the prevalence of geriatric alcoholism, the two typical drinking patterns seen in the elderly, the acute and chronic consequences of alcohol consumption with particular relevance to older persons, barriers to proper assessment of alcoholism in this age group, usefulness of available screening tools, treatment of alcohol withdrawal in the elderly, treatment of alcohol dependence in the elderly with focus on brief intervention, and aspects of nonalcohol drug abuse in the elderly.

  4. The clinical and radiological assessment of periodontal bone loss treatment using Emdogain. (United States)

    Tokajuk, G; Pawińska, M; Kedra, B A


    ADMISSION: Emdogain is the only one biomaterial using biomicra effect which is practiced in periodontal surgery. The purpose of the study was a clinical and radiological assessment of bone loss treatment using Emdogain. There were 19 persons examined (11 women and 8 men) which have bone loss treated. Initial and monitoring examination after 10 months embraced clinical parameters such as PPD, CAL and radiological--based on intraoral x-ray pictures. Emdogain treatment was made according to surgical procedures. The research has shown reduction of the depth of periodontal pockets average about 3.4 mm and attachment connective tissue growth about 2.2 mm. Bone loss filling was on 67.1% level. Bone loss filling and growth of connective tissue attachment are in our research lower than in most of the others publications. Our observation concerned 10 months period so we should expect better effects after longer time. MOTIONS: Emdogain is safe and effective regeneration material.

  5. Risk of malignancy with systemic psoriasis treatment in the Psoriasis Longitudinal Assessment Registry. (United States)

    Fiorentino, David; Ho, Vincent; Lebwohl, Mark G; Leite, Luiz; Hopkins, Lori; Galindo, Claudia; Goyal, Kavitha; Langholff, Wayne; Fakharzadeh, Steven; Srivastava, Bhaskar; Langley, Richard G


    The effect of systemic therapy on malignancy risk among patients with psoriasis is not fully understood. Evaluate the impact of systemic treatment on malignancy risk among patients with psoriasis in the Psoriasis Longitudinal Assessment and Registry (PSOLAR). Nested case-control analyses were performed among patients with no history of malignancy. Cases were defined as first malignancy (other than nonmelanoma skin cancer) in the Psoriasis Longitudinal Assessment and Registry, and controls were matched by age, sex, geographic region, and time on registry. Study therapies included methotrexate, ustekinumab, and tumor necrosis factor-α (TNF-α) inhibitors. Exposure was defined as 1 or more doses of study therapy within 12 months of malignancy onset and further stratified by duration of therapy. Multivariate conditional logistic regression, adjusted for potential confounders, was used to estimate odds ratios of malignancies associated with therapy. Among 12,090 patients, 252 malignancy cases were identified and 1008 controls were matched. Treatment with methotrexate or ustekinumab for more than 0 months to less than 3 months, 3 months to less than 12 months, or 12 months or longer was not associated with increased malignancy risk versus no exposure. Longer-term (≥12 months) (odds ratio, 1.54; 95% confidence interval, 1.10-2.15; P = .01), but not shorter-term treatment, with a TNF-α inhibitor was associated with increased malignancy risk. Cases and controls could belong to 1 or more therapy categories. Long-term (≥12 months) treatment with a TNF-α inhibitor, but not methotrexate and ustekinumab, may increase risk for malignancy in patients with psoriasis. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.


    Directory of Open Access Journals (Sweden)

    Hristina Lalabonova


    Full Text Available Decubitus ulcers in the oral mucosa tend to be very painful causing discomforting sensation in patients in speaking and eating. Low energy lasers can provide an alternative method for the treatment of these ulcers.The aim of the present paper was to assess clinically the healing effect of low level laser irradiation on oral mucosa decubitus ulcers.Material and methods: A total of 90 patients with decubitus ulcers were treated in the present study; they were randomly assigned to three groups: group I included 30 patients treated with low level laser (LLL irradiation (wavelength of irradiation 658 nm; group II - 30 patients treated with laser irradiation of 904 nm; and group III (controls - 30 patients who received a standard conventional treatment with "granofurin" and "solcoseryl".The treatment sessions in all three groups were administered once daily. The patients in groups I and II were irradiated with focused irradiation at an angle from a distance using a conically shaped light probe 3 mm in diameter. The irradiated area was 0.5 cm2. The light was focused on the oral mucosa ulcer and the surrounding inflamed mucosa at a distance of 0.5 to 1 cm. Diode lasers were used in the study. The dosage of irradiation was 1.2 J/cm2.Results and discussion: The treatment effect was evaluated by changes in the studied parameters: pain intensity, erythema, and epithelialization. They were assessed at baseline, and at days 1, 3 and 5. Conclusions: LLLT administered with the proposed methodology manages pain rapidly and accelerates the process of epithelialization of decubitus ulcers in the soft tissues of the mouth.

  7. Benefit-risk assessment of diacerein in the treatment of osteoarthritis. (United States)

    Panova, Elena; Jones, Graeme


    Osteoarthritis (OA) is the leading musculoskeletal cause of disability. Despite this, there is no consensus on the precise definition of OA and what is the best treatment to improve symptoms and slow disease progression. Current pharmacological treatments include analgesics, non-steroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase (COX) inhibitors. None of those treatments are disease-modifying agents that target the core pathological processes in OA. Diacerein, a semi-synthetic anthraquinone derivative, inhibits the interleukin-1-beta (IL-1β) cytokine which, according to animal studies, plays a key role in the pathogenesis of OA. Diacerein was synthesized in 1980 and licensed in some European Union and Asian countries for up to 20 years. It has shown modest efficacy and acceptable tolerability in a number of trials of low to moderate quality. Early this year, the European Medicines Agency (EMA) conducted a review and restricted the use of diacerein-containing medicines. This was because of major concerns about the frequency and severity of diarrhoea and liver disorders in OA patients. In addition, the EMA's Pharmacovigilance Risk Assessment Committee (PRAC) questioned the limited clinical benefits of diacerein, which, in their view, did not outweigh its risks. The aim of this review is to provide a benefit-risk assessment of diacerein in the treatment of OA, based on asystematic evaluation of the published efficacy and safety data. Overall, there is evidence that diacerein is modestly effective for symptoms and possibly for radiographic changes, but this needs to be balanced against higher rates of gastrointestinal toxicity.

  8. Metabolic Imaging to Assess Treatment Response to Cytotoxic and Cytostatic Agents

    Directory of Open Access Journals (Sweden)

    Natalie Julie Serkova


    Full Text Available For several decades, cytotoxic chemotherapeutic agents were considered the basis of anti-cancer treatment for patients with metastatic tumors. A decrease in tumor burden, assessed by volumetric computed tomography (CT and magnetic resonance imaging (MRI, according to the Response Evaluation Criteria in Solid Tumors (RECIST, was considered as a radiological response to cytotoxic chemotherapies. In addition to RECIST-based dimensional measurements, a metabolic response to cytotoxic drugs can be assessed by positron emission tomography (PET using 18F-fluoro-thymidine (FLT as a radioactive tracer for drug-disrupted DNA synthesis. The decreased 18FLT-PET uptake is often seen concurrently with increased apparent diffusion coefficients (ADC by diffusion weighted imaging (DWI due to chemotherapy-induced changes in tumor cellularity. Recently, the discovery of molecular origins of tumorogenesis led to the introduction of novel signal transduction inhibitors (STIs. STIs are targeted cytostatic agents; their effect is based on a specific biological inhibition with no immediate cell death. As such, tumor size is not anymore a sensitive end-point for a treatment response to STIs; novel physiological imaging end-points are desirable. For receptor tyrosine kinase inhibitors as well as modulators of the downstream signaling pathways, an almost immediate inhibition in glycolytic activity (the Warburg effect and phospholipid turnover (the Kennedy pathway has been seen by metabolic imaging in the first 24 hours of treatment. The quantitative imaging end-points by magnetic resonance spectroscopy (MRS and metabolic PET (including 18F-fluoro-deoxy-glucose, FDG, and total choline provide an early treatment response to targeted STIs, before a reduction in tumor burden can be seen.

  9. Usefulness of plain radiography for assessing hypouricemic treatment response in patients with tophaceous gout. (United States)

    Suh, Young Sun; Cheon, Yun-Hong; Kim, Ji Eun; Kim, Ji-Min; Kim, Sang-Hyon; Lee, Won-Seok; Yoo, Wan-Hee; Lee, Sang-Il; Kim, Hyun-Ok


    To investigate whether plain radiography is useful for assessing the changes in gouty tophi size following hypouricemic therapy. Gout was diagnosed according to the American College of Rheumatology criteria. Before and after hypouricemic treatment, serum uric acid level was measured, and plain radiography was performed to measure gouty tophi size. The tophi were graded by measuring the maximum vertical and horizontal diameters, and they were scored by adding up the scores of the grades. The vertical diameter was measured on both sides of the proximal phalanges (PPs). The horizontal diameter was measured on the lateral side of the PPs. The maximum vertical diameter measurement was graded 0-4. The maximum horizontal diameter measurement was graded 0-3. Seven hundred first metatarsal phalangeal joints (MTPJ) of 350 patients with gout were assessed for gouty tophi. Tophi were observed using plain radiography in 174 MTPJs (24.9%) of 109 patients (31.1%). Follow-up plain radiography was performed in 60 of these patients. Before the treatment, the average serum uric acid level of these patients was 8.3 ± 1.9 mg/dL, and the average tophi score was 3.7 ± 2.5. After hypouricemic treatment, the uric acid level decreased to 5.9 ± 1.6 mg/dL (P < 0.05), and the average tophi score decreased to 1.5 ± 1.8 (P < 0.05). This new method for measuring gouty tophi using plain radiography may be useful for evaluating changes in gouty tophi size following hypouricemic treatment. © 2016 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

  10. Substance Abuse Prevention, Assessment, and Treatment for Lesbian, Gay, Bisexual, and Transgender Youth. (United States)

    Aromin, Romulo Alcalde


    Knowing how to manage substance abuse in all youth is an important aspect of pediatric care, including providing clinically appropriate anticipatory guidance, monitoring, assessment, and treatment. Although most lesbian, gay, bisexual, and transgender (LGBT) youth do not abuse substances, as a group they experience unique challenges in self-identity development that put them at an increased risk for substance abuse. This article addresses prevention and management of substance use in LGBT youth relevant to pediatrics and allied professions as an aspect of their overall health care. It reviews basic information about substance abuse in youth and special considerations for LGBT youth. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. [The Probabilistic Efficiency Frontier: A Value Assessment of Treatment Options in Hepatitis C]. (United States)

    Mühlbacher, Axel C; Sadler, Andrew


    Background The German Institute for Quality and Efficiency in Health Care (IQWiG) recommends the concept of the efficiency frontier to assess health care interventions. The efficiency frontier supports regulatory decisions on reimbursement prices for the appropriate allocation of health care resources. Until today this cost-benefit assessment framework has only been applied on the basis of individual patient-relevant endpoints. This contradicts the reality of a multi-dimensional patient benefit. Objective The objective of this study was to illustrate the operationalization of multi-dimensional benefit considering the uncertainty in clinical effects and preference data in order to calculate the efficiency of different treatment options for hepatitis C (HCV). This case study shows how methodological challenges could be overcome in order to use the efficiency frontier for economic analysis and health care decision-making. Method The operationalization of patient benefit was carried out on several patient-relevant endpoints. Preference data from a discrete choice experiment (DCE) study and clinical data based on clinical trials, which reflected the patient and the clinical perspective, respectively, were used for the aggregation of an overall benefit score. A probabilistic efficiency frontier was constructed in a Monte Carlo simulation with 10000 random draws. Patient-relevant endpoints were modeled with a beta distribution and preference data with a normal distribution. The assessment of overall benefit and costs provided information about the adequacy of the treatment prices. The parameter uncertainty was illustrated by the price-acceptability-curve and the net monetary benefit. Results Based on the clinical and preference data in Germany, the interferon-free treatment options proved to be efficient for the current price level. The interferon-free therapies of the latest generation achieved a positive net cost-benefit. Within the decision model, these therapies

  12. How Do We Assess Dissociation in Treatment Seeking Refugees in the West?

    DEFF Research Database (Denmark)

    Palic, Sabina; Elklit, Ask; Armour, Cherie

    Not enough attention is paid to dissociation in treatment of traumatized refugees in western countries. Knowledge about the assessment, the extent, and the content of dissociation in this group is lacking. An evaluation of measures and description of dissociative symptoms was carried out in 86......-D but they showed only moderate classification agreement. The DES was found to be the preferred measure since the SIDES-D seemed to partly tap correlates of lasting psychiatric illness. The DES-Taxon functioned well as an abbreviated version of the DES. Thirty percent of the group was estimated to have pathological...

  13. Instrumented gait analysis for planning and assessment of treatment in cerebral palsy

    Directory of Open Access Journals (Sweden)

    Thomas Raji


    Full Text Available Background: To improve the walking efficiency of children with cerebral palsy, gait must be documented accurately so that the abnormalities can be assessed and the best treatment option can be selected. Methods: Gait was analysed using Selspot kinematic system with a Kistler force plate and the motion analysis ambulatory EMG system connected to a personal computer. Results: Walking speed and stride length had improved in children. Conclusion: Gait analysis can help to accomplish improvement in walking efficiency of children with cerebral palsy.

  14. Assessment and Surgical Treatment of Calcinosis of the Shoulder Associated with CREST Syndrome

    Directory of Open Access Journals (Sweden)

    R. Manohara


    Full Text Available We report an unusual case of a 65-year-old lady with CREST syndrome with multiple upper and lower limb calcinosis, who presented with severe shoulder pain and stiffness, with widespread intra- and extra-articular calcinosis, which was refractory to conservative measures. We were able to identify the main cause of her symptoms through serial diagnostic injections as calcific biceps tendinosis. We will discuss her assessment and surgical management and the pathophysiology and various treatment modalities for managing the soft tissue calcinosis in rheumatological diseases.

  15. Assessment and Surgical Treatment of Calcinosis of the Shoulder Associated with CREST Syndrome. (United States)

    Manohara, R; Breusch, S J


    We report an unusual case of a 65-year-old lady with CREST syndrome with multiple upper and lower limb calcinosis, who presented with severe shoulder pain and stiffness, with widespread intra- and extra-articular calcinosis, which was refractory to conservative measures. We were able to identify the main cause of her symptoms through serial diagnostic injections as calcific biceps tendinosis. We will discuss her assessment and surgical management and the pathophysiology and various treatment modalities for managing the soft tissue calcinosis in rheumatological diseases.

  16. Assessing Non-Technical Site Suitability Criteria for Stormwater Capture, Treatment and Recharge (United States)

    Eisenstein, W.


    This presentation will describe a new method for assessing non-technical site suitability criteria for the siting of stormwater capture, treatment and recharge (or stormwater CTR) facilities in Sonoma County, California, USA. "Non-technical site suitability criteria" include issues such as community acceptance, aesthetics, nuisances and hazards, and compatibility with neighboring land uses, and are distinguished from "technical criteria" such as hydrology and soil characteristics that are the traditional subject of suitability analyses. Non-technical criteria are rarely, if ever, considered in formal siting suitability studies conducted by agencies and municipalities, yet can be fatal to the prospects of a given project's construction if not identified and mitigated. The researchers developed a new method for identifying and spatially characterizing relevant non-technical criteria through interviews and questionnaires with community stakeholders, and introducing those criteria into a spatial multi-criteria decision analysis framework that assesses site suitabilty across a study watershed (the Upper Petaluma River watershed in Sonoma County).

  17. Assessment of adult hip dysplasia and the outcome of surgical treatment

    DEFF Research Database (Denmark)

    Troelsen, Anders


    and osteoarthritis and resulted in general recommendations regarding diagnostic assessment of hip dysplasia. Pelvic tilt was shown to differ significantly between the supine and weight-bearing positions in patients with dysplastic hip joints. This is a finding that adds controversy to the application of neutral...... in dysplastic hips is contradictory to the historical finding that hip dysplasia is characterized by insufficient anterior and lateral coverage. In general, the findings have important implications for orthopedic surgeons and radiologists dealing with diagnostic assessment of painful hips in young adults...... magnetic resonance arthrography remains the gold standard. PERIACETABULAR OSTEOTOMY FOR SURGICAL TREATMENT OF HIP DYSPLASIA IN ADULTS: Encouraging hip joint survival and clinical outcome were reported at medium-term follow-up after periacetabular osteotomy. The small number of studies reporting the outcome...

  18. Life-cycle assessment of a waste refinery process for enzymatic treatment of municipal solid waste

    DEFF Research Database (Denmark)

    Tonini, Davide; Astrup, Thomas


    production and saving fossil resources. This is especially important with respect to residual waste (i.e. the remains after source-separation and separate collection) which in Denmark is typically incinerated. In this paper, a life-cycle assessment and energy balance of a pilot-scale waste refinery......Decrease of fossil fuel dependence and resource saving has become increasingly important in recent years. From this perspective, higher recycling rates for valuable materials (e.g. metals) as well as energy recovery from waste streams could play a significant role substituting for virgin material...... for the enzymatic treatment of municipal solid waste (MSW) is presented. The refinery produced a liquid (liquefied organic materials and paper) and a solid fraction (non-degradable materials) from the initial waste. A number of scenarios for the energy utilization of the two outputs were assessed. Co...

  19. Telepractice in the Assessment and Treatment of Individuals with Aphasia: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Nerissa Hall


    Full Text Available Telepractice involves the application of technology to deliver services over a geographical distance. Studies in which telepractice procedures were used in the assessment or treatment of individuals with aphasia were reviewed. Systematic searches identified 10 studies meeting inclusion criteria. These studies were evaluated in terms of the: (a characteristics of the participants, (b technology utilized (c, services delivered via telepractice (d, research methodology, and (e results and conclusions of the study. Telepractice was used by speech-language pathologists and the allied health professionals to assist with the delivery of services to participants with aphasia by their caretakers or clinicians. The services delivered included appraisal, diagnostic assessments, interventions, and consultation. This review suggests that telepractice is a viable method of service delivery for individuals with aphasia and warrants additional research. Guidelines for practitioners and potential directions for future research are discussed.

  20. Telepractice in the assessment and treatment of individuals with aphasia: a systematic review. (United States)

    Hall, Nerissa; Boisvert, Michelle; Steele, Richard


    Telepractice involves the application of technology to deliver services over a geographical distance. Studies in which telepractice procedures were used in the assessment or treatment of individuals with aphasia were reviewed. Systematic searches identified 10 studies meeting inclusion criteria. These studies were evaluated in terms of the: (a) characteristics of the participants, (b) technology utilized (c), services delivered via telepractice, (d) research methodology, and (e) results and conclusions of the study. Telepractice was used by speech-language pathologists and allied health professionals to assist with the delivery of services to participants with aphasia by their caretakers or clinicians. The services delivered included appraisal, diagnostic assessments, interventions, and consultation. This review suggests that telepractice is a viable method of service delivery for individuals with aphasia, however further research is warranted. Guidelines for practitioners and potential directions for future research are discussed.

  1. Life cycle assessment of pig slurry treatment technologies for nutrient redistribution in Denmark

    DEFF Research Database (Denmark)

    ten Hoeve, Marieke; Hutchings, Nicholas John; Peters, Gregory


    on a combination of values derived from the literature and simulations with the Farm-N model for Danish agricultural and climatic conditions. The environmental impact categories assessed were climate change, freshwater eutrophication, marine eutrophication, terrestrial acidification, natural resource use, and soil......Animal slurry management is associated with a range of impacts on fossil resource use and the environment. The impacts are greatest when large amounts of nutrient-rich slurry from livestock production cannot be adequately utilised on adjacent land. To facilitate nutrient redistribution, a range...... of different technologies are available. This study comprised a life cycle assessment of the environmental impacts from handling 1000. kg of pig slurry ex-animal. Application of untreated pig slurry onto adjacent land was compared with using four different treatment technologies to enable nutrient...

  2. The assessment and treatment of postural disorders in cerebellar ataxia: a systematic review. (United States)

    Marquer, A; Barbieri, G; Pérennou, D


    Gait and balance disorders are often major causes of handicap in patients with cerebellar ataxia. Although it was thought that postural and balance disorders in cerebellar ataxia were not treatable, recent studies have demonstrated the beneficial effects of rehabilitation programs. This article is the first systematic review on the treatment of postural disorders in cerebellar ataxia. Nineteen articles were selected, of which three were randomized, controlled trials. Various aetiologies of cerebellar ataxia were studied: five studies assessed patients with multiple sclerosis, four assessed patients with degenerative ataxia, two assessed stroke patients and eight assessed patients with various aetiologies. Accurate assessment of postural disorders in cerebellar ataxia is very important in both clinical trials and clinical practice. The Scale for the Assessment and Rating of Ataxia (SARA) is a simple, validated measurement tool, for which 18 of the 40 points are related to postural disorders. This scale is useful for monitoring ataxic patients with postural disorders. There is now moderate level evidence that rehabilitation is efficient to improve postural capacities of patients with cerebellar ataxia - particularly in patients with degenerative ataxia or multiple sclerosis. Intensive rehabilitation programs with balance and coordination exercises are necessary. Although techniques such as virtual reality, biofeedback, treadmill exercises with supported bodyweight and torso weighting appear to be of value, their specific efficacy has to be further investigated. Drugs have only been studied in degenerative ataxia, and the level of evidence is low. There is now a need for large, randomized, controlled trials testing rehabilitation programs suited to postural and gait disorders of patients with cerebellar ataxia. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  3. Assessing the impacts of changes in treatment technology on energy and greenhouse gas balances for organic waste and wastewater treatment using historical data

    DEFF Research Database (Denmark)

    Hansen, Jens Aage; Poulsen, Tjalfe


    production from the remaining organic municipal waste. Wastewater treatment has changed from direct discharge of untreated wastewater to full organic matter and nutrient (N, P) removal combined with anaerobic digestion of the sludge for biogas production with power and heat generation. These changes......Historical data on organic waste and wastewater treatment during the period of 1970ĝ€"2020 were used to assess the impact of treatment on energy and greenhouse gas (GHG) balances. The assessment included the waste fractions: Sewage sludge, food waste, yard waste and other organic waste (paper...... in treatment technology have resulted in the waste and wastewater treatment systems in Aalborg progressing from being net consumers of energy and net emitters of GHG, to becoming net producers of energy and net savers of GHG emissions (due to substitution of fossil fuels elsewhere). If it is assumed...

  4. TSD-DOSE: A radiological dose assessment model for treatment, storage, and disposal facilities

    Energy Technology Data Exchange (ETDEWEB)

    Pfingston, M.; Arnish, J.; LePoire, D.; Chen, S.-Y.


    Past practices at US Department of Energy (DOE) field facilities resulted in the presence of trace amounts of radioactive materials in some hazardous chemical wastes shipped from these facilities. In May 1991, the DOE Office of Waste Operations issued a nationwide moratorium on shipping all hazardous waste until procedures could be established to ensure that only nonradioactive hazardous waste would be shipped from DOE facilities to commercial treatment, storage, and disposal (TSD) facilities. To aid in assessing the potential impacts of shipments of mixed radioactive and chemically hazardous wastes, a radiological assessment computer model (or code) was developed on the basis of detailed assessments of potential radiological exposures and doses for eight commercial hazardous waste TSD facilities. The model, called TSD-DOSE, is designed to incorporate waste-specific and site-specific data to estimate potential radiological doses to on-site workers and the off-site public from waste-handling operations at a TSD facility. The code is intended to provide both DOE and commercial TSD facilities with a rapid and cost-effective method for assessing potential human radiation exposures from the processing of chemical wastes contaminated with trace amounts of radionuclides.

  5. Assessment of the nutrient removal effectiveness of floating treatment wetlands applied to urban retention ponds. (United States)

    Wang, Chih-Yu; Sample, David J


    The application of floating treatment wetlands (FTWs) in point and non-point source pollution control has received much attention recently. Although the potential of this emerging technology is supported by various studies, quantifying FTW performance in urban retention ponds remains elusive due to significant research gaps. Actual urban retention pond water was utilized in this mesocosm study to evaluate phosphorus and nitrogen removal efficiency of FTWs. Multiple treatments were used to investigate the contribution of each component in the FTW system with a seven-day retention time. The four treatments included a control, floating mat, pickerelweed (Pontederia cordata L.), and softstem bulrush (Schoenoplectus tabernaemontani). The water samples collected on Day 0 (initial) and 7 were analyzed for total phosphorus (TP), total particulate phosphorus, orthophosphate, total nitrogen (TN), organic nitrogen, ammonia nitrogen, nitrate-nitrite nitrogen, and chlorophyll-a. Statistical tests were used to evaluate the differences between the four treatments. The effects of temperature on TP and TN removal rates of the FTWs were described by the modified Arrhenius equation. Our results indicated that all three FTW designs, planted and unplanted floating mats, could significantly improve phosphorus and nitrogen removal efficiency (%, E-TP and E-TN) compared to the control treatment during the growing season, i.e., May through August. The E-TP and E-TN was enhanced by 8.2% and 18.2% in the FTW treatments planted with the pickerelweed and softstem bulrush, respectively. Organic matter decomposition was likely to be the primary contributor of nutrient removal by FTWs in urban retention ponds. Such a mechanism is fostered by microbes within the attached biofilms on the floating mats and plant root surfaces. Among the results of the four treatments, the FTWs planted with pickerelweed had the highest E-TP, and behaved similarly with the other two FTW treatments for nitrogen removal

  6. A novel approach to assess the treatment response using Gaussian random field in PET

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Mengdie [Department of Biomedical Engineering, Tsinghua University, Beijing 100084, China and Center for Advanced Medical Imaging Science, Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital, Boston, Massachusetts 02114 (United States); Guo, Ning [Center for Advanced Medical Imaging Science, Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital, Boston, Massachusetts 02114 (United States); Hu, Guangshu; Zhang, Hui, E-mail:, E-mail: [Department of Biomedical Engineering, Tsinghua University, Beijing 100084 (China); El Fakhri, Georges; Li, Quanzheng, E-mail:, E-mail: [Center for Advanced Medical Imaging Science, Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital, Boston, Massachusetts 02114 and Department of Radiology, Harvard Medical School, Boston, Massachusetts 02115 (United States)


    Purpose: The assessment of early therapeutic response to anticancer therapy is vital for treatment planning and patient management in clinic. With the development of personal treatment plan, the early treatment response, especially before any anatomically apparent changes after treatment, becomes urgent need in clinic. Positron emission tomography (PET) imaging serves an important role in clinical oncology for tumor detection, staging, and therapy response assessment. Many studies on therapy response involve interpretation of differences between two PET images, usually in terms of standardized uptake values (SUVs). However, the quantitative accuracy of this measurement is limited. This work proposes a statistically robust approach for therapy response assessment based on Gaussian random field (GRF) to provide a statistically more meaningful scale to evaluate therapy effects. Methods: The authors propose a new criterion for therapeutic assessment by incorporating image noise into traditional SUV method. An analytical method based on the approximate expressions of the Fisher information matrix was applied to model the variance of individual pixels in reconstructed images. A zero mean unit variance GRF under the null hypothesis (no response to therapy) was obtained by normalizing each pixel of the post-therapy image with the mean and standard deviation of the pretherapy image. The performance of the proposed method was evaluated by Monte Carlo simulation, where XCAT phantoms (128{sup 2} pixels) with lesions of various diameters (2–6 mm), multiple tumor-to-background contrasts (3–10), and different changes in intensity (6.25%–30%) were used. The receiver operating characteristic curves and the corresponding areas under the curve were computed for both the proposed method and the traditional methods whose figure of merit is the percentage change of SUVs. The formula for the false positive rate (FPR) estimation was developed for the proposed therapy response

  7. Assessing drinking outcomes in alcohol treatment efficacy studies: selecting a yardstick of success. (United States)

    Sobell, Linda Carter; Sobell, Mark B; Connors, Gerard J; Agrawal, Sangeeta


    Although the number of alcohol treatment efficacy trials has mushroomed, there is no consensus on how best to measure outcomes. To advance the goal of establishing cross-trial consistency in measuring outcomes in clinical efficacy studies, the National Institute on Alcohol Abuse and Alcoholism convened a panel of experts and charged them with exploring, debating, and, ultimately, selecting a "sentinel" or "optimal" outcome measure to be used in future alcohol treatment studies. The goal of this article, one in a series of several presented at the National Institute on Alcohol Abuse and Alcoholism conference, is to discuss (1) the rationale underlying selection of an optimal outcome measure, (2) the necessary characteristics of an optimal outcome measure, (3) the utility of selecting an optimal measure, and (4) which drinking assessment methods could be used to collect data to portray the optimal outcome measure. At a minimum, the criteria for an "optimal" measure include that it be psychometrically sound. In addition, it should have considerable currency in the field, thereby increasing its prospects for adoption. The measure should also be consistent with the concepts of greatest interest and relevance to the field (e.g., directly reflect the fundamental goal of alcohol treatment). In light of these highly desired features, percent of days heavy drinking was chosen at the conference as a practical and relevant measure of alcohol treatment outcome. Percent of days heavy drinking should be the optimal measure of alcohol treatment outcome. Currently, daily drinking estimation methods are the most useful for gathering data that can reflect the optimal measure. In addition, data gathered by daily drinking estimation methods can be used to study a variety of other outcome variables of interest to clinical researchers.

  8. Assessment and risk reduction of infectious pathogens on chiropractic treatment tables

    Directory of Open Access Journals (Sweden)

    Husbands Chris


    Full Text Available Abstract Background To investigate the presence of pathogenic microbes on chiropractic treatment tables in one outpatient teaching clinic. Additional aims were to test inexpensive disinfectants on tables that may kill microbes and suggest infection control measures for chiropractic offices, clinics and classrooms. The aim of the study was to assess the presence of pathogenic microbes on treatment tables in one outpatient teaching clinic and determine a simple behavioral model for infection control including table disinfection and accepted hand washing and sanitizing protocols. Methods 10 treatment tables were selected and sampled for possible microbial flora on face and hand pieces. Samples were cultured on MacConky's agar and mannitol salt agar, labeled and incubated for up to 48 hours. Confirmatory testing of microbes to determine if drug resistant flora were present was performed. Among tables tested, 5 were selected to test disinfectants. One-half of the face piece and 1 hand piece were treated with two different wipes and then post-tested for microbes. Results Pathogenic microbes were present on chiropractic treatment tables including methicillin-resistant Staph aureus. Simple disinfectants neutralized the pathogens. A rudimentary disinfection procedure and infection control measures are suggested based on the findings. Conclusion Pathogenic microbes may be present on chiropractic treatment tables and can be effectively killed with proper disinfecting. Hand washing/sanitizing is an important measure in infection control as is table disinfecting. Rudimentary behavioral changes to improve chiropractic clinic infection control are needed. More comprehensive behavioral models are needed. All teaching clinics and private chiropractic offices should adopt infection control practices including routine table disinfecting and hand sanitizing. Effective measures can be put in place at minimal costs. Accrediting bodies of chiropractic institutions

  9. CBCT in orthodontics: assessment of treatment outcomes and indications for its use (United States)

    Nervina, J M


    Since its introduction into dentistry in 1998, CBCT has become increasingly utilized for orthodontic diagnosis, treatment planning and research. The utilization of CBCT for these purposes has been facilitated by the relative advantages of three-dimensional (3D) over two-dimensional radiography. Despite many suggested indications of CBCT, scientific evidence that its utilization improves diagnosis and treatment plans or outcomes has only recently begun to emerge for some of these applications. This article provides a comprehensive and current review of key studies on the applications of CBCT in orthodontic therapy and for research to decipher treatment outcomes and 3D craniofacial anatomy. The current diagnostic and treatment planning indications for CBCT include impacted teeth, cleft lip and palate and skeletal discrepancies requiring surgical intervention. The use of CBCT in these and other situations such as root resorption, supernumerary teeth, temporomandibular joint (TMJ) pathology, asymmetries and alveolar boundary conditions should be justified on the basis of the merits relative to risks of imaging. CBCT has also been used to assess 3D craniofacial anatomy in health and disease and of treatment outcomes including that of root morphology and angulation; alveolar boundary conditions; maxillary transverse dimensions and maxillary expansion; airway morphology, vertical malocclusion and obstructive sleep apnoea; TMJ morphology and pathology contributing to malocclusion; and temporary anchorage devices. Finally, this article utilizes findings of these studies and current voids in knowledge to provide ideas for future research that could be beneficial for further optimizing the use of CBCT in research and the clinical practice of orthodontics. PMID:25358833

  10. A software prototype for the assessment of tumor treatment response using diffusion and perfusion MR imaging. (United States)

    Sakkalis, Vangelis; Manikis, Georgios C; Papanikolaou, Nickolas; Karatzanis, Ioannis; Marias, Kostas


    Advanced MRI techniques including diffusion and perfusion weighted imaging, has the potential to provide early surrogate biomarkers to detect, characterize and assess treatment response of tumors. However, the widely accepted Response Evaluation Criteria in Solid Tumors (RECIST) are still considered as the gold standard for the evaluation of treatment response in solid tumors, even if according to recent studies RECIST seem to disregard the extent of necrosis, which is the target of all effective locoregional therapies. This is partly due to the fact that measurements of tumor size aren't the best criterion for assessing actual early response. On the other hand, more sophisticated techniques such as the Apparent Diffusion Coefficient (ADC) and perfusion parameters are usually processed manually and evaluated independently using commercial CAD software, not widely available. In this paper we present an open access extensible software platform providing both diffusion and perfusion analysis in a single, user friendly environment that allows the radiologist to easily and objectively evaluate tumor response to therapy.

  11. Ultrasonography as an objective tool for assessment of infantile hemangioma treatment with propranolol. (United States)

    Rotter, Anita; Samorano, Luciana Paula; de Oliveira Labinas, Glaucia Helena; Alvarenga, Juliana Gobbi; Rivitti-Machado, Maria Cecília; Bouer, Márcio; Santos, Paulo C C; Silvestre, Daniel A M; de Oliveira, Zilda Najjar Prado


    Infantile hemangiomas (IHs) are the most common benign vascular tumors of childhood. Propranolol is an effective drug in treating IH. A reliable and complementary instrument is necessary to evaluate IH response to propranolol in addition to clinical and photographic assessments. Ultrasonography is a simple and non-invasive technique that enables precise measurements of tumor size and contributes to objective follow-up. To demonstrate the use of serial ultrasonography as an adjunctive tool for assessment of IH treatment with propranolol. A retrospective study of 19 patients with IH treated with propranolol was conducted from January 2009 to March 2014. Data of individual IH volume at the beginning and at least 6 months after the onset of treatment and overall volume reduction by ultrasonographic measurement were obtained. We observed a statistically significant IH volume reduction of approximately 0.51 cm3 . This volume corresponds to an average reduction of 47% in the final volume compared with the initial volume. Ultrasonographic measurements contribute to demonstrate tumor regression and IH response to propranolol. Thus, ultrasonography is an important instrument to guide therapeutic strategies. © 2016 The International Society of Dermatology.

  12. Decentralized peri-urban wastewater treatment technologies assessment integrating sustainability indicators. (United States)

    Mena-Ulecia, Karel; Hernández, Heykel Hernández


    Selection of treatment technologies without considering the environmental, economic and social factors associated with each geographical context risks the occurrence of negative impacts that were not properly foreseen, working against the sustainable performance of the technology. The principal aim of this study was to evaluate 12 technologies for decentralized treatment of domestic wastewater applicable to peri-urban communities using sustainability approaches and, at the same time, continuing a discussion about how to address a more integrated assessment of overall sustainability. For this, a set of 13 indicators that embody the environmental, economic and social approach for the overall sustainability assessment were used by means of a target plot diagram as a tool for integrating indicators that represent a holistic analysis of the technologies. The obtained results put forward different degrees of sustainability, which led to the selection of: septic tank+land infiltration; up-flow anaerobic reactor+high rate trickling filter and septic tank+anaerobic filter as the most sustainable and attractive technologies to be applied in peri-urban communities, according to the employed indicators.

  13. Bladder cancer treatment response assessment using deep learning in CT with transfer learning (United States)

    Cha, Kenny H.; Hadjiiski, Lubomir M.; Chan, Heang-Ping; Samala, Ravi K.; Cohan, Richard H.; Caoili, Elaine M.; Paramagul, Chintana; Alva, Ajjai; Weizer, Alon Z.


    We are developing a CAD system for bladder cancer treatment response assessment in CT. We compared the performance of the deep-learning convolution neural network (DL-CNN) using different network sizes, and with and without transfer learning using natural scene images or regions of interest (ROIs) inside and outside the bladder. The DL-CNN was trained to identify responders (T0 disease) and non-responders to chemotherapy. ROIs were extracted from segmented lesions in pre- and post-treatment scans of a patient and paired to generate hybrid pre-post-treatment paired ROIs. The 87 lesions from 82 patients generated 104 temporal lesion pairs and 6,700 pre-post-treatment paired ROIs. Two-fold cross-validation and receiver operating characteristic analysis were performed and the area under the curve (AUC) was calculated for the DL-CNN estimates. The AUCs for prediction of T0 disease after treatment were 0.77+/-0.08 and 0.75+/-0.08, respectively, for the two partitions using DL-CNN without transfer learning and a small network, and were 0.74+/-0.07 and 0.74+/-0.08 with a large network. The AUCs were 0.73+/-0.08 and 0.62+/-0.08 with transfer learning using a small network pre-trained with bladder ROIs. The AUC values were 0.77+/-0.08 and 0.73+/-0.07 using the large network pre-trained with the same bladder ROIs. With transfer learning using the large network pretrained with the Canadian Institute for Advanced Research (CIFAR-10) data set, the AUCs were 0.72+/-0.06 and 0.64+/-0.09, respectively, for the two partitions. None of the differences in the methods reached statistical significance. Our study demonstrated the feasibility of using DL-CNN for the estimation of treatment response in CT. Transfer learning did not improve the treatment response estimation. The DL-CNN performed better when transfer learning with bladder images was used instead of natural scene images.

  14. Oral Health-Related Complications of Breast Cancer Treatment: Assessing Dental Hygienists’ Knowledge and Professional Practice (United States)

    Taichman, L. Susan; Gomez, Grace; Inglehart, Marita Rohr


    Objective Approximately 200,000 women are diagnosed with breast cancer in the U.S. every year. These patients commonly suffer from oral complications of their cancer therapy. The purpose of this study was to assess dental hygienists’ knowledge and professional practice related to providing care for breast cancer patients. Methods A pre-tested 43-item survey was mailed to a random sample of 10% of all licensed dental hygienists in the State of Michigan (N=962). The survey assessed the respondents’ knowledge of potential oral complications of breast cancer treatments as well as their professional practices when treating patients with breast cancer. After two mailings, the response rate was 37% (N=331). Descriptive and inferential analyses were conducted using SAS. Results Many dental hygienists were unaware of the recommended clinical guidelines for treating breast cancer patients and lacked specific knowledge pertaining to the commonly prescribed anti-estrogen medications for pre-and postmenopausal breast cancer patients. Over 70% of the respondents indicated they were unfamiliar with the AI class of medications. Only 13% of dental hygienists correctly identified the mechanism of action of anti-estrogen therapy. Dental hygienists reported increased gingival inflammation, gingival bleeding, periodontal pocketing, xerostomia and burning tissues in patients receiving anti-estrogen therapies. Less than 10% believed that their knowledge of breast cancer treatments and the oral side effects is up to date. Conclusions Results indicate a need for more education about the potential oral effects of breast cancer therapies and about providing the best possible care for patients undergoing breast cancer treatment. PMID:26338905

  15. Characterization and assessment of nanoencapsulated sanguinarine chloride as a potential treatment for melanoma. (United States)

    Rosen, Jamie; Landriscina, Angelo; Adler, Brandon L; Krauz, Aimee; Doerner, Jessica; Navati, Mahantesh; Musaev, Tagai; Gravekamp, Claudia; Nosanchuk, Joshua; Friedman, Adam J


    Sanguinarine has a history of use in both folk medicine and early dermatology for the treatment of cutaneous neoplasms. Applied indiscriminately, bloodroot is an escharotic agent with potential to cause extensive tissue necrosis. However, when used in a controlled fashion, sanguinarine imparts selective cytotoxic/anti-proliferative activity through multiple mechanisms against human/ murine melanoma. To exploit sanguinarine's observed activity against melanoma, a targeted delivery system is required. We present a sol-gel based nanoparticulate platform for encapsulating sanguinarine chloride(sang-np)-a targeted therapeutic capable of steady, reliable delivery of predictable quantities of drug over a sustained time period with minimal undesirable effects. Size and release kinetics of sang-np were characterized using dynamic light scattering and ultraviolet-visible spectroscopy respectively. In vitro efficacy of sang-np was assessed. At both 2 and 24 hours, free sanguinarine killed > 90% of B16 melanoma cells, assessed via MTT assay. At 2 hours, sang-np killed a portion of melanoma cells, increasing to percentages comparable to free sanguinarine by 24 hours. Control(empty) nanoparticles exerted minimal toxicity to melanoma cells at both time points. TUNEL assay revealed that treatment with both sanguinarine and sang-np induces apoptosis in B16 melanoma cells, suggesting that both treatments act via the same mechanism of action. These data confirm controlled release of sanguinarine from sang-np, as well as comparable efficacy and mechanism of action to sanguinarine alone. This suggests that nanoparticle delivery of sanguinarine may be a unique approach to capitalize on this potent agent's inherent anti-tumor activity and overcome many of the limitations with its current formulation.

  16. Life cycle assessment of four potable water treatment plants in northeastern Colombia

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    Oscar Orlando Ortiz Rodriguez


    Full Text Available There is currently great concern about the processes that directly or indirectly contribute to the potential for global warming, such as stratospheric ozone depletion or acidification. In this context, and provided that treated water is a basic public utility in urban centers around the world as well as in some rural areas, its impact on the environment is of great interest. Therefore, this study applied the environmental methodology of Life Cycle Assessment (LCA to evaluate the environmental loads of four potable water treatment plants (PWTPs located in northeastern Colombia following the international guidelines delineated in ISO 14040. The different stages of the drinking water process were thoroughly assessed, from the catchment point through pumping to the distribution network. The functional unit was defined as 1 m3 of drinking water produced at the plant. The data were analyzed through the database Ecoinvent v.3.01, and modeled and processed in the software LCA-Data Manager. The results showed that in plants PLA-CA and PLA-PO, the flocculation process has the highest environmental load, which is mostly attributable to the coagulant agent, with a range between 47-73% of the total impact. In plants PLA-TON and PLA-BOS, electricity consumption was identified as the greatest impact source, with percentages ranging from 67 to 85%. Treatment processes and techniques, bioclimatic conditions and culturally driven consumption behavior varied from region to region. Furthermore, changes in treatment processes and techniques are likely to affect the environment during all stages of a plant’s operational cycle.

  17. Phase 4 study to assess tretinoin pump for the treatment of facial acne. (United States)

    Eichenfield, Lawrence F; Nighland, Marge; Rossi, Ana Beatris; Cook-Bolden, Fran; Grimes, Pearl; Fried, Richard; Levy, Sharon


    It is well known that the setting of clinical trials for registration studies do not necessarily represent efficacy seen in clinical practice, where physicians have the flexibility to select, combine, and change the acne treatment prescription. In this phase 4, open-label, multicenter, community-based study, 544 patients who were dissatisfied with their current acne treatment received tretinoin gel microsphere (TGM) 0.04% or 0.1% in a pump dispenser for 12 weeks. Patients were allowed the use of up to 2 other concurrent acne therapies, not including other retinoids. A total of 361 patients received TGM 0.04% and 183 received TGM 0.1%. Compliance was high (defined as 75% to 100% of prescribed doses taken) for approximately 95% of patients in both groups at every evaluation. At week 12, the mean modified Global Acne Grade score (mGAGs) and the investigator global evaluation (IGE) demonstrated significant (Pacne was assessed as cleared or almost cleared. Most side effects were characteristic of topical retinoids. These results indicate TGM in a pump dispenser as an effective, well-tolerated acne treatment that is associated with a high rate of compliance.

  18. Posttraumatic Stress Disorder: Overview of Evidence-Based Assessment and Treatment

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    Cynthia L. Lancaster


    Full Text Available Posttraumatic stress disorder (PTSD is a chronic psychological disorder that can develop after exposure to a traumatic event. This review summarizes the literature on the epidemiology, assessment, and treatment of PTSD. We provide a review of the characteristics of PTSD along with associated risk factors, and describe brief, evidence-based measures that can be used to screen for PTSD and monitor symptom changes over time. In regard to treatment, we highlight commonly used, evidence-based psychotherapies and pharmacotherapies for PTSD. Among psychotherapeutic approaches, evidence-based approaches include cognitive-behavioral therapies (e.g., Prolonged Exposure and Cognitive Processing Therapy and Eye Movement Desensitization and Reprocessing. A wide variety of pharmacotherapies have received some level of research support for PTSD symptom alleviation, although selective serotonin reuptake inhibitors have the largest evidence base to date. However, relapse may occur after the discontinuation of pharmacotherapy, whereas PTSD symptoms typically remain stable or continue to improve after completion of evidence-based psychotherapy. After reviewing treatment recommendations, we conclude by describing critical areas for future research.

  19. Clinical Assessment of Extract in the Treatment of Female Sexual Dysfunction

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    Carlos R.B. Gama


    Full Text Available This is a qualitative—quantitative study based on hospital records of female patients of reproductive age, presenting sexual dysfunction, and treated with 250 mg Tribulus terrestris extract (1 tablet thrice daily for 90 days. Safety monitoring included vital signs, physical examination, laboratory tests, and occurrence of adverse events. Efficacy analysis included results of the Female Sexual Function Index (FSFI, dehydroepiandrosterone (DHEA levels together with total and free testosterone, and the patient and physician assessments. There was a statistically significant improvement in total FSFI scores ( P < 0.0001 post-treatment, with improvement among 106 (88.33% subjects. There was a statistically significant ( P < 0.0001 increase in the level of DHEA, while the levels of both serum testosterone ( P = 0.284 and free testosterone decreased ( P < 0.0001. Most adverse events recorded were related to the gastrointestinal tract. Physical examination showed no significant changes post-treatment. Based on the results, it is concluded that the T. terrestris extract is safe and effective in the treatment of female sexual dysfunction.

  20. Glutathione cycle in diquat neurotoxicity: Assessed by intrastriatal pre-treatment with glutathione reductase

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    Đurđević Dragan


    Full Text Available Diquat (DQ neurotoxicity mechanisms are unknown, although, it's systemic toxicity is mediated by free radical reactions. The role of glutathione cycle was assessed by glutathione reductase (GR applied in the pre-treatment of DQ poisoning. Wistar rats were used and tested compounds were administered intrastriatally (i.s. in one single dose. Total glutathione (tGSH, glutathione disulfide (GSSG and glutathione peroxidase (GPx were measured in the vulnerable brain regions (VBRs (striatum, hippocampus and cortex, at 30 minutes, 24 hours and 7 days post treatment. Results from the intact and the sham operated groups were not statistically different. Rapid spatial spreading of oxidative stress was confirmed in the examined VBRs. Mortality (30-40%, within 24hrs and signs of lethargy were observed in the DQ group. Activity of GPx activity was elevated and GSSG/GSH was higher in the examined VBRs during the experiment, compared to the controls. The i.s. pre-treatment with GR achieved neuroprotective role against DQ induced neurotoxicity, based on animal survival, absence of lethargy and decreased GPx activity and GSSG/GSH in the examined VBRs during the experiment, compared to the DQ group. Our results confirmed that oxidation of GSH was the reason for the reduced antioxidative defense against DQ neurotoxicity. [Projekat Ministarstva nauke Republike Srbije, br. III41018

  1. Microbiological assessment of saliva from children subsequent to atraumatic restorative treatment (ART). (United States)

    Carvalho, C K S; Bezerra, A C B


    The aim of this study was to evaluate mutans streptococci (MS) in the saliva following use of the atraumatic restorative treatment (ART) technique. Sixteen 5-7-year-old children had restorations using the ART technique and employing FUJI IX glass-ionomer cement as the restorative material. Decayed tissue was manually excavated without local anaesthesia, being careful to avoid discomfort. Saliva was collected for microbiological assessment using Kit Caritest MS before treatment, one week, four weeks and one year after ART was used. The procedure for saliva collection, incubation, storage, and comparative reading of MS counts followed the manufacturer's instructions. The data were statistically analysed, using non-parametric tests (Wilcoxon Signed Ranks and Sign Test) at a significance level of 0.05. The results showed a significant reduction of MS levels in saliva when comparing the results before treatment with those obtained one week (95.95%; P = 0.003), four weeks (93.27%; P = 0.000) and one year (95.56%; P = 0.002) after ART. It is concluded from the results that the ART technique proved satisfactory and appeared to have produced a significant and sustained reduction in levels of MS. These results need to be confirmed in a larger study.

  2. Assessment technique for acne treatments based on statistical parameters of skin thermal images. (United States)

    Padilla-Medina, J Alfredo; León-Ordoñez, Francisco; Prado-Olivarez, Juan; Vela-Aguirre, Noe; Ramírez-Agundis, Agustin; Díaz-Carmona, Javier


    Acne vulgaris as an inflammatory disease, with an excessive production of subdermal fat, modifies the dynamics of the bloodstream, and consequently temperature, on the affected skin zone. A high percentage of this heat interchange is manifested as electromagnetic radiation with far-infrared wavelengths, which can be captured through a thermal imaging camera. A technique based on thermal image analysis for efficiency assessment in acne vulgaris is described. The procedure is based on computing statistical parameters of thermal images captured from the affected skin zone being attended by an acne treatment. The proposed technique was used to determine the skin thermal behavior according to acne severity levels in different acne treatment stages. Infrared images of acne skin zones on eight patients, diagnosed with acne vulgaris and attended by one specific acne treatment, were weekly registered during 11 weeks. The infrared images were captured until no more improvement in affected zones was detected. The obtained results suggest a direct relationship between the used statistical parameters, particularly first- and second-order statistics, and the acne vulgaris severity level on the affected zones.

  3. An integrated decision making approach for assessing healthcare waste treatment technologies from a multiple stakeholder. (United States)

    Shi, Hua; Liu, Hu-Chen; Li, Ping; Xu, Xue-Guo


    With increased worldwide awareness of environmental issues, healthcare waste (HCW) management has received much attention from both researchers and practitioners over the past decade. The task of selecting the optimum treatment technology for HCWs is a challenging decision making problem involving conflicting evaluation criteria and multiple stakeholders. In this paper, we develop an integrated decision making framework based on cloud model and MABAC method for evaluating and selecting the best HCW treatment technology from a multiple stakeholder perspective. The introduced framework deals with uncertain linguistic assessments of alternatives by using interval 2-tuple linguistic variables, determines decision makers' relative weights based on the uncertainty and divergence degrees of every decision maker, and obtains the ranking of all HCW disposal alternatives with the aid of an extended MABAC method. Finally, an empirical example from Shanghai, China, is provided to illustrate the feasibility and effectiveness of the proposed approach. Results indicate that the methodology being proposed is more suitable and effective to handle the HCW treatment technology selection problem under vague and uncertain information environment. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. [The importance of a developmental approach in psychiatric assessment and treatment of adults with intellectual disability]. (United States)

    Sappok, T; Schade, C; Kaiser, H; Dosen, A; Diefenbacher, A


    Mental disorders are 3-4 times more frequent in individuals with intellectual disabilities than in those without. From a developmental perspective the reason for this high prevalence could be, besides biological aberrations, a personality development with a difference between cognitive and emotional developmental levels. This discrepancy renders the person being highly vulnerable for the onset of problem behaviour and psychiatric disorders. For a proper insight into processes which have led to the disorder, it is necessary to evaluate the level of emotional development. This can be determined by the "schema of emotional development (SEO)" developed by A. Dosen. By means of a case description the authors demonstrate the application of SEO in the assessment and utilization of the concept of the level of emotional development in clinical practice. The knowledge of the level of emotional development contributes to the explaining and understanding of the disorder, and also facilitates the establishment of an integrated diagnosis and the creation of appropriate integrated treatment strategies. Hence, temper tantrums, sleep patterns and mood improved in the case described. Besides biopsychosocial aspects, the developmental aspect, and in particular the level of emotional development should be taken into consideration in the diagnostic work-up and treatment of individuals with intellectual disabilities and mental health problems. The data generated by the SEO may help in understanding the disorder and developing a treatment approach for these individuals. © Georg Thieme Verlag KG Stuttgart · New York.

  5. Assessment of therapeutic biomarkers in the treatment of children with postural tachycardia syndrome and vasovagal syncope. (United States)

    Lin, Jing; Jin, Hongfang; Du, Junbao


    Postural tachycardia syndrome and vasovagal syncope are common causes of orthostatic intolerance in children. The supplementation with water, or salt, or midodrine, or β-blocker was applied to children with postural tachycardia syndrome or vasovagal syncope. However, the efficacy of such medication varied and was not satisfied. This review aimed to summarise the current biomarkers in the treatment of the diseases. Studies were collected from online electronic databases, including OVID Medline, PubMed, ISI Web of Science, and associated references. The main areas assessed in the included studies were clinical improvement, the cure rate, and the individualised treatment for postural tachycardia syndrome and vasovagal syncope in children. Haemodynamic change during head-up tilt test, and detection of 24-hour urinary sodium excretion, flow-mediated vasodilation, erythrocytic H₂S, and plasma pro-adrenomedullin as biological markers were the new ways that were inexpensive, non-invasive, and easy to test for finding those who would be suitable for a specific drug and treatment. With the help of biomarkers, the therapeutic efficacy was greatly increased for children with postural tachycardia syndrome and vasovagal syncope.

  6. Primary or recurring extra-abdominal desmoid fibromatosis: assessment of treatment by observation only. (United States)

    Barbier, O; Anract, P; Pluot, E; Larouserie, F; Sailhan, F; Babinet, A; Tomeno, B


    Extra-abdominal desmoid fibromatosis (EADF) is a benign tumoral condition, classically managed by more or less radical and sometimes mutilating excision. This treatment strategy is associated with a recurrence rate of nearly 50% according to various reports. EADF may show spontaneous stabilization over time. A retrospective series of 26 cases of EADF managed by simple observation was studied to assess spontaneous favorable evolution and identify possible factors impacting evolution. Eleven cases were of primary EADF with no treatment or surgery, and 15 of recurrence after surgery with no adjuvant treatment. MRI was the reference examination during follow-up. Twenty-four cases showed stabilization at a median 14 months; there were no cases of renewed evolution after stabilization. One primary tumor showed spontaneous regression, and one recurrence still showed evolution at end of follow-up (23 months). The sole factor impacting potential for evolution was prior surgery. No radiologic or pathologic criteria of evolution emerged from analysis. The present series, one of the largest dedicated to EADF managed by observation, confirmed recent literature findings: a conservative "wait-and-see" attitude is reasonable and should be considered when large-scale resection would entail significant functional or esthetic impairment. Level IV, retrospective study. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  7. Assessment of cardiac valve dysfunction in patients receiving cabergoline treatment for hyperprolactinaemia. (United States)

    Tan, Tricia; Cabrita, Ines Z; Hensman, Davina; Grogono, Joanna; Dhillo, Waljit S; Baynes, Kevin C; Eliahoo, Joseph; Meeran, Karim; Robinson, Stephen; Nihoyannopoulos, Petros; Martin, Niamh M


    Cabergoline is a highly effective medical treatment for patients with hyperprolactinaemia. There is an increased risk of valvular heart disease in patients receiving cabergoline for Parkinson's disease. This study examined whether cabergoline treatment of hyperprolactinaemia is associated with a greater prevalence of valvulopathy. Cross-sectional, two-dimensional echocardiographic study performed by a single echocardiographer. Seventy-two patients (median age 36 years, 19 men) receiving cabergoline for hyperprolactinaemia, and 72 controls prospectively matched for age, sex and cardiovascular risk factors. Measurements Assessment of valvular mobility, regurgitation and morphology. Median cumulative dose exposure for cabergoline was 126 (58-258) mg, and patients had received cabergoline for 53 (26-96) months. The frequency of mild mitral regurgitation was identical (5/72, 7%) in patient and control groups. Mild aortic regurgitation was not significantly different between groups (4/72 [controls] vs 2/72 [patients], P = 0.681). There was only one case of tricuspid regurgitation, which was mild and observed in a cabergoline-treated patient. Nodular thickening of the right coronary cusp, noncoronary cusp or left coronary cusp of the aortic valve was observed at a similar frequency in both groups. There were no cases of extensive thickening of any valvular leaflet. Our data demonstrates that there is no association between cabergoline treatment for hyperprolactinaemia and valvulopathy. This study therefore supports continued use of low-dose cabergoline for patients with hyperprolactinaemia.

  8. Measuring Treatment Outcomes in Comorbid Insomnia and Fibromyalgia: Concordance of Subjective and Objective Assessments. (United States)

    Mundt, Jennifer M; Crew, Earl C; Krietsch, Kendra; Roth, Alicia J; Vatthauer, Karlyn; Robinson, Michael E; Staud, Roland; Berry, Richard B; McCrae, Christina S


    In insomnia, actigraphy tends to underestimate wake time compared to diaries and PSG. When chronic pain co-occurs with insomnia, sleep may be more fragmented, including more movement and arousals. However, individuals may not be consciously aware of these arousals. We examined the baseline concordance of diaries, actigraphy, and PSG as well as the ability of each assessment method to detect changes in sleep following cognitive behavioral therapy for insomnia (CBT-I). Adults with insomnia and fibromyalgia (n = 113) were randomized to CBT-I, CBT for pain, or waitlist control. At baseline and posttreatment, participants completed one night of PSG and two weeks of diaries/actigraphy. At baseline, objective measures estimated lower SOL, higher TST, and higher SE than diaries (ps treatment-related changes. PSG values did not change significantly for any sleep parameters. However, diaries showed improvements in SOL, WASO, and SE, and actigraphy also detected the WASO and SE improvements (ps insomnia. However, actigraphy showed greater sensitivity to treatment-related changes than PSG; PSG failed to detect any improvements, but actigraphy demonstrated changes in WASO and SE, which were also found with diaries. In comorbid insomnia/fibromyalgia, actigraphy may therefore have utility in measuring treatment outcomes. © 2015 American Academy of Sleep Medicine.

  9. Assessment of dissociation in Bosnian treatment-seeking refugees in Denmark. (United States)

    Palic, Sabina; Carlsson, Jessica; Armour, Cherie; Elklit, Ask


    Dissociative experiences are common in traumatized individuals, and can sometimes be mistaken for psychosis. It is difficult to identify pathological dissociation in the treatment of traumatized refugees, because there is a lack of systematic clinical descriptions of dissociative phenomena in refugees. Furthermore, we are currently unaware of how dissociation measures perform in this clinical group. To describe the phenomenology of dissociative symptoms in Bosnian treatment-seeking refugees in Denmark. As a part of a larger study, dissociation was assessed systematically in 86 Bosnian treatment-seeking refugees using a semi-structured clinical interview (Structured Interview for Disorders of Extreme Stress-dissociation subscale; SIDES-D) and a self-report scale (Dissociative Experiences Scale; DES). The SIDES-D indicated twice as high prevalence of pathological dissociation as the DES. According to the DES, 30% of the refugees had pathological dissociation 15 years after their resettlement. On the SIDES-D, depersonalization and derealization experiences were the most common. Also, questions about depersonalization and derealization at times elicited reporting of visual and perceptual hallucinations, which were unrelated to traumatic re-experiencing. Questions about personality alteration elicited spontaneous reports of a phenomenon of "split" pre- and post-war identity in the refugee group. Whether this in fact is a dissociative phenomenon, characteristic of severe traumatization in adulthood, needs further examination. Knowledge of dissociative symptoms in traumatized refugees is important in clinical settings to prevent misclassification and to better target psychotherapeutic interventions. Much development in the measurement of dissociation in refugees is needed.

  10. Sports Eligibility After Risk Assessment and Treatment in Children with Asymptomatic Ventricular Pre-excitation. (United States)

    Di Mambro, Corrado; Drago, F; Milioni, M; Russo, M S; Righi, D; Placidi, S; Remoli, R; Palmieri, R; Gimigliano, F; Santucci, L M; Silvetti, M S; Prosperi, M


    Many studies concern the management of young patients with symptomatic Wolff-Parkinson-White (WPW) syndrome, but little information exists on the significance and prognosis of ventricular pre-excitation (VPE) in asymptomatic children. The aim of the study was to evaluate the risk of sudden death in young athletes with asymptomatic VPE by transesophageal electrophysiological study (TEEPS) and their sports eligibility after the risk assessment and/or ablative treatment. Ninety-one asymptomatic children and adolescents underwent TEEPS both at rest and during adrenergic stress (exercise testing or isoproterenol infusion). After electrophysiological testing, patients were assessed in the 36 months of follow-up. Thirty-three patients (36.3 %) had a benign form of VPE and were allowed to participate in competitions. Ten patients (11 %) were at borderline risk; thus, sport eligibility was evaluated individually. Forty-eight patients (52.7 %) showed inducible sustained atrioventricular reentrant tachycardia and/or atrial fibrillation (AF), 11 of whom (12.1 % of total population) had a potential risk of sudden cardiac death due to AF inducibility during physical stress. Forty-five young athletes underwent transcatheter ablation (TCA). TCA was interrupted in 12 patients (26.7 %) because of the high procedural risk linked to septal accessory pathway (AP) location. There were no TCA-related complications, and all patients remained asymptomatic during follow-up. Most of the young athletes with asymptomatic VPE may be allowed to participate in competitive sports after an adequate risk assessment and/or ablative treatment. However, in our opinion, special care should be taken to avoid procedural complications, which are unacceptable in asymptomatic patients.

  11. Communication subjective assessments of patients undergoing compulsory treatment with the severity of negative symptoms and cognitive functioning level

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    Kabanov T.N.


    Full Text Available The article presents the results of studies on the relationship of subjective assessments of the mentally ill with the severity of negative symptoms and cognitive functioning level. The features of patients perception of various aspects of compulsory treatment and subjective satisfaction with treatment. In a study of 94 male patients with a diagnosis of organic mental disorder and schizophrenia was used diagnostic system, consisting of patopsihologicheskogo study, formal survey map, the scale of assessment of negative symptoms SANS, questionnaire symptom levels SCL-90, self-existing problems, as well as - in Test authoring tool sheet to treatment and hospital stay (VG Bulygin, Kabanov, TN, 2011. The differences in subjective assessments of aspects of compulsory treatment and social functioning of patients with varying degrees of severity of negative symptoms and dependence of subjective assessments of the level of cognitive functioning.

  12. Rapid and Quantitative Assessment of Cancer Treatment Response Using In Vivo Bioluminescence Imaging

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    Alnawaz Rehemtulla


    Full Text Available Current assessment of orthotopic tumor models in animals utilizes survival as the primary therapeutic end point. In vivo bioluminescence imaging (BLI is a sensitive imaging modality that is rapid and accessible, and may comprise an ideal tool for evaluating antineoplastic therapies [1 ]. Using human tumor cell lines constitutively expressing luciferase, the kinetics of tumor growth and response to therapy have been assessed in intraperitoneal [2], subcutaneous, and intravascular [3] cancer models. However, use of this approach for evaluating orthotopic tumor models has not been demonstrated. In this report, the ability of BLI to noninvasively quantitate the growth and therapeuticinduced cell kill of orthotopic rat brain tumors derived from 9L gliosarcoma cells genetically engineered to stably express firefly luciferase (9LLuc was investigated. Intracerebral tumor burden was monitored over time by quantitation of photon emission and tumor volume using a cryogenically cooled CCD camera and magnetic resonance imaging (MRI, respectively. There was excellent correlation (r=0.91 between detected photons and tumor volume. A quantitative comparison of tumor cell kill determined from serial MRI volume measurements and BLI photon counts following 1,3-bis(2-chloroethyl-1-nitrosourea (BCNU treatment revealed that both imaging modalities yielded statistically similar cell kill values (P=.951. These results provide direct validation of BLI imaging as a powerful and quantitative tool for the assessment of antineoplastic therapies in living animals.

  13. Health Technology Assessment of Belimumab: A New Monoclonal Antibody for the Treatment of Systemic Lupus Erythematosus

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    Maria Lucia Specchia


    Full Text Available Objective. Systemic lupus erythematosus (SLE is treated with anti-inflammatory and immunosuppressive drugs and off-label biologics. Belimumab is the first biologic approved after 50 years as an add-on therapy for active disease. This paper summarizes a health technology assessment performed in Italy. Methods. SLE epidemiology and burden were assessed using the best published international and national evidences and efficacy and safety of belimumab were synthesized using clinical data. A cost-effectiveness analysis was performed by a lifetime microsimulation model comparing belimumab to standard of care (SoC. Organizational and ethical implications were discussed. Results. Literature review showed that SLE affects 47 per 100,000 people for a total of 28,500 patients in Italy, 50% of whom are affected by active form of the disease despite SoC. These patients, if autoantibodies and anti-dsDNA positive with low complement, are eligible for belimumab. SLE determines work disability and a 2–5-fold increase in mortality. Belimumab with SoC may prevent 4,742 flares in three years being cost-effective with an incremental cost-effectiveness ratio of €32,859 per quality adjusted life year gained. From the organizational perspective, the development of clear and comprehensive clinical pathways is crucial. Conclusions. The assessment supports the use of belimumab into the SLE treatment paradigm in Italy.

  14. Treatments for hyperemesis gravidarum and nausea and vomiting in pregnancy: a systematic review and economic assessment. (United States)

    O'Donnell, Amy; McParlin, Catherine; Robson, Stephen C; Beyer, Fiona; Moloney, Eoin; Bryant, Andrew; Bradley, Jennifer; Muirhead, Colin; Nelson-Piercy, Catherine; Newbury-Birch, Dorothy; Norman, Justine; Simpson, Emma; Swallow, Brian; Yates, Laura; Vale, Luke


    Nausea and vomiting in pregnancy (NVP) affects up to 85% of all women during pregnancy, but for the majority self-management suffices. For the remainder, symptoms are more severe and the most severe form of NVP - hyperemesis gravidarum (HG) - affects 0.3-1.0% of pregnant women. There is no widely accepted point at which NVP becomes HG. This study aimed to determine the relative clinical effectiveness and cost-effectiveness of treatments for NVP and HG. MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, PsycINFO, Commonwealth Agricultural Bureaux (CAB) Abstracts, Latin American and Caribbean Health Sciences Literature, Allied and Complementary Medicine Database, British Nursing Index, Science Citation Index, Social Sciences Citation Index, Scopus, Conference Proceedings Index, NHS Economic Evaluation Database, Health Economic Evaluations Database, China National Knowledge Infrastructure, Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects were searched from inception to September 2014. References from studies and literature reviews identified were also examined. Obstetric Medicine was hand-searched, as were websites of relevant organisations. Costs came from NHS sources. A systematic review of randomised and non-randomised controlled trials (RCTs) for effectiveness, and population-based case series for adverse events and fetal outcomes. Treatments: vitamins B6 and B12, ginger, acupressure/acupuncture, hypnotherapy, antiemetics, dopamine antagonists, 5-hydroxytryptamine receptor antagonists, intravenous (i.v.) fluids, corticosteroids, enteral and parenteral feeding or other novel treatment. Two reviewers extracted data and quality assessed studies. Results were narratively synthesised; planned meta-analysis was not possible due to heterogeneity and incomplete reporting. A simple economic evaluation considered the implied values of treatments. Seventy

  15. Clinical assessment and treatment in paediatric wards in the north-east of the United Republic of Tanzania

    DEFF Research Database (Denmark)

    Reyburn, Hugh; Mwakasungula, Emmanuel; Chonya, Semkini


    OBJECTIVE: We assessed paediatric care in the 13 public hospitals in the north-east of the United Republic of Tanzania to determine if diagnoses and treatments were consistent with current guidelines for care. METHODS: Data were collected over a five-day period in each site where paediatric...... and associated with missed diagnoses and inappropriate treatments. Improved assessment and records are essential to initiate change, but achieving this will be a challenging task....

  16. Physiotherapy in hip and knee osteoarthritis: development of a practice guideline concerning initial assessment, treatment and evaluation.


    Peter, W.F.H.; Jansen, M.J.; Hurkmans, E.J.; Bloo, H.; Dekker-Bakker, L.M.M.C.J.; Dilling, R.G.; Hilberdink, W.K.H.A.; Kersten-Smit, C.; Rooij, M. de; Veenhof, C.; Vermeulen, H.M.; Vos, R.J. de; Schoones, J.W.; Vliet Vlieland, T.P.M.


    BACKGROUND: An update of a Dutch physiotherapy practice guideline in Hip and Knee Osteoarthritis (HKOA) was made, based on current evidence and best practice. METHODS: A guideline steering committee, comprising 10 expert physiotherapists, selected topics concerning the guideline chapters: initial assessment, treatment and evaluation. With respect to treatment a systematic literature search was performed using various databases, and the evidence was graded (1-4). For the initial assessment and...

  17. Assessment of potential greenhouse gas mitigation of available household solid waste treatment technologies

    Directory of Open Access Journals (Sweden)

    Hoang Minh Giang


    Full Text Available Current household solid waste treatment practices in most cities in Vietnam caused a great amount of direct greenhouse gas (GHG emissions. Available solid waste treatment technologies should be seriously taken  into consideration as a wedge of GHG mitigation in waste sector base on presently Vietnamese economic conditions. This study aim to evaluate the potential amount of GHG mitigation from current domestic solid waste treatment technologies in Vietnam including landfills and composting from various management scenarios. In oder to use Tier 2 model of IPCC 2006 for GHG estimation from landfills, an analysis on current household solid waste management system of the city was obtained by using material flow analysis approach. A case study in Hanoi, the capital city of Vietnam was carried out in this research. As a result, there was a reduced of over 70% of the amount of CH4 emissions and  up to 53% of total GHG saving (CO2-eq from avoiding organic waste to landfill. In addition, applying an energy recovery from LFG system to available landfills would lead to aproximately 75% of GHG saved compare to current emission of waste sector.Doi: Giang, H.M.,Luong, N.D., and Huong, L.T.M.2013. Assessment of potential greenhouse gas mitigation of available household solid waste treatment technologies. . Waste Technology 1(1:6-9. Doi:

  18. A Randomized Controlled Trial of Cognitive Debiasing Improves Assessment and Treatment Selection for Pediatric Bipolar Disorder (United States)

    Jenkins, Melissa M.; Youngstrom, Eric A.


    Objective This study examined the efficacy of a new cognitive debiasing intervention in reducing decision-making errors in the assessment of pediatric bipolar disorder (PBD). Method The study was a randomized controlled trial using case vignette methodology. Participants were 137 mental health professionals working in different regions of the US (M=8.6±7.5 years of experience). Participants were randomly assigned to a (1) brief overview of PBD (control condition), or (2) the same brief overview plus a cognitive debiasing intervention (treatment condition) that educated participants about common cognitive pitfalls (e.g., base-rate neglect; search satisficing) and taught corrective strategies (e.g., mnemonics, Bayesian tools). Both groups evaluated four identical case vignettes. Primary outcome measures were clinicians’ diagnoses and treatment decisions. The vignette characters’ race/ethnicity was experimentally manipulated. Results Participants in the treatment group showed better overall judgment accuracy, p < .001, and committed significantly fewer decision-making errors, p < .001. Inaccurate and somewhat accurate diagnostic decisions were significantly associated with different treatment and clinical recommendations, particularly in cases where participants missed comorbid conditions, failed to detect the possibility of hypomania or mania in depressed youths, and misdiagnosed classic manic symptoms. In contrast, effects of patient race were negligible. Conclusions The cognitive debiasing intervention outperformed the control condition. Examining specific heuristics in cases of PBD may identify especially problematic mismatches between typical habits of thought and characteristics of the disorder. The debiasing intervention was brief and delivered via the Web; it has the potential to generalize and extend to other diagnoses as well as to various practice and training settings. PMID:26727411

  19. Assessing Intra-arterial Complications of Planning and Treatment Angiograms for Y-90 Radioembolization

    Energy Technology Data Exchange (ETDEWEB)

    Ahmed, Osman, E-mail: [Rush University Medical Center, Section of Interventional Radiology, Department of Radiology (United States); Patel, Mikin V. [University of Chicago, Department of Radiology (United States); Masrani, Abdulrahman; Chong, Bradford; Osman, Mohammed; Tasse, Jordan; Soni, Jayesh; Turba, Ulku Cenk; Arslan, Bulent [Rush University Medical Center, Section of Interventional Radiology, Department of Radiology (United States)


    PurposeTo report hepatic arterial-related complications encountered during planning and treatment angiograms for radioembolization and understand any potential-associated risk factors.Materials and Methods518 mapping or treatment angiograms for 180 patients with primary or metastatic disease to the liver treated by Yttrium-90 radioembolization between 2/2010 and 12/2015 were retrospectively reviewed. Intra-procedural complications were recorded per SIR guidelines. Patient demographics, indication for treatment, prior exposure to chemotherapeutic agents, operator experience, and disease burden were reviewed. Technical variables including type of radioembolic (glass vs. resin microspheres), indication for angiography (mapping vs. treatment), variant anatomy, and attempts at coil embolization were also assessed.ResultsThirteen (13/518, 2.5%) arterial-related complications occurred in 13 patients. All but two complications resulted during transcatheter coil embolization to prevent non-target embolization. Complications included coil migration (n = 6), arterial dissection (n = 2), focal vessel perforation (n = 2), arterial thrombus (n = 2), and vasospasm prohibiting further arterial sub-selection (n = 1). Transarterial coiling was identified as a significant risk factor of complications on both univariate and multivariate regression analysis (odds ratio 7.8, P = 0.004). Usage of resin microspheres was also a significant risk factor (odds ratio 9.5, P = 0.042). No other technical parameters or pre-procedural variables were significant after adjusting for confounding on multivariate analysis (P > 0.05).ConclusionIntra-procedural hepatic arterial complications encountered during radioembolization were infrequent but occurred mainly during coil embolization to prevent non-target delivery to extra-hepatic arteries.

  20. Hyperbaric Oxygen Therapy for the Treatment of Diabetic Foot Ulcers: A Health Technology Assessment (United States)

    Lambrinos, Anna; Chan, Brian; Wells, David; Holubowich, Corinne


    Background About 15% to 25% of people with diabetes will develop a foot ulcer. These wounds are often resistant to healing; therefore, people with diabetes experience lower limb amputation at about 20 times the rate of people without diabetes. If an ulcer does not heal with standard wound care, other therapeutic interventions are offered, one of which is hyperbaric oxygen therapy (HBOT). However, the effectiveness of this therapy is not clearly known. The objectives of this health technology assessment were to assess the safety, clinical effectiveness, and cost-effectiveness of standard wound care plus HBOT versus standard wound care alone for the treatment of diabetic foot ulcers. We also investigated the preferences and perspectives of people with diabetic foot ulcers through lived experience. Methods We performed a review of the clinical and economic literature for the effectiveness and cost-effectiveness of hyperbaric oxygen therapy, as well as the budget impact of HBOT from the perspective of the Ministry of Health and Long-Term Care. We assessed the quality of the body of clinical evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. To better understand the preferences, perspectives, and values of patients with diabetic foot ulcers and their experience with HBOT, we conducted interviews and administered an online survey. Results Seven randomized controlled trials and one nonrandomized controlled trial met the inclusion criteria. Comparing standard wound care plus HBOT with standard wound care alone, we found mixed results for major amputation rates (GRADE quality of evidence: low), a significant difference in favour of standard wound care plus HBOT on ulcers healed (GRADE quality of evidence: low), and no difference in terms of adverse events (GRADE quality of evidence: moderate). There is a large degree of uncertainty associated with the evaluation of the cost-effectiveness of standard wound

  1. Predictive vs. empiric assessment of schistosomiasis: implications for treatment projections in Ghana.

    Directory of Open Access Journals (Sweden)

    Achille Kabore

    Full Text Available BACKGROUND: Mapping the distribution of schistosomiasis is essential to determine where control programs should operate, but because it is impractical to assess infection prevalence in every potentially endemic community, model-based geostatistics (MBG is increasingly being used to predict prevalence and determine intervention strategies. METHODOLOGY/PRINCIPAL FINDINGS: To assess the accuracy of MBG predictions for Schistosoma haematobium infection in Ghana, school surveys were evaluated at 79 sites to yield empiric prevalence values that could be compared with values derived from recently published MBG predictions. Based on these findings schools were categorized according to WHO guidelines so that practical implications of any differences could be determined. Using the mean predicted values alone, 21 of the 25 empirically determined 'high-risk' schools requiring yearly praziquantel would have been undertreated and almost 20% of the remaining schools would have been treated despite empirically-determined absence of infection - translating into 28% of the children in the 79 schools being undertreated and 12% receiving treatment in the absence of any demonstrated need. CONCLUSIONS/SIGNIFICANCE: Using the current predictive map for Ghana as a spatial decision support tool by aggregating prevalence estimates to the district level was clearly not adequate for guiding the national program, but the alternative of assessing each school in potentially endemic areas of Ghana or elsewhere is not at all feasible; modelling must be a tool complementary to empiric assessments. Thus for practical usefulness, predictive risk mapping should not be thought of as a one-time exercise but must, as in the current study, be an iterative process that incorporates empiric testing and model refining to create updated versions that meet the needs of disease control operational managers.

  2. Personalized, assessment-based, and tiered medical education curriculum integrating treatment guidelines for atrial fibrillation. (United States)

    Lee, Brian C; Ruiz-Cordell, Karyn D; Haimowitz, Steven M; Williams, Cara; Stambler, Bruce S; Mandarakas, Anthia


    This continuing medical education (CME) curriculum utilizes the Learner Assessment Platform (LAP), providing learners with personalized educational pathways related to atrial fibrillation treatment. There are improvements in knowledge among physician learners after CME, especially among LAP learners. In this LAP-based curriculum, an evaluation of learner deficits on designated learning objectives was conducted in tier 1 and used to direct learners to individualized tier 2 activities. Performance was assessed across learner tracks from baseline to learners' final intervention. Retention data were measured by the postcurriculum assessment, completed 8 weeks after the learners last intervention. Additionally, each activity included a unique matched set of pretest and post-test questions assessing the 4 learner domains: knowledge, competence, confidence, and practice patterns. Significant learner improvement was measured across the curriculum over all 4 learner-domains: 48% (P < 0.0005), 78% (P < 0.0005), 21% (P < 0.0005), and 20% (P < 0.0005) improvements for knowledge, competence, confidence, and practice, respectively. Significant gains in participant performance scores (28% increase, P < 0.0005) by the final activity was observed. Learners who participated in the LAP (N = 989) demonstrated greater improvement in performance from baseline compared to non-LAP learners (41% increase for LAP vs 23% and 26% increase for non-LAP learners who completed 1 (N = 1899) or ≥2 (N = 533) activities, respectively, P = 0.003). The participant population (N = 3421) achieved statistically significant improvement across the curriculum, with LAP learners showing greater performance gains compared to non-LAP learners. These findings support the value of the LAP methodology in providing a cumulative and individualized CME experience. © 2017 Wiley Periodicals, Inc.

  3. Parent knowledge of disease management in cystic fibrosis: Assessing behavioral treatment management. (United States)

    Nicolais, Christina J; Bernstein, Ruth; Riekert, Kristin A; Quittner, Alexandra L


    Cystic fibrosis (CF) is a life-shortening, burdensome disease requiring complex knowledge to manage the disease. Significant gaps in knowledge have been documented for parents, which may lead to unintentionally poor adherence and insufficient transfer of treatment responsibility from parents to adolescents. There are no current, validated measures of parent knowledge for this population and there are no measures that assess the knowledge required for day-to-day behavioral management of CF. We assessed the psychometric properties of the parent version of the Knowledge of Disease Management-Cystic Fibrosis measure (KDM-CF-P) using data from iCARE (I Change Adherence and Raise Expectations), a randomized control adherence intervention trial. A total of 196 parents in the iCARE standard care/control arm completed 35 items assessing their knowledge of disease management at their 12-month study visit, prior to beginning the intervention. Items were eliminated from the measure if they met the threshold for ceiling effects, were deemed clinically irrelevant, or did not correlate well with their intended scale. Item-to-total correlations, confirmatory factor analysis, discriminant function, reliability, and convergent validity were calculated. The KDM-CF-P (19 items) demonstrated internal consistency of KR20 = 0.60 on each scale and a two-scale structure. Convergent validity for knowledge scores was found with maternal education, family income, and type of medical insurance. Parents correctly answered approximately 85% of items on the KDM-CF-P. The KDM-CF-P psychometrics support a two-scale measure with clinical utility. It is useful for assessing gaps in knowledge that can be remediated through individualized, tailored interventions. © 2017 Wiley Periodicals, Inc.

  4. Twenty -year post-treatment assessment of class II division 1 malocclusion treated with non-extraction approach

    Directory of Open Access Journals (Sweden)

    Ashok Karad


    This article describes twenty-year post-treatment assessment of a class II division 1 malocclusion case, treated in the late mixed dentition stage, with the non-extraction treatment approach - molar-inserted headgear along with a fixed appliance therapy.

  5. Assessing Compliance With Mercaptopurine Treatment in Younger Patients With Acute Lymphoblastic Leukemia in First Remission | Division of Cancer Prevention (United States)

    This randomized phase III trial studies compliance to a mercaptopurine treatment intervention compared to standard of care in younger patients with acute lymphoblastic leukemia in remission. Assessing ways to help patients who have acute lymphoblastic leukemia to take their medications as prescribed may help them in taking their medications more consistently and may improve treatment outcomes. |

  6. Single-Participant Assessment of Treatment Mediators: Strategy Description and Examples from a Behavioral Activation Intervention for Depressed Adolescents (United States)

    Gaynor, Scott T.; Harris, Amanda


    Determining the means by which effective psychotherapy works is critical. A generally recommended strategy for identifying the potential causal variables is to conduct group-level statistical tests of treatment mediators. Herein the case is made for also assessing mediators of treatment outcome at the level of the individual participant.…

  7. Importance of food waste pre-treatment efficiency for global warming potential in life cycle assessment of anaerobic digestion systems

    DEFF Research Database (Denmark)

    Carlsson, My; Naroznova, Irina; Møller, Jacob


    A need for improvement of food waste (FIAT) pre-treatment methods has been recognized, but few life cycle assessments (LCA) of FIN management systems have considered the pre-treatment with respect to input energy, loss of organic material and nutrients for anaerobic digestion (AD) and/or further...

  8. [Clinical features, treatments and outcome of obsessive-compulsive disorder (OCD) focusing on the assessment and characteristics of patients with treatment-refractory OCD]. (United States)

    Matsunaga, Hisato


    Obsessive-compulsive disorder (OCD) is fairly common, with prevalence estimates ranging from 1 to 2%. OCD is generally described as having a chronic course with periods of waxing and waning of symptoms, and most individuals with OCD are at risk for other comorbid psychiatric disorders such as major depression. It is associated with considerable impairment and disability, in that individuals with OCD often experience severe social and interpersonal difficulties, familial dysfunction, occupational problems and impaired quality of life. Indeed, WHO classifies OCD as one of the top 10 most debilitating illnesses. Despite the proven effectiveness of cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) in the treatment of OCD, these 2 treatment strategies have demonstrated inadequate responses in at least 40% of OCD patients. Moreover, even when the best available treatments are applied, a number of patients remain severely affected and experience treatment-refractory OCD. Long-term follow-up (up to 40 years) studies also suggest that OCD often results in a chronic and lifelong condition with low rates of remission and with a relatively high probability of relapse. Thus, a "treatment-refractory" status should be assessed in each OCD individual according to responses to all available therapeutic alternatives, along with the long-term course and outcome. For further exploration of the treatment strategies for OCD patients assessed as "treatment-refractory", definition of the condition as well as the optimization and standardization of the currently best available treatments is needed. In particular, taking into account the psychopathologically and biologically heterogeneous nature of OCD, optimal and rational treatment strategies should be independently examined for each distinct OCD subtype. Further advance of social support and educational systems may also be helpful to promote earlier intervention for the treatment of individuals at

  9. Medical and health economic assessment of radiosurgery for the treatment of brain metastasis

    Directory of Open Access Journals (Sweden)

    von der Schulenburg, Johann-Matthias


    Full Text Available Background: Radiotherapy for patients suffering from malignant neoplasms has developed greatly during the past decades. Stereotactic radiosurgery (SRS is one important radiotherapeutic option which is defined by a single and highly focussed application of radiation during a specified time interval. One of its important indications is the treatment of brain metastases. Objectives: The objective of this HTA is to summarise the current literature concerning the treatment of brain metastasis and to compare SRS as a single or additional treatment option to alternative treatment options with regard to their medical effectiveness/efficacy, safety and cost-effectiveness as well as their ethical, social and legal implications. Methods: A structured search and hand search of identified literature are performed from January 2002 through August 2007 to identify relevant publications published in English or German. Studies targeting patients with single or multiple brain metastases are included. The methodological quality of included studies is assessed according to quality criteria, based on the criteria of evidence based medicine. Results: Of 1,495 publications 15 medical studies meet the inclusion criteria. Overall study quality is limited and with the exception of two randomized controlleed trials (RCT and two meta-analyses only historical cohort studies are identified. Reported outcome measures are highly variable between studies. Studies with high methodological quality provide evidence, that whole-brain radiotherapy (WBRT in addition to SRS and SRS in addition to WBRT is associated with improved local tumour control rates and neurological function. However, only in patients with single brain metastasis, RPA-class 1 (RPA = Recursive partitioning analysis and certain primary tumour entities, this combination of SRS and WBRT is associated with superior survival compared to WBRT alone. Studies report no significant differences in adverse events between

  10. Family Assessment/Treatment/Evaluation Methods Integrated for Helping Teen Suicide Attempters/Families in Short Term Psychiatric Hospitalization Programs. (United States)

    Shepard, Suzanne

    The assessment process can be integrated with treatment and evaluation for helping teenage suicide attempters and families in short term psychiatric hospitalization programs. The method is an extremely efficient way for the therapist to work within a given time constraint. During family assessment sufficient information can be gathered to…

  11. Assessing Client Progress Session by Session in the Treatment of Social Anxiety Disorder: The Social Anxiety Session Change Index (United States)

    Hayes, Sarah A.; Miller, Nathan A.; Hope, Debra A.; Heimberg, Richard G.; Juster, Harlan R.


    Frequent assessment during therapy can improve treatments and provide accountability. However, clinicians often do not monitor progress because of the time it takes to administer and score assessments. In response, the Social Anxiety Session Change Index (SASCI) was developed. The SASCI is a short, easily administered rating of subjective…

  12. The Collaborative Assessment and Management of Suicidality versus Treatment as Usual: A Retrospective Study with Suicidal Outpatients (United States)

    Jobes, David A.; Wong, Steven A.; Conrad, Amy K.; Drozd, John F.; Neal-Walden, Tracy


    The Collaborative Assessment and Management of Suicidality (CAMS) is a novel clinical approach used to identify, assess, and manage suicidal outpatients (Jobes & Drozd, 2004). The results of a retrospective study evaluating the impact of CAMS versus treatment as usual (TAU) on suicidal outpatients are presented. Patients in the CAMS treatment…

  13. Assessing the ecotoxicity of metal nano-oxides with potential for wastewater treatment. (United States)

    Nogueira, V; Lopes, I; Rocha-Santos, T A P; Rasteiro, M G; Abrantes, N; Gonçalves, F; Soares, A M V M; Duarte, A C; Pereira, R


    The rapid development of nanotechnology and the increasing use of nanomaterials (NMs) raise concern about their fate and potential effects in the environment, especially for those that could be used for remediation purposes and that will be intentionally released to the environment. Despite the remarkable emerging literature addressing the biological effects of NMs to aquatic organisms, the existing information is still scarce and contradictory. Therefore, aimed at selecting NMs for the treatment of organic and inorganic effluents, we assessed the potential toxicity of NiO (100 and 10-20 nm), Fe2O3 (≈85 × 425 nm), and TiO2 ( NiO (10-20 nm) > TiO2 ( Fe2O3, allowing to infer that apparently Fe2O3 NMs seems to be the one with less risks for receiving aquatic systems.

  14. Greenhouse gas emissions from wastewater treatment plants: measurements and carbon footprint assessment

    DEFF Research Database (Denmark)

    Delre, Antonio

    assessment allows the quantification of the overall contribution of a WWTP to climate change. The principal aim of this PhD thesis was to implement the MTDM application at WWTPs, in order to quantify plant-integrated CH4 and N2O emissions. Additionally, the influence of analytical instrument characteristics......The anthropogenic emissions of greenhouse gases (GHGs) into the atmosphere are of great concern, due to their effect on climate change. To curb the increased accumulation of GHGs in the atmosphere, the United Nations Framework Convention on Climate Change promotes the reporting of national...... anthropogenic GHG emissions. Wastewater treatment plants (WWTPs) emit two potent GHGs, namely methane (CH4) and nitrous oxide (N2O), but also carbon dioxide (CO2), which is not accounted as a GHG, due to its biogenic origin (IPCC, 2006). Currently, CH4 and N2O emissions from WWTPs are estimated according...

  15. Wastewater treatment and public health in Nunavut: a microbial risk assessment framework for the Canadian Arctic

    DEFF Research Database (Denmark)

    Daley, Kiley; Jamieson, Rob; Rainham, Daniel


    Wastewater management in Canadian Arctic communities is influenced by several geographical factors including climate, remoteness, population size, and local food-harvesting practices. Most communities use trucked collection services and basic treatment systems, which are capable of only low...... into the terrestrial and aquatic environment at random times. Northern communities rely heavily on their local surroundings as a source of food, drinking water, and recreation, thus creating the possibility of human exposure to wastewater effluent. Human exposure to microbial hazards present in municipal wastewater....... This review offers a conceptual framework and evaluation of current knowledge to enable the first microbial risk assessment of exposure scenarios associated with food-harvesting and recreational activities in Arctic communities, where simplified wastewater systems are being operated....

  16. Development assessment of natural latex membranes: a new proposal for the treatment of amblyopia

    Energy Technology Data Exchange (ETDEWEB)

    Ribeiro, Jaqueline Alves; Rosa, Suelia Rodrigues Fleury, E-mail: [Laboratorio de Engenharia e Biomaterial (BioEngLab), Faculdade Gama, Universidade de Brasilia (UnB), DF (Brazil); Leite, Cicilia Raquel Maia; Vasconcelos, Claudio Lopes; Soares, Joao Maria [Universidade do Estado do Rio Grande do Norte (UERN), Mossoro, RN (Brazil)


    The ophthalmic dysfunction amblyopia, commonly known as lazy eye, is characterized by decreased vision in one eye due to improper development in childhood. The aim of this study was to obtain and characterize natural rubber membranes and to assess their utility as an eye film capable of altering the passage of light. The latex membranes were produced using the Van Gogh method and the deposition technique and were analyzed by physical and chemical methods to determine the properties of latex in natura and of natural rubber membranes. The materials were characterized by X-ray diffractometry, scanning electron microscopy, thermogravimetry, differential scanning calorimetry, analysis of water sorption and light crossing analysis. We report here a new approach to the treatment of patients with amblyopia using latex membranes. (author)

  17. Bath Salt-Induced Psychosis: Nursing Assessment, Diagnosis, Treatment, and Outcomes. (United States)

    Stiles, Brandie Marie; Fish, Anne F; Cook, Cynthia A; Silva, Victor


    To review what is known about the assessment, diagnosis, treatment, and outcomes of patients with bath salt-induced psychosis. Comprehensive review and synthesis of research, case reports, and state-level data. Of the 42 case reports found, only 18 confirmed the presence of bath salts through laboratory testing. Twelve of the confirmed cases died. In most of the case reports, law enforcement was involved prior to hospitalization due to bizarre behaviors, delusions, and hallucinations. Due to the severity of both physical and psychological symptoms in patients in bath salt-induced psychosis, nurses, other healthcare providers, police, and hospital security personnel must work collaboratively to provide safe care. © 2015 Wiley Periodicals, Inc.

  18. Fuzzy logic based risk assessment of effluents from waste-water treatment plants. (United States)

    Cabanillas, Julián; Ginebreda, Antoni; Guillén, Daniel; Martínez, Elena; Barceló, Damià; Moragas, Lucas; Robusté, Jordi; Darbra, Rosa Ma


    This paper presents a new methodology to assess the risk of water effluents from waste-water treatment plants (WWTPs) based on fuzzy logic, a well-known theory to deal with uncertainty, especially in the environmental field where data are often lacking. The method has been tested using the effluent's pollution data coming from 22 waste-water treatment plants (WWTPs) located in Catalonia (NE Spain). Thirty-eight pollutants were analyzed along three campaigns performed yearly from 2008 to 2010. Whereas 9 compounds have been detected in more than 70% of the samples analyzed, 7 compounds have been found at levels equal or higher than the river Environmental Quality Standards set by the Water Framework Directive. Upon combination of both criteria (presence and concentration), compounds of greatest environmental concern in the WWTP studied are nickel, the herbicide diuron, and the endocrine disruptors nonyl and octylphenol. It is remarkable the low variability of the pollutant concentration just differing for the case of nickel and zinc. These low values of exposure together with other pollutants' characteristics provide a medium or low risk assessment for all the WWTPs. The results of this new method have been compared with COMMPS procedure, a solid method developed in the context of the Water Framework Directive, and they show that the fuzzy model is more conservative than COMMPS. This is due to different reasons: the fuzzy model takes into account the persistence of chemical compounds whereas COMMPS does not; the fuzzy model includes the weights provided by an expert group inquired in previous works and also considers the uncertainty of the environmental data, avoiding the crisp values and offering a range of overlapping between the different fuzzy sets. However, the results even if being more conservative with fuzzy logic, are in good agreement with a solid methodology such as the COMMPS procedure. Copyright © 2012 Elsevier B.V. All rights reserved.

  19. [Comparative assessment of cryosurgical treatment results in allergic and non-allergic rhinitis]. (United States)

    Zielińska-Bliżniewska, Hanna; Repetowski, Marcin; Miłoński, Jarosław; Olszewski, Jurek


    The aim of the work was to assess the treatment efficiency in patients with allergic and non-allergic vasomotor rhinitis after cryoablation procedures. The study covered 60 patients, including 32 women and 28 men, aged 18-66. The patients were divided into two groups: I - 30 patients with chronic allergic rhinitis, II - 30 patients with non-allergic vasomotor rhinitis. The study methodology involved: an otorhinolaryngological interview with a questionnaire and an allergological interview, an objective otolaryngological and rhinomanometrical examination with Homoth apparatus, a subjective evaluation questionnaire for nasal blockage intensification (the scale ranging from 0 to 10), skin tests to aeorallergens and food allergens (Allergopharma Co.), nasal endoscopy with a straight rigid Eleps endoscope before the treatment and 3 months following it. The cryoablation of nasal conchas was performed under local infiltration anesthesia (1% Xylokaina solution) using the Cryo-S apparatus from CryoFlex Poland Company and a flat probe in a spatula shape (L-50) that was placed on the outer surfaces of the inferior nasal concha. The inferior nasal concha cryoablation resulted in a statistically significant improvement in the subjective assessment scale in group I by 82.6% and group II by 141.2%. In the endoscopic examination 3 months following the cryoablation a good nasal patency was achieved in 63.3% patients from group I and 76.7% patients from group II. The conducted studies show a better nasal passages patency in patients with non-allergic rhinitis than in those with allergic rhinitis. Cryoablation procedures on the inferior nasal conchas are not the primary therapy, but together with other methods they can immensely improve the life comfort of a rhinitis patient. Copyright © 2011 Polish Otolaryngology Society. Published by Elsevier Urban & Partner (Poland). All rights reserved.

  20. Weighing environmental advantages and disadvantages of advanced wastewater treatment of micro-pollutants using environmental life cycle assessment

    DEFF Research Database (Denmark)

    Wenzel, Henrik; Larsen, Henrik Fred; Clauson-Kaas, Jes


    -off was investigated using Life Cycle Assessment (LCA) methodology and based on a literature review of advanced treatment performance. The LCA evaluation comprised sand filtration, ozonation and MBRs and assessed the effect of extending existing tertiary treatment with these technologies on a variety of micro......-pollutants being: heavy metals (Cd, Pb, Ni), endocrine disruptors (E2 and EE2), PAH, DEHP, and detergents (LAS & NPE). It was found, in some of the studied scenarios, that more environmental impact may be induced than removed by the advanced treatment. The study showed that for the 3 technologies, sand filtration...

  1. Life cycle assessment of introducing an anaerobic digester in a municipal wastewater treatment plant in Spain. (United States)

    Blanco, David; Collado, Sergio; Laca, Adriana; Díaz, Mario


    Anaerobic digestion (AD) is being established as a standard technology to recover some of the energy contained in the sludge in wastewater treatment plants (WWTPs) as biogas, allowing an economy in electricity and heating and a decrease in climate gas emission. The purpose of this study was to quantify the contributions to the total environmental impact of the plant using life cycle assessment methodology. In this work, data from real operation during 2012 of a municipal WWTP were utilized as the basis to determine the impact of including AD in the process. The climate change human health was the most important impact category when AD was included in the treatment (Scenario 1), especially due to fossil carbon dioxide emissions. Without AD (Scenario 2), increased emissions of greenhouse gases, mostly derived from the use of electricity, provoked a rise in the climate change categories. Biogas utilization was able to provide 47% of the energy required in the WWTP in Scenario 1. Results obtained make Scenario 1 the better environmental choice by far, mainly due to the use of the digested sludge as fertilizer.

  2. [School accidents--an epidemiological assessment of injury types and treatment effort]. (United States)

    Kraus, R; Heiss, C; Alt, V; Schnettler, R


    Children and adolescents spend up to 50% of their time at school. The purpose of this study was to assess injury patterns with their treatment of school accidents in a Trauma Service of a German University Hospital and to compare these data to the literature. All school accidents from 01.07.1999 to 30.06.2004 were statistically analysed in a retrospective manner by chart review. There were 1399 school accidents treated in our department. Average age of the injured children was 11.8 years with a boy:girl ratio of 3:2. Almost 40% of the injuries occurred during school sport. The most frequently injured region was the upper extremity including the hand (36.8%). Distortion and contusion were the most frequent diagnoses of all injuries. 16% of the cases had to be treated surgically and/or under general anaesthesia and also a total of 16% of the patients had to be admitted to the hospital. It can be concluded for school facilities that special attention has to be paid during school sports activity and breaks because they account for most accidents. Traffic education may reduce severe injuries. For diagnosis and treatment of school accidents specific knowledge of the growing longbones of the upper extremity and the hand is important.

  3. Assessment of Deep Partial Thickness Burn Treatment with Keratin Biomaterial Hydrogels in a Swine Model

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    D. Poranki


    Full Text Available Partial thickness burns can advance to full thickness after initial injury due to inadequate tissue perfusion and increased production of inflammatory cytokines, which has been referred to as burn wound progression. In previous work, we demonstrated that a keratin biomaterial hydrogel appeared to reduce burn wound progression. In the present study, we tested the hypothesis that a modified keratin hydrogel could reduce burn wound progression and speed healing. Standardized burn wounds were created in Yorkshire swine and treated within 30 minutes with keratin hydrogel (modified and unmodified, collagen hydrogel, or silver sulfadiazine (SSD. Digital images of each wound were taken for area measurements immediately prior to cleaning and dressing changes. Wound tissue was collected and assessed histologically at several time points. Wound area showed a significant difference between hydrogels and SSD groups, and rates of reepithelialization at early time points showed an increase when keratin treatment was used compared to both collagen and SSD. A linear regression model predicted a time to wound closure of approximately 25 days for keratin hydrogel while SSD treatment required 35 days. There appeared to be no measurable differences between the modified and unmodified formulations of keratin hydrogels.

  4. Family Accommodation of Child and Adolescent Anxiety: Mechanisms, Assessment, and Treatment. (United States)

    Norman, Kaila R; Silverman, Wendy K; Lebowitz, Eli R


    Anxiety disorders are the most common mental health concern for youth. Unfortunately, a substantial number of children and adolescents do not respond positively to current evidence-based interventions and/or relapse. As pediatric anxiety disorders are fundamentally a systemic phenomenon, focusing on the ways in which parents become involved in their children's anxiety symptoms may be a promising alternative approach to treatment. To inform psychiatric mental health nurse practitioners (PMHNPs) about the phenomenology, associated neurobiology, and assessment of family accommodation (FA) as well as clinical interventions targeting FA. FA refers to ways that parents adapt their own behaviors to reduce their children's anxiety-related distress. A literature search was performed using Psyc-INFO and PubMed. Current findings indicate a high prevalence of FA associated with pediatric anxiety disorders. FA has a potentially deleterious impact on course of illness and treatment response and is associated with greater caregiver burden. Potential neurobiological underpinnings of FA include dysregulation of parent cortico-limbic circuitry and the oxytocinergic system. PMHNPs are in a unique position to identify families engaged in problematic FA, educate their clientele, provide psychotherapy services with the goal of reducing FA, and consult with multidisciplinary team members. © 2015 Wiley Periodicals, Inc.

  5. Brave new worlds--review and update on virtual reality assessment and treatment in psychosis. (United States)

    Veling, Wim; Moritz, Steffen; van der Gaag, Mark


    In recent years, virtual reality (VR) research on psychotic disorders has been initiated. Several studies showed that VR can elicit paranoid thoughts about virtual characters (avatars), both in patients with psychotic disorders and healthy individuals. Real life symptoms and VR experiences were correlated, lending further support to its validity. Neurocognitive deficits and difficulties in social behavior were found in schizophrenia patients, not only in abstract tasks but also using naturalistic virtual environments that are more relevant to daily life, such as a city or encounters with avatars. VR treatments are conceivable for most dimensions of psychotic disorders. There is a small but expanding literature on interventions for delusions, hallucinations, neurocognition, social cognition, and social skills; preliminary results are promising. VR applications for assessment and treatment of psychotic disorders are in their infancy, but appear to have a great potential for increasing our understanding of psychosis and expanding the therapeutic toolbox. © The Author 2014. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email:

  6. Computerized acoustic assessment of treatment efficacy of nebulized epinephrine and albuterol in RSV bronchiolitis. (United States)

    Beck, Raphael; Elias, Nael; Shoval, Shay; Tov, Naveh; Talmon, Gil; Godfrey, Simon; Bentur, Lea


    We evaluated the use of computerized quantification of wheezing and crackles compared to a clinical score in assessing the effect of inhaled albuterol or inhaled epinephrine in infants with RSV bronchiolitis. Computerized lung sounds analysis with quantification of wheezing and crackles and a clinical score were used during a double blind, randomized, controlled nebulized treatment pilot study. Infants were randomized to receive a single dose of 1 mgr nebulized l-epinephrine or 2.5 mgr nebulized albuterol. Computerized quantification of wheezing and crackles (PulmoTrack) and a clinical score were performed prior to, 10 minutes post and 30 minutes post treatment. Results were analyzed with Student's t-test for independent samples, Mann-Whitney U test and Wilcoxon test. 15 children received albuterol, 12 received epinephrine. The groups were identical at baseline. Satisfactory lung sounds recording and analysis was achieved in all subjects. There was no significant change in objective quantification of wheezes and crackles or in the total clinical scores either within the groups or between the groups. There was also no difference in oxygen saturation and respiratory distress. Computerized lung sound analysis is feasible in young infants with RSV bronchiolitis and provides a non-invasive, quantitative measure of wheezing and crackles in these infants.

  7. Environmental and economic life cycle assessment for sewage sludge treatment processes in Japan. (United States)

    Hong, Jinglan; Hong, Jingmin; Otaki, Masahiro; Jolliet, Olivier


    Life cycle assessment for sewage sludge treatment was carried out by estimating the environmental and economic impacts of the six alternative scenarios most often used in Japan: dewatering, composting, drying, incineration, incinerated ash melting and dewatered sludge melting, each with or without digestion. Three end-of-life treatments were also studied: landfilling, agricultural application and building material application. The results demonstrate that sewage sludge digestion can reduce the environmental load and cost through reduced dry matter volume. The global warming potential (GWP) generated from incineration and melting processes can be significantly reduced through the reuse of waste heat for electricity and/or heat generation. Equipment production in scenarios except dewatering has an important effect on GWP, whereas the contribution of construction is negligible. In addition, the results show that the dewatering scenario has the highest impact on land use and cost, the drying scenario has the highest impact on GWP and acidification, and the incinerated ash melting scenario has the highest impact on human toxicity due to re-emissions of heavy metals from incinerated ash in the melting unit process. On the contrary, the dewatering, composting and incineration scenarios generate the lowest impact on human toxicity, land use and acidification, respectively, and the incinerated ash melting scenario has the lowest impact on GWP and cost. Heavy metals released from atmospheric effluents generated the highest human toxicity impact, with the effect of dioxin emissions being significantly lower. This study proved that the dewatered sludge melting scenario is an environmentally optimal and economically affordable method.

  8. Computerized acoustic assessment of treatment efficacy of nebulized epinephrine and albuterol in RSV bronchiolitis

    Directory of Open Access Journals (Sweden)

    Talmon Gil


    Full Text Available Abstract Aim We evaluated the use of computerized quantification of wheezing and crackles compared to a clinical score in assessing the effect of inhaled albuterol or inhaled epinephrine in infants with RSV bronchiolitis. Methods Computerized lung sounds analysis with quantification of wheezing and crackles and a clinical score were used during a double blind, randomized, controlled nebulized treatment pilot study. Infants were randomized to receive a single dose of 1 mgr nebulized l-epinephrine or 2.5 mgr nebulized albuterol. Computerized quantification of wheezing and crackles (PulmoTrack® and a clinical score were performed prior to, 10 minutes post and 30 minutes post treatment. Results were analyzed with Student's t-test for independent samples, Mann-Whitney U test and Wilcoxon test. Results 15 children received albuterol, 12 received epinephrine. The groups were identical at baseline. Satisfactory lung sounds recording and analysis was achieved in all subjects. There was no significant change in objective quantification of wheezes and crackles or in the total clinical scores either within the groups or between the groups. There was also no difference in oxygen saturation and respiratory distress. Conclusion Computerized lung sound analysis is feasible in young infants with RSV bronchiolitis and provides a non-invasive, quantitative measure of wheezing and crackles in these infants. Trial registration number: NCT00361452

  9. Seasonal assessment, treatment and removal of heavy metal concentrations in a tropical drinking water reservoir

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    Mustapha Moshood Keke


    Full Text Available Heavy metals are present in low concentrations in reservoirs, but seasonal anthropogenic activities usually elevate the concentrations to a level that could become a health hazard. The dry season concentrations of cadmium, copper, iron, lead, mercury, nickel and zinc were assessed from three sites for 12 weeks in Oyun reservoir, Offa, Nigeria. Triplicate surface water samples were collected and analysed using atomic absorption spectrophotometry. The trend in the level of concentrations in the three sites is site C > B > A, while the trend in the levels of the concentrations in the reservoir is Ni > Fe > Zn > Pb > Cd > Cu > Hg. Ni, Cd, Pb and Hg were found to be higher than the WHO guidelines for the metals in drinking water. The high concentration of these metals was from anthropogenic watershed run-off of industrial effluents, domestic sewages and agricultural materials into the reservoir coming from several human activities such as washing, bathing, fish smoking, especially in site C. The health effects of high concentration of these metals in the reservoir were highlighted. Methods for the treatment and removal of the heavy metals from the reservoir during water purification such as active carbon adsorption, coagulation-flocculation, oxidation-filtration, softening treatment and reverse osmosis process were highlighted. Other methods that could be used include phytoremediation, rhizofiltration, bisorption and bioremediation. Watershed best management practices (BMP remains the best solution to reduce the intrusion of the heavy metals from the watershed into the reservoir.

  10. Treatment of blunt thoracic aortic injury in Germany-Assessment of the TraumaRegister DGU®. (United States)

    Gombert, Alexander; Barbati, Mohammad E; Storck, Martin; Kotelis, Drosos; Keschenau, Paula; Pape, Hans-Christoph; Andruszkow, Hagen; Lefering, Rolf; Hildebrand, Frank; Greiner, Andreas; Jacobs, Michael J; Grommes, Jochen


    Using the data delivered by the German Trauma Register DGU® from 2002 till 2013, the value of different therapies of blunt thoracic aortic injury (BTAI) in Germany was analyzed. Prospectively collected data of patients suffering from BTAI were retrospectively analyzed with focus on the different treatment modalities for grade I-IV injuries. 821 patients suffering from BTAI were identified: 51.6% (424) grade I injury, 35.4% (291) grade II or III injury and 12.9% (106) grade IV injury (77.5% men [44.94 ± 20.6 years]). The main patterns of injury were high- speed accidents and falls (78.0% [n = 640], 21.8% [n = 171] respectively). Significant differences between grade I and grade II/III as well as IV injuries could be assessed for the incidence of cardiopulmonary resuscitation, a Glasgow Coma Scale score below 8 and a systolic blood pressure below 90 mmHg (p-value: injuries and cardiac arrest. Endovascular therapy became the treatment of choice for BTAI in Germany. Patients who have been treated by surgical means showed the highest survival rate, especially endovascular therapy showed a favorable low mortality rate.

  11. Assessment of The Clinical Outcome of IM rod Fxation in The Treatment of Tibial Congenital Pseudoarthrosis

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    Mehdi Ramezan Shirazi


    Full Text Available Background:Pseudoarthrosis of the tibia poses one of the most challenging treatment problems in all of orthopedics.The goal of the study was to assess the clinical outcome of intramedullary rod fixation in its treatment.Methods:The results of the management for nine patients with pseudoarthrosis of the tibia with IM rod fixation were reviewed retrospectively between 1986 - 2006. The mean duration of follow up was 8.95 years (range,3.5 months to 14.2 years.The   mean age of the patients at the latest follow up was 13.5 years (range, 9 to 23 years.Results:Initial union of the fracture site occurred in seven of nine patients with the mean duration of 7.6 months (range, 3.5 to 15.5 months.Five patients had limb length discrepancy with the mean of 7.2 cm (range,1.5 - 12 cm.Three of them were treated with tibia lengthening procedure with the Ilizarov method.One had a peroneal nerve palsy postoperatively.Two patients had refracture treated with casting and rod exchange. Electrical stimulation was applied in two patients but it was impossible to predict how much it played a role in the union.Conclusion: IM rod fixation technique has a satisfactory functional outcome.The   technique has a high level of acceptance by parents and patients. It should be recommended as the treatment of choice for the management of congenital pseudoarthrosis of the tibia.  

  12. Optimization of low energy sonication treatment for granular activated carbon colonizing biomass assessment. (United States)

    Saccani, G; Bernasconi, M; Antonelli, M


    This study is aimed at optimizing a low energy sonication (LES) treatment for granular activated carbon (GAC)-colonizing biomass detachment and determination, evaluating detachment efficiency and the effects of ultrasound exposure on bacterial cell viability. GAC samples were collected from two filters fed with groundwater. Conventional heterotrophic plate count (HPC) and fluorescence microscopy with a double staining method were used to evaluate cell viability, comparing two LES procedures, without and with periodical bulk substitution. A 20 min LES treatment, with bulk substitution after cycles of 5 min as maximum treatment time, allowed to recover 87%/100% of attached biomass, protecting detached bacteria from ultrasound damaging effects. Observed viable cell inactivation rate was 6.5/7.9% cell/min, with membrane-compromised cell damage appearing to be even higher (11.5%/13.1% cell/min). Assessing bacterial detachment and damaging ultrasound effects, fluorescence microscopy turned out to be more sensitive compared to conventional HPC. The optimized method revealed a GAC-colonizing biomass of 9.9 x 10(7) cell/gGAC for plant 1 and 8.8 x 10(7) cell/gGAC for plant 2, 2 log lower than reported in literature. The difference between the two GAC-colonizing biomasses is higher in terms of viable cells (46.3% of total cells in plant 1 GAC-colonizing biomass compared to the 33.3% in plant 2). Studying influent water contamination through multivariate statistical analyses, apossible combined toxic and genotoxic effect of chromium VI and trichloroethylene was suggested as a reason for the lower viable cell fraction observed in plant 2 GAC-colonizing population.

  13. Assessment of the effectiveness of low level laser in the treatment of alveolar osteitis

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    Jovanović Goran


    Full Text Available Background/Aim. Alveolar osteitis (AO is the extraction wound healing disorder with a presence of severe pain. Low level laser therapy stimulates cell metabolism and microcirculation, have has pronounced analgesic, antiedematous and anti-inflammatory effect and speeds up wound healing process. The aim of this study was to present results of clinical research that examined the effectiveness of low level laser in pain relief and healing of extraction wounds with alveolar osteitis in the lower jaw which was formed on the second day after tooth extraction. Methods. The study was conducted on 60 subjects divided into the study and the control group. In both groups extraction wounds were processed in similar way, except that in the study group was applied daily treatment of low level laser with a total of eight sessions of radiation, while in the control group extraction wounds were dressed with zinc oxide eugenol paste, which was changed every 48 hours up to the pain cessation. Measurement of pain intensity was done with a visual analogue scale (VAS 10 min prior to processing of extraction wounds and daily for the next eight days. Assessment of the effectiveness of low level laser on healing of extraction wounds was performed on the day eight of the treatment. Results. On the day five after beginning of the treatment of extraction wounds with alveolar osteitis in the patients of the study group a lower average value of pain as compared to the control group was registered. This difference was increased within the following days. Extraction wounds healing in the study group was more successful and faster than in the control group. Conclusion. This study suggested that the reduction of pain was more pronounced in the patients with alveolar osteitis whose extraction wounds were subjected to low level laser radiation in comparison to those in which extraction wounds were treated with zinc oxide eugenol paste.

  14. Life Cycle Assessment: A Tool for Evaluating and Comparing Different Treatment Options for Plastic Wastes from Old Television Sets

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    G Dodbiba


    Full Text Available In the present work, energy recovery and mechanical recycling, two treatment options for plastic wastes from discarded television sets, have been assessed and compared in the context of the life cycle assessment methodology (LCA. The environmental impact of each option was assessed by calculating the depletion of abiotic resources (ADP and the global warming potential (GWP. Then, the indicators were compared, and the option with the smaller environmental impact was selected. The main finding of this study was that mechanical recycling of plastics is a more attractive treatment option in environmental terms than incineration for energy recovery.

  15. Assessing racial/ethnic disparities in chemotherapy treatment among breast cancer patients in context of changing treatment guidelines. (United States)

    Silva, Abigail; Rauscher, Garth H; Hoskins, Kent; Rao, Ruta; Ferrans, Carol Estwing


    Conflicting study results with regards to racial/ethnic disparities in chemotherapy use among breast cancer patients may be due to the different sample populations, treatment data sources, and treatment eligibility definitions used. This study examined chemotherapy disparity in the context of changing treatment guidelines and explored factors that may help explain treatment differences observed. The data come from a population-based study that included interview and medical record data (including state cancer registry) from non-Hispanic (nH) White, nH Black, and Hispanic breast cancer patients diagnosed in 2005-2008. Logistic regression using model-based standardization was used to estimate age-adjusted risk differences and multivariate analysis was conducted to identify explanatory factors of the differences. Per the 2005/2006 National Comprehensive Cancer Network (NCCN) guidelines, minority patients appeared more likely than nH White patients to receive a chemotherapy recommendation (0.87 vs 0.75, p = 0.003). When eligibility was determined per the 2007 guidelines, there was no disparity because under these guidelines, nH White patients were more likely than minority patients to have tumors that no longer required chemotherapy. There was evidence that chemotherapy advances for breast cancer patients are implemented in the clinical setting well ahead of NCCN guidelines. Finally, among eligible patients, chemotherapy recommendation was very high and virtually always accepted and received, with no disparities found at these points of clinical care. The findings suggest that an evaluation of guideline-adherent chemotherapy treatment patterns must carefully consider the definition of treatment eligibility, given ongoing changes in treatment guidelines and early uptake of new diagnostic tools and treatments.

  16. Cognitive dysfunction in major depression and bipolar disorder: Assessment and treatment options. (United States)

    MacQueen, Glenda M; Memedovich, Katherine A


    Cognitive dysfunction is a recognized feature of mood disorders, including major depressive disorder (MDD) and bipolar disorder (BD). Cognitive impairment is associated with poor overall functional outcome and is therefore an important feature of illness to optimize for patients' occupational and academic outcomes. While generally people with BD appear to have a greater degree of cognitive impairment than those with MDD, direct comparisons of both patient groups within a single study are lacking. There are a number of methods for the assessment of cognitive function, but few are currently used in clinical practice. Current symptoms, past course of illness, clinical features, such as the presence of psychosis and comorbid conditions, may all influence cognitive function in mood disorders. Despite the general lack of assessment of cognitive function in clinical practice, clinicians are increasingly targeting cognitive symptoms as part of comprehensive treatment strategies. Novel pharmacological agents may improve cognitive function, but most studies of standard mood stabilizers, such as lithium and the anticonvulsants, have focused on whether or not the medications impair cognition. Non-pharmacological strategies, such as cognitive remediation and exercise, are increasingly studied in patients with mood disorders. Despite the growing interest in strategies to manage cognitive function, there is a paucity of high-quality trials examining either pharmacological or non-pharmacological modes of intervention. © 2016 The Authors. Psychiatry and Clinical Neurosciences © 2016 Japanese Society of Psychiatry and Neurology.

  17. Human Laboratory Settings for Assessing Drug Craving; Implications for the Evaluation of Treatment Efficacy

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    Zahra Alam Mehrjerdi


    Full Text Available Research on assessing craving in laboratory settings often involves inducing and then measuring craving in subjects. Cue-induced craving is studied in laboratory settings using the cue reactivity paradigm, in which drug-related photos, videos, evocative scripts, olfactory cues, and paraphernalia may induce craving. Cue-induced craving evoked by drug-related stimuli could be associated with relapse and recurrence of drug addiction. In this article, the authors review different methods of assessing craving in laboratory settings and explain how human laboratory settings can bridge the gap between randomized clinical trials (RCTs and animal models on pharmacological treatments for drug dependence. The brief reviewed literature provides strong evidence that laboratory-based studies of craving may improve our understanding of how subjective reports of drug craving are related to objective measures of drug abuse and laboratory settings provide an opportunity to measure the degree to which they co-vary during pharmacological interventions. This issue has important implications inclinical studies.

  18. Zebrafish and clean water technology: assessing soil bioretention as a protective treatment for toxic urban runoff. (United States)

    McIntyre, J K; Davis, J W; Incardona, J P; Stark, J D; Anulacion, B F; Scholz, N L


    Urban stormwater contains a complex mixture of contaminants that can be acutely toxic to aquatic biota. Green stormwater infrastructure (GSI) is a set of evolving technologies intended to reduce impacts on natural systems by slowing and filtering runoff. The extent to which GSI methods work as intended is usually assessed in terms of water quantity (hydrology) and quality (chemistry). Biological indicators of GSI effectiveness have received less attention, despite an overarching goal of protecting the health of aquatic species. Here we use the zebrafish (Danio rerio) experimental model to evaluate bioinfiltration as a relatively inexpensive technology for treating runoff from an urban highway with dense motor vehicle traffic. Zebrafish embryos exposed to untreated runoff (48-96h; six storm events) displayed an array of developmental abnormalities, including delayed hatching, reduced growth, pericardial edema, microphthalmia (small eyes), and reduced swim bladder inflation. Three of the six storms were acutely lethal, and sublethal toxicity was evident across all storms, even when stormwater was diluted by as much as 95% in clean water. As anticipated from exposure to cardiotoxic polycyclic aromatic hydrocarbons (PAHs), untreated runoff also caused heart failure, as indicated by circulatory stasis, pericardial edema, and looping defects. Bioretention treatment dramatically improved stormwater quality and reversed nearly all forms of developmental toxicity. The zebrafish model therefore provides a versatile experimental platform for rapidly assessing GSI effectiveness. Copyright © 2014 Elsevier B.V. All rights reserved.

  19. Sustainability of Endovenous Iron Deficiency Anaemia Treatment: Hospital-Based Health Technology Assessment in IBD Patients. (United States)

    Poscia, A; Stojanovic, J; Kheiraoui, F; Proli, E M; Scaldaferri, F; Volpe, M; Di Pietro, M L; Gasbarrini, A; Fabrizio, L; Boccia, S; Favaretti, C


    Iron deficiency anaemia (IDA) is the main extraintestinal manifestation affecting patients with inflammatory bowel disease (IBD). The Health Technology Assessment approach was applied to evaluate the sustainability of intravenous (IV) iron formulations in the Italian hospital setting, with particular focus on ferric carboxymaltose. Data on the epidemiology of IBD and associated IDA, in addition to the efficacy and safety of IV iron formulations currently used in Italy, were retrieved from scientific literature. A hospital-based cost-analysis of the outpatient delivery of IV iron treatments was performed. Organizational and ethical implications were discussed. IDA prevalence in IBD patients varies markedly from 9 to 73%. IV iron preparations were proven to have good efficacy and safety profiles, and ferric carboxymaltose provided a fast correction of haemoglobin and serum ferritin levels in iron-deficient patients. Despite a higher price, ferric carboxymaltose would confer a beneficial effect to the hospital, in terms of reduced cost related to individual patient management and additionally to the patient by reducing the number of infusions and admissions to healthcare facilities. Ethically, the evaluation is appropriate due to its efficacy and compliance. This assessment supports the introduction of ferric carboxymaltose in the Italian outpatient setting.

  20. Sustainability assessment of tertiary wastewater treatment technologies: a multi-criteria analysis. (United States)

    Plakas, K V; Georgiadis, A A; Karabelas, A J


    The multi-criteria analysis gives the opportunity to researchers, designers and decision-makers to examine decision options in a multi-dimensional fashion. On this basis, four tertiary wastewater treatment (WWT) technologies were assessed regarding their sustainability performance in producing recycled wastewater, considering a 'triple bottom line' approach (i.e. economic, environmental, and social). These are powdered activated carbon adsorption coupled with ultrafiltration membrane separation (PAC-UF), reverse osmosis, ozone/ultraviolet-light oxidation and heterogeneous photo-catalysis coupled with low-pressure membrane separation (photocatalytic membrane reactor, PMR). The participatory method called simple multi-attribute rating technique exploiting ranks was employed for assigning weights to selected sustainability indicators. This sustainability assessment approach resulted in the development of a composite index as a final metric, for each WWT technology evaluated. The PAC-UF technology appears to be the most appropriate technology, attaining the highest composite value regarding the sustainability performance. A scenario analysis confirmed the results of the original scenario in five out of seven cases. In parallel, the PMR was highlighted as the technology with the least variability in its performance. Nevertheless, additional actions and approaches are proposed to strengthen the objectivity of the final results.

  1. Assessment of Predictive Response Factors to Intragastric Balloon Therapy for the Treatment of Obesity. (United States)

    Madeira, Eduardo; Madeira, Miguel; Guedes, Erika Paniago; Mafort, Thiago Thomaz; Neto, Leonardo Vieira; de Oliveira Moreira, Rodrigo; de Pinho, Paulo Roberto Alves; Lopes, Agnaldo José; Farias, Maria Lucia Fleiuss


    Obesity is a worldwide epidemic that is difficult to control with non-invasive treatments, which usually present poor results. In this context, the intragastric balloon (IGB) is an important tool that presents a mean body weight loss (BWL) estimated at approximately 12%, although individual responses are highly variable. This study assesses whether there are factors that can predict responses to IGB therapy either before or early after placement of the device. A total of 50 obese patients underwent insertion of IGB placed endoscopically, and patients were monitored for 6 months. The evaluated predictive factors involved general characteristics and psychological, social, and dyspeptic aspects, and the preliminary results obtained in the first month after balloon placement. The mean weight loss was 11.5%, and 48% of the participants presented BWL >10%. Among the factors analyzed before IGB placement, only advanced age (P = .04) and higher scores obtained in the social relationships domain of a shorter version of the World Health Organization's Quality of Life questionnaire (P = .02) were significant. Analysis of the factors evaluated after IGB placement revealed that the BWL amounts observed in week 2 (P = .001) and week 4 (P < .001) and the intensity of dyspeptic symptoms in week 2 (P < .001) were positive predictive factors. The assessment of predictive factors may help to manage patients with IGB.

  2. Fibromyalgia, a missed comorbidity in spondyloarthritis: prevalence and impact on assessment and treatment. (United States)

    Mease, Philip J


    Fibromyalgia is a clinical representation of the neurobiological phenomenon of central sensitization, characterized by chronic widespread pain, fatigue, sleep disturbance, and other symptoms. Fibromyalgia may occur in conjunction with chronic rheumatic diseases, driven by the effects of chronic pain and inflammation and likely influenced by the patient's genetic and psychoemotional background. This article reviews the data on prevalence of concomitant fibromyalgia and its impact on disease assessment in patients with spondyloarthritis (SpA) and psoriatic arthritis (PsA). Fibromyalgia occurs in 2-8% of the general population. In AxSpA cohorts the prevalence has been reported in 4-25%, and in PsA, 16-22%, the majority being female. Measures of disease activity which are comprised partly or wholly of patient-reported outcomes such as pain and patient global are significantly higher in patients with concomitant fibromyalgia and do not improve as much with treatment as more objective measures, a finding which has been observed in other diseases such as rheumatoid arthritis and lupus. Fibromyalgia occurs in a significant proportion of patients with SpA and PsA. Disease activity measures with subjective elements are conflated in patients with fibromyalgia and do not reliably assess true inflammatory disease. This needs to be taken into account when evaluating the impact of immunomodulatory therapy.

  3. TSD-DOSE : a radiological dose assessment model for treatment, storage, and disposal facilities.

    Energy Technology Data Exchange (ETDEWEB)

    Pfingston, M.


    In May 1991, the U.S. Department of Energy (DOE), Office of Waste Operations, issued a nationwide moratorium on shipping slightly radioactive mixed waste from DOE facilities to commercial treatment, storage, and disposal (TSD) facilities. Studies were subsequently conducted to evaluate the radiological impacts associated with DOE's prior shipments through DOE's authorized release process under DOE Order 5400.5. To support this endeavor, a radiological assessment computer code--TSD-DOSE (Version 1.1)--was developed and issued by DOE in 1997. The code was developed on the basis of detailed radiological assessments performed for eight commercial hazardous waste TSD facilities. It was designed to utilize waste-specific and site-specific data to estimate potential radiological doses to on-site workers and the off-site public from waste handling operations at a TSD facility. The code has since been released for use by DOE field offices and was recently used by DOE to evaluate the release of septic waste containing residual radioactive material to a TSD facility licensed under the Resource Conservation and Recovery Act. Revisions to the code were initiated in 1997 to incorporate comments received from users and to increase TSD-DOSE's capability, accuracy, and flexibility. These updates included incorporation of the method used to estimate external radiation doses from DOE's RESRAD model and expansion of the source term to include 85 radionuclides. In addition, a detailed verification and benchmarking analysis was performed.

  4. Influence of data collection schemes on the Life Cycle Assessment of a municipal wastewater treatment plant. (United States)

    Yoshida, Hiroko; Clavreul, Julie; Scheutz, Charlotte; Christensen, Thomas H


    A Life Cycle Assessment (LCA) of a municipal wastewater treatment plant (WWTP) was conducted to illustrate the effect of an emission inventory data collection scheme on the outcomes of an environmental impact assessment. Due to their burden in respect to data collection, LCAs often rely heavily on existing emission and operational data, which are gathered under either compulsory monitoring or reporting requirements under law. In this study, an LCA was conducted using three input data sources: Information compiled under compulsory disclosure requirements (the European Pollutant Release and Transfer Registry), compliance with national discharge limits, and a state-of-the-art emission data collection scheme conducted at the same WWTP. Parameter uncertainty for each collection scheme was assessed through Monte Carlo simulation. The comparison of the results confirmed that LCA results depend heavily on input data coverage. Due to the threshold on reporting value, the E-PRTR did not capture the impact for particulate matter emission, terrestrial acidification, or terrestrial eutrophication. While the current practice can capture more than 90% of non-carcinogenic human toxicity and marine eutrophication, an LCA based on the data collection scheme underestimates impact potential due to limitations of substance coverage. Besides differences between data collection schemes, the results showed that 3-13,500% of the impacts came from background systems, such as from the provisioning of fuel, electricity, and chemicals, which do not need to be disclosed currently under E-PRTR. The incidental release of pollutants was also assessed by employing a scenario-based approach, the results of which demonstrated that these non-routine emissions could increase overall WWTP greenhouse gas emissions by between 113 and 210%. Overall, current data collection schemes have the potential to provide standardized data collection and form the basis for a sound environmental impact assessment, but

  5. The role of thromboelastometry in the assessment and treatment of coagulopathy in liver transplant patients. (United States)

    Zamper, Raffael Pereira Cezar; Amorim, Thiago Chaves; Costa, Luiz Guilherme Villares da; Takaoka, Flávio; Serpa, Ary


    Perioperative monitoring of coagulation is vital to assess bleeding risks, diagnose deficiencies associated with hemorrhage, and guide hemostatic therapy in major surgical procedures, such as liver transplantation. Routine static tests demand long turnaround time and do not assess platelet function; they are determined on plasma at a standard temperature of 37°C; hence these tests are ill-suited for intraoperative use. In contrast, methods which evaluate the viscoelastic properties of whole blood, such as thromboelastogram and rotational thromboelastometry, provide rapid qualitative coagulation assessment and appropriate guidance for transfusion therapy. These are promising tools for the assessment and treatment of hyper- and hypocoagulable states associated with bleeding in liver transplantation. When combined with traditional tests and objective assessment of the surgical field, this information provides ideal guidance for transfusion strategies, with potential improvement of patient outcomes. RESUMO A monitorização perioperatória da coagulação é fundamental para estimar o risco de sangramento, diagnosticar deficiências causadoras de hemorragia e guiar terapias hemostáticas durante procedimentos cirúrgicos de grande porte, como o transplante hepático. Os testes estáticos, comumente usados na prática clínica, são insatisfatórios no intraoperatório, pois demandam tempo e não avaliam a função plaquetária; são determinados no plasma e realizados em temperatura padrão de 37°C. Os métodos que avaliam as propriedades viscoelásticas do sangue total, como o tromboelastograma e a tromboelastometria rotacional, podem suprir as deficiências dos testes estáticos tradicionais, uma vez que permitem avaliar a coagulação de forma rápida e qualitativa, guiando a terapia transfusional de forma adequada. A tromboelastometria rotacional mostrou-se promissora na avaliação e no tratamento de estados de hipercoagulação e hipocoagulação, associados a

  6. Malignant gliomas: current perspectives in diagnosis, treatment, and early response assessment using advanced quantitative imaging methods

    Directory of Open Access Journals (Sweden)

    Ahmed R


    Full Text Available Rafay Ahmed,1 Matthew J Oborski,2 Misun Hwang,1 Frank S Lieberman,3 James M Mountz11Department of Radiology, 2Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; 3Department of Neurology and Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USAAbstract: Malignant gliomas consist of glioblastomas, anaplastic astrocytomas, anaplastic oligodendrogliomas and anaplastic oligoastrocytomas, and some less common tumors such as anaplastic ependymomas and anaplastic gangliogliomas. Malignant gliomas have high morbidity and mortality. Even with optimal treatment, median survival is only 12–15 months for glioblastomas and 2–5 years for anaplastic gliomas. However, recent advances in imaging and quantitative analysis of image data have led to earlier diagnosis of tumors and tumor response to therapy, providing oncologists with a greater time window for therapy management. In addition, improved understanding of tumor biology, genetics, and resistance mechanisms has enhanced surgical techniques, chemotherapy methods, and radiotherapy administration. After proper diagnosis and institution of appropriate therapy, there is now a vital need for quantitative methods that can sensitively detect malignant glioma response to therapy at early follow-up times, when changes in management of nonresponders can have its greatest effect. Currently, response is largely evaluated by measuring magnetic resonance contrast and size change, but this approach does not take into account the key biologic steps that precede tumor size reduction. Molecular imaging is ideally suited to measuring early response by quantifying cellular metabolism, proliferation, and apoptosis, activities altered early in treatment. We expect that successful integration of quantitative imaging biomarker assessment into the early phase of clinical trials could provide a novel approach for testing new therapies

  7. Life cycle assessment of constructed wetland systems for wastewater treatment coupled with microbial fuel cells. (United States)

    Corbella, Clara; Puigagut, Jaume; Garfí, Marianna


    The aim of this study was to assess the environmental impact of microbial fuel cells (MFCs) implemented in constructed wetlands (CWs). To this aim a life cycle assessment (LCA) was carried out comparing three scenarios: 1) a conventional CW system (without MFC implementation); 2) a CW system coupled with a gravel-based anode MFC, and 3) a CW system coupled with a graphite-based anode MFC. All systems served a population equivalent of 1500 p.e. They were designed to meet the same effluent quality. Since MFCs implemented in CWs improve treatment efficiency, the CWs coupled with MFCs had lower specific area requirement compared to the conventional CW system. The functional unit was 1m3 of wastewater. The LCA was performed with the software SimaPro® 8, using the CML-IA baseline method. The three scenarios considered showed similar environmental performance in all the categories considered, with the exception of Abiotic Depletion Potential. In this impact category, the potential environmental impact of the CW system coupled with a gravel-based anode MFC was around 2 times higher than that generated by the conventional CW system and the CW system coupled with a graphite-based anode MFC. It was attributed to the large amount of less environmentally friendly materials (e.g. metals, graphite) for MFCs implementation, especially in the case of gravel-based anode MFCs. Therefore, the CW system coupled with graphite-based anode MFC appeared as the most environmentally friendly solution which can replace conventional CWs reducing system footprint by up to 20%. An economic assessment showed that this system was around 1.5 times more expensive than the conventional CW system. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Treatment

    National Research Council Canada - National Science Library

    Safaa M. Raghab; Ahmed M. Abd El Meguid; Hala A. Hegazi


    ... composed. This paper presents the results of the analyses of leachate treatment from the solid waste landfill located in Borg El Arab landfill in Alexandria using an aerobic treatment process which was applied...

  9. Botulinum toxin in hemifacial spasm: the challenge to assess the effect of treatment. (United States)

    Wabbels, Bettina; Roggenkämper, Peter


    Hemifacial spasm is characterized by intermittent tonic or clonic contractions of the muscles supplied by the facial nerve. Although vision is less impaired than in patients with blepharospasm, the disease can impose significant psychosocial burden on patient's life. Botulinum toxin (BoNT) is the well-established pharmacotherapy of choice, but evidence from controlled clinical trials is sparse. There is a broad variety of rating scales used in clinical studies with BoNT and obviously no consensus has been reached how to assess treatment outcome in hemifacial spasm. Clinical rating scales focusing on objective function were used in a couple of controlled studies with BoNT and were appropriate to discriminate between BoNTA and placebo. But it has not been shown that they would be sensitive enough to detect minor differences between several BoNT formulations. Although most of the clinical scales consist of a five-point rating, the descriptors for the ordinal numbers are not necessarily the same so that the results of different clinical studies are not comparable to each other. The main disadvantage of clinical scales is that they do not take into account patient's perspective of disability and impact on daily life. For this reason some clinical studies applied health-related quality of life (HRQoL) questionnaires to assess efficacy, and one research group worked on the development of disease-specific tools. Although these HRQoL questionnaires have been validated and a good correlation to disease severity could be demonstrated, they are far from having become an established variable for efficacy assessment in hemifacial spasm trials. The challenge remains to establish tools which are appropriate to rate BoNT treatment effects in hemifacial spasm. Currently, it is virtually impossible to identify one rating scale which can cover all relevant aspects of the disorder. In consequence we recommend the implementation of a combination of different rating scales which address

  10. Assessment and Treatment of Deviant Behavior in Children - Section Four: Evaluation of Three Experimental and One Control Strategy in Facilitating Generalization and Maintenance of Treatment Effects Following Two Months of Treatment in a Token Economy. Final Report. (United States)

    Walker, Hill M.; Buckley, Nancy K.

    The document is section four of a six part report on the assessment and treatment of deviant behavior in children. The effects of three experimental strategy were investigated to facilitate generalization of treatment effects following 2 months in a token economy classroom. Forty four subjects were assigned to one of three experimental strategies,…

  11. Individualized assessments in treatment research: an examination of parent-nominated target problems in the treatment of disruptive behaviors in youth with Tourette syndrome. (United States)

    McGuire, Joseph F; Sukhodolsky, Denis G; Bearss, Karen; Grantz, Heidi; Pachler, Maryellen; Lombroso, Paul J; Scahill, Lawrence


    Youth with Tourette syndrome (TS) often exhibit disruptive behaviors. Although improvement data on rating scales support the efficacy of structured psychotherapeutic interventions, there is growing interest in personalized outcome assessments. This report examined parent-nominated target problems (PTPs) as an individualized outcome measure in 48 youth with TS and disruptive behaviors, who participated in one of two randomized psychotherapy trials. At baseline, parents described two primary problems to an independent evaluator who generated a structured narrative for each problem. These narratives were reviewed and updated at endpoint. When rated by five treatment-blind judges, the PTP rating demonstrated excellent reliability and good convergent validity with the Disruptive Behavior Rating Scale (DBRS). The PTP rating exhibited comparable treatment effects to the DBRS, and accounted for additional variance in global treatment outcome. The PTP rating serves a reliable, valid, and sensitive personalized assessment in research trials that provides complementary information to standardized rating scales.

  12. DCE-MRI for Pre-Treatment Prediction and Post-Treatment Assessment of Treatment Response in Sites of Squamous Cell Carcinoma in the Head and Neck.

    Directory of Open Access Journals (Sweden)

    Ann D King

    Full Text Available It is important to identify patients with head and neck squamous cell carcinoma (SCC who fail to respond to chemoradiotherapy so that they can undergo post-treatment salvage surgery while the disease is still operable. This study aimed to determine the diagnostic performance of dynamic contrast enhanced (DCE-MRI using a pharmacokinetic model for pre-treatment predictive imaging, as well as post-treatment diagnosis, of residual SCC at primary and nodal sites in the head and neck.Forty-nine patients with 83 SCC sites (primary and/or nodal underwent pre-treatment DCE-MRI, and 43 patients underwent post-treatment DCE-MRI, of which 33 SCC sites had a residual mass amenable to analysis. Pre-treatment, post-treatment and % change in the mean Ktrans, kep, ve and AUGC were obtained from SCC sites. Logistic regression was used to correlate DCE parameters at each SCC site with treatment response at the same site, based on clinical outcome at that site at a minimum of two years.None of the pre-treatment DCE-MRI parameters showed significant correlations with SCC site failure (SF (29/83 sites or site control (SC (54/83 sites. Post-treatment residual masses with SF (14/33 had significantly higher kep (p = 0.05, higher AUGC (p = 0.02, and lower % reduction in AUGC (p = 0.02, than residual masses with SC (19/33, with the % change in AUGC remaining significant on multivariate analysis.Pre-treatment DCE-MRI did not predict which SCC sites would fail treatment, but post-treatment DCE-MRI showed potential for identifying residual masses that had failed treatment.

  13. Assessing the impacts of changes in treatment technology on energy and greenhouse gas balances for organic waste and wastewater treatment using historical data. (United States)

    Poulsen, Tjalfe G; Hansen, Jens Aage


    Historical data on organic waste and wastewater treatment during the period of 1970-2020 were used to assess the impact of treatment on energy and greenhouse gas (GHG) balances. The assessment included the waste fractions: Sewage sludge, food waste, yard waste and other organic waste (paper, plastic, etc.). Data were collected from Aalborg, a municipality located in Northern Denmark. During the period from 1970-2005, Aalborg Municipality has changed its waste treatment strategy from landfilling of all wastes toward composting of yard waste and incineration with combined heat and power production from the remaining organic municipal waste. Wastewater treatment has changed from direct discharge of untreated wastewater to full organic matter and nutrient (N, P) removal combined with anaerobic digestion of the sludge for biogas production with power and heat generation. These changes in treatment technology have resulted in the waste and wastewater treatment systems in Aalborg progressing from being net consumers of energy and net emitters of GHG, to becoming net producers of energy and net savers of GHG emissions (due to substitution of fossil fuels elsewhere). If it is assumed that the organic waste quantity and composition is the same in 1970 and 2005, the technology change over this time period has resulted in a progression from a net annual GHG emission of 200 kg CO( 2)-eq. capita(-1) in 1970 to a net saving of 170 kg CO(2)-eq. capita(-1) in 2005 for management of urban organic wastes.

  14. Female patients' and parents' assessment of deformity- and brace-related stress in the conservative treatment of adolescent idiopathic scoliosis. (United States)

    Misterska, Ewa; Glowacki, Maciej; Latuszewska, Joanna


    A cross-sectional analysis of parents' and patients' perceptions of deformity- and brace-related stress regarding conservative treatment of adolescent idiopathic scoliosis. The purpose of this study was to determine the agreement between patients' and parents' assessments of emotional stress and to compare these assessments with radiographical measurements of spinal deformity. Conservative treatment in patients with scoliosis may cause emotional stress. To our knowledge, no group has ever reported patient and parental estimation of stress related to wearing a brace and spinal deformity in girls with adolescent idiopathic scoliosis. Sixty-three pairs of parents and girls with adolescent idiopathic scoliosis treated with a Cheneau brace were separately asked to complete the Bad Sobberheim Stress Questionnaire-Deformity and the Bad Sobberheim Stress Questionnaire-Brace. The age range of the patients was from 10 to 17 years. Patients were assessed at a mean of 14.12 (SD, 10.99) months after the start of the conservative treatment. Patients thought that a moderate level of stress was connected with conservative treatment; however, the stress level, related to perceived trunk deformation, was low. From the parents' perspective, patients experienced a moderate level of stress during conservative treatment and related to spinal deformity. The study groups differ in their perception of stress levels due to body disfigurement but not during the conservative treatment. Parent-patient stress-level disparities were not related to body mass index, age of the patient, brace application, and radiographical measurements of spinal deformity. Patients and parents perceive the emotional stress related to brace treatment in the same way; however, parents overestimate the assessment of stress levels related to body deformity. From the perspective of patients and parents, brace wearing increased the level of stress induced by the deformity alone. Complete assessment of conservative

  15. Improvement of anaerobic digestion of sewage sludge in a wastewater treatment plant by means of mechanical and thermal pre-treatments: Performance, energy and economical assessment. (United States)

    Ruffino, Barbara; Campo, Giuseppe; Genon, Giuseppe; Lorenzi, Eugenio; Novarino, Daniel; Scibilia, Gerardo; Zanetti, Mariachiara


    Performances of mechanical and low-temperature (plant (2,300,000p.e.). Thermal pre-treatments returned disintegration rates of one order of magnitude higher than mechanical ones (about 25% vs. 1.5%). The methane specific production increased by 21% and 31%, with respect to untreated samples, for treatment conditions of respectively 70 and 90°C, 3h. Thermal pre-treatments also decreased WAS viscosity. Preliminary energy and economic assessments demonstrated that a WAS final total solid content of 5% was enough to avoid the employment of auxiliary methane for the pre-treatment at 90°C and the subsequent AD process, provided that all the heat generated was transferred to WAS through heat exchangers. Moreover, the total revenues from sale of the electricity produced from biogas increased by 10% with respect to the present scenario. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. [Improving shared decision-making for hospital patients: Description and evaluation of a treatment intensity assessment tool]. (United States)

    Amblàs-Novellas, Jordi; Casas, Sílvia; Catalán, Rosa María; Oriol-Ruscalleda, Margarita; Lucchetti, Gianni Enrico; Quer-Vall, Francesc Xavier


    Shared decision-making between patients and healthcare professionals is crucial to guarantee adequate coherence between patient values and preferences, caring aims and treatment intensity, which is key for the provision of patient-centred healthcare. The assessment of such interventions are essential for caring continuity purposes. To do this, reliable and easy-to-use assessment systems are required. This study describes the results of the implementation of a hospital treatment intensity assessment tool. The pre-implementation and post-implementation results were compared between two cohorts of patients assessed for one month. Some record of care was registered in 6.1% of patients in the pre-implementation group (n=673) compared to 31.6% of patients in the post-implementation group (n=832) (P<.01), with differences between services. Hospital mortality in both cohorts is 1.9%; in the pre-implementation group, 93.75% of deceased patients had treatment intensity assessment. In hospital settings, the availability of a specific tool seems to encourage very significantly shared decision-making processes between patients and healthcare professionals -multiplying by more than 5 times the treatment intensity assessment. Moreover, such tools help in the caring continuity processes between different teams and the personalisation of caring interventions to be monitored. More research is needed to continue improving shared decision-making for hospital patients. Copyright © 2015 SEGG. Published by Elsevier Espana. All rights reserved.

  17. Values of functional indexes in assessment of efficacy of osteoarthritis treatment with Chondrolon and Zel T in polyclinic

    Directory of Open Access Journals (Sweden)

    O Y Maiko


    Full Text Available Objective. To study change of knee joints functional disability in pts with predominantly I-II stage of knee osteoarthritis (OA with clinical tests and WOMAC index for assessment of efficacy of treatment with Chondrolon and Zel T in polyclinic. Material and methods. 70 pts with I and II stage of OA according to Kellgren-Lawrence aged from 40 to 67 years were included. They were divided in 2 groups (30 pts in group I and40 pts in group II. Group I pts were treated with Chondrolon and group II pts – with Zel T. Treatment efficacy was assessed with WOMAC index, functional Lequesne index, pain on VAS at rest and at movement, knee mobility, time of walking for 30 m and walking stairs. Results. Positive changes of all parameters were revealed in both groups: significant improvement of pain on VAS, functional tests, Lequesne index, WOMAC scales was achieved. During treatment with Zel T improvement of the efficacy measures increased slower, mainly after 12 weeks of treatment (during treatment with Chondrolon – after8 weeks. Both drugs provided functional improvement assessed by WOMAC index butChondrolon was more effective. Conclusion. Chondrolon and Zel T can be used for treatment of OA at I or II stage with moderate knee joints functional disability. Course of treatment with Zel T should be continued not less than 3 months and with Chondrolon – 2 months.

  18. Water Footprint Assessment in Waste Water Treatment Plant: Indicator of the sustainability of urban water cycle. (United States)

    Gómez Llanos, Eva; Durán Barroso, Pablo; Matías Sánchez, Agustín; Fernández Rodríguez, Santiago; Guzmán Caballero, Raúl


    The seventeen Sustainable Development Goals (SDG) represent a challenge for citizens and countries around the world by working together to reduce social inequality, to fight poverty and climate change. The Goal six water and sanitation aims for ensuring, among others, the protection and restoration of water-related ecosystem (target 6.6) and encouraging the water use efficiency (target 6.3). The commitment to this goal is not only the development of sanitation infrastructure, but also incorporates the necessity of a sustainable and efficient management from ecological and economic perspectives. Following this approach, we propose a framework for assessing the waste water treatment plant (WWTP) management based on the Water Footprint (WF) principles. The WF as indicator is able to highlight the beneficial role of WWTPs within the environment and provide a complementary information to evaluate the impact of a WWTP regarding to the use of freshwater and energy. Therefore, the footprint family provides an opportunity to relate the reduction of pollutant load in a WWTP and the associated consumptions in terms of electricity and chemical products. As a consequence, the new methodology allows a better understanding of the interactions among water and energy resources, economic requirements and environmental risks. Because of this, the current technologies can be improved and innovative solutions for monitoring and management of urban water use can be integrated. The WF was calculated in four different WWTP located in the North East of Extremadura (SW Spain) which have activated sludge process as secondary treatment. This zone is characterized by low population density but an incipient tourism development. The WF estimation and its relationship with the electricity consumption examines the efficiency of each WWTP and identifies the weak points in the management in terms of the sustainability. Consequently, the WF establishes a benchmark for multidisciplinary decision

  19. Typologies of prescription opioid use in a large sample of adults assessed for substance abuse treatment.

    Directory of Open Access Journals (Sweden)

    Traci C Green

    Full Text Available As a population, non-medical prescription opioid users are not well-defined. We aimed to derive and describe typologies of prescription opioid use and nonmedical use using latent class analysis in an adult population being assessed for substance abuse treatment.Latent class analysis was applied to data from 26,314 unique respondents, aged 18-70, self-reporting past month use of a prescription opioid out of a total of 138,928 cases (18.9% collected by the Addiction Severity Index-Multimedia Version (ASI-MV®, a national database for near real-time prescription opioid abuse surveillance. Data were obtained from November 2005 through December 2009. Substance abuse treatment, criminal justice, and public assistance programs in the United States submitted data to the ASI-MV database (n = 538. Six indicators of the latent classes derived from responses to the ASI-MV, a version of the ASI modified to collect prescription opioid abuse and chronic pain experience. The latent class analysis included respondent home ZIP code random effects to account for nesting of respondents within ZIP code.A four-class adjusted latent class model fit best and defined clinically interpretable and relevant subgroups: Use as prescribed, Prescribed misusers, Medically healthy abusers, and Illicit users. Classes varied on key variables, including race/ethnicity, gender, concurrent substance abuse, duration of prescription opioid abuse, mental health problems, and ASI composite scores. Three of the four classes (81% of respondents exhibited high potential risk for fatal opioid overdose; 18.4% exhibited risk factors for blood-borne infections.Multiple and distinct profiles of prescription opioid use were detected, suggesting a range of use typologies at differing risk for adverse events. Results may help clinicians and policy makers better focus overdose and blood-borne infection prevention efforts and intervention strategies for prescription opioid abuse reduction.

  20. Typologies of prescription opioid use in a large sample of adults assessed for substance abuse treatment. (United States)

    Green, Traci C; Black, Ryan; Grimes Serrano, Jill M; Budman, Simon H; Butler, Stephen F


    As a population, non-medical prescription opioid users are not well-defined. We aimed to derive and describe typologies of prescription opioid use and nonmedical use using latent class analysis in an adult population being assessed for substance abuse treatment. Latent class analysis was applied to data from 26,314 unique respondents, aged 18-70, self-reporting past month use of a prescription opioid out of a total of 138,928 cases (18.9%) collected by the Addiction Severity Index-Multimedia Version (ASI-MV®), a national database for near real-time prescription opioid abuse surveillance. Data were obtained from November 2005 through December 2009. Substance abuse treatment, criminal justice, and public assistance programs in the United States submitted data to the ASI-MV database (n = 538). Six indicators of the latent classes derived from responses to the ASI-MV, a version of the ASI modified to collect prescription opioid abuse and chronic pain experience. The latent class analysis included respondent home ZIP code random effects to account for nesting of respondents within ZIP code. A four-class adjusted latent class model fit best and defined clinically interpretable and relevant subgroups: Use as prescribed, Prescribed misusers, Medically healthy abusers, and Illicit users. Classes varied on key variables, including race/ethnicity, gender, concurrent substance abuse, duration of prescription opioid abuse, mental health problems, and ASI composite scores. Three of the four classes (81% of respondents) exhibited high potential risk for fatal opioid overdose; 18.4% exhibited risk factors for blood-borne infections. Multiple and distinct profiles of prescription opioid use were detected, suggesting a range of use typologies at differing risk for adverse events. Results may help clinicians and policy makers better focus overdose and blood-borne infection prevention efforts and intervention strategies for prescription opioid abuse reduction.

  1. Life Cycle Assessment of mechanical biological pre-treatment of Municipal Solid Waste: a case study. (United States)

    Beylot, Antoine; Vaxelaire, Stéphane; Zdanevitch, Isabelle; Auvinet, Nicolas; Villeneuve, Jacques


    The environmental performance of mechanical biological pre-treatment (MBT) of Municipal Solid Waste is quantified using Life Cycle Assessment (LCA), considering one of the 57 French plants currently in operation as a case study. The inventory is mostly based on plant-specific data, extrapolated from on-site measurements regarding mechanical and biological operations (including anaerobic digestion and composting of digestate). The combined treatment of 46,929 tonnes of residual Municipal Solid Waste and 12,158 tonnes of source-sorted biowaste (as treated in 2010 at the plant) generates 24,550 tonnes CO2-eq as an impact on climate change, 69,943kg SO2-eq on terrestrial acidification and 19,929kg NMVOC-eq on photochemical oxidant formation, in a life-cycle perspective. On the contrary MBT induces environmental benefits in terms of fossil resource depletion, human toxicity (carcinogenic) and ecotoxicity. The results firstly highlight the relatively large contribution of some pollutants, such as CH4, emitted at the plant and yet sometimes neglected in the LCA of waste MBT. Moreover this study identifies 4 plant-specific operation conditions which drive the environmental impact potentials induced by MBT: the conditions of degradation of the fermentable fraction, the collection of gaseous flows emitted from biological operations, the abatement of collected pollutants and NOx emissions from biogas combustion. Finally the results underline the relatively large influence of the operations downstream the plant (in particular residuals incineration) on the environmental performance of waste MBT. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Biomolecular assessment of renal function in various types of surgical treatment of renal cell carcinoma

    Directory of Open Access Journals (Sweden)

    Popkov V.M.


    Full Text Available Objective: to assess the possibility of using the markers of acute kidney injury to predict the preoperative risk for the subsequent decline in glomerular filtration rate in different types of surgical treatment of renal cell carcinoma (RCC. Material and methods. 60 patients with histologically confirmed RCC T1-3M0N0 operated in the clinic of urology of Saratov State Medical University n.a. V. I. Razumovsky in the volume of nephrectomy or partial nephrectomy. Before surgery all patients underwent standard examination intended for patients with kidney tumors: ultrasound, MRI, excretory urography and dynamic renoscintigraphy, the perioperative values of serum creatinine and glomerular filtration rate were determined. Using the method of immuno-enzymatic analysis the concentrations of excreted with the urine NGAL and IL-18 in serum samples at the preoperative stage, after 5 days and after 1 month of postoperative follow-up were investigated. Differences in clinical data and clinical variables were compared by using Spearman rank correlations and t-test. Results. The determined parameters of acute kidney injury markers IL-18 and NGAL in the early postoperative period were increased in patients after open nephrectomy. Moreover, the correlation analysis according to the Spearman method revealed a strong significant correlation between the preoperative levels of IL-18 and GFR after surgery (r=1; p<0.05. Conclusion. Laparoscopic resection of RCC is the method of choice for surgical treatment of RCC. As a predictor of adverse prognosis, the level of IL-18 in serum may be used. Its increase correlates with a decline in renal function in the postoperative period, and according to some reports, IL-18 also is an independent predictor of adverse prognosis in patients with a localized RCC.

  3. Recent advances in pathogenesis, assessment, and treatment of atherosclerosis [version 1; referees: 3 approved

    Directory of Open Access Journals (Sweden)

    J. David Spence


    Full Text Available In recent years, there have been a number of advances in the pathogenesis and treatment of atherosclerosis and in assessing prognosis in carotid atherosclerosis. Risk stratification to improve vascular prevention by identifying patients most likely to benefit from intensive therapy is much improved by measuring carotid plaque burden. In patients with asymptomatic carotid stenosis, a number of modalities can be used to identify the 10-15% who could benefit from endarterectomy or stenting. Transcranial Doppler embolus detection, echolucency and ulceration on 3D ultrasound, intraplaque hemorrhage on magnetic resonance imaging (MRI, and reduced cerebrovascular reserve are useful already; new approaches including plaque texture on ultrasound and imaging of plaque inflammation and early calcification on positron emission tomography/computed tomography (PET/CT are in development. The discovery that the intestinal microbiome produces vasculotoxic metabolites from dietary constituents such as carnitine in meat (particularly red meat and phosphatidylcholine from egg yolk and other sources has revolutionized nutritional aspects of vascular prevention. Because many of these vasculotoxic metabolites are removed by the kidney, it is particularly important in patients with renal failure to limit their intake of red meat and egg yolk. A new approach to lowering low-density lipoprotein (LDL cholesterol by blocking the action of an enzyme that destroys LDL receptors promises to revolutionize vascular prevention once less costly treatments are developed, and a new approach to vascular prevention—“treating arteries instead of risk factors”—shows promise but requires randomized trials. These advances all promise to help in the quest to prevent strokes in high-risk patients.

  4. Lumbar spinal stenosis: assessment of long-term outcome 12 years after operative and conservative treatment. (United States)

    Hurri, H; Slätis, P; Soini, J; Tallroth, K; Alaranta, H; Laine, T; Heliövaara, M


    The present study focuses on the long-term prognosis of radiographically verified stenosis of the lower lumbar spine. The purpose here was to describe the outcome 12 years after radiographic diagnosis of spinal stenosis and to identify factors predicting disability after operative or conservative treatment. Data were compiled on 75 patients (43 men and 32 women) with changes in functional myelography diagnostic for spinal stenosis. Their mean age at the interview 12 years later was 61 years. The sagittal diameter of the dural sac was measured from baseline myelographs at all intervertebral levels and was corrected for magnification. In the interview, subjective outcome assessment was obtained with a structured questionnaire, and the low-back disorder was scored using the Oswestry disability index. The sagittal diameter of the dural sac was severely stenotic (<7.0 mm) in 32 patients (26 operated), and moderately stenotic (7.0-10.5 mm) in 43 patients (31 operated). The severity of the stenosis significantly predicted disability, even when the effects of age, sex, therapy regimen, and body mass index were adjusted for. For moderate and severe stenosis, the adjusted mean Oswestry indices were 28.4 and 39.1, respectively (p = 0.01). Therapy as such (operative versus nonoperative) did not significantly correlate with later disability. The radiographic severity of lumbar spinal stenosis predicts disability independently of therapy regimen. Randomized clinical trials are needed to establish the indications for surgical and conservative treatment. Radiographic severity of the stenosis should be considered as an effect-modifying or confounding factor in clinical trials and other studies focusing on the outcome of lumbar spinal stenosis.

  5. Measuring ability to assess claims about treatment effects: the development of the 'Claim Evaluation Tools'. (United States)

    Austvoll-Dahlgren, Astrid; Semakula, Daniel; Nsangi, Allen; Oxman, Andrew David; Chalmers, Iain; Rosenbaum, Sarah; Guttersrud, Øystein


    To describe the development of the Claim Evaluation Tools, a set of flexible items to measure people's ability to assess claims about treatment effects. Methodologists and members of the community (including children) in Uganda, Rwanda, Kenya, Norway, the UK and Australia. In the iterative development of the items, we used purposeful sampling of people with training in research methodology, such as teachers of evidence-based medicine, as well as patients and members of the public from low-income and high-income countries. Development consisted of 4 processes: (1) determining the scope of the Claim Evaluation Tools and development of items; (2) expert item review and feedback (n=63); (3) cognitive interviews with children and adult end-users (n=109); and (4) piloting and administrative tests (n=956). The Claim Evaluation Tools database currently includes a battery of multiple-choice items. Each item begins with a scenario which is intended to be relevant across contexts, and which can be used for children (from age 10  and above), adult members of the public and health professionals. People with expertise in research methods judged the items to have face validity, and end-users judged them relevant and acceptable in their settings. In response to feedback from methodologists and end-users, we simplified some text, explained terms where needed, and redesigned formats and instructions. The Claim Evaluation Tools database is a flexible resource from which researchers, teachers and others can design measurement instruments to meet their own requirements. These evaluation tools are being managed and made freely available for non-commercial use (on request) through Testing Treatments interactive ( PACTR201606001679337 and PACTR201606001676150; Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  6. On-Ice Functional Assessment of an Elite Ice Hockey Goaltender After Treatment for Femoroacetabular Impingement. (United States)

    Tramer, Joseph S; Deneweth, Jessica M; Whiteside, David; Ross, James R; Bedi, Asheesh; Goulet, Grant C


    Femoroacetabular impingement (FAI) is a major cause of performance inhibition in elite-level athletes. The condition is characterized by pain, osseous abnormalities such as an increased alpha angle, and decreased range of motion at the affected hip joint. Arthroscopic surgical decompression is useful in reshaping the joint to alleviate symptoms. Functional kinematic outcomes of sport-specific movements after surgery, however, are presently unknown. The ability of an ice hockey goaltender to execute sport-specific movements would improve after arthroscopic surgery. Clinical research. Level 5. An ice hockey goaltender was evaluated after arthroscopic correction of FAI on the symptomatic hip. Passive range of motion and radiographic parameters were assessed from a computed tomography-derived 3-dimensional model. An on-ice motion capture system was also used to determine peak femoral shock and concurrent hip joint postures during the butterfly and braking movements. Maximum alpha angles were 47° in the surgical and 61° in the nonsurgical hip. Internal rotation range of motion was, on average, 23° greater in the surgically corrected hip compared with contralateral. Peak shock was lower in the surgical hip by 1.39 g and 0.86 g during butterfly and braking, respectively. At peak shock, the surgical hip demonstrated increased flexion, adduction, and internal rotation for both tasks (butterfly, 6.1°, 12.3°, and 30.8°; braking, 14.8°, 19.2°, and 41.4°). On-ice motion capture revealed performance differences between hips after arthroscopic surgery in a hockey goaltender. Range of motion and the patient's subjective assessment of hip function were improved in the surgical hip. While presenting as asymptomatic, it was discovered that the contralateral hip displayed measurements consistent with FAI. Therefore, consideration of preemptive treatment in a presently painless hip may be deemed beneficial for young athletes seeking a long career in sport, and future work is

  7. The SIGHT questionnaire: A novel assessment tool for Satisfaction In Genital Hypospadias Treatment. (United States)

    Ardelt, Peter U; Cederqvist, Marco; Barth, Michael; Frankenschmidt, Alexander


    Psychosexual development is currently underrepresented in hypospadias outcome research. The aim of this study was to develop and validate a questionnaire addressing psychosexual long-term satisfaction, specifically of adolescent patients, after hypospadias repair. In a multistep participative design we identified key interests of adolescent patients with hypospadias. Next, a questionnaire addressing specifically the psychosexual satisfaction of adolescents after hypospadias repair was established. A population of 109 former patients with hypospadias was then assessed using this questionnaire. Furthermore, functional and cosmetic aspects, behavioural anomalies, and sexual activity were investigated. Age-matched patients undergoing circumcision served as control patients. Possible influence factors on patient satisfaction were investigated. Clinical trial registry site: German Registry of Clinical Trials DRKS, Freiburg, Germany (Reference: DRKS00003432). Key interests of adolescent patients were "normal appearance of the penis", "normal function of the penis regarding voiding and sexual activity", "no limitations regarding cosmetic appearance to others", "no limitations to sexual activity", and an "unimpaired masculine identity". The "Satisfaction In Genital Hypospadias Treatment" (SIGHT) questionnaire was developed using these items and using previously published evaluation systems. Nine questions address psychosexual aspects and two additional questions address current sexual activity. Internal consistency was high and retest reliability acceptable. The patient population showed a normal strength and difficulties score (SDQ). Overall satisfaction was high and similar to that of the control group. In a Spearman correlation a high SDQ value, erectile problems, and complications correlated negatively with satisfaction. To date, few studies have examined patients' satisfaction and psychosexuality. To our knowledge, the SIGHT questionnaire is the first to be developed

  8. Assessment of oral health status and treatment needs of Santhal tribes of Dhanbad District, Jharkhand. (United States)

    Kumar, Gunjan; Tripathi, Ranjan Mani; Dileep, C L; Trehan, Megha; Malhotra, Shitanshu; Singh, Pallavi


    India has an assortment of tribal population living in isolated pockets, and the Santhals are numerically predominant in Jharkhand. This study was aimed at assessing the oral health status and treatment needs of Santhals residing in Dhanbad, Jharkhand. A cross-sectional survey of 921 Santhals of Topchanchi Block was conducted. A modified World Health Organization (WHO) Oral Health Assessment Form (1997) was utilized and examined according to the WHO methodology (1997). The recorded data was statistically analyzed using the Statistical Package for the Social Sciences version 15. Based on the occupation, it was seen that 620 (67.3%) participants practiced agriculture and 206 (22.4%) worked as laborers. The mean decayed missing filled tooth (score was 3.56 ± 1.93 in 2-5-year-old participants. In the higher age groups of 35-44 and 65-74 years, the scores were 5.21 ± 2.34 and 7.42 ± 4.29, respectively. Participants with bleeding gums were predominantly seen in the age group of 35-44 years (0.91 ± 0.08). Approximately 138 (54.1%) participants had a loss of attachment of 4-5 mm in the 35-44 year age group. In the 13-15-year-old age group, 0.14 ± 0.05 teeth needed two surfaces fillings. A total of 118 (12.8%) participants needed one-unit prosthesis in the upper jaw. This study showed that a majority of Santhal tribals used twigs to routinely clean their teeth. Poor oral hygiene and periodontal status was seen among the tribes.

  9. Assessing Progress during Treatment for Young Children with Autism Receiving Intensive Behavioural Interventions (United States)

    Hayward, Diane; Eikeseth, Svein; Gale, Catherine; Morgan, Sally


    This study examined progress after 1 year of treatment for children with autism who received a mean of 36 hours per week one-to-one University of California at Los Angeles Applied Behavior Analysis (UCLA ABA) treatment. Two types of service provision were compared: an intensive clinic based treatment model with all treatment personnel (N = 23),…

  10. Quantitative assessment of solid waste treatment systems in the industrial ecology perspective by exergy analysis. (United States)

    Dewulf, Jo P; Van Langenhove, Herman R


    Solid waste treatment options (recycling, incineration, and landfilling; the two latter processes both with co-generation of heat and electricity) have been studied for cardboard, newspaper, polyethylene, poly(ethylene terephthalate), polypropylene, polystyrene, and poly(vinyl chloride) waste. The conversion processes have been analyzed in terms of the second law of thermodynamics. The analysis allows calculating the exergy (useful energy) embodied in conversion products that can be obtained from the required inputs for the treatment processes. Taking into account the waste materials and the resources to convert them, it proved that recycling is the most efficient option for polyethylene with an efficiency of 62.5% versus 43.6% for incineration and 0.9% for landfilling. Next, waste treatment has been put into the broader perspective of industrial ecology. Exergetic efficiencies of industrial metabolic options have been calculated. Here resources for manufacturing and converting solid products have been considered. Furthermore, selection of one type of conversion excludes the generation of other potential conversion products. Therefore, it has to be taken into account that these latter products still have to be produced starting from virgin resources. Recycling proved to be the most efficient strategy: the ratio eta between exergy embodied in all delivered products on one hand, and all exergy withdrawn from the ecosphere or from waste materials on the other hand, is the highest. For polyethylene, eta proved to be 0.568, whereas eta is 0.503 and 0.329 for incineration and landfilling, respectively. On the other hand, if R the ratio between exergy of delivered products on one hand and exergy of virgin materials on the other hand is calculated, the differences between the industrial metabolic options are larger. Recycling polyethylene showed a ratio R of 0.936, whereas ratios of 0.772 and 0.531 were found for incineration and landfilling, respectively. It has been

  11. Pre-treatment and post-treatment assessment of the C(6) test in patients with persistent symptoms and a history of Lyme borreliosis. (United States)

    Fleming, R V; Marques, A R; Klempner, M S; Schmid, C H; Dally, L G; Martin, D S; Philipp, M T


    It was recently reported that antibody to C(6), a peptide that reproduces an invariable region of the VlsE lipoprotein of Borrelia burgdorferi, declined in titer by a factor of four or more in a significant proportion of patients after successful antibiotic treatment of acute localized or disseminated Lyme borreliosis. The present study evaluated the C(6) test as a predictor of therapy outcome in a population of patients with post-treatment Lyme disease syndrome. The serum specimens tested were from patients with well-documented, previously treated Lyme borreliosis who had persistent musculoskeletal or neurocognitive symptoms. All of the patients had participated in a recent double-blind, placebo-controlled antibiotic trial in which serum samples were collected at baseline and 6 months thereafter, $132#e. 3 months following treatment termination. In this patient population no correlation was found between a decline of C(6) antibody titer of any magnitude and treatment or clinical outcome. Antibodies to C(6) persisted in these patients with post-treatment Lyme disease syndrome following treatment, albeit at a markedly lower prevalence and titer than in untreated patients with acute disseminated Lyme disease. The results indicate that C(6) antibody cannot be used to assess treatment outcome or the presence of active infection in this population.

  12. Development and description of measurement properties of an instrument to assess treatment burden among patients with multiple chronic conditions

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    Tran Viet-Thi


    Full Text Available Abstract Background Patients experience an increasing treatment burden related to everything they do to take care of their health: visits to the doctor, medical tests, treatment management and lifestyle changes. This treatment burden could affect treatment adherence, quality of life and outcomes. We aimed to develop and validate an instrument for measuring treatment burden for patients with multiple chronic conditions. Methods Items were derived from a literature review and qualitative semistructured interviews with patients. The instrument was then validated in a sample of patients with chronic conditions recruited in hospitals and general practitioner clinics in France. Factor analysis was used to examine the questionnaire structure. Construct validity was studied by the relationships between the instrument's global score, the Treatment Satisfaction Questionnaire for Medication (TSQM scores and the complexity of treatment as assessed by patients and physicians. Agreement between patients and physicians was appraised. Reliability was determined by a test-retest method. Results A sample of 502 patients completed the Treatment Burden Questionnaire (TBQ, which consisted of 7 items (2 of which had 4 subitems defined after 22 interviews with patients. The questionnaire showed a unidimensional structure. The Cronbach's α was 0.89. The instrument's global score was negatively correlated with TSQM scores (rs = -0.41 to -0.53 and positively correlated with the complexity of treatment (rs = 0.16 to 0.40. Agreement between patients and physicians (n = 396 was weak (intraclass correlation coefficient 0.38 (95% confidence interval 0.29 to 0.47. Reliability of the retest (n = 211 patients was 0.76 (0.67 to 0.83. Conclusions This study provides the first valid and reliable instrument assessing the treatment burden for patients across any disease or treatment context. This instrument could help in the development of treatment strategies that are both

  13. Individualized assessment and treatment program for alcohol dependence: results of an initial study to train coping skills. (United States)

    Litt, Mark D; Kadden, Ronald M; Kabela-Cormier, Elise


    Cognitive-behavioral treatments (CBT) are among the most popular interventions offered for alcohol and other substance use disorders, but it is not clear how they achieve their effects. CBT is purported to exert its beneficial effects by altering coping skills, but data supporting coping changes as the mechanism of action are mixed. The purpose of this pilot study was to test a treatment in which coping skills were trained in a highly individualized way, allowing us to determine if such training would result in an effective treatment. Participants were assigned randomly to a comprehensive packaged CBT program (PCBT), or to an individualized assessment and treatment program (IATP). The IATP program employed experience sampling via cellphone to assess coping skills prior to treatment, and provided therapists with a detailed understanding of patients' coping strengths and deficits. Out-patient treatment. A total of 110 alcohol-dependent men and women. Participants in both conditions completed experience sampling of situations, drinking and coping efforts prior to, and following, 12 weeks of treatment. Time-line follow-back procedures were also used to record drinking at baseline and post-treatment. IATP yielded higher proportion of days abstinent (PDA) at post-treatment (P coping responses and less drinking in high-risk situations, as recorded by experience sampling at post-treatment. Post-treatment coping response rates were associated with decreases in drinking. The IATP approach was more successful than PCBT at training adaptive coping responses for use in situations presenting a high risk for drinking. The highly individualized IATP approach may prove to be an effective treatment strategy for alcohol-dependent patients.

  14. Life cycle assessment applied to wastewater treatment; Analyse de cycle de vie appliquee aux systemes de traitement des eaux usees

    Energy Technology Data Exchange (ETDEWEB)

    Renou, S.


    Nowadays, the environmental performances of wastewater treatment systems are not properly analyzed. Thus, the development of an exhaustive and reliable method is needed to help stakeholders to choose the best environmental solutions. Life cycle assessment (LCA) was selected as a starting point to answer this problem. LCA has been tested. This tool is essential to analyze the environmental performances of wastewater treatment systems. In order to fulfill our goal, the best compromise seems to be the association of LCA, to assess global impacts, with others methodologies, to assess local impacts. Finally, a software has been developed to compare urban sludge treatment and recovering process trains. Two impacts, energy and greenhouse effect, are currently included in. The software and its development steps are described and illustrated through two case studies. This tool has made LCA easier to apply and more useful to wastewater field stakeholders. (author)

  15. Diagnosis and treatment of dementia: 1. Risk assessment and primary prevention of Alzheimer disease. (United States)

    Patterson, Christopher; Feightner, John W; Garcia, Angeles; Hsiung, G-Y Robin; MacKnight, Christopher; Sadovnick, A Dessa


    In addition to nonmodifiable genetic risk factors, potentially modifiable factors such as hypertension, hyperlipidemia and environmental exposures have been identified as risk factors for Alzheimer disease. In this article, we provide physicians with practical guidance on risk assessment and primary prevention of Alzheimer disease based on recommendations from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, held in March 2006. We developed evidence-based guidelines using systematic literature searches, with specific criteria for study selection and quality assessment, and a clear and transparent decision-making process. We selected studies published from January 1996 to December 2005 that met the following criteria: dementia (all-cause, Alzheimer disease or vascular dementia) as the outcome; longitudinal cohort study; study population broadly reflective of Canadian demographics; and genetic risk factors and general risk factors (e.g., hypertension, education, occupation and chemical exposure) identified. We graded the strength of evidence using the criteria of the Canadian Task Force on Preventive Health Care. Of 3424 articles on potentially modifiable risk factors for dementia, 1719 met our inclusion criteria; 60 were deemed to be of good or fair quality. Of 1721 articles on genetic risk factors, 62 that met our inclusion criteria were deemed to be of good or fair quality. On the basis of evidence from these articles, we made recommendations for the risk assessment and primary prevention of Alzheimer disease. For the primary prevention of Alzheimer's disease, there is good evidence for controlling vascular risk factors, especially hypertension (grade A), and weak or insufficient evidence for manipulation of lifestyle factors and prescribing of medications (grade C). There is good evidence to avoid estrogens and high-dose (> 400 IU/d) of vitamin E for this purpose (grade E). Genetic counselling and testing may be offered to at

  16. Developmental kinesiology: three levels of motor control in the assessment and treatment of the motor system. (United States)

    Kobesova, Alena; Kolar, Pavel


    Three levels of sensorimotor control within the central nervous system (CNS) can be distinguished. During the neonatal stage, general movements and primitive reflexes are controlled at the spinal and brain stem levels. Analysis of the newborn's spontaneous general movements and the assessment of primitive reflexes is crucial in the screening and early recognition of a risk for abnormal development. Following the newborn period, the subcortical level of the CNS motor control emerges and matures mainly during the first year of life. This allows for basic trunk stabilization, a prerequisite for any phasic movement and for the locomotor function of the extremities. At the subcortical level, orofacial muscles and afferent information are automatically integrated within postural-locomotor patterns. Finally, the cortical (the highest) level of motor control increasingly becomes activated. Cortical control is important for the individual qualities and characteristics of movement. It also allows for isolated segmental movement and relaxation. A child with impaired cortical motor control may be diagnosed with developmental dyspraxia or developmental coordination disorder. Human ontogenetic models, i.e., developmental motor patterns, can be used in both the diagnosis and treatment of locomotor system dysfunction. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. Comparison of Evidence-based and Conventional Education Effects on Radiography Assessment before Endodontic Treatment

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    Shimasadat Miri


    Full Text Available Introduction: Evidence-based education has been introduced to dentistry as a new educational tool. However, its effectiveness should be evaluated in different educational topics. The aim of this study was to compare the effects of evidence-based and conventional education on radiography assessment before endodontic treatment. Methods: In this semi-experimental study 75 senior dental students of Kermanshah Dentistry School were enrolled. Demographic information and the results of evaluation were collected using a weblog designed for this purpose. 20 questions were prepared to be answered in 30 minutes. 12 topics were covered in the questionnaire. To analyze the data, the paired sample t-test, Wilcoxon, and Whitney U tests were used. Results: The finding of the present study showed that total scores of the test in both conventional and evidence-based groups significantly improved after education (P=0.005 and P=0.001, respectively. There was a significant difference between the two groups (P=0.047 and evidence-based education showed better results in comparison with conventional one. Conclusion: The present study asserts that evidence-based education can lead to better diagnostic performance of senior dental students and thus can be used as an efficient alternative for conventional education methods in dental schools.

  18. Nationwide veterans affairs quality measure for cancer: the family assessment of treatment at end of life. (United States)

    Finlay, Esme; Shreve, Scott; Casarett, David


    The Veterans Affairs (VA) health care system has created a national initiative to measure quality of care at the end of life. This article describes the first phase of this national initiative, the Family Assessment of Treatment at End of Life (FATE), in evaluating the quality of end-of-life care for veterans dying with cancer. In the initial phase, next of kin of patients from five VA Medical Centers were contacted 6 weeks after patients' deaths and invited to participate in a telephone interview, and surrogates for 262 cancer patients completed FATE interviews. Decedents were 98% male with an average age of 72 years. There was substantial variation among sites. Higher FATE scores, consistent with family reports of higher satisfaction with care, were associated with palliative care consultation and hospice referral and having a Do Not Resuscitate order at the time of death, whereas an intensive care unit death was associated with lower scores. Early experience with FATE suggests that it will be a helpful tool to characterize end-of-life cancer care and to identify targets for quality improvement.

  19. Comprehensive assessment of cytochromes P450 and transporter genetics with endoxifen concentration during tamoxifen treatment. (United States)

    Marcath, Lauren A; Deal, Allison M; Van Wieren, Emily; Danko, William; Walko, Christine M; Ibrahim, Joseph G; Weck, Karen E; Jones, David R; Desta, Zeruesenay; McLeod, Howard L; Carey, Lisa A; Irvin, William J; Hertz, Daniel L


    Tamoxifen bioactivation to endoxifen is mediated primarily by CYP2D6; however, considerable variability remains unexplained. Our aim was to perform a comprehensive assessment of the effect of genetic variation in tamoxifen-relevant enzymes and transporters on steady-state endoxifen concentrations. Comprehensive genotyping of CYP enzymes and transporters was performed using the iPLEX ADME PGx Pro Panel in 302 tamoxifen-treated breast cancer patients. Predicted activity phenotype for 19 enzymes and transporters were analyzed for univariate association with endoxifen concentration, and then adjusted for CYP2D6 and clinical covariates. In univariate analysis, higher activity of CYP2C8 (regression β=0.22, P=0.020) and CYP2C9 (β=0.20, P=0.04), lower body weight (β=-0.014, P<0.0001), and endoxifen measurement during winter (each β<-0.39, P=0.002) were associated with higher endoxifen concentrations. After adjustment for the CYP2D6 diplotype, weight, and season, CYP2C9 remained significantly associated with higher concentrations (P=0.02), but only increased the overall model R by 1.3%. Our results further support a minor contribution of CYP2C9 genetic variability toward steady-state endoxifen concentrations. Integration of clinician and genetic variables into individualized tamoxifen dosing algorithms would marginally improve their accuracy and potentially enhance tamoxifen treatment outcomes.

  20. Telepractice in the assessment and treatment of individuals with autism spectrum disorders: A systematic review. (United States)

    Boisvert, Michelle; Lang, Russell; Andrianopoulos, Mary; Boscardin, Mary Lynn


    Studies involving the use of telepractice in the delivery of services to individuals with autism spectrum disorders (ASD) were reviewed with the intent to inform practice and identify areas for future research. Systematic searches of electronic databases, reference lists and journals identified eight studies that met pre-determined inclusion criteria. These studies were analysed and summarized in terms of the: (a) characteristics of the participants, (b) technology utilized, (c) services delivered via telepractice, (d) research methodology and (e) results of the study. Telepractice was used by university-based researchers, behaviour analysts, psychiatrists and psychologists to assist caretakers and educators in the delivery of services to 46 participants with ASD. The services delivered included behavioural and diagnostic assessments, educational consulting, guidance and supervision of behavioural interventions and coaching/training in the implementation of a comprehensive early intervention programme. Results suggests telepractice is a promising service delivery approach in the treatment of individuals with ASD that warrants additional research. Guidelines for practitioners and potential directions for future research are discussed.

  1. Toward the elimination of lymphatic filariasis by 2020: treatment update and impact assessment for the endgame. (United States)

    Rebollo, Maria P; Bockarie, Moses J


    Lymphatic filariasis (LF) is an important public health problem endemic in 73 countries, where it is a major cause of acute and chronic morbidity and a significant impediment to socioeconomic development. It is targeted for elimination by 2020, through preventive chemotherapy using albendazole in combination with either ivermectin or diethylcarbamazine citrate. Preventive chemotherapy enables the regular and coordinated administration of safe, single-dose medications delivered through mass drug administration (MDA). Many countries are now scaling down MDA activities after achieving 100% geographic coverage and instituting monitoring and evaluation procedures to establish the impact of several consecutive rounds of MDA and determine if transmission has been interrupted. At the same time, countries yet to initiate MDA for elimination of LF will adopt improved mapping and coverage assessment protocols to accelerate the efforts for achieving global elimination by 2020. This review provides an update on treatment for LF and describes the current global status of the elimination efforts, transmission control processes and strategies for measuring impact and continuing surveillance after MDA has ceased.


    Directory of Open Access Journals (Sweden)

    Dragana M. KLJAJIKJ


    Full Text Available Interpersonal communication, psychosocial and mental development of personality and its all other functions take place through the motor control. The most common neurological syndrome is a type of peripheral paresis/paralysis of plexus bracialis, which in most cases occurs at birth and significantly compromises the growth and development of the upper extremities and affects the psychomotor performance. The aim of this study was to evaluate the level of visual perception in children with lesion of plexus brachialis and the effect of the somatopedic treatment over the level of increase of the visual perception. The study sample was consisted of 60 preschool children accommodated at the Rehabilitation Centre “Dr. Miroslav Zotović” in Belgrade (experimental group and examiners that followed regular checkups and had discontinuity in their therapy (control group. For the research purposes, we used The Test for Visual Perception Assessment. By analyzing the results, we concluded that in both, in the first and the second measuring there was a statistically significant correlation between the experimental and the control groups (I measuring: p<0.001, r = 0.408; II measuring: p <0.001, r = 0.593.

  3. Water quantity and quality assessment on a tertiary treatment wetland in a tropical climate. (United States)

    Sun, Guangzhi; Saeed, Tanveer; Zhang, Guangxin; Sivakugan, Nagaratnam


    This study aimed to assess the quantity and quality of water in a surface flow constructed wetland in Australia's far north Queensland. Owing to tropical climate in the region, the wetland provided dual functions: retention of a treated wastewater for zero discharge during the dry season and tertiary treatment prior to discharge during the wet season. Rainfall data, permeability of wetland soil, evaporation, inflow and outflow were analysed in a water balance analysis; the results showed that based on a 72-year-average rainfall pattern, daily wastewater inflow of 85 m(3)/d is the maximum this wetland can cope with without breaching its discharge certificate. In water quality analysis, the K-C* model was used to predict changes of biochemical oxygen demand (BOD, suspended solids (SS), total nitrogen (TN), total phosphorus (TP) and faecal coliforms (FC) in the wetland. Model predictions were compared with field sampling results. It was found that the wetland was effective in removing FC (>99.9%), TN (70.7%) and TP (68.2%), for which the predictions by the K-C* model were consistent with field testing results. However, significant disparities between the predictions and testing results were found for BOD and SS. A revised K-C* equation was proposed to account for the internal generation of organics in constructed wetlands with a long retention time.

  4. Assessment in the mouse of cefoperazone as a treatment for mastitis. (United States)

    Anderson, J C; Craven, N


    The value of cefoperazone in mastitis therapy was assessed in the mouse model of mastitis primarily by its effect on bacterial cell numbers in the gland. In addition histological studies showed that the drug was not an irritant in the mammary gland. Pharmacokinetic studies showed that it was slowly absorbed from the gland (six days to absorb 500 micrograms) but was easily removed by milking. In ascending order of efficacy cefoperazone (500 micrograms/gland) was active against four-hour-old intramammary infections caused by Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, Streptococcus agalactiae and Strep uberis. The effect against Staph aureus was titrated down to a dose of 50 micrograms/gland. Cefoperazone was not bactericidal against intracellular staphylococci but it did sensitise them to the action of lytic enzyme. Cefoperazone and cloxacillin behaved similarly against progressive staphylococcal mastitis. Both antibiotics significantly reduced the bacterial numbers when four-hour-old infections were treated but the effect on 26-hour-old infections was perceptible only when each antibiotic was assayed against saline treatment in the mouse. The results suggest that further studies in dairy cattle should be undertaken.

  5. Musculoskeletal Simulation for Assessment of Effect of Movement-Based Structure-Modifying Treatment Strategies

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    Tien Tuan Dao


    Full Text Available The better understanding of the complex mechanism between neural motor control and its resulting joint kinematics and muscle forces allows a better elucidation of the mechanisms behind body growth, aging progression, and disease development. This study aimed at investigating the impact of movement-based structure-modifying treatment strategies on joint kinematics, muscle forces, and muscle synergies of the gait with instrumented implant. A patient-specific musculoskeletal model was used to quantitatively assess the deviations of joint and muscle behaviors between the normal gait and 4 gait modifications (bouncy, medial thrust, midcrouch, and mtp (i.e., gait with forefoot strike. Moreover, muscle synergy analysis was performed using EMG-based nonnegative matrix factorization. Large variation of 19 degrees and 190 N was found for knee flexion/extension and lower limb muscle forces, respectively. EMG-based muscle synergy analysis revealed that the activation levels of the vastus lateralis and tibialis anterior are dominant for the midcrouch gait. In addition, an important contribution of semimembranosus to the medial thrust and midcrouch gaits was also observed. In fact, such useful information could allow a better understanding of the joint function and muscle synergy strategies leading to deeper knowledge of joint and muscle mechanisms related to neural voluntary motor commands.

  6. Occurrence, removal, and risk assessment of antibiotics in 12 wastewater treatment plants from Dalian, China. (United States)

    Zhang, Xin; Zhao, Hongxia; Du, Juan; Qu, Yixuan; Shen, Chen; Tan, Feng; Chen, Jingwen; Quan, Xie


    In this study, the occurrence and removal efficiencies of 31 antibiotics, including 11 sulfonamides (SAs), five fluoroquinolones (FQs), four macrolides (MLs), four tetracyclines (TCs), three chloramphenicols (CAPs), and four other antibiotics (Others), were investigated in 12 municipal wastewater treatment plants (WWTPs) in Dalian, China. A total of 29 antibiotics were detected in wastewater samples with the concentration ranging from 63.6 to 5404.6 ng/L. FQs and SAs were the most abundant antibiotic classes in most wastewater samples, accounting for 42.2 and 23.9% of total antibiotic concentrations, respectively, followed by TCs (16.0%) and MLs (14.8%). Sulfamethoxazole, erythromycin, clarithromycin, azithromycin, ofloxacin, and norfloxacin were the most frequently detected antibiotics; of these, the concentration of ofloxacin was the highest in most of influent (average concentration = 609.8 ng/L) and effluent (average concentration = 253.4 ng/L) samples. The removal efficiencies varied among WWTPs in the range of -189.9% (clarithromycin) to 100% (enoxacin, doxycycline, etc), and more than 50% of antibiotics could not be efficiently removed with the removal efficiency less than 65%. An environmental risk assessment was also performed in the WWTP effluents by calculating the risk quotient (RQ), and high RQ values (>1) indicated erythromycin and clarithromycin might cause the ecological risk on organisms in surrounding water near discharge point of WWTPs in this area, which warrants further attention.

  7. Assessing the application of advanced oxidation processes, and their combination with biological treatment, to effluents from pulp and paper industry


    Merayo Cuevas, Noemí; Hermosilla Redondo, Daphne; Blanco Jaen, Laura; Cortijo, Luis; Blanco Suárez, Ángeles


    The closure of water circuits within pulp and paper mills has resulted in a higher contamination load of the final mill effluent, which must consequently be further treated in many cases to meet the standards imposed by the legislation in force. Different treatment strategies based on advanced oxidation processes (ozonation and TiO2-photocatalysis), and their combination with biological treatment (MBR), are herein assessed for effluents of a recycled paper mill and a kraft pulp mill. Ozone tr...

  8. Systematic review and assessment of systematic reviews examining the effect of periodontal treatment on glycemic control in patients with diabetes


    Hasuike, Akira; Iguchi, Shinya; Suzuki, Daigo; Kawano, Eisuke; Sato, Shuichi


    Objetives There have been several systematic reviews(SRs) on whether periodontal treatment for an individual with both periodontal disease and diabetes can improve diabetes outcomes. The purpose of this investigation was to conduct a systematic review (SR) of previous meta-analyses, and to assess the methodological quality of the SRs examining the effects of periodontal treatment and diabetes. (PROSPERO Registration # CRD 42015023470). Study Design We searched five electronic databases and id...

  9. Psychosocial assessment and monitoring in the new era of non-interferon-alpha hepatitis C virus treatments. (United States)

    Rowan, Paul J; Bhulani, Nizar


    Chronic hepatitis C virus (HCV) is a global concern. With the 2014 Food and Drug Administration approvals of two direct-acting antiviral (DAA) regimens, ledipasvir/sofosbuvir regimen and the ombitasvir/paritaprevir/ritonavir and dasabuvir regimen, we may now be in the era of all-pill regimens for HCV. Until this development, interferon-alpha along with Ribavirin has remained part of the standard of care for HCV patients. That regimen necessitates psychosocial assessment of factors affecting treatment eligibility, including interferon-alpha-related depressive symptoms, confounding psychiatric conditions, and social aspects such as homelessness affecting treatment eligibility. These factors have delayed as much as 70% of otherwise eligible candidates from interferon-based treatment, and have required treating physicians to monitor psychiatric as well as medical side effects throughout treatment. All-pill DAA regimens with the efficaciousness that would preclude reliance upon interferon-alpha or ribavirin have been anticipated for years. Efficacy studies for these recently approved DAA regimens provide evidence to assess the degree that psychosocial assessment and monitoring will be required. With shorter treatment timelines, greatly reduced side effect profiles, and easier regimens, psychosocial contraindications are greatly reduced. However, current or recent psychiatric comorbidity, and drug-drug interactions with psychiatric drugs, will require some level of clinical attention. Evidence from these efficacy studies tentatively demonstrate that the era of needing significant psychosocial assessment and monitoring may be at an end, as long as a manageable handful of clinical issues are managed.

  10. Development and preliminary reliability testing of an assessment of patient independence in performing a treatment program: standardized scenarios. (United States)

    Harris-Hayes, Marcie; Holtzman, Gregory W; Earley, Jeanne A; Van Dillen, Linda R


    Physical therapists often assess patient independence through observation; however, it is not known if therapists make these judgments reliably. We have developed a standardized method to assess a patient's ability to perform his or her treatment program independently. To develop a standardized assessment of patient independence in performance of a treatment program and examine the intra- and inter-rater reliability decisions made by two physical therapists. Test-retest. An assessment of patient independence in performance was developed. Standardized patient scenarios were used to assess the intra- and inter-tester reliability of two physical therapists. Percentage of agreement (%) and kappa's coefficient (k and k(w)) indexed rater reliability. Intra-rater reliability of therapist 1 was as follows: knowledge: % = 95, k = 0.90; performance: % = 95, k(w) = 0.82. Intra-rater reliability of therapist 2 was as follows: knowledge: % = 85, k = 0.68; performance: % = 94, k(w) = 0.80. Inter-rater reliability for knowledge was % = 91 and k = 0.79 and for performance was % = 91 and k(w) = 0.72. Trained therapists displayed substantial to excellent intra-rater reliability and substantial inter-rater reliability in assessing a patient's independence in a treatment program. :

  11. French Health Technology Assessment of Antineoplastic Drugs Indicated in the Treatment of Solid Tumours: Perspective for Future Trends. (United States)

    Chouaid, Christos; Borget, Isabelle; Braun, Eric; Bazil, Marie-Laure; Schaetz, Dominique; Rémuzat, Cécile; Toumi, Mondher


    France is one of the European countries that spend the most on oncology drugs. To keep pharmaceutical expenditure under control, Health Authorities highly scrutinize market access of costly medicines. To assess current and future trends in French health technology assessment (HTA) of antineoplastic drugs indicated in the treatment of solid tumours. A review of the SMR and ASMR drivers of the Transparency Committee (CT) opinions issued for antineoplastic drugs indicated in the treatment of solid tumours and approved between 2009 and 2014 was performed to assess current trends in French health technology assessment (HTA), complemented by an expert board consultation to capture the critical issues on the future of antineoplastic drugs HTA. Thirty-one drugs indicated for the treatment of solid tumours were identified (77 % targeted therapies). Initial CT assessments were available for 26 drugs. Four key items in the CT assessment were identified: 1) Clinical trial methodology; 2) Acceptance of progression-free survival (PFS) as a valuable endpoint; 3) Transferability of clinical trials in clinical practice; 4) Unpredictability of CT decisions. Experts raised the important development of personalised medicines in oncology and key challenges for oncology products to generate information expected from HTA perspective. The French system remains committed to its values and philosophy (access of all innovations for everybody) which are threatened by the increasing launch of innovative therapies and budget constraint. Both HTA decision framework evolution and revision of the current pricing process should be considered in France to cope with these new challenges.

  12. Is treatment of atrial fibrillation in primary care based on thromboembolic risk assessment?

    NARCIS (Netherlands)

    Rutten, F.H.; Hak, E.; Stalman, W.A.B.; Verheij, T.J.M.; Hoes, A.W.


    Background. Antithrombotic treatment in atrial fibrillation should be guided by the risk of thromboembolic events. Although practice studies have shown underutilization of antithrombotics, it is not clear whether physicians make use of thromboembolic risk stratification in their treatment decisions,

  13. Surgical treatment of neurogenic stress urinary incontinence: A systematic review of quality assessment and surgical outcomes

    NARCIS (Netherlands)

    Farag, F.; Koens, M.J.; Sievert, K.D.; Ridder, D. de; Feitz, W.; Heesakkers, J.P.


    BACKGROUND: There are many opinions but little firm knowledge about the optimal treatment of neurogenic stress urinary incontinence (NSUI). OBJECTIVE: To scrutinize the quality and surgical outcomes of the available treatment modalities in the published literature. EVIDENCE ACQUISITION: A systematic

  14. Radiological assessment of water treatment processes in a water treatment plant in Saudi Arabia: Water and sludge radium content, radon air concentrations and dose rates

    Energy Technology Data Exchange (ETDEWEB)

    Al-Jaseem, Q.Kh., E-mail: [Nuclear Science Research Institute (NSRI), King Abdulaziz City for Science and Technology (KACST), P.O. Box 6086, Riyadh 11442 (Saudi Arabia); Almasoud, Fahad I. [Nuclear Science Research Institute (NSRI), King Abdulaziz City for Science and Technology (KACST), P.O. Box 6086, Riyadh 11442 (Saudi Arabia); Ababneh, Anas M. [Physics Dept., Faculty of Science, Islamic University in Madinah, Al-Madinah, P.O. Box 170 (Saudi Arabia); Al-Hobaib, A.S. [Nuclear Science Research Institute (NSRI), King Abdulaziz City for Science and Technology (KACST), P.O. Box 6086, Riyadh 11442 (Saudi Arabia)


    There is an increase demand for clean water sources in Saudi Arabia and, yet, renewable water resources are very limited. This has forced the authorities to explore deep groundwater which is known to contain large concentrations of radionuclides, mainly radium isotopes. Lately, there has been an increase in the number of water treatment plants (WTPs) around the country. In this study, a radiological assessment of a WTP in Saudi Arabia was performed. Raw water was found to have total radium activity of 0.23 Bq/L, which exceeds the international limit of 0.185 Bq/L (5 pCi/L). The WTP investigated uses three stages of treatment: flocculation/sedimentation, sand filtration and reverse osmosis. The radium removal efficiency was evaluated for each stage and the respective values were 33%, 22% and 98%. Moreover, the activity of radium in the solid waste generated from the WTP in the sedimentation and sand filtrations stages were measured and found to be 4490 and 6750 Bq/kg, respectively, which exceed the national limit of 1000 Bq/kg for radioactive waste. A radiological assessment of the air inside the WTP was also performed by measuring the radon concentrations and dose rates and were found in the ranges of 2–18 Bq/m{sup 3} and 70–1000 nSv/h, respectively. The annual effective dose was calculated and the average values was found to be 0.3 mSv which is below the 1 mSv limit. - Highlights: • Radiological assessment of groundwater treatment plant was performed. • Radium Removal efficiency was calculated for different stages during water treatment. • Radium concentrations in sludge were measured and found to exceed the national limit for radioactive waste. • Air radon concentrations and dose rates were monitored in the water treatment plant. • The Reverse Osmosis (RO) unit was found to record the highest air radon concentrations and dose rates.

  15. Dental aesthetics assessed against orthodontic treatment complexity and need in Nigerian patients with sickle-cell anemia. (United States)

    Onyeaso, Chukwudi O; daCosta, Oluranti O


    This study investigates the relationship between dental aesthetics and orthodontic treatment complexity and need in a group of patients with sickle-cell anemia (SCA) in Nigeria. The study sample consisted of 176 individuals - 77 (43.8%) male and 99 (56.3%) female subjects with SCA (aged 10 to 35 years) who were coming for routine medical care to two outpatient clinics. Dental aesthetics were assessed using the Standardized Continuum of Aesthetic Need component of the Index of Orthodontic Treatment Need. Treatment complexity and need were assessed according to the Index of Complexity, Outcome and Need and Dental Aesthetic Index. Both parametric and nonparametric statistics were employed in the data analysis. Significant positive relationships were found between dental aesthetics and orthodontic treatment complexity as well as treatment need according to both indices (p= .000). The correlations of the scores for dental aesthetics and the objectively derived treatment complexity and need were significant (p= .01). About 50% of the subjects had poor dental aesthetics and this correlated with their high orthodontic treatment complexity and need.

  16. Occurrence and assessment of treatment efficiency of nonylphenol, octylphenol and bisphenol-A in drinking water in Taiwan. (United States)

    Chen, H W; Liang, C H; Wu, Z M; Chang, E E; Lin, T F; Chiang, P C; Wang, G S


    Occurrence and methods for the removal of nonylphenolic compounds in drinking water have been gaining increased attention due to their widespread presence in natural water and the potential health risks from the consumptions of drinking water. The purpose of this study was to assess the occurrence of nonylphenol (NP), octylphenol (OP), and bisphenol-A (BPA) in water sources and treated water in Taiwan, to evaluate the treatment efficiencies of these compounds in both the conventional (coagulation, sedimentation, filtration and chlorination) and advanced treatment processes. The treatment efficiencies of these chemicals were assessed based on their concentrations in water sources, and the results were verified with laboratory simulated treatment processes. A survey of NP, OP, and BPA in 11 Taiwanese water sources showed that all of them could be identified in most of the sampled sources, and that higher concentrations of NP were found when the raw water was contaminated by domestic wastewater. However, higher treatment efficiency could be observed when the NP concentration in water source is high. Laboratory simulation studies of conventional treatment processes showed that chlorination played an important role in the degradation of NP in raw water. Treatment efficiencies of 60%-90% were achieved for NP removal when sufficient chlorine dosages were applied to satisfy chlorine demands. However, results also showed that conventional coagulation and rapid filtration processes were less effective in the reduction of phenolic compounds in water. Copyright © 2013 Elsevier B.V. All rights reserved.

  17. Chlorinated solvents in a petrochemical wastewater treatment plant: an assessment of their removal using self-organising maps. (United States)

    Tobiszewski, Marek; Tsakovski, Stefan; Simeonov, Vasil; Namieśnik, Jacek


    The self-organising map approach was used to assess the efficiency of chlorinated solvent removal from petrochemical wastewater in a refinery wastewater treatment plant. Chlorinated solvents and inorganic anions (11 variables) were determined in 72 wastewater samples, collected from three different purification streams. The classification of variables identified technical solvents, brine from oil desalting and runoff sulphates as pollution sources in the refinery, affecting the quality of wastewater treatment plant influent. The classification of samples revealed the formation of five clusters: the first three clusters contained samples collected from the drainage water, process water and oiled rainwater treatment streams. The fourth cluster consisted mainly of samples collected after biological treatment, and the fifth one of samples collected after an unusual event. SOM analysis showed that the biological treatment step significantly reduced concentrations of chlorinated solvents in wastewater. Copyright © 2012 Elsevier Ltd. All rights reserved.

  18. Performance assessment of the BEBIG MultiSource® high dose rate brachytherapy treatment unit (United States)

    Palmer, Antony; Mzenda, Bongile


    A comprehensive system characterisation was performed of the Eckert & Ziegler BEBIG GmbH MultiSource® High Dose Rate (HDR) brachytherapy treatment unit with an 192Ir source. The unit is relatively new to the UK market, with the first installation in the country having been made in the summer of 2009. A detailed commissioning programme was devised and is reported including checks of the fundamental parameters of source positioning, dwell timing, transit doses and absolute dosimetry of the source. Well chamber measurements, autoradiography and video camera analysis techniques were all employed. The absolute dosimetry was verified by the National Physical Laboratory, UK, and compared to a measurement based on a calibration from PTB, Germany, and the supplied source certificate, as well as an independent assessment by a visiting UK centre. The use of the 'Krieger' dosimetry phantom has also been evaluated. Users of the BEBIG HDR system should take care to avoid any significant bend in the transfer tube, as this will lead to positioning errors of the source, of up to 1.0 mm for slight bends, 2.0 mm for moderate bends and 5.0 mm for extreme curvature (depending on applicators and transfer tube used) for the situations reported in this study. The reason for these errors and the potential clinical impact are discussed. Users should also note the methodology employed by the system for correction of transit doses, and that no correction is made for the initial and final transit doses. The results of this investigation found that the uncorrected transit doses lead to small errors in the delivered dose at the first dwell position, of up to 2.5 cGy at 2 cm (5.6 cGy at 1 cm) from a 10 Ci source, but the transit dose correction for other dwells was accurate within 0.2 cGy. The unit has been mechanically reliable, and source positioning accuracy and dwell timing have been reproducible, with overall performance similar to other existing HDR equipment. The unit is capable of high

  19. Comparative analysis of three data treatment techniques for landslide susceptibility assessment in the Eastern Pyrenees, Spain. (United States)

    Amorim, S.; Corominas, J.; Lantada, N.; Angulo, C.; Baeza, C.


    In this communication, the comparison of three data treatment methodologies for assessing landslide susceptibility is presented. The artificial neural networks (ANN) analysis, discriminant analysis (DA) and logistic regression (LR) have been performed in a test area of the Eastern Pyrenees (Spain), at a local scale (1:5.000). The main objective of our research is the comparison of the results obtained with the different techniques and to discuss the advantages and drawbacks of each of them. A database containing an inventory of 280 shallow landslides triggered during the intense rainy event of November of 1982 has been used. Additional information on significant conditioning factors such as vegetation cover and presence of superficial formation has been included as well as other input variables captured automatically from the Digital Elevation Model (DEM). ANN was performed with MATLAB while DA and LR with the statistical package SPSS. The input data and the results have been implemented on a GIS platform (ArcGIS). The test area has a size of about 40km2 and the susceptibility has been determined at each cell (15x15m). The input variables were selected from previous susceptibility assessment studies carried out in the area. The training and validation analyses have worked with two input cell classes (stable and unstable) and final maps with five susceptibility levels have been prepared. DA and LR classify dichotomous variables. The ANN analysis has been carried out with both classification and regression structures. The Receiver Operating Characteristic (ROC) curves obtained are similar in all the models. However, frequency histograms on stable and unstable populations show significant differences in the distance between the mean values of the populations and in the distribution of the overlapping area. The susceptibility maps prepared with ANN and LR minimize the potentially unstable area. The cumulative percentage curves (Duman et al. 2006) show that using

  20. Development and psychometric validation of a novel patient survey to assess perceived quality of substance abuse treatment in South Africa. (United States)

    Myers, Bronwyn; Govender, Rajen; Koch, J Randy; Manderscheid, Ron; Johnson, Kim; Parry, Charles D H


    A hybrid performance measurement system that combines patient-reported outcome data with administrative data has been developed for South African substance abuse treatment services. This paper describes the development and psychometric validation of one component of this system, the South African Addiction Treatment Services Assessment (SAATSA). First, a national steering committee identified five domains and corresponding indicators on which treatment quality should be assessed. A decision was made to develop a patient survey to assess several of these indicators. A stakeholder work group sourced survey items and generated additional items where appropriate. The feasibility and face validity of these items were examined during cognitive response testing with 16 patients. This led to the elimination of several items. Next, we conducted an initial psychometric validation of the SAATSA with 364 patients from residential and outpatient services. Exploratory (EFA) and confirmatory factor analyses (CFA) were conducted to assess the latent structure of the SAATSA. Findings highlighted areas where the SAATSA required revision. Following revision, we conducted another psychometric validation with an additional sample of 285 patients. We used EFA and CFA to assess construct validity and we assessed reliability using Cronbach's measure of internal consistency. The final version of the SAATSA comprised 31 items (rated on a four-point response scale) that correspond to six scales. Four of these scales are patient-reported outcome measures (substance use, quality of life, social connectedness and HIV risk outcomes) that together assess the perceived effectiveness of treatment. The remaining two scales assess patients' perceptions of access to and quality of care. The models for the final revised scales had good fit and the internal reliability of these scales was good to excellent, with Cronbach's α ranging from 0.72 to 0.89. A lack of adequate measurement tools hampers

  1. Repository performance assessment of waste forms from the electrometallurgical treatment of sodium-bonded spent nuclear fuel

    Energy Technology Data Exchange (ETDEWEB)

    Morris, E. E.; Fanning, T. H.; Feldman, E. E.; Petri, M. C.


    The ceramic and metal waste forms produced by electrometallurgical treatment of sodium-bonded spent nuclear fuel are undergoing evaluation as to how they will perform within the geologic repository which is proposed to be built at Yucca Mountain. An initial assessment, making use of preliminary degradation models for the waste forms, is described. The analyses are performed with a simplified version of the Total System Performance Assessment--Viability Assessment repository model. Results indicate that the ability of the ceramic and metal waste forms to retain radionuclides is similar to and sometimes better than defense high-level waste glass.

  2. Analysis of Frequency of Use of Different Scar Assessment Scales Based on the Scar Condition and Treatment Method


    Seong Hwan Bae; Yong Chan Bae


    Analysis of scars in various conditions is essential, but no consensus had been reached on the scar assessment scale to select for a given condition. We reviewed papers to determine the scar assessment scale selected depending on the scar condition and treatment method. We searched PubMed for articles published since 2000 with the contents of the scar evaluation using a scar assessment scale with a Journal Citation Report impact factor >0.5. Among them, 96 articles that conducted a scar evalu...

  3. Diagnosis, Risk Assessment, and Treatment Decisions for Occlusal Caries: A Survey from the Danish Public Dental Health Service. (United States)

    Carvalho, Joana Christina; Qvist, Vibeke; Aimée, Nicole R; Mestrinho, Heliana D; Bakhshandeh, Azam


    This study validates a case-based survey method and analyzes the extent to which Danish dental professionals apply current concepts and strategies for occlusal caries management in children, adolescents, and young adults. A case-based, precoded questionnaire consisting of 10 clinical cases/patients with 26 teeth/occlusal surfaces was developed. The cases were set up in a PowerPoint presentation and color printed as a booklet illustrating patients with different patterns of caries activity, severity, and risk. A total of 69 dental professionals participated. Content and face validity of the survey method was established using a panel of experts. The panel also assessed the reliability of the method using a test-retest procedure (κ ≥ 0.80) and acting as benchmark. Measurements of agreement between dental professional and benchmark assessments showed substantial agreement for overall caries activity and risk assessment of patients and for clinical and radiographic severity of occlusal lesions (κ = 0.61-0.67). For assessment of caries lesion activity on occlusal surfaces, the agreement was moderate (κ = 0.50). Regarding treatment decisions, dental professionals showed substantial agreement when indicating restorative treatments (κ = 0.68). Multivariate logistic regression analysis showed a significant influence of various patient-, lesion-, and participant-related variables in the assessment of caries risk, caries activity and severity, and treatment decision. In conclusion, Danish dental professionals participating in the study apply reasonably well current concepts on overall caries activity and risk assessment, clinical and radiographic severity of occlusal lesions, and, to a certain extent, assessment of caries lesion activity on occlusal surfaces. Nonoperative treatment decisions had a high priority among Danish professionals. © 2017 S. Karger AG, Basel.

  4. Guidance for treatment of variability and uncertainty in ecological risk assessments of contaminated sites

    Energy Technology Data Exchange (ETDEWEB)



    Uncertainty is a seemingly simple concept that has caused great confusion and conflict in the field of risk assessment. This report offers guidance for the analysis and presentation of variability and uncertainty in ecological risk assessments, an important issue in the remedial investigation and feasibility study processes. This report discusses concepts of probability in terms of variance and uncertainty, describes how these concepts differ in ecological risk assessment from human health risk assessment, and describes probabilistic aspects of specific ecological risk assessment techniques. The report ends with 17 points to consider in performing an uncertainty analysis for an ecological risk assessment of a contaminated site.

  5. Assessment and treatment of hepatitis C virus infection among people who inject drugs in the opioid substitution setting: ETHOS study. (United States)

    Alavi, Maryam; Grebely, Jason; Micallef, Michelle; Dunlop, Adrian J; Balcomb, Annie C; Day, Carolyn A; Treloar, Carla; Bath, Nicky; Haber, Paul S; Dore, Gregory J


    Access to hepatitis C virus (HCV) treatment remains extremely limited among people who inject drugs (PWID). HCV assessment and treatment was evaluated through an innovative model for the provision of HCV care among PWID with chronic HCV infection. Enhancing Treatment for Hepatitis C in Opioid Substitution Settings (ETHOS) was a prospective observational cohort. Recruitment was through 5 opioid substitution treatment (OST) clinics, 2 community health centers, and 1 Aboriginal community controlled health organization in New South Wales, Australia. Among 387 enrolled participants, mean age was 41 years, 71% were male, and 15% were of Aboriginal ethnicity. Specialist assessment was undertaken in 191 (49%) participants, and 84 (22%) commenced interferon-based treatment. In adjusted analysis, HCV specialist assessment was associated with non-Aboriginal ethnicity (adjusted odds ratio [AOR], 4.02; 95% confidence interval [CI], 2.05-7.90), no recent benzodiazepine use (AOR, 2.06; 95% CI, 1.31-3.24), and non-1 HCV genotype (AOR, 2.13; 95% CI, 1.32-3.43). In adjusted analysis, HCV treatment was associated with non-Aboriginal ethnicity (AOR, 4.59; 95% CI, 1.49-14.12), living with the support of family and/or friends (AOR, 2.15; 95% CI, 1.25-3.71), never receiving OST (AOR, 4.40; 95% CI, 2.27-8.54), no recent methamphetamine use (AOR, 2.26; 95% CI, 1.12-4.57), and non-1 HCV genotype (AOR, 3.07; 95% CI, 1.67-5.64). HCV treatment uptake was relatively high among this highly marginalized population of PWID. Potentially modifiable factors associated with treatment include drug use and social support.

  6. Effect of a perspective-taking intervention on the consideration of pain assessment and treatment decisions. (United States)

    Wandner, Laura D; Torres, Calia A; Bartley, Emily J; George, Steven Z; Robinson, Michael E


    Pain is often poorly managed, highlighting the need to better understand and treat patients' pain. Research suggests that pain is assessed and treated differently depending on patient sex, race, and/or age. Perspective-taking, whereby one envisions the perspective of another, has been found to reduce racial disparities in pain management. This study used virtual human (VH) technology to examine whether a perspective-taking intervention impacts pain management decisions. Ninety-six participants were randomized to an online treatment or control group and viewed 16 video clips of VHs with standardized levels of pain. Participants provided ratings on the VHs' pain intensity and their willingness to administer opioids to them. The intervention group received a brief perspective-taking intervention that consisted of having participants imagine how the patient's suffering could affect his/her life, whereas the control group was asked to wait for the next VH videos to load. A LENS model analysis was used to investigate both group level (nomothetic) and individual level (idiographic) decision policies. A LENS model of analysis is typically used as an analog method for capturing how groups of people and individuals use information in their environment to form judgments. Nomothetic results found that participants rated pain higher and were more likely to prescribe opioids to VHs postintervention, irrespective of group. Idiographic results, however, found that the use of cues to make pain management decisions was mitigated by the perspective-taking group. The participants in the perspective-taking group were more likely to think about pain and the patients' perspective during the intervention, while control participants were more likely to reflect on the VHs' sex, race, or age. A brief intervention may alter participants' pain management decisions. These results indicate that a brief intervention might be an initial step toward aligning observers' pain management ratings with

  7. Review of Childhood Obesity: From Epidemiology, Etiology, and Comorbidities to Clinical Assessment and Treatment. (United States)

    Kumar, Seema; Kelly, Aaron S


    Childhood obesity has emerged as an important public health problem in the United States and other countries in the world. Currently 1 in 3 children in the United States is afflicted with overweight or obesity. The increasing prevalence of childhood obesity is associated with emergence of comorbidities previously considered to be "adult" diseases including type 2 diabetes mellitus, hypertension, nonalcoholic fatty liver disease, obstructive sleep apnea, and dyslipidemia. The most common cause of obesity in children is a positive energy balance due to caloric intake in excess of caloric expenditure combined with a genetic predisposition for weight gain. Most obese children do not have an underlying endocrine or single genetic cause for their weight gain. Evaluation of children with obesity is aimed at determining the cause of weight gain and assessing for comorbidities resulting from excess weight. Family-based lifestyle interventions, including dietary modifications and increased physical activity, are the cornerstone of weight management in children. A staged approach to pediatric weight management is recommended with consideration of the age of the child, severity of obesity, and presence of obesity-related comorbidities in determining the initial stage of treatment. Lifestyle interventions have shown only modest effect on weight loss, particularly in children with severe obesity. There is limited information on the efficacy and safety of medications for weight loss in children. Bariatric surgery has been found to be effective in decreasing excess weight and improving comorbidities in adolescents with severe obesity. However, there are limited data on the long-term efficacy and safety of bariatric surgery in adolescents. For this comprehensive review, the literature was scanned from 1994 to 2016 using PubMed using the following search terms: childhood obesity, pediatric obesity, childhood overweight, bariatric surgery, and adolescents. Copyright © 2016 Mayo

  8. Statistical Assessment of Proton Treatment Plans Under Setup and Range Uncertainties

    Energy Technology Data Exchange (ETDEWEB)

    Park, Peter C.; Cheung, Joey P.; Zhu, X. Ronald [Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Lee, Andrew K. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Sahoo, Narayan [Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Tucker, Susan L. [Department of Bioinformatics and Computational Biology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Liu, Wei; Li, Heng; Mohan, Radhe; Court, Laurence E. [Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Dong, Lei, E-mail: [Scripps Proton Therapy Center, San Diego, California (United States)


    Purpose: To evaluate a method for quantifying the effect of setup errors and range uncertainties on dose distribution and dose–volume histogram using statistical parameters; and to assess existing planning practice in selected treatment sites under setup and range uncertainties. Methods and Materials: Twenty passively scattered proton lung cancer plans, 10 prostate, and 1 brain cancer scanning-beam proton plan(s) were analyzed. To account for the dose under uncertainties, we performed a comprehensive simulation in which the dose was recalculated 600 times per given plan under the influence of random and systematic setup errors and proton range errors. On the basis of simulation results, we determined the probability of dose variations and calculated the expected values and standard deviations of dose–volume histograms. The uncertainties in dose were spatially visualized on the planning CT as a probability map of failure to target coverage or overdose of critical structures. Results: The expected value of target coverage under the uncertainties was consistently lower than that of the nominal value determined from the clinical target volume coverage without setup error or range uncertainty, with a mean difference of −1.1% (−0.9% for breath-hold), −0.3%, and −2.2% for lung, prostate, and a brain cases, respectively. The organs with most sensitive dose under uncertainties were esophagus and spinal cord for lung, rectum for prostate, and brain stem for brain cancer. Conclusions: A clinically feasible robustness plan analysis tool based on direct dose calculation and statistical simulation has been developed. Both the expectation value and standard deviation are useful to evaluate the impact of uncertainties. The existing proton beam planning method used in this institution seems to be adequate in terms of target coverage. However, structures that are small in volume or located near the target area showed greater sensitivity to uncertainties.

  9. Objective Assessment of Vergence after Treatment of Concussion-Related CI: A Pilot Study. (United States)

    Scheiman, Mitchell M; Talasan, Henry; Mitchell, G Lynn; Alvarez, Tara L


    To evaluate changes in objective measures of disparity vergence after office-based vision therapy (OBVT) for concussion-related convergence insufficiency (CI) and determine the feasibility of using this objective assessment as an outcome measure in a clinical trial. This was a prospective, observational trial. All participants were treated with weekly OBVT with home reinforcement. Participants included two adolescents and three young adults with concussion-related, symptomatic CI. The primary outcome measure was average peak velocity for 4° symmetrical convergence steps. Other objective outcome measures of disparity vergence included time to peak velocity, latency, accuracy, settling time, and main sequence. We also evaluated saccadic eye movements using the same outcome measures. Changes in clinical measures (near point of convergence, positive fusional vergence at near, Convergence Insufficiency Symptom Survey [CISS] score) were evaluated. There were statistically significant and clinically meaningful changes in all clinical measures for convergence. Four of the five subjects met clinical success criteria. For the objective measures, we found a statistically significant increase in peak velocity, response accuracy to 4° symmetrical convergence and divergence step stimuli, and the main sequence ratio for convergence step stimuli. Objective saccadic eye movements (5 and 10°) appeared normal pre-OBVT and did not show any significant change after treatment. This is the first report of the use of objective measures of disparity vergence as outcome measures for concussion-related convergence insufficiency. These measures provide additional information that is not accessible with clinical tests about underlying physiological mechanisms leading to changes in clinical findings and symptoms. The study results also demonstrate that patients with concussion can tolerate the visual demands (over 200 vergence and versional eye movements) during the 25-minute testing time

  10. Evaluation of quantitative PCR combined with PMA treatment for molecular assessment of microbial water quality. (United States)

    Gensberger, Eva Theres; Polt, Marlies; Konrad-Köszler, Marianne; Kinner, Paul; Sessitsch, Angela; Kostić, Tanja


    Microbial water quality assessment currently relies on cultivation-based methods. Nucleic acid-based techniques such as quantitative PCR (qPCR) enable more rapid and specific detection of target organisms and propidium monoazide (PMA) treatment facilitates the exclusion of false positive results caused by DNA from dead cells. Established molecular assays (qPCR and PMA-qPCR) for legally defined microbial quality parameters (Escherichia coli, Enterococcus spp. and Pseudomonas aeruginosa) and indicator organism group of coliforms (implemented on the molecular detection of Enterobacteriaceae) were comparatively evaluated to conventional microbiological methods. The evaluation of an extended set of drinking and process water samples showed that PMA-qPCR for E. coli, Enterococcus spp. and P. aeruginosa resulted in higher specificity because substantial or complete reduction of false positive signals in comparison to qPCR were obtained. Complete compliance to reference method was achieved for E. coli PMA-qPCR and 100% specificity for Enterococcus spp. and P. aeruginosa in the evaluation of process water samples. A major challenge remained in sensitivity of the assays, exhibited through false negative results (7-23%), which is presumably due to insufficient sample preparation (i.e. concentration of bacteria and DNA extraction), rather than the qPCR limit of detection. For the detection of the indicator group of coliforms, the evaluation study revealed that the utilization of alternative molecular assays based on the taxonomic group of Enterobacteriaceae was not adequate. Given the careful optimization of the sensitivity, the highly specific PMA-qPCR could be a valuable tool for rapid detection of hygienic parameters such as E. coli, Enterococcus spp. and P. aeruginosa. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. The FORECAST study - Focal recurrent assessment and salvage treatment for radiorecurrent prostate cancer. (United States)

    Kanthabalan, A; Shah, T; Arya, M; Punwani, S; Bomanji, J; Haroon, A; Illing, R O; Latifoltojar, A; Freeman, A; Jameson, C; van der Meulen, J; Charman, S; Emberton, M; Ahmed, H U


    One-third of men may experience biochemical failure by 8years following radical radiotherapy for localised prostate cancer. Over 90% of men are started on androgen deprivation therapy (ADT) which is non-curative and confers systemic side-effects. Focal salvage therapy (FST) limits collateral tissue damage and may improve therapeutic ratios. In order to deliver FST, distant disease must be ruled-out and intra-prostatic disease must be accurately detected, localised and characterised. FORECAST - Focal Recurrent Assessment and Salvage Treatment - is a study designed to evaluate a novel imaging-based diagnostic and therapeutic complex intervention pathway for men who fail radiotherapy. Men with biochemical failure following radical prostate radiotherapy, prior to salvage therapy will be recruited. They will undergo whole-body multi-parametric MRI (WB-MRI), choline PET/CT, bone-scan and pelvic-mpMRI and then MRI transperineal-targeted biopsies (MRI-TB) and Transperineal Template Prostate Mapping Biopsy (TPM). Those suitable for FST will undergo either high intensity focused ultrasound (HIFU) or cryotherapy. Primary outcome measures: a) the accuracy of WB-MRI to detect distant metastatic disease; b) accuracy of prostate mpMRI in local detection of radiorecurrent prostate cancer; c) detection accuracy of MRI-TB; and d) rate of urinary incontinence following FST. Focal salvage therapy may confer lower rates of morbidity whilst retaining disease control. In order to deliver FST, intra- and extra-prostatic disease must be detected early and localised accurately. Novel diagnostic techniques including WB-MRI and MRI-TB may improve the detection of distant and local disease whilst reducing healthcare burdens compared with current imaging and biopsy strategies. Copyright © 2015. Published by Elsevier Inc.

  12. Assessment of soil ecosystem in degraded areas of vineyards after organic treatments (United States)

    Landi, Silvia; D'Errico, Giada; Gagnarli, Elena; Simoni, Sauro; Goggioli, Donatella; Guidi, Silvia; D'Avino, Lorenzo; Lagomarsino, Alessandra; Valboa, Giuseppe; Castaldini, Maurizio; Elio Agnelli, Alessandro; Fantappiè, Maria; Lorenzetti, Romina; Priori, Simone; Costantini, Edoardo A. C.


    In Italian vineyards, it is quite common to have areas characterized by problems in vine health, grape production and quality, often caused by improper land preparation before vine plantation and/or management. Causes for soil malfunctioning can include reduced contribution of the soil fauna to the ecosystem services such as nutrient cycles and organic matter turnover. ReSolVe is a transnational and interdisciplinary project, supported by Core-Organic+ program, aimed at testing the effects of selective agronomic strategies for restoring optimal soil functionality in degraded areas within organic vineyard. For this purpose, the evaluation and biomonitoring of the abundance of soil mesofauna, nematodes and microarthropods, represents an efficient tool to characterize the effects of crop management on soil quality. Assessing enzyme activities involved in the main biogeochemical cycling of C, N, P and S can also provide indication of soil functions and health status. Italian experimental plots are situated in two commercial farms in Tuscany: i) Fontodi, Panzano in Chianti (FI), which has been managed organically for more than 20 years and ii) San Disdagio, Roccastrada (GR), under organic farming since 2014. In each farm, three plots (250 m2 each) in the degraded areas and three relative control plots in the non-degraded areas were selected. The different restoring strategies implemented in each area were: i) compost, produced on farm by manure + pruning residue + grass, ii) faba bean and winter barley green manure, iii) dry mulching after sowing with Trifolium squarrosum L. Each treated and control plot has been studied for soil nematodes, microarthropods, enzymatic activity, and organic matter turnover using tea-bag index, as well as total organic carbon (TOC) and total nitrogen (TN). Soil sampling was carried out to 0-30 cm depth for TOC, TN, enzymes and nematodes and to 10 cm for microarthropods. Tea-bag index was determined following the Keuskamp et al. method


    Energy Technology Data Exchange (ETDEWEB)



    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

  14. An In-Depth Survey of the Screening and Assessment Practices of Highly Regarded Adolescent Substance Abuse Treatment Programs (United States)

    Gans, Jeremy; Falco, Mathea; Schackman, Bruce R.; Winters, Ken C.


    Aims: To examine the quality of screening and assessment practices at some of the most highly regarded adolescent substance use treatment programs in the United States. Methods: Between March and September 2005, telephone surveys were administered to directors of highly regarded programs. Several different publications and databases were then used…

  15. From Custody to Community: Development of Assessment and Treatment for Juveniles Serving Sentences for Sex Offences in an Irish Context (United States)

    Slattery, Peter; Cherry, Joan; Swift, Aaron; Tallon, Mary; Doyle, Ian


    The Baseline Project provided an assessment package and treatment for juveniles (aged 16-21 years) serving sentences for sexual offences, and was the only such programme available in Ireland (ROI). It was a venture between the Northside Inter-Agency Project and the Psychology Department of the Irish Prison Service and worked with juveniles on a…

  16. Assessment and Treatment of Cognition and Communication Skills in Adults With Acquired Brain Injury via Telepractice: A Systematic Review. (United States)

    Coleman, Jaumeiko J; Frymark, Tobi; Franceschini, Nicole M; Theodoros, Deborah G


    This is a systematic review of assessment and treatment of cognitive and communicative abilities of individuals with acquired brain injury via telepractice versus in person. The a priori clinical questions were informed by previous research that highlights the importance of considering any functional implications of outcomes, determining disorder- and setting-specific concerns, and measuring the potential impact of diagnostic accuracy and treatment efficacy data on interpretation of findings. A literature search of multiple databases (e.g., PubMed) was conducted using key words and study inclusion criteria associated with the clinical questions. Ten group studies were accepted that addressed assessment of motor speech, language, and cognitive impairments; assessment of motor speech and language activity limitations/participation restrictions; and treatment of cognitive impairments and activity limitations/participation restrictions. In most cases, equivalence of outcomes was noted across service delivery methods. Limited findings, lack of diagnostic accuracy and treatment efficacy data, and heterogeneity of assessments and interventions precluded robust evaluation of clinical implications for telepractice equivalence and the broader area of telepractice efficacy. Future research is needed that will build upon current knowledge through replication. In addition, further evaluation at the impairment and activity limitation/participation restriction levels is needed.

  17. The School Psychologist's Primer on Childhood Depression: A Review of Research Regarding Epidemiology, Etiology, Assessment, and Treatment (United States)

    Ruderman, Matthew A.; Stifel, Skye W. F.; O'Malley, Meagan; Jimerson, Shane R.


    The purpose of this article is to provide school psychologists with a synthesis of important information regarding the epidemiology, etiology, assessment, and treatment of childhood depression. A review of the recent research and relevant literature is summarized reflecting the contemporary knowledge regarding depression during childhood and…

  18. Radiofrequency thermal ablation of hepatocellular carcinoma: using contrast-enhanced harmonic power doppler sonography to assess treatment outcome. (United States)

    Cioni, D; Lencioni, R; Rossi, S; Garbagnati, F; Donati, F; Crocetti, L; Bartolozzi, C


    We evaluated the accuracy of contrast-enhanced harmonic power Doppler sonography in assessing the outcome of radiofrequency thermal ablation of hepatocellular carcinoma. Fifty patients with 65 hepatocellular carcinoma nodules (1-5 cm in diameter; mean diameter, 2.5 cm) were studied using unenhanced and contrast-enhanced harmonic power Doppler sonography before and after IV administration of a microbubble contrast agent. The examinations were repeated after treatment of the tumors with radiofrequency ablation. Findings of the Doppler studies were compared with those of dual-phase helical CT, which were used as points of reference for assessing treatment outcome. Before radiofrequency treatment, intratumoral blood flow was revealed by unenhanced power Doppler sonography in 48 (74%) of 65 hepatocellular carcinoma nodules. After injection of the contrast agent, intratumoral enhancement was observed in 61 (94%) of 65 hepatocellular carcinomas (p enhancement on power Doppler sonograms. In nine of the 10 lesions that showed a residual viable tumor on helical CT scans, persistent intratumoral enhancement-matching the enhancing areas on helical CT images-was revealed by power Doppler sonography. These nine hepatocellular carcinomas were subjected to repeated radiofrequency thermal ablation with the guidance of contrast-enhanced power Doppler sonography. Complete necrosis was seen after the second treatment session in six of the nine lesions. Contrast-enhanced harmonic power Doppler sonography is an accurate technique for assessing the outcome of radiofrequency thermal ablation of hepatocellular carcinoma and may be useful in guiding additional treatment in patients with incomplete response to initial efforts.

  19. Dental anxiety among adult patients and its correlation with self-assessed dental status and treatment needs. (United States)

    Syed, Shahbano; Bilal, Sobia; Dawani, Narendar; Rizvi, Kulsoom


    To evaluate the dental anxiety levels and to assess its correlation with self-assessed dental status and treatment needs of patients. The study was conducted at the Out Patient Department of Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Karachi. Using non-probability quota sampling, the study included the first 32 patients between 18 and 35 years of age, visiting the facility. Over a period of one month (22 working days) 704 patients comprised the study population. They were interviewed using a structured questionnaire to self-assess their dental anxiety levels, oral health status and treatment needs. The data was analysed using SPSS 17.0 with descriptive frequencies and chi-square test. Of the total participants, 650 (92.32%) patients provided consent. Average dental anxiety scale score was 12.46, representing high anxiety score. There were 174 (26.8%) smokers; only 234 (36%) had visited a dentist less than a year ago; 385 (59.2%) considered their dental health to be satisfactory; 306 (47.1%) thought of their treatment needs to be 'little'; 222 (34.2%) brushed their teeth twice daily. Dental anxiety was statistically significant with treatment needs and dental status. Relation of tooth-brushing with last dental visit and treatment needs was also found to be significant. A high level of dental anxiety was observed among the study population. The dental professionals should seek ways to help dentally anxious individuals.

  20. Non-pharmacological management of primary and secondary insomnia among older people: review of assessment tools and treatments. (United States)

    Petit, Lyndal; Azad, Nahid; Byszewski, Anna; Sarazan, Francine F-A; Power, Barbara


    primary and secondary insomnia, especially among older adults, is frequently encountered by family physicians. Pharmacological interventions, although effective in some circumstances, can be detrimental in others. Non-pharmacological management of insomnia may allow the patients to self-administer the treatment. review of published literature of assessment tools and treatments for primary and secondary insomnia. two frequently used self-reporting methods for obtaining sleep data are sleep diaries and Pittsburg Sleep Quality Index. A large amount of research supports the use of non-pharmacological treatments such as stimulus control, sleep restriction, sleep hygiene education, cognitive therapy, multi-component therapy and paradoxical intention. assessing the nature of insomnia by using an effective assessment tool and providing patients with a non-pharmacological treatment should be the first intervention for insomnia. It is shown that non-pharmacological treatments for primary and secondary insomnia are feasible and effective alternatives to the use of benzodiazepines, and that family physicians should consider these when managing older patients with insomnia.

  1. Initial assessment and treatment of refugees in the Mediterranean Sea (a secondary data analysis concerning the initial assessment and treatment of 2656 refugees rescued from distress at sea in support of the EUNAVFOR MED relief mission of the EU). (United States)

    Kulla, M; Josse, F; Stierholz, M; Hossfeld, B; Lampl, L; Helm, M


    As a part of the European Union Naval Force - Mediterranean Operation Sophia (EUNAVFOR Med), the Federal Republic of Germany is contributing to avoid further loss of lives at sea by supplying two naval vessels. In the study presented here we analyse the medical requirements of such rescue missions, as well as the potential benefits of various additional monitoring devices in identifying sick/injured refugees within the primary onboard medical assessment process. Retrospective analysis of the data collected between May - September 2015 from a German Naval Force frigate. Initial data collection focused on the primary medical assessment and treatment process of refugees rescued from distress at sea. Descriptive statistics, uni- and multivariate analysis were performed. The study has received a positive vote from the Ethics Commission of the University of Ulm, Germany (request no. 284/15) and has been registered in the German Register of Clinical Studies (no. DRKS00009535). A total of 2656 refugees had been rescued. 16.9 % of them were classified as "medical treatment required" within the initial onboard medical assessment process. In addition to the clinical assessment by an emergency physician, pulse rate (PR), core body temperature (CBT) and oxygen saturation (SpO2) were evaluated. Sick/injured refugees displayed a statistically significant higher PR (114/min vs. 107/min; p refugee boats. A cut-off value of clinical importance could not be found. Predominant diagnoses have been dermatological diseases (55.4), followed by internal diseases (27.7) and trauma (12.1 %). None of the refugees classified as "healthy" within the primary medical assessment process changed to "medical treatment required" during further observation. The initial medical assessment by an emergency physician has proved successful. PR, CBT and SpO2 didn't have any clinical impact to improve the identification of sick/injured refugees within the primary onboard assessment process.

  2. Weighing environmental advantages and disadvantages of advanced wastewater treatment of micro-pollutants using environmental life cycle assessment

    DEFF Research Database (Denmark)

    Wenzel, Henrik; Larsen, Henrik Fred; Clauson-Kaas, Jes


    Much research and development effort is directed towards advances in municipal wastewater treatment aiming at reducing the effluent content of micro-pollutants and pathogens. The objective is to further reduce the eco-toxicity, hormone effects and pathogenic effects of the effluent. Such further...... polishing of the effluent, however, involves an environmental trade-off: the reduction in eco-toxicity, hormone effects, etc. will happen at the expense of increased resource- and energy consumption. Obviously, at some point of further advances, there must be an ‘environmental break-even'. This trade......-off was investigated using Life Cycle Assessment (LCA) methodology and based on a literature review of advanced treatment performance. The LCA evaluation comprised sand filtration, ozonation and MBRs and assessed the effect of extending existing tertiary treatment with these technologies on a variety of micro-pollutants...

  3. Virtual reality in the assessment and treatment of psychosis: a systematic review of its utility, acceptability and effectiveness. (United States)

    Rus-Calafell, M; Garety, P; Sason, E; Craig, T J K; Valmaggia, L R


    Over the last two decades, there has been a rapid increase of studies testing the efficacy and acceptability of virtual reality in the assessment and treatment of mental health problems. This systematic review was carried out to investigate the use of virtual reality in the assessment and the treatment of psychosis. Web of Science, PsychInfo, EMBASE, Scopus, ProQuest and PubMed databases were searched, resulting in the identification of 638 articles potentially eligible for inclusion; of these, 50 studies were included in the review. The main fields of research in virtual reality and psychosis are: safety and acceptability of the technology; neurocognitive evaluation; functional capacity and performance evaluation; assessment of paranoid ideation and auditory hallucinations; and interventions. The studies reviewed indicate that virtual reality offers a valuable method of assessing the presence of symptoms in ecologically valid environments, with the potential to facilitate learning new emotional and behavioural responses. Virtual reality is a promising method to be used in the assessment of neurocognitive deficits and the study of relevant clinical symptoms. Furthermore, preliminary findings suggest that it can be applied to the delivery of cognitive rehabilitation, social skills training interventions and virtual reality-assisted therapies for psychosis. The potential benefits for enhancing treatment are highlighted. Recommendations for future research include demonstrating generalisability to real-life settings, examining potential negative effects, larger sample sizes and long-term follow-up studies. The present review has been registered in the PROSPERO register: CDR 4201507776.

  4. Using Descriptive Assessment in the Treatment of Bite Acceptance and Food Refusal (United States)

    Casey, Sean D.; Perrin, Christopher J.; Lesser, Aaron D.; Perrin, Stefanie H.; Casey, Cheryl L.; Reed, Gregory K.


    The feeding behaviors of two children who maintained failure to thrive diagnoses and displayed food refusal are assessed in their homes. Descriptive assessments are used to identify schedules of consequence provided by each child's care providers for bite acceptance and food refusal behaviors. Assessments reveal rich schedules of praise and access…

  5. Evidence-Based Assessment of Child Obsessive Compulsive Disorder: Recommendations for Clinical Practice and Treatment Research (United States)

    Lewin, Adam B.; Piacentini, John


    Obsessive-compulsive disorder (OCD) presents heterogeneously and can be difficult to assess in youth. This review focuses on research-supported assessment approaches for OCD in childhood. Content areas include pre-visit screening, diagnostic establishment, differential diagnosis, assessment of comorbid psychiatric conditions, tracking symptom…

  6. Physiotherapy in hip and knee osteoarthritis: development of a practice guideline concerning initial assessment, treatment and evaluation. (United States)

    Peter, W F; Jansen, M J; Hurkmans, E J; Bloo, H; Dekker, J; Dilling, R G; Hilberdink, W; Kersten-Smit, C; de Rooij, M; Veenhof, C; Vermeulen, H M; de Vos, R J; Schoones, J W; Vliet Vlieland, T P


    An update of a Dutch physiotherapy practice guideline in Hip and Knee Osteoarthritis (HKOA) was made, based on current evidence and best practice. A guideline steering committee, comprising 10 expert physiotherapists, selected topics concerning the guideline chapters: initial assessment, treatment and evaluation. With respect to treatment a systematic literature search was performed using various databases, and the evidence was graded (1-4). For the initial assessment and evaluation mainly review papers and textbooks were used. Based on evidence and expert opinion, recommendations were formulated. A first draft of the guideline was reviewed by 17 experts from different professional backgrounds. A second draft was field-tested by 45 physiotherapists. In total 11 topics were selected. For the initial assessment, three recommendations were formulated, pertaining to history taking, red flags, and formulating treatment goals. Concerning treatment, 7 recommendations were formulated; (supervised) exercise therapy, education and self management interventions, a combination of exercise and manual therapy, postoperative exercise therapy and taping of the patella were recommended. Balneotherapy and hydrotherapy in HKOA, and thermotherapy, TENS, and Continuous Passive Motion in knee OA were neither recommended nor discouraged. Massage therapy, ultrasound, electrotherapy, electromagnetic field, Low Level Laser Therapy, preoperative physiotherapy and education could not be recommended. For the evaluation of treatment goals the following measurement instruments were recommended: Lequesne index, Western Ontario and McMaster Universities osteoarthritis index, Hip disability and Osteoarthritis Outcome Score and Knee injury and Osteoarthritis Outcome Score, 6-minute walktest, Timed Up and Go test, Patient Specific Complaint list, Visual Analoge Scale for pain, Intermittent and Constant OsteoArthritis Pain Questionnaire, goniometry, Medical Research Council for strength, handheld

  7. Assessment of a sewage sludge treatment on cadmium, copper and zinc bioavailability in barley, ryegrass and earthworms

    Energy Technology Data Exchange (ETDEWEB)

    Renoux, Agnes Y. [Sanexen Environmental Services Inc., 1471 Lionel-Boulet Boulevard, Varennes, Quebec J3X 1P7 (Canada)]. E-mail:; Rocheleau, Sylvie [Biotechnology Research Institute, National Research Council of Canada, 6100 Royalmount Avenue, Montreal, Quebec H4P 2R2 (Canada); Sarrazin, Manon [Biotechnology Research Institute, National Research Council of Canada, 6100 Royalmount Avenue, Montreal, Quebec H4P 2R2 (Canada); Sunahara, Geoffrey I. [Biotechnology Research Institute, National Research Council of Canada, 6100 Royalmount Avenue, Montreal, Quebec H4P 2R2 (Canada)]. E-mail:; Blais, Jean-Francois [Institut national de la recherche scientifique (INRS-ETE), Centre Eau, Terre et Environnement, 490 rue de la Couronne street, Quebec, Quebec G1K 9A9 (Canada)]. E-mail:


    The toxicity and bioavailability of metals were assessed to verify the efficiency of a new chemical leaching process (METIX-AC) to minimize the risk of metals found in municipal sewage sludge. For this purpose, sludge samples were spiked with cadmium, copper and/or zinc before being treated using METIX-AC. The sludge decontamination resulted in a removal of spiked metals (79-89%), in a decrease of the more labile fractions, and in a corresponding increase of the residual fraction. The toxicity observed after exposure of two plant species, barley (Hordeum vulgare) and ryegrass (Lolium perenne), and a terrestrial invertebrate, Eisenia andrei, to sludge-soil mixtures, disappeared after treatment, although the adverse effects were minor before treatment. The sludge treatment also significantly decreased the bioaccumulation of cadmium, copper, and zinc in the exposed species. For cadmium, maximum tissue concentrations of 0.45 {+-} 0.08 mg/kg in barley, 0.79 {+-} 0.27 mg/kg in ryegrass, and 21.82 {+-} 1.85 mg/kg in earthworm exposed to sludge before treatment decreased after treatment to values similar to those observed with negative controls. - Assessment of a sewage sludge treatment on metal bioavailability as measured by metal speciation, toxicity and bioaccumulation.

  8. Trauma-related dissociative (conversion) disorders in children and adolescents--an overview of assessment tools and treatment principles. (United States)

    Diseth, Trond H; Christie, Helen J


    A high proportion of patients in child and adolescent psychiatry with significant dissociative symptomatology after early childhood traumatization may go undiagnosed, be wrongly diagnosed and/or inappropriately treated. The diagnostics and treatment of dissociative disorders have been limited by lack of comprehensive, reliable and valid instruments and the ongoing polarization and fierce controversy regarding treatment. However, recent neurobiological findings of neurochemical, functional and structural cerebral consequences of early stressful childhood experiences point out a need for active, early and effective identification and treatment interventions. We present an update on assessment tools available in the Nordic countries, and an overview of different appropriate therapeutic intervention models for children and adolescents. A systematic overview of studies of dissociation in children and adolescent published over the last decade disclosed a total of 1019 references. The 465 papers describing aspects of assessment tools and/or treatment were studied in detail. Reliable and valid screening questionnaires and diagnostic interviews for children and adolescents now allow for effective early identification of dissociative disorders. A combination of individual psychotherapy, pharmacotherapy and family therapy are often required to handle dissociative disorders in children and adolescents. Cognitive-behavioural therapy, hypnotherapy, Eye-Movement Desensitization-Reprocessing (EMDR), psychodynamic therapy and an integrated approach are the main described psychotherapeutic approaches, but treatment of dissociation in children and adolescent does not require allegiance to any one particular treatment model. However, achievement of physical safety by providing a safe environment is a primary goal that supersedes any other therapeutic work. Assessments tools are now available, and appropriate therapeutic intervention models may hopefully contribute to reduce the risk

  9. Effects of Heat-treatments on the Mechanical Strength of Coated YSZ: An Experimental Assessment

    DEFF Research Database (Denmark)

    Toftegaard, Helmuth Langmaack; Sørensen, Bent F.; Linderoth, Søren


    The mechanical strength of thin, symmetric sandwich specimens consisting of a dense yttria-stabilized zirconia (YSZ) substrate coated with a porous NiO–YSZ layer at both major faces was investigated. Specimens were loaded in uniaxial tension to failure following heat treatments at various...... temperatures. In comparison with the YSZ material, the failure strength of coated specimens was found to increase for heat treatments at 1100°C, but decreased again with further increased heat-treatment temperatures....

  10. Assessment of coercive and noncoercive pressures to enter drug abuse treatment. (United States)

    Marlowe, D B; Kirby, K C; Bonieskie, L M; Glass, D J; Dodds, L D; Husband, S D; Platt, J J; Festinger, D S


    This paper reports preliminary data derived from a standardized interview scoring procedure for detecting and characterizing coercive and noncoercive pressures to enter substance abuse treatment. Coercive and noncoercive pressures stemming from multiple psychosocial domains are operationalized through recourse to established behavioral principles. Inter-rater reliability for the scoring procedure was exceptional over numerous rater trials. Substantive analyses indicate that, among clients in outpatient cocaine treatment, 'coercion' is operative in multiple psychosocial domains, and that subjects perceive legal pressures as exerting substantially less influence over their decisions to enter treatment than informal psychosocial pressures. Implications for drug treatment planning, legal and ethical issues, and directions for future research are proposed.

  11. Assessment

    National Research Council Canada - National Science Library

    Gehan Elassal; Mona Elsheikh; Abdel Gawad Abu Zeid


    .... Subjects and methods: 80 COPD patients were assessed using SCID for establishing psychiatric diagnosis, Beck depression inventory for assessment of the severity of depressive symptoms, Hamilton anxiety scale...

  12. Environmental assessment of nutrient recycling from biological pig slurry treatment--impact of fertilizer substitution and field emissions. (United States)

    Brockmann, Doris; Hanhoun, Mary; Négri, Ophélie; Hélias, Arnaud


    Pig slurry treatment is an important means in reducing nitrogen loads applied to farmland. Solid phase separation prior to biological treatment further allows for recovering phosphorus with the solid phase. The organic residues from the pig slurry treatment