WorldWideScience

Sample records for call trial impact

  1. Study protocol of the YOU CALL - WE CALL TRIAL: impact of a multimodal support intervention after a "mild" stroke

    Directory of Open Access Journals (Sweden)

    Bravo Gina

    2010-01-01

    Full Text Available Abstract Background More than 60% of new strokes each year are "mild" in severity and this proportion is expected to rise in the years to come. Within our current health care system those with "mild" stroke are typically discharged home within days, without further referral to health or rehabilitation services other than advice to see their family physician. Those with mild stroke often have limited access to support from health professionals with stroke-specific knowledge who would typically provide critical information on topics such as secondary stroke prevention, community reintegration, medication counselling and problem solving with regard to specific concerns that arise. Isolation and lack of knowledge may lead to a worsening of health problems including stroke recurrence and unnecessary and costly health care utilization. The purpose of this study is to assess the effectiveness, for individuals who experience a first "mild" stroke, of a sustainable, low cost, multimodal support intervention (comprising information, education and telephone support - "WE CALL" compared to a passive intervention (providing the name and phone number of a resource person available if they feel the need to - "YOU CALL", on two primary outcomes: unplanned-use of health services for negative events and quality of life. Method/Design We will recruit 384 adults who meet inclusion criteria for a first mild stroke across six Canadian sites. Baseline measures will be taken within the first month after stroke onset. Participants will be stratified according to comorbidity level and randomised to one of two groups: YOU CALL or WE CALL. Both interventions will be offered over a six months period. Primary outcomes include unplanned use of heath services for negative event (frequency calendar and quality of life (EQ-5D and Quality of Life Index. Secondary outcomes include participation level (LIFE-H, depression (Beck Depression Inventory II and use of health services for

  2. Unscheduled Telephone Calls to Measure Percent Syllables Stuttered during Clinical Trials

    Science.gov (United States)

    Karimi, Hamid; O'Brian, Sue; Onslow, Mark; Jones, Mark; Menzies, Ross; Packman, Ann

    2013-01-01

    Purpose: Researchers have used unscheduled telephone calls for many years during clinical trials to measure adult stuttering severity before and after treatment. Because variability is a hallmark of stuttering severity with adults, it is questionable whether an unscheduled telephone call is truly representative of their everyday speech. Method:…

  3. Impact of Using CALL on Iranian EFL Learners' Vocabulary Knowledge

    Science.gov (United States)

    Yunus, Melor Md; Salehi, Hadi; Amini, Mahdi

    2016-01-01

    Computer Assisted Language Learning (CALL) integration in EFL contexts has intensified noticeably in recent years. This integration might be in different ways and for different purposes such as vocabulary acquisition, grammar learning, phonology, writing skills, etc. More explicitly, this study is an attempt to explore the effect of using CALL on…

  4. The Strategic Impact of Techno logy Based CRM on Call Centers’ Performance

    OpenAIRE

    Aliyu Olayemi Abdullateef; Sany Sanuri Mohd Mokhtar; Rushami Zien Yusoff

    2011-01-01

    The primary objective of this paper is to test a model that can explain the impact of technology based CRM on inbound call center performance. To do this, data were collected from 168 call center managers and analyzed through structural equation modeling. The research findings indicate that technology based CRM significantly a ffects first call resolution and perceived service quality, but weakly influence caller satisfactions through the mediating role of firs ...

  5. Standardizing in vitro diagnostics tasks in clinical trials: a call for action.

    Science.gov (United States)

    Lippi, Giuseppe; Simundic, Ana-Maria; Rodriguez-Manas, Leocadio; Bossuyt, Patrick; Banfi, Giuseppe

    2016-05-01

    Translational research is defined as the process of applying ideas, insights and discoveries generated through basic scientific inquiry to treatment or prevention of human diseases. Although precise information is lacking, several lines of evidence attest that up to 95% early-phase studies may not translate into tangible outcomes for improving clinical management. Major theoretical hurdles exist in the translational process, but is it also undeniable that many studies may have failed for practical reasons, such as the use of inappropriate diagnostic testing for evaluating efficacy, effectiveness or safety of a given medical intervention, or poor quality in laboratory testing. This can generate biased test results and result in misconceptions during data interpretation, eventually leading to no clinical benefit, possible harm, and a waste of valuable resources. From a genuine economic perspective, it can be estimated that over 10 million euros of funding may be lost each year in clinical trials in the European Union due to preanalytical and analytical problems. These are mostly attributions to the heterogeneity of current guidelines and recommendations for the testing process, to the poor evidence base for basic pre-analytical, analytical and post-analytical requirements in clinical trials, and to the failure to thoughtfully integrate the perspectives of clinicians, patients, nurses and diagnostic companies in laboratory best practices. The most rational means for filling the gap between what we know and what we practice in clinical trials cannot discount the development of multidisciplinary teams including research scientists, clinicians, nurses, patients associations and representative of in vitro diagnostic (IVD) companies, who should actively interplay and collaborate with laboratory professionals to adapt and disseminate evidence-based recommendations about biospecimen collection and management into the research settings, from preclinical to phase III studies

  6. Standardizing in vitro diagnostics tasks in clinical trials: a call for action

    Science.gov (United States)

    Simundic, Ana-Maria; Rodriguez-Manas, Leocadio; Bossuyt, Patrick; Banfi, Giuseppe

    2016-01-01

    Translational research is defined as the process of applying ideas, insights and discoveries generated through basic scientific inquiry to treatment or prevention of human diseases. Although precise information is lacking, several lines of evidence attest that up to 95% early-phase studies may not translate into tangible outcomes for improving clinical management. Major theoretical hurdles exist in the translational process, but is it also undeniable that many studies may have failed for practical reasons, such as the use of inappropriate diagnostic testing for evaluating efficacy, effectiveness or safety of a given medical intervention, or poor quality in laboratory testing. This can generate biased test results and result in misconceptions during data interpretation, eventually leading to no clinical benefit, possible harm, and a waste of valuable resources. From a genuine economic perspective, it can be estimated that over 10 million euros of funding may be lost each year in clinical trials in the European Union due to preanalytical and analytical problems. These are mostly attributions to the heterogeneity of current guidelines and recommendations for the testing process, to the poor evidence base for basic pre-analytical, analytical and post-analytical requirements in clinical trials, and to the failure to thoughtfully integrate the perspectives of clinicians, patients, nurses and diagnostic companies in laboratory best practices. The most rational means for filling the gap between what we know and what we practice in clinical trials cannot discount the development of multidisciplinary teams including research scientists, clinicians, nurses, patients associations and representative of in vitro diagnostic (IVD) companies, who should actively interplay and collaborate with laboratory professionals to adapt and disseminate evidence-based recommendations about biospecimen collection and management into the research settings, from preclinical to phase III studies.

  7. Virtual house calls for Parkinson disease (Connect.Parkinson): study protocol for a randomized, controlled trial

    OpenAIRE

    Achey, Meredith A; Beck, Christopher A.; Beran, Denise B.; Boyd, Cynthia M.; Schmidt, Peter N; Allison W Willis; Riggare, Sara S.; Simone, Richard B.; Biglan, Kevin M.; Dorsey, E. Ray

    2014-01-01

    Background Interest in improving care for the growing number of individuals with chronic conditions is rising. However, access to care is limited by distance, disability, and distribution of doctors. Small-scale studies in Parkinson disease, a prototypical chronic condition, have suggested that delivering care using video house calls is feasible, offers similar clinical outcomes to in-person care, and reduces travel burden. Methods/Design We are conducting a randomized comparative effectivene...

  8. Road Impacts on Abundance, Call Traits, and Body Size of Rainforest Frogs in Northeast Australia

    Directory of Open Access Journals (Sweden)

    Miriam W. Goosem

    2010-09-01

    Full Text Available Frogs are potentially sensitive indicators of road impacts, with studies indicating particular susceptibility to road mortality. Calling, i.e., breeding, behavior could also be affected by traffic noise. We investigated effects on frog abundance and calling behavior where a busy highway crosses rainforest stream breeding habitat in northeast Australia. Frog abundance was repeatedly surveyed along five stream transects during a summer breeding season. Abundance of two species, Litoria rheocola and Austrochaperina pluvialis, increased significantly with perpendicular distance from the road along two transects. No trends in abundance were detected for A. pluvialis on two other transects where it was common, or for Litoria serrata on one transect where abundance was sufficient for analysis. Both species with lowered abundance near the road, L. rheocola and A. pluvialis, are rare in road kill statistics along this highway, suggesting road mortality is not the cause of reduced frog abundance near the road. We postulate that lowered abundance may reflect traffic noise effects. We analyzed calls of the International Union for Conservation of Nature endangered species L. rheocola along the one stream transect on which it was common. We found significant trends in two call traits over a very fine scale: both call rate and dominant frequency were significantly higher closer to the road. Furthermore, males were significantly smaller closer to the road. These call and body size trends most likely reflect road impacts, but resolving these is complicated by correlations between traits. Potential mechanisms, effects on fitness, and management recommendations to mitigate the impacts of roads on frogs are outlined.

  9. The Strategic Impact of Techno logy Based CRM on Call Centers’ Performance

    Directory of Open Access Journals (Sweden)

    Aliyu Olayemi Abdullateef

    2011-04-01

    Full Text Available The primary objective of this paper is to test a model that can explain the impact of technology based CRM on inbound call center performance. To do this, data were collected from 168 call center managers and analyzed through structural equation modeling. The research findings indicate that technology based CRM significantly a ffects first call resolution and perceived service quality, but weakly influence caller satisfactions through the mediating role of firs t call resolutions. Observably, this research believes that customer contact centers as the first touch points to company are dependent on other factors such as company policy, product quality, customer characteristics, etc. to influence caller sati sfactions, but unfortunately most of these factors fall outside the operational control of cont act center activities. The findings in this research has empirically provided the long waiting evidence that technology based CRM applications within the inbound contact center industry can only influence caller satisfactions through first call resolution and perceived service quality. A major implication for call center managers is that this research findings has availed them the opportunity on how to effectively develop, implement, and evaluate their CRM applications.

  10. Clinical Trials and their Impact on Society

    OpenAIRE

    Olga Lidia Cuevas Pérez; Ana María Molina Gómez; Diana Rosa Fernández Ruiz

    2016-01-01

    Today there are countless examples that illustrate the nature of technoscience, including biotechnology and pharmacology. The clinical trial is the appropriate methodology used by clinical pharmacology to test the efficacy and safety of a treatment or intervention in humans. It constitutes the cornerstone of research. Once the preclinical research is completed, one of the biggest challenges currently facing the Cuban Pharmaceutical and Biotechnological Industry is precisely the clinical evalu...

  11. Impact of the European Clinical Trials Directive on prospective academic clinical trials associated with BMT

    OpenAIRE

    Frewer, L. J.; Coles, D.; van der Lans, I A; Schroeder, D.; Champion, K.; Apperley, J. F.

    2010-01-01

    The European Clinical Trials Directive (EU 2001; 2001/20/EC) was introduced to improve the efficiency of commercial and academic clinical trials. Concerns have been raised by interested organizations and institutions regarding the potential for negative impact of the Directive on non-commercial European clinical research. Interested researchers within the European Group for Blood and Marrow Transplantation (EBMT) were surveyed to determine whether researcher experiences confirmed this view. F...

  12. Impact of radiation research on clinical trials in radiation oncology

    International Nuclear Information System (INIS)

    The authors present an outline review of the history of the formation of the cooperative group called International Clinical Trials in Radiation Oncology (ICTRO), and the following areas are briefly discussed together with some projections for the direction of clinical trials in radiation oncology into the 1990s:- radiosensitizers, radioprotectors, and their combination, drug-radiation interactions, dose/time/fractionation, hyperthermia, biological response modifiers and radiolabelled antibodies, high LET, particularly neutron therapy, large field irradiation and interoperative irradiation, research studies on specific sites. (U.K.)

  13. Occupational voice demands and their impact on the call-centre industry

    Directory of Open Access Journals (Sweden)

    Duffy OM

    2009-04-01

    Full Text Available Abstract Background Within the last decade there has been a growth in the call-centre industry in the UK, with a growing awareness of the voice as an important tool for successful communication. Occupational voice problems such as occupational dysphonia, in a business which relies on healthy, effective voice as the primary professional communication tool, may threaten working ability and occupational health and safety of workers. While previous studies of telephone call-agents have reported a range of voice symptoms and functional vocal health problems, there have been no studies investigating the use and impact of vocal performance in the communication industry within the UK. This study aims to address a significant gap in the evidence-base of occupational health and safety research. The objectives of the study are: 1. to investigate the work context and vocal communication demands for call-agents; 2. to evaluate call-agents' vocal health, awareness and performance; and 3. to identify key risks and training needs for employees and employers within call-centres. Methods and design This is an occupational epidemiological study, which plans to recruit call-centres throughout the UK and Ireland. Data collection will consist of three components: 1. interviews with managers from each participating call-centre to assess their communication and training needs; 2. an online biopsychosocial questionnaire will be administered to investigate the work environment and vocal demands of call-agents; and 3. voice acoustic measurements of a random sample of participants using the Multi-dimensional Voice Program (MDVP. Qualitative content analysis from the interviews will identify underlying themes and issues. A multivariate analysis approach will be adopted using Structural Equation Modelling (SEM, to develop voice measurement models in determining the construct validity of potential factors contributing to occupational dysphonia. Quantitative data will be

  14. Calls Forecast for the Moscow Ambulance Service. The Impact of Weather Forecast

    Science.gov (United States)

    Gordin, Vladimir; Bykov, Philipp

    2015-04-01

    We use the known statistics of the calls for the current and previous days to predict them for tomorrow and for the following days. We assume that this algorithm will work operatively, will cyclically update the available information and will move the horizon of the forecast. Sure, the accuracy of such forecasts depends on their lead time, and from a choice of some group of diagnoses. For comparison we used the error of the inertial forecast (tomorrow there will be the same number of calls as today). Our technology has demonstrated accuracy that is approximately two times better compared to the inertial forecast. We obtained the following result: the number of calls depends on the actual weather in the city as well as on its rate of change. We were interested in the accuracy of the forecast for 12-hour sum of the calls in real situations. We evaluate the impact of the meteorological errors [1] on the forecast errors of the number of Ambulance calls. The weather and the Ambulance calls number both have seasonal tendencies. Therefore, if we have medical information from one city only, we should separate the impacts of such predictors as "annual variations in the number of calls" and "weather". We need to consider the seasonal tendencies (associated, e. g. with the seasonal migration of the population) and the impact of the air temperature simultaneously, rather than sequentially. We forecasted separately the number of calls with diagnoses of cardiovascular group, where it was demonstrated the advantage of the forecasting method, when we use the maximum daily air temperature as a predictor. We have a chance to evaluate statistically the influence of meteorological factors on the dynamics of medical problems. In some cases it may be useful for understanding of the physiology of disease and possible treatment options. We can assimilate some personal archives of medical parameters for the individuals with concrete diseases and the relative meteorological archive. As a

  15. A global call for action to include gender in research impact assessment.

    Science.gov (United States)

    Ovseiko, Pavel V; Greenhalgh, Trisha; Adam, Paula; Grant, Jonathan; Hinrichs-Krapels, Saba; Graham, Kathryn E; Valentine, Pamela A; Sued, Omar; Boukhris, Omar F; Al Olaqi, Nada M; Al Rahbi, Idrees S; Dowd, Anne-Maree; Bice, Sara; Heiden, Tamika L; Fischer, Michael D; Dopson, Sue; Norton, Robyn; Pollitt, Alexandra; Wooding, Steven; Balling, Gert V; Jakobsen, Ulla; Kuhlmann, Ellen; Klinge, Ineke; Pololi, Linda H; Jagsi, Reshma; Smith, Helen Lawton; Etzkowitz, Henry; Nielsen, Mathias W; Carrion, Carme; Solans-Domènech, Maite; Vizcaino, Esther; Naing, Lin; Cheok, Quentin H N; Eckelmann, Baerbel; Simuyemba, Moses C; Msiska, Temwa; Declich, Giovanna; Edmunds, Laurel D; Kiparoglou, Vasiliki; Buchan, Alison M J; Williamson, Catherine; Lord, Graham M; Channon, Keith M; Surender, Rebecca; Buchan, Alastair M

    2016-01-01

    Global investment in biomedical research has grown significantly over the last decades, reaching approximately a quarter of a trillion US dollars in 2010. However, not all of this investment is distributed evenly by gender. It follows, arguably, that scarce research resources may not be optimally invested (by either not supporting the best science or by failing to investigate topics that benefit women and men equitably). Women across the world tend to be significantly underrepresented in research both as researchers and research participants, receive less research funding, and appear less frequently than men as authors on research publications. There is also some evidence that women are relatively disadvantaged as the beneficiaries of research, in terms of its health, societal and economic impacts. Historical gender biases may have created a path dependency that means that the research system and the impacts of research are biased towards male researchers and male beneficiaries, making it inherently difficult (though not impossible) to eliminate gender bias. In this commentary, we - a group of scholars and practitioners from Africa, America, Asia and Europe - argue that gender-sensitive research impact assessment could become a force for good in moving science policy and practice towards gender equity. Research impact assessment is the multidisciplinary field of scientific inquiry that examines the research process to maximise scientific, societal and economic returns on investment in research. It encompasses many theoretical and methodological approaches that can be used to investigate gender bias and recommend actions for change to maximise research impact. We offer a set of recommendations to research funders, research institutions and research evaluators who conduct impact assessment on how to include and strengthen analysis of gender equity in research impact assessment and issue a global call for action. PMID:27432056

  16. Effects of a Phone Call Intervention to Promote Adherence to Antiretroviral Therapy and Quality of Life of HIV/AIDS Patients in Baoshan, China: A Randomized Controlled Trial

    OpenAIRE

    Weibin Zheng; Virasakdi Chongsuvivatwong; Edward McNeil; Rassamee Sangthong; Dongsheng Huang; Xuemei Yang

    2013-01-01

    Background. Suboptimal adherence to antiretroviral therapy (ART) is still pervasive. The effect of using a mobile phone call intervention to improve patient adherence is currently not known. Objective. This study aims to investigate the effects of a phone call intervention on adherence to ART and quality of life (QOL) of treatment-naive and treatment-experienced patients. Methods. A randomized controlled trial was conducted in the three largest public hospitals. Adherence was measured by self...

  17. The journal impact factor as a predictor of trial quality and outcomes

    DEFF Research Database (Denmark)

    Gluud, Lise L; Sørensen, Thorkild I A; Gøtzsche, Peter C; Gluud, Christian

    2005-01-01

    To examine the association between the impact factor and characteristics of hepatobiliary randomized clinical trials.......To examine the association between the impact factor and characteristics of hepatobiliary randomized clinical trials....

  18. McCall's Area Transformation versus the Integrated Impact Indicator (I3)

    CERN Document Server

    Leydesdorff, Loet

    2012-01-01

    In a study entitled "Skewed Citation Distributions and Bias Factors: Solutions to two core problems with the journal impact factor," Mutz & Daniel (2012) propose (i) McCall's (1922) Area Transformation of the skewed citation distribution so that this data can be considered as normally distributed (Krus & Kennedy, 1977), and (ii) to control for different document types as a co-variate (Rubin, 1977). This approach provides an alternative to Leydesdorff & Bornmann's (2011) Integrated Impact Indicator (I3). As the authors note, the two approaches are akin. Can something be said about the relative quality of the two approaches? To that end, I replicated the study of Mutz & Daniel for the 11 journals in the Subject Category "mathematical psychology," but using additionally I3 on the basis of continuous quantiles (Leydesdorff & Bornmann, in press) and its variant PR6 based on the six percentile rank classes distinguished by Bornmann & Mutz (2011) as follows: the top-1%, 95-99%, 90-95%, 75-90%...

  19. Impact of the chorus environment on temporal processing of advertisement calls by gray treefrogs

    Science.gov (United States)

    Schwartz, Joshua; Huth, Kenneth; Lasker, Jeffrey

    2001-05-01

    Male gray treefrogs advertise for mates using calls that consist of a series of pulses. Pulse duration, interpulse interval, and pulse shape determine whether a call is recognized as a conspecific signal by females. Females use call rate and call pulse number to assess relative calling performance by males, and prefer males that display high calling efforts. However, within choruses call overlap among males and background noise can compromise the ability of females to detect and correctly interpret temporal information in calls. Phonotaxis tests using calls suffering from different patterns of overlap or with internal gaps were used to investigate specific consequences of interference and masking as well as mechanisms that might alleviate such problems. Our data indicate that females do not employ a process analogous to phonemic restoration to ``fill in'' missing call segments; however, if a sufficient percent of call elements fall within species-specific ranges, females may ignore call anomalies. Additional findings are generally consistent with those from a recent study on anuran auditory midbrain neurons that count and indicate that inappropriate pulse intervals can reset the pulse counting process. [Work supported by NSF and a Pace University Eugene M. Lang Research Fellowship.

  20. Evaluating the Motivational Impact of CALL Systems: Current Practices and Future Directions

    Science.gov (United States)

    Bodnar, Stephen; Cucchiarini, Catia; Strik, Helmer; van Hout, Roeland

    2016-01-01

    A major aim of computer-assisted language learning (CALL) is to create computer environments that facilitate students' second language (L2) acquisition. To achieve this aim, CALL employs technological innovations to create novel types of language practice. Evaluations of the new practice types serve the important role of distinguishing effective…

  1. Impactful Clinical Trials of 2015: What Clinicians Need to Know.

    Science.gov (United States)

    Singh, Narendra; Gupta, Milan

    2016-08-01

    Randomized clinical trials (RCTs) remain the foundation for assessing and introducing evidence-based therapies into cardiovascular (CV) medicine. In 2015, a number of RCTs were reported and published that have great potential to improve CV outcomes and thus to change clinical practice. We highlight the results and implications of major RCTs in the areas of acute coronary syndrome (ACS), interventional cardiology, atrial fibrillation, lipids, heart failure, diabetes, and hypertension. Among the trials we discuss, PEGASUS and DAPT provide guidance regarding the potential benefits and hazards of longer-term dual-antiplatelet therapy after percutaneous coronary intervention (PCI) or myocardial infarction (MI). The BRIDGE study evaluated the role of bridging patients with atrial fibrillation who underwent noncardiac surgery with low-molecular-weight heparin while temporarily discontinuing their oral anticoagulant. The REVERSE-AD trial addressed the highly relevant issue of the first reversal agent (idarucizumab) for the direct oral anticoagulant dabigatran. The IMPROVE-IT assessed the benefits of adding ezetimibe to a statin in patients with ACS. Coupled with the latest studies involving proprotein convertase subtilisin/kexin type 9 inhibitors, the lipid field was particularly active in 2015. The year ended with major headlines in hypertension and diabetes. The SPRINT may lead to a new era in hypertension, with lowered blood pressure (BP) targets, and EMPA-REG became the first study ever to demonstrate a convincing reduction in CV events with a glucose-lowering agent, in this case empagliflozin. The results of these and other trials will likely impact practice guidelines and improve outcomes for our patients. PMID:27038506

  2. Impacts of Location on Bank Call Center Services: The Case of Turkey

    OpenAIRE

    Hakan Özkan Ahmet

    2012-01-01

    Purpose - The CRM sector represents the quality of a company. The quality of a company might be evaluated by taking the services of a call center as a measure by the customers, because CRM is the most interactive point of the operations of all companies. Call centers represent companies with 24/7 service. Companies have to search for ways to increase the quality of their service and CRM. Call center companies started to move to Anatolia in response to government incentives. The purpose of thi...

  3. Occupational voice demands and their impact on the call-centre industry

    OpenAIRE

    Duffy OM; Hazlett, DE; Moorhead SA

    2009-01-01

    Abstract Background Within the last decade there has been a growth in the call-centre industry in the UK, with a growing awareness of the voice as an important tool for successful communication. Occupational voice problems such as occupational dysphonia, in a business which relies on healthy, effective voice as the primary professional communication tool, may threaten working ability and occupational health and safety of workers. While previous studies of telephone call-agents have reported a...

  4. The Impact of Simulation Training on Call Center Agent Performance: A Field-Based Investigation

    OpenAIRE

    Nagesh N. Murthy; Goutam N. Challagalla; Leslie H. Vincent; Tasadduq A. Shervani

    2008-01-01

    The most prevalent form of training call center agents is via classroom instruction coupled with role-plays. Role-play training has a theoretical base in behavior modeling that entails observation, practice, and feedback. Emerging simulation-based technologies offer enhancements to behavior modeling that are absent in role-play training. This study evaluates the effectiveness of simulation-based training (henceforth, simulation training) as a behavior modeling technique vis-à-vis role-play tr...

  5. Bullied youth: the impact of bullying through lesbian, gay, and bisexual name calling.

    Science.gov (United States)

    Evans, Caroline B R; Chapman, Mimi V

    2014-11-01

    Bullying is a common experience for many school-aged youth, but the majority of bullying research and intervention does not address the content of bullying behavior, particularly teasing. Understanding the various forms of bullying as well as the language used in bullying is important given that bullying can have persistent consequences, particularly for victims who are bullied through biased-based bullying, such as being called gay, lesbian, or queer. This study examines bullying experiences in a racially and ethnically diverse sample of 3,379 rural elementary-, middle-, and high-school youth. We use latent class analysis to establish clusters of bullying behaviors, including forms of biased-based bullying. The resulting classes are examined to ascertain if and how bullying by biased-based labeling is clustered with other forms of bullying behavior. This analysis identifies 3 classes of youth: youth who experience no bullying victimization, youth who experience social and emotional bullying, and youth who experience all forms of social and physical bullying, including being bullied by being called gay, lesbian, or queer. Youth in Classes 2 and 3 labeled their experiences as bullying. Results indicate that youth bullied by being called gay, lesbian, or queer are at a high risk of experiencing all forms of bullying behavior, highlighting the importance of increased support for this vulnerable group. PMID:25545432

  6. Relational Dynamics in Perception: Impacts on Trial-to-trial Variation

    OpenAIRE

    Shimon Marom

    2011-01-01

    We show that trial-to-trial variability in sensory detection of a weak visual stimulus is dramatically diminished when rather than presenting a fixed stimulus contrast, fluctuations in a subject's judgment are matched by fluctuations in stimulus contrast. This attenuation of fluctuations does not involve a change in the subject's psychometric function. The result is consistent with the interpretation of trial-to-trial variability in this sensory detection task being a high-level meta-cognitiv...

  7. Synthesis report on the call ‘Pilot projects to carry out ESF related counterfactual impact evaluations’

    OpenAIRE

    ELIA LEANDRO; SANTANGELO GIULIA; SCHNEPF SYLKE

    2015-01-01

    In order to measure the causal effect of a policy, a specific approach called ‘counterfactual impact evaluation’ is needed. This report highlights that data access, networking, capacity building and taking evaluation requirements into account during the policy implementation are key for shifting to a culture of causal evaluation of policies. These results derive from eight pilot projects funded by DG Employment, Social Affairs and Inclusion to foster the measurement of causal effects of Europ...

  8. Disrupted seasonal biology impacts health, food security, and ecosystems: a call for integrated research

    NARCIS (Netherlands)

    Stevenson, T.J.; Visser, M.E.; Arnold, W.; Barrett, P.; Biello, S.; Dawson, A.; Denlinger, D.L.; Dominoni, D.; Ebling, F.J.; Elton, S.; Evans, N.; Ferguson, H.M.; Foster, R.G.; Hau, M.; Haydon, D.T.; Hazlerigg, D.G.; Heideman, P.; Hopcraft, J.G.C.; Jonsson, N.N.; Kronfeld-Schor, N.; Kumar, V.; Lincoln, G.A.; MacLeod, R.; Martin, S.A.M.; Martinez-Bakker, M.; Nelson, R.J.; Reed, T.; Robinso, J.E.; Rock, D.; Schwartz, W.J.; Steffan-Dewenter, I.; Tauber, E.; Thackeray, S.J.; Umstatter, C.; Yoshimura, T.; Helm, B.

    2015-01-01

    The rhythm of life on earth is shaped by seasonal changes in the environment. Plants and animals show profound annual cycles in physiology, health, morphology, behaviour and demography in response to environmental cues. Seasonal biology impacts ecosystems and agriculture, with consequences for human

  9. Impact of sending email reminders of the legal requirement for posting results on ClinicalTrials.gov: cohort embedded pragmatic randomized controlled trial

    OpenAIRE

    Maruani, Annabel; Boutron, Isabelle; Baron, Gabriel; Ravaud, Philippe

    2014-01-01

    Objective To evaluate the impact of sending an email to responsible parties of completed trials that do not comply with the Food and Drug Administration Amendments Act 801 legislation, to remind them of the legal requirement to post results. Design Cohort embedded pragmatic randomized controlled trial. Setting Trials registered on ClinicalTrials.gov. Participants 190 out of 379 trials randomly selected by computer generated randomization list to receive the intervention (personalized emails s...

  10. Disrupted seasonal biology impacts health, food security, and ecosystems: a call for integrated research

    OpenAIRE

    Stevenson, T. J.; Visser, M.E; Arnold, W; Barrett, P; Biello, S; Dawson, A.; Denlinger, D. L.; Dominoni, D.; Ebling, F.J.; Elton, S.; Evans, N.; Ferguson, H M; Foster, R G; Hau, M.; Haydon, D.T.

    2015-01-01

    The rhythm of life on earth is shaped by seasonal changes in the environment. Plants and animals show profound annual cycles in physiology, health, morphology, behaviour and demography in response to environmental cues. Seasonal biology impacts ecosystems and agriculture, with consequences for humans and biodiversity. Human populations show robust annual rhythms in health and well-being, and the birth month can have lasting effects that persist throughout life. This review emphasizes the need...

  11. Calling in sick: impacts of fever on intra-urban human mobility.

    Science.gov (United States)

    Perkins, T Alex; Paz-Soldan, Valerie A; Stoddard, Steven T; Morrison, Amy C; Forshey, Brett M; Long, Kanya C; Halsey, Eric S; Kochel, Tadeusz J; Elder, John P; Kitron, Uriel; Scott, Thomas W; Vazquez-Prokopec, Gonzalo M

    2016-07-13

    Pathogens inflict a wide variety of disease manifestations on their hosts, yet the impacts of disease on the behaviour of infected hosts are rarely studied empirically and are seldom accounted for in mathematical models of transmission dynamics. We explored the potential impacts of one of the most common disease manifestations, fever, on a key determinant of pathogen transmission, host mobility, in residents of the Amazonian city of Iquitos, Peru. We did so by comparing two groups of febrile individuals (dengue-positive and dengue-negative) with an afebrile control group. A retrospective, semi-structured interview allowed us to quantify multiple aspects of mobility during the two-week period preceding each interview. We fitted nested models of each aspect of mobility to data from interviews and compared models using likelihood ratio tests to determine whether there were statistically distinguishable differences in mobility attributable to fever or its aetiology. Compared with afebrile individuals, febrile study participants spent more time at home, visited fewer locations, and, in some cases, visited locations closer to home and spent less time at certain types of locations. These multifaceted impacts are consistent with the possibility that disease-mediated changes in host mobility generate dynamic and complex changes in host contact network structure. PMID:27412286

  12. Relational Dynamics in Perception: Impacts on trial-to-trial variation

    Directory of Open Access Journals (Sweden)

    Shimon Marom

    2011-04-01

    Full Text Available We show that trial-to-trial variability in sensory detection of a weak visual stimulus is dramatically diminished when rather than presenting a fixed stimulus contrast, fluctuations in a subject's judgment are matched by fluctuations in stimulus contrast. This attenuation of fluctuations does not involve a change in the subject's psychometric function. The result is consistent with the interpretation of trial-to-trial variability in this sensory detection task being a high-level meta-cognitive control process that explores for something that our brains are so used to: subject-object relational dynamics.

  13. The effect of nurses’ preparedness and nurse practitioner status on triage call management in primary care: A secondary analysis of cross-sectional data from the ESTEEM trial

    Science.gov (United States)

    Varley, Anna; Warren, Fiona C.; Richards, Suzanne H.; Calitri, Raff; Chaplin, Katherine; Fletcher, Emily; Holt, Tim A.; Lattimer, Valerie; Murdoch, Jamie; Richards, David A.; Campbell, John

    2016-01-01

    Background Nurse-led telephone triage is increasingly used to manage demand for general practitioner consultations in UK general practice. Previous studies are equivocal about the relationship between clinical experience and the call outcomes of nurse triage. Most research is limited to investigating nurse telephone triage in out-of-hours settings. Objective To investigate whether the professional characteristics of primary care nurses undertaking computer decision supported software telephone triage are related to call disposition. Design Questionnaire survey of nurses delivering the nurse intervention arm of the ESTEEM trial, to capture role type (practice nurse or nurse practitioner), prescriber status, number of years’ nursing experience, graduate status, previous experience of triage, and perceived preparedness for triage. Our main outcome was the proportion of triaged patients recommended for follow-up within the practice (call disposition), including all contact types (face-to-face, telephone or home visit), by a general practitioner or nurse. Settings 15 general practices and 7012 patients receiving the nurse triage intervention in four regions of the UK. Participants 45 nurse practitioners and practice nurse trained in the use of clinical decision support software. Methods We investigated the associations between nursing characteristics and triage call disposition for patient ‘same-day’ appointment requests in general practice using multivariable logistic regression modelling. Results Valid responses from 35 nurses (78%) from 14 practices: 31/35 (89%) had ≥10 years’ experience with 24/35 (69%) having ≥20 years. Most patient contacts (3842/4605; 86%) were recommended for follow-up within the practice. Nurse practitioners were less likely to recommend patients for follow-up odds ratio 0.19, 95% confidence interval 0.07; 0.49 than practice nurses. Nurses who reported that their previous experience had prepared them less well for triage were more

  14. Intervention to prevent further falls in older people who call an ambulance as a result of a fall: a protocol for the iPREFER randomised controlled trial

    Science.gov (United States)

    2013-01-01

    Background An increasing number of falls result in an emergency call and the subsequent dispatch of paramedics. In the absence of physical injury, abnormal physiological parameters or change in usual functional status, it could be argued that routine conveyance by ambulance to the Emergency Department (ED) is not the most effective or efficient use of resources. Further, it is likely that non-conveyed older fallers have the potential to benefit from timely access to fall risk assessment and intervention. The aim of this randomised controlled trial is to evaluate the effect of a timely and tailored falls assessment and management intervention on the number of subsequent falls and fall-related injuries for non-conveyed older fallers. Methods Community dwelling people aged 65 years or older who are not conveyed to the ED following a fall will be eligible to be visited at home by a research physiotherapist. Consenting participants will receive individualised intervention strategies based on risk factors identified at baseline. All pre-test measures will be assessed prior to randomisation. Post-test measures will be undertaken by a researcher blinded to group allocation 6 months post-baseline. Participants in the intervention group will receive individualised pro-active fall prevention strategies from the clinical researcher to ensure that risk factors are addressed adequately and interventions carried out. The primary outcome measure will be the number of falls recorded by a falls diary over a 12 month period. Secondary outcome measures assessed six months after baseline will include the subsequent use of medical and emergency services and uptake of recommendations. Data will be analysed using the intention-to-treat principle. Discussion As there is currently little evidence regarding the effectiveness or feasibility of alternate models of care following ambulance non-conveyance of older fallers, there is a need to explore assessment and intervention programs to

  15. Modeling the impact of a carbon tax: A trial analysis for Washington State

    International Nuclear Information System (INIS)

    In recent years, energy policy makers have proposed a carbon tax as an economy-wide policy tool to curb greenhouse gas (GHG) emissions. The quantification of its impact on GHG emissions has relied on an energy-economy model, whose complexity often makes it difficult to comprehend how it simulates the interaction of a carbon tax and energy demand. This study therefore aims at developing an alternative model called the Carbon Tax Analysis Model (C-TAM). The elasticity-based approach used in C-TAM is less sophisticated than an equilibrium-based approach used in an energy-economy model, but C-TAM is designed to maximize its predictive capabilities by using a wide range of elasticities for each sector and fuel use, accounting for likely changes in fuel mix for electricity generation, and addressing the model's sensitivity to elasticity estimates with Monte Carlo simulation. The trial analysis in this study evaluates a potential carbon tax in Washington State, suggesting a carbon tax at US$30 per metric ton of CO2 (tCO2) lowers GHG emissions by 8.4% from the business-as-usual (BAU) scenario in 2035. The study concludes that C-TAM can provide meaningful policy implications by forecasting detailed impact on revenues and energy demand for each sector and fuel use. - Highlights: ► An elasticity-based model is developed to forecast the impact of a carbon tax. ► This model can show detailed impacts on each sector and fuel use. ► Extensive literature review and sensitivity analyses cover the model's weakness. ► A carbon tax is effective in curbing greenhouse gas emissions in Washington State. ► A carbon tax is however more effective if implemented nationwide.

  16. MIRANDA RULE. IMPACT ON THE ROMANIAN CRIMINAL TRIAL

    OpenAIRE

    Mircea DAMASCHIN; Dumitru, Corina

    2009-01-01

    We hereby want to analyze the right of the accused or of the defendant against self incrimination in a criminal trial, a relatively recent right introduced in the Romanian law, directly connected with the right to self defense in a criminal trial. Furthermore, we will approach the obligations held by the Romanian legislator, within the prerogatives of the criminal legal authorities for guaranteeing this right and meanings that can be retained in case of breach of such procedure. In order to e...

  17. The effect of genetic test-based risk information on behavioral outcomes: A critical examination of failed trials and a call to action.

    Science.gov (United States)

    Austin, Jehannine

    2015-12-01

    Encouraging individuals at risk for common complex disease like heart disease, cancer, and diabetes to adopt lifestyle changes (e.g., smoking cessation, exercise, proper nutrition, increased screening) could be powerful public health tools to decrease the enormous personal and economic burden of these conditions. Theoretically, genetic risk information appears to be a compelling tool that could be used to provoke at-risk individuals to adopt these lifestyle changes. Unfortunately, however, numerous studies now have shown that providing individuals with genetic test-based risk information has little to no impact on their behavior. In this article (a commentary not a systematic review), the failed trials in which genetic information has been used as a tool to induce behavior change will be critically examined in order to identify new and potentially more effective ways forward. PMID:26284465

  18. MIRANDA RULE. IMPACT ON THE ROMANIAN CRIMINAL TRIAL

    Directory of Open Access Journals (Sweden)

    Mircea DAMASCHIN

    2009-10-01

    Full Text Available We hereby want to analyze the right of the accused or of the defendant against self incrimination in a criminal trial, a relatively recent right introduced in the Romanian law, directly connected with the right to self defense in a criminal trial. Furthermore, we will approach the obligations held by the Romanian legislator, within the prerogatives of the criminal legal authorities for guaranteeing this right and meanings that can be retained in case of breach of such procedure. In order to establish the origin of the regulation, the first section of the study will describe the history of the institution, starting from the Supreme Court jurisprudence from the state if Arizona in the already famous trial Arizona vs. Miranda. We will further present the legal framework instituted for implementing this right in the European legal space, section in which we will also approach the position of the European Court of Human Rights with respect to the issue subjected to the analysis. In the third section, we will present the legal framework instituted in Romania, while attempting to mainly highlight the legal relevance of this basic procedural right, as well as the possibility of retaining the existence of an inter conditioning with the principle of the right to a fair trial, according to the European Convention on Human Rights and Fundamental Freedoms.

  19. Impact of registration on clinical trials on infection risk in pediatric acute myeloid leukemia.

    Science.gov (United States)

    Dix, David; Aplenc, Richard; Bowes, Lynette; Cellot, Sonia; Ethier, Marie-Chantal; Feusner, Jim; Gillmeister, Biljana; Johnston, Donna L; Lewis, Victor; Michon, Bruno; Mitchell, David; Portwine, Carol; Price, Victoria; Silva, Mariana; Stobart, Kent; Yanofsky, Rochelle; Zelcer, Shayna; Beyene, Joseph; Sung, Lillian

    2016-04-01

    Little is known about the impact of enrollment on therapeutic clinical trials on adverse event rates. Primary objective was to describe the impact of clinical trial registration on sterile site microbiologically documented infection for children with newly diagnosed acute myeloid leukemia (AML). We conducted a multicenter cohort study that included children aged ≤18 years with de novo AML. Primary outcome was microbiologically documented sterile site infection. Infection rates were compared between those registered and not registered on clinical trials. Five hundred seventy-four children with AML were included of which 198 (34.5%) were registered on a therapeutic clinical trial. Overall, 400 (69.7%) had at least one sterile site microbiologically documented infection. In multiple regression, registration on clinical trials was independently associated with a higher risk of microbiologically documented sterile site infection [adjusted odds ratio (OR) 1.24, 95% confidence interval (CI) 1.01-1.53; p = 0.040] and viridans group streptococcal infection (OR 1.46, 95% CI 1.08-1.98; p = 0.015). Registration on trials was not associated with Gram-negative or invasive fungal infections. Children with newly diagnosed AML enrolled on clinical trials have a higher risk of microbiologically documented sterile site infection. This information may impact on supportive care practices in pediatric AML. PMID:26515793

  20. Impact of including Korean randomized controlled trials in Cochrane reviews of acupuncture.

    Directory of Open Access Journals (Sweden)

    Kun Hyung Kim

    Full Text Available OBJECTIVE: Acupuncture is commonly practiced in Korea and is regularly evaluated in clinical trials. Although many Cochrane reviews of acupuncture include searches of both English and Chinese databases, there is no information on the value of searching Korean databases. This study aimed to investigate the impact of searching Korean databases and journals for trials eligible for inclusion in existing Cochrane acupuncture reviews. METHODS: We searched 12 Korean databases and seven Korean journals to identify randomised trials meeting the inclusion criteria for acupuncture reviews in the Cochrane Database of Systematic Reviews. We compared risk of bias assessments of the Korean trials with the trials included in the Cochrane acupuncture reviews. Where possible, we added data from the Korean trials to the existing meta-analyses in the relevant Cochrane review and conducted sensitivity analyses to test the robustness of the results. RESULTS: Sixteen Korean trials (742 participants met the inclusion criteria for eight Cochrane acupuncture reviews (125 trials; 13,041 participants. Inclusion of the Korean trials provided data for 20% of existing meta-analyses (24 out of 120. Inclusion of the Korean trials did not change the direction of effect in any of the existing meta-analyses. The effect size and heterogeneity remained mostly unchanged. In only one meta-analysis did the significance change. Compared to the studies included in the Cochrane acupuncture reviews, the risk of bias in the Korean trials was higher in terms of outcome assessor blinding and allocation concealment. CONCLUSIONS: Many Korean studies contributed additional data to the existing meta-analyses in Cochrane acupuncture reviews. Although inclusion of these studies did not alter the results of the meta-analyses, comprehensive searches of the literature are important to avoid potential language bias. The identification and inclusion of eligible Korean trials should be considered for

  1. Translation of a book of evidence and its impact on a criminal trial - A case study

    OpenAIRE

    Jarmolowska, Karolina

    2012-01-01

    Interpreting in a legal setting in Ireland is not subject to any regulation. Police and court interpreters are neither certified nor tested. The current study aims to analyse the impact on a criminal trial of unqualified interpreters’ assistance in the pre-trial process. The starting point of the investigation is an analysis of witness statements written with the assistance of unqualified interpreters. It is followed by an analysis of the statements’ translation into Polish. The analysis ...

  2. Database trial impact on graduate nursing comprehensive exams.

    Science.gov (United States)

    Pionke, Katharine; Huckstadt, Alicia

    2015-10-01

    While the authors were doing a test period of databases, the question of whether or not databases affect outcomes of graduate nursing comprehensive examinations came up. This study explored that question through using citation analysis of exams that were taken during a database trial and exams that were not. The findings showed no difference in examination pass/fail rates. While the pass/fail rates did not change, a great deal was learned in terms of citation accuracy and types of materials that students used, leading to discussions about changing how citation and plagiarism awareness were taught. PMID:26512218

  3. Randomized Trial of a Gatekeeper Program for Suicide Prevention: 1-year Impact on Secondary School Staff

    OpenAIRE

    Wyman, Peter A.; Brown, C Hendricks; Inman, Jeff; Cross, Wendi; Schmeelk-Cone, Karen; Guo, Jing; PENA, JUAN B.

    2008-01-01

    Gatekeeper-training programs, designed to increase identification and referral of suicidal individuals, are widespread but largely untested. A group-based randomized trial with 32 schools examined impact of QPR (Question, Persuade, Refer) training on a stratified random sample of 249 staff with one-year average follow-up. To test QPR impact, we introduced and contrasted two models of gatekeeper-training effects in a population: Gatekeeper Surveillance and Gatekeeper Communication. Intent-to-t...

  4. Randomized, Controlled Trial to Examine the Impact of Providing Yogurt to Women Enrolled in WIC

    Science.gov (United States)

    Fung, Ellen B.; Ritchie, Lorrene D.; Walker, Brent H.; Gildengorin, Ginny; Crawford, Patricia B.

    2010-01-01

    Objective: Examine the impact of providing yogurt to women enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Design: Randomized, controlled intervention trial. Setting: Two California WIC local agency sites. Participants: 511 pregnant, breast-feeding, or postpartum women. Intervention: Substitution of…

  5. Reconsidering Findings of "No Effects" in Randomized Control Trials: Modeling Differences in Treatment Impacts

    Science.gov (United States)

    Chaney, Bradford

    2016-01-01

    The primary technique that many researchers use to analyze data from randomized control trials (RCTs)--detecting the average treatment effect (ATE)--imposes assumptions upon the data that often are not correct. Both theory and past research suggest that treatments may have significant impacts on subgroups even when showing no overall effect.…

  6. From the Cotton Fields to the Ties That Bind: Jim Pusack's Enduring Impact on Today's CALL Development

    Science.gov (United States)

    Jones, Linda C.

    2010-01-01

    From 1981 to today, the encouragement Jim Pusack and his colleague Sue Otto gave faculty to develop and/or implement CALL into the curriculum has been vital to our L2 teaching evolution. This article describes how their efforts evolved over the last two and a half decades and the ties that bind their efforts with today's CALL development.

  7. Community falls prevention for people who call an emergency ambulance after a fall: an economic evaluation alongside a randomised controlled trial

    OpenAIRE

    Sach, Tracey H; Logan, Philippa A.; Coupland, Carol A. C.; Gladman, John R. F.; Sahota, Opinder; Stoner-Hobbs, Valarie; Robertson, Kate; Tomlinson, Vicki; Ward, Marie; Avery, Anthony J

    2012-01-01

    Objective: we estimated the cost-effectiveness of a community falls prevention service compared with usual care from a National Health Service and personal social services perspective over the 12 month trial period.

  8. Dementia across the Lifespan and around the Globe-Pathophysiology, Prevention, Treatment, and Societal Impact: A Call for Papers.

    Science.gov (United States)

    2016-08-01

    In this months editorial, the PLOS Medicine Editors announce an upcoming Special Issue and call for papers, with Guest Editors Carol Brayne and Bruce Miller, on dementia across the lifespan and around the globe. PMID:27575695

  9. Impact of Leadership Styles on Employee Adaptability in Call Center: A Perspective of Telecommunication Industry in Malaysia

    OpenAIRE

    Rajendran Muthuveloo; Kanagaletchumy Kathamuthu; Teoh Ai Ping

    2014-01-01

    The purpose of this study is to find how employees adapt to different leadership styles in call centers in the telecommunication industry. This exploratory research was conducted among employees in call centers in the telecommunication industry to test the relationship between Leadership Styles and Employee Adaptability. The researcher used statistical inference and more specifically Linear Regression to test the relationship between the two variables. Results indicated that all the three Lea...

  10. Computer-Assisted Language Learning (CALL in the EFL Classroom and its Impact on Effective Teaching-learning Process in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Naiyer Azam Hashmi

    2016-03-01

    Full Text Available It is very interesting to see how Computer Assisted Language Learning (CALL has attracted many Arab students in learning English as a foreign language in the institutions of higher learning. It has great impact on their academic lives especially on teaching-learning process inside the classrooms. As a response to the students’ attraction in call, computer technologies have been brought into classrooms where they are considered to be effective in enhancing students learning and addressing certain education problems. The institutions of higher learning in Saudi Arabia, their students and faculty members have decided to try their best to utilize computer and other related technologies in their EFL classrooms for their fruitful teaching and learning outcomes. Thus, computers have taken centre stage and play an important role when it comes to language instruction in Saudi Arabia.Keywords:  CALL, Computer technologies, Foreign Language, Institutions of Higher-learning, Impact, Classrooms, Teaching, Learning, Issue

  11. The Impacts of Inclusion in Clinical Trials on Outcomes among Patients with Metastatic Breast Cancer (MBC.

    Directory of Open Access Journals (Sweden)

    Ji Yun Lee

    Full Text Available Metastatic breast cancer (MBC remains a devastating and incurable disease. Over the past decade, the implementation of clinical trials both with and without molecular targeted therapeutics has impacted the daily clinical treatment of patients with MBC. In this study, we determine whether including MBC patients in clinical trials affects clinical outcomes.We retrospectively reviewed data for a total of 863 patients diagnosed with initial or recurrent (after receiving adjuvant systemic treatments following surgery metastatic disease between January 2000 and December 2013. Data were obtained from the breast cancer database of Samsung Medical Center.Among the 806 patients selected for inclusion, 188 (23% had participated in clinical trials. A total of 185 clinical trials were conducted from 2000 to 2014. When compared with earlier periods (n = 10 for 2000-2004, clinical trial enrollment significantly increased over time (n = 103 for 2005-2009, P = 0.024; n = 110 for 2010-2014, P = 0.046. Multivariate analyses revealed that biologic subtype, distant recurrence free interval (DRFI, and clinical trial enrollment were independent predictors of overall survival. Patients who participated in clinical trials showed improved survival, with a hazard ratio of 0.75 (95% CI, 0.59-0.95, which was associated with a 25% reduction in the risk of death. However, subgroup analysis showed that this improved survival benefit was not maintained in patients with triple negative breast cancer (TNBC.Although not conclusive, we could speculate that there were differences in the use of newer agents or regimens over time, and these differences appear to be associated with improved survival.

  12. An Integrated Model for Patient Care and Clinical Trials (IMPACT) to support clinical research visit scheduling workflow for future learning health systems.

    Science.gov (United States)

    Weng, Chunhua; Li, Yu; Berhe, Solomon; Boland, Mary Regina; Gao, Junfeng; Hruby, Gregory W; Steinman, Richard C; Lopez-Jimenez, Carlos; Busacca, Linda; Hripcsak, George; Bakken, Suzanne; Bigger, J Thomas

    2013-08-01

    We describe a clinical research visit scheduling system that can potentially coordinate clinical research visits with patient care visits and increase efficiency at clinical sites where clinical and research activities occur simultaneously. Participatory Design methods were applied to support requirements engineering and to create this software called Integrated Model for Patient Care and Clinical Trials (IMPACT). Using a multi-user constraint satisfaction and resource optimization algorithm, IMPACT automatically synthesizes temporal availability of various research resources and recommends the optimal dates and times for pending research visits. We conducted scenario-based evaluations with 10 clinical research coordinators (CRCs) from diverse clinical research settings to assess the usefulness, feasibility, and user acceptance of IMPACT. We obtained qualitative feedback using semi-structured interviews with the CRCs. Most CRCs acknowledged the usefulness of IMPACT features. Support for collaboration within research teams and interoperability with electronic health records and clinical trial management systems were highly requested features. Overall, IMPACT received satisfactory user acceptance and proves to be potentially useful for a variety of clinical research settings. Our future work includes comparing the effectiveness of IMPACT with that of existing scheduling solutions on the market and conducting field tests to formally assess user adoption. PMID:23684593

  13. Continued vorapaxar versus withdrawed clopidogrel both on top of low dose aspirin in patients undergoing heart surgery: A call for randomized trial.

    Science.gov (United States)

    Serebruany, Victor L; Kim, Moo Hyun; Golukhova, Elena; Pya, Yury; Bekbossynova, Makhabbat; Cattaneo, Marco; Marciniak, Thomas A

    2016-07-15

    Despite advanced techniques and improved clinical outcomes, the optimal antiplatelet strategy following coronary artery bypass grafting (CABG) is an unsolved mystery. Vorapaxar, a novel platelet thrombin receptor (PAR-1/4) blocker, is currently approved for post-myocardial infarction and peripheral artery disease indications on top of clopidogrel or/and aspirin. We here summarize the outcomes in patients after CABG for justification of a future vorapaxar trial. We comprehended the CABG outcomes after vorapaxar yielded from TRACER, TRA2P trials, and affiliated FDA reviews. The verified evidence suggests that composite of death, myocardial infarction and stroke occurred in 2.2% of vorapaxar vs. 8.1% placebo in TRA2P. These data were similar to the endpoint differences (5.9% after vorapaxar vs. 8.3% for placebo) in TRACER. The mortality reduction also consistently suggests vorapaxar advantage (1.7% vs. 2.5% in TRA2P, and 1.7% vs. 3.9% in TRACER). Notably, the post-CABG bleeding risks after vorapaxar were only slightly, but not significantly higher. Moreover, the bleeding disadvantage in the experimental arm was most likely related to overtreatment since majority of patients in both TRACER and TRA2P received triple antiplatelet therapy with aspirin, clopidogrel on top of vorapaxar. Overall, the FDA-confirmed evidence advocate for the future vorapaxar post-CABG outcome-driven trial. The head-to-head trial testing dual therapy with continued over CABG vorapaxar versus withdrawed clopidogrel, both on top of low dose aspirin is warranted. We conclude that the primary outcomes including mortality were consistently better for heart surgery patients after vorapaxar, while the excess of bleeding was mild. Continuing vorapaxar during CABG may be superior to currently recommended withdrawal antiplatelet strategies, and should be tested in an adequately powered randomized outcome-driven trial. PMID:27128545

  14. CSF Biomarkers of Alzheimer’s Disease: Impact on Disease Concept, Diagnosis, and Clinical Trial Design

    OpenAIRE

    Fagan, Anne M.

    2014-01-01

    Data from clinicopathologic and biomarker studies have converged to support the view of Alzheimer’s disease (AD) as a continuum, with pathology developing decades prior to the onset of cognitive symptoms which culminate as dementia at the end stage of the disease. This concept is impacting disease nomenclature, diagnostic criteria, prognostic potential, and clinical trial design. Revisions to diagnostic criteria to incorporate biomarker results have recently been proposed in order to increase...

  15. Impact of Seed Voucher System on Rice Farmers’ Welfare in Nigeria: A Randomized Control Trial Approach

    OpenAIRE

    Awotide, Bola Amoke; Awoyemi, Taiwo Timothy; Diagne, Aliou; Ojehomon, Vivian E.T.

    2012-01-01

    This study adopted Randomized Control Trial to examine the impact of seed voucher system on farming households’ welfare in Nigeria using cross-sectional data of 600 rice farmers randomly selected from the three major rice ecologies of Nigeria. The WALD estimate reveals that the use of seed voucher increased household Per Capita Expenditure (PCE) by N14705.91. While the result of the Local Average Treatment Effect (LATE), shows a positive and significant impact of N7928.15 on PCE. Therefore, t...

  16. A Call for a Community of Practice to Assess the Impact of Emerging Technologies on Undergraduate Biology Education

    Directory of Open Access Journals (Sweden)

    Jamie L. Jensen

    2012-02-01

    Full Text Available Recent recommendations for educational research encourage empirically tested, theory-based, completely transparent, and broadly applicable studies. In light of these recommendations, we call for a research standard and community of practice in the evaluation of technology use in the undergraduate life science classroom. We outline appropriate research methodology, review and critique the past research on technology usage and, lastly, suggest a new and improved focus for research on emerging technologies.

  17. Impact of Early Electronic Prescribing on Pharmacists’ Clarification Calls in Four Community Pharmacies Located in St John’s, Newfoundland

    OpenAIRE

    Phillips, Jennifer L.; Shea, Jennifer M; Leung, Valerie; MacDonald, Don

    2015-01-01

    Background Electronic prescribing (e-prescribing) can potentially help prevent medication errors. As the use of e-prescribing increases across Canada, understanding the benefits and gaps of early e-prescribing can help inform deployment of future e-prescribing systems. Objective The purpose of this exploratory study was to determine the prevalence of, reasons for, and average time taken for pharmacist clarification calls to prescribers for electronic medical record (EMR)-generated and handwri...

  18. EMERGENCY CALLS

    CERN Multimedia

    Medical Service

    2001-01-01

    IN URGENT NEED OF A DOCTOR GENEVA EMERGENCY SERVICES GENEVA AND VAUD 144 FIRE BRIGADE 118 POLICE 117 CERN FIREMEN 767-44-44 ANTI-POISONS CENTRE Open 24h/24h 01-251-51-51 Patient not fit to be moved, call family doctor, or: GP AT HOME, open 24h/24h 748-49-50 Association Of Geneva Doctors Emergency Doctors at home 07h-23h 322 20 20 Patient fit to be moved: HOPITAL CANTONAL CENTRAL 24 Micheli-du-Crest 372-33-11 ou 382-33-11 EMERGENCIES 382-33-11 ou 372-33-11 CHILDREN'S HOSPITAL 6 rue Willy-Donzé 372-33-11 MATERNITY 32 bvd.de la Cluse 382-68-16 ou 382-33-11 OPHTHALMOLOGY 22 Alcide Jentzer 382-33-11 ou 372-33-11 MEDICAL CENTRE CORNAVIN 1-3 rue du Jura 345 45 50 HOPITAL DE LA TOUR Meyrin EMERGENCIES 719-61-11 URGENCES PEDIATRIQUES 719-61-00 LA TOUR MEDICAL CENTRE 719-74-00 European Emergency Call 112 FRANCE EMERGENCY SERVICES 15 FIRE BRIGADE 18 POLICE 17 CERN FIREMEN AT HOME 00-41-22-767-44-44 ANTI-POISONS CENTRE Open 24h/24h 04-72-11-69-11 All doctors ...

  19. Calling for a reappraisal of the impact of quinoa expansion on agricultural sustainability in the Andean highlands

    OpenAIRE

    Winkel, Thierry; Alvarez-Flores, R.; Bertero, D.; De Cruz, P.; Del Castillo, C.; Joffre, R; Peredo Parada, S.; Sáez Tonacca, L.

    2014-01-01

    The debate on the environmental and social sustentainability of quinoa in its area of major world production (southern highlands of Bolivia) revived with the acceptance by the United Nations of the Bolivian proposal to declare in 2013 as the Year of the Quinoa. Public debate focused on local impacts of quinoa expansion in the Southern highlands of Bolivia, denouncing several negative impacts of quinoa culture such as land degradation, socioeconomic disrupts and biodiversity loss. However, the...

  20. The antiestrogens tamoxifen and fulvestrant abolish estrogenic impacts of 17α-ethinylestradiol on male calling behavior of Xenopus laevis.

    Science.gov (United States)

    Hoffmann, Frauke; Kloas, Werner

    2012-01-01

    Various synthetic chemicals released to the environment can interfere with the endocrine system of vertebrates. Many of these endocrine disrupting compounds (EDCs) exhibit estrogenic activity and can interfere with sexual development and reproductive physiology. More recently, also chemicals with different modes of action (MOAs), such as antiestrogenic, androgenic and antiandrogenic EDCs, have been shown to be present in the environment. However, to date EDC-research primarily focuses on exposure to EDCs with just one MOA, while studies examining the effects of simultaneous exposure to EDCs with different MOAs are rare, although they would reflect more real, natural exposure situations. In the present study the combined effects of estrogenic and antiestrogenic EDCs were assessed by analyzing the calling behavior of short-term exposed male Xenopus laevis. The estrogenic 17α-ethinylestradiol (EE2), and the antiestrogenic EDCs tamoxifen (TAM) and fulvestrant (ICI) were used as model substances. As previously demonstrated, sole EE2 exposure (10-10 M) resulted in significant alterations of the male calling behavior, including altered temporal and spectral parameters of the advertisement calls. Sole TAM (10-7 M, 10-8 M, 10-10 M) or ICI (10-7 M) exposure, on the other hand, did not affect any of the measured parameters. If frogs were co-exposed to EE2 (10-10 M) and TAM (10-7 M) the effects of EE2 on some parameters were abolished, but co-exposure to EE2 and ICI (10-7 M) neutralized all estrogenic effects. Thus, although EDCs with antiestrogenic MOA might not exhibit any effects per se, they can alter the estrogenic effects of EE2. Our observations demonstrate that there is need to further investigate the combined effects of EDCs with various, not only opposing, MOAs as this would reflect realistic wildlife situations. PMID:23028589

  1. The effect of nurses' preparedness and nurse practitioner status on triage call management in primary care: a secondary analysis of cross-sectional data from the ESTEEM Trial

    OpenAIRE

    Varley, Anna; Warren, Fiona C; Richards, Suzanne H; Calitri, Raff; Chaplin, Katherine; Fletcher, Emily; Holt, Tim A; Lattimer, Valerie; Murdoch, Jamie; Richards, David A; Campbell, John

    2016-01-01

    Background: Nurse-led telephone triage is increasingly used to manage demand for GP consultations in UK general practice. Previous studies are equivocal about the relationship between clinical experience and the call outcomes of nurse triage. Most research is limited to investigating nurse telephone triage in out-of-hours settings. Objective: To investigate whether the professional characteristics of primary care nurses undertaking computer decision supported software telephone triage are rel...

  2. Management of optic neuritis and impact of clinical trials: an international survey

    DEFF Research Database (Denmark)

    Biousse, Valérie; Calvetti, Olivier; Drews-Botsch, Carolyn D;

    2009-01-01

    countries, steroids were often prescribed to improve visual outcome or to decrease the long-term risk of multiple sclerosis. INTERPRETATION: Although recent clinical trials have changed the management of acute ON around the world, many neurologists and ophthalmologists do not evaluate and treat acute ON......OBJECTIVE: 1) To evaluate the management of acute isolated optic neuritis (ON) by ophthalmologists and neurologists; 2) to evaluate the impact of clinical trials; 3) to compare these practices among 7 countries. METHODS: A survey on diagnosis and treatment of acute isolated ON was sent to 5......,443 neurologists and 6,099 ophthalmologists in the southeast-USA, Canada, Australia/New Zealand, Denmark, France, and Thailand. USA data were compared to those of other countries. RESULTS: We collected 3,142 surveys (1,449 neurologists/1,693 ophthalmologists) (29.8% response rate). In all countries, ON patients...

  3. Management of optic neuritis and impact of clinical trials: an international survey

    DEFF Research Database (Denmark)

    Biousse, Valérie; Calvetti, Olivier; Drews-Botsch, Carolyn D;

    2009-01-01

    more frequently presented to ophthalmologists, and were subsequently referred to neurologists or subspecialists. Evaluation and management of ON varied among countries, mostly because of variations in healthcare systems, imaging access, and local guidelines. A brain MRI was obtained for 70-80% of ON...... countries, steroids were often prescribed to improve visual outcome or to decrease the long-term risk of multiple sclerosis. INTERPRETATION: Although recent clinical trials have changed the management of acute ON around the world, many neurologists and ophthalmologists do not evaluate and treat acute ON...... patients according to the best evidence from clinical research. This confirms that evaluation of the impact of major clinical trials ("translational T2 clinical research") is essential when assessing the effects of interventions designed to improve quality of care....

  4. Impact of Epidural Failures on the Results of a Prospective, Randomized Trial.

    Science.gov (United States)

    Desai, Amita; Alemayehu, Hanna; Weesner, Kathryn A; St Peter, Shawn D

    2016-04-01

    Introduction We conducted a prospective randomized trial to evaluate the merits of two established postoperative pain management strategies: thoracic epidural (EPI) versus patient-controlled analgesia (PCA) with intravenous narcotics after minimally invasive repair of pectus excavatum. Pain scores favored the EPI group for the first two postoperative days only. Critics of the trial suggest that if the epidural failure rate was not so high, results may have favored the EPI group. Therefore, we performed a subset analysis of the EPI group to evaluate the impact of these failures. Methods Patients for whom epidural catheter could not be placed or whose catheters were removed early owing to dysfunction were compared with those with well-functioning catheters. Those with well-functioning catheters were also compared with the PCA group. A two-tailed independent Student t-test and a two-tailed Fisher exact test were used where appropriate. Results Of 55 patients in the EPI group, 12 patients (21.8%) had failed placement or required early removal. Comparing those with failed placements with the rest of the group, there was no difference in daily visual analogue scale pain scores or measures of hospital course. Likewise, comparing those with well-functioning catheters only to those in the PCA group, the results of the trial are replicated in terms of pain scores, hospital course, and length of stay. Conclusion In patients with failed epidural therapy, there is no significant difference in postoperative hospital course. Comparing those with well-functioning catheters to those in the PCA group, trial results are replicated-that is, no significant difference in length of stay, time to regular diet, or time to transition to oral medications. Therefore, failure rate in the EPI group did not influence the results of the trial. PMID:25643246

  5. The impact of homicide trials on the forensic pathologist's time--the Fulton County experience.

    Science.gov (United States)

    Hanzlick, R

    1997-05-01

    Subpoenas received for criminal trials related to homicides in Fulton County (Atlanta) Georgia were tracked in a computer database for an 18 month period in order to determine the proportion of forensic pathologist worktime required for testimony in homicide cases. The number of subpoenas received annually amounted to 64% of the average number of homicides occurring annually. Testimony was required in about 33% of cases in which a subpoena was received, and, therefore, the number of testimony appearances per year was about 21% of the average annual number of homicides. Assuming a 40 hour work week for 52 weeks per year and an average of 3 hours of time preparing for, traveling to, and testifying in court, the time required of the forensic pathologist to testify in homicide trials amounted to about 2% of a full-time-equivalent. Although the time required for testimony in homicide cases may vary among jurisdictions because of the nature of its homicides, distance and travel time to court, and other factors, the data presented here may be used to estimate the impact of homicide trial court time on forensic pathology practice. PMID:9144948

  6. A critical evaluation of social impact assessment methodologies and a call to measure economic and social impact holistically through the External Rate of Return platform

    OpenAIRE

    Florman, Mark; Vidra, Robyn Klingler; Facada, Martim Jacinto

    2016-01-01

    Companies, investors, international organisations and non-governmental organisations have designed frameworks and tools for measuring the social impact of business. In this report we evaluate the landscape of existing social impact assessment methods. We first delineate the characteristics, context and development of leading methodologies. We then critically evaluate the strengths and weaknesses of today’s leading social impact assessment methodologies. We identify the strengths of existing a...

  7. Effect of Text Message, Phone Call, and In-Person Appointment Reminders on Uptake of Repeat HIV Testing among Outpatients Screened for Acute HIV Infection in Kenya: A Randomized Controlled Trial

    Science.gov (United States)

    Wahome, Elizabeth W.; Gichuru, Evanson N.; Mwashigadi, Grace M.; Thiong’o, Alexander N.; Prins, Henrieke A. B.; Rinke de Wit, Tobias F.; Graham, Susan M.; Sanders, Eduard J.

    2016-01-01

    Background Following HIV-1 acquisition, many individuals develop an acute retroviral syndrome and a majority seek care. Available antibody testing cannot detect an acute HIV infection, but repeat testing after 2–4 weeks may detect seroconversion. We assessed the effect of appointment reminders on attendance for repeat HIV testing. Methods We enrolled, in a randomized controlled trial, 18–29 year old patients evaluated for acute HIV infection at five sites in Coastal Kenya (ClinicalTrials.gov NCT01876199). Participants were allocated 1:1 to either standard appointment (a dated appointment card) or enhanced appointment (a dated appointment card plus SMS and phone call reminders, or in-person reminders for participants without a phone). The primary outcome was visit attendance, i.e., the proportion of participants attending the repeat test visit. Factors associated with attendance were examined by bivariable and multivariable logistic regression. Principal Findings Between April and July 2013, 410 participants were randomized. Attendance was 41% (85/207) for the standard group and 59% (117/199) for the enhanced group, for a relative risk of 1.4 [95% Confidence Interval, CI, 1.2–1.7].Higher attendance was independently associated with older age, study site, and report of transactional sex in past month. Lower attendance was associated with reporting multiple partners in the past two months. Conclusions Appointment reminders through SMS, phone calls and in-person reminders increased the uptake of repeat HIV test by forty percent. This low-cost intervention could facilitate detection of acute HIV infections and uptake of recommended repeat testing. Trial Registration Clinicaltrials.gov NCT01876199 PMID:27077745

  8. The impact of drug shortages on patients with cardiovascular disease: causes, consequences, and a call to action.

    Science.gov (United States)

    Reed, Brent N; Fox, Erin R; Konig, Madeleine; Jackevicius, Cynthia A; Masoudi, Frederick A; Rabinstein, Alejandro A; Page, Robert L

    2016-05-01

    Shortages of cardiovascular drugs have become increasingly common, representing an ongoing public health crisis. Given few therapeutic alternatives to many of the drugs in short supply, these shortages also pose a major challenge for cardiovascular care professionals. Although changes in the regulatory environment have led to some improvements in recent years, problems involving manufacturing processes remain the most common underlying cause. Because of the complex nature of drug shortages, sustainable solutions to prevent and mitigate them will require collaboration between regulatory agencies, drug manufacturers, and other key stakeholder groups. In this report, we describe the scope of the cardiovascular drug shortage crisis in the United States, including its underlying causes and the efforts currently being made to address it. Furthermore, we provide specific recommendations for how cardiovascular care professionals can be involved in efforts to limit the impact of drug shortages on patient care as well as policy changes aimed at preventing and mitigating them. PMID:27179732

  9. The Impact of Concomitant Medication Use on Patient Eligibility for Phase I Cancer Clinical Trials

    Directory of Open Access Journals (Sweden)

    Mitesh J. Borad, Kelly K. Curtis, Hani M. Babiker, Martin Benjamin, Raoul Tibes, Ramesh K. Ramanathan, Karen Wright, Amylou C. Dueck, Gayle Jameson, Daniel D. Von Hoff

    2012-01-01

    Full Text Available Concomitant medication (CM use may result in Phase I cancer clinical trial ineligibility due to concern for potential CM-investigational drug interactions or alteration of investigational drug absorption. Few studies have examined the impact of CM use on trial eligibility. Methods: We reviewed records of 274 patients on Phase I trials at a single academic institution. Demographics, CM identities and classes, CM discontinuation, reasons, and incidence of CM substitution were recorded. CM-investigational drug cytochrome P450 (CYP enzyme interactions were documented. Statistical analysis was performed using descriptive statistics. Results: 273 of 274 patients (99.6%, 95% confidence interval [CI] 98.9-100% took CM, with a median of 8 CM per patient (range 0 - 42. CM discontinuation occurred in 67 cases (25%, 95% CI 19-30%. The most common CM classes discontinued were herbal (17 cases, 25%, 95% CI 16-37% and proton pump inhibitors (15 cases, 22%, 95% CI 12-32%. CM discontinuation reasons were: protocol prohibition (32 cases, 48%, 95% CI 36-60%; potential CM-investigational drug interaction (25 cases, 37%, 95% CI 26-49%; other (10 cases, 15%, 95% CI 6-23%. A potential CM-investigational drug CYP interaction was noted in 122 cases (45%, 95% CI 39-50%. CM potentially weakly decreased investigational drug metabolism in 52 cases (43%, 95% CI 34-51%, and potentially strongly decreased investigational drug metabolism in 17 cases (14%, 95% CI 8-20%. Investigational drug potentially weakly decreased CM metabolism in 39 cases (32%, 95% CI 24-40%, and potentially strongly decreased CM metabolism in 28 cases (23%, 95% CI 15-30%. CM substitution occurred in 36/67 cases (54%, 95% CI 41-66% where CM were discontinued to allow for eventual participation in clinical trials. Overall in 2 cases (0.7%, 95% CI 0.1-2.6%, patients were protocol ineligible because CM could not be discontinued or substituted. Conclusions: This study highlights the high prevalence of

  10. Impact on learning of an e-learning module on leukaemia: a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Morgulis Yuri

    2012-05-01

    Full Text Available Abstract Background e-learning resources may be beneficial for complex or conceptually difficult topics. Leukaemia is one such topic, yet there are no reports on the efficacy of e-learning for leukaemia. This study compared the learning impact on senior medical students of a purpose-built e-learning module on leukaemia, compared with existing online resources. Methods A randomised controlled trial was performed utilising volunteer senior medical students. Participants were randomly allocated to Study and Control groups. Following a pre-test on leukaemia administered to both groups, the Study group was provided with access to the new e-learning module, while the Control group was directed to existing online resources. A post-test and an evaluation questionnaire were administered to both groups at the end of the trial period. Results Study and Control groups were equivalent in gender distribution, mean academic ability, pre-test performance and time studying leukaemia during the trial. The Study group performed significantly better than the Control group in the post-test, in which the group to which the students had been allocated was the only significant predictor of performance. The Study group’s evaluation of the module was overwhelmingly positive. Conclusions A targeted e-learning module on leukaemia had a significant effect on learning in this cohort, compared with existing online resources. We believe that the interactivity, dialogic feedback and integration with the curriculum offered by the e-learning module contributed to its impact. This has implications for e-learning design in medicine and other disciplines.

  11. Impact of more intensive written information in patients having radical radiation therapy: Results of a prospective randomized phase III trial

    International Nuclear Information System (INIS)

    Background and purpose: A diagnosis of malignancy and its treatment is a very stressful time for patients and their families. This study was conducted to determine the impact of more intensive written information on patients' anxiety levels. The secondary aim was to determine the impact of this information on patients' satisfaction levels. Materials and methods: This prospective randomized trial consisted of patients with a pathological diagnosis of cancer having radical radiotherapy (RT). Patients were randomized to receive the more intensive information (including written information and a telephone call from the research nurse) or not to receive the more intensive information at the time of their initial consultation with the radiation oncologist. Study questionnaires measuring anxiety (STAI form) were completed prior to their first consultation (baseline) at the time of simulation (pre-RT) and at the completion of radiotherapy. A second questionnaire assessing satisfaction with the information given (ISQ) was completed at the time of simulation prior to commencing RT. Results: One hundred and ninety-four patients were enrolled in the study. The mean age of the patients was 58.5 years and 70% of patients were female. Breast cancer (67%) was the commonest cancer. One hundred and two patients were randomized to receive the intensive information package and 92 patients received the standard consultation. There was no significant difference in mean State or Trait anxiety scores between any of the time intervals and no difference between the two information groups. There was no significant difference between the groups with regard to mean satisfaction scores with the overall information given, nor with any individual question. The satisfaction scores with lifestyle information given were lower than those for any other type of information in both randomization arms. Conclusion: More intensive information did not significantly change patients' anxiety scores or

  12. Positive Outcomes Influence the Rate and Time to Publication, but Not the Impact Factor of Publications of Clinical Trial Results

    OpenAIRE

    Suñé, Pilar; Suñé, Josep Maria; Montoro, J. Bruno

    2013-01-01

    Objectives: Publication bias may affect the validity of evidence based medical decisions. The aim of this study is to assess whether research outcomes affect the dissemination of clinical trial findings, in terms of rate, time to publication, and impact factor of journal publications. Methods and Findings: All drug-evaluating clinical trials submitted to and approved by a general hospital ethics committee between 1997 and 2004 were prospectively followed to analyze their fate and publication....

  13. What Difference Does Patient and Public Involvement Make and What Are Its Pathways to Impact? Qualitative Study of Patients and Researchers from a Cohort of Randomised Clinical Trials

    OpenAIRE

    Dudley, Louise; Gamble, Carrol; Preston, Jennifer; Buck, Deborah; ,; Hanley, Bec; Williamson, Paula; Young, Bridget

    2015-01-01

    Background Patient and public involvement (PPI) is advocated in clinical trials yet evidence on how to optimise its impact is limited. We explored researchers' and PPI contributors' accounts of the impact of PPI within trials and factors likely to influence its impact. Methods Semi-structured qualitative interviews with researchers and PPI contributors accessed through a cohort of randomised clinical trials. Analysis of transcripts of audio-recorded interviews was informed by the principles o...

  14. The impact of radiologists' expertise on screen results decisions in a CT lung cancer screening trial

    International Nuclear Information System (INIS)

    To evaluate the impact of radiological expertise on screen result decisions in a CT lung cancer screening trial. In the NELSON lung cancer screening trial, the baseline CT result was based on the largest lung nodule's volume. The protocol allowed radiologists to manually adjust screen results in cases of high suspicion of benign or malignant nodule nature. Participants whose baseline CT result was based on a solid or part-solid nodule were included in this study. Adjustments by radiologists at baseline were evaluated. Histology was the reference for diagnosis or to confirm benignity and stability on subsequent CT examinations. A total of 3,318 participants (2,796 male, median age 58.0 years) were included. In 195 participants (5.9 %) the initial baseline screen result was adjusted by the radiologist. Adjustment was downwards from positive or indeterminate to negative in two and 119 participants, respectively, and from positive to indeterminate in 65 participants. None of these nodules turned out to be malignant. In 9/195 participants (4.6 %) the screen result was adjusted upwards from negative to indeterminate or indeterminate to positive; two nodules were malignant. In one in 20 cases of baseline lung cancer screening, nodules were reclassified by the radiologist, leading to a reduction of false-positive screen results. (orig.)

  15. Dichotomizing a continuous outcome in cluster randomized trials: impact on power.

    Science.gov (United States)

    Caille, Agnès; Leyrat, Clémence; Giraudeau, Bruno

    2012-10-30

    In cluster randomized trials (CRTs), clusters of individuals are randomized rather than the individuals themselves. For such trials, power depends in part on the degree of similarity among responses within a cluster, which is quantified by the intaclass correlation coefficient (ICC). Thus, for a fixed sample size, power decreases with increasing ICC. In reliability studies with two observers, dichotomizing a continuous outcome variable has been shown to reduce the ICC. We checked (by a simulation study) that this property still applies to CRTs, in which cluster sizes are variable and usually greater than in reliability studies and observations (within clusters) are exchangeable. Then, in a CRT, dichotomizing a continuous outcome actually induces two antagonistic effects: decreased power because of loss of information and increased power induced by attenuation of the ICC. Therefore, we aimed to assess the impact of dichotomizing a continuous outcome on power in a CRT. We derived an analytical formula for power based on a generalized estimating equation approach after dichotomizing a continuous outcome. This theoretical result was obtained by considering equal cluster sizes, and we then assessed its accuracy (by a simulation study) in the more realistic situation of varying cluster sizes. We showed that dichotomization is associated with decreased power: attenuation of the ICC does not compensate for the loss of power induced by loss of information. Loss of power is reduced with increased initial continuous-outcome ICC and/or prevalence of success for the dichotomized outcome approaching 50%. PMID:22733454

  16. Call Forecasting for Inbound Call Center

    OpenAIRE

    Peter Vinje

    2009-01-01

    In a scenario of inbound call center customer service, the ability to forecast calls is a key element and advantage. By forecasting the correct number of calls a company can predict staffing needs, meet service level requirements, improve customer satisfaction, and benefit from many other optimizations. This project will show how elementary statistics can be used to predict calls for a specific company, forecast the rate at which calls are increasing/decreasing, and determine if the calls may...

  17. Trial Protocol: Using genotype to tailor prescribing of nicotine replacement therapy: a randomised controlled trial assessing impact of communication upon adherence

    Directory of Open Access Journals (Sweden)

    Prevost A Toby

    2010-11-01

    Full Text Available Abstract Background The behavioural impact of pharmacogenomics is untested; informing smokers of genetic test results for responsiveness to smoking cessation medication may increase adherence to this medication. The objective of this trial is to estimate the impact upon adherence to nicotine replacement therapy (NRT of informing smokers that their oral dose of NRT has been tailored to a DNA analysis. Hypotheses to be tested are as follows: IAdherence to NRT is greater among smokers informed that their oral dose of NRT is tailored to an analysis of DNA (genotype, compared to one tailored to nicotine dependence questionnaire score (phenotype. II Amongst smokers who fail to quit at six months, motivation to make another quit attempt is lower when informed that their oral dose of NRT was tailored to genotype rather than phenotype. Methods/Design An open label, parallel groups randomised trial in which 630 adult smokers (smoking 10 or more cigarettes daily using National Health Service (NHS stop smoking services in primary care are randomly allocated to one of two groups: i. NRT oral dose tailored by DNA analysis (OPRM1 gene (genotype, or ii. NRT oral dose tailored by nicotine dependence questionnaire score (phenotype The primary outcome is proportion of prescribed NRT consumed in the first 28 days following an initial quit attempt, with the secondary outcome being motivation to make another quit attempt, amongst smokers not abstinent at six months. Other outcomes include adherence to NRT in the first seven days and biochemically validated smoking abstinence at six months. The primary outcome will be collected on 630 smokers allowing sufficient power to detect a 7.5% difference in mean proportion of NRT consumed using a two-tailed test at the 5% level of significance between groups. The proportion of all NRT consumed in the first four weeks of quitting will be compared between arms using an independent samples t-test and by estimating the 95

  18. Call Center ist nicht gleich Call Center

    OpenAIRE

    Baumgartner, Marc; Udris, Ivars

    2005-01-01

    Untersuchungen in 14 Schweizer Call Centers erbrachten vier Call Center-Typen, die sich hinsichtlich Arbeitstätigkeiten und Kommunikationsrichtung voneinander unterscheiden: (a) Beratungs- und Beschwerdemanagement, (b) Informationsmanagement, (c) Auftragsmanagement und (d) Kunden- und Kampagnenmanagement. Dies hat auch Auswirkungen auf die Personalstruktur, -selektion und -entwicklung der Call Center. Es wird der Frage nachgegangen, welche Kompetenzanforderungen in den unterschiedlichen Call ...

  19. Randomized Trial of a Statewide Home Visiting Program to Prevent Child Abuse: Impact in Reducing Parental Risk Factors

    Science.gov (United States)

    Duggan, Anne; Fuddy, Loretta; Burrell, Lori; Higman, Susan M.; McFarlane, Elizabeth; Windham, Amy; Sia, Calvin

    2004-01-01

    Objectives: To assess the impact of a home visiting program in reducing malleable parental risk factors for child abuse in families of newborns identified, through population-based screening, as at-risk of child abuse. Methods: This randomized trial focused on Healthy Start Program (HSP) sites operated by three community-based organizations on…

  20. Critical Reflections on the Impact(s of the So-Called ‘Teacher Incentive’ on Zimbabwe’s Public Education

    Directory of Open Access Journals (Sweden)

    Munyaradzi Mawere

    2012-08-01

    Full Text Available For some decades, Zimbabwe’s public education has been ranked one of the best in Southern Africa, Africa and the world-over. This was chiefly a result of high quality teachers, high quality supervision of examinations adopted from its colonial master (Britain, and good working conditions for education practitioners, among other reasons. This reality, however, has turned the otherwise since the turn of the new millennium and especially in the recent years due to economic meltdown in the country and mass exodus of qualified teachers to ‘greener pastures’. Confronted with its deepening and crippling economic levels, the government of Zimbabwe has clearly indicated that it is unable to provide conducive conditions for the practitioners in public education, a situation that resulted in a series of strikes by practitioners which threatened to paralyse all the teaching-learning activities in the country. It is out of this background that the system of incentives to teachers was introduced to augment the meagre salaries earned by teachers so that public education in the country would not face liquidation or total paralysis. Yet, while the introduction of incentives in public education seems to have boosted morale of some teachers, it has deflated that of the majority of the practitioners in the profession. This paper examines the problems and/or impact of teacher incentives on education quality and stakeholders, that is, students, teachers, parents/guardians and the Ministry of Education, Sport, Arts and Culture.

  1. What Difference Does Patient and Public Involvement Make and What Are Its Pathways to Impact? Qualitative Study of Patients and Researchers from a Cohort of Randomised Clinical Trials.

    Directory of Open Access Journals (Sweden)

    Louise Dudley

    Full Text Available Patient and public involvement (PPI is advocated in clinical trials yet evidence on how to optimise its impact is limited. We explored researchers' and PPI contributors' accounts of the impact of PPI within trials and factors likely to influence its impact.Semi-structured qualitative interviews with researchers and PPI contributors accessed through a cohort of randomised clinical trials. Analysis of transcripts of audio-recorded interviews was informed by the principles of the constant comparative method, elements of content analysis and informant triangulation.We interviewed 21 chief investigators, 10 trial managers and 17 PPI contributors from 28 trials. The accounts of informants within the same trials were largely in agreement. Over half the informants indicted PPI had made a difference within a trial, through contributions that influenced either an aspect of a trial, or how researchers thought about a trial. According to informants, the opportunity for PPI to make a difference was influenced by two main factors: whether chief investigators had goals and plans for PPI and the quality of the relationship between the research team and the PPI contributors. Early involvement of PPI contributors and including them in responsive (e.g. advisory groups and managerial (e.g. trial management groups roles were more likely to achieve impact compared to late involvement and oversight roles (e.g. trial steering committees.Those seeking to enhance PPI in trials should develop goals for PPI at an early stage that fits the needs of the trial, plan PPI implementation in accordance with these goals, invest in developing good relationships between PPI contributors and researchers, and favour responsive and managerial roles for contributors in preference to oversight-only roles. These features could be used by research funders in judging PPI in trial grant applications and to inform policies to optimise PPI within trials.

  2. Call Forecasting for Inbound Call Center

    Directory of Open Access Journals (Sweden)

    Peter Vinje

    2009-01-01

    Full Text Available In a scenario of inbound call center customer service, the ability to forecast calls is a key element and advantage. By forecasting the correct number of calls a company can predict staffing needs, meet service level requirements, improve customer satisfaction, and benefit from many other optimizations. This project will show how elementary statistics can be used to predict calls for a specific company, forecast the rate at which calls are increasing/decreasing, and determine if the calls may stop at some point.

  3. How Do School-Based Prevention Programs Impact Teachers? Findings from a Randomized Trial of an Integrated Classroom Management and Social-Emotional Program.

    Science.gov (United States)

    Domitrovich, Celene E; Bradshaw, Catherine P; Berg, Juliette K; Pas, Elise T; Becker, Kimberly D; Musci, Rashelle; Embry, Dennis D; Ialongo, Nicholas

    2016-04-01

    A number of classroom-based interventions have been developed to improve social and behavioral outcomes for students, yet few studies have examined how these programs impact the teachers who are implementing them. Impacts on teachers may affect students and therefore also serve as an important proximal outcome to examine. The current study draws upon data from a school-based randomized controlled trial testing the impact of two prevention programs. In one intervention condition, teachers were trained in the classroom behavior management program, PAX Good Behavior Game (PAX GBG). In a second intervention condition, teachers were trained to use an integrated program, referred to as PATHS to PAX, of the PAX GBG and a social and emotional learning curriculum called Promoting Alternative Thinking Strategies (PATHS©). This study aimed to determine whether both interventions positively impacted teachers, with a particular interest in the teachers' own beliefs and perceptions regarding self-efficacy, burnout, and social-emotional competence. The sample included 350 K-5 teachers across 27 schools (18 schools randomized to intervention, 9 to control). Multilevel latent growth curve analyses indicated that the PATHS to PAX condition generally demonstrated the most benefits to teachers, relative to both the control and PAX GBG conditions. These findings suggest that school-based preventive interventions can have a positive impact on teachers' beliefs and perceptions, particularly when the program includes a social-emotional component. Several possible mechanisms might account for the added benefit to teachers. Additional research is needed to better understand how these programs impact teachers, as well as students. PMID:26749578

  4. Impact of pedometer-based walking on menopausal women's sleep quality: a randomized controlled trial.

    Science.gov (United States)

    Tadayon, M; Abedi, P; Farshadbakht, F

    2016-08-01

    Objective Sleep disturbances are one of the most common psycho-physiological issues among postmenopausal women. This study was designed to evaluate the impact of walking with a pedometer on the sleep quality of postmenopausal Iranian women. Methods This randomized, controlled trial was conducted on 112 women who were randomly assigned to two groups. The women in the intervention group (n = 56) were asked to walk with a pedometer each day for 12 weeks and to increase their walking distance by 500 steps per week. A sociodemographic instrument and the Pittsburgh Sleep Quality Index were used to collect data. Sleep quality was measured at baseline, 4, 8, and 12 weeks after intervention. The control group (n = 56) did not receive any intervention. Results After 12 weeks, subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction improved to a significantly greater extent in the intervention group than in the control group (p sleep quality score was significantly higher in the intervention group than in the control group (0.64 vs. 0.98, p = 0.001). Conclusion This study showed that walking with a pedometer is an easy and cost-effective way to improve the quality of sleep among postmenopausal women. Use of this method in public health centers is recommended. PMID:26757356

  5. Protein kinase G signaling in cardiac pathophysiology: Impact of proteomics on clinical trials.

    Science.gov (United States)

    Kirk, Jonathan A; Holewinski, Ronald J; Crowgey, Erin L; Van Eyk, Jennifer E

    2016-03-01

    The protective role of cyclic guanosine monophosphate (cGMP)-stimulated protein kinase G (PKG) in the heart makes it an attractive target for therapeutic drug development to treat a variety of cardiac diseases. Phosphodiesterases degrade cGMP, thus phosphodiesterase inhibitors that can increase PKG are of translational interest and the subject of ongoing human trials. PKG signaling is complex, however, and understanding its downstream phosphorylation targets and upstream regulation are necessary steps toward safe and efficacious drug development. Proteomic technologies have paved the way for assays that allow us to peer broadly into signaling minutia, including protein quantity changes and phosphorylation events. However, there are persistent challenges to the proteomic study of PKG, such as the impact of the expression of different PKG isoforms, changes in its localization within the cell, and alterations caused by oxidative stress. PKG signaling is also dependent upon sex and potentially the genetic and epigenetic background of the individual. Thus, the rigorous application of proteomics to the field will be necessary to address how these effectors can alter PKG signaling and interfere with pharmacological interventions. This review will summarize PKG signaling, how it is being targeted clinically, and the proteomic challenges and techniques that are being used to study it. PMID:26670943

  6. Initial data report in response to the surplus plutonium disposition environmental impact statement data call for the UO2 supply. Revision 1

    International Nuclear Information System (INIS)

    The purpose of this document is to support the US Department of Energy (DOE) Fissile Materials Disposition Program's preparation of the draft Surplus Plutonium Disposition Environmental Impact Statement. This is one of several responses to data calls generated to provide background information on activities associated with the operation of the Mixed-Oxide (MOX) Fuel Fabrication Facility. Urania feed for the MOX Fuel Fabrication Facility may be either natural or depleted. Natural uranium typically contains 0.0057 wt% 234U, 0.711 wt% 235U, and the majority as 238U. The fissile isotope is 235U, and uranium is considered depleted if the total 235U content is less than 0.711 wt% as found in nature. The average composition of 235U in DOE's total depleted urania inventory is 0.20 wt%. The depleted uranium assay range proposed for use in this program is 0.2500--0.2509 wt%. Approximately 30% more natural uranium would be required than depleted uranium based on the importance of maintaining a specific fissile portion in the MOX fuel blend. If the uranium component constitutes a larger quantity of fissile material, less plutonium can be dispositioned on an annual basis. The percentage composition, referred to as assay, of low-enriched uranium necessary for controlled fission in commercial light-water nuclear power reactors is 1.8--5.0 wt% 235U. This data report provides information on the schedule, acquisition, impacts, and conversion process for using uranium, derived from depleted uranium hexafluoride (UF6), as the diluent for the weapons-grade plutonium declared as surplus. The case analyzed is use of depleted UF6 in storage at the Portsmouth Gaseous Diffusion Plant in Piketon, Ohio, being transported to a representative UF6 to uranium dioxide conversion facility (GE Nuclear Energy) for processing, and subsequently transported to the MOX Fuel Fabrication Facility

  7. [Positive impact on the Expanded Program on Immunization when sending call-back SMS through a Computerized Immunization Register, Bobo Dioulasso (Burkina Faso)].

    Science.gov (United States)

    Schlumberger, M; Bamoko, A; Yaméogo, T M; Rouvet, F; Ouedraogo, R; Traoré, B; Tinto, M; Bakyono, J F; Sombie, I; Bazié, B B; Ganama, S; Savadogo, Y; Yelkoumi, G A

    2015-12-01

    The impact of a Computerized Immunization Register (CIR) on Expanded Program on Immunization (EPI), with sending SMS to parents before immunization sessions, has never been studied in sub-Saharan Africa. The objective of this study is to measure EPI quickness and completeness of vaccinations after sending call-back SMS to parents through CIR put in place in a health center. In a health center, chosen at random (Colma 1) in the city of Bobo Dioulasso, Burkina Faso, West Africa, mothers, at first EPI session, if they had a mobile phone available at hand or in her surrounding, were randomized for receiving, or not, a call-back SMS before following EPI sessions, after child registration on a Francophone CIR (Siloxane's Intervax ©). Mothers, which were sent SMS and did not correctly followed sessions were asked through mobile phone why their child was late for EPI. 523 newborns were included in the study, with 253 whose parents were sent SMS, and 268 being informed of sessions only by ordinary methods. At second EPI session at 2 months of age, there was a statistical significant increase of coverage for children whose parents received SMS (pSMS (p=0.03). At third EPI session at 3 months of age, attendance to EPI for children whose parents were sent SMS was significantly better (pSMS (p=0.02). At fourth EPI session at 4 months of age, attendance for children with SMS was significantly better for children whose parents were sent SMS (pSMS, 19 (19%) parents could not be reached on the telephone. 31/82 (38%) mothers had shifted for EPI to a more proximate vaccination center (Colma 2), and 5 (6%) to private or civil servants clinic. 14/82 (17%) mothers had been travelling far from health center. Ten (12%) admitted neglect of EPI sessions. Two (2%) children had deceased, and one mother did not come back to Colma 1 after her child's AEFI. One child has been dismissed two times of vaccination following recommendation not to open a measles multi-dose vial for a single child

  8. Impact of copula directional specification on multi-trial evaluation of surrogate endpoints

    OpenAIRE

    Renfro, Lindsay A.; Shang, Hongwei; Sargent, Daniel J

    2015-01-01

    Evaluation of surrogate endpoints using patient-level data from multiple trials is the gold standard, where multi-trial copula models are used to quantify both patient-level and trial-level surrogacy. While limited consideration has been given in the literature to copula choice (e.g., Clayton), no prior consideration has been given to direction of implementation (via survival versus distribution functions). We demonstrate that evenwith the “correct” copula family, directional misspecification...

  9. Maximising the impact of qualitative research in feasibility studies for randomised controlled trials: guidance for researchers

    OpenAIRE

    O’Cathain, A.; Hoddinott, P.; Lewin, S; Thomas, K J; Young, B; Adamson, J.; Jansen, J.F.M.; Mills, N; Moore, G.; Donovan, J.L.

    2015-01-01

    Feasibility studies are increasingly undertaken in preparation for randomised controlled trials in order to explore uncertainties and enable trialists to optimise the intervention or the conduct of the trial. Qualitative research can be used to examine and address key uncertainties prior to a full trial. We present guidance that researchers, research funders and reviewers may wish to consider when assessing or undertaking qualitative research within feasibility studies for randomised controll...

  10. Impact of sham-controlled vertebroplasty trials on referral patterns at two academic medical centers

    OpenAIRE

    Lindsey, Sara S.; Kallmes, David F.; Opatowsky, Michael J.; Broyles, Elizabeth A.; Layton, Kennith F.

    2013-01-01

    Debate persists regarding the merit of vertebroplasty following publication of blinded vertebroplasty trials in 2009, one of which was the Investigational Vertebroplasty Efficacy and Safety Trial (INVEST). This study was performed to determine whether referring physicians at two academic medical centers were aware of the trial results and to assess if this awareness prompted a change in their treatment of osteoporotic fractures. E-mail surveys were distributed to physicians within the Mayo Cl...

  11. The impact of trial runs on the acceptability of pigouvian taxes: experimental evidence

    Energy Technology Data Exchange (ETDEWEB)

    Cherry, Todd L.; Kallbekken, Steffen; Kroll, Stephen

    2011-07-01

    This paper examines the political difficulty of enacting welfare-enhancing Pigouvian taxes. Using referenda in a market experiment with externalities, we investigate the effect of trial periods on the acceptability of two theoretically equivalent variants of Pigouvian taxes. While implementing either tax is in subjects material self-interest, we find significant levels of opposition to both tax schemes, though the level differs considerably. Results show that trial runs can overcome initial tax aversion, significantly increasing acceptability. The effect is robust across tax schemes, but a trial with one scheme does not affect the acceptability of the other. Trial periods also mitigate initial biases in preferences of alternative tax schemes. (auth)

  12. Conflicts of interest at medical journals: the influence of industry-supported randomised trials on journal impact factors and revenue - cohort study

    DEFF Research Database (Denmark)

    Lundh, Andreas; Barbateskovic, Marija; Hróbjartsson, Asbjørn;

    2010-01-01

    transparency in reporting of conflict of interest is an increasingly important aspect of publication in medical journals. Publication of large industry-supported trials may generate many citations and journal income through reprint sales and thereby be a source of conflicts of interest for journa....... We investigated industry-supported trials' influence on journal impact factors and revenue....

  13. Conflicts of interest at medical journals: the influence of industry-supported randomised trials on journal impact factors and revenue - cohort study

    DEFF Research Database (Denmark)

    Lundh, Andreas; Barbateskovic, Marija; Hróbjartsson, Asbjørn;

    2010-01-01

    transparency in reporting of conflict of interest is an increasingly important aspect of publication in medical journals. Publication of large industry-supported trials may generate many citations and journal income through reprint sales and thereby be a source of conflicts of interest for journals....... We investigated industry-supported trials' influence on journal impact factors and revenue....

  14. Impact assessment of the European Clinical Trials Directive: a longitudinal, prospective, observational study analyzing patterns and trends in clinical drug trial applications submitted since 2001 to regulatory agencies in six EU countries

    Directory of Open Access Journals (Sweden)

    Hartmann Markus

    2012-04-01

    Full Text Available Abstract Background Shifts in clinical trial application rates over time indicate if the attractiveness of a country or region for the conduct of clinical trials is growing or decreasing. The purpose of this observational study was to track changes in drug trial application patterns across several EU countries in order to analyze the medium-term impact of the EU Clinical Trials Directive 2001/20/EC on the conduct of drug trials. Methods Rates of Clinical Trial Applications (CTA for studies with medicinal products in those six countries in the EU, which authorize on average more than 500 trials per year, were analyzed. Publicly available figures on the number of annually submitted CTA, the distribution of trials per phase and the type of sponsorship were tracked; missing data were provided by national drug agencies. Results Since 2001, the number of CTA in Italy and Spain increased significantly (5.0 and 2.5% average annual growth. For Italy, the gain was driven by a strong increase of applications from academic trial sponsors; Spain's growth was due to a rise in trials run by commercial sponsors. The Netherlands, Germany, France and the UK saw a decline (1.9, 2.3, 3.0 and 5.3% average annual diminution; significant (P Conclusions The EU Clinical Trials Directive 2001/20/EC did not achieve the harmonization of clinical trial requirements across Europe. Rather, it resulted in the leveling of clinical trial activities caused by a continuing decrease in CTA rates in the Netherlands, Germany, France and the UK. Southern European countries, Italy and Spain, benefited to some extent from policy changes introduced by the Directive. In Italy's case, national funding measures helped to considerably promote the conduct of non-commercial trials. On the other hand, the EU Directive-driven transition from liberal policy environments, based on non-explicit trial approval through notifications, towards red-taped processes of trial authorization, contributed to

  15. Impact of treatment with rosuvastatin and atorvastatin on cardiovascular outcomes: evidence from the Archimedes-simulated clinical trials

    Directory of Open Access Journals (Sweden)

    Colivicchi F

    2015-11-01

    Full Text Available Furio Colivicchi,1 Catarina Sternhufvud,2 Sanjay K Gandhi3 1Cardiology Division, Emergency Department, San Filippo Neri Hospital, ASL Roma E, Rome, Italy; 2Global Payer Evidence and Pricing, AstraZeneca R&D, Mölndal, Sweden; 3Global Health Economics and Outcomes Research, TEVA Pharmaceuticals, Frazer, PA, United States Objective: No clinical trials have been conducted to directly compare the effect of the two high-intensity statins, rosuvastatin and atorvastatin, on cardiovascular outcomes. However, three such trials have been computer-simulated using the Archimedes model, an individual-based simulation of human physiology and behaviors, treatment interventions, and health care systems. The results are reviewed here.Methods: The first simulated trial assessed clinical outcomes in patients receiving available doses of the two drugs. The second assessed the impact of initial treatment decisions, while the third assessed the effect of switching from rosuvastatin to atorvastatin.Results: In the first simulated trial, treatment with rosuvastatin was estimated to result in greater reductions than treatment with atorvastatin in major adverse cardiac event (MACE rates at 5 years and 20 years at all doses examined (relative risk [RR]: 0.897, 0.888, and 0.930 at 5 years for rosuvastatin 20 mg vs atorvastatin 40 mg, rosuvastatin 40 mg vs atorvastatin 80 mg, and rosuvastatin 20 mg vs atorvastatin 80 mg, respectively; all P<0.05. In the second simulated trial, outcomes were significantly better in patients initially prescribed rosuvastatin than in those initially prescribed atorvastatin (RR of MACE at 5 years: 0.918; P<0.001. In the third simulated trial, risk of MACE was significantly greater in patients switching from rosuvastatin to atorvastatin than in those remaining on rosuvastatin (RR at 5 years: 1.109; P<0.001.Conclusion: The results of these simulated clinical trials suggest improved outcomes among patients receiving rosuvastatin relative to

  16. The impact of negative forensic evidence on mock jurors' perceptions of a trial of drug-facilitated sexual assault.

    Science.gov (United States)

    Jenkins, Gwen; Schuller, Regina A

    2007-08-01

    Legal concerns with regard to the adverse impact of a negative toxicological screening for date-rape drugs in a case of drug-facilitated sexual assault (DFSA) were the focus of a recent Canadian case (R. v. Alouache, 2003). To assess the impact of a negative forensic report, as well as the impact of expert testimony explaining the many factors that may contribute to a negative outcome, participants (N=171) received a written trial stimulus in which the forensic evidence (negative report, negative report plus expert testimony, no negative report and no expert testimony control) and the complainant's beverage consumption (alcohol, cola) were systematically varied. Results indicate that a negative finding in the absence of expert testimony produced greater verdict leniency and more favourable evaluations of the defendant's case. In contrast, no differences were found between the case in which the expert testified and a case in which the negative report and expert testimony were omitted. PMID:17211690

  17. Protecting intellectual property associated with Canadian academic clinical trials - approaches and impact

    Directory of Open Access Journals (Sweden)

    Ross Sue

    2012-12-01

    Full Text Available Abstract Intellectual property is associated with the creative work needed to design clinical trials. Two approaches have developed to protect the intellectual property associated with multicentre trial protocols prior to site initiation. The ‘open access’ approach involves publishing the protocol, permitting easy access to the complete protocol. The main advantages of the open access approach are that the protocol is freely available to all stakeholders, permitting them to discuss the protocol widely with colleagues, assess the quality and rigour of the protocol, determine the feasibility of conducting the trial at their centre, and after trial completion, to evaluate the reported findings based on a full understanding of the protocol. The main potential disadvantage of this approach is the potential for plagiarism; however if that occurred, it should be easy to identify because of the open access to the original trial protocol, as well as ensure that appropriate sanctions are used to deal with plagiarism. The ‘restricted access’ approach involves the use of non-disclosure agreements, legal documents that must be signed between the trial lead centre and collaborative sites. Potential sites must guarantee they will not disclose any details of the study before they are permitted to access the protocol. The main advantages of the restricted access approach are for the lead institution and nominated principal investigator, who protect their intellectual property associated with the trial. The main disadvantages are that ownership of the protocol and intellectual property is assigned to the lead institution; defining who ‘needs to know’ about the study protocol is difficult; and the use of non-disclosure agreements involves review by lawyers and institutional representatives at each site before access is permitted to the protocol, significantly delaying study implementation and adding substantial indirect costs to research institutes

  18. Protecting intellectual property associated with Canadian academic clinical trials--approaches and impact.

    Science.gov (United States)

    Ross, Sue; Magee, Laura; Walker, Mark; Wood, Stephen

    2012-01-01

    Intellectual property is associated with the creative work needed to design clinical trials. Two approaches have developed to protect the intellectual property associated with multicentre trial protocols prior to site initiation. The 'open access' approach involves publishing the protocol, permitting easy access to the complete protocol. The main advantages of the open access approach are that the protocol is freely available to all stakeholders, permitting them to discuss the protocol widely with colleagues, assess the quality and rigour of the protocol, determine the feasibility of conducting the trial at their centre, and after trial completion, to evaluate the reported findings based on a full understanding of the protocol. The main potential disadvantage of this approach is the potential for plagiarism; however if that occurred, it should be easy to identify because of the open access to the original trial protocol, as well as ensure that appropriate sanctions are used to deal with plagiarism. The 'restricted access' approach involves the use of non-disclosure agreements, legal documents that must be signed between the trial lead centre and collaborative sites. Potential sites must guarantee they will not disclose any details of the study before they are permitted to access the protocol. The main advantages of the restricted access approach are for the lead institution and nominated principal investigator, who protect their intellectual property associated with the trial. The main disadvantages are that ownership of the protocol and intellectual property is assigned to the lead institution; defining who 'needs to know' about the study protocol is difficult; and the use of non-disclosure agreements involves review by lawyers and institutional representatives at each site before access is permitted to the protocol, significantly delaying study implementation and adding substantial indirect costs to research institutes. This extra step may discourage sites from

  19. Quality improvements in prostate radiotherapy: outcomes and impact of comprehensive quality assurance during the TROG 03.04 'RADAR' trial

    International Nuclear Information System (INIS)

    The Trans-Tasman Radiation Oncology Group 03.04 'Randomised Androgen Deprivation and Radiotherapy' multicentre prostate cancer trial examined the optimal duration of androgen deprivation in combination with dose-escalated radiotherapy. Rigorous quality assurance (QA) processes were undertaken to ensure the validity and reliability of the radiation therapy treatment plan data. QA processes included a planning benchmarking exercise and a periodic audit of target and normal tissue delineation. Centralised electronic review of digital plan data for external-beam radiotherapy was undertaken to detect protocol variations. The impact of clinical factors and feedback to submitting centres during the trial on variation rates was investigated. Twenty-three centres across Australia and New Zealand recruited 1071 participants to the trial. Treatment plans for 754 participants receiving external-beam treatment alone were reviewed. From these, 1185 minor and 86 major variations were identified, leading to feedback to treating centres to reduce variations for subsequent patients' treatment and plans, suggesting improvement in treatment quality through these QA programs. Participant anatomical factors (delineated clinical target volume and rectal volume) and treatment planning factors (beam energy, beam definition and patient position orientation) were found to significantly impact variation rates. The dummy run demonstrated disagreement in identification of the base of the prostate and the superior extent of the rectum. Feedback from the periodic audit led to a change of practice at five contributing centres. he application of a suite of complementary QA activities allows the quality of trial data to be optimised and quantified, and can provide a catalyst for reforming treatment practices.

  20. The acceptability and impact of a randomised controlled trial of welfare rights advice accessed via primary health care: qualitative study

    Directory of Open Access Journals (Sweden)

    Howel Denise

    2006-06-01

    Full Text Available Abstract Background Qualitative research is increasingly used alongside randomised controlled trials (RCTs to study a range of factors including participants' experiences of a trial. The need for a sound evidence base within public health will increase the need for RCTs of non-clinical interventions. Welfare rights advice has been proposed as an intervention with potential to reduce health inequalities. This qualitative study, nested within an RCT of the impact of welfare rights advice, examined the acceptability of the intervention, the acceptability of the research process and the perceived impact of the intervention. Methods 25 men and women aged 60 years or over were recruited from four general practices in Newcastle upon Tyne (UK, a sub-sample of those who consented to be contacted (n = 96 during the RCT baseline interview. Semi-structured interviews were undertaken and analysed using the Framework Method. Results Participants viewed the trial positively although, despite agreeing that the information leaflet was clear, some had agreed to participate without being fully aware of what was involved. Some participants were unaware of the implications of randomisation. Most thought it fair, but a few concerns were raised about the control condition. The intervention was acceptable and made participants feel confident about applying for benefit entitlements. 14 out of 25 participants received some financial award; median weekly income gain was £57 (€84, $101. The perceived impact of additional finances was considerable and included: increased affordability of necessities and occasional expenses; increased capacity to deal with emergencies; and a reduction in stress related to financial worries. Overall, perceived independence and ability to participate in society increased. Most participants perceived benefits to their mental well-being, but no-one reported an improvement in physical health. The RCT showed little or no effect on a wide range

  1. Impact of Video Self-Monitoring with Graduated Training on Implementation of Embedded Instructional Learning Trials

    Science.gov (United States)

    Bishop, Crystal D.; Snyder, Patricia A.; Crow, Robert E.

    2015-01-01

    We used a multi-component single-subject experimental design across three preschool teachers to examine the effects of video self-monitoring with graduated training and feedback on the accuracy with which teachers monitored their implementation of embedded instructional learning trials. We also examined changes in teachers' implementation of…

  2. Assessing Impact and Bridging Methodological Divides: Randomized Trials in Countries Affected by Conflict

    Science.gov (United States)

    Burde, Dana

    2012-01-01

    Randomized trials have experienced a marked surge in endorsement and popularity in education research in the past decade. This surge reignited paradigm debates and spurred qualitative critics to accuse these experimental designs of eclipsing qualitative research. This article reviews a current iteration of this debate and examines two randomized…

  3. Web Call Example Application

    OpenAIRE

    Li, Shanbo

    2009-01-01

    Web Call Example Application from Ericsson Developer Connection is an application that hosted at a web server and supplies functionality of VoIP phone calls. Users can access the service from desktop browser, mobile phone browser or Java ME Client. Users can also manage their contact books. Each user can have more than one VoIP service accounts, so they can choose the cheapest on when they make phone call. The Web Call Example Application supports two kinds of VoIP phone call connection: Rela...

  4. Leveraging microfinance to impact HIV and financial behaviors among adolescents and their mothers in West Bengal: a cluster randomized trial.

    Science.gov (United States)

    Spielberg, Freya; Crookston, Benjamin T; Chanani, Sheila; Kim, Jaewhan; Kline, Sean; Gray, Bobbi L

    2013-01-01

    Microfinance can be used to reach women and adolescent girls with HIV prevention education. We report findings from a cluster-randomized control trial among 55 villages in West Bengal to determine the impact of non-formal education on knowledge, attitudes and behaviors for HIV prevention and savings. Multilevel regression models were used to evaluate differences between groups for key outcomes while adjusting for cluster correlation and differences in baseline characteristics. Women and girls who received HIV education showed significant gains in HIV knowledge, awareness that condoms can prevent HIV, self-efficacy for HIV prevention, and confirmed use of clean needles, as compared to the control group. Condom use was rare and did not improve for women. While HIV testing was uncommon, knowledge of HIV-testing resources significantly increased among girls, and trended in the positive direction among women in intervention groups. Conversely, the savings education showed no impact on financial knowledge or behavior change. PMID:23324373

  5. Impact of treatment planning and delivery factors on gastrointestinal toxicity: an analysis of data from the RADAR prostate radiotherapy trial

    International Nuclear Information System (INIS)

    To assess the impact of incremental modifications of treatment planning and delivery technique, as well as patient anatomical factors, on late gastrointestinal toxicity using data from the TROG 03.04 RADAR prostate radiotherapy trial. The RADAR trial accrued 813 external beam radiotherapy participants during 2003–2008 from 23 centres. Following review and archive to a query-able database, digital treatment plans and data describing treatment technique for 754 patients were available for analysis. Treatment demographics, together with anatomical features, were assessed using uni- and multivariate regression models against late gastrointestinal toxicity at 18-, 36- and 54-month follow-up. Regression analyses were reviewed in the context of dose-volume data for the rectum and anal canal. A multivariate analysis at 36-month follow-up shows that patients planned using a more rigorous dose calculation algorithm (DCA) was associated with a lower risk of stool frequency (OR: 0.435, CI: 0.242–0.783, corrected p = 0.04). Patients using laxative as a method of bowel preparation had higher risk of having increased stool frequency compared to patients with no dietary intervention (OR: 3.639, CI: 1.502–8.818, corrected p = 0.04). Despite higher risks of toxicities, the anorectum, anal canal and rectum dose-volume histograms (DVH) indicate patients using laxative had unremarkably different planned dose distributions. Patients planned with a more rigorous DCA had lower median DVH values between EQD23 = 15 Gy and EQD23 = 35 Gy. Planning target volume (PTV), conformity index, rectal width and prescription dose were not significant when adjusted for false discovery rate. Number of beams, beam energy, treatment beam definition, positioning orientation, rectum-PTV separation, rectal length and mean cross sectional area did not affect the risk of toxicities. The RADAR study dataset has allowed an assessment of technical modifications on gastrointestinal toxicity. A number of

  6. Impact of intermittent screening and treatment for malaria among school children in Kenya: a cluster randomised trial.

    Directory of Open Access Journals (Sweden)

    Katherine E Halliday

    2014-01-01

    Full Text Available BACKGROUND: Improving the health of school-aged children can yield substantial benefits for cognitive development and educational achievement. However, there is limited experimental evidence of the benefits of alternative school-based malaria interventions or how the impacts of interventions vary according to intensity of malaria transmission. We investigated the effect of intermittent screening and treatment (IST for malaria on the health and education of school children in an area of low to moderate malaria transmission. METHODS AND FINDINGS: A cluster randomised trial was implemented with 5,233 children in 101 government primary schools on the south coast of Kenya in 2010-2012. The intervention was delivered to children randomly selected from classes 1 and 5 who were followed up for 24 months. Once a school term, children were screened by public health workers using malaria rapid diagnostic tests (RDTs, and children (with or without malaria symptoms found to be RDT-positive were treated with a six dose regimen of artemether-lumefantrine (AL. Given the nature of the intervention, the trial was not blinded. The primary outcomes were anaemia and sustained attention. Secondary outcomes were malaria parasitaemia and educational achievement. Data were analysed on an intention-to-treat basis. During the intervention period, an average of 88.3% children in intervention schools were screened at each round, of whom 17.5% were RDT-positive. 80.3% of children in the control and 80.2% in the intervention group were followed-up at 24 months. No impact of the malaria IST intervention was observed for prevalence of anaemia at either 12 or 24 months (adjusted risk ratio [Adj.RR]: 1.03, 95% CI 0.93-1.13, p = 0.621 and Adj.RR: 1.00, 95% CI 0.90-1.11, p = 0.953 respectively, or on prevalence of P. falciparum infection or scores of classroom attention. No effect of IST was observed on educational achievement in the older class, but an apparent negative

  7. Intervention impact on depression product appraisal and purchasing behavior by employers: a randomized trial

    OpenAIRE

    Rost, Kathryn M.; Marshall, Donna; Xu, Stanley

    2014-01-01

    Background Employers can purchase high quality depression products that provide the type, intensity and duration of depression care management shown to improve work outcomes sufficiently for many employers to achieve a return on investment. The purpose of this randomized controlled trial was to test an intervention to encourage employers to purchase a high quality depression product for their workforce. Methods Twenty nine organizations recruited senior health benefit professional members rep...

  8. Community health and medical provision: impact on neonates (the CHAMPION trial)

    OpenAIRE

    Frost Chris; Jayanty Chitra; Figueiredo Ryan; Mukherjee Rohini; Mendiratta Tarana; Eble Alexander; Mann Vera; Boone Peter; Padmanabh M Reddy; Elbourne Diana

    2007-01-01

    Abstract Background The trial aims to evaluate whether neonatal mortality can be reduced through systemic changes to the provision and promotion of healthcare. Neonatal mortality rates in India are high compared to other low income countries, and there is a wide variation of rates across regions. There is evidence that relatively inexpensive interventions may be able to prevent up to 75% of these deaths. One area with a particularly high rate is Mahabubnagar District in Andhra Pradesh, where ...

  9. A randomized controlled trial evaluating the impact of knowledge translation and exchange strategies

    Directory of Open Access Journals (Sweden)

    O'Mara Linda

    2009-09-01

    Full Text Available Abstract Context Significant resources and time are invested in the production of research knowledge. The primary objective of this randomized controlled trial was to evaluate the effectiveness of three knowledge translation and exchange strategies in the incorporation of research evidence into public health policies and programs. Methods This trial was conducted with a national sample of public health departments in Canada from 2004 to 2006. The three interventions, implemented over one year in 2005, included access to an online registry of research evidence; tailored messaging; and a knowledge broker. The primary outcome assessed the extent to which research evidence was used in a recent program decision, and the secondary outcome measured the change in the sum of evidence-informed healthy body weight promotion policies or programs being delivered at health departments. Mixed-effects models were used to test the hypotheses. Findings One hundred and eight of 141 (77% health departments participated in this study. No significant effect of the intervention was observed for primary outcome (p e.g., value placed on research evidence in decision making. Conclusion The results of this study suggest that under certain conditions tailored, targeted messages are more effective than knowledge brokering and access to an online registry of research evidence. Greater emphasis on the identification of organizational factors is needed in order to implement strategies that best meet the needs of individual organizations. Trial Registration The trial registration number and title are as follows: ISRCTN35240937 -- Is a knowledge broker more effective than other strategies in promoting evidence-based physical activity and healthy body weight programming?

  10. Protocol for a randomised controlled trial examining the impact of a web-based personally controlled health management system on the uptake of influenza vaccination rates

    Directory of Open Access Journals (Sweden)

    Lau Annie Y S

    2012-04-01

    Full Text Available Abstract Background Online social networking and personally controlled health management systems (PCHMS offer a new opportunity for developing innovative interventions to prevent diseases of public health concern (e.g., influenza but there are few comparative studies about patterns of use and impact of these systems. Methods/Design A 2010 CONSORT-compliant randomised controlled trial with a two-group parallel design will assess the efficacy of a web-based PCHMS called Healthy.me in facilitating the uptake of influenza vaccine amongst university students and staff. Eligible participants are randomised either to obtain access to Healthy.me or a 6-month waitlist. Participants complete pre-study, post-study and monthly surveys about their health and utilisation of health services. A post-study clinical audit will be conducted to validate self-reports about influenza vaccination and visits to the university health service due to influenza-like illness (ILI amongst a subset of participants. 600 participants older than 18 years with monthly access to the Internet and email will be recruited. Participants who (i discontinue the online registration process; (ii report obtaining an influenza vaccination in 2010 before the commencement of the study; or (iii report being influenced by other participants to undertake influenza vaccination will be excluded from analysis. The primary outcome measure is the number of participants obtaining influenza vaccination during the study. Secondary outcome measures include: number of participants (i experiencing ILI symptoms, (ii absent from or experiencing impairment in work or study due to ILI symptoms, (iii using health services or medications due to ILI symptoms; (iv expressing positive or negative attitudes or experiences towards influenza vaccination, via their reasons of receiving (or not receiving influenza vaccine; and (v their patterns of usage of Healthy.me (e.g., frequency and timing of hits, duration of

  11. Does mass azithromycin distribution impact child growth and nutrition in Niger? A cluster-randomized trial.

    Directory of Open Access Journals (Sweden)

    Abdou Amza

    2014-09-01

    Full Text Available Antibiotic use on animals demonstrates improved growth regardless of whether or not there is clinical evidence of infectious disease. Antibiotics used for trachoma control may play an unintended benefit of improving child growth.In this sub-study of a larger randomized controlled trial, we assess anthropometry of pre-school children in a community-randomized trial of mass oral azithromycin distributions for trachoma in Niger. We measured height, weight, and mid-upper arm circumference (MUAC in 12 communities randomized to receive annual mass azithromycin treatment of everyone versus 12 communities randomized to receive biannual mass azithromycin treatments for children, 3 years after the initial mass treatment. We collected measurements in 1,034 children aged 6-60 months of age.We found no difference in the prevalence of wasting among children in the 12 annually treated communities that received three mass azithromycin distributions compared to the 12 biannually treated communities that received six mass azithromycin distributions (odds ratio = 0.88, 95% confidence interval = 0.53 to 1.49.We were unable to demonstrate a statistically significant difference in stunting, underweight, and low MUAC of pre-school children in communities randomized to annual mass azithromycin treatment or biannual mass azithromycin treatment. The role of antibiotics on child growth and nutrition remains unclear, but larger studies and longitudinal trials may help determine any association.

  12. Influence of pain and gender on impact loading during walking: a randomised trial

    DEFF Research Database (Denmark)

    Henriksen, Marius; Christensen, Robin; Alkjaer, Tine;

    2008-01-01

    -factor in development of knee osteoarthritis. Thus the purpose of this study was to investigate the influence of experimental muscle pain and gender on generation and attenuation of impact loading during walking. METHODS: Ten healthy males and 10 healthy females were recruited. Impact loadings during walking were......: Experimental muscle pain did not affect generation or attenuation of impact loading in either gender. While the impact loading magnitude was similar across genders, lower loading rates and more efficient attenuation were observed in females. INTERPRETATION: It is concluded that generation and attenuation...

  13. Effect of gender and call duration on customer satisfaction in call center big data

    OpenAIRE

    Quim Llimona; Jordi Luque; Xabier Anguera; Zoraida Hidalgo; Souneil Park; Nuria Oliver

    2015-01-01

    Customer center call data is typically collected by organizations and corporations in order to improve customer experience through the analysis of such call data. In this paper, we report our findings when analysing more than 26 thousand calls to the call centers of a large corporation in a Latin American country. We focus on the impact of gender and call duration on selfreported customer satisfaction. Speech-based gender detection technology is employed to automatically detect the gender...

  14. A call for better care: the impact of postnatal contact services on women’s parenting confidence and experiences of postpartum care in Queensland, Australia

    OpenAIRE

    Miller, Yvette D; Dane, Aimée C; Thompson, Rachel

    2014-01-01

    Background Universal postnatal contact services are provided in several Australian states, but their impact on women’s postnatal care experience has not been evaluated. Furthermore, there is lack of evidence or consensus about the optimal type and amount of postpartum care after hospital discharge for maternal outcomes. This study aimed to assess the impact of providing Universal Postnatal Contact Service (UPNCS) funding to public birthing facilities in Queensland, Australia on women’s postna...

  15. Evaluating research and impact: a bibliometric analysis of research by the NIH/NIAID HIV/AIDS clinical trials networks.

    Directory of Open Access Journals (Sweden)

    Scott R Rosas

    Full Text Available Evaluative bibliometrics uses advanced techniques to assess the impact of scholarly work in the context of other scientific work and usually compares the relative scientific contributions of research groups or institutions. Using publications from the National Institute of Allergy and Infectious Diseases (NIAID HIV/AIDS extramural clinical trials networks, we assessed the presence, performance, and impact of papers published in 2006-2008. Through this approach, we sought to expand traditional bibliometric analyses beyond citation counts to include normative comparisons across journals and fields, visualization of co-authorship across the networks, and assess the inclusion of publications in reviews and syntheses. Specifically, we examined the research output of the networks in terms of the a presence of papers in the scientific journal hierarchy ranked on the basis of journal influence measures, b performance of publications on traditional bibliometric measures, and c impact of publications in comparisons with similar publications worldwide, adjusted for journals and fields. We also examined collaboration and interdisciplinarity across the initiative, through network analysis and modeling of co-authorship patterns. Finally, we explored the uptake of network produced publications in research reviews and syntheses. Overall, the results suggest the networks are producing highly recognized work, engaging in extensive interdisciplinary collaborations, and having an impact across several areas of HIV-related science. The strengths and limitations of the approach for evaluation and monitoring research initiatives are discussed.

  16. Daily Pomegranate intake has no impact on PSA levels in patients with advanced prostate cancer - Results of a phase IIb randomized controlled trial

    OpenAIRE

    Stenner-Liewen, Frank; Liewen, Heike; Cathomas, Richard; Renner, Christoph; Petrausch, Ulf; Sulser, Tullio; Spanaus, Katharina; Seifert, Hans Helge; Strebel, Räto Thomas; Knuth, Alexander; Samaras, Panagiotis; Müntener, Michael

    2013-01-01

    Pomegranate has been shown to prolong PSA doubling time in early prostate cancer, but no data from a placebo controlled trial has been published yet. The objective of this study was to prospectively evaluate the impact of pomegranate juice in patients with prostate cancer. We conducted a phase IIb, double blinded, randomized placebo controlled trial in patients with histologically confirmed prostate cancer. Only patients with a PSA value ≥ 5ng/ml were included. The subjects consumed 500 ml of...

  17. Daily Pomegranate Intake Has No Impact on PSA Levels in Patients with Advanced Prostate Cancer - Results of a Phase IIb Randomized Controlled Trial

    OpenAIRE

    Stenner-Liewen, Frank; Liewen, Heike; Cathomas, Richard; Renner, Christoph; Petrausch, Ulf; Sulser, Tullio; Spanaus, Katharina; Seifert, Hans Helge; Strebel, Räto Thomas; Knuth, Alexander; Samaras, Panagiotis; Müntener, Michael

    2013-01-01

    Pomegranate has been shown to prolong PSA doubling time in early prostate cancer, but no data from a placebo controlled trial has been published yet. The objective of this study was to prospectively evaluate the impact of pomegranate juice in patients with prostate cancer. We conducted a phase IIb, double blinded, randomized placebo controlled trial in patients with histologically confirmed prostate cancer. Only patients with a PSA value ≥ 5ng/ml were included. The subjects consumed 500 ml of...

  18. Reducing the environmental impact of trials: a comparison of the carbon footprint of the CRASH-1 and CRASH-2 clinical trials

    Directory of Open Access Journals (Sweden)

    Roberts Ian

    2011-02-01

    Full Text Available Abstract Background All sectors of the economy, including the health research sector, must reduce their carbon emissions. The UK National Institute for Health Research has recently prepared guidelines on how to minimize the carbon footprint of research. We compare the carbon emissions from two international clinical trials in order to identify where emissions reductions can be made. Methods We conducted a carbon audit of two clinical trials (the CRASH-1 and CRASH-2 trials, quantifying the carbon dioxide emissions produced over a one-year audit period. Carbon emissions arising from the coordination centre, freight delivery, trial-related travel and commuting were calculated and compared. Results The total emissions in carbon dioxide equivalents during the one-year audit period were 181.3 tonnes for CRASH-1 and 108.2 tonnes for CRASH-2. In total, CRASH-1 emitted 924.6 tonnes of carbon dioxide equivalents compared with 508.5 tonnes for CRASH-2. The CRASH-1 trial recruited 10,008 patients over 5.1 years, corresponding to 92 kg of carbon dioxide per randomized patient. The CRASH-2 trial recruited 20,211 patients over 4.7 years, corresponding to 25 kg of carbon dioxide per randomized patient. The largest contributor to emissions in CRASH-1 was freight delivery of trial materials (86.0 tonnes, 48% of total emissions, whereas the largest contributor in CRASH-2 was energy use by the trial coordination centre (54.6 tonnes, 30% of total emissions. Conclusions Faster patient recruitment in the CRASH-2 trial largely accounted for its greatly increased carbon efficiency in terms of emissions per randomized patient. Lighter trial materials and web-based data entry also contributed to the overall lower carbon emissions in CRASH-2 as compared to CRASH-1. Trial Registration Numbers CRASH-1: ISRCTN74459797 CRASH-2: ISRCTN86750102

  19. The impact of text message reminders on adherence to antimalarial treatment in northern Ghana: a randomized trial.

    Directory of Open Access Journals (Sweden)

    Julia R G Raifman

    Full Text Available BACKGROUND: Low rates of adherence to artemisinin-based combination therapy (ACT regimens increase the risk of treatment failure and may lead to drug resistance, threatening the sustainability of current anti-malarial efforts. We assessed the impact of text message reminders on adherence to ACT regimens. METHODS: Health workers at hospitals, clinics, pharmacies, and other stationary ACT distributors in Tamale, Ghana provided flyers advertising free mobile health information to individuals receiving malaria treatment. The messaging system automatically randomized self-enrolled individuals to the control group or the treatment group with equal probability; those in the treatment group were further randomly assigned to receive a simple text message reminder or the simple reminder plus an additional statement about adherence in 12-hour intervals. The main outcome was self-reported adherence based on follow-up interviews occurring three days after treatment initiation. We estimated the impact of the messages on treatment completion using logistic regression. RESULTS: 1140 individuals enrolled in both the study and the text reminder system. Among individuals in the control group, 61.5% took the full course of treatment. The simple text message reminders increased the odds of adherence (adjusted OR 1.45, 95% CI [1.03 to 2.04], p-value 0.028. Receiving an additional message did not result in a significant change in adherence (adjusted OR 0.77, 95% CI [0.50 to 1.20], p-value 0.252. CONCLUSION: The results of this study suggest that a simple text message reminder can increase adherence to antimalarial treatment and that additional information included in messages does not have a significant impact on completion of ACT treatment. Further research is needed to develop the most effective text message content and frequency. TRIAL REGISTRATION: ClinicalTrials.gov NCT01722734.

  20. The Impact of Short-Term Video Games on Performance among Children with Developmental Delays: A Randomized Controlled Trial

    Science.gov (United States)

    Hsieh, Ru-Lan; Lee, Wen-Chung; Lin, Jui-Hsiang

    2016-01-01

    This prospective, randomized controlled study investigated the effects of short-term interactive video game playing among children with developmental delays participating in traditional rehabilitation treatment at a rehabilitation clinic. One hundred and one boys and 46 girls with a mean age of 5.8 years (range: 3 to 12 years) were enrolled in this study. All patients were confirmed to suffer from developmental delays, and were participating in traditional rehabilitation treatment. Children participated in two periods of 4 weeks each, group A being offered intervention of eight 30-minute sessions of interactive video games in the first period, and group B in the second, in addition to the traditional rehabilitation treatment. The physical, psychosocial, and total health of the children was periodically assessed using the parent-reported Pediatric Quality of Life Inventory-Generic Core Scales (PedsQL); and the children’s upper extremity and physical function, transfer and basic mobility, sports and physical functioning, and global functioning were assessed using the Pediatric Outcomes Data Collection Instrument. Parental impact was evaluated using the PedsQL-Family Impact Module for family function, PedsQL-Health Satisfaction questionnaire for parents’ satisfaction with their children’s care and World Health Organization-Quality of Life-Brief Version for quality of life. Compared with the baseline, significant improvements of physical function were observed in both groups (5.6 ± 19.5, p = 0.013; 4.7 ± 13.8, p = 0.009) during the intervention periods. No significant improvement of psychosocial health, functional performance, or family impact was observed in children with developmental delays. Short-term interactive video game play in conjunction with traditional rehabilitation treatment improved the physical health of children with developmental delays. Trial Registration: ClinicalTrials.gov NCT02184715 PMID:26983099

  1. Lactate threshold predicting time-trial performance: impact of heat and acclimation

    OpenAIRE

    Lorenzo, Santiago; Minson, Christopher T.; Babb, Tony G.; Halliwill, John R.

    2011-01-01

    The relationship between exercise performance and lactate and ventilatory thresholds under two distinct environmental conditions is unknown. We examined the relationships between six lactate threshold methods (blood- and ventilation-based) and exercise performance in cyclists in hot and cool environments. Twelve cyclists performed a lactate threshold test, a maximal O2 uptake (V̇o2max) test, and a 1-h time trial in hot (38°C) and cool (13°C) conditions, before and after heat acclimation. Eigh...

  2. A Calling-based Counterfactual Self:Concept,Formation and Impact%基于呼唤的假设自我:概念、形成与影响*

    Institute of Scientific and Technical Information of China (English)

    田喜洲

    2015-01-01

    呼唤( calling)是个体对追求目标的内心认同与强烈渴望,实现呼唤能使个体体验到更多的工作意义、个人使命与真实自我。但并非所有呼唤都能实现,曾经本可以选择但又放弃了呼唤的自我对现实自我、职业与生活有何影响?基于假设思维、自我概念和呼唤研究的已有成果,可以发现:(1)基于呼唤的假设自我( counterfactual self based on calling,CSC)是与事实自我并行的新构念;(2) CSC对呼唤与假设思维研究具有重要理论贡献;(3) CSC能对个人情感、认知、动机与行为产生直接影响。%Calling is an individual identity and a strong inner desire for the pursuit of one’s goals. A-chieving a calling allows an individual to experience the meaning of one’s work,mission and a true self. However,not all callings can be achieved,and what is the impact of the calling which you could have chosen but had to give up on your self-concept,career and life? Based on the counterfactual thinking,self-concept and calling-related researches,this paper argues that: ( a) counterfactual self based on calling( CSC) is a new construct paralleling actual self; ( b) CSC has contributed much to theoretical research of calling and counter-factual thinking; ( c) CSC can have direct impact on individual’emotion,cognition,motivation and behav-ior.

  3. Impact of Cocoa Consumption on Inflammation Processes—A Critical Review of Randomized Controlled Trials

    Directory of Open Access Journals (Sweden)

    Sabine Ellinger

    2016-05-01

    Full Text Available Background: Cocoa flavanols have strong anti-inflammatory properties in vitro. If these also occur in vivo, cocoa consumption may contribute to the prevention or treatment of diseases mediated by chronic inflammation. This critical review judged the evidence for such effects occurring after cocoa consumption. Methods: A literature search in Medline was performed for randomized controlled trials (RCTs that investigated the effects of cocoa consumption on inflammatory biomarkers. Results: Thirty-three RCTs were included, along with 9 bolus and 24 regular consumption studies. Acute cocoa consumption decreased adhesion molecules and 4-series leukotrienes in serum, nuclear factor κB activation in leukocytes, and the expression of CD62P and CD11b on monocytes and neutrophils. In healthy subjects and in patients with cardiovascular diseases, most regular consumption trials did not find any changes except for a decreased number of endothelial microparticles, but several cellular and humoral inflammation markers decreased in patients suffering from type 2 diabetes and impaired fasting glucose. Conclusions: Little evidence exists that consumption of cocoa-rich food may reduce inflammation, probably by lowering the activation of monocytes and neutrophils. The efficacy seems to depend on the extent of the basal inflammatory burden. Further well-designed RCTs with inflammation as the primary outcome are needed, focusing on specific markers of leukocyte activation and considering endothelial microparticles as marker of vascular inflammation.

  4. Impact of Cocoa Consumption on Inflammation Processes—A Critical Review of Randomized Controlled Trials

    Science.gov (United States)

    Ellinger, Sabine; Stehle, Peter

    2016-01-01

    Background: Cocoa flavanols have strong anti-inflammatory properties in vitro. If these also occur in vivo, cocoa consumption may contribute to the prevention or treatment of diseases mediated by chronic inflammation. This critical review judged the evidence for such effects occurring after cocoa consumption. Methods: A literature search in Medline was performed for randomized controlled trials (RCTs) that investigated the effects of cocoa consumption on inflammatory biomarkers. Results: Thirty-three RCTs were included, along with 9 bolus and 24 regular consumption studies. Acute cocoa consumption decreased adhesion molecules and 4-series leukotrienes in serum, nuclear factor κB activation in leukocytes, and the expression of CD62P and CD11b on monocytes and neutrophils. In healthy subjects and in patients with cardiovascular diseases, most regular consumption trials did not find any changes except for a decreased number of endothelial microparticles, but several cellular and humoral inflammation markers decreased in patients suffering from type 2 diabetes and impaired fasting glucose. Conclusions: Little evidence exists that consumption of cocoa-rich food may reduce inflammation, probably by lowering the activation of monocytes and neutrophils. The efficacy seems to depend on the extent of the basal inflammatory burden. Further well-designed RCTs with inflammation as the primary outcome are needed, focusing on specific markers of leukocyte activation and considering endothelial microparticles as marker of vascular inflammation. PMID:27240397

  5. Callings and Organizational Behavior

    Science.gov (United States)

    Elangovan, A. R.; Pinder, Craig C.; McLean, Murdith

    2010-01-01

    Current literature on careers, social identity and meaning in work tends to understate the multiplicity, historical significance, and nuances of the concept of calling(s). In this article, we trace the evolution of the concept from its religious roots into secular realms and develop a typology of interpretations using occupation and religious…

  6. Call Center Capacity Planning

    DEFF Research Database (Denmark)

    Nielsen, Thomas Bang

    The main topics of the thesis are theoretical and applied queueing theory within a call center setting. Call centers have in recent years become the main means of communication between customers and companies, and between citizens and public institutions. The extensively computerized infrastructure...

  7. Impact of an Educational Program to Reduce Healthcare Resources in Community-Acquired Pneumonia: The EDUCAP Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Jordi Adamuz

    Full Text Available Additional healthcare visits and rehospitalizations after discharge are frequent among patients with community-acquired pneumonia (CAP and have a major impact on healthcare costs. We aimed to determine whether the implementation of an individualized educational program for hospitalized patients with CAP would decrease subsequent healthcare visits and readmissions within 30 days of hospital discharge.A multicenter, randomized trial was conducted from January 1, 2011 to October 31, 2014 at three hospitals in Spain. We randomly allocated immunocompetent adults patients hospitalized for CAP to receive either an individualized educational program or conventional information before discharge. The educational program included recommendations regarding fluid intake, adherence to drug therapy and preventive vaccines, knowledge and management of the disease, progressive adaptive physical activity, and counseling for alcohol and smoking cessation. The primary trial endpoint was a composite of the frequency of additional healthcare visits and rehospitalizations within 30 days of hospital discharge. Intention-to-treat analysis was performed.We assigned 102 patients to receive the individualized educational program and 105 to receive conventional information. The frequency of the composite primary end point was 23.5% following the individualized program and 42.9% following the conventional information (difference, -19.4%; 95% confidence interval, -6.5% to -31.2%; P = 0.003.The implementation of an individualized educational program for hospitalized patients with CAP was effective in reducing subsequent healthcare visits and rehospitalizations within 30 days of discharge. Such a strategy may help optimize available healthcare resources and identify post-acute care needs in patients with CAP.Controlled-Trials.com ISRCTN39531840.

  8. Assessing the impact of a new delivery method of insulin on glycemic control using a novel trial design

    Directory of Open Access Journals (Sweden)

    Thomas Strack

    2009-01-01

    Full Text Available Thomas Strack1, Luc Martinez2, Stefano Del Prato3, Larry Blonde4, Burkhard Göke5, Vincent Woo6, Ann Millward7, Ramon Gomis8, Bill Canovatchel1, David Lawrence1, Nick Freemantle9 on behalf of the EXPERIENCE Trial Team1Pfizer Inc., New York, NY, USA; 2Société Française de Médecine Générale, Issy les Moulineaux, France; 3University of Pisa, Pisa, Italy; 4Ochsner Medical Center, New Orleans, LO, USA; 5University of Munich, Munich, Germany; 6Health Sciences Centre, Winnipeg, Canada; 7Peninsula Medical School, Plymouth, UK; 8University of Barcelona, Barcelona, Spain; 9University of Birmingham, Birmingham, UKObjective: The purpose of the trial was to examine the impact of inhaled human insulin (INH on patient or physician willingness to adopt insulin after oral diabetes agent failure.Research design and methods: The EXPERIENCE trial was a one-year randomized controlled trial conducted at primary, secondary and tertiary care facilities in Europe and North America. The primary study endpoint was difference in glycated hemoglobin (A1c between randomized groups at 26 weeks, and results from that phase have been reported previously. The present report concerns results from the second 26-week extension phase. We also consider the applicability of the design. The trial recruited 727 patients with type 2 diabetes mellitus who, prior to randomization, were using two or more oral diabetes agents and whose A1c was ≥8.0%. Patients were randomized to two treatment settings: Group 1 (usual care with the option of INH or Group 2 (usual care only. Usual care included adjusting oral therapy (optimizing current regimen or adding/deleting agents and/or initiating subcutaneous (SC insulin.Results: At baseline, insulin was initiated by more (odds ratio [OR] 6.0;95% confidence interval [CI] 4.2 to 8.8; P < 0.0001 patients in Group 1 (86.2%; 76.7% INH plus 9.5% SC than in Group 2 (50.7%; SC insulin only. The largest reduction from baseline in A1c was in Group 1 (

  9. Use of a multi-process phytoremediation system for decontamination of petroleum impacted soils : results of successful field trials

    Energy Technology Data Exchange (ETDEWEB)

    Greenberg, B.M.; Gurska, J.; Huang, X.D.; Gerhardt, K.E.; Yu, X.M.; Nykamp, J.; MacNeill, G.; Yang, S.; Lu, X.; Glick, B. [Waterloo Univ., ON (Canada). Dept. of Biology]|[Waterloo Environmental Biotechnology Inc., Hamilton, ON (Canada); Wang, W.; Knezevich, N. [Waterloo Univ., ON (Canada). Dept. of Biology; Gerwing, P.; Cryer, K. [Earthmaster Environmental Strategies Inc., Calgary, AB (Canada); Reid, N. [EBA Engineering Consultants Ltd., Edmonton, AB (Canada)

    2008-07-01

    The multi-process phytoremediation system (MPPS) was developed to degrade petroleum hydrocarbons (PHCs) in impacted soils. Phytoremediation of persistent contaminants in soils holds significant promise for rapid remediation kinetics. MPPS effectively removes polycyclic aromatic hydrocarbons (PAHs), total petroleum hydrocarbons (TPHs) and chlorinated hydrocarbons (CHCs) from soils. A plant growth promoting rhizobacteria interaction is the main element for success as it mitigates stress ethylene effects in plants, leading to high root biomass which, in turn, promotes growth of rhizosphere organisms. Field tests of the MPPS were initiated at a farm site in Sarnia, Ontario in the summer of 2004. The field was contaminated with petroleum hydrocarbons from refinery oil sludge. The second field trial was performed for 3 consecutive years at a petroleum contaminated biopile in Turner Valley, Alberta. The paper presented the results of the successful field tests of the MPPS. It was concluded that increased root biomass is achieved in the contaminated soils, which leads to more efficient and complete removal of TPHs in the field. Three years of field trials of the MPPS showed that remediation continues with successive seasons. 28 refs., 1 tab., 3 figs.

  10. Use of a multi-process phytoremediation system for decontamination of petroleum impacted soils : results of successful field trials

    International Nuclear Information System (INIS)

    The multi-process phytoremediation system (MPPS) was developed to degrade petroleum hydrocarbons (PHCs) in impacted soils. Phytoremediation of persistent contaminants in soils holds significant promise for rapid remediation kinetics. MPPS effectively removes polycyclic aromatic hydrocarbons (PAHs), total petroleum hydrocarbons (TPHs) and chlorinated hydrocarbons (CHCs) from soils. A plant growth promoting rhizobacteria interaction is the main element for success as it mitigates stress ethylene effects in plants, leading to high root biomass which, in turn, promotes growth of rhizosphere organisms. Field tests of the MPPS were initiated at a farm site in Sarnia, Ontario in the summer of 2004. The field was contaminated with petroleum hydrocarbons from refinery oil sludge. The second field trial was performed for 3 consecutive years at a petroleum contaminated biopile in Turner Valley, Alberta. The paper presented the results of the successful field tests of the MPPS. It was concluded that increased root biomass is achieved in the contaminated soils, which leads to more efficient and complete removal of TPHs in the field. Three years of field trials of the MPPS showed that remediation continues with successive seasons. 28 refs., 1 tab., 3 figs

  11. A blind trial evaluation of a crime scene methodology for deducing impact velocity and droplet size from circular bloodstains.

    Science.gov (United States)

    Hulse-Smith, Lee; Illes, Mike

    2007-01-01

    In a previous study, mechanical engineering models were utilized to deduce impact velocity and droplet volume of circular bloodstains by measuring stain diameter and counting spines radiating from their outer edge. A blind trial study was subsequently undertaken to evaluate the accuracy of this technique, using an applied, crime scene methodology. Calculations from bloodstains produced on paper, drywall, and wood were used to derive surface-specific equations to predict 39 unknown mock crime scene bloodstains created over a range of impact velocities (2.2-5.7 m/sec) and droplet volumes (12-45 microL). Strong correlations were found between expected and observed results, with correlation coefficients ranging between 0.83 and 0.99. The 95% confidence limit associated with predictions of impact velocity and droplet volume was calculated for paper (0.28 m/sec, 1.7 microL), drywall (0.37 m/sec, 1.7 microL), and wood (0.65 m/sec, 5.2 microL). PMID:17209911

  12. Impact of myocardial ischemia on myocardial revascularization in stable ischemic heart disease. Lessons from the COURAGE and FAME 2 trials.

    Science.gov (United States)

    Torosoff, M T; Sidhu, M S; Boden, W E

    2013-06-01

    In patients with stable ischemic heart disease (SIHD), myocardial revascularization should be performed to either improve survival or improve symptoms and functional status among patients who are not well controlled with optimal medical therapy (OMT). A general consensus exists on the core elements of OMT, which include both lifestyle intervention and intensive secondary prevention with proven pharmacotherapies. By contrast, however, there is less general agreement as to what constitutes the optimal approach to revascularization in SIHD patients. The COURAGE and FAME 2 randomized trials form the foundation of the current clinical evidence base and raise the important question: "What is the impact of myocardial ischemia on myocardial revascularization in stable ischemic heart disease?" PMID:23695652

  13. Randomized clinical trial on the use of antispasmodic drugs in barium enema: impact on radiological practice

    International Nuclear Information System (INIS)

    Purpose: To assess the willingness of radiologists to change their practice when the results of a randomized clinical trial (RCT) on the use of antispasmodic drugs in barium enema are presented. Materials and Methods: During the years 1994 and 1995 two postal questionnaires were sent to 481 practicing radiologists who were all members of the Netherlands Society of Radiology. In the first questionnaire the respondents were asked to give the characteristics of their practices in performing daily barium enema. The data from this questionnaire was used as a reference. The second questionnaire was sent to the respondents together with an abstract on the randomized clinical trial supporting the use of antispasmodic drugs in barium enema. We also indicated a preference for Buscopan over Glucagon as the antispasmodic drug. The willingness to change prescription habits was measured by comparing the data of the two questionnaires. Results: Of 481 practicing radiologists, 312 responded to the first questionnaire and gave information of their prescription habits (response rate 64%). These 312 responders were sent an abstract of the RCT and were asked to fill out a second questionnaire to determine their willingness to change their practice. Two hundred and sixty-seven radiologists responded (response rate 86%). A significant number of 119 (51%) were willing to increase the use of antispasmodic drugs. A significant number of 128 (55%) chose to increase the use of Buscopan, while a significant number of 81 (32%) were willing to decrease the use of Glucagon. Conclusion: Direct exposure to the results of an RCT recommending the use of antispasmodic drugs in barium enema, especially Buscopan, is likely to increase its use by practicing radiologists

  14. How should the impact of different presentations of treatment effects on patient choice be evaluated? A pilot randomized trial.

    Directory of Open Access Journals (Sweden)

    Cheryl Carling

    Full Text Available BACKGROUND: Different presentations of treatment effects can affect decisions. However, previous studies have not evaluated which presentations best help people make decisions that are consistent with their own values. We undertook a pilot study to compare different methods for doing this. METHODS AND FINDINGS: We conducted an Internet-based randomized trial comparing summary statistics for communicating the effects of statins on the risk of coronary heart disease (CHD. Participants rated the relative importance of treatment consequences using visual analogue scales (VAS and category rating scales (CRS with five response options. We randomized participants to either VAS or CRS first and to one of six summary statistics: relative risk reduction (RRR and five absolute measures of effect: absolute risk reduction, number needed to treat, event rates, tablets needed to take, and natural frequencies (whole numbers. We used logistic regression to determine the association between participants' elicited values and treatment choices. 770 participants age 18 or over and literate in English completed the study. In all, 13% in the VAS-first group failed to complete their VAS rating, while 9% of the CRS-first group failed to complete their scoring (p = 0.03. Different ways of weighting the elicited values had little impact on the analyses comparing the different presentations. Most (51% preferred the RRR compared to the other five summary statistics (1% to 25%, p = 0.074. However, decisions in the group presented the RRR deviated substantially from those made in the other five groups. The odds of participants in the RRR group deciding to take statins were 3.1 to 5.8 times that of those in the other groups across a wide range of values (p = 0.0007. Participants with a scientific background, who were more numerate or had more years of education were more likely to decide not to take statins. CONCLUSIONS: Internet-based trials comparing different presentations

  15. Randomized Trial of a Statewide Home Visiting Program: Impact in Preventing Child Abuse and Neglect

    Science.gov (United States)

    Duggan, Anne; McFarlane, Elizabeth; Fuddy, Loretta; Burrell, Lori; Higman, Susan M.; Windham, Amy; Sia, Calvin

    2004-01-01

    Objectives: To assess the impact of home visiting in preventing child abuse and neglect in the first 3 years of life in families identified as at-risk of child abuse through population-based screening at the child's birth. Methods: This experimental study focused on Hawaii Healthy Start Program (HSP) sites operated by three community-based…

  16. Influence of pain and gender on impact loading during walking: A randomised trial

    DEFF Research Database (Denmark)

    Henriksen, M.; Christensen, R.; Alkjaer, T.;

    2008-01-01

    Background. Knee joint ostcoarthritis is painful and with an overweight of female incidence. The cardinal symptom is pain, which Causes compensatory gait changes, and gender differences in pain sensitivity exist. Impact loadings at heel strike during walking are suspected as a co-factor in...

  17. A cluster randomised trial to assess the impact of clinical pathways on AMI management in rural Australian emergency departments

    Directory of Open Access Journals (Sweden)

    Snow Pamela C

    2009-05-01

    Full Text Available Abstract Background People living in rural Australia are more likely to die in hospital following an acute myocardial infarction than those living in major cities. While several factors, including time taken to access hospital care, contribute to this risk, it is also partially attributable to the lower uptake of evidence-based guidelines for the administration of thrombolytic drugs in rural emergency departments where up to one-third of eligible patients do not receive this life-saving intervention. Clinical pathways have the potential to link evidence to practice by integrating guidelines into local systems, but their impact has been hampered by variable implementation strategies and sub-optimal research designs. The purpose of this study is to determine the impact of a five-step clinical pathways implementation process on the timely and efficient administration of thrombolytic drugs for acute myocardial infarctions managed in rural Australian emergency departments. Methods/Design The design is a two-arm, cluster-randomised trial with rural hospital emergency departments that treat and do not routinely transfer acute myocardial infarction patients. Six rural hospitals in the state of Victoria will participate, with three in the intervention group and three in the control group. Intervention hospitals will participate in a five-step clinical pathway implementation process: engagement of clinicians, pathway development according to local resources and systems, reminders, education, and audit and feedback. Hospitals in the control group will each receive a hard copy of Australian national guidelines for chest pain and acute myocardial infarction management. Each group will include 90 cases to give a power of 80% at 5% significance level for the two primary outcome measures: proportion of those eligible for thrombolysis receiving the drug and time to delivery of thrombolytic drug. Discussion Improved compliance with thrombolytic guidelines via

  18. Calling Dunbar's Numbers

    OpenAIRE

    MacCarron, Pádraig; Kaski, Kimmo; Dunbar, Robin

    2016-01-01

    The social brain hypothesis predicts that humans have an average of about 150 relationships at any given time. Within this 150, there are layers of friends of an ego, where the number of friends in a layer increases as the emotional closeness decreases. Here we analyse a mobile phone dataset, firstly, to ascertain whether layers of friends can be identified based on call frequency. We then apply different clustering algorithms to break the call frequency of egos into clusters and compare the ...

  19. Successful field trial of a multi-process phytoremediation system for remediation of petroleum impacted soils

    Energy Technology Data Exchange (ETDEWEB)

    Reid, N. [EBA Engineering Consultants Ltd., Calgary, AB (Canada); Greenberg, B.M. [Waterloo Univ., ON (Canada)]|[Waterloo Environmental Biotechnology Inc., Waterloo, ON (Canada)

    2007-07-01

    This presentation described a field trial of a new phytoremediation technology. The multi process phytoremediation system (MPPS) was designed for use in physical soil treatment and used seeds inoculated with plant growth promoting rhizobacteria (PGPR). The technology aerated the soil and photo-oxidized petroleum hydrocarbons (PHC) by exposing them to the light. In this study, 2 natural non-pathogenic strains of Pseudomonas putida were applied to seeds prior to planting. PGPR was used to create conditions suitable for the biodegradation of PHC, while also preserving natural soil structure and texture. High levels of microbial biomass in the soil were achieved. The presentation also provided details of a field study conducted in Hinton, Alberta which established vegetation in the treatment area in order to reduce PHC levels. The area was contaminated with compost invert drilling mud (CIDM) that had previously and unsuccessfully been treated with a biopile. The treatment plan consisted of aeration, soil sampling, and seeding. Soil and vegetation sampling was also conducted. Results of the study showed the vegetation was well established using the technique, and reduced hydrocarbon levels by between 17 and 53 per cent. It was concluded that continued hydrocarbon reduction levels are anticipated using the technology. tabs., figs.

  20. The impact of farmers’ participation in field trials in creating awareness and stimulating compliance with the World Health Organization’s farm-based multiple-barrier approach

    DEFF Research Database (Denmark)

    Amponsah, Owusu; Vigre, Håkan; Schou, Torben Wilde;

    2015-01-01

    The results of a study aimed as assessing the extent to which urban vegetable farmers’ participation in field trials can impact on their awareness and engender compliance with the World Health Organization’s farm-based multiple-barrier approach are presented in this paper. Both qualitative and qu...

  1. A Randomized Controlled Trial of the Impact of Therapeutic Horse Riding on the Quality of Life, Health, and Function of Children with Cerebral Palsy

    Science.gov (United States)

    Davis, E.; Davies, B.; Wolfe, R.; Raadsveld, R.; Heine, B.; Thomason, P.; Dobson, Fiona; Graham, H. K.

    2009-01-01

    This randomized controlled trial examined whether therapeutic horse riding has a clinically significant impact on the physical function, health and quality of life (QoL) of children with cerebral palsy (CP). Ninety-nine children aged 4 to 12 years with no prior horse riding experience and various levels of impairment (Gross Motor Function…

  2. Impact of a manualized multifocal perinatal home-visiting program using psychologists on postnatal depression: the CAPEDP randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Romain Dugravier

    Full Text Available CONTEXT: Postnatal maternal depression (PND is a significant risk factor for infant mental health. Although often targeted alongside other factors in perinatal home-visiting programs with vulnerable families, little impact on PND has been observed. OBJECTIVE: This study evaluates the impact on PND symptomatology of a multifocal perinatal home-visiting intervention using psychologists in a sample of women presenting risk factors associated with infant mental health difficulties. METHODS: 440 primiparous women were recruited at their seventh month of pregnancy. All were future first-time mothers, under 26, with at least one of three additional psychosocial risk factors: low educational level, low income, or planning to raise the child without the father. The intervention consisted of intensive multifocal home visits through to the child's second birthday. The control group received care as usual. PND symptomatology was assessed at baseline and three months after birth using the Edinburgh Postnatal Depression Scale (EPDS. RESULTS: At three months postpartum, mean (SD EPDS scores were 9.4 (5.4 for the control group and 8.6 (5.4 for the intervention group (p = 0.18. The difference between the mean EPDS scores was 0.85 (95% CI: 0.35; 1.34. The intervention group had significantly lower EPDS scores than controls in certain subgroups: women with few depressive symptoms at inclusion (EPDS <8: difference = 1.66 (95%CI: 0.17; 3.15, p = 0.05, adjusted for baseline EPDS score, women who were planning to raise the child with the child's father: difference = 1.45 (95%CI: 0.27; 2.62, p = 0.04 (adjusted; women with a higher educational level: difference = 1.59 (95%CI: 0.50; 2.68 p = 0.05 (adjusted. CONCLUSION: CAPEDP failed to demonstrate an overall impact on PND. However, post-hoc analysis reveals the intervention was effective in terms of primary prevention and in subgroups of women without certain risk factors. Effective overall reduction of PND

  3. Participating in Clinical Trials

    Medline Plus

    Full Text Available ... ways of finding a disease before symptoms occur. These methods, often called screening tests, can include imaging ... getting a disease or a specific medical problem. These trials find out if lifestyle changes, such as ...

  4. The impact of the carer support needs assessment tool (CSNAT) in community palliative care using a stepped wedge cluster trial.

    Science.gov (United States)

    Aoun, Samar M; Grande, Gunn; Howting, Denise; Deas, Kathleen; Toye, Chris; Troeung, Lakkhina; Stajduhar, Kelli; Ewing, Gail

    2015-01-01

    Family caregiving towards the end-of-life entails considerable emotional, social, financial and physical costs for caregivers. Evidence suggests that good support can improve caregiver psychological outcomes. The primary aim of this study was to investigate the impact of using the carer support needs assessment tool (CSNAT), as an intervention to identify and address support needs in end of life home care, on family caregiver outcomes. A stepped wedge design was used to trial the CSNAT intervention in three bases of Silver Chain Hospice Care in Western Australia, 2012-14. The intervention consisted of at least two visits from nurses (2-3 weeks apart) to identify, review and address caregivers' needs. The outcome measures for the intervention and control groups were caregiver strain and distress as measured by the Family Appraisal of Caregiving Questionnaire (FACQ-PC), caregiver mental and physical health as measured by SF-12v2, and caregiver workload as measured by extent of caregiver assistance with activities of daily living, at baseline and follow up. Total recruitment was 620. There was 45% attrition for each group between baseline and follow-up mainly due to patient deaths resulting in 322 caregivers completing the study (233 in the intervention group and 89 in the control group). At follow-up, the intervention group showed significant reduction in caregiver strain relative to controls, p=0.018, d=0.348 (95% CI 0.25 to 0.41). Priority support needs identified by caregivers included knowing what to expect in the future, having time for yourself in the day and dealing with your feelings and worries. Despite the challenges at the clinician, organisational and trial levels, the CSNAT intervention led to an improvement in caregiver strain. Effective implementation of an evidence-informed and caregiver-led tool represents a necessary step towards helping palliative care providers better assess and address caregiver needs, ensuring adequate family caregiver support

  5. The Impact of Short-Term Video Games on Performance among Children with Developmental Delays: A Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Ru-Lan Hsieh

    Full Text Available This prospective, randomized controlled study investigated the effects of short-term interactive video game playing among children with developmental delays participating in traditional rehabilitation treatment at a rehabilitation clinic. One hundred and one boys and 46 girls with a mean age of 5.8 years (range: 3 to 12 years were enrolled in this study. All patients were confirmed to suffer from developmental delays, and were participating in traditional rehabilitation treatment. Children participated in two periods of 4 weeks each, group A being offered intervention of eight 30-minute sessions of interactive video games in the first period, and group B in the second, in addition to the traditional rehabilitation treatment. The physical, psychosocial, and total health of the children was periodically assessed using the parent-reported Pediatric Quality of Life Inventory-Generic Core Scales (PedsQL; and the children's upper extremity and physical function, transfer and basic mobility, sports and physical functioning, and global functioning were assessed using the Pediatric Outcomes Data Collection Instrument. Parental impact was evaluated using the PedsQL-Family Impact Module for family function, PedsQL-Health Satisfaction questionnaire for parents' satisfaction with their children's care and World Health Organization-Quality of Life-Brief Version for quality of life. Compared with the baseline, significant improvements of physical function were observed in both groups (5.6 ± 19.5, p = 0.013; 4.7 ± 13.8, p = 0.009 during the intervention periods. No significant improvement of psychosocial health, functional performance, or family impact was observed in children with developmental delays. Short-term interactive video game play in conjunction with traditional rehabilitation treatment improved the physical health of children with developmental delays.ClinicalTrials.gov NCT02184715.

  6. Transitant per Calle Mayor

    OpenAIRE

    Mestre Pérez, Rosanna

    2000-01-01

    RESUM Aquest treball és una lectura crítica de la pel.lícula Calle Mayor, dirigida per Juan Antonio Bardem en 1956, on pretenem analitzar de quina manera el film construeix un agosarat discurs de crítica social. Malgrat les dures limitacions extradiscursives en què la pel.lícula va veure la llum (censura oficial, empresonament del director durant el rodage...), Calle Mayor va aconseguir tractar allò del que no shi podia parlar (crítica sociopolítica) a través dun argument de...

  7. Too close to call

    DEFF Research Database (Denmark)

    Kurrild-Klitgaard, Peter

    2012-01-01

    The note briefly outlines a new model for the explanation of US presidential elections, founded on (a) recent economic growth and (b) a measure of what may be called “’the cost of ruling”. The former is based in changes in real disposable income for the period following a mid-term election, while...... a number of other frequent explanations and is found to be quite robust. When augmented with approval ratings for incumbent presidents, the explanatory power increases to 83 pct. and only incorrectly calls one of the last 15 US presidential elections. Applied to the 2012 election as a forecasting...

  8. A call for surveys

    DEFF Research Database (Denmark)

    Bernstein, Philip A.; Jensen, Christian S.; Tan, Kian-Lee

    2012-01-01

    The database field is experiencing an increasing need for survey papers. We call on more researchers to set aside time for this important writing activity. The database field is growing in population, scope of topics covered, and the number of papers published. Each year, thousands of new papers ...

  9. CALLING AQUARIUM LOVERS...

    CERN Multimedia

    2002-01-01

    CERN's anemones will soon be orphans. We are looking for someone willing to look after the aquarium in the main building, for one year. If you are interested, or if you would like more information, please call 73830. (The anemones living in the aquarium thank you in anticipation.)

  10. Artificial Intelligence and CALL.

    Science.gov (United States)

    Underwood, John H.

    The potential application of artificial intelligence (AI) to computer-assisted language learning (CALL) is explored. Two areas of AI that hold particular interest to those who deal with language meaning--knowledge representation and expert systems, and natural-language processing--are described and examples of each are presented. AI contribution…

  11. Physical Therapy on Trial: The Rational, Organization, and Impact of a Mock Trial on Physical Therapy Students' Attitudes toward and Confidence in Research.

    Science.gov (United States)

    Heiss, Deborah Givens; Basso, D. Michele

    2003-01-01

    Multiple surveys of 48 physical therapy students measured the effects of participation in mock trials on skills for evaluating and using research. Participation resulted in increased confidence in their ability to interpret research and positive attitudes about it. (Contains 25 references.) (SK)

  12. LOST to follow-up Information in Trials (LOST-IT: a protocol on the potential impact

    Directory of Open Access Journals (Sweden)

    Salazar Arturo

    2009-06-01

    Full Text Available Abstract Background Incomplete ascertainment of outcomes in randomized controlled trials (RCTs is likely to bias final study results if reasons for unavailability of patient data are associated with the outcome of interest. The primary objective of this study is to assess the potential impact of loss to follow-up on the estimates of treatment effect. The secondary objectives are to describe, for published RCTs, (1 the reporting of loss to follow-up information, (2 the analytic methods used for handling loss to follow-up information, and (3 the extent of reported loss to follow-up. Methods We will conduct a systematic review of reports of RCTs recently published in five top general medical journals. Eligible RCTs will demonstrate statistically significant effect estimates with respect to primary outcomes that are patient-important and expressed as binary data. Teams of 2 reviewers will independently determine eligibility and extract relevant information from each eligible trial using standardized, pre-piloted forms. To assess the potential impact of loss to follow-up on the estimates of treatment effect we will, for varying assumptions about the outcomes of participants lost to follow-up (LTFU, calculate (1 the percentage of RCTs that lose statistical significance and (2 the mean change in effect estimate across RCTs. The different assumptions we will test are the following: (1 none of the LTFU participants had the event; (2 all LTFU participants had the event; (3 all LTFU participants in the treatment group had the event; none of those in the control group had it (worst case scenario; (4 the event incidence among LTFU participants (relative to observed participants increased, with a higher relative increase in the intervention group; and (5 the event incidence among LTFU participants (relative to observed participants increased in the intervention group and decreased in the control group. Discussion We aim to make our objectives and methods

  13. Psychosocial impact of alternative management policies for low-grade cervical abnormalities: results from the TOMBOLA randomised controlled trial.

    Directory of Open Access Journals (Sweden)

    Linda Sharp

    -points. CONCLUSIONS: There was no difference in the longer-term psychosocial impact of management policies based on cytological surveillance or initial colposcopy. Policy-makers, clinicians, and women themselves can be reassured that neither management policy has a significantly greater psychosocial cost. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN 34841617.

  14. Clinical trials of cancer screening in the developing world and their impact on cancer healthcare.

    Science.gov (United States)

    Sankaranarayanan, R; Sauvaget, C; Ramadas, K; Ngoma, T; Teguete, I; Muwonge, R; Naud, P; Nessa, A; Kuhaprema, T; Qiao, Y

    2011-11-01

    Several research and training initiatives were organized by the International Agency for Research on Cancer (IARC) in collaboration with national institutions in countries such as Angola, Brazil, Burkina Faso, China, Republic of Congo, Guinea, India, Mali, Mauritania, Nepal, Niger, Peru, Tanzania and Thailand among others, to address feasible and effective means of early detection and prevention of cervical, breast and oral cancers. The impact of these activities, that involved over 600 000 participants and more than 1200 healthcare personnel trained on strengthening the local health services in terms of infrastructure, human resources and service delivery aspects in host countries and other regions, is addressed here. These studies, inbuilt in appropriate health services platforms, have resulted in the development and sustenance of several continuing point of care services of screening and treatment in most host countries, particularly in sub-Saharan Africa, and have catalysed regional early detection programmes in India, China and Thailand. The IARC collaborative studies have evolved into major focal points of training and extending services in many countries. The large evidence base, resulting from ours and other studies is likely, in due course, to facilitate much wider scaling up of screening and treatment services through organised programmes. PMID:22039141

  15. Calling Dunbar's Numbers

    CERN Document Server

    MacCarron, Pádraig; Dunbar, Robin

    2016-01-01

    The social brain hypothesis predicts that humans have an average of about 150 relationships at any given time. Within this 150, there are layers of friends of an ego, where the number of friends in a layer increases as the emotional closeness decreases. Here we analyse a mobile phone dataset, firstly, to ascertain whether layers of friends can be identified based on call frequency. We then apply different clustering algorithms to break the call frequency of egos into clusters and compare the number of alters in each cluster with the layer size predicted by the social brain hypothesis. In this dataset we find strong evidence for the existence of a layered structure. The clustering yields results that match well with previous studies for the innermost and outermost layers, but for layers in between we observe large variability.

  16. Flight calls and orientation

    DEFF Research Database (Denmark)

    Larsen, Ole Næsbye; Andersen, Bent Bach; Kropp, Wibke;

    2008-01-01

      In a pilot experiment a European Robin, Erithacus rubecula, expressing migratory restlessness with a stable orientation, was video filmed in the dark with an infrared camera and its directional migratory activity was recorded. The flight overhead of migrating conspecifics uttering nocturnal...... flight calls was simulated by sequential computer controlled activation of five loudspeakers placed in a linear array perpendicular to the bird's migration course. The bird responded to this stimulation by changing its migratory course in the direction of that of the ‘flying conspecifics' but after about...... 30 minutes it drifted back to its original migration course. The results suggest that songbirds migrating alone at night can use the flight calls from conspecifics as additional cues for orientation and that they may compare this information with other cues to decide what course to keep....

  17. A Call for Justice

    OpenAIRE

    Marques-Silva, Joao; Brahmachari, Debahuti; Sakallah, Karem; Lynce, Ines

    2015-01-01

    Abstract A new development can be identified within the civil society in Malaysia. A development that has resulted in a general call for justice, voiced through coalition groups that cut across categories of affiliation. This development is triggered by an increasing inculcation of Islamic values into the political system, which has interfered with the understanding of Malaysia as a country that can provide a framework for coexistence within a multicultural society. This thesis seeks ...

  18. Multimodality and CALL

    OpenAIRE

    Guichon, Nicolas; Cohen, Cathy

    2016-01-01

    This chapter explores the issues pertaining to multimodality, which has always been considered as a defining characteristic of CALL (Chapelle 2009). The chapter begins by critically examining the various definitions of multimodality, especially in the field of second language acquisition and cognitive psychology and explores the distinction between mode, modality and channel. With reference to specific studies conducted in the field, we then investigate the potential of multimodality for seco...

  19. Using community readiness key informant assessments in a randomized group prevention trial: impact of a participatory community-media intervention.

    Science.gov (United States)

    Slater, Michael D; Edwards, Ruth W; Plested, Barbara A; Thurman, Pamela J; Kelly, Kathleen J; Comello, Maria Leonora G; Keefe, Thomas J

    2005-02-01

    This study examines the role of key informant community readiness assessments in a randomized group trial testing the impact of a participatory community-media intervention (which was also complemented by in-school efforts). These assessments were used to help match communities in random assignment, as a source of formative data about the community, as the basis for a coalition-building workshop, and as an evaluation tool, with a follow-up set of surveys approximately 2 years after the baseline survey. Results of the nested, random effects analysis indicated that the intervention influenced community knowledge of efforts and (at marginally significant levels) improved prevention leadership quality and community climate supportive of prevention efforts. There was evidence that the professional affiliation of informants in some cases had an effect on their assessments, which could be controlled in the analysis. The authors conclude that key informant community readiness assessments can usefully serve to supplement aggregated measures of individual attitudes and behavior (reported elsewhere for this study) in evaluating community-based interventions. PMID:15751598

  20. The Impact of Aloe vera and Calendula on Perineal Healing after Episiotomy in Primiparous Women: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Farideh Eghdampour

    2013-11-01

    Full Text Available Introduction: Episiotomy is used for enlarging the perineum. Aloe vera and Calendula have been used for treating different diseases from ancient times, limited researches have been done regarding the healing of these plants. Since the effect of their ointment on episiotomy healing has not been studied, this study is being done for determining the impact of Aloe vera and Calendula on episiotomy healing in primiparous women. Methods: This clinical trial involves 111 qualified primiparous women admitted in Lolagar hospital. They were randomly categorized into three groups of control (n=1 and experimental (n=2 groups. The women in experimental group used Aloe vera and Calendula Ointment every 8 hours and the control group used hospital routine on episiotomy for 5 days. The data were collected by demographic questionnaire and redness, edema, ecchymosis, discharge and approximation scale (REEDA which investigated the episiotomy healing before and five days after intervention in two groups. ANOVA, Tukey test, Kruskal-wallis, Chi-square were used for data analysis. Results: The three groups do not have statistically significant different regarding demographic and other intervening variables. Comparing the mean of REEDA in five days after delivery showed statistically significant difference between control and experimental groups.Conclusion: According to the results, using Aloe vera and Calendula ointment considerably increases the speed of episiotomy wound healing so it can be used for quickening the episiotomy healing.

  1. A Cluster Randomised Trial Introducing Rapid Diagnostic Tests into Registered Drug Shops in Uganda: Impact on Appropriate Treatment of Malaria.

    Directory of Open Access Journals (Sweden)

    Anthony K Mbonye

    Full Text Available Inappropriate treatment of malaria is widely reported particularly in areas where there is poor access to health facilities and self-treatment of fevers with anti-malarial drugs bought in shops is the most common form of care-seeking. The main objective of the study was to examine the impact of introducing rapid diagnostic tests for malaria (mRDTs in registered drug shops in Uganda, with the aim to increase appropriate treatment of malaria with artemisinin-based combination therapy (ACT in patients seeking treatment for fever in drug shops.A cluster-randomized trial of introducing mRDTs in registered drug shops was implemented in 20 geographical clusters of drug shops in Mukono district, central Uganda. Ten clusters were randomly allocated to the intervention (diagnostic confirmation of malaria by mRDT followed by ACT and ten clusters to the control arm (presumptive treatment of fevers with ACT. Treatment decisions by providers were validated by microscopy on a reference blood slide collected at the time of consultation. The primary outcome was the proportion of febrile patients receiving appropriate treatment with ACT defined as: malaria patients with microscopically-confirmed presence of parasites in a peripheral blood smear receiving ACT or rectal artesunate, and patients with no malaria parasites not given ACT.A total of 15,517 eligible patients (8672 intervention and 6845 control received treatment for fever between January-December 2011. The proportion of febrile patients who received appropriate ACT treatment was 72·9% versus 33·7% in the control arm; a difference of 36·1% (95% CI: 21·3 - 50·9, p<0·001. The majority of patients with fever in the intervention arm accepted to purchase an mRDT (97·8%, of whom 58·5% tested mRDT-positive. Drug shop vendors adhered to the mRDT results, reducing over-treatment of malaria by 72·6% (95% CI: 46·7- 98·4, p<0·001 compared to drug shop vendors using presumptive diagnosis (control arm

  2. A review and additional post-hoc analyses of the incidence and impact of constipation observed in darifenacin clinical trials

    Directory of Open Access Journals (Sweden)

    Tack J

    2012-09-01

    Full Text Available Jan Tack,1 Jean-Jacques Wyndaele,2 Greg Ligozio,3 Mathias Egermark41University of Leuven, Gastroenterology Section, Leuven, 2University of Antwerp, Department of Urology, Antwerp, Belgium; 3Novartis Pharmaceuticals Corporation, NJ, USA; 4Roche Diagnostics Scandinavia AB, Bromma, Sweden and formerly of Novartis Pharma AG, Basel, SwitzerlandBackground: Constipation is a common side effect of antimuscarinic treatment for overactive bladder (OAB. This review evaluates the incidence and impact of constipation on the lives of patients with OAB being treated with darifenacin.Methods: Constipation data from published Phase III and Phase IIIb/IV darifenacin studies were reviewed and analyzed. Over 4000 patients with OAB (aged 18–89 years; ≥80% female enrolled in nine studies (three Phase III [data from these fixed-dose studies were pooled and provide the primary focus for this review], three Phase IIIb, and three Phase IV. The impact of constipation was assessed by discontinuations, use of concomitant laxatives, patient-reported perception of treatment, and a bowel habit questionnaire.Results: In the pooled Phase III trials, 14.8% (50/337 of patients on darifenacin 7.5 mg/day and 21.3% (71/334 on 15 mg/day experienced constipation compared with 12.6% (28/223 and 6.2% (24/388 with tolterodine and placebo, respectively. In addition, a few patients discontinued treatment due to constipation (0.6% [2/337], 1.2% [4/334], 1.8% [4/223], and 0.3% [1/388] in the darifenacin 7.5 mg/day or 15 mg/day, tolterodine, and placebo groups, respectively, or required concomitant laxatives (3.3% [11/337], 6.6% [22/334], 7.2% [16/223], and 1.5% [6/388] in the darifenacin 7.5 mg/day or 15 mg/day, tolterodine, and placebo groups, respectively. Patient-reported perception of treatment quality was observed to be similar between patients who experienced constipation and those who did not. During the long-term extension study, a bowel habit questionnaire showed only small

  3. Step-wedge cluster-randomised community-based trials: An application to the study of the impact of community health insurance

    Directory of Open Access Journals (Sweden)

    Kynast-Wolf Gisela

    2008-10-01

    Full Text Available Abstract Background We describe a step-wedge cluster-randomised community-based trial which has been conducted since 2003 to accompany the implementation of a community health insurance (CHI scheme in West Africa. The trial aims at overcoming the paucity of evidence-based information on the impact of CHI. Impact is defined in terms of changes in health service utilisation and household protection against the cost of illness. Our exclusive focus on the description and discussion of the methods is justified by the fact that the study relies on a methodology previously applied in the field of disease control, but never in the field of health financing. Methods First, we clarify how clusters were defined both in respect of statistical considerations and of local geographical and socio-cultural concerns. Second, we illustrate how households within clusters were sampled. Third, we expound the data collection process and the survey instruments. Finally, we outline the statistical tools to be applied to estimate the impact of CHI. Conclusion We discuss all design choices both in relation to methodological considerations and to specific ethical and organisational concerns faced in the field. On the basis of the appraisal of our experience, we postulate that conducting relatively sophisticated trials (such as our step-wedge cluster-randomised community-based trial aimed at generating sound public health evidence, is both feasible and valuable also in low income settings. Our work shows that if accurately designed in conjunction with local health authorities, such trials have the potential to generate sound scientific evidence and do not hinder, but at times even facilitate, the implementation of complex health interventions such as CHI.

  4. MEDICAL SERVICE - URGENT CALLS

    CERN Multimedia

    Service Médical

    2000-01-01

    IN URGENT NEED OF A DOCTOR GENEVA: EMERGENCY SERVICES GENEVA AND VAUD 144 FIRE BRIGADE 118 POLICE 117 CERN FIREMEN 767-44-44 ANTI-POISONS CENTRE Open 24h/24h 01-251-51-51 Patient not fit to be moved, call family doctor, or: GP AT HOME: Open 24h/24h 748-49-50 AMG- Association Of Geneva Doctors: Emergency Doctors at home 07h-23h 322 20 20 Patient fit to be moved: HOPITAL CANTONAL CENTRAL 24 Micheli-du-Crest 372-33-11 ou 382-33-11 EMERGENCIES 382-33-11 ou 372-33-11 CHILDREN'S HOSPITAL 6 rue Willy-Donzé 372-33-11 MATERNITY 32 bvd.de la Cluse 382-68-16 ou 382-33-11 OPHTHALMOLOGY 22 Alcide Jentzer 382-33-11 ou 372-33-11 MEDICAL CENTRE CORNAVIN 1-3 rue du Jura 345 45 50 HOPITAL DE LA TOUR Meyrin 719-61-11 EMERGENCIES 719-61-11 CHILDREN'S EMERGENCIES 719-61-00 LA TOUR MEDICAL CENTRE 719-74-00 European Emergency Call 112   FRANCE: EMERGENCY SERVICES 15 FIRE BRIGADE 18 POLICE 17 CERN FIREMEN AT HOME 00-41-22-767-44-44 ...

  5. An Island Called Cuba

    Directory of Open Access Journals (Sweden)

    Jean Stubbs

    2011-06-01

    Full Text Available Review of: An Island Called Home: Returning to Jewish Cuba. Ruth Behar, photographs by Humberto Mayol. New Brunswick NJ: Rutgers University Press, 2007. xiii + 297 pp. (Cloth US$ 29.95 Fidel Castro: My Life: A Spoken Autobiography. Fidel Castro & Ignacio Ramonet. New York: Scribner/Simon & Schuster, 2008. vii + 724 pp. (Paper US$ 22.00, e-book US$ 14.99 Cuba: What Everyone Needs to Know. Julia E. Sweig. New York: Oxford University Press, 2009. xiv + 279 pp. (Paper US$ 16.95 [First paragraph] These three ostensibly very different books tell a compelling story of each author’s approach, as much as the subject matter itself. Fidel Castro: My Life: A Spoken Autobiography is based on a series of long interviews granted by the then-president of Cuba, Fidel Castro, to Spanish-Franco journalist Ignacio Ramonet. Cuba: What Everyone Needs to Know, by U.S. political analyst Julia Sweig, is one of a set country series, and, like Ramonet’s, presented in question/answer format. An Island Called Home: Returning to Jewish Cuba, with a narrative by Cuban-American anthropologist Ruth Behar and photographs by Cuban photographer Humberto Mayol, is a retrospective/introspective account of the Jewish presence in Cuba. While from Ramonet and Sweig we learn much about the revolutionary project, Behar and Mayol convey the lived experience of the small Jewish community against that backdrop.

  6. Call for volunteers

    CERN Multimedia

    2008-01-01

    CERN is calling for volunteers from all members of the Laboratory for organizing the two exceptional Open days.CERN is calling for volunteers from all members of the Laboratory’s personnel to help with the organisation of these two exceptional Open Days, for the visits of CERN personnel and their families on the Saturday and above all for the major public Open Day on the Sunday. As for the 50th anniversary in 2004, the success of the Open Days will depend on a large number of volunteers. All those working for CERN as well as retired members of the personnel can contribute to making this event a success. Many guides will be needed at the LHC points, for the activities at the surface and to man the reception and information points. The aim of these major Open Days is to give the local populations the opportunity to discover the fruits of almost 20 years of work carried out at CERN. We are hoping for some 2000 volunteers for the two Open Days, on the Saturday from 9 a.m. to ...

  7. Enhanced Counseling for Women Undergoing BRCA1/2 Testing: Impact on Knowledge and Psychological Distress – Results From a Randomized Clinical Trial

    OpenAIRE

    Roussi, Pagona; Sherman, Kerry Anne; Miller, Suzanne; Buzaglo, Joanne; Daly, Mary; Taylor, Alan; Ross, Eric; Godwin, Andrew

    2010-01-01

    This randomized controlled trial evaluated the impact of an enhanced counseling intervention on knowledge about the heritability of breast and ovarian cancer and distress, as a function of BRCA test result, among high-risk women. Before deciding about whether or not to undergo genetic testing, participants were randomly assigned to the enhanced counseling intervention (N = 69), designed to promote cognitive and affective processing of cancer risk information (following the standard individual...

  8. A cluster-randomized trial assessing the impact of school water, sanitation, and hygiene improvements on pupil enrollment and gender parity in enrollment

    OpenAIRE

    Garn, Joshua V.; Greene, Leslie E.; Dreibelbis, Robert; Saboori, Shadi; Rheingans, Richard D.; Freeman, Matthew C.

    2013-01-01

    We employed a cluster randomized trial design to measure the impact of a school based water, sanitation, and hygiene (WASH) improvement on pupil enrollment and on gender parity in enrollment, in primary schools in Nyanza Province, Kenya (2007-2009). Among schools with poor water access during the dry season, those that received a water supply, hygiene promotion and water treatment (HP&WT) and sanitation improvement, demonstrated increased enrollment (β=0.091 [0.009, 0.173] ...

  9. Impact of Surgical Varicocele Repair on Pregnancy Rate in Subfertile Men With Clinical Varicocele and Impaired Semen Quality: A Meta-Analysis of Randomized Clinical Trials

    OpenAIRE

    Kim, Kyu Hyun; Lee, Joo Yong; Kang, Dong Hyuk; Lee, Hyungmin; Seo, Ju Tae; Cho, Kang Su

    2013-01-01

    Purpose To elucidate the impact of surgical varicocele repair on the pregnancy rate through new meta-analyses of randomized clinical trials that compared surgical varicocele repair and observation. Materials and Methods The PubMed and Embase online databases were searched for studies released before December 2012. References were manually reviewed, and two researchers independently extracted the data. To assess the quality of the studies, the Cochrane risk of bias as a quality assessment tool...

  10. The impact of providing rapid diagnostic malaria tests on fever management in the private retail sector in Ghana: a cluster randomized trial

    OpenAIRE

    Ansah, Evelyn K; Narh-Bana, Solomon; Affran-Bonful, Harriet; Bart-Plange, Constance; Cundill, Bonnie; Gyapong, Margaret; Whitty, Christopher J. M.

    2015-01-01

    Objective To examine the impact of providing rapid diagnostic tests for malaria on fever management in private drug retail shops where most poor rural people with fever present, with the aim of reducing current massive overdiagnosis and overtreatment of malaria. Design Cluster randomized trial of 24 clusters of shops. Setting Dangme West, a poor rural district of Ghana. Participants Shops and their clients, both adults and children. Interventions Providing rapid diagnostic tests with realisti...

  11. Global collaborative networks on meta-analyses of randomized trials published in high impact factor medical journals: a social network analysis

    OpenAIRE

    Catalá-López, Ferrán; Alonso-Arroyo, Adolfo; Hutton, Brian; Aleixandre-Benavent, Rafael; Moher, David

    2014-01-01

    Abstract Background Research collaboration contributes to the advancement of knowledge by exploiting the results of scientific efforts more efficiently, but the global patterns of collaboration on meta-analysis are unknown. The purpose of this research was to describe and characterize the global collaborative patterns in meta-analyses of randomized trials published in high impact factor medical journals over the past three decades. Methods This was a cross-sectional, social network analysis. ...

  12. The Impact of a School-Based Hygiene, Water Quality and Sanitation Intervention on Soil-Transmitted Helminth Reinfection: A Cluster-Randomized Trial

    OpenAIRE

    Matthew C. Freeman; Clasen, Thomas; Brooker, Simon J.; Akoko, Daniel O.; Rheingans, Richard

    2013-01-01

    We conducted a cluster-randomized trial to assess the impact of a school-based water treatment, hygiene, and sanitation program on reducing infection with soil-transmitted helminths (STHs) after school-based deworming. We assessed infection with STHs at baseline and then at two follow-up rounds 8 and 10 months after deworming. Forty government primary schools in Nyanza Province, Kenya were randomly selected and assigned to intervention or control arms. The intervention reduced reinfection pre...

  13. Impact of a School-Based Hygiene Promotion and Sanitation Intervention on Pupil Hand Contamination in Western Kenya: A Cluster Randomized Trial

    OpenAIRE

    Greene, Leslie E.; Matthew C. Freeman; Akoko, Daniel; Saboori, Shadi; Moe, Christine; Rheingans, Richard

    2012-01-01

    Handwashing with soap effectively reduces exposure to diarrhea-causing pathogens. Interventions to improve hygiene and sanitation conditions in schools within low-income countries have gained increased attention; however, their impact on schoolchildren's exposure to fecal pathogens has not been established. Our trial examined whether a school-based water, sanitation, and hygiene intervention reduced Escherichia coli contamination on pupils' hands in western Kenya. A hygiene promotion and wate...

  14. The impact of school fruit tuck shops and school food policies on children's fruit consumption: a cluster randomised trial of schools in deprived areas

    OpenAIRE

    Moore, L; Tapper, K.

    2008-01-01

    Aims: To estimate the impact of school fruit tuck shops on children’s consumption of fruit and sweet and savoury snacks. Design: Cluster randomised effectiveness trial with school as the unit of randomisation. Setting: 43 primary schools in deprived areas in south Wales and south-west England with a range of school food policies. Intervention: Schools operated fruit tuck shops throughout one academic year. Control schools did not do so. Measures: Repeated cross-sections of chi...

  15. Impact of NGO Training and Support Intervention on Diarrhoea Management Practices in a Rural Community of Bangladesh: An Uncontrolled, Single-Arm Trial

    OpenAIRE

    Rahman, Ahmed S.; Mohammad Rafiqul Islam; Koehlmoos, Tracey P; Mohammad Jyoti Raihan; Mohammad Mehedi Hasan; Tahmeed Ahmed; Larson, Charles P.

    2014-01-01

    PURPOSE/OBJECTIVE: The evolving Non-Governmental Organization (NGO) sector in Bangladesh provides health services directly, however some NGOs indirectly provide services by working with unlicensed providers. The primary objective of this study was to examine the impact of NGO training of unlicensed providers on diarrhoea management and the scale up of zinc treatment in rural populations. METHODS: An uncontrolled, single-arm trial for a training and support intervention on diarrhoea outcomes w...

  16. Impact of a theoretically based sex education programme (SHARE) delivered by teachers on NHS registered conceptions and terminations: final results of cluster randomised trial

    OpenAIRE

    Henderson, M.; Wight, D; Raab, G M; Abraham, C.; Parkes, A; Scott, S.; Hart, G.

    2007-01-01

    Objective To assess the impact of a theoretically based sex education programme (SHARE) delivered by teachers compared with conventional education in terms of conceptions and terminations registered by the NHS.Design Follow-up of cluster randomised trial 4.5 years after intervention.Setting NHS records of women who had attended 25 secondary schools in east Scotland.Participants 4196 women (99.5% of those eligible) Intervention SHARE programme (intervention group) v existing sex education (con...

  17. Impact of a theoretically based sex education programme (SHARE) delivered by teachers on NHS registered conceptions and terminations: final results of cluster randomised trial

    OpenAIRE

    Wright, D; Raab, G M; Abraham, C.; Scott, S.; Hart, G.

    2006-01-01

    Objective: To assess the impact of a theoretically based sex education programme (SHARE) delivered by teachers compared with conventional education in terms of conceptions and terminations registered by the NHS. Design Follow-up of cluster randomised trial 4.5 years after intervention. Setting: NHS records of women who had attended 25 secondary schools in east Scotland. Participants: 4196 women (99.5% of those eligible). Intervention: SHARE programme (intervention group) v ...

  18. Impact of a stress coping strategy on perceived stress levels and performance during a simulated cardiopulmonary resuscitation: a randomized controlled trial

    OpenAIRE

    Hunziker, Sabina; Pagani, Simona; Fasler, Katrin; Tschan, Franziska; Semmer, Norbert K.; Marsch, Stephan

    2013-01-01

    Background Cardiopulmonary resuscitation (CPR) causes significant stress for the rescuers which may cause deficiencies in attention and increase distractibility. This may lead to misjudgements of priorities and delays in CPR performance, which may further increase mental stress (vicious cycle). This study assessed the impact of a task-focusing strategy on perceived stress levels and performance during a simulated CPR scenario. Methods This prospective, randomized-controlled trial was conducte...

  19. Impact of a stress coping strategy on perceived stress levels and performance during a simulated cardiopulmonary resuscitation: a randomized controlled trial

    OpenAIRE

    Hunziker, Sabina; Pagani, Simona; Fasler, Katrin; Tschan, Franziska; Semmer, Norbert K.; Marsch, Stephan

    2013-01-01

    Background Cardiopulmonary resuscitation (CPR) causes significant stress, which may cause deficiencies in attention and increase distractibility. This may lead to misjudgements of priorities and delays in CPR performance, which may further increase mental stress (vicious cycle). This study assessed the impact of a task-focusing strategy on perceived stress levels and performance during a simulated CPR scenario. Methods This prospective, randomized-controlled trial was conduc...

  20. Impact of depressive symptoms, self-esteem and neuroticism on trajectories of overgeneral autobiographical memory over repeated trials.

    Science.gov (United States)

    Kashdan, Todd B; Roberts, John E; Carlos, Erica L

    2006-04-01

    The present study examined trajectories of change in the frequency of overgeneral autobiographical memory (OGM) over the course of repeated trials, and tested whether particular dimensions of depressive symptomatology (somatic and cognitive-affective distress), self-esteem, and neuroticism account for individual differences in these trajectories. Given that depression is associated with impairments in effortful processing, we predicted that over repeated trials depression would be associated with increasingly OGM. Generalised Linear Mixed Models with Penalised Quasi-Likelihood demonstrated significant linear and quadratic trends in OGM over repeated trials, and somatic distress and self-esteem moderated these slopes. The form of these interactions suggested that somatic distress and low self-esteem primarily contribute to OGM during the second half of the trial sequence. The present findings demonstrate the value of a novel analytical approach to OGM that estimates individual trajectories of change over repeated trials. PMID:26529212

  1. Impact of early versus delayed umbilical cord clamping on post partum blood loss: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Yogiraj Vaijanathrao Chidre,Vijayalakshmi Chirumamilla

    2015-08-01

    Methods: A randomized, controlled trial was performed on 183 consenting women fulfilling eligibility criteria in labour ward of a teaching hospital in India. They were randomly assigned into early cord clamping or delayed cord clamping group; other components of active management of third stage of labour being same for all. The duration of third stage of labour was noted. Quantitative assessment of post partum blood loss was done using BRASSS-V drapes and weighing blood soaked pads. Cord blood haemoglobin and hematocrit at birth and infant haemoglobin and hematocrit at 90 +/-7 days were estimated. Statistical analysis done using students unpaired and lsquo;t' test. Results: No difference was noted in the mean blood loss (203.52 +/- 122.74 ml versus 200.74+/- 104.07 ml in early and delayed cord clamping respectively and the duration of third stage of labour (Mean: 296.59+/- 98.97 seconds versus 281.79+/-104.59 seconds for early and delayed clamping respectively. Infant haemoglobin at 90 +/-7 days was 11.07 +/- 1.27 gm/dl versus 12.70+/- 1.41 gm/dl (p=0.0000 and infant hematocrit at 90 +/-7 days was 34.13+/-3.93 % versus 39.33 +/-4.88 % in early and delayed clamping respectively (p=0.0000. Conclusion: The timing of cord clamping has no impact on the mean blood loss and duration of third stage of labour. Delayed clamping significantly increases mean venous haemoglobin and hematocrit at 90 +/-7 days without increasing NICU admissions. [Int J Reprod Contracept Obstet Gynecol 2015; 4(4.000: 1103-1108

  2. Positive impact of child feeding training program for primary care health professionals: a cluster randomized field trial

    Directory of Open Access Journals (Sweden)

    Márcia Regina Vitolo

    2014-12-01

    Full Text Available OBJECTIVE: To assess the impact of a child feeding training program for primary care health professionals about breastfeeding and complementary feeding practices. METHODS: Cluster-randomized field trial conducted in the city of Porto Alegre, (RS, Brazil. Twenty primary health care centers (HCC were randomized into intervention (n = 9 and control (n = 11 groups. The health professionals (n = 200 at the intervention group centers received training about healthy feeding practices. Pregnant women were enrolled at the study. Up to six months of child's age, home visits were made to obtain variables related to breastfeeding and introduction of foods. RESULTS: 619 children were evaluated: 318 from the intervention group and 301 from the control group. Exclusive breastfeeding prevalence in the first (72.3 versus 59.4%; RR = 1.21; 95%CI 1.08 - 1.38, second (62.6 versus 48.2%; RR = 1.29; 95%CI 1.10 - 1.53, and third months of life (44.0% versus 34.6%; RR = 1.27; 95%CI 1.04 - 1.56 was higher in the intervention group compared to the control group. The prevalence of children who consumed meat four or five times per week was higher in the intervention group than in the control group (36.8 versus 22.6%; RR = 1.62; 95%CI 1.32 - 2.03. The prevalence of children who had consumed soft drinks (34.9 versus 52.5%; RR = 0.66; 95%CI 0.54 - 0.80, chocolate (24.5 versus 36.7% RR = 0.66 95%CI 0.53 - 0.83, petit suisse (68.9 versus 79.7; 95%CI 0.75 - 0.98 and coffee (10.4 versus 20.1%; RR = 0.51; 95%CI 0.31 - 0.85 in their six first months of life was lower in the intervention group. CONCLUSION: The training of health professionals had a positive impact on infant feeding practices, contributing to the promotion of child health.

  3. Impact of a parent-child sexual communication campaign: results from a controlled efficacy trial of parents

    Directory of Open Access Journals (Sweden)

    Evans W Douglas

    2010-07-01

    Full Text Available Abstract Background Prior research supports the notion that parents have the ability to influence their children's decisions regarding sexual behavior. Yet parent-based approaches to curbing teen pregnancy and STDs have been relatively unexplored. The Parents Speak Up National Campaign (PSUNC is a multimedia campaign that attempts to fill this void by targeting parents of teens to encourage parent-child communication about waiting to have sex. The campaign follows a theoretical framework that identifies cognitions that are targeted in campaign messages and theorized to influence parent-child communication. While a previous experimental study showed PSUNC messages to be effective in increasing parent-child communication, it did not address how these effects manifest through the PSUNC theoretical framework. The current study examines the PSUNC theoretical framework by 1 estimating the impact of PSUNC on specific cognitions identified in the theoretical framework and 2 examining whether those cognitions are indeed associated with parent-child communication Methods Our study consists of a randomized efficacy trial of PSUNC messages under controlled conditions. A sample of 1,969 parents was randomly assigned to treatment (PSUNC exposure and control (no exposure conditions. Parents were surveyed at baseline, 4 weeks, 6 months, 12 months, and 18 months post-baseline. Linear regression procedures were used in our analyses. Outcome variables included self-efficacy to communicate with child, long-term outcome expectations that communication would be successful, and norms on appropriate age for sexual initiation. We first estimated multivariable models to test whether these cognitive variables predict parent-child communication longitudinally. Longitudinal change in each cognitive variable was then estimated as a function of treatment condition, controlling for baseline individual characteristics. Results Norms related to appropriate age for sexual

  4. Optimising the changing role of the community pharmacist: a randomised trial of the impact of audit and feedback

    Science.gov (United States)

    Winslade, Nancy; Eguale, Tewodros; Tamblyn, Robyn

    2016-01-01

    Objective To evaluate the impact of comparative performance feedback to community pharmacists on provision of professional services and the quality of patients’ medication use. Design Randomised, controlled, single-blind trial. Setting All 1833 community pharmacies in the Quebec province, Canada. Participants 1814 pharmacies not opting out and with more than 5 dispensings of the target medications during the 6-month baseline were randomised by a 2×2 factorial design to feedback first for hypertension adherence (907 control, 907 intervention) followed by randomisation for asthma adherence (791 control, 807 intervention). 1422 of 1814 pharmacies had complete information available during the follow-up for hypertension intervention (706 intervention, 716 control), and 1301 of 1598 had the follow-up information for asthma (657 intervention, 644 control). Intervention Using provincial billing data to measure performance, mailed comparative feedback reported the pharmacy-level percentage of dispensings to patients non-adherent to antihypertensive medications or overusing asthma rescue inhalers. Primary and secondary outcome measures The number of hypertension/asthma services billed per pharmacy and percentage of dispensings to non-adherent patients over the 12 months post intervention. Results Feedback on the asthma measure led to increased provision of asthma services (control 0.2, intervention 0.4, RR 1.58, 95% CI 1.02 to 2.46). However, this did not translate into reductions in patients’ overuse of rescue inhalers (control 45.5%, intervention 44.6%, RR 0.99, 95% CI 0.98 to 1.01). For non-adherence to antihypertensive medications, feedback resulted in no difference in either provision of hypertension services (control 0.7, intervention 0.8, RR 1.25, 95% CI 0.86 to 1.82) or antihypertensive treatment adherence (control 27.9%, intervention 28.0%, RR 1.0, 95% CI 0.99 to 1.00). Baseline performance did not influence results, and there was no evidence of a cumulative

  5. To be called upon

    DEFF Research Database (Denmark)

    Kublitz, Anja

    2015-01-01

    When Danish Muslims explain what made them decide to travel to the Middle East and take up arms in the wake of the Arab Spring, they say that they were called upon. Displayed on videos on social media, women and sometimes children begged them to come to their rescue. In light of some of the...... responses to the Arab spring among Danish Muslims, this paper will offer some preliminary reflections on how we can understand ‘the mass’ and an ‘intimacy of the mass’ when the mass is no longer a crowd. According to Marx the mass grows quantitatively from the local to the global, but what happens to the...... mass if it is no longer a causal phenomenon that expands from small to big, but rather a simultaneous multitude of one to one relations that are neither local nor global? How are the one and the many related in this specific setting? Furthermore, many of the videos display dead bodies. How can we...

  6. A Thing Called Prisoner

    OpenAIRE

    Rauxloh, RE

    2006-01-01

    This paper is a response to J.C. Oleson’s article “The Punitive Coma” , which suggests that prisoners should be put into a narcotic coma in order to abolish prison violence and make imprisonment less expensive and more efficient. I argue that this treatment is an unusual and cruel punishment that not only violates most of the constitutional rights of prisoners but most of all deprives them of their human dignity. Furthermore, it would have considerable negative impacts on the Criminal Justice...

  7. Who calls the tune?

    Directory of Open Access Journals (Sweden)

    Claude Chastagner

    2011-04-01

    Full Text Available The real action was taking place behind the scenes.Irwin Pincus, music publisherA couple of weeks ago, while researching for this paper, I decided to read again Chronicles, Bob Dylan’s autobiography. Chapter 4 deals with the recording in a rented New Orleans mansion of Oh Mercy, the 1989 album produced by Daniel Lanois, unanimously hailed as Dylan’s resurrection. Dylan insists on the significant impact Lanois had on his own artistry. Through conversations, flashes of rage and frustration, and...

  8. Acromegaly Clinical Trial Methodology Impact on Reported Biochemical Efficacy Rates of Somatostatin Receptor Ligand Treatments: A Meta-Analysis

    OpenAIRE

    CARMICHAEL, JOHN D.; Bonert, Vivien S.; Nuño, Miriam; Ly, Diana; Melmed, Shlomo

    2014-01-01

    Introduction: Biochemical efficacy of somatostatin receptor ligand (SRL) treatment in acromegaly is defined by metrics for GH and IGF-1 control. Since the earliest therapeutic trials, biochemical control criteria, medical formulations, and assay techniques have evolved. Materials and Methods: We searched PubMed for English-language trials published from 1974 to 2012 evaluating 10 or more patients, with a duration of more than 3 months and biochemical control as a key objective. We used a rand...

  9. The impact of insecticide-treated school uniforms on dengue infections in school-aged children: study protocol for a randomised controlled trial in Thailand

    Directory of Open Access Journals (Sweden)

    Wilder-Smith Annelies

    2012-11-01

    Full Text Available Abstract Background There is an urgent need to protect children against dengue since this age group is particularly sensitive to the disease. Since dengue vectors are active mainly during the day, a potential target for control should be schools where children spend a considerable amount of their day. School uniforms are the cultural norm in most developing countries, worn throughout the day. We hypothesise that insecticide-treated school uniforms will reduce the incidence of dengue infection in school-aged children. Our objective is to determine the impact of impregnated school uniforms on dengue incidence. Methods A randomised controlled trial will be conducted in eastern Thailand in a group of schools with approximately 2,000 students aged 7–18 years. Pre-fabricated school uniforms will be commercially treated to ensure consistent, high-quality insecticide impregnation with permethrin. A double-blind, randomised, crossover trial at the school level will cover two dengue transmission seasons. Discussion Practical issues and plans concerning intervention implementation, evaluation, analysing and interpreting the data, and possible policy implications arising from the trial are discussed. Trial registration clinicaltrial.gov. Registration number: NCT01563640

  10. Impact of different exercise training modalities on the coronary collateral circulation and plaque composition in patients with significant coronary artery disease (EXCITE trial: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Uhlemann Madlen

    2012-09-01

    patients with significant CAD compared to a sedentary control group. It also examines the impact of two intensities of ET on the CBF as well as the histological plaque composition. The trial started recruitment in June 2009 and will complete recruitment until June 2012. First results are expected in December 2012 (4-week follow-up, final results (12-month long-term secondary endpoint in December 2013. Trial registration Clinical trial registration information-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01209637

  11. Your Wake-Up Call

    Science.gov (United States)

    ... Home Current Issue Past Issues Your Wake-Up Call Past Issues / Summer 2007 Table of Contents For ... infant younger than one year old. Some people call SIDS "crib death" because many babies who die ...

  12. Impact of percutaneous coronary intervention on biomarker levels in patients in the subacute phase following myocardial infarction: the Occluded Artery Trial (OAT) biomarker ancillary study

    OpenAIRE

    Kruk, Mariusz; Menon, Venu; Kądziela, Jacek; Sadowski, Zygmunt; Rużyłło, Witold; Janas, Jadwiga; Roik, Marek; Opolski, Grzegorz; Zmudka, Krzysztof; Czunko, Piotr; Kurowski, Michal; Busz-Papież, Benita; Zinka, Elzbieta; Jablonski, Wojciech; Jaworska, Krystyna

    2013-01-01

    Background The purpose of the Occluded Artery Trial (OAT) Biomarker substudy was to evaluate the impact of infarct related artery (IRA) revascularization on serial levels of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and dynamics of other biomarkers related to left ventricular remodeling, fibrosis and angiogenesis. Methods Patients were eligible for OAT-Biomarker based on the main OAT criteria. Of 70 patients (age 60.8 ± 8.8, 25% women) enrolled in the substudy, 37 were ra...

  13. Using Administrative Data to Evaluate Impacts in a School-Randomized Trial of the 4Rs Program

    Science.gov (United States)

    Berg, Juliette; Torrente, Catalina; Aber, J. Lawrence; Jones, Stephanie M.; Brown, Joshua L.

    2010-01-01

    The 4Rs Program (Reading, Writing, Respect and Resolution) is a "dual focus" whole school universal intervention designed to promote literacy development and social-emotional learning, that is currently being rigorously evaluated using a school-randomized trial of 18 elementary schools (9 intervention, 9 control) in New York City. The present…

  14. Measuring the impact and costs of a universal group based parenting programme: protocol and implementation of a trial

    Directory of Open Access Journals (Sweden)

    Winstanley Sarah

    2010-06-01

    Full Text Available Abstract Background Sub-optimal parenting is a common risk factor for a wide range of negative health, social and educational outcomes. Most parenting programmes have been developed in the USA in the context of delinquency prevention for targeted or indicated groups and the main theoretical underpinning for these programmes is behaviour management. The Family Links Nurturing Programme (FLNP focuses on family relationships as well as behaviour management and is offered on a universal basis. As a result it may be better placed to improve health and educational outcomes. Developed in the UK voluntary sector, FLNP is popular with practitioners, has impressed policy makers throughout the UK, has been found to be effective in before/after and qualitative studies, but lacks a randomised controlled trial (RCT evidence base. Methods/Design A multi-centre, investigator blind, randomised controlled trial of the FLNP with a target sample of 288 south Wales families who have a child aged 2-4 yrs living in or near to Flying Start/Sure Start areas. Changes in parenting, parent child relations and parent and child wellbeing are assessed with validated measures immediately and at 6 months post intervention. Economic components include cost consequences and cost utility analyses based on parental ranking of states of quality of life. Attendance and completion rates and fidelity to the FLNP course delivery are assessed. A nested qualitative study will assess reasons for participation and non-participation and the perceived value of the programme to families. By the end of May 2010, 287 families have been recruited into the trial across four areas of south Wales. Recruitment has not met the planned timescales with barriers including professional anxiety about families entering the control arm of the trial, family concern about video and audio recording, programme facilitator concern about the recording of FLNP sessions for fidelity purposes and delays due to the

  15. Opinions and perceptions regarding the impact of new regulatory guidelines: A survey in Indian Clinical Trial Investigators

    Directory of Open Access Journals (Sweden)

    Rashmi Kadam

    2016-01-01

    Full Text Available Background: Clinical research in India experienced dramatic changes with series of stringent guidelines introduced by regulatory authorities. These guidelines posed significant challenges for the clinical trial industry. Objective: To assess the perceptions and opinion of Indian Investigators about the new regulatory guidelines. Methods: We developed a survey questionnaire on recent regulatory guidelines which was hosted on a web portal. Seventy-three investigators from India participated in the survey. Results: Central registration of Ethics Committees (ECs was agreed by 90.1% participants, 76.8% participants agreed to compensation of subjects for study related Serious Adverse Events (SAE's. The compulsion to include government sites in clinical trials was not agreed by 49.3% participants while 21.2% agreed to it. Restriction on a number of trials per investigator was agreed by 49.3% of participants while 40.9% disagreed. Participants (50.7% disagreed to the introduction of audio-video (AV recording of informed consent, 36.6% agreed and 12.7% were neutral. Discussion: Participants observed that post central registration; ECs have improved systems with adequate member composition, functional Standard Operating Procedures, and timely approvals. Participants agreed that compensation of study related SAE's would assure subject protection and safety. The introduction of AV consenting was strongly debated sighting sociocultural issues in the implementation of the same. Conclusion: Participants endorsed guidelines pertaining to the central registration of ECs, SAE related compensation. Restrictions on a number of trials per investigator and AV consenting were debated ardently. The response of the survey participants who are clinical trial investigators in India showed general acceptance, effectiveness and anticipated compliance to the new regulatory guidelines.

  16. Opinions and perceptions regarding the impact of new regulatory guidelines: A survey in Indian Clinical Trial Investigators

    Science.gov (United States)

    Kadam, Rashmi; Borde, Sanghratna; Madas, Sapna; Nagarkar, Aarti; Salvi, Sundeep; Limaye, Sneha

    2016-01-01

    Background: Clinical research in India experienced dramatic changes with series of stringent guidelines introduced by regulatory authorities. These guidelines posed significant challenges for the clinical trial industry. Objective: To assess the perceptions and opinion of Indian Investigators about the new regulatory guidelines. Methods: We developed a survey questionnaire on recent regulatory guidelines which was hosted on a web portal. Seventy-three investigators from India participated in the survey. Results: Central registration of Ethics Committees (ECs) was agreed by 90.1% participants, 76.8% participants agreed to compensation of subjects for study related Serious Adverse Events (SAE's). The compulsion to include government sites in clinical trials was not agreed by 49.3% participants while 21.2% agreed to it. Restriction on a number of trials per investigator was agreed by 49.3% of participants while 40.9% disagreed. Participants (50.7%) disagreed to the introduction of audio-video (AV) recording of informed consent, 36.6% agreed and 12.7% were neutral. Discussion: Participants observed that post central registration; ECs have improved systems with adequate member composition, functional Standard Operating Procedures, and timely approvals. Participants agreed that compensation of study related SAE's would assure subject protection and safety. The introduction of AV consenting was strongly debated sighting sociocultural issues in the implementation of the same. Conclusion: Participants endorsed guidelines pertaining to the central registration of ECs, SAE related compensation. Restrictions on a number of trials per investigator and AV consenting were debated ardently. The response of the survey participants who are clinical trial investigators in India showed general acceptance, effectiveness and anticipated compliance to the new regulatory guidelines.

  17. Impact of an indigenous microbial enhanced oil recovery field trial on microbial community structure in a high pour-point oil reservoir.

    Science.gov (United States)

    Zhang, Fan; She, Yue-Hui; Li, Hua-Min; Zhang, Xiao-Tao; Shu, Fu-Chang; Wang, Zheng-Liang; Yu, Long-Jiang; Hou, Du-Jie

    2012-08-01

    Based on preliminary investigation of microbial populations in a high pour-point oil reservoir, an indigenous microbial enhanced oil recovery (MEOR) field trial was carried out. The purpose of the study is to reveal the impact of the indigenous MEOR process on microbial community structure in the oil reservoir using 16Sr DNA clone library technique. The detailed monitoring results showed significant response of microbial communities during the field trial and large discrepancies of stimulated microorganisms in the laboratory and in the natural oil reservoir. More specifically, after nutrients injection, the original dominant populations of Petrobacter and Alishewanella in the production wells almost disappeared. The expected desirable population of Pseudomonas aeruginosa, determined by enrichment experiments in laboratory, was stimulated successfully in two wells of the five monitored wells. Unexpectedly, another potential population of Pseudomonas pseudoalcaligenes which were not detected in the enrichment culture in laboratory was stimulated in the other three monitored production wells. In this study, monitoring of microbial community displayed a comprehensive alteration of microbial populations during the field trial to remedy the deficiency of culture-dependent monitoring methods. The results would help to develop and apply more MEOR processes. PMID:22159733

  18. Impact of an indigenous microbial enhanced oil recovery field trial on microbial community structure in a high pour-point oil reservoir

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Fan; Zhang, Xiao-Tao; Hou, Du-Jie [China Univ. of Geosciences, Beijing (China). The Key Lab. of Marine Reservoir Evolution and Hydrocarbon Accumulation Mechanism; She, Yue-Hui [Yangtze Univ., Jingzhou, Hubei (China). College of Chemistry and Environmental Engineering; Huazhong Univ. of Science and Technology, Wuhan (China). College of Life Science and Technology; Li, Hua-Min [Beijing Bioscience Research Center (China); Shu, Fu-Chang; Wang, Zheng-Liang [Yangtze Univ., Jingzhou, Hubei (China). College of Chemistry and Environmental Engineering; Yu, Long-Jiang [Huazhong Univ. of Science and Technology, Wuhan (China). College of Life Science and Technology

    2012-08-15

    Based on preliminary investigation of microbial populations in a high pour-point oil reservoir, an indigenous microbial enhanced oil recovery (MEOR) field trial was carried out. The purpose of the study is to reveal the impact of the indigenous MEOR process on microbial community structure in the oil reservoir using 16Sr DNA clone library technique. The detailed monitoring results showed significant response of microbial communities during the field trial and large discrepancies of stimulated microorganisms in the laboratory and in the natural oil reservoir. More specifically, after nutrients injection, the original dominant populations of Petrobacter and Alishewanella in the production wells almost disappeared. The expected desirable population of Pseudomonas aeruginosa, determined by enrichment experiments in laboratory, was stimulated successfully in two wells of the five monitored wells. Unexpectedly, another potential population of Pseudomonas pseudoalcaligenes which were not detected in the enrichment culture in laboratory was stimulated in the other three monitored production wells. In this study, monitoring of microbial community displayed a comprehensive alteration of microbial populations during the field trial to remedy the deficiency of culture-dependent monitoring methods. The results would help to develop and apply more MEOR processes. (orig.)

  19. Heterospecific Acoustic Interference: Effects on Calling in Oophaga pumilio.

    Science.gov (United States)

    Wong, Stefanie; Parada, Humberto; Narins, Peter M

    2009-01-01

    Call rate suppression is a common short-term solution for avoiding acoustic interference in animals. It has been widely documented between and within frog species, but the effects of non-anuran calling on frog vocalizations is less well known. Heterospecific acoustic interference on the calling of Oophaga pumilio (Bauer, 1994) (formerly Dendrobates pumilio) males was studied in a lowland, wet tropical forest in SE Nicaragua. Acoustic playback experiments were conducted to characterize the responses of O. pumilio males to interfering calls of cicadas, two species of crickets and a sympatric dendrobatid frog, Phyllobates lugubris. Call rate, call bout duration, percent of time calling, dominant frequency and latency to first-call were analyzed. Significant call rate suppression was observed during all stimulus playbacks, yet no significant differences were found in spontaneous call rates during pre- and post-playback trials. Dominant frequency significantly decreased after P. lugubris playback and first-call latency significantly decreased in response to both cicada and tree cricket playbacks. These results provide robust evidence that O. pumilio males can dynamically modify their calling pattern in unique ways, depending on the source of the heterospecific acoustic interference. PMID:20953296

  20. Long-term biological and behavioural impact of an adolescent sexual health intervention in Tanzania: follow-up survey of the community-based MEMA kwa Vijana Trial.

    Directory of Open Access Journals (Sweden)

    Aoife M Doyle

    2010-06-01

    Full Text Available BACKGROUND: The ability of specific behaviour-change interventions to reduce HIV infection in young people remains questionable. Since January 1999, an adolescent sexual and reproductive health (SRH intervention has been implemented in ten randomly chosen intervention communities in rural Tanzania, within a community randomised trial (see below; NCT00248469. The intervention consisted of teacher-led, peer-assisted in-school education, youth-friendly health services, community activities, and youth condom promotion and distribution. Process evaluation in 1999-2002 showed high intervention quality and coverage. A 2001/2 intervention impact evaluation showed no impact on the primary outcomes of HIV seroincidence and herpes simplex virus type 2 (HSV-2 seroprevalence but found substantial improvements in SRH knowledge, reported attitudes, and some reported sexual behaviours. It was postulated that the impact on "upstream" knowledge, attitude, and reported behaviour outcomes seen at the 3-year follow-up would, in the longer term, lead to a reduction in HIV and HSV-2 infection rates and other biological outcomes. A further impact evaluation survey in 2007/8 ( approximately 9 years post-intervention tested this hypothesis. METHODS AND FINDINGS: This is a cross-sectional survey (June 2007 through July 2008 of 13,814 young people aged 15-30 y who had attended trial schools during the first phase of the MEMA kwa Vijana intervention trial (1999-2002. Prevalences of the primary outcomes HIV and HSV-2 were 1.8% and 25.9% in males and 4.0% and 41.4% in females, respectively. The intervention did not significantly reduce risk of HIV (males adjusted prevalence ratio [aPR] 0.91, 95%CI 0.50-1.65; females aPR 1.07, 95%CI 0.68-1.67 or HSV-2 (males aPR 0.94, 95%CI 0.77-1.15; females aPR 0.96, 95%CI 0.87-1.06. The intervention was associated with a reduction in the proportion of males reporting more than four sexual partners in their lifetime (aPR 0.87, 95%CI 0

  1. [The impact of researchers loyal to Big Pharma on the ethics and quality of clinical trials in Latin America].

    Science.gov (United States)

    Ugalde, Antonio; Homedes, Núria

    2015-03-01

    This article explains the difficulties innovative pharmaceutical firms have in repaying shareholders with attractive dividends. The problem is the result of the expiration of the patents of blockbuster drugs and the difficulties that the firms have in bringing new blockbuster drugs to the market. One of the solutions companies have found has been to accelerate the implementation of clinical trials in order to expedite the commercialization of new drugs. Doing so increases the period in which they can sell drugs at monopoly prices. We therefore discuss how innovative pharmaceutical firms shorten the implementation time of clinical trials in Latin America and the consequences such actions have on the quality of the collected data, the protection of human rights of the subjects of experimentation, and compliance with the ethical principles approved in international declarations. PMID:25853831

  2. Radiochemotherapy of locally advanced anal canal carcinoma: Prospective assessment of early impact on the quality of life (randomized trial ACCORD 03)

    International Nuclear Information System (INIS)

    Background and purpose: The aim of this study was to prospectively assess the quality of life (QOL) of patients treated by concomitant chemo radiation for locally advanced anal canal carcinoma. Materials and methods: We report on a subgroup of 119 patients enrolled in a 306-patient therapeutic intensification prospective trial (ACCORD 03). This trial evaluated the impact on colostomy-free survival of induction chemotherapy and/or high dose radiotherapy (factorial design 2 * 2 treatment arms). QOL was assessed both before and 2 months after treatment using the EORTC QLQ-C30 questionnaire as well as a questionnaire relating to anal sphincter conservative treatment (AS-CT). Results: Compared to pre-treatment scores, patients reported significant improvement in their emotional function (+8.4 points p = 0.002), global health status (+5.9 points p = 0.0007), as well as a decrease in insomnia (-13.8 points p < 0.0001), constipation (-12.0 points p < 0.0001), appetite loss (-10.3 points p < 0.0001) and pain (-9.6 points p = 0.0002). The AS-CT degree of satisfaction with intestinal functions score was increased (+11.2 points p < 0.0001). Conclusion: This is the first prospective study comparing QOL of patients with advanced anal canal carcinoma, before and 2 months after conservative treatment. Two months after treatment, QOL was improved. Induction chemotherapy and/or high dose radiotherapy did not provide a negative impact on QOL

  3. Long-term effect of rehabilitation in coronary artery disease patients: randomized clinical trial of the impact of exercise volume

    OpenAIRE

    Hansen, Dominique; Dendale, Paul; Raskin, Anita; Schoonis, Annick; Berger, Jan; Vlassak, Irmien; Meeusen, Romain

    2010-01-01

    Objective: To assess whether exercise volume during phase II rehabilitation affects long-term clinical benefits in patients with coronary artery disease. Design: Prospective randomized clinical trial with long-term follow-up. Setting: Hospital outpatient clinic. Subjects: Coronary artery disease patients (age 65 +/- 9 years, 82% males) attending a phase II rehabilitation programme were randomized into two groups of exercise volumes: 40-versus 60-minute training sessions. Patients exercised fo...

  4. The impact of a pledge campaign and the promise of publicity: a randomized controlled trial of charitable donations

    OpenAIRE

    Sarah Cotterill, Peter John, Alice Moseley

    2013-01-01

    Objective This study investigates whether asking people to make a pledge causes them to donate to a charitable cause and whether the promise of public recognition increases the effectiveness of the request. Method A randomized controlled trial in Manchester, United Kingdom, where households were sent letters asking them to donate a book for school libraries in South Africa. Results People who are asked to make a pledge and offered local public recognition are more likely to mak...

  5. The Ghana essential health interventions program: a plausibility trial of the impact of health systems strengthening on maternal & child survival

    OpenAIRE

    Awoonor-williams, John Koku; Bawah, Ayaga A; Nyonator, Frank K; Asuru, Rofina; Oduro, Abraham; Ofosu, Anthony; Phillips, James F

    2013-01-01

    Background During the 1990s, researchers at the Navrongo Health Research Centre in northern Ghana developed a highly successful community health program. The keystone of the Navrongo approach was the deployment of nurses termed community health officers to village locations. A trial showed that, compared to areas relying on existing services alone, the approach reduced child mortality by half, maternal mortality by 40%, and fertility by nearly a birth — from a total fertility rate of 5.5 in o...

  6. Impact of treatment with rosuvastatin and atorvastatin on cardiovascular outcomes: evidence from the Archimedes-simulated clinical trials

    OpenAIRE

    Colivicchi F.; Sternhufvud C; Gandhi SK

    2015-01-01

    Furio Colivicchi,1 Catarina Sternhufvud,2 Sanjay K Gandhi3 1Cardiology Division, Emergency Department, San Filippo Neri Hospital, ASL Roma E, Rome, Italy; 2Global Payer Evidence and Pricing, AstraZeneca R&D, Mölndal, Sweden; 3Global Health Economics and Outcomes Research, TEVA Pharmaceuticals, Frazer, PA, United States Objective: No clinical trials have been conducted to directly compare the effect of the two high-intensity statins, rosuvastatin and atorvastatin, on cardiovascular ou...

  7. The impact of a school-based water supply and treatment, hygiene, and sanitation programme on pupil diarrhoea: a cluster-randomized trial.

    Science.gov (United States)

    Freeman, M C; Clasen, T; Dreibelbis, R; Saboori, S; Greene, L E; Brumback, B; Muga, R; Rheingans, R

    2014-02-01

    The impact of improved water, sanitation, and hygiene (WASH) access on mitigating illness is well documented, although impact of school-based WASH on school-aged children has not been rigorously explored. We conducted a cluster-randomized trial in Nyanza Province, Kenya to assess the impact of a school-based WASH intervention on diarrhoeal disease in primary-school pupils. Two study populations were used: schools with a nearby dry season water source and those without. Pupils attending 'water-available' schools that received hygiene promotion and water treatment (HP&WT) and sanitation improvements showed no difference in period prevalence or duration of illness compared to pupils attending control schools. Those pupils in schools that received only the HP&WT showed similar results. Pupils in 'water-scarce' schools that received a water-supply improvement, HP&WT and sanitation showed a reduction in diarrhoea incidence and days of illness. Our study revealed mixed results on the impact of improvements to school WASH improvements on pupil diarrhoea. PMID:23702047

  8. Design of a trial to evaluate the impact of clinical pharmacists and community health promoters working with African-Americans and Latinos with Diabetes

    Directory of Open Access Journals (Sweden)

    Gerber Ben S

    2012-10-01

    Full Text Available Abstract Background Given the increasing prevalence of diabetes and the lack of patients reaching recommended therapeutic goals, novel models of team-based care are emerging. These teams typically include a combination of physicians, nurses, case managers, pharmacists, and community-based peer health promoters (HPs. Recent evidence supports the role of pharmacists in diabetes management to improve glycemic control, as they offer expertise in medication management with the ability to collaboratively intensify therapy. However, few studies of pharmacy-based models of care have focused on low income, minority populations that are most in need of intervention. Alternatively, HP interventions have focused largely upon low income minority groups, addressing their unique psychosocial and environmental challenges in diabetes self-care. This study will evaluate the impact of HPs as a complement to pharmacist management in a randomized controlled trial. Methods/Design The primary aim of this randomized trial is to evaluate the effectiveness of clinical pharmacists and HPs on diabetes behaviors (including healthy eating, physical activity, and medication adherence, hemoglobin A1c, blood pressure, and LDL-cholesterol levels. A total of 300 minority patients with uncontrolled diabetes from the University of Illinois Medical Center ambulatory network in Chicago will be randomized to either pharmacist management alone, or pharmacist management plus HP support. After one year, the pharmacist-only group will be intensified by the addition of HP support and maintenance will be assessed by phasing out HP support from the pharmacist plus HP group (crossover design. Outcomes will be evaluated at baseline, 6, 12, and 24 months. In addition, program and healthcare utilization data will be incorporated into cost and cost-effectiveness evaluations of pharmacist management with and without HP support. Discussion The study will evaluate an innovative, integrated

  9. Call Admission Control in Mobile Wireless

    OpenAIRE

    Goril, J.; Dobos, L.

    2002-01-01

    Some problems related to wireless network access are discussed in the article. Special attention is paid to Medium Access Control and Call Admission Control. Both have direct impact on communication link accession. While the first one dictates how to, the second one decides who can access the link. The problems with wireless medium access are mentioned and requirements on MAC protocols are named. Also need for CAC algorithms is illustrated and simple functional example is proposed. Finally, t...

  10. Impact of hormonal treatment duration in combination with radiotherapy for locally advanced prostate cancer: Meta-analysis of randomized trials

    Directory of Open Access Journals (Sweden)

    Pinnarò Paola

    2010-12-01

    Full Text Available Abstract Background Hormone therapy plus radiotherapy significantly decreases recurrences and mortality of patients affected by locally advanced prostate cancer. In order to determine if difference exists according to the hormonal treatment duration, a literature-based meta-analysis was performed. Methods Relative risks (RR were derived through a random-effect model. Differences in primary (biochemical failure, BF; cancer-specific survival, CSS, and secondary outcomes (overall survival, OS; local or distant recurrence, LR/DM were explored. Absolute differences (AD and the number needed to treat (NNT were calculated. Heterogeneity, a meta-regression for clinic-pathological predictors and a correlation test for surrogates were conducted. Results Five trials (3,424 patients were included. Patient population ranged from 267 to 1,521 patients. The longer hormonal treatment significantly improves BF (with significant heterogeneity with an absolute benefit of 10.1%, and a non significant trend in CSS. With regard to secondary end-points, the longer hormonal treatment significantly decrease both the LR and the DM with an absolute difference of 11.7% and 11.5%. Any significant difference in OS was observed. None of the three identified clinico-pathological predictors (median PSA, range 9.5-20.35, Gleason score 7-10, 27-55% patients/trial, and T3-4, 13-77% patients/trial, did significantly affect outcomes. At the meta-regression analysis a significant correlation between the overall treatment benefit in BF, CSS, OS, LR and DM, and the length of the treatment was found (p≤0.03. Conclusions Although with significant heterogeneity (reflecting different patient' risk stratifications, a longer hormonal treatment duration significantly decreases biochemical, local and distant recurrences, with a trend for longer cancer specific survival.

  11. The impact of tailored diabetes registry report cards on measures of disease control: a nested randomized trial

    Directory of Open Access Journals (Sweden)

    Steele Andrew W

    2011-02-01

    Full Text Available Abstract Background Most studies of diabetes self-management that show improved clinical outcome performance involve multiple, time-intensive educational sessions in a group format. Most provider performance feedback interventions do not improve intermediate outcomes, yet lack targeted, patient-level feedback. Methods 5,457 low-income adults with diabetes at eight federally-qualified community health centers participated in this nested randomized trial. Half of the patients received report card mailings quarterly; patients at 4 of 8 clinics received report cards at every clinic visit; and providers at 4 of 8 clinics received quarterly performance feedback with targeted patient-level data. Expert-recommended glycemic, lipid, and blood pressure outcomes were assessed. Assessment of report card utility and patient and provider satisfaction was conducted through mailed patient surveys and mid- and post-intervention provider interviews. Results Many providers and the majority of patients perceived the patient report card as being an effective tool. However, patient report card mailings did not improve process outcomes, nor did point-of-care distribution improve intermediate outcomes. Clinics with patient-level provider performance feedback achieved a greater absolute increase in the percentage of patients at target for glycemic control compared to control clinics (6.4% vs 3.8% respectively, Generalized estimating equations Standard Error 0.014, p Conclusions Patient performance report cards were generally well received by patients and providers, but were not associated with improved outcomes. Targeted, patient-level feedback to providers improved glycemic performance. Provider frustration highlights the need to supplement provider outreach efforts. Trial Registration ClinicalTrials.gov: NCT00827710

  12. Application of Affect to CALL

    Institute of Scientific and Technical Information of China (English)

    李露

    2006-01-01

    This essay mainly attempts to discuss some affective factors in CALL, with focus on affective influence on English (foreign language) learning and thus concludes that in the process of CALL related affect should be activated and made good use of to better foreign language teaching and learning.

  13. When to Call Your Pediatrician

    Science.gov (United States)

    ... in Action Medical Editor & Editorial Advisory Board Sponsors Sponsorship Opporunities Spread the Word Shop AAP Find a ... to Call Your Pediatrician Page Content Article Body Is it OK to call my child's pediatrician even if I'm not sure my ...

  14. The ESEP study: Salpingostomy versus salpingectomy for tubal ectopic pregnancy; The impact on future fertility: A randomised controlled trial

    Directory of Open Access Journals (Sweden)

    van Mello Norah M

    2008-06-01

    Full Text Available Abstract Background For most tubal ectopic pregnancies (EP surgery is the treatment of first choice. Whether surgical treatment should be performed conservatively (salpingostomy or radically (salpingectomy in women wishing to preserve their reproductive capacity, is subject to debate. Salpingostomy preserves the tube, but bears the risks of both persistent trophoblast and repeat ipsilateral tubal EP. Salpingectomy, avoids these risks, but leaves only one tube for reproductive capacity. This study aims to reveal the trade-off between both surgical options: whether the potential advantage of salpingostomy, i.e. a better fertility prognosis as compared to salpingectomy, outweighs the potential disadvantages, i.e. persistent trophoblast and an increased risk for a repeat EP. Methods/Design International multi centre randomised controlled trial comparing salpingostomy versus salpingectomy in women with a tubal EP without contra lateral tubal pathology. Hemodynamically stable women with a presumptive diagnosis of tubal EP, scheduled for surgery, are eligible for inclusion. Patients pregnant after in vitro fertilisation (IVF and/or known documented tubal pathology are excluded. At surgery, a tubal EP must be confirmed. Only women with a tubal EP amenable to both interventions and a healthy contra lateral tube are included. Salpingostomy and salpingectomy are performed according to standard procedures of participating hospitals. Up to 36 months after surgery, women will be contacted to assess their fertility status at six months intervals starting form the day of the operation. The primary outcome measure is the occurrence of spontaneous viable intra uterine pregnancy. Secondary outcome measures are persistent trophoblast, repeat EP, all pregnancies including those resulting from IVF and financial costs. The analysis will be performed according to the intention to treat principle. A cost-effectiveness analysis will be performed within a decision

  15. Linking CALL and SLA: Using the IRIS Database to Locate Research Instruments

    Science.gov (United States)

    Handley, Zöe; Marsden, Emma

    2014-01-01

    To establish an evidence base for future computer-assisted language learning (CALL) design, CALL research needs to move away from CALL versus non-CALL comparisons, and focus on investigating the differential impact of individual coding elements, that is, specific features of a technology which might have an impact on learning (Pederson, 1987).…

  16. Spatial diffusion patterns of call-centers in the Netherlands

    OpenAIRE

    Bruinsma, Frank; Rietveld, Piet; Beekman, Michiel

    2002-01-01

    The focus in this paper is on spatial diffusion patterns of call centers in The Netherlands. The number of call centers has increased rapidly in the last decade and it seems that impacts of call centers on the labor market still underestimated. We will pay attention to two spatial levels: first urban versus rural and second local. Given the labor intensity and quality required by call centers and the absence of physical contacts with consumers one might expect that most call centers are locat...

  17. SIMULATION MODELS OF CALL ADMISSION CONTROL SCHEMES USING GPSS

    Directory of Open Access Journals (Sweden)

    Vassilya ABDULOVA

    2014-01-01

    Full Text Available In cellular wireless networks, a variety of channel allocation schemes have been developed for achieving high capacity with minimal interference. The choice of channel allocation scheme impacts the performance of the system, particularly as how calls are managed when a mobile user is handed off from one cell to another. Call Admission Control schemes take into account the effect of handoffs in the performance of the system, particularly call blocking probability and call dropping probability. In this study, we present simulation models and programs of some popular Call Admission Control schemes using GPSS simulation tool.

  18. Ethosomal nanocarriers: the impact of constituents and formulation techniques on ethosomal properties, in vivo studies, and clinical trials.

    Science.gov (United States)

    Abdulbaqi, Ibrahim M; Darwis, Yusrida; Khan, Nurzalina Abdul Karim; Assi, Reem Abou; Khan, Arshad A

    2016-01-01

    Ethosomal systems are novel lipid vesicular carriers containing a relatively high percentage of ethanol. These nanocarriers are especially designed for the efficient delivery of therapeutic agents with different physicochemical properties into deep skin layers and across the skin. Ethosomes have undergone extensive research since they were invented in 1996; new compounds were added to their initial formula, which led to the production of new types of ethosomal systems. Different preparation techniques are used in the preparation of these novel carriers. For ease of application and stability, ethosomal dispersions are incorporated into gels, patches, and creams. Highly diverse in vivo models are used to evaluate their efficacy in dermal/transdermal delivery, in addition to clinical trials. This article provides a detailed review of the ethosomal systems and categorizes them on the basis of their constituents to classical ethosomes, binary ethosomes, and transethosomes. The differences among these systems are discussed from several perspectives, including the formulation, size, ζ-potential (zeta potential), entrapment efficiency, skin-permeation properties, and stability. This paper gives a detailed review on the effects of ethosomal system constituents, preparation methods, and their significant roles in determining the final properties of these nanocarriers. Furthermore, the novel pharmaceutical dosage forms of ethosomal gels, patches, and creams are highlighted. The article also provides detailed information regarding the in vivo studies and clinical trials conducted for the evaluation of these vesicular systems. PMID:27307730

  19. The impact of routine open nonsuction drainage on fluid accumulation after thyroid surgery: a prospective randomised clinical trial.

    LENUS (Irish Health Repository)

    Neary, Peter M

    2012-01-01

    Thyroid drains following thyroid surgery are routinely used despite minimal supportive evidence. Our aim in this study is to determine the impact of routine open drainage of the thyroid bed postoperatively on ultrasound-determined fluid accumulation at 24 hours.

  20. Safety, tolerability, and impact on allergic inflammation of autologous E.coli autovaccine in the treatment of house dust mite asthma - a prospective open clinical trial

    Directory of Open Access Journals (Sweden)

    Schulze Johannes

    2011-06-01

    Full Text Available Abstract Background Asthma is increasing worldwide and results from a complex immunological interaction between genetic susceptibility and environmental factors. Autovaccination with E. coli induces a strong TH-1 immune response, thus offering an option for the treatment of allergic diseases. Methods Prospective open trial on safety, tolerability, and impact on allergic inflammation of an autologous E.coli autovaccine in intermittent or mild persistent house dust mite asthma. Determination of exhaled nitric monoxide (eNO before and after bronchial mite challenge initially and after nine months of autovaccination. Results In nine subjects and a total of 306 injections, we observed 101 episodes of local erythema (33.3%; median of maximal diameter 2.5 cm, 95 episodes of local swelling (31.1%; median of maximal diameter 3 cm, and 27 episodes of local pain (8.8%. Four subjects reported itching at the injection site with a total of 30 episodes (9.8%. Median eNO increase after autovaccination was significantly smaller (from 27.3 to 33.8 ppb; p = 0.334 compared to initial values (from 32.6 to 42.2 ppb; p = 0.046 (p = 0.034. We observed no serious adverse events. All organ functions (inclusive electrocardiogramm and laboratory testing of the blood (clinical chemistry, hematology and the urine (screening test, Β-microglobuline were within normal limits. Vital signs undulated within the physiological variability. Conclusion The administration of autologous autovacine for the treatment of house dust mite asthma resulted in a reduction of the eNO increase upon bronchial mite challenge. In nine subjects and 306 injections, only a few mild local reactions and no systemic severe adverse events were observed. Trial registration EudraCT Nr. 2005-005534-12 ClinicalTrials.gov ID NCT00677209

  1. Impact of NGO training and support intervention on diarrhoea management practices in a rural community of Bangladesh: an uncontrolled, single-arm trial.

    Directory of Open Access Journals (Sweden)

    Ahmed S Rahman

    Full Text Available PURPOSE/OBJECTIVE: The evolving Non-Governmental Organization (NGO sector in Bangladesh provides health services directly, however some NGOs indirectly provide services by working with unlicensed providers. The primary objective of this study was to examine the impact of NGO training of unlicensed providers on diarrhoea management and the scale up of zinc treatment in rural populations. METHODS: An uncontrolled, single-arm trial for a training and support intervention on diarrhoea outcomes was employed in a rural sub-district of Bangladesh during 2008. Two local NGOs and their catchment populations were chosen for the study. The intervention included training of unlicensed health care providers in the management of acute childhood diarrhoea, particularly emphasizing zinc treatment. In addition, community-based promotion of zinc treatment was carried out. Baseline and endline ecologic surveys were carried out in intervention and control villages to document changes in treatments received for diarrhoea in under-five children. RESULTS: Among surveyed household with an active or recent acute childhood diarrhoea episode, 69% sought help from a health provider. Among these, 62.8% visited an unlicensed private provider. At baseline, 23.9% vs. 22% of control and intervention group children with diarrhoea had received zinc of any type. At endline (6 months later this had changed to 15.3% vs. 30.2%, respectively. The change in zinc coverage was significantly higher in the intervention villages (p<0.01. Adherence with giving zinc for 10 days or more was significantly higher in the intervention households (9.2% vs. 2.5%; p<0.01. Child's age, duration of diarrhoea, type of diarrhoea, parental year of schooling as well as oral rehydration solution (ORS and antibiotic usage were significant predictors of zinc usage. CONCLUSION: Training of unlicensed healthcare providers through NGOs increased zinc coverage in the diarrhoea management of under-five children in

  2. Impact of the Daily Use of a Microcrystal Hydroxyapatite Dentifrice on De Novo Plaque Formation and Clinical/Microbiological Parameters of Periodontal Health. A Randomized Trial

    Science.gov (United States)

    Schlagenhauf, Ulrich; May, Theodor W.; Gravemeier, Martina; Prior, Karola; Petersilka, Gregor; Ehmke, Benjamin

    2016-01-01

    Aim This 12-week prospective, randomized, double-blind, two-center trial evaluated the impact of a microcrystalline zinc hydroxyapatite (mHA) dentifrice on plaque formation rate (PFR) in chronic periodontitis patients. We hypothesized that mHA precipitates cause delayed plaque development when compared to a fluoridated control (AmF/SnF2), and therefore would improve periodontal health. Material & Methods At baseline and after 4 and 12 weeks, PFR and other clinical and microbiological parameters were recorded. Seventy periodontitis patients received a mHA or AmF/SnF2 dentifrice as daily oral care without hygiene instructions. Four weeks after baseline, participants received full mouth debridement and continued using the dentifrices for another 8 weeks. Results Primary outcome PFR did not change statistically significantly from baseline to weeks 4 and 12, neither in mHA (n = 33; 51.7±17.2% vs. 48.5±16.65% vs. 48.4±19.9%) nor in AmF/SnF2-group (n = 34; 52.3±17.5% vs. 52.5±21.3% vs. 46.1±21.8%). Secondary clinical parameters such as plaque control record, gingival index, bleeding on probing, and pocket probing depth improved, but between-group differences were not statistically significant. Microbiological analyses showed similar slight decreases in colony-forming units in both groups. Conclusion In patients with mild-to-moderate periodontitis, periodontal therapy and use of a mHA-or AmF/SnF2 dentifrice without instructions induced comparable improvements in periodontal health but did not significantly reduce the PFR. Trial Registration ClincalTrials.gov NCT02697539 PMID:27467683

  3. La calle de la Lona

    OpenAIRE

    Marín Reñasco, Alejandro

    2014-01-01

    Relato en el que se describe el ambiente cargado de realidad cotidiana de los habitantes de una calle, la calle de la lona. En el transcurso de la mañana de un sábado en una calle ubicado en una zona obrera de una ciudad cualquiera, el autor disecciona con un lenguaje preciso y brillante los juegos de los niños que aprovechan la mañana de libranza escolar para liberarse de la atmósfera cargada de sus casas alejándose del control familiar transgrediendo los límites de la calle…allá donde el mu...

  4. The impact of dose of the angiotensin-receptor blocker valsartan on the post-myocardial infarction ventricular remodeling: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Cho Young-Rak

    2011-11-01

    Full Text Available Abstract Background Angiotensin-converting enzyme inhibitors and the angiotensin-receptor blocker valsartan ameliorate ventricular remodeling after myocardial infarction (MI. Based on previous clinical trials, a maximum clinical dose is recommended in practical guidelines. Yet, has not been clearly demonstrated whether the recommended dose is more efficacious compared to the lower dose that is commonly used in clinical practice. Method/Design Valsartan in post-MI remodeling (VALID is a randomized, open-label, single-blinded multicenter study designed to compare the efficacy of different clinical dose of valsartan on the post-MI ventricular remodeling. This study also aims to assess neurohormone change and clinical parameters of patients during the post-infarct period. A total of 1116 patients with left ventricular dysfunction following the first episode of acute ST-elevation MI are to be enrolled and randomized to a maximal tolerable dose (up to 320 mg/day or usual dose (80 mg/day of valsartan for 12 months in 2:1 ratio. Echocardiographic analysis for quantifying post-MI ventricular remodeling is to be conducted in central core laboratory. Clinical assessment and laboratory test are performed at fixed times. Discussion VALID is a multicenter collaborative study to evaluate the impact of dose of valsartan on the post-MI ventricular remodeling. The results of the study provide information about optimal dosing of the drug in the management of patients after MI. The results will be available by 2012. Trial registration NCT01340326

  5. The impact of transitioning from a 24-hour to a 16-hour call model amongst a cohort of Canadian anesthesia residents at McMaster University – a survey study

    Directory of Open Access Journals (Sweden)

    Sussman D

    2015-08-01

    Full Text Available David Sussman, James E Paul Department of Anesthesia, McMaster University, Hamilton, ON, Canada Purpose: The primary objective of this study was to assess anesthesia residents' opinions and perceptions on wellness/burnout, fatigue, education, and patient safety after the initiation of a reduced call model (16-hour call. Methods: A prospective cohort study was conducted at three time points during the 2013–2014 academic year. A web-based questionnaire consisting of 23 questions was electronically distributed to all anesthesia residents from postgraduate years (PGY 1 to 5 who were part of the active call roster (n=84 at McMaster University in Hamilton, Ontario. Descriptive summaries were calculated, counts and percentages were used for categorical variables, and answers to open text questions were reviewed for themes. Results: A response rate of 67% was obtained for this study. A majority of anesthesia residents (65% approved of 16-hour call, felt that their overall quality of life as a senior resident (PGY3 or greater or junior resident (PGY2 and below had improved (73% and 55%, respectively, and reported overall feeling less fatigued. Most respondents indicated that the quality of education remained unchanged (47%, or had improved (31%. And most felt better prepared for the royal college exam (52%. Most felt patient safety had improved or was unchanged (both 48%. Conclusion: The study demonstrates that 16-hour call improved resident wellness, reduced burnout and fostered an environment where residents are less fatigued and more satisfied with their educational experience promoting an environment of patient safety. Overall, the anesthesia residency group demonstrated that not only is 16-hour call preferred but beneficial. Keywords: resident wellness, reduced call model, duty hours, patient safety, cohort study, fatigue 

  6. Impact of postal invitations and user fee on influenza vaccination rates among the elderly. A randomized controlled trial in general practice

    DEFF Research Database (Denmark)

    Nexøe, J; Kragstrup, J; Rønne, T

    1997-01-01

    OBJECTIVE: To examine the impact of postal invitations and user fee on influenza vaccination rates. DESIGN: A controlled randomized trial in 13 general practices. One third of the participating patients received postal invitations to influenza vaccination free of charge. Another third received...... postal invitations to influenza vaccination on paying the usual fee (US$ 40-60). The last third served as a control group, being vaccinated at their own request and paying the usual fee. SETTING: General practice in the Counties of Funen and Vejle, Denmark. PATIENTS: Five hundred and eighty-five patients......, compared with 49% (42-56%) in the group who received a postal reminder and paid the usual fee, and 72% (65-78%) in the group invited to be vaccinated free of charge. CONCLUSION: It is suggested that GPs send postal invitations to their elderly patients in the risk groups urgently recommending influenza...

  7. Design of the OPUS School Meal Study: A randomised controlled trial assessing the impact of serving school meals based on the New Nordic Diet

    DEFF Research Database (Denmark)

    Damsgaard, Camilla T.; Dalskov, Stine-Mathilde; Petersen, Rikke A.;

    2012-01-01

    Introduction: Danish children consume too much sugar and not enough whole grain, fish, fruit, and vegetables. The Nordic region is rich in such foods with a strong health-promoting potential. We lack randomised controlled trials that investigate the developmental and health impact of serving school......, 1021 children from 3rd and 4th grades (8–11 years old) at nine Danish municipal schools were invited to participate. Classes were assigned to two 3-month periods with free school meals based on the New Nordic Diet (NND) or their usual packed lunch (control). Dietary intake, nutrient status, physical...... invited) participated. Although their parents were slightly better educated than the background population, children from various socioeconomic backgrounds were included. The proportion of overweight and obese children (14%) resembled that of earlier examinations of Danish school children. Drop out was 8...

  8. Ethosomal nanocarriers: the impact of constituents and formulation techniques on ethosomal properties, in vivo studies, and clinical trials

    Directory of Open Access Journals (Sweden)

    Abdulbaqi IM

    2016-05-01

    Full Text Available Ibrahim M Abdulbaqi, Yusrida Darwis, Nurzalina Abdul Karim Khan, Reem Abou Assi, Arshad A Khan School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia Abstract: Ethosomal systems are novel lipid vesicular carriers containing a relatively high percentage of ethanol. These nanocarriers are especially designed for the efficient delivery of therapeutic agents with different physicochemical properties into deep skin layers and across the skin. Ethosomes have undergone extensive research since they were invented in 1996; new compounds were added to their initial formula, which led to the production of new types of ethosomal systems. Different preparation techniques are used in the preparation of these novel carriers. For ease of application and stability, ethosomal dispersions are incorporated into gels, patches, and creams. Highly diverse in vivo models are used to evaluate their efficacy in dermal/ transdermal delivery, in addition to clinical trials. This article provides a detailed review of the ethosomal systems and categorizes them on the basis of their constituents to classical ethosomes, binary ethosomes, and transethosomes. The differences among these systems are discussed from several perspectives, including the formulation, size, ζ-potential (zeta potential, entrapment efficiency, skin-permeation properties, and stability. This paper gives a detailed review on the effects of ethosomal system constituents, preparation methods, and their significant roles in determining the final properties of these nanocarriers. Furthermore, the novel pharmaceutical dosage forms of ethosomal gels, patches, and creams are highlighted. The article also provides detailed information regarding the in vivo studies and clinical trials conducted for the evaluation of these vesicular systems. Keywords: ethosomes, transdermal, lipid-based vesicles, delivery systems

  9. Malware Detection Through Call Graphs

    OpenAIRE

    Kinable, Joris

    2010-01-01

    Each day, anti-virus companies receive large quantities of potentially harmful executables. Many of the malicious samples among these executables are variations of earlier encountered malware, created by their authors to evade pattern-based detection. Consequently, robust detection approaches are required, capable of recognizing similar samples automatically.In this thesis, malware detection through call graphs is studied. In a call graph, the functions of a binary executable are represented ...

  10. Impact of a clinical decision model for febrile children at risk for serious bacterial infections at the emergency department: a randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Evelien de Vos-Kerkhof

    Full Text Available To assess the impact of a clinical decision model for febrile children at risk for serious bacterial infections (SBI attending the emergency department (ED.Randomized controlled trial with 439 febrile children, aged 1 month-16 years, attending the pediatric ED of a Dutch university hospital during 2010-2012. Febrile children were randomly assigned to the intervention (clinical decision model; n = 219 or the control group (usual care; n = 220. The clinical decision model included clinical symptoms, vital signs, and C-reactive protein and provided high/low-risks for "pneumonia" and "other SBI". Nurses were guided by the intervention to initiate additional tests for high-risk children. The clinical decision model was evaluated by 1 area-under-the-receiver-operating-characteristic-curve (AUC to indicate discriminative ability and 2 feasibility, to measure nurses' compliance to model recommendations. Primary patient outcome was defined as correct SBI diagnoses. Secondary process outcomes were defined as length of stay; diagnostic tests; antibiotic treatment; hospital admission; revisits and medical costs.The decision model had good discriminative ability for both pneumonia (n = 33; AUC 0.83 (95% CI 0.75-0.90 and other SBI (n = 22; AUC 0.81 (95% CI 0.72-0.90. Compliance to model recommendations was high (86%. No differences in correct SBI determination were observed. Application of the clinical decision model resulted in less full-blood-counts (14% vs. 22%, p-value < 0.05 and more urine-dipstick testing (71% vs. 61%, p-value < 0.05.In contrast to our expectations no substantial impact on patient outcome was perceived. The clinical decision model preserved, however, good discriminatory ability to detect SBI, achieved good compliance among nurses and resulted in a more standardized diagnostic approach towards febrile children, with less full blood-counts and more rightfully urine-dipstick testing.Nederlands Trial Register NTR2381.

  11. A mixed methods pilot study with a cluster randomized control trial to evaluate the impact of a leadership intervention on guideline implementation in home care nursing

    Directory of Open Access Journals (Sweden)

    Tourangeau Ann

    2008-12-01

    Full Text Available Abstract Background Foot ulcers are a significant problem for people with diabetes. Comprehensive assessments of risk factors associated with diabetic foot ulcer are recommended in clinical guidelines to decrease complications such as prolonged healing, gangrene and amputations, and to promote effective management. However, the translation of clinical guidelines into nursing practice remains fragmented and inconsistent, and a recent homecare chart audit showed less than half the recommended risk factors for diabetic foot ulcers were assessed, and peripheral neuropathy (the most significant predictor of complications was not assessed at all. Strong leadership is consistently described as significant to successfully transfer guidelines into practice. Limited research exists however regarding which leadership behaviours facilitate and support implementation in nursing. The purpose of this pilot study is to evaluate the impact of a leadership intervention in community nursing on implementing recommendations from a clinical guideline on the nursing assessment and management of diabetic foot ulcers. Methods Two phase mixed methods design is proposed (ISRCTN 12345678. Phase I: Descriptive qualitative to understand barriers to implementing the guideline recommendations, and to inform the intervention. Phase II: Matched pair cluster randomized controlled trial (n = 4 centers will evaluate differences in outcomes between two implementation strategies. Primary outcome: Nursing assessments of client risk factors, a composite score of 8 items based on Diabetes/Foot Ulcer guideline recommendations. Intervention: In addition to the organization's 'usual' implementation strategy, a 12 week leadership strategy will be offered to managerial and clinical leaders consisting of: a printed materials, b one day interactive workshop to develop a leadership action plan tailored to barriers to support implementation; c three post-workshop teleconferences. Discussion This

  12. Evolution of advertisement calls in African clawed frogs

    OpenAIRE

    Tobias, Martha L.; Evans, Ben J; Kelley, Darcy B.

    2011-01-01

    For most frogs, advertisement calls are essential for reproductive success, conveying information on species identity, male quality, sexual state and location. While the evolutionary divergence of call characters has been examined in a number of species, the relative impacts of genetic drift or natural and sexual selection remain unclear. Insights into the evolutionary trajectory of vocal signals can be gained by examining how advertisement calls vary in a phylogenetic context. Evolution by g...

  13. A Randomized Trial Assessing the Impact of a Personal Printed Feedback Portrait on Statin Prescribing in Primary Care

    Science.gov (United States)

    Dormuth, Colin R.; Carney, Greg; Taylor, Suzanne; Bassett, Ken; Maclure, Malcolm

    2012-01-01

    Introduction: Knowledge translation (KT) initiatives have the potential to improve prescribing quality and produce savings that exceed the cost of the KT program itself, including the cost of evaluation using pragmatic study methods. Our objective was to measure the impact and estimated savings resulting from the distribution of individualized…

  14. Call-Routing Schemes for Call-Center Outsourcing

    OpenAIRE

    Noah Gans; Yong-Pin Zhou

    2007-01-01

    Companies may choose to outsource parts, but not all, of their call-center operations. In some cases, they classify customers as high or low value, serving the former with their in-house operations and routing the latter to an outsourcer. Typically, they impose service-level constraints on the time each type of customer waits on hold. This paper considers four schemes for routing low-value calls between the client company and the outsourcer. These schemes vary in the complexity of their routi...

  15. Evolution of advertisement calls in African clawed frogs

    Science.gov (United States)

    Tobias, Martha L.; Evans, Ben J.; Kelley, Darcy B.

    2014-01-01

    Summary For most frogs, advertisement calls are essential for reproductive success, conveying information on species identity, male quality, sexual state and location. While the evolutionary divergence of call characters has been examined in a number of species, the relative impacts of genetic drift or natural and sexual selection remain unclear. Insights into the evolutionary trajectory of vocal signals can be gained by examining how advertisement calls vary in a phylogenetic context. Evolution by genetic drift would be supported if more closely related species express more similar songs. Conversely, a poor correlation between evolutionary history and song expression would suggest evolution shaped by natural or sexual selection. Here, we measure seven song characters in 20 described and two undescribed species of African clawed frogs (genera Xenopus and Silurana) and four populations of X. laevis. We identify three call types — click, burst and trill — that can be distinguished by click number, call rate and intensity modulation. A fourth type is biphasic, consisting of two of the above. Call types vary in complexity from the simplest, a click, to the most complex, a biphasic call. Maximum parsimony analysis of variation in call type suggests that the ancestral type was of intermediate complexity. Each call type evolved independently more than once and call type is typically not shared by closely related species. These results indicate that call type is homoplasious and has low phylogenetic signal. We conclude that the evolution of call type is not due to genetic drift, but is under selective pressure. PMID:24723737

  16. Evolution of advertisement calls in African clawed frogs.

    Science.gov (United States)

    Tobias, Martha L; Evans, Ben J; Kelley, Darcy B

    2011-01-01

    For most frogs, advertisement calls are essential for reproductive success, conveying information on species identity, male quality, sexual state and location. While the evolutionary divergence of call characters has been examined in a number of species, the relative impacts of genetic drift or natural and sexual selection remain unclear. Insights into the evolutionary trajectory of vocal signals can be gained by examining how advertisement calls vary in a phylogenetic context. Evolution by genetic drift would be supported if more closely related species express more similar songs. Conversely, a poor correlation between evolutionary history and song expression would suggest evolution shaped by natural or sexual selection. Here, we measure seven song characters in 20 described and two undescribed species of African clawed frogs (genera Xenopus and Silurana) and four populations of X. laevis. We identify three call types - click, burst and trill - that can be distinguished by click number, call rate and intensity modulation. A fourth type is biphasic, consisting of two of the above. Call types vary in complexity from the simplest, a click, to the most complex, a biphasic call. Maximum parsimony analysis of variation in call type suggests that the ancestral type was of intermediate complexity. Each call type evolved independently more than once and call type is typically not shared by closely related species. These results indicate that call type is homoplasious and has low phylogenetic signal. We conclude that the evolution of call type is not due to genetic drift, but is under selective pressure. PMID:24723737

  17. Optimizing Programs Using Call Graphs

    Directory of Open Access Journals (Sweden)

    Pravin Kandala

    2014-02-01

    Full Text Available When working with complex software, visualization improves understanding considerably. Thus enhancing the ability of programmers to picture the relationships between components in a complex program not only saves time but becomes progressively mission- critical with increasing software complexity. Call Graph Generation Tool is a visualization tool which provides programmers different metrics to assess the software code. The different metrics include total n umber of lines in the function, total number of executable lines, number of unreachable lines, and cyclomatic complexity of the program. It provides a graphical representation of the function calls in a tree like structure. The tool accepts a „C‟ program and generates a funct ions call graph along with the functional metrics. The call graph generation tool provides both static and dynamic view. The whole programming is done using java technology. Thus, this tool helps the developer to know the program flow and thereby decide the optimality of the program. In situations where in, a single program is to be selected from available programs, this tool helps to figure out it. This paper depicts usage of call graph Generator to assess the reachability and exactness of the programs.

  18. OPTIMIZING PROGRAMS USING CALL GRAPHS

    Directory of Open Access Journals (Sweden)

    Pravin Kandala

    2015-11-01

    Full Text Available When working with complex software, visualization improves understanding considerably. Thus enhancing the ability of programmers to picture the relationships between components in a complex program not only saves time but becomes progressively mission- critical with increasing software complexity. Call Graph Generation Tool is a visualization tool which provides programmers different metrics to assess the software code. The different metrics include total number of lines in the function, total number of executable lines, number of unreachable lines, and cyclomatic complexity of the program. It provides a graphical representation of the function calls in a tree like structure. The tool accepts a „C‟ program and generates a functions call graph along with the functional metrics. The call graph generation tool provides both static and dynamic view. The whole programming is done using java technology. Thus, this tool helps the developer to know the program flow and thereby decide the optimality of the program. In situations where in, a single program is to be selected from available programs, this tool helps to figure out it. This paper depicts usage of call graph Generator to assess the reachability and exactness of the programs.

  19. Impact of a Randomized Controlled Trial in Arsenic Risk Communication on Household Water-Source Choices in Bangladesh

    Science.gov (United States)

    Tarozzi, Alessandro; Pfaff, Alexander; Balasubramanya, Soumya; Ahmed, Kazi Matin; van Geen, Alexander

    2013-01-01

    We conducted a randomized controlled trial in rural Bangladesh to examine how household drinking-water choices were affected by two different messages about risk from naturally occurring groundwater arsenic. Households in both randomized treatment arms were informed about the arsenic level in their well and whether that level was above or below the Bangladesh standard for arsenic. Households in one group of villages were encouraged to seek water from wells below the national standard. Households in the second group of villages received additional information explaining that lower-arsenic well water is always safer and these households were encouraged to seek water from wells with lower levels of arsenic, irrespective of the national standard. A simple model of household drinking-water choice indicates that the effect of the emphasis message is theoretically ambiguous. Empirically, we find that the richer message had a negative, but insignificant, effect on well-switching rates, but the estimates are sufficiently precise that we can rule out large positive effects. The main policy implication of this finding is that a one-time oral message conveying richer information on arsenic risks, while inexpensive and easily scalable, is unlikely to be successful in reducing exposure relative to the status-quo policy. PMID:23997355

  20. A Pilot Trial of Mindfulness Meditation Training for ADHD in Adulthood: Impact on Core Symptoms, Executive Functioning, and Emotion Dysregulation.

    Science.gov (United States)

    Mitchell, John T; McIntyre, Elizabeth M; English, Joseph S; Dennis, Michelle F; Beckham, Jean C; Kollins, Scott H

    2013-12-01

    Objective: Mindfulness meditation training is garnering increasing empirical interest as an intervention for ADHD in adulthood, although no studies of mindfulness as a standalone treatment have included a sample composed entirely of adults with ADHD or a comparison group. The aim of this study was to assess the feasibility, acceptability, and preliminary efficacy of mindfulness meditation for ADHD, executive functioning (EF), and emotion dysregulation symptoms in an adult ADHD sample. Method: Adults with ADHD were stratified by ADHD medication status and otherwise randomized into an 8-week group-based mindfulness treatment (n = 11) or waitlist group (n = 9). Results: Treatment feasibility and acceptability were positive. In addition, self-reported ADHD and EF symptoms (assessed in the laboratory and ecological momentary assessment), clinician ratings of ADHD and EF symptoms, and self-reported emotion dysregulation improved for the treatment group relative to the waitlist group over time with large effect sizes. Improvement was not observed for EF tasks. Conclusion: Findings support preliminary treatment efficacy, though require larger trials. (J. of Att. Dis. XXXX; XX(X) XX-XX). PMID:24305060

  1. Clinical Trials

    Science.gov (United States)

    Clinical trials are research studies that test how well new medical approaches work in people. Each study answers ... prevent, screen for, diagnose, or treat a disease. Clinical trials may also compare a new treatment to a ...

  2. Trial by Fire: a Natural Disaster’s Impact on Attitudes toward the Government in Rural Russia

    OpenAIRE

    Yegor Lazarev; Anton Sobolev; Irina Soboleva; Boris Sokolov

    2012-01-01

    This study aims to explore the psychological foundations of political support under a nondemocratic regime by investigating the impact of a natural disaster on attitudes toward the government. The research exploits the enormous wildfires that occurred in rural Russia during the summer of 2010 as a natural experiment. Since wildfire spreads due to the direction of the wind, the local distribution of fire is as if random: one village may burn while the neighboring village is left unscathed. We ...

  3. Impact of Yoga Nidra on psychological general wellbeing in patients with menstrual irregularities: A randomized controlled trial

    OpenAIRE

    Khushbu Rani; Tiwari, S.C.; Uma Singh; Agrawal, G. G.; Archana Ghildiyal; Neena Srivastava

    2011-01-01

    Background: Yogic relaxation therapy (Yoga Nidra) has been effectively prescribed in conjunction with other medical and yogic procedures in the management of severe psychosomatic diseases, including cancer, bronchial asthma, colitis, peptic ulcer and menstrual irregularities. Aim of the study: To assess the impact of Yoga Nidra on psychological problems in patients with menstrual disorders. Materials and Methods: Patients were recruited from the Department of Obstetrics and Gynecolog...

  4. Measuring quality of life: impact of chemotherapy for advanced colorectal cancer. Experience from two recent large phase III trials.

    OpenAIRE

    Anderson, H; Palmer, M. K.

    1998-01-01

    When assessing the value of a particular treatment, it is important to consider the impact it may have on the quality of life of those being treated. This is particularly so for cancer patients, whose life expectancy may be short. Patients with advanced colorectal cancer who participated in two international comparative studies of raltitrexed ('Tomudex') vs standard 5-fluorouracil (5-FU) plus leucovorin (LV) completed previously validated quality-of-life questionnaires (EORTC questionnaire, E...

  5. Juror decision-making in a mock sexually violent predator trial: gender differences in the impact of divergent types of expert testimony.

    Science.gov (United States)

    Guy, Laura S; Edens, John F

    2003-01-01

    Despite widespread use of mental health testimony in cases where violence risk is at issue, relatively little is known about the impact of such information on juror decision-making. This study addressed the effects of testimony based on three types of risk assessment instrument or method (clinical opinion, actuarial assessment, and ratings of psychopathy) to examine whether they would have differential impact on jurors' perceptions of the defendant. In a mock sexually violent predator civil commitment trial, 172 undergraduates were presented a case summary that included prosecution and defense expert testimony related to violence risk based on one of the three methods noted above. Consistent with earlier research, the hypothesis that a defendant described as a "high risk psychopath" by the prosecution would be judged more severely than a defendant judged as "high risk" based on other evaluation procedures was supported, but only among female jurors. Unlike prior studies, little support was found for the hypothesis that clinical opinion testimony would be more influential than actuarially based testimony for either gender. Mechanisms that may underlie the observed gender differences are discussed, as are the potential implications of these findings for civil commitment proceedings. PMID:12645046

  6. The Wireless Nursing Call System

    DEFF Research Database (Denmark)

    Jensen, Casper Bruun

    2006-01-01

    This paper discusses a research project in which social scientists were involved both as analysts and supporters during a pilot with a new wireless nursing call system. The case thus exemplifies an attempt to participate in developing dependable health care systems and offers insight into the cha......This paper discusses a research project in which social scientists were involved both as analysts and supporters during a pilot with a new wireless nursing call system. The case thus exemplifies an attempt to participate in developing dependable health care systems and offers insight...

  7. Impact of prenatal education on maternal utilization of analgesic interventions at future infant vaccinations: a cluster randomized trial.

    Science.gov (United States)

    Taddio, Anna; Smart, Sarah; Sheedy, Matthuschka; Yoon, Eugene W; Vyas, Charmy; Parikh, Chaitya; Pillai Riddell, Rebecca; Shah, Vibhuti

    2014-07-01

    Analgesic interventions are not routinely used during vaccine injections in infants. Parents report a desire to mitigate injection pain, but lack the knowledge about how to do so. The objective of this cluster-randomized trial was to evaluate the effect of a parent-directed prenatal education teaching module about vaccination pain management on analgesic utilization at future infant vaccinations. Expectant mothers enrolled in prenatal classes at Mount Sinai Hospital in Toronto were randomized to a 20-30minute interactive presentation about vaccination pain management (experimental group) or general vaccination information (control group). Both presentations included a PowerPoint (Microsoft Corporation, Redmond, WA, USA) and video presentation, take-home pamphlet, and "Question and Answer" period. The primary outcome was self-reported utilization of breastfeeding, sugar water, or topical anaesthetics at routine 2-month infant vaccinations. Between October 2012 and July 2013, 197 expectant mothers from 28 prenatal classes participated; follow-up was obtained in 174 (88%). Maternal characteristics did not differ (P>0.05) between groups. Utilization of one or more prespecified pain interventions occurred in 34% of participants in the experimental group, compared to 17% in the control group (P=0.01). Inclusion of a pain management module in prenatal classes led to increased utilization of evidence-based pain management interventions by parents at the 2-month infant vaccination appointment. Educating parents offers a novel and effective way of improving the quality of pain care delivered to infants during vaccination. Additional research is needed to determine if utilization can be bolstered further using techniques such as postnatal hospital reinforcement, reminder cards, and clinician education. PMID:24704427

  8. A Cluster Randomised Trial Introducing Rapid Diagnostic Tests into Registered Drug Shops in Uganda: Impact on Appropriate Treatment of Malaria

    OpenAIRE

    Mbonye, AK; Magnussen, P; Lal, S; Hansen, KS; Cundill, B; Chandler, C.; Clarke, SE

    2015-01-01

    Background Inappropriate treatment of malaria is widely reported particularly in areas where there is poor access to health facilities and self-treatment of fevers with anti-malarial drugs bought in shops is the most common form of care-seeking. The main objective of the study was to examine the impact of introducing rapid diagnostic tests for malaria (mRDTs) in registered drug shops in Uganda, with the aim to increase appropriate treatment of malaria with artemisinin-based combination therap...

  9. Psychological and behavioural impact of genetic testing smokers for lung cancer risk: a phase II exploratory trial.

    Science.gov (United States)

    Sanderson, Saskia C; Humphries, Steve E; Hubbart, Christina; Hughes, Eluned; Jarvis, Martin J; Wardle, Jane

    2008-05-01

    The behavioural and psychological impact of genetic testing for lung cancer susceptibility was examined among smokers (N = 61) who were randomly allocated to a GSTM1 genetic testing group (with GSTM1-missing or GSTM1-present result) or no-test control group. The GSTM1-missing (higher risk) group reported greater motivation to quit smoking, and both genetic testing groups reported lower depression than the control group at one-week follow-up (p lifestyle-related genetic susceptibility tests. PMID:18420756

  10. Nursing care as a calling.

    Science.gov (United States)

    Raatikainen, R

    1997-06-01

    A calling is a deep desire to devote oneself to serving people according to the high values of the task or profession. The aim of this study is to clarify the relationship between a calling experience and professional knowledge, nursing action and motivation. The data were collected from all the registered nurses (n = 179) at five hospitals. The response was 70%. The nurses who were committed to their profession and experienced their job as a calling, had a good knowledge about the ill feeling and maladjustment of their patients and were also good sources of support for their patients. They understood the importance of family ties and offered support to their patients' families. They were aware of the needs of dying patients and their concern with spiritual questions, and satisfied these needs well. It was characteristic for them to collaborate closely within a team, to experience the content of their work as enriching and to possess proficient professional abilities. They were therefore excellent in supporting both the individual patient and his or her family. They had a deep understanding of the whole process of patient care. According to these results the calling experience is not in conflict with professional principles. PMID:9181405

  11. A trial of two trouts: Comparing the impacts of rainbow and brown trout on a native galaxiid

    Science.gov (United States)

    Young, K.A.; Dunham, J.B.; Stephenson, J.F.; Terreau, A.; Thailly, A.F.; Gajardo, G.; de Leaniz, C. G.

    2010-01-01

    Rainbow trout Oncorhynchus mykiss and brown trout Salmo trutta are the world's two most widespread exotic fishes, dominate the fish communities of most cold-temperate waters in the southern hemisphere and are implicated in the decline and extirpation of native fish species. Here, we provide the first direct comparison of the impacts of rainbow and brown trout on populations of a native fish by quantifying three components of exotic species impact: range, abundance and effect. We surveyed 54 small streams on the island of Chilo?? in Chilean Patagonia and found that the rainbow trout has colonized significantly more streams and has a wider geographic range than brown trout. The two species had similar post-yearling abundances in allopatry and sympatry, and their abundances depended similarly on reach-level variation in the physical habitat. The species appeared to have dramatically different effects on native drift-feeding Aplochiton spp., which were virtually absent from streams invaded by brown trout but shared a broad sympatric range with rainbow trout. Within this range, the species' post-yearling abundances varied independently before and after controlling for variation in the physical habitat. In the north of the island, Aplochiton spp. inhabited streams uninvaded by exotic trouts. Our results provide a context for investigating the mechanisms responsible for apparent differences in rainbow and brown trout invasion biology and can help inform conservation strategies for native fishes in Chilo?? and elsewhere. ?? 2010 The Authors. Journal compilation ?? 2010 The Zoological Society of London.

  12. Evaluation of the impact of school gardening interventions on children's knowledge of and attitudes towards fruit and vegetables. A cluster randomised controlled trial.

    Science.gov (United States)

    Hutchinson, Jayne; Christian, Meaghan Sarah; Evans, Charlotte Elizabeth Louise; Nykjaer, Camilla; Hancock, Neil; Cade, Janet Elizabeth

    2015-08-01

    Involvement of children in gardening has the potential to increase liking of fruit and vegetables (FV) and consequently, intake, but research results are mixed. School gardening led by external specialists such as the Royal Horticultural Society (RHS) could have more impact than teacher-led gardening on children's knowledge of, and attitudes towards, FV. Data from a cluster randomised controlled trial were used to compare a RHS-led school gardening intervention with a teacher-led gardening intervention amongst 7-10 year olds in 21 London schools. A short questionnaire was developed and used to identify children's knowledge and attitudes towards FV consumption before the garden intervention and 18 months afterwards. Results from multilevel regression models, both unadjusted and adjusted for baseline responses and socio-demographic factors, were reported. Attitudes to FV intake were compared between groups. Change in FV knowledge was used to predict change in FV consumption assessed using 24-hour food diaries. In comparison with the RHS-led group (n = 373), teacher-led children (n = 404) were more likely to agree they ate lots of fruit (p gardening was associated with a greater increase in the total number of vegetables recognised (p = 0.031). No other differences in improvements in attitudes, or associations between change in FV recognition and intake were found. In relation to improvements in children's recognition and attitudes towards eating FV, this trial produced limited evidence that gardening activity packages led by external specialists (RHS-led) provide additional benefits over those led by teachers trained by the RHS. Indeed, the latter were potentially more effective. PMID:25937511

  13. The Efficacy of Two Adolescent Substance Abuse Treatments and the Impact of Comorbid Depression: Results of a Small Randomized Controlled Trial

    Science.gov (United States)

    Santisteban, Daniel A.; Mena, Maite P.; Muir, Joan; McCabe, Brian E.; Abalo, Clara; Cummings, Amanda M.

    2016-01-01

    Objective The purpose of this randomized trial was to investigate the efficacy of two behavioral treatments focusing on different change mechanisms in ameliorating a borderline personality disorder constellation of behaviors and substance use in adolescents referred by juvenile diversion programs. Methods Forty adolescents 14 to 17 years of age and meeting DSM IV criteria for borderline personality disorder and substance use disorders were randomized to Integrative Borderline Personality Disorder-Oriented Adolescent Family Therapy (I-BAFT) or Individual Drug Counseling (IDC). This design allowed a comparison of two manualized interventions, one family-based and one individually-oriented. Profiles of clinical change were used to detect impact and to estimate treatment effect sizes. Results Primary analyses showed that both interventions had a clinically significant impact on borderline personality disorder behaviors 12 months after baseline but with no differential treatment effects. The impact on substance use was more complex. Subgroup analyses revealed that adolescents with depression had significantly more severe profiles of borderline personality disorder and substance use. These youth were the only group to show reductions in substance use, but only if they received the I-BAFT intervention. Study data also documented the high dosage of intensive residential treatment needed by this population. Conclusions and Implications for Practice Results highlight the intensive treatment needs of juvenile justice involved youth with co-occurring substance use and borderline personality disorder including depression, the hybrid outpatient and residential treatment often required by this population, and the promise of a family oriented approach particularly for youth with severe symptoms and co-occurring depression. PMID:25799306

  14. Impact of a physical activity intervention program on cognitive predictors of behaviour among adults at risk of Type 2 diabetes (ProActive randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Sutton Stephen

    2009-03-01

    Full Text Available Abstract Background In the ProActive Trial an intensive theory-based intervention program was no more effective than theory-based brief advice in increasing objectively measured physical activity among adults at risk of Type 2 diabetes. We aimed to illuminate these findings by assessing whether the intervention program changed cognitions about increasing activity, defined by the Theory of Planned Behaviour, in ways consistent with the theory. Methods N = 365 sedentary participants aged 30–50 years with a parental history of Type 2 diabetes were randomised to brief advice alone or to brief advice plus the intervention program delivered face-to-face or by telephone. Questionnaires at baseline, 6 and 12 months assessed cognitions about becoming more physically active. Analysis of covariance was used to test intervention impact. Bootstrapping was used to test multiple mediation of intervention impact. Results At 6 months, combined intervention groups (face-to-face and telephone reported that they found increasing activity more enjoyable (affective attitude, d = .25, and they perceived more instrumental benefits (e.g., improving health (d = .23 and more control (d = .32 over increasing activity than participants receiving brief advice alone. Stronger intentions (d = .50 in the intervention groups than the brief advice group at 6 months were partially explained by affective attitude and perceived control. At 12 months, intervention groups perceived more positive instrumental (d = .21 and affective benefits (d = .29 than brief advice participants. The intervention did not change perceived social pressure to increase activity. Conclusion Lack of effect of the intervention program on physical activity over and above brief advice was consistent with limited and mostly small short-term effects on cognitions. Targeting affective benefits (e.g., enjoyment, social interaction and addressing barriers to physical activity may strengthen intentions, but

  15. Ultrasound call detection in capybara

    Directory of Open Access Journals (Sweden)

    Selene S.C. Nogueira

    2012-07-01

    Full Text Available The vocal repertoire of some animal species has been considered a non-invasive tool to predict distress reactivity. In rats ultrasound emissions were reported as distress indicator. Capybaras[ vocal repertoire was reported recently and seems to have ultrasound calls, but this has not yet been confirmed. Thus, in order to check if a poor state of welfare was linked to ultrasound calls in the capybara vocal repertoire, the aim of this study was to track the presence of ultrasound emissions in 11 animals under three conditions: 1 unrestrained; 2 intermediately restrained, and 3 highly restrained. The ultrasound track identified frequencies in the range of 31.8±3.5 kHz in adults and 33.2±8.5 kHz in juveniles. These ultrasound frequencies occurred only when animals were highly restrained, physically restrained or injured during handling. We concluded that these calls with ultrasound components are related to pain and restraint because they did not occur when animals were free of restraint. Thus we suggest that this vocalization may be used as an additional tool to assess capybaras[ welfare.

  16. Impact of glatiramer acetate on paraclinical markers of neuroprotection in multiple sclerosis: A prospective observational clinical trial.

    Science.gov (United States)

    Ehling, Rainer; Di Pauli, Franziska; Lackner, Peter; Rainer, Carolyn; Kraus, Viktoria; Hegen, Harald; Lutterotti, Andreas; Kuenz, Bettina; De Zordo, Tobias; Schocke, Michael; Glatzl, Susanne; Löscher, Wolfgang N; Deisenhammer, Florian; Reindl, Markus; Berger, Thomas

    2015-10-15

    Data from in vitro and animal studies support a neuroprotective role of glatiramer acetate (GA) in multiple sclerosis (MS). We investigated prospectively whether treatment with GA leads to clinical and paraclinical changes associated with neuroprotection in patients with relapsing-remitting (RR) MS. Primary aim of this clinical study was to determine serum BDNF levels in RR-MS patients who were started on GA as compared to patients who remained therapy-naive throughout 24 months. Secondary outcomes included relapses and EDSS, cognition, quality of life, fatigue and depression, BDNF expression levels on peripheral immune cells (FACS, RT-PCR), serum anti-myelin basic peptide (MBP) antibody status, evoked potential and cerebral MRI studies. While GA treatment did not alter serum levels or expression levels on peripheral immune cells of BDNF over time it resulted in a transient increase of serum IgG antibody response to MBP, mainly due to subtype IgG1 (p<0.05), after 3 months. However, no significant differences were found between GA treated and therapy-naive patients with regard to serum BDNF and intracellular BDNF expression levels, nerve conduction (including median and tibial nerve somatosensory, pattern-shift visual and upper and lower limb motor evoked potentials) or MRI (including volume of hyperintense lesions, volume of hypointense lesions after CE, mean diffusivity and fractional anisotropy) outcome parameters. In conclusion, our findings do not support a major impact of GA treatment on paraclinical markers of neuroprotection in human RR-MS. PMID:26439969

  17. Overnight resting of PBMC changes functional signatures of antigen specific T- cell responses: impact for immune monitoring within clinical trials.

    Directory of Open Access Journals (Sweden)

    Sarah Kutscher

    Full Text Available Polyfunctional CD4 or CD8 T cells are proposed to represent a correlate of immune control for persistent viruses as well as for vaccine mediated protection against infection. A well-suited methodology to study complex functional phenotypes of antiviral T cells is the combined staining of intracellular cytokines and phenotypic marker expression using polychromatic flow cytometry. In this study we analyzed the effect of an overnight resting period at 37 °C on the quantity and functionality of HIV-1, EBV, CMV, HBV and HCV specific CD4 and CD8 T-cell responses in a cohort of 21 individuals. We quantified total antigen specific T cells by multimer staining and used 10-color intracellular cytokine staining (ICS to determine IFNγ, TNFα, IL2 and MIP1β production. After an overnight resting significantly higher numbers of functionally active T cells were detectable by ICS for all tested antigen specificities, whereas the total number of antigen specific T cells determined by multimer staining remained unchanged. Overnight resting shifted the quality of T-cell responses towards polyfunctionality and increased antigen sensitivity of T cells. Our data suggest that the observed effect is mediated by T cells rather than by antigen presenting cells. We conclude that overnight resting of PBMC prior to ex vivo analysis of antiviral T-cell responses represents an efficient method to increase sensitivity of ICS-based methods and has a prominent impact on the functional phenotype of T cells.

  18. The Impact of Repeat HIV Testing on Risky Sexual Behavior: Evidence from a Randomized Controlled Trial in Malawi

    Science.gov (United States)

    Delavande, Adeline; Wagner, Zachary; Sood, Neeraj

    2016-01-01

    A significant proportion of HIV-positive adults in sub-Saharan Africa are in serodiscordant relationships. Identification of such serodiscordant couples through couple HIV testing and counseling (HTC) is thought to promote safe sexual behavior and reduce the probability of within couple seroconversion. However, it is possible HTC benefits are not sustained over time and therefore repeated HTC may be more effective at preventing seroconversion than one time HTC. We tested this theory in Zomba, Malawi by randomly assigning 170 serodiscordant couples to receive repeated HTC and 167 serodiscordant couples to receive one time HTC upon study enrollment (control group). We used linear probability models and probit model with couple fixed effects to assess the impact of the intervention on risky sexual behavior. At one-year follow-up, we found that couples that received repeated HTC reported significantly more condom use. However, we found no difference in rate of seroconversion between groups, nor did we find differences in subjective expectations about seroconversion or false beliefs about HIV, two expected pathways of behavior change. We conclude that repeated HTC may promote safe sexual behavior, but this result should be interpreted with caution, as it is inconsistent with the result from biological and subjective outcomes.

  19. The impact of luteal phase support on endometrial estrogen and progesterone receptor expression: a randomized control trial

    Directory of Open Access Journals (Sweden)

    Brezina Paul R

    2012-02-01

    Full Text Available Abstract Background To assess the impact of luteal phase support on the expression of estrogen receptor (ER alpha and progesterone receptors B (PR-B on the endometrium of oocyte donors undergoing controlled ovarian hyperstimulation (COH. Methods A prospective, randomized study was conducted in women undergoing controlled ovarian hyperstimulation for oocyte donation. Participants were randomized to receive no luteal support, vaginal progesterone alone, or vaginal progesterone plus orally administered 17 Beta estradiol. Endometrial biopsies were obtained at 4 time points in the luteal phase and evaluated by tissue microarray for expression of ER alpha and PR-B. Results One-hundred and eight endometrial tissue samples were obtained from 12 patients. No differences were found in expression of ER alpha and PR-B among all the specimens with the exception of one sample value. Conclusions The administration of progesterone during the luteal phase of COH for oocyte donor cycles, either with or without estrogen, does not significantly affect the endometrial expression of ER alpha and PR.

  20. The Breathing for Life Trial: a randomised controlled trial of fractional exhaled nitric oxide (FENO)-based management of asthma during pregnancy and its impact on perinatal outcomes and infant and childhood respiratory health

    OpenAIRE

    Vanessa E. Murphy; Jensen, Megan E.; Mattes, Joerg; Hensley, Michael J.; Giles, Warwick B; Peek, Michael J.; Bisits, Andrew; Callaway, Leonie K.; McCaffery, Kirsten; Barrett, Helen L.; Colditz, Paul B.; Seeho, Sean K.; Attia, John; Searles, Andrew; Doran, Christopher

    2016-01-01

    Background Asthma exacerbations are common during pregnancy and associated with an increased risk of adverse perinatal outcomes. Adjusting asthma treatment based on airway inflammation rather than symptoms reduces the exacerbation rate by 50 %. The Breathing for Life Trial (BLT) will test whether this approach also improves perinatal outcomes. Methods/design BLT is a multicentre, parallel group, randomised controlled trial of asthma management guided by fractional exhaled nitric oxide (FENO, ...

  1. Does improving maternal knowledge of vaccines impact infant immunization rates? A community-based randomized-controlled trial in Karachi, Pakistan

    Directory of Open Access Journals (Sweden)

    Agha Ajmal

    2011-04-01

    Full Text Available Abstract Background In Pakistan, only 59-73% of children 12-23 months of age are fully immunized. This randomized, controlled trial was conducted to assess the impact of a low-literacy immunization promotion educational intervention for mothers living in low-income communities of Karachi on infant immunization completion rates. Methods Three hundred and sixty-six mother-infant pairs, with infants aged ≤ 6 weeks, were enrolled and randomized into either the intervention or control arm between August - November 2008. The intervention, administered by trained community health workers, consisted of three targeted pictorial messages regarding vaccines. The control group received general health promotion messages based on Pakistan's Lady Health Worker program curriculum. Assessment of DPT/Hepatitis B vaccine completion (3 doses was conducted 4-months after enrollment. A Poisson regression model was used to estimate effect of the intervention. The multivariable Poisson regression model included maternal education, paternal occupation, ownership of home, cooking fuel used at home, place of residence, the child's immunization status at enrollment, and mother's perception about the impact of immunization on child's health. Results Baseline characteristics among the two groups were similar. At 4 month assessment, among 179 mother-infant pairs in the intervention group, 129 (72.1% had received all 3 doses of DPT/Hepatitis B vaccine, whereas in the control group 92/178 (51.7% had received all 3 doses. Multivariable analysis revealed a significant improvement of 39% (adjusted RR = 1.39; 95% CI: 1.06-1.81 in DPT-3/Hepatitis B completion rates in the intervention group. Conclusion A simple educational intervention designed for low-literate populations, improved DPT-3/Hepatitis B vaccine completion rates by 39%. These findings have important implications for improving routine immunization rates in Pakistan.

  2. Impact of Gender, Partner Status, and Race on Locoregional Failure and Overall Survival in Head and Neck Cancer Patients in Three Radiation Therapy Oncology Group Trials

    International Nuclear Information System (INIS)

    Purpose: We investigated the impact of race, in conjunction with gender and partner status, on locoregional control (LRC) and overall survival (OS) in three head and neck trials conducted by the Radiation Therapy Oncology Group (RTOG). Methods and Materials: Patients from RTOG studies 9003, 9111, and 9703 were included. Patients were stratified by treatment arms. Covariates of interest were partner status (partnered vs. non-partnered), race (white vs. non-white), and sex (female vs. male). Chi-square testing demonstrated homogeneity across treatment arms. Hazards ratio (HR) was used to estimate time to event outcome. Unadjusted and adjusted HRs were calculated for all covariates with associated 95% confidence intervals (CIs) and p values. Results: A total of 1,736 patients were analyzed. Unpartnered males had inferior OS rates compared to partnered females (adjusted HR = 1.22, 95% CI, 1.09-1.36), partnered males (adjusted HR = 1.20, 95% CI, 1.09-1.28), and unpartnered females (adjusted HR = 1.20, 95% CI, 1.09-1.32). White females had superior OS compared with white males, non-white females, and non-white males. Non-white males had inferior OS compared to white males. Partnered whites had improved OS relative to partnered non-white, unpartnered white, and unpartnered non-white patients. Unpartnered males had inferior LRC compared to partnered males (adjusted HR = 1.26, 95% CI, 1.09-1.46) and unpartnered females (adjusted HR = 1.30, 95% CI, 1.05-1.62). White females had LRC superior to non-white males and females. White males had improved LRC compared to non-white males. Partnered whites had improved LRC compared to partnered and unpartnered non-white patients. Unpartnered whites had improved LRC compared to unpartnered non-whites. Conclusions: Race, gender, and partner status had impacts on both OS and locoregional failure, both singly and in combination.

  3. The Impact of Aerobic Exercise on Brain-Derived Neurotrophic Factor and Neurocognition in Individuals With Schizophrenia: A Single-Blind, Randomized Clinical Trial.

    Science.gov (United States)

    Kimhy, David; Vakhrusheva, Julia; Bartels, Matthew N; Armstrong, Hilary F; Ballon, Jacob S; Khan, Samira; Chang, Rachel W; Hansen, Marie C; Ayanruoh, Lindsey; Lister, Amanda; Castrén, Eero; Smith, Edward E; Sloan, Richard P

    2015-07-01

    Individuals with schizophrenia display substantial neurocognitive deficits for which available treatments offer only limited benefits. Yet, findings from studies of animals, clinical and nonclinical populations have linked neurocognitive improvements to increases in aerobic fitness (AF) via aerobic exercise training (AE). Such improvements have been attributed to up-regulation of brain-derived neurotrophic factor (BDNF). However, the impact of AE on neurocognition, and the putative role of BDNF, have not been investigated in schizophrenia. Employing a proof-of-concept, single-blind, randomized clinical trial design, 33 individuals with schizophrenia were randomized to receive standard psychiatric treatment (n = 17; "treatment as usual"; TAU) or attend a 12-week AE program (n = 16) utilizing active-play video games (Xbox 360 Kinect) and traditional AE equipment. Participants completed assessments of AF (indexed by VO2 peak ml/kg/min), neurocognition (MATRICS Consensus Cognitive Battery), and serum-BDNF before and after and 12-week period. Twenty-six participants (79%) completed the study. At follow-up, the AE participants improved their AF by 18.0% vs a -0.5% decline in the TAU group (P = .002) and improved their neurocognition by 15.1% vs -2.0% decline in the TAU group (P = .031). Hierarchical multiple regression analyses indicated that enhancement in AF and increases in BDNF predicted 25.4% and 14.6% of the neurocognitive improvement variance, respectively. The results indicate AE is effective in enhancing neurocognitive functioning in people with schizophrenia and provide preliminary support for the impact of AE-related BDNF up-regulation on neurocognition in this population. Poor AF represents a modifiable risk factor for neurocognitive dysfunction in schizophrenia for which AE training offer a safe, nonstigmatizing, and side-effect-free intervention. PMID:25805886

  4. Assessing the impact of water filters and improved cook stoves on drinking water quality and household air pollution: a randomised controlled trial in Rwanda.

    Directory of Open Access Journals (Sweden)

    Ghislaine Rosa

    Full Text Available Diarrhoea and respiratory infections remain the biggest killers of children under 5 years in developing countries. We conducted a 5-month household randomised controlled trial among 566 households in rural Rwanda to assess uptake, compliance and impact on environmental exposures of a combined intervention delivering high-performance water filters and improved stoves for free. Compliance was measured monthly by self-report and spot-check observations. Semi-continuous 24-h PM2.5 monitoring of the cooking area was conducted in a random subsample of 121 households to assess household air pollution, while samples of drinking water from all households were collected monthly to assess the levels of thermotolerant coliforms. Adoption was generally high, with most householders reporting the filters as their primary source of drinking water and the intervention stoves as their primary cooking stove. However, some householders continued to drink untreated water and most continued to cook on traditional stoves. The intervention was associated with a 97.5% reduction in mean faecal indicator bacteria (Williams means 0.5 vs. 20.2 TTC/100 mL, p<0.001 and a median reduction of 48% of 24-h PM2.5 concentrations in the cooking area (p = 0.005. Further studies to increase compliance should be undertaken to better inform large-scale interventions.Clinicaltrials.gov; NCT01882777; http://clinicaltrials.gov/ct2/results?term=NCT01882777&Search=Search.

  5. Environmental constraints and call evolution in torrent-dwelling frogs.

    Science.gov (United States)

    Goutte, Sandra; Dubois, Alain; Howard, Samuel D; Marquez, Rafael; Rowley, Jodi J L; Dehling, J Maximilian; Grandcolas, Philippe; Rongchuan, Xiong; Legendre, Frédéric

    2016-04-01

    Although acoustic signals are important for communication in many taxa, signal propagation is affected by environmental properties. Strong environmental constraints should drive call evolution, favoring signals with greater transmission distance and content integrity in a given calling habitat. Yet, few empirical studies have verified this prediction, possibly due to a shortcoming in habitat characterization, which is often too broad. Here we assess the potential impact of environmental constraints on the evolution of advertisement call in four groups of torrent-dwelling frogs in the family Ranidae. We reconstruct the evolution of calling site preferences, both broadly categorized and at a finer scale, onto a phylogenetic tree for 148 species with five markers (∼3600 bp). We test models of evolution for six call traits for 79 species with regard to the reconstructed history of calling site preferences and estimate their ancestral states. We find that in spite of existing morphological constraints, vocalizations of torrent-dwelling species are most probably constrained by the acoustic specificities of torrent habitats and particularly their high level of ambient noise. We also show that a fine-scale characterization of calling sites allows a better perception of the impact of environmental constraints on call evolution. PMID:26960074

  6. The impact of leadership programme on self-esteem and self-efficacy in school: a randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Martin C S Wong

    Full Text Available BACKGROUND: Leadership training programs by experiential learning among adolescents are very popular worldwide and in particular developed countries, but there exists few studies which formally assessed their impact on the psychological well-being of program participants. This study evaluated the effectiveness of leadership training programs on self-esteem and self-efficacy among adolescents. METHODOLOGY/PRINCIPAL FINDINGS: a total of 180 students of the same grade of one secondary school were randomized into an intervention (n = 50 and a control group (n = 130. The students in the intervention group participated in a 6-month program of leadership training and service learning, while the control group did not participate in any training. Their self-esteem and self-efficacy were assessed by Rosenberg Self-Esteem questionnaire and Chinese Adaptation of the General Self-Efficacy Scale, respectively, before and after the program. Both scales have been recognized internationally as valid and reliable survey instruments to measure these psychological attributes. The scores were compared by Student's tests according to gender. A total of 180 students were enrolled during the study period October, 2009 to May, 2010. Their mean age was 15.18 years (0.62 and 56.7% were male. Students allocated to the intervention and control group had statistically similar demographic characteristics except gender (male 36.0% vs. 64.6%, p = 0.001. Overall, the self-esteem scores increased by 1.28 and decreased by 0.30 (p = 0.161 while the self-efficacy scores increased by 0.26 and decreased by 0.76 (p = 0.429 in the intervention and control group, respectively. Among female students, the intervention group showed significant improvements in both self-esteem (2.38 vs. -0.24, p<0.001 and self-efficacy (1.32 vs. -0.04, p = 0.043. CONCLUSIONS/SIGNIFICANCE: Leadership training program were not found to be effective to enhance self-esteem and self

  7. Advanced Call Center Supporting WAP Access

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Traditional call centers can be accessed via speech only, and the call center based on web provides both data and speech access, but it needs a powerful terminal-computer. By analyzing traditional call centers and call centers based on web, this paper presents the framework of an advanced call center supporting WAP access. A typical service is also described in detail.

  8. Impact of thrombus aspiration during ST-Elevation Myocardial Infarction : a six month composite endpoint and risk of stroke analyses of the TASTE trial

    OpenAIRE

    Olivecrona, Goran K.; Lagerqvist, Bo; Frobert, Ole; Gudnason, Thorarinn; Maeng, Michael; Ramunddal, Truls; Haupt, Jan; Kellerth, Thomas; Stewart, Jason; Sarno, Giovanna; Jensen, Jens; Östlund, Ollie; James, Stefan K

    2016-01-01

    Background: Routine thrombus aspiration during primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) did not reduce the primary composite endpoint in the "A Randomised Trial of Routine Aspiration ThrOmbecTomy With PCI Versus PCI ALone in Patients With STEMI Undergoing Primary PCI" (TOTAL) trial. We aimed to analyse a similar endpoint in "The Thrombus Aspiration in ST-Elevation myocardial infarction in Scandinavia" (TASTE) trial up to 180 days. Methods:...

  9. Impact of the Patient-Reported Outcomes Management Information System (PROMIS) upon the Design and Operation of Multi-center Clinical Trials: a Qualitative Research Study

    OpenAIRE

    Eisenstein, Eric L.; Diener, Lawrence W.; Nahm, Meredith; Weinfurt, Kevin P.

    2010-01-01

    New technologies may be required to integrate the National Institutes of Health’s Patient Reported Outcome Management Information System (PROMIS) into multi-center clinical trials. To better understand this need, we identified likely PROMIS reporting formats, developed a multi-center clinical trial process model, and identified gaps between current capabilities and those necessary for PROMIS. These results were evaluated by key trial constituencies. Issues reported by principal investigators ...

  10. Impact of 4.0% chlorhexidine cleansing of the umbilical cord on mortality and omphalitis among newborns of Sylhet, Bangladesh: design of a community-based cluster randomized trial

    Directory of Open Access Journals (Sweden)

    Ahmed Saifuddin

    2009-10-01

    Full Text Available Abstract Background The World Health Organization recommends dry cord care for newborns but this recommendation may not be optimal in low resource settings where most births take place in an unclean environment and infections account for up to half of neonatal deaths. A previous trial in Nepal indicated that umbilical cord cleansing with 4.0% chlorhexidine could substantially reduce mortality and omphalitis risk, but policy changes await additional community-based data. Methods The Projahnmo Chlorhexidine study was a three-year, cluster-randomized, community-based trial to assess the impact of three cord care regimens on neonatal mortality and omphalitis. Women were recruited mid-pregnancy, received a basic package of maternal and neonatal health promotion messages, and were followed to pregnancy outcome. Newborns were visited at home by local village-based workers whose areas were randomized to either 1 single- or 2 7-day cord cleansing with 4.0% chlorhexidine, or 3 promotion of dry cord care as recommended by WHO. All mothers received basic messages regarding hand-washing, clean cord cutting, and avoidance of harmful home-base applications to the cord. Death within 28 days and omphalitis were the primary outcomes; these were monitored directly through home visits by community health workers on days 1, 3, 6, 9, 15, and 28 after birth. Discussion Due to report in early 2010, the Projahnmo Chlorhexidine Study examines the impact of multiple or single chlorhexidine cleansing of the cord on neonatal mortality and omphalitis among newborns of rural Sylhet District, Bangladesh. The results of this trial will be interpreted in conjunction with a similarly designed trial previously conducted in Nepal, and will have implications for policy guidelines for optimal cord care of newborns in low resource settings in Asia. Trial Registration ClinicalTrials.gov (NCT00434408

  11. Impact of biodegradable versus durable polymer drug-eluting stents on clinical outcomes in patients with coronary artery disease: a meta-analysis of 15 randomized trials

    Institute of Scientific and Technical Information of China (English)

    Zhang Yaojun; Tian Nailiang; Dong Shengjie; Ye Fei; Li Minghui; Christos V.Bourantas; Javaid Iqbal

    2014-01-01

    Background Drug eluting stents (DESs) made with biodegradable polymer have been developed in an attempt to improve clinical outcomes.However,the impact of biodegradable polymers on clinical events and stent thrombosis (ST) remains controversial.Methods We searched Medline,the Cochrane Library and other internet sources,without language or date restrictions for articles comparing clinical outcomes between biodegradable polymer DES and durable polymer DES.Safety endpoints were ST (definite,definite/probable),mortality,and myocardial infarction (MI).Efficacy endpoints were major adverse cardiac event (MACE) and target lesion revascularization (TLR).Results We identified 15 randomized controlled trials (n=17 068) with a weighted mean follow-up of 20.6 months.There was no statistical difference in the incidence of definite/probable ST between durable polymer-and biodegradable polymerDES; relative risk (RR) 0.83; 95% confidence interval (CI) 0.62-1.11; P=0.22.Biodegradable polymer DES had similar rates of definite ST (RR 0.94,95% CI 0.66-1.33,P=0.72),mortality (RR 0.94,95% C/0.82-1.09,P=0.43),MI (RR 1.08,95% CI 0.92-1.26.P=0.35),MACE (RR 0.99,95% CI 0.91-1.09,P=0.85),and TLR (RR,0.94,95% CI 0.83-1.06,P=0.30) compared with durable polymer DES.Based on the stratified analysis of the included trials,the treatment effect on definite ST was different at different follow-up times:≤1 year favoring durable polymer DES and >1 year favoring biodegradable polymer DES.Conclusions Biodegradable polymer DES has similar safety and efficacy for treating patients with coronary artery disease compared with durable polymer DES.Further data with longer term follow-up are warranted to confirm the potential benefits of biodegradable polymer DES.

  12. Anal Carcinoma: Impact of TN Category of Disease on Survival, Disease Relapse, and Colostomy Failure in US Gastrointestinal Intergroup RTOG 98-11 Phase 3 Trial

    Energy Technology Data Exchange (ETDEWEB)

    Gunderson, Leonard L., E-mail: gunderson.leonard@mayo.edu [Mayo Clinic Cancer Center, Scottsdale, Arizona (United States); Moughan, Jennifer [Radiation Therapy Oncology Group, Philadelphia, Pennsylvania (United States); Ajani, Jaffer A. [The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Pedersen, John E. [Cross Cancer Institute, Edmonton, Alberta (Canada); Winter, Kathryn A. [Radiation Therapy Oncology Group, Philadelphia, Pennsylvania (United States); Benson, Al B. [Northwestern University, Chicago, Illinois (United States); Thomas, Charles R. [Knight Cancer Institute/Oregon Health and Science University, Portland, Oregon (United States); Mayer, Robert J. [Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Haddock, Michael G. [Mayo Clinic Cancer Center, Rochester, Minnesota (United States); Rich, Tyvin A. [University of Virginia, Charlottesville, Virginia (United States); Willett, Christopher G. [Duke University, Durham, North Carolina (United States)

    2013-11-15

    Purpose: The long-term update of US GI Intergroup RTOG 98-11 anal cancer trial found that concurrent chemoradiation (CCRT) with fluorouracil (5-FU) plus mitomycin had a significant impact on disease-free survival (DFS) and overall survival (OS) compared with induction plus concurrent 5-FU plus cisplatin. The intent of the current analysis was to determine the impact of tumor node (TN) category of disease on survival (DFS and OS), colostomy failure (CF), and relapse (local-regional failure [LRF] and distant metastases [DM]) in this patient group. Methods and Materials: DFS and OS were estimated univariately by using the Kaplan-Meier method, and 6 TN categories were compared by the log–rank test (T2N0, T3N0, T4N0, T2N1-3, T3N1-3, and T4N1-3). Time to relapse and colostomy were estimated by the cumulative incidence method, and TN categories were compared using Gray's test. Results: Of 682 patients, 620 were analyzable for outcomes by TN category. All endpoints showed statistically significant differences among the TN categories of disease (OS, P<.0001; DFS, P<.0001; LRF, P<.0001; DM, P=.0011; CF, P=.01). Patients with the poorest OS, DFS, and LRF outcomes were those with T3-4N-positive (+) disease. CF was lowest for T2N0 and T2N+ (11%, 11%, respectively) and worst for the T4N0, T3N+, and T4N+ categories (26%, 27%, 24%, respectively). Conclusions: TN category of disease has a statistically significant impact on OS, DFS, LRF, DM, and CF in patients treated with CCRT and provides excellent prognostic information for outcomes in patients with anal carcinoma. Significant challenges remain for patients with T4N0 and T3-4N+ categories of disease with regard to survival, relapse, and CF and lesser challenges for T2-3N0/T2N+ categories.

  13. Anal Carcinoma: Impact of TN Category of Disease on Survival, Disease Relapse, and Colostomy Failure in US Gastrointestinal Intergroup RTOG 98-11 Phase 3 Trial

    International Nuclear Information System (INIS)

    Purpose: The long-term update of US GI Intergroup RTOG 98-11 anal cancer trial found that concurrent chemoradiation (CCRT) with fluorouracil (5-FU) plus mitomycin had a significant impact on disease-free survival (DFS) and overall survival (OS) compared with induction plus concurrent 5-FU plus cisplatin. The intent of the current analysis was to determine the impact of tumor node (TN) category of disease on survival (DFS and OS), colostomy failure (CF), and relapse (local-regional failure [LRF] and distant metastases [DM]) in this patient group. Methods and Materials: DFS and OS were estimated univariately by using the Kaplan-Meier method, and 6 TN categories were compared by the log–rank test (T2N0, T3N0, T4N0, T2N1-3, T3N1-3, and T4N1-3). Time to relapse and colostomy were estimated by the cumulative incidence method, and TN categories were compared using Gray's test. Results: Of 682 patients, 620 were analyzable for outcomes by TN category. All endpoints showed statistically significant differences among the TN categories of disease (OS, P<.0001; DFS, P<.0001; LRF, P<.0001; DM, P=.0011; CF, P=.01). Patients with the poorest OS, DFS, and LRF outcomes were those with T3-4N-positive (+) disease. CF was lowest for T2N0 and T2N+ (11%, 11%, respectively) and worst for the T4N0, T3N+, and T4N+ categories (26%, 27%, 24%, respectively). Conclusions: TN category of disease has a statistically significant impact on OS, DFS, LRF, DM, and CF in patients treated with CCRT and provides excellent prognostic information for outcomes in patients with anal carcinoma. Significant challenges remain for patients with T4N0 and T3-4N+ categories of disease with regard to survival, relapse, and CF and lesser challenges for T2-3N0/T2N+ categories

  14. Social calls of flying big brown bats (Eptesicus fuscus

    Directory of Open Access Journals (Sweden)

    GenevieveSpanjerWright

    2013-08-01

    Full Text Available Vocalizations serving a variety of social functions have been reported in many bat species (Order Chiroptera. While echolocation by big brown bats (Eptesicus fuscus has been the subject of extensive study, calls used by this species for communication have received comparatively little research attention. Here, we report on a rich repertoire of vocalizations produced by big brown bats in a large flight room equipped with synchronized high speed stereo video and audio recording equipment. Bats were studied individually and in pairs, while sex, age, and experience with a novel foraging task were varied. We used Discriminant Function Analysis to classify six different vocalizations that were recorded when two bats were present. Contingency table analyses revealed a higher prevalence of social calls when males were present, and some call types varied in frequency of emission based on trial type or bat age. Bats flew closer together around the time some social calls were emitted, indicating that communicative calls may be selectively produced when conspecifics fly near one another. These findings are the first reports of social calls from flying big brown bats and provide insight into the function of communicative vocalizations emitted by this species.

  15. Investigating CALL in the Classroom: Situational Variables to Consider

    Directory of Open Access Journals (Sweden)

    Darlene Liutkus

    2012-01-01

    Full Text Available A new paradigm in second language pedagogy has Computer Assisted Language Learning (CALL playing a significant role. Much of the literature to-date claims that CALL can have a positive impact on students’ second language acquisition (SLA. Mixed method of research produces data to investigate if CALL positively affects student language proficiency, motivation and autonomy. Classroom observation of participants in their natural environment is a qualitative technique used but has situational variables that could skew results if not structured. A questionnaire is a quantitative tool that can offer insight regarding participants’ perception of performance but can contradict what the researcher has observed. This paper will take an in-depth look at variables such as: instructor’s pedagogical application; blending CALL into the curriculum; types of CALL implemented; feedback received and their implications for design of the data collection tools

  16. Reciprocity of mobile phone calls

    CERN Document Server

    Kovanen, Lauri; Kaski, Kimmo

    2010-01-01

    We present a study of the reciprocity of human behaviour based on mobile phone usage records. The underlying question is whether human relationships are mutual, in the sense that both are equally active in keeping up the relationship, or is it on the contrary typical that relationships are lopsided, with one party being significantly more active than the other. We study this question with the help of a mobile phone data set consisting of all mobile phone calls between 5.3 million customers of a single mobile phone operator. It turns out that lopsided relations are indeed quite common, to the extent that the variation cannot be explained by simple random deviations or by variations in personal activity. We also show that there is no non-trivial correlation between reciprocity and local network density.

  17. The structure of call-by-value

    OpenAIRE

    Führmann, Carsten

    2000-01-01

    Understanding procedure calls is crucial in computer science and everyday programming. Among the most common strategies for passing procedure arguments ('evaluation strategies') are 'call-by-name', 'call-by-need', and 'call-by-value', where the latter is the most commonly used. While reasoning about procedure calls is simple for call-by-name, problems arise for call-by-need and call-by-value, because it matters how often and in which order the arguments of a procedure are evaluated. We s...

  18. A Quantitative, Pooled Analysis and Systematic Review of Controlled Trials on the Impact of Electrical Stimulation Settings and Placement on Pressure Ulcer Healing Rates in Persons With Spinal Cord Injuries.

    Science.gov (United States)

    Liu, Liang; Moody, Julie; Gall, Angela

    2016-07-01

    Pressure ulcers (PrUs) are among the most common secondary complications following spinal cord injury (SCI). External electrical current applied to a wound is believed to mimic the body's natural bioelectricity and to restart and stimulate endogenous electrical fields to promote wound healing. A systematic review was conducted to critically appraise and synthesize updated evidence on the impact of electrical stimulation (ES) versus standard wound care (comprising cleansing, dressing, nutrition, and debridement as necessary) and/or sham stimulation on PrU healing rates in persons with SCIs. Medline, Embase, the Cumulative Index for Nursing and Allied Health Literature (CINAHL), PsycINFO, and Cochrane Central were searched using the terms spinal cord injury, electrical stimulation, and pressure ulcer in free text and MESH terms. Publications were limited to peer-reviewed, randomized controlled trials (RCTs) and non-RCTs (CCTs) published in English from 1985 to 2014. The methodological quality of the RCTs was evaluated using the Jadad scale; CCTs were assessed using the Downs and Black tool. Pooled analyses were performed to calculate the mean difference (MD) for continuous data, odds ratio (OR) for dichotomous data, and 95% confidence intervals (CI). A total of 8 trials were reviewed - 6 RCTs and 2 CCTs included a total of 517 SCI participants who had at least 1 PrU. The number of patients per study ranged from 7 to 150 and the number of wounds from 7 to 192. Comparison models included ES irrespective of current type and placement of electrodes against sham/no ES (7 trials), ES delivered by electrodes overlaid on the ulcer versus sham/no ES (4 trials), ES delivered by electrodes placed on intact skin around the ulcer versus sham/no ES (4 trials), ES delivered by electrodes overlaid on the wound bed versus placed on intact skin around the ulcer (1 trial), ES with pulsed current versus sham/no ES (6 trials), ES with constant current versus sham/no ES (2 trials), pulsed

  19. How does the impact of a community trial on cardio-metabolic risk factors differ in terms of gender and living area? Findings from the Isfahan healthy heart program

    OpenAIRE

    Nizal Sarrafzadegan; Roya Kelishadi; Mansour Siavash; Gholamhossein Sadri; Hossein Malekafzali; Masoud Pourmoghaddas; Shahin Shirani; Maryam Boshtam; Sedigheh Asgary; Noushin Mohammadifard; Ahmad Bahonar; Babak Eshrati; Farhad Ghamsari

    2012-01-01

    Objective: To assess the impact of gender and living area on cardiovascular risk factors in the context of a comprehensive lifestyle intervention program. Design: Data from independent sample surveys before (2000--2001) and after (2007) a community trial, entitled the Isfahan Healthy Heart Program (IHHP) were used to compare differences in the intervention area (IA) and reference area (RA) by gender and living area. Setting: The interventions targeted the population living in Isfahan and Naja...

  20. The Impact of a 24 Month Housing First Intervention on Participants’ Body Mass Index and Waist Circumference: Results from the At Home / Chez Soi Toronto Site Randomized Controlled Trial

    OpenAIRE

    Julia Woodhall-Melnik; Vachan Misir; Vered Kaufman-Shriqui; Patricia O'Campo; Vicky Stergiopoulos; Stephen Hwang

    2015-01-01

    Research suggests that individuals experiencing homelessness have high rates of overweight and obesity. Unhealthy weights and homelessness are both associated with increased risk of poor health and mortality. Using longitudinal data from 575 participants at the Toronto site of the At Home/Chez Soi randomized controlled trial, we investigate the impact of receiving a Housing First intervention on the Body Mass Index (BMI) and waist circumference of participants with moderate and high needs for...

  1. The experience of work in a call centre environment

    Directory of Open Access Journals (Sweden)

    Sanet Hauptfleisch

    2006-02-01

    Full Text Available This qualitative research study explored the work experience in a call centre environment in an information technology call centre based in South Africa, which service foreign customers exclusively. Three data collection methods were used, namely narratives, in-depth interviews with call centre consultants, and observation. Following a grounded theory approach, four themes were elicited, namely the perceptions of team members, uncertainty created by a constantly changing environment, perceived distances due to management practices, and depersonalisation experienced while actually dealing with customers. In addition to this, the reported impact of these themes on work performance was explored and compared to existing research.

  2. Impact of the Patient-Reported Outcomes Management Information System (PROMIS) upon the Design and Operation of Multi-center Clinical Trials: a Qualitative Research Study

    Science.gov (United States)

    Diener, Lawrence W.; Nahm, Meredith; Weinfurt, Kevin P.

    2013-01-01

    New technologies may be required to integrate the National Institutes of Health’s Patient Reported Outcome Management Information System (PROMIS) into multi-center clinical trials. To better understand this need, we identified likely PROMIS reporting formats, developed a multi-center clinical trial process model, and identified gaps between current capabilities and those necessary for PROMIS. These results were evaluated by key trial constituencies. Issues reported by principal investigators fell into two categories: acceptance by key regulators and the scientific community, and usability for researchers and clinicians. Issues reported by the coordinating center, participating sites, and study subjects were those faced when integrating new technologies into existing clinical trial systems. We then defined elements of a PROMIS Tool Kit required for integrating PROMIS into a multi-center clinical trial environment. The requirements identified in this study serve as a framework for future investigators in the design, development, implementation, and operation of PROMIS Tool Kit technologies. PMID:20703765

  3. SU-D-17A-04: The Impact of Audiovisual Biofeedback On Image Quality During 4D Functional and Anatomic Imaging: Results of a Prospective Clinical Trial

    International Nuclear Information System (INIS)

    Purpose: The ability of audiovisual (AV) biofeedback to improve breathing regularity has not previously been investigated for functional imaging studies. The purpose of this study was to investigate the impact of AV biofeedback on 4D-PET and 4D-CT image quality in a prospective clinical trial. We hypothesized that motion blurring in 4D-PET images and the number of artifacts in 4D-CT images are reduced using AV biofeedback. Methods: AV biofeedback is a real-time, interactive and personalized system designed to help a patient self-regulate his/her breathing using a patient-specific representative waveform and musical guides. In an IRB-approved prospective clinical trial, 4D-PET and 4D-CT images of 10 lung cancer patients were acquired with AV biofeedback (AV) and free breathing (FB). The 4D-PET images in 6 respiratory bins were analyzed for motion blurring by: (1) decrease of GTVPET and (2) increase of SUVmax in 4-DPET compared to 3D-PET. The 4D-CT images were analyzed for artifacts by: (1) comparing normalized cross correlation-based scores (NCCS); and (2) quantifying a visual assessment score (VAS). A two-tailed paired t-test was used to test the hypotheses. Results: The impact of AV biofeedback on 4D-PET and 4D-CT images varied widely between patients, suggesting inconsistent patient comprehension and capability. Overall, the 4D-PET decrease of GTVPET was 2.0±3.0cm3 with AV and 2.3±3.9cm3 for FB (p=0.61). The 4D-PET increase of SUVmax was 1.6±1.0 with AV and 1.1±0.8 with FB (p=0.002). The 4D-CT NCCS were 0.65±0.27 with AV and 0.60±0.32 for FB (p=0.32). The 4D-CT VAS was 0.0±2.7 (p=ns). Conclusion: A 10-patient study demonstrated a statistically significant reduction of motion blurring of AV over FB for 1/2 functional 4D-PET imaging metrics. No difference between AV and FB was found for 2 anatomic 4D-CT imaging metrics. Future studies will focus on optimizing the human-computer interface and including patient training sessions for improved comprehension and

  4. SU-D-17A-04: The Impact of Audiovisual Biofeedback On Image Quality During 4D Functional and Anatomic Imaging: Results of a Prospective Clinical Trial

    Energy Technology Data Exchange (ETDEWEB)

    Keall, P; Pollock, S [University of Sydney, Sydney (Australia); Yang, J; Diehn, M; Berger, J; Graves, E; Loo, B [Stanford University, Stanford, CA (United States); Yamamoto, T [UC Davis School of Medicine, Sacramento, CA (United States)

    2014-06-01

    Purpose: The ability of audiovisual (AV) biofeedback to improve breathing regularity has not previously been investigated for functional imaging studies. The purpose of this study was to investigate the impact of AV biofeedback on 4D-PET and 4D-CT image quality in a prospective clinical trial. We hypothesized that motion blurring in 4D-PET images and the number of artifacts in 4D-CT images are reduced using AV biofeedback. Methods: AV biofeedback is a real-time, interactive and personalized system designed to help a patient self-regulate his/her breathing using a patient-specific representative waveform and musical guides. In an IRB-approved prospective clinical trial, 4D-PET and 4D-CT images of 10 lung cancer patients were acquired with AV biofeedback (AV) and free breathing (FB). The 4D-PET images in 6 respiratory bins were analyzed for motion blurring by: (1) decrease of GTVPET and (2) increase of SUVmax in 4-DPET compared to 3D-PET. The 4D-CT images were analyzed for artifacts by: (1) comparing normalized cross correlation-based scores (NCCS); and (2) quantifying a visual assessment score (VAS). A two-tailed paired t-test was used to test the hypotheses. Results: The impact of AV biofeedback on 4D-PET and 4D-CT images varied widely between patients, suggesting inconsistent patient comprehension and capability. Overall, the 4D-PET decrease of GTVPET was 2.0±3.0cm3 with AV and 2.3±3.9cm{sup 3} for FB (p=0.61). The 4D-PET increase of SUVmax was 1.6±1.0 with AV and 1.1±0.8 with FB (p=0.002). The 4D-CT NCCS were 0.65±0.27 with AV and 0.60±0.32 for FB (p=0.32). The 4D-CT VAS was 0.0±2.7 (p=ns). Conclusion: A 10-patient study demonstrated a statistically significant reduction of motion blurring of AV over FB for 1/2 functional 4D-PET imaging metrics. No difference between AV and FB was found for 2 anatomic 4D-CT imaging metrics. Future studies will focus on optimizing the human-computer interface and including patient training sessions for improved

  5. Impact of L-carnitine on plasma lipoprotein(a) concentrations: A systematic review and meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Serban, Maria-Corina; Sahebkar, Amirhossein; Mikhailidis, Dimitri P; Toth, Peter P; Jones, Steven R; Muntner, Paul; Blaha, Michael J; Andrica, Florina; Martin, Seth S; Borza, Claudia; Lip, Gregory Y H; Ray, Kausik K; Rysz, Jacek; Hazen, Stanley L; Banach, Maciej

    2016-01-01

    We aimed to assess the impact of L-carnitine on plasma Lp(a) concentrations through systematic review and meta-analysis of available RCTs. The literature search included selected databases up to 31(st) January 2015. Meta-analysis was performed using fixed-effects or random-effect model according to I(2) statistic. Effect sizes were expressed as weighted mean difference (WMD) and 95% confidence interval (CI). The meta-analysis showed a significant reduction of Lp(a) levels following L-carnitine supplementation (WMD: -8.82 mg/dL, 95% CI: -10.09, -7.55, p < 0.001). When the studies were categorized according to the route of administration, a significant reduction in plasma Lp(a) concentration was observed with oral (WMD: -9.00 mg/dL, 95% CI: -10.29, -7.72, p < 0.001) but not intravenous L-carnitine (WMD: -2.91 mg/dL, 95% CI: -10.22, 4.41, p = 0.436). The results of the meta-regression analysis showed that the pooled estimate is independent of L-carnitine dose (slope: -0.30; 95% CI: -4.19, 3.59; p = 0.878) and duration of therapy (slope: 0.18; 95% CI: -0.22, 0.59; p = 0.374). In conclusion, the meta-analysis suggests a significant Lp(a) lowering by oral L-carnitine supplementation. Taking into account the limited number of available Lp(a)-targeted drugs, L-carnitine might be an effective alternative to effectively reduce Lp(a). Prospective outcome trials will be required to fully elucidate the clinical value and safety of oral L-carnitine supplementation. PMID:26754058

  6. A cluster-randomized trial assessing the impact of school water, sanitation, and hygiene improvements on pupil enrollment and gender parity in enrollment.

    Science.gov (United States)

    Garn, Joshua V; Greene, Leslie E; Dreibelbis, Robert; Saboori, Shadi; Rheingans, Richard D; Freeman, Matthew C

    2013-10-01

    We employed a cluster randomized trial design to measure the impact of a school based water, sanitation, and hygiene (WASH) improvement on pupil enrollment and on gender parity in enrollment, in primary schools in Nyanza Province, Kenya (2007-2009). Among schools with poor water access during the dry season, those that received a water supply, hygiene promotion and water treatment (HP&WT) and sanitation improvement, demonstrated increased enrollment (β=0.091 [0.009, 0.173] p=0.03), which translates to 26 additional pupils per school on average. The proportion of girls enrolled in school also increased by 4% (prevalence ratio (PR)=1.04 [1.00, 1.07] p=0.02). Among schools with better baseline water access during the dry season (schools that didn't receive a water source), we found no evidence of increased enrollment in schools that received a HP&WT intervention (β=0.016 [-0.039, 0.072] p=0.56) or the HP&WT and sanitation intervention (β=0.027 [-0.028, 0.082]p=0.34), and there was no evidence of improved gender parity (PR=0.99 [0.96, 1.02] p=0.59, PR=1.00 [0.97, 1.02] p=0.75, respectively). Our findings suggest that increased school enrollment and improved gender parity may be influenced by a comprehensive WASH program that includes an improved water source; schools with poor water access during the dry season may benefit most from these interventions. PMID:24392220

  7. Animal source foods have a positive impact on the primary school test scores of Kenyan schoolchildren in a cluster-randomised, controlled feeding intervention trial.

    Science.gov (United States)

    Hulett, Judie L; Weiss, Robert E; Bwibo, Nimrod O; Galal, Osman M; Drorbaugh, Natalie; Neumann, Charlotte G

    2014-03-14

    Micronutrient deficiencies and suboptimal energy intake are widespread in rural Kenya, with detrimental effects on child growth and development. Sporadic school feeding programmes rarely include animal source foods (ASF). In the present study, a cluster-randomised feeding trial was undertaken to determine the impact of snacks containing ASF on district-wide, end-term standardised school test scores and nutrient intake. A total of twelve primary schools were randomly assigned to one of three isoenergetic feeding groups (a local plant-based stew (githeri) with meat, githeri plus whole milk or githeri with added oil) or a control group receiving no intervention feeding. After the initial term that served as baseline, children were fed at school for five consecutive terms over two school years from 1999 to 2001. Longitudinal analysis was used controlling for average energy intake, school attendance, and baseline socio-economic status, age, sex and maternal literacy. Children in the Meat group showed significantly greater improvements in test scores than those in all the other groups, and the Milk group showed significantly greater improvements in test scores than the Plain Githeri (githeri+oil) and Control groups. Compared with the Control group, the Meat group showed significant improvements in test scores in Arithmetic, English, Kiembu, Kiswahili and Geography. The Milk group showed significant improvements compared with the Control group in test scores in English, Kiswahili, Geography and Science. Folate, Fe, available Fe, energy per body weight, vitamin B₁₂, Zn and riboflavin intake were significant contributors to the change in test scores. The greater improvements in test scores of children receiving ASF indicate improved academic performance, which can result in greater academic achievement. PMID:24168874

  8. The Impact of an Intervention to Improve Malaria Care in Public Health Centers on Health Indicators of Children in Tororo, Uganda (PRIME): A Cluster-Randomized Trial.

    Science.gov (United States)

    Staedke, Sarah G; Maiteki-Sebuguzi, Catherine; DiLiberto, Deborah D; Webb, Emily L; Mugenyi, Levi; Mbabazi, Edith; Gonahasa, Samuel; Kigozi, Simon P; Willey, Barbara A; Dorsey, Grant; Kamya, Moses R; Chandler, Clare I R

    2016-08-01

    Optimizing quality of care for malaria and other febrile illnesses is a complex challenge of major public health importance. To evaluate the impact of an intervention aiming to improve malaria case management on the health of community children, a cluster-randomized trial was conducted from 2010-2013 in Tororo, Uganda, where malaria transmission is high. Twenty public health centers were included; 10 were randomized in a 1:1 ratio to intervention or control. Households within 2 km of health centers provided the sampling frame for the evaluation. The PRIME intervention included training in fever case management using malaria rapid diagnostic tests (mRDTs), patient-centered services, and health center management; plus provision of mRDTs and artemether-lumefantrine. Cross-sectional community surveys were conducted at baseline and endline (N = 8,766), and a cohort of children was followed for approximately 18 months (N = 992). The primary outcome was prevalence of anemia (hemoglobin < 11.0 g/dL) in children under 5 years of age in the final community survey. The intervention was delivered successfully; however, no differences in prevalence of anemia or parasitemia were observed between the study arms in the final community survey or the cohort. In the final survey, prevalence of anemia in children under 5 years of age was 62.5% in the intervention versus 63.1% in control (adjusted risk ratio = 1.01; 95% confidence interval = 0.91-1.13; P = 0.82). The PRIME intervention, focusing on training and commodities, did not produce the expected health benefits in community children in Tororo. This challenges common assumptions that improving quality of care and access to malaria diagnostics will yield health gains. PMID:27273646

  9. Reduced reward-driven eating accounts for the impact of a mindfulness-based diet and exercise intervention on weight loss: Data from the SHINE randomized controlled trial.

    Science.gov (United States)

    Mason, Ashley E; Epel, Elissa S; Aschbacher, Kirstin; Lustig, Robert H; Acree, Michael; Kristeller, Jean; Cohn, Michael; Dallman, Mary; Moran, Patricia J; Bacchetti, Peter; Laraia, Barbara; Hecht, Frederick M; Daubenmier, Jennifer

    2016-05-01

    Many individuals with obesity report over eating despite intentions to maintain or lose weight. Two barriers to long-term weight loss are reward-driven eating, which is characterized by a lack of control over eating, a preoccupation with food, and a lack of satiety; and psychological stress. Mindfulness training may address these barriers by promoting awareness of hunger and satiety cues, self-regulatory control, and stress reduction. We examined these two barriers as potential mediators of weight loss in the Supporting Health by Integrating Nutrition and Exercise (SHINE) randomized controlled trial, which compared the effects of a 5.5-month diet and exercise intervention with or without mindfulness training on weight loss among adults with obesity. Intention-to-treat multiple mediation models tested whether post-intervention reward-driven eating and psychological stress mediated the impact of intervention arm on weight loss at 12- and 18-months post-baseline among 194 adults with obesity (BMI: 30-45). Mindfulness (relative to control) participants had significant reductions in reward-driven eating at 6 months (post-intervention), which, in turn, predicted weight loss at 12 months. Post-intervention reward-driven eating mediated 47.1% of the total intervention arm effect on weight loss at 12 months [β = -0.06, SE(β) = 0.03, p = .030, 95% CI (-0.12, -0.01)]. This mediated effect was reduced when predicting weight loss at 18 months (p = .396), accounting for 23.0% of the total intervention effect, despite similar weight loss at 12 months. Psychological stress did not mediate the effect of intervention arm on weight loss at 12 or 18 months. In conclusion, reducing reward-driven eating, which can be achieved using a diet and exercise intervention that includes mindfulness training, may promote weight loss (clinicaltrials.gov registration: NCT00960414). PMID:26867697

  10. Impact of statin therapy on plasma levels of plasminogen activator inhibitor-1. A systematic review and meta-analysis of randomised controlled trials.

    Science.gov (United States)

    Sahebkar, Amirhossein; Catena, Cristiana; Ray, Kausik K; Vallejo-Vaz, Antonio J; Reiner, Željko; Sechi, Leonardo A; Colussi, GianLuca

    2016-07-01

    Elevated plasma levels of the pro-thrombotic and pro-inflammatory factor plasminogen activator inhibitor-1 (PAI-1) may contribute to the pathogenesis of atherosclerotic cardiovascular disease. Beyond their lipid-lowering effect, statins have been shown to modulate plasma PAI-1 levels but evidence from individual randomised controlled trials (RCTs) is controversial. Therefore, we aimed to assess the potential effects of statin therapy on plasma PAI-1 concentration through a meta-analysis of RCTs. We searched Medline and SCOPUS databases (up to October 3, 2014) to identify RCTs investigating the effect of statin therapy on plasma PAI-1 concentrations. We performed random-effects meta-analysis and assessed heterogeneity (I² test, subgroup and sensitivity analyses) and publication bias (funnel plot, Egger and "trim and fill" tests). Sixteen RCTs (comprising 19 treatment arms) were included and pooled analyses showed a significant effect of statins in reducing plasma PAI-1 concentrations (weighted mean difference WMD: -15.72 ng/ml, 95 % confidence interval [CI]: -25.01, -6.43,). In subgroup analysis, this effect remained significant in with lipophilic statins (atorvastatin and simvastatin) (WMD: -21.32 ng/ml, 95 % CI: -32.73, -9.91, I²=99 %) and particularly atorvastatin (WMD: -20.88 ng/mL, 95 % CI: -28.79, -12.97, I2=97 %). In the meta-regression analysis, the impact of statins on PAI-1 did not correlate with the administered dose, duration of treatment and changes in plasma LDL-cholesterol concentrations. Finally, evidence of publication bias was observed. In conclusion, taking into account the limit of heterogeneity between studies, the present meta-analysis suggests that statin therapy (mainly atorvastatin) significantly lowers plasma PAI-1 concentrations. PMID:27009446

  11. Homo Economicus and the Salem Witch Trials.

    Science.gov (United States)

    Mixon, Franklin G., Jr.

    2000-01-01

    Provides background information on the Salem Witch Trials (Salem, Massachusetts) and the medical explanation of the young village girls' behavior in Salem called ergotism (bread poisoning). Presents an economic interpretation of those trials, stating that the ministers employed religious beliefs about witchcraft to maintain their churchs' monopoly…

  12. A randomized, double-blind, placebo-controlled, clinical trial of the impact of malaria prevention on the educational attainment of school children.

    Science.gov (United States)

    Fernando, Deepika; de Silva, Damani; Carter, Richard; Mendis, Kamini N; Wickremasinghe, Rajitha

    2006-03-01

    A double-blind, placebo-controlled trial of nine months duration was carried out to investigate the impact of malaria and its prevention on the educational attainment of school children in a malaria-endemic area in southern Sri Lanka where both Plasmodium falciparum and P. vivax infections are prevalent. A total of 587 children attending grades 1-5 in four schools and resident in the area were randomly allocated to chloroquine (n = 295) and placebo (n = 292) arms. Language and mathematics scores of end-of-term school examinations for 1998 and 1999 and number of days absent and reasons for absenteeism during seven months pre-intervention and nine months of the intervention were recorded. The results indicate that there were no differences in language (95% confidence interval [CI] = 48.44-53.78 in chloroquine group and 50.43-55.81 in placebo group) and mathematics (95% CI = 49.24-54.38 in chloroquine group and 51.12-56.38 in placebo group) scores between the two groups prior to the intervention. During the intervention, the malaria incidence rate decreased by 55% (95% CI = 49-61%) and school absenteeism due to malaria was reduced by 62.5% (95% CI = 57-68%) in children who received chloroquine compared with the placebo group. Post-intervention, children who received chloroquine scored approximately 26% higher in both language (95% CI = 21-31%) and mathematics (95% CI = 23-33%) than children who received placebo. In a multivariate model, educational attainment was significantly associated with taking chloroquine prophylaxis and absenteeism due to malaria (P < 0.001 for both) but not due to health causes other than malaria or non-health causes. Language scores were associated with number of malaria attacks (P < 0.022). Educational attainment was significantly better among children whose compliance to chloroquine prophylaxis was higher (P < 0.001). The data suggest that malarial attacks have an adverse impact on the educational attainment of the school child and

  13. Impact of different privacy conditions and incentives on survey response rate, participant representativeness, and disclosure of sensitive information: a randomized controlled trial

    Science.gov (United States)

    2014-01-01

    Background Anonymous survey methods appear to promote greater disclosure of sensitive or stigmatizing information compared to non-anonymous methods. Higher disclosure rates have traditionally been interpreted as being more accurate than lower rates. We examined the impact of 3 increasingly private mailed survey conditions—ranging from potentially identifiable to completely anonymous—on survey response and on respondents’ representativeness of the underlying sampling frame, completeness in answering sensitive survey items, and disclosure of sensitive information. We also examined the impact of 2 incentives ($10 versus $20) on these outcomes. Methods A 3X2 factorial, randomized controlled trial of 324 representatively selected, male Gulf War I era veterans who had applied for United States Department of Veterans Affairs (VA) disability benefits. Men were asked about past sexual assault experiences, childhood abuse, combat, other traumas, mental health symptoms, and sexual orientation. We used a novel technique, the pre-merged questionnaire, to link anonymous responses to administrative data. Results Response rates ranged from 56.0% to 63.3% across privacy conditions (p = 0.49) and from 52.8% to 68.1% across incentives (p = 0.007). Respondents’ characteristics differed by privacy and by incentive assignments, with completely anonymous respondents and $20 respondents appearing least different from their non-respondent counterparts. Survey completeness did not differ by privacy or by incentive. No clear pattern of disclosing sensitive information by privacy condition or by incentive emerged. For example, although all respondents came from the same sampling frame, estimates of sexual abuse ranged from 13.6% to 33.3% across privacy conditions, with the highest estimate coming from the intermediate privacy condition (p = 0.007). Conclusion Greater privacy and larger incentives do not necessarily result in higher disclosure rates of sensitive information

  14. Impact of Multi-Micronutrient Fortified Rice on Hemoglobin, Iron and Vitamin A Status of Cambodian Schoolchildren: a Double-Blind Cluster-Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Marlène Perignon

    2016-01-01

    Full Text Available In Cambodia, micronutrient deficiencies remain a critical public health problem. Our objective was to evaluate the impact of multi-micronutrient fortified rice (MMFR formulations, distributed through a World Food Program school-meals program (WFP-SMP, on the hemoglobin concentrations and iron and vitamin A (VA status of Cambodian schoolchildren. The FORISCA-UltraRice+NutriRice study was a double-blind, cluster-randomized, placebo-controlled trial. Sixteen schools participating in WFP-SMP were randomly assigned to receive extrusion-fortified rice (UltraRice Original, UltraRice New (URN, or NutriRice or unfortified rice (placebo six days a week for six months. Four additional schools not participating in WFP-SMP were randomly selected as controls. A total of 2440 schoolchildren (6–16 years old participated in the biochemical study. Hemoglobin, iron status, estimated using inflammation-adjusted ferritin and transferrin receptors concentrations, and VA status, assessed using inflammation-adjusted retinol-binding protein concentration, were measured at the baseline, as well as at three and six months. Baseline prevalence of anemia, depleted iron stores, tissue iron deficiency, marginal VA status and VA deficiency were 15.6%, 1.4%, 51.0%, 7.9%, and 0.7%, respectively. The strongest risk factors for anemia were hemoglobinopathy, VA deficiency, and depleted iron stores (all p < 0.01. After six months, children receiving NutriRice and URN had 4 and 5 times less risk of low VA status, respectively, in comparison to the placebo group. Hemoglobin significantly increased (+0.8 g/L after three months for the URN group in comparison to the placebo group; however, this difference was no longer significant after six months, except for children without inflammation. MMFR containing VA effectively improved the VA status of schoolchildren. The impact on hemoglobin and iron status was limited, partly by sub-clinical inflammation. MMFR combined with non

  15. Predictors and impact of non-adherence in adults with attention-deficit/hyperactivity disorder receiving OROS methylphenidate: results from a randomized, placebo-controlled trial

    Directory of Open Access Journals (Sweden)

    Kooij J J Sandra

    2013-01-01

    Full Text Available Abstract Background Medication non-adherence has an important impact on treatment efficacy and healthcare burden across a range of conditions and therapeutic areas. The aim of this analysis was to determine predictors of non-adherence and impact of non-adherence on treatment response in adults with attention-deficit/hyperactivity disorder (ADHD. Methods Post-hoc analysis of a 13-week randomized, double-blind placebo-controlled study of OROS methylphenidate (MPH 54 and 72 mg/day. Primary efficacy variable was the Conners’ Adult ADHD Rating Scale – Screening Version (CAARS:O-SV. Daily adherence was calculated as average daily adherence (100 × capsules taken/2, with overall adherence calculated as the average daily adherence. Predictors of adherence were assessed using mixed-effects logistic regression. Descriptive statistics were generated for change in CAARS:O-SV score for adherent (> 95% adherence and non-adherent subjects. Predictors of change were analyzed using a mixed model. Results Subjects were allocated to OROS MPH (54 mg, n = 87; 72 mg, n = 92 or placebo (n = 97. Mean adherence was 92.6% and 93.3% (OROS MPH 54 and 72 mg/day, respectively, versus 97.5% (placebo. Adherence was higher and less variable in completers. Factors significantly associated with non-adherence included female sex, shorter time since ADHD diagnosis, higher education level (completion of university and score on the Drug Use Screening Inventory psychiatric disorders subscale. Improvements from baseline in CAARS:O-SV score were numerically greater in subjects defined as adherent than in those who were non-adherent. Significant predictors of CAARS:O-SV change in patients who completed the study included percentage adherence up to the point of assessment (p p p = 0.0003. Conclusion The results of this analysis suggest that newly diagnosed patients, those with a high score on the DUSI-R psychiatric disorder scale, women, and subjects with high educational degrees may

  16. Rationale, design and methods for a randomised and controlled trial of the impact of virtual reality games on motor competence, physical activity, and mental health in children with developmental coordination disorder

    Directory of Open Access Journals (Sweden)

    Straker Leon M

    2011-08-01

    Full Text Available Abstract Background A healthy start to life requires adequate motor development and physical activity participation. Currently 5-15% of children have impaired motor development without any obvious disorder. These children are at greater risk of obesity, musculoskeletal disorders, low social confidence and poor mental health. Traditional electronic game use may impact on motor development and physical activity creating a vicious cycle. However new virtual reality (VR game interfaces may provide motor experiences that enhance motor development and lead to an increase in motor coordination and better physical activity and mental health outcomes. VR games are beginning to be used for rehabilitation, however there is no reported trial of the impact of these games on motor coordination in children with developmental coordination disorder. Methods This cross-over randomised and controlled trial will examine whether motor coordination is enhanced by access to active electronic games and whether daily activity, attitudes to physical activity and mental health are also enhanced. Thirty children aged 10-12 years with poor motor coordination (≤ 15th percentile will be recruited and randomised to a balanced ordering of 'no active electronic games' and 'active electronic games'. Each child will participate in both conditions for 16 weeks, and be assessed prior to participation and at the end of each condition. The primary outcome is motor coordination, assessed by kinematic and kinetic motion analysis laboratory measures. Physical activity and sedentary behaviour will be assessed by accelerometry, coordination in daily life by parent report questionnaire and attitudes to physical activity, self-confidence, anxiety and depressed mood will be assessed by self report questionnaire. A sample of 30 will provide a power of > 0.9 for detecting a 5 point difference in motor coordination on the MABC-2 TIS scale (mean 17, sd = 5. Discussion This is the first trial to

  17. Advanced Call Center Supporting WAP Access

    Institute of Scientific and Technical Information of China (English)

    YUANXiao-hua; CHENJun-liang

    2001-01-01

    Traditional call centers can be accessed via speech only, and the call center based on web provides both da-ta and speech access,but it needs a powerful terminal-computer.By analyzing traditional call centers and call cen-ters based on web, this paper presents the framework of an advanced call center supporting WAP access.A typical service is also described in detail.

  18. African HIV/AIDS trials are more likely to report adequate allocation concealment and random generation than North American trials.

    OpenAIRE

    Nandi Siegfried; Michael Clarke; Jimmy Volmink; Lize Van der Merwe

    2008-01-01

    BACKGROUND: Adherence to good methodological quality is necessary to minimise bias in randomised conrolled trials (RCTs). Specific trial characteristics are associated with better trial quality, but no studies to date are specific to HIV/AIDS or African trials. We postulated that location may negatively impact on trial quality in regions where resources are scarce. METHODS: 1) To compare the methodological quality of all HIV/AIDS RCTs conducted in Africa with a random sample of similar trials...

  19. Stroke Trials Registry

    Science.gov (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Trials Registry Clinical Trials Interventions Conditions Sponsors ... a clinical trial near you Welcome to the Stroke Trials Registry Our registry of clinical trials in ...

  20. Evaluation of the impact of a school gardening intervention on children’s fruit and vegetable intake: a randomised controlled trial

    OpenAIRE

    Christian, Meaghan S; Evans, Charlotte EL; Nykjaer, Camilla; Hancock, Neil; Cade, Janet E

    2014-01-01

    Background Current academic literature suggests that school gardening programmes can provide an interactive environment with the potential to change children’s fruit and vegetable intake. This is the first cluster randomised controlled trial (RCT) designed to evaluate whether a school gardening programme can have an effect on children’s fruit and vegetable intake. Methods The trial included children from 23 schools; these schools were randomised into two groups, one to receive the Royal Horti...

  1. The Mobile Solutions for Immunization (M-SIMU) Trial: A Protocol for a Cluster Randomized Controlled Trial That Assesses the Impact of Mobile Phone Delivered Reminders and Travel Subsidies to Improve Childhood Immunization Coverage Rates and Timeliness in Western Kenya

    OpenAIRE

    Gibson, Dustin G.; Kagucia, E. Wangeci; Ochieng, Benard; Hariharan, Nisha; Obor, David; Moulton, Lawrence H.; Peter J. Winch; Levine, Orin S.; Odhiambo, Frank; O'Brien, Katherine L.; Feikin, Daniel R.

    2016-01-01

    Background Text message (short message service, SMS) reminders and incentives are two demand-side interventions that have been shown to improve health care–seeking behaviors by targeting participant characteristics such as forgetfulness, lack of knowledge, and transport costs. Applying these interventions to routine pediatric immunizations may improve vaccination coverage and timeliness. Objective The Mobile Solutions for Immunization (M-SIMU) trial aims to determine if text message reminders...

  2. Impact of early parenteral nutrition completing enteral nutrition in adult critically ill patients (EPaNIC trial): a study protocol and statistical analysis plan for a randomized controlled trial

    OpenAIRE

    Wilmer Alexander; Hermans Greet; Casaer Michaël P; Van den Berghe Greet

    2011-01-01

    Abstract Background For critically ill patients treated in intensive care units (ICU), two feeding strategies are currently being advocated, one by American/Canadian and the other by European expert guidelines. These guidelines differ particularly in the timing of initiating parenteral nutrition (PN) in patients for whom enteral nutrition (EN) does not reach caloric targets. Methods/Design The EPaNIC trial is an investigator-initiated, non-commercial, multi-center, randomized, controlled, cli...

  3. Leveraging management information in improving call centre productivity

    Directory of Open Access Journals (Sweden)

    Manthisana Mosese

    2016-04-01

    Full Text Available Background: The availability and efficient use of management information is one of the key strategic levers in driving growth and competitiveness for companies. Management information facilitates vital decision making that assists organisations in improving their competitiveness. For call centre operations, competitiveness entails improving productivity and customer service, and management information is essential in this endeavour.Objectives: This research explored the use of management information and its impact on two fundamental functions namely, improving productivity without compromising the quality of service, in the call centre of a well-known South African fashion retailer, Edcon. Following the implementation of the call centre technology project the research set out to determine how Edcon can transform their call centre to improve productivity and customer service through effective utilisation of their management information. Method: Internal documents and reports were analysed to provide the basis of evaluation between the measures of productivity prior to and post the implementation of a technology project at Edcon’s call centre. Semi-structured in-depth and group interviews were conducted to establish the importance and use of management information in improving productivity and customer service. Results: The results indicated that the availability of management information has indeed contributed to improved efficiency at the Edcon call centre. Although literature claims that there is a correlation between a call centre technology upgrade and improvement in performance, evident in the return on investment being realised within a year or two of implementation, it fell beyond the scope of this study to investigate the return on investment for Edcon’s call centre. Conclusion: Although Edcon has begun realising benefits in improved productivity in their call centre from their available management information, information will

  4. a randomized, controlled trial

    OpenAIRE

    Reinecke, Franziska

    2010-01-01

    The polycystic ovarian syndrome (PCOS) is characterized by hyperandrogenism and associated with obesity and impaired glucose metabolism. Despite the high prevalence of PCOS and the considerable clinical impact, the precise interplay between metabolism and hyperandrogenemia is not entirely clear. To analyse the effects of intravenous lipid and heparin infusion on circulating androgen levels in healthy women, we performed a randomized controlled cross-over trial. 12 healthy young women durin...

  5. Impact of combining intermittent preventive treatment with home management of malaria in children less than 10 years in a rural area of Senegal: a cluster randomized trial

    Directory of Open Access Journals (Sweden)

    Tine Roger CK

    2011-12-01

    Full Text Available Abstract Background Current malaria control strategies recommend (i early case detection using rapid diagnostic tests (RDT and treatment with artemisinin combination therapy (ACT, (ii pre-referral rectal artesunate, (iii intermittent preventive treatment and (iv impregnated bed nets. However, these individual malaria control interventions provide only partial protection in most epidemiological situations. Therefore, there is a need to investigate the potential benefits of integrating several malaria interventions to reduce malaria prevalence and morbidity. Methods A randomized controlled trial was carried out to assess the impact of combining seasonal intermittent preventive treatment in children (IPTc with home-based management of malaria (HMM by community health workers (CHWs in Senegal. Eight CHWs in eight villages covered by the Bonconto health post, (South Eastern part of Senegal were trained to diagnose malaria using RDT, provide prompt treatment with artemether-lumefantrine for uncomplicated malaria cases and pre-referral rectal artesunate for complicated malaria occurring in children under 10 years. Four CHWs were randomized to also administer monthly IPTc as single dose of sulphadoxine-pyrimethamine (SP plus three doses of amodiaquine (AQ in the malaria transmission season, October and November 2010. Primary end point was incidence of single episode of malaria attacks over 8 weeks of follow up. Secondary end points included prevalence of malaria parasitaemia, and prevalence of anaemia at the end of the transmission season. Primary analysis was by intention to treat. The study protocol was approved by the Senegalese National Ethical Committee (approval 0027/MSP/DS/CNRS, 18/03/2010. Results A total of 1,000 children were enrolled. The incidence of malaria episodes was 7.1/100 child months at risk [95% CI (3.7-13.7] in communities with IPTc + HMM compared to 35.6/100 child months at risk [95% CI (26.7-47.4] in communities with only HMM (a

  6. OARSI Clinical Trials Recommendations

    DEFF Research Database (Denmark)

    Emery, C. A.; Roos, Ewa M.; Verhagen, E.; Finch, C. F.; Bennell, K. L.; Story, B.; Spindler, K.; Kemp, J.; Lohmander, L. S.

    2015-01-01

    The risk of post-traumatic osteoarthritis (PTOA) substantially increases following joint injury. Research efforts should focus on investigating the efficacy of preventative strategies in high quality randomized controlled trials (RCT). The objective of these OARSI RCT recommendations is to inform...... regarding the research question, research design, study participants, randomization, baseline characteristics, intervention, outcome measurement, analysis, implementation, cost evaluation, reporting and future considerations including the impact on development of PTOA. Methodological recommendations for...... will facilitate between study comparisons to inform best practice in injury prevention that will have the greatest public health impact....

  7. The function of migratory bird calls

    DEFF Research Database (Denmark)

    Reichl, Thomas; Andersen, Bent Bach; Larsen, Ole Næsbye;

    The function of migratory bird calls: do they influence orientation and navigation?   Thomas Reichl1, Bent Bach Andersen2, Ole Naesbye Larsen2, Henrik Mouritsen1   1Institute of Biology, University of Oldenburg, Oldenburg, D-26111 Oldenburg, Germany 2Institute of Biology, University of Southern...... Denmark, Odense, DK-5230 Odense M, Denmark   Many migrating passerines emit special calls during nocturnal flight, the so-called flight calls. Several functions of the calls have been suggested but largely remain speculative. Flight calls have been hypothesized to maintain groups during nocturnal...... migration and to stimulate migratory restlessness in conspecifics. We wished to test if conspecific flight calls influence the flight direction of a nocturnal migrant, the European Robin (Erithacus rubecula), i.e. if flight calls help migrants keeping course. Wild caught birds showing migratory restlessness...

  8. Call packing bounds for overflow queues

    OpenAIRE

    van Dijk; Sluis, van der, B.

    2004-01-01

    Finite queueing loss systems are studied with overflow. For these systems there is no simple analytic expression for the loss probability or throughput. This paper aims to prove and promote easily computable bounds as based upon the so-called call packing principle. Under call packing a standard product form expression is available. It is proven that call packing leads to a guaranteed upper bound for the loss probability. In addition, an analytic error bound for the accuracy is derived which ...

  9. Analysis of a hospital call center

    OpenAIRE

    Budak, Ezel Ezgi

    2012-01-01

    Ankara : The Department of Industrial Engineering and the Graduate School of Engineering and Science of Bilkent University, 2012. Thesis (Master's) -- Bilkent University, 2012. Includes bibliographical refences. In this thesis, we study the call center operations of a particular hospital located in Ankara, namely Güven Hospital. The hospital call center takes role as a medical consulting and appointment center and also domestic call traffic flows over the call center. These ...

  10. Collaborative trial on groundwater sampling

    OpenAIRE

    Ghestem, Jean Philippe; Fisicaro, Paula; Champion, Rachel

    2011-01-01

    The trial presented here was conducted by BRGM in collaboration with LNE under the work program AQUAREF 2009 with the support of ONEMA. This is a collaborative trial on groundwater sampling and on field physico chemical measurement. It is not a proficiency test. He had three goals: * Observe and evaluate the practices of groundwater sampling to improve future guides, standards and specifications. * Assess the impact of sampling on variability of results. * Study the accuracy of field measurem...

  11. A multicentric randomized controlled trial on the impact of lengthening the interval between neoadjuvant radiochemotherapy and surgery on complete pathological response in rectal cancer (GRECCAR-6 trial): rationale and design

    International Nuclear Information System (INIS)

    Neoadjuvant radiochemotherapy (RCT) is now part of the armamentarium of cancer of the lower and middle rectum. It is recommended in current clinical practice prior to surgical excision if the lesion is classified T3/T4 or N+. Histological complete response, defined by the absence of persistent tumor cell invasion and lymph node (ypT0N0) after pathological examination of surgical specimen has been shown to be an independent prognostic factor of overall survival and disease-free survival. Surgical excision is usually performed between 6 and 8 weeks after completion of CRT and pathological complete response rate ranges around 12%. In retrospective studies, a lengthening of the interval after RCT beyond 10 weeks was found as an independent factor increasing the rate of pathological complete response (between 26% and 31%), with a longer disease-free survival and without increasing the operative morbidity. The aim of the present study is to evaluate in 264 patients the rate of pathological complete response rate of rectal cancer after RCT by lengthening the time between RCT and surgery. The current study is a multicenter randomized trial in two parallel groups comparing 7 and 11 weeks of delay between the end of RCT and cancer surgery of rectal tumors. At the end of the RCT, surgery is planified and randomization is performed after patient’s written consent for participation. The histological complete response (ypT0N0) will be determined with analysis of the complete residual tumor and double reading by two pathologists blinded of the group of inclusion. Patients will be followed in clinics for 5 years after surgery. Participation in this trial does not change patient’s management in terms of treatment, investigations or visits. Secondary endpoints will include overall and disease free survival, rate of sphincter conservation and quality of mesorectal excision. The number of patients needed is 264. ClinicalTrial.gov: http://www.clinicaltrials.gov/NCT01648894

  12. Call packing bound for overflow loss systems

    NARCIS (Netherlands)

    N.M. van Dijk; E. van der Sluis

    2009-01-01

    Finite loss queues with overflow naturally arise in a variety of communications structures. For these systems, there is no simple analytic expression for the loss probability. This paper proves and promotes easily computable bounds based on the so-called call packing principle. Under call packing, a

  13. Call packing bounds for overflow queues

    NARCIS (Netherlands)

    N.M. van Dijk; E. van der Sluis

    2004-01-01

    Finite queueing loss systems are studied with overflow. For these systems there is no simple analytic expression for the loss probability or throughput. This paper aims to prove and promote easily computable bounds as based upon the so-called call packing principle. Under call packing a standard pro

  14. HOW TO CALL THE CERN FIRE BRIGADE

    CERN Multimedia

    2001-01-01

    The telephone numbers of the CERN Fire Brigade are: 74444 for emergency calls 74848 for other calls Note The number 112 will stay in use for emergency calls from 'wired' telephones, however, from mobile phones it leads to non-CERN emergency services.

  15. HOW TO CALL THE CERN FIRE BRIGADE

    CERN Multimedia

    2002-01-01

    The telephone numbers of the CERN Fire Brigade are: 74444 for emergency calls 74848 for other calls Note The number 112 will stay in use for emergency calls from 'wired' telephones, however, from mobile phones it leads to non-CERN emergency services.  

  16. HOW TO CALL THE CERN FIRE BRIGADE

    CERN Multimedia

    2001-01-01

    The telephone numbers of the CERN Fire Brigade are: 74444 for emergency calls 74848 for other calls Note: the number 112 will stay in use for emergency calls from 'wired' telephones, however, from mobile phones it leads to non-CERN emergency services.

  17. How to call the Fire Brigade

    CERN Multimedia

    2003-01-01

    The telephone numbers for the CERN Fire Brigade are: 74444 for emergency calls 74848 for other calls Note The number 112 will stay in use for emergency calls from "wired" telephones, however, from mobile phones it leads to non-CERN emergency services.

  18. HOW TO CALL THE CERN FIRE BRIGADE

    CERN Multimedia

    2002-01-01

    The telephone numbers of the CERN Fire Brigade are: 74444 for emergency calls 74848 for other calls Note The number 112 will stay in use for emergency calls from 'wired' telephones, however, from mobile phones it leads to non-CERN emergency services.

  19. 47 CFR 2.302 - Call signs.

    Science.gov (United States)

    2010-10-01

    ... citations affecting § 2.302, see the List of CFR Sections Affected in the Finding Aids section of this... 47 Telecommunication 1 2010-10-01 2010-10-01 false Call signs. 2.302 Section 2.302... RULES AND REGULATIONS Call Signs and Other Forms of Identifying Radio Transmissions § 2.302 Call...

  20. When to Call the Baby's Doctor

    Science.gov (United States)

    ... g n a n c y When to Call the Baby’s Doctor P rint - and -G o ... for new moms is figuring out when to call the doctor. As a general rule of thumb, ... suspect something is not right, you should always call the doctor. Even small changes in eating, sleeping, ...

  1. Perceiving a Calling, Living a Calling, and Job Satisfaction: Testing a Moderated, Multiple Mediator Model

    Science.gov (United States)

    Duffy, Ryan D.; Bott, Elizabeth M.; Allan, Blake A.; Torrey, Carrie L.; Dik, Bryan J.

    2012-01-01

    The current study examined the relation between perceiving a calling, living a calling, and job satisfaction among a diverse group of employed adults who completed an online survey (N = 201). Perceiving a calling and living a calling were positively correlated with career commitment, work meaning, and job satisfaction. Living a calling moderated…

  2. Calling behavior of blue and fin whales off California

    Science.gov (United States)

    Oleson, Erin Marie

    Passive acoustic monitoring is an effective means for evaluating cetacean presence in remote regions and over long time periods, and may become an important component of cetacean abundance surveys. To use passive acoustic recordings for abundance estimation, an understanding of the behavioral ecology of cetacean calling is crucial. In this dissertation, I develop a better understanding of how blue (Balaenoptera musculus) and fin (B. physalus ) whales use sound with the goal of evaluating passive acoustic techniques for studying their populations. Both blue and fin whales produce several different call types, though the behavioral and environmental context of these calls have not been widely investigated. To better understand how calling is used by these whales off California I have employed both new technologies and traditional techniques, including acoustic recording tags, continuous long-term autonomous acoustic recordings, and simultaneous shipboard acoustic and visual surveys. The outcome of these investigations has led to several conclusions. The production of blue whale calls varies with sex, behavior, season, location, and time of day. Each blue whale call type has a distinct behavioral context, including a male-only bias in the production of song, a call type thought to function in reproduction, and the production of some calls by both sexes. Long-term acoustic records, when interpreted using all call types, provide a more accurate measure of the local seasonal presence of whales, and how they use the region annually, seasonally and daily. The relative occurrence of different call types may indicate prime foraging habitat and the presence of different segments of the population. The proportion of animals heard calling changes seasonally and geographically relative to the number seen, indicating the calibration of acoustic and visual surveys is complex and requires further study on the motivations behind call production and the behavior of calling whales

  3. Response of coyotes to avian distress calls : testing the startle-predator and predator-attraction hypotheses

    OpenAIRE

    Knowlton, Frederick; Conover, Michael R.; Wise, Kristi K.

    1999-01-01

    We tested two hypotheses proposed to explain why many birds emit distress calls when in the grasp of a predator: the startle-predator and predator-attraction hypotheses. Responses of captive coyotes to a starling distress call were compared between no-call and call trials to determine whether coyotes are startled by the call, and if so, whether they habituated to it. The coyotes were then paired and re-tested to determine whether the call incites a second coyote to approach and interfere with...

  4. Participating in Clinical Trials

    Medline Plus

    Full Text Available ... treatment, screening, diagnostic, prevention, and supportive care trials. Treatment Trials In treatment trials, researchers may gather information about experimental treatments, ...

  5. The job demands-resources model of work engagement in South African call centres

    OpenAIRE

    Yolandi Janse van Rensburg; Billy Boonzaier; Michèle Boonzaier

    2013-01-01

    Orientation: A ‘sacrificial human resource strategy’ is practised in call centres, resulting in poor employee occupational health. Consequently, questions are posed in terms of the consequences of call centre work and which salient antecedent variables impact the engagement and wellbeing of call centre representatives.Research purpose: Firstly, to gauge the level of employee engagement amongst a sample of call centre representatives in South Africa and, secondly, to track the paths through wh...

  6. Family physician decisions following stroke symptom onset and delay times to ambulance call

    OpenAIRE

    Donnan Geoffrey; Nicol Marcus; Mosley Ian; Dewey Helen

    2011-01-01

    Abstract Background For stroke patients, calling an ambulance has been shown to be associated with faster times to hospital than contacting a family physician. However little is known about the impact of decisions made by family physicians on delay times for stroke patients once they have been called. We aimed to test the hypotheses that among ambulance transported stroke patients: • Factors associated with first calling a family physician, could be identified. • Time to ambulance call will b...

  7. Bonobos extract meaning from call sequences.

    Directory of Open Access Journals (Sweden)

    Zanna Clay

    Full Text Available Studies on language-trained bonobos have revealed their remarkable abilities in representational and communication tasks. Surprisingly, however, corresponding research into their natural communication has largely been neglected. We address this issue with a first playback study on the natural vocal behaviour of bonobos. Bonobos produce five acoustically distinct call types when finding food, which they regularly mix together into longer call sequences. We found that individual call types were relatively poor indicators of food quality, while context specificity was much greater at the call sequence level. We therefore investigated whether receivers could extract meaning about the quality of food encountered by the caller by integrating across different call sequences. We first trained four captive individuals to find two types of foods, kiwi (preferred and apples (less preferred at two different locations. We then conducted naturalistic playback experiments during which we broadcasted sequences of four calls, originally produced by a familiar individual responding to either kiwi or apples. All sequences contained the same number of calls but varied in the composition of call types. Following playbacks, we found that subjects devoted significantly more search effort to the field indicated by the call sequence. Rather than attending to individual calls, bonobos attended to the entire sequences to make inferences about the food encountered by a caller. These results provide the first empirical evidence that bonobos are able to extract information about external events by attending to vocal sequences of other individuals and highlight the importance of call combinations in their natural communication system.

  8. Alpha-internexin expression predicts outcome in anaplastic oligodendroglial tumors and may positively impact the efficacy of chemotherapy: European organization for research and treatment of cancer trial 26951

    NARCIS (Netherlands)

    Mokhtari, K.; Ducray, F.; Kros, J.M.; Gorlia, T.; Idbaih, A.; Taphoorn, M.; Wesseling, P.; Hoang-Xuan, K.; Bent, M.J. van den; Sanson, M.

    2011-01-01

    BACKGROUND: Although it has been demonstrated that the neuronal intermediate filament alpha-internexin (INA) is closely related to 1p19q codeletion in gliomas, its prognostic and predictive value has not yet been confirmed in a prospective trial. The authors of this report assessed the prognostic si

  9. The Impact of Two Workplace-Based Health Risk Appraisal Interventions on Employee Lifestyle Parameters, Mental Health and Work Ability: Results of a Randomized Controlled Trial

    Science.gov (United States)

    Addley, K.; Boyd, S.; Kerr, R.; McQuillan, P.; Houdmont, J.; McCrory, M.

    2014-01-01

    Health risk appraisals (HRA) are a common type of workplace health promotion programme offered by American employers. In the United Kingdom, evidence of their effectiveness for promoting health behaviour change remains inconclusive. This randomized controlled trial examined the effects of two HRA interventions on lifestyle parameters, mental…

  10. The K-trial. A 33-years study of the connections between manuring, soils and crops

    OpenAIRE

    Kjellenberg, Lars; Granstedt, Artur

    2005-01-01

    In 1958 started a comparative fertilization trial, called the K-trial, within the frames of Scandinavian Research Circle for Biodynamic Agriculture. The trial ended in 1990. This report accounts for the results that have been collected over this 33-year long trial-period. The ambition with the trial was to develop methods of analyses that could indicate foodstuff quality. The long-term trial-period also brought along, a possibility to study the correlation of fertilization, soil and crop....

  11. Civil society perspectives on negative biomedical HIV prevention trial results and implications for future trials.

    Science.gov (United States)

    Essack, Zaynab; Koen, Jennifer; Slack, Catherine; Lindegger, Graham; Newman, Peter A

    2012-01-01

    Community engagement is crucial to ongoing development and testing of sorely needed new biomedical HIV prevention technologies. Yet, negative trial results raise significant challenges for community engagement in HIV prevention trials, including the early termination of the Cellulose Sulfate microbicide trial and two Phase IIb HIV vaccine trials (STEP and Phambili). The present study aimed to explore the perspectives and experiences of civil society organization (CSO) representatives regarding negative HIV prevention trial results and perceived implications for future trials. We conducted in-depth interviews with 14 respondents from a broad range of South African and international CSOs, and analyzed data using thematic analysis. CSO representatives reported disappointment in response to negative trial results, but acknowledged such outcomes as inherent to clinical research. Respondents indicated that in theory negative trial results seem likely to impact on willingness to participate in future trials, but that in practice people in South Africa have continued to volunteer. Negative trial results were described as having contributed to improving ethical standards, and to a re-evaluation of the scientific agenda. Such negative results were identified as potentially impacting on funding for trials and engagement activities. Our findings indicate that trial closures may be used constructively to support opportunities for reflection and renewed vigilance in strategies for stakeholder engagement, communicating trial outcomes, and building research literacy among communities; however, these strategies require sustained resources for community engagement and capacity-building. PMID:22360605

  12. Participating in Clinical Trials

    Medline Plus

    Full Text Available Home > Health topics A-Z > Participating in Clinical Trials: About Clinical Trials In This Topic About Clinical Trials Risks ... centers across the country. The National Institutes of Health funds much of this basic research. Screening Trials ...

  13. Participating in Clinical Trials

    Medline Plus

    Full Text Available ... Usually, trial participants must show signs of the disease or condition before they can join this type of trial. Prevention Trials Click for more information In prevention trials, ...

  14. IMPACTS !

    CERN Multimedia

    2008-01-01

    (Photo courtesy of Don Davis / NASA)The University of Geneva (UNIGE) and the Ecole Polytechnique Fédérale of Lausanne (EPFL) are organising the 4th series of public lectures on astronomy, on the theme of "Impacts". The schedule is as follows: Il y a 100 ans : une explosion dans la Tunguska – Dr. Frédéric COURBIN, EPFL Les impacts sur Terre – Prof. Didier Queloz, UNIGE La fin des dinosaures – Dr. Stéphane Paltani, UNIGE Wednesday 7 May 2008, from 7.00 p.m. to 9.00 p.m. Auditoire CO1, EPFL, Ecublens Thursday 08 May 2008, from 7.00 p.m. to 9.00 p.m. Auditoire Rouiller, Uni-Dufour, Genève All 3 lectures will be givent each evening! Admission free Information: 022 379 22 00

  15. Synergistic modeling of call center operations

    OpenAIRE

    2006-01-01

    We synergistically apply queueing theory, integer programming, and stochastic simulation to determine an optimal staffing policy for a repair call handling center. A stationary Markovian queueing model is employed to determine minimal staffing levels for a sequence of time intervals with varying call volumes and mean handling times. These staffing requirements populate an integer program model for determining the mix of call agent shifts that will achieve service quality standards at minimum ...

  16. Bonobos extract meaning from call sequences

    OpenAIRE

    Clay, Zanna; Zuberbuehler, Klaus

    2011-01-01

    Studies on language-trained bonobos have revealed their remarkable abilities in representational and communication tasks. Surprisingly, however, corresponding research into their natural communication has largely been neglected. We address this issue with a first playback study on the natural vocal behaviour of bonobos. Bonobos produce five acoustically distinct call types when finding food, which they regularly mix together into longer call sequences. We found that individual call types were...

  17. Long-distance calls in Neotropical primates

    OpenAIRE

    Oliveira Dilmar A.G.; Ades César

    2004-01-01

    Long-distance calls are widespread among primates. Several studies concentrate on such calls in just one or in few species, while few studies have treated more general trends within the order. The common features that usually characterize these vocalizations are related to long-distance propagation of sounds. The proposed functions of primate long-distance calls can be divided into extragroup and intragroup ones. Extragroup functions relate to mate defense, mate attraction or resource defense...

  18. CALL for endangered languages: Challenges and rewards

    OpenAIRE

    Ward, Monica; Van Genabith, Josef

    2003-01-01

    The interaction between CALL and Endangered Languages (EL) is an under-researched and under-exploited field. It is perhaps no surprise that this should be the case as CALL in the EL context has to address additional requirements and deal with extra constraints over and above those that prevail in mainstream CALL. This article introduces the topic of Endangered Languages and lists two classifications for Endangered Languages (Terralingua, 2000; Unesco, 1993). It outlines why a language becomes...

  19. Performance Indicators for Call Centers with Impatience

    OpenAIRE

    Jouini, Oualid; Koole, Ger; Roubos, Alex

    2013-01-01

    International audience An important feature of call center modeling is the presence of impatient customers. In this paper, we consider single-skill call centers including customer abandonments. We study a number of different service level definitions, including all those used in practice, and show how to explicitly compute their performance measures. Based on data from different call centers, new models are defined that extend the common Erlang A model. We show that the new models fit real...

  20. Call Duration Characteristics based on Customers Location

    Directory of Open Access Journals (Sweden)

    Žvinys Karolis

    2014-05-01

    Full Text Available Nowadays a lot of different researches are performed based on call duration distributions (CDD analysis. However, the majority of studies are linked with social relationships between the people. Therefore the scarcity of information, how the call duration is associated with a user's location, is appreciable. The goal of this paper is to reveal the ties between user's voice call duration and the location of call. For this reason we analyzed more than 5 million calls from real mobile network, which were made over the base stations located in rural areas, roads, small towns, business and entertainment centers, residential districts. According to these site types CDD’s and characteristic features for call durations are given and discussed. Submitted analysis presents the users habits and behavior as a group (not an individual. The research showed that CDD’s of customers being them in different locations are not equal. It has been found that users at entertainment, business centers are tend to talk much shortly, than people being at home. Even more CDD can be distorted strongly, when machinery calls are evaluated. Hence to apply a common CDD for a whole network it is not recommended. The study also deals with specific parameters of call duration for distinguished user groups, the influence of network technology for call duration is considered.

  1. Multidimensional views on mobile call network

    Institute of Scientific and Technical Information of China (English)

    Shengqi YANG; Bin WU; Bai WANG

    2009-01-01

    Recent studies on social network have spurred significant interests in human behaviors. Nowadays, various kinds of interpersonal human interactions, from mobile calls to emalls, provide particular avenues to explore the inher-ent properties of communication patterns. In this article, we present a comprehensive study on a massive anonymous call records obtained from a major mobile service operator. The important difference laid in our work and previous mainly topological analyses is that we report on multiple aspects of the dataset. By investigating the calls of the users, we find out that most calls tend to last within one minute. Call du-ration between two females is much longer than that of two males. But calls of males generally involve more stations than that of female, indicating a larger mobile range of the males. We also observed that people tend to communicate more with each other when they share similar characters. Besides, the network is well-connected and robust to random attack. We also demonstrate that the close-knit sub-groups with little discrepancy in the characteristics of its involved users usually evoke more calls. Another interesting discov-ery is that call behaviors among people between workdays and weekends is obviously distinct. Generally speaking, the goal that we research on call network through multidimen-sional analyses is to uncover the intricate patterns of human communications and put up reasonable insights into future service intelligence.

  2. When They Talk about CALL: Discourse in a Required CALL Class

    Science.gov (United States)

    Kessler, Greg

    2010-01-01

    This study investigates preservice teachers' discourse about CALL in a required CALL class which combines theory and practice. Thirty-three students in a Linguistics MA program CALL course were observed over a 10-week quarter. For all of these students, it was their first formal exposure to CALL as a discipline. Communication in the class…

  3. The Mobile Solutions for Immunization (M-SIMU) Trial: A Protocol for a Cluster Randomized Controlled Trial That Assesses the Impact of Mobile Phone Delivered Reminders and Travel Subsidies to Improve Childhood Immunization Coverage Rates and Timeliness in Western Kenya

    Science.gov (United States)

    Kagucia, E. Wangeci; Ochieng, Benard; Hariharan, Nisha; Obor, David; Moulton, Lawrence H; Winch, Peter J; Levine, Orin S; Odhiambo, Frank; O'Brien, Katherine L; Feikin, Daniel R

    2016-01-01

    Background Text message (short message service, SMS) reminders and incentives are two demand-side interventions that have been shown to improve health care–seeking behaviors by targeting participant characteristics such as forgetfulness, lack of knowledge, and transport costs. Applying these interventions to routine pediatric immunizations may improve vaccination coverage and timeliness. Objective The Mobile Solutions for Immunization (M-SIMU) trial aims to determine if text message reminders, either with or without mobile phone–based incentives, sent to infant’s parents can improve immunization coverage and timeliness of routine pediatric vaccines in rural western Kenya. Methods This is a four-arm, cluster, randomized controlled trial. Villages are randomized to one of four study arms prior to enrollment of participants. The study arms are: (1) no intervention (a general health-related text message will be texted to this group at the time of enrollment), (2) text message reminders only, (3) text message reminders and a 75 Kenyan Shilling (KES) incentive, or (4) text message reminders and a KES200 incentive. Participants assigned to study arms 2-4 will receive two text message reminders; sent 3 days before and one day before the scheduled immunization visit at 6, 10, and 14 weeks for polio and pentavalent (containing diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenza type b antigens) type b antigens) vaccines, and at 9 months for measles vaccine. Participants in incentive arms will, in addition to text message reminders as above, receive mobile phone–based incentives after each timely vaccination, where timely is defined as vaccination within 2 weeks of the scheduled date for each of the four routine expanded program immunization (EPI) vaccination visits. Mother-infant pairs will be followed to 12 months of age where the primary outcome, a fully immunized child, will be ascertained. A fully immunized child is defined as a child receiving

  4. Assessing the impact of a school-based latrine cleaning and handwashing program on pupil absence in Nyanza Province, Kenya: A cluster-randomized trial

    OpenAIRE

    Bethany A Caruso; Freeman, Matthew C.; Garn, Joshua V.; Dreibelbis, Robert; Saboori, Shadi; Muga, Richard; Rheingans, Richard

    2014-01-01

    Improving school water, sanitation and hygiene (WASH) conditions has been shown to be effective in reducing pupil absence and illness. However, the benefit of sanitation and hygiene promotion improvements at school may depend on the conditions of the latrines and availability of consumables. We employed a three-arm, cluster-randomized trial to determine if a low-cost, policy-relevant, environmental-level latrine cleaning intervention could a) improve latrine cleanliness, b) increase latrine u...

  5. Impact of preoperative 5α-reductase inhibitors on perioperative blood loss in patients with benign prostatic hyperplasia: a meta-analysis of randomized controlled trials

    OpenAIRE

    Zhu, Yi-Ping; Dai, Bo; Zhang, Hai-Liang; Shi, Guo-Hai; Ye, Ding-wei

    2015-01-01

    Background The ability of 5α-reductase inhibitors (5ARIs) to decrease blood loss during transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) remains controversial. We aimed to conduct a meta-analysis of all randomized controlled trials (RCTs) to establish the role of 5ARI use prior to TURP. Methods We searched studies from the electronic databases PubMed, Embase, Scopus, and Cochrane Library from inception to March 25, 2014. Meta-analysis was performed using t...

  6. Implementation of a guideline-based clinical pathway of care to improve health outcomes following whiplash injury (Whiplash ImPaCT: protocol of a randomised, controlled trial

    Directory of Open Access Journals (Sweden)

    Trudy Rebbeck

    2016-04-01

    Discussion: This research is significant as it will be the first study to address the heterogeneity of whiplash by implementing a clinical pathway of care that matches evidence-based interventions to projected risk of poor recovery. The results of this trial have the potential to change clinical practice for WAD, thereby maximising treatment effects, improving patient outcomes, reducing costs and maintaining the compulsory third party system.

  7. Impact of Denture Cleaning Method and Overnight Storage Condition on Denture Biofilm Mass and Composition: A Cross-Over Randomized Clinical Trial

    OpenAIRE

    Joke Duyck; Katleen Vandamme; Stefanie Krausch-Hofmann; Lies Boon; Katrien De Keersmaecker; Eline Jalon; Wim Teughels

    2016-01-01

    Background Appropriate oral hygiene is required to maintain oral health in denture wearers. This study aims to compare the role of denture cleaning methods in combination with overnight storage conditions on biofilm mass and composition on acrylic removable dentures. Methods In a cross-over randomized controlled trial in 13 older people, 4 conditions with 2 different mechanical cleaning methods and 2 overnight storage conditions were considered: (i) brushing and immersion in water without a c...

  8. Impact of the Positive Action program on school-level indicators of academic achievement, absenteeism, and disciplinary outcomes: A matched-pair, cluster randomized, controlled trial

    OpenAIRE

    Snyder, Frank; Vuchinich, Samuel; Acock, Alan; Washburn, Isaac; Beets, Michael; Li, Kin-Kit

    2010-01-01

    This paper reports the effects of a comprehensive elementary school-based social-emotional and character education program on school-level achievement, absenteeism, and disciplinary outcomes utilizing a matched-pair, cluster randomized, controlled design. The Positive Action Hawai‘i trial included 20 racially/ethnically diverse schools (mean enrollment = 544) and was conducted from the 2002-03 through the 2005-06 academic years. Using school-level archival data, analyses comparing change from...

  9. The impact of oxandolone and timing of pubertal induction on final height in Turner sydrome: a randomised, double-blind, placebo-controlled trial

    OpenAIRE

    Gault, E.J.; Perry, R J; Cole, T J; Casey, S.; Paterson, W.M.; Hindmarsh, P.J.; Betts, P; Dunger, D B; Donaldson, M D C

    2011-01-01

    Objective: To examine the effect of oxandrolone and the timing of pubertal induction on final height in girls with Turner’s syndrome receiving a standard dose of growth hormone. Design: Randomised, double blind, placebo controlled trial. Setting:36 paediatric endocrinology departments in UK hospitals. Participants: Girls with Turner’s syndrome aged 7-13 years at recruitment, receiving recombinant growth hormone therapy (10 mg/m2/week). Interventions Participants were randomise...

  10. Do the Views of the Prosecutorâ s Offices Have an Impact on Whether Intimate Partner Violence Cases Go To Trial?

    OpenAIRE

    Kershaw, Njeri

    2009-01-01

    Each year there are approximately 589, 000 nonfatal violent victimizations (e.g., aggravated assault, simple assault) committed by an intimate partner (US Dept. of Justice, 2003). Of that, roughly 85% of these violent victimizations were committed against females (US Dept. of Justice, 2003). Even with this large amount of violence against women, only about 33% of the perpetrators of those crimes are brought to trial in state courts (US Dept. of Justice, 2005). Even a cursory look at the li...

  11. Impact of enzalutamide on quality of life in men with metastatic castration-resistant prostate cancer after chemotherapy: additional analyses from the AFFIRM randomized clinical trial

    OpenAIRE

    Cella, D; Ivanescu, C; Holmstrom, S.; Bui, C. N.; Spalding, J.; Fizazi, K.

    2014-01-01

    Background To present longitudinal changes in Functional Assessment of Cancer Therapy-Prostate (FACT-P) scores during 25-week treatment with enzalutamide or placebo in men with progressive metastatic castration-resistant prostate cancer (mCRPC) after chemotherapy in the AFFIRM trial. Patients and methods Patients were randomly assigned to enzalutamide 160 mg/day or placebo. FACT-P was completed before randomization, at weeks 13, 17, 21, and 25, and every 12 weeks thereafter while on study tre...

  12. The impact of isosorbide mononitrate on cervical ripening and labor induction in primiparous women with term pregnancy: A double-blind, randomized, controlled trial

    OpenAIRE

    Yazdizadeh, Hamideh; Abedi, Parvin; Najar, Shahnaz; Angali, Kambiz Ahmadi

    2013-01-01

    Background: The most favorable method for cervical ripening is not fully agreed upon by practitioners; however, vaginal administration of isosorbide mononitrate (IMN) is considered a low-risk method of labor induction for pregnant women at full term. Our study was designed to assess the effect of IMN on cervical ripening and labor induction among primiparous women in Iran. Materials and Methods: A randomized, double-blind, placebo-controlled trial was conducted on 90 primiparous women with Bi...

  13. Impact of Vitamin D on Chronic Kidney Diseases in Non-Dialysis Patients: A Meta-Analysis of Randomized Controlled Trials

    OpenAIRE

    Xu, Lijuan; WAN, XUESI; Huang, Zhimin; Zeng, Fangfang; Wei, Guohong; Fang, Donghong; Deng, Wanping; Li, Yanbing

    2013-01-01

    Background and Objectives Recent studies have supported a role for both newer and more established vitamin D compounds in improving proteinuria, although systematic evaluation is lacking. Furthermore, concerns remain regarding the influence of vitamin D on the progression of renal function. We analyzed the efficacy and safety of vitamin D in non-dialysis patients and compared the use of newer versus established vitamin D compounds by performing a meta-analysis of randomized controlled trials....

  14. Performance evaluation of Call-center with call redirection: Ocena performanc klicnega centra s preusmerjanjem klicev:

    OpenAIRE

    Efimushkin, Vladimir; Žepič, Drago

    2007-01-01

    The object of investigation is an analytical model for a Call-center functioning with a traffic distribution (call redirection) mechanism. Call-center functioning is described by the Markov process. A solution for stationary distribution is found and expressions for the main performance characteristics for the Call-center functioning are given. The proposed analytical model enables an investigation in different call traffic management schemes for the cases of agents overload and underload. ...

  15. Core Competencies Of A Call Centre AgentCore Competencies Of A Call Centre Agent

    OpenAIRE

    Christine White; Vera Roos

    2005-01-01

    Call centre agents are becoming increasingly important in the call centre context. They act as a contact point between the customer and the company. Call centre agents should have certain competencies to perform their duties sufficiently. Identifying competencies, required to be effective agents, will ease the task of training and recruitment. Due to the interrelatedness of the call centre agent, the management of a call centre and customers, all relevant role players’ perceptions were taken ...

  16. Impact of Tai Chi exercise on multiple fracture-related risk factors in post-menopausal osteopenic women: a pilot pragmatic, randomized trial

    Directory of Open Access Journals (Sweden)

    Wayne Peter M

    2012-01-01

    Full Text Available Abstract Background Tai Chi (TC is a mind-body exercise that shows potential as an effective and safe intervention for preventing fall-related fractures in the elderly. Few randomized trials have simultaneously evaluated TC's potential to reduce bone loss and improve fall-predictive balance parameters in osteopenic women. Methods In a pragmatic randomized trial, 86 post-menopausal osteopenic women, aged 45-70, were recruited from community clinics. Women were assigned to either nine months of TC training plus usual care (UC vs. UC alone. Primary outcomes were changes between baseline and nine months of bone mineral density (BMD of the proximal femur and lumbar spine (dual-energy X-ray absorptiometry and serum markers of bone resorption and formation. Secondary outcomes included quality of life. In a subsample (n = 16, quiet standing fall-predictive sway parameters and clinical balance tests were also assessed. Both intent-to-treat and per-protocol analyses were employed. Results For BMD, no intent-to-treat analyses were statistically significant; however, per protocol analyses (i.e., only including TC participants who completed ≥ 75% training requirements of femoral neck BMD changes were significantly different between TC and UC (+0.04 vs. -0.98%; P = 0.05. Changes in bone formation markers and physical domains of quality of life were also more favorable in per protocol TC vs. UC (P = 0.05. Changes in sway parameters were significantly improved by TC vs. UC (average sway velocity, P = 0.027; anterior-posterior sway range, P = 0.014. Clinical measures of balance and function showed non-significant trends in favor of TC. Conclusions TC training offered through existing community-based programs is a safe, feasible, and promising intervention for reducing multiple fracture risks. Our results affirm the value of a more definitive, longer-term trial of TC for osteopenic women, adequately powered to detect clinically relevant effects of TC on

  17. Coaching "Callings" throughout the Adult Life Cycle.

    Science.gov (United States)

    Hudson, Frederic M.

    2001-01-01

    The process of "callings" continues throughout life. Coaching can connect the present to the future in a meaningful way. Callings represent a value shift requiring revision of the nature and scope of one's central purpose in life and meaningful activities. (JOW)

  18. 78 FR 21891 - Rural Call Completion

    Science.gov (United States)

    2013-04-12

    ... in Rulemaking Proceedings, 63 FR 24121 (1998). Electronic Filers: Comments may be filed..., we propose to apply these obligations to the first facilities-based provider in the call- delivery... call. In cases where the first facilities-based provider serves multiple non-facilities-...

  19. Applying Pedagogical Principles to CALL Courseware Development.

    Science.gov (United States)

    Wyatt, David H.

    This paper on the application of principles to computer-assisted language learning (CALL) first clarifies the the relationships between the capabilities of the computer (and computer-controlled technology) and the main approaches to second language learning. Fourteen common types of CALL programs are briefly reviewed. A "relational" classification…

  20. 78 FR 76218 - Rural Call Completion

    Science.gov (United States)

    2013-12-17

    ... choice. If that reseller making the initial long-distance call path choice uses VoIP technology, in the..., interexchange carriers (IXCs), commercial mobile radio service (CMRS) providers, and VoIP service providers... the prohibition on call blocking; made clear that carriers' blocking of VoIP-PSTN traffic...

  1. Call-Center – Rationalisierung im Dilemma

    OpenAIRE

    Holtgrewe, Ursula; Gundtoft, Lars

    2001-01-01

    Die Verfasser untersuchen Funktionen, Lösungen und Probleme der Organisationsform Call-Center. Aus organisationssoziologischer Sicht werden grundlegende Funktionen und Dilemmata organisationeller Grenzstellen beleuchtet und mit Informationen über Organisations- und Beschäftigtenstruktur, Arbeitsweisen und Kundenbeziehungen der verschiedenen Typen von Call-Centern abgeglichen. Die Untersuchung ist auf drei Ebenen angelegt: Aus systematisch-struktureller Sicht werden Organisationsdilemmata an d...

  2. A CALL for Improved School Leadership

    Science.gov (United States)

    Halverson, Richard; Kelley, Carolyn; Shaw, James

    2014-01-01

    The Comprehensive Assessment of Leadership for Learning (CALL) is a formative assessment that provides feedback to schools on the research-based leadership practices necessary to improve teaching and learning. Instead of focusing on an individual leader, CALL measures leadership practices in tasks carried out by actors across the school and…

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

    DEFF Research Database (Denmark)

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

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

  4. Voice over internet protocol with prepaid calling card solutions

    Science.gov (United States)

    Gunadi, Tri

    2001-07-01

    The VoIP technology is growing up rapidly, it has big network impact on PT Telkom Indonesia, the bigger telecommunication operator in Indonesia. Telkom has adopted VoIP and one other technology, Intelligent Network (IN). We develop those technologies together in one service product, called Internet Prepaid Calling Card (IPCC). IPCC is becoming new breakthrough for the Indonesia telecommunication services especially on VoIP and Prepaid Calling Card solutions. Network architecture of Indonesia telecommunication consists of three layer, Local, Tandem and Trunck Exchange layer. Network development researches for IPCC architecture are focus on network overlay hierarchy, Internet and PSTN. With this design hierarchy the goal of Interworking PSTN, VoIP and IN calling card, become reality. Overlay design for IPCC is not on Trunck Exchange, this is the new architecture, these overlay on Tandem and Local Exchange, to make the faster call processing. The nodes added: Gateway (GW) and Card Management Center (CMC) The GW do interfacing between PSTN and Internet Network used ISDN-PRA and Ethernet. The other functions are making bridge on circuit (PSTN) with packet (VoIP) based and real time billing process. The CMC used for data storage, pin validation, report activation, tariff system, directory number and all the administration transaction. With two nodes added the IPCC service offered to the market.

  5. Communication cliques in mobile phone calling networks

    CERN Document Server

    Li, Ming-Xia; Jiang, Zhi-Qiang; Zhou, Wei-Xing

    2015-01-01

    People in modern societies form different social networks through numerous means of communication. These communication networks reflect different aspects of human's societal structure. The billing records of calls among mobile phone users enable us to construct a directed calling network (DCN) and its Bonferroni network (SVDCN) in which the preferential communications are statistically validated. Here we perform a comparative investigation of the cliques of the original DCN and its SVDCN constructed from the calling records of more than nine million individuals in Shanghai over a period of 110 days. We find that the statistical properties of the cliques of the two calling networks are qualitatively similar and the clique members in the DCN and the SVDCN exhibit idiosyncratic behaviors quantitatively. Members in large cliques are found to be spatially close to each other. Based on the clique degree profile of each mobile phone user, the most active users in the two calling networks can be classified in to seve...

  6. Call Admission Control in Mobile Cellular Networks

    CERN Document Server

    Ghosh, Sanchita

    2013-01-01

    Call Admission Control (CAC) and Dynamic Channel Assignments (DCA) are important decision-making problems in mobile cellular communication systems. Current research in mobile communication considers them as two independent problems, although the former greatly depends on the resulting free channels obtained as the outcome of the latter. This book provides a solution to the CAC problem, considering DCA as an integral part of decision-making for call admission. Further, current technical resources ignore movement issues of mobile stations and fluctuation in network load (incoming calls) in the control strategy used for call admission. In addition, the present techniques on call admission offers solution globally for the entire network, instead of considering the cells independently.      CAC here has been formulated by two alternative approaches. The first approach aimed at handling the uncertainty in the CAC problem by employing fuzzy comparators.  The second approach is concerned with formulation of CAC ...

  7. Call cultures in orang-utans?

    Directory of Open Access Journals (Sweden)

    Serge A Wich

    Full Text Available BACKGROUND: Several studies suggested great ape cultures, arguing that human cumulative culture presumably evolved from such a foundation. These focused on conspicuous behaviours, and showed rich geographic variation, which could not be attributed to known ecological or genetic differences. Although geographic variation within call types (accents has previously been reported for orang-utans and other primate species, we examine geographic variation in the presence/absence of discrete call types (dialects. Because orang-utans have been shown to have geographic variation that is not completely explicable by genetic or ecological factors we hypothesized that this will be similar in the call domain and predict that discrete call type variation between populations will be found. METHODOLOGY/PRINCIPAL FINDINGS: We examined long-term behavioural data from five orang-utan populations and collected fecal samples for genetic analyses. We show that there is geographic variation in the presence of discrete types of calls. In exactly the same behavioural context (nest building and infant retrieval, individuals in different wild populations customarily emit either qualitatively different calls or calls in some but not in others. By comparing patterns in call-type and genetic similarity, we suggest that the observed variation is not likely to be explained by genetic or ecological differences. CONCLUSION/SIGNIFICANCE: These results are consistent with the potential presence of 'call cultures' and suggest that wild orang-utans possess the ability to invent arbitrary calls, which spread through social learning. These findings differ substantially from those that have been reported for primates before. First, the results reported here are on dialect and not on accent. Second, this study presents cases of production learning whereas most primate studies on vocal learning were cases of contextual learning. We conclude with speculating on how these findings might

  8. The Child and Adolescent Psychiatry Trials Network

    Science.gov (United States)

    March, John S.; Silva, Susan G.; Compton, Scott; Anthony, Ginger; DeVeaugh-Geiss, Joseph; Califf, Robert; Krishnan, Ranga

    2004-01-01

    Objective: The current generation of clinical trials in pediatric psychiatry often fails to maximize clinical utility for practicing clinicians, thereby diluting its impact. Method: To attain maximum clinical relevance and acceptability, the Child and Adolescent Psychiatry Trials Network (CAPTN) will transport to pediatric psychiatry the practical…

  9. Controversy, Trials, and Crime--Oh My!

    Science.gov (United States)

    Rott, Kim

    2006-01-01

    Teenagers' innate interest with the justice system is one of the reasons that so many high school literary classics teem with criminals, controversial issues, and trials. Novels such as "To Kill a Mockingbird," "A Separate Peace," "The Crucible," and "Twelve Angry Men" feature high-impact trials. In the author's desire to tap into this interest,…

  10. ICT and the location of call centres: regional and local patterns

    OpenAIRE

    Bruinsma, Frank; Rietveld, Piet; Beekman, Michiel

    2004-01-01

    One of the sectors that gained most of the boost in ICT developments is the call centres sector. The focus in this paper is on spatial diffusion patterns of call centres in the Netherlands. The number of call centres has increased rapidly in the last decade and it seems that impacts of call centres on the labour market are still underestimated. We will pay attention to two spatial levels: first, regional and second, local. Given the labour intensity and quality required by call centres and th...

  11. Study protocol: Improving patient choice in treating low back pain (IMPACT - LBP: A randomised controlled trial of a decision support package for use in physical therapy

    Directory of Open Access Journals (Sweden)

    Tysall Colin

    2011-02-01

    Full Text Available Abstract Background Low back pain is a common and costly condition. There are several treatment options for people suffering from back pain, but there are few data on how to improve patients' treatment choices. This study will test the effects of a decision support package (DSP, designed to help patients seeking care for back pain to make better, more informed choices about their treatment within a physiotherapy department. The package will be designed to assist both therapist and patient. Methods/Design Firstly, in collaboration with physiotherapists, patients and experts in the field of decision support and decision aids, we will develop the DSP. The work will include: a literature and evidence review; secondary analysis of existing qualitative data; exploration of patients' perspectives through focus groups and exploration of experts' perspectives using a nominal group technique and a Delphi study. Secondly, we will carry out a pilot single centre randomised controlled trial within NHS Coventry Community Physiotherapy. We will randomise physiotherapists to receive either training for the DSP or not. We will randomly allocate patients seeking treatment for non specific low back pain to either a physiotherapist trained in decision support or to receive usual care. Our primary outcome measure will be patient satisfaction with treatment at three month follow-up. We will also estimate the cost-effectiveness of the intervention, and assess the value of conducting further research. Discussion Informed shared decision-making should be an important part of any clinical consultation, particularly when there are several treatments, which potentially have moderate effects. The results of this pilot will help us determine the benefits of improving the decision-making process in clinical practice on patient satisfaction. Trial registration Current Controlled Trials ISRCTN46035546

  12. Impact of Denture Cleaning Method and Overnight Storage Condition on Denture Biofilm Mass and Composition: A Cross-Over Randomized Clinical Trial

    Science.gov (United States)

    Duyck, Joke; Vandamme, Katleen; Krausch-Hofmann, Stefanie; Boon, Lies; De Keersmaecker, Katrien; Jalon, Eline; Teughels, Wim

    2016-01-01

    Background Appropriate oral hygiene is required to maintain oral health in denture wearers. This study aims to compare the role of denture cleaning methods in combination with overnight storage conditions on biofilm mass and composition on acrylic removable dentures. Methods In a cross-over randomized controlled trial in 13 older people, 4 conditions with 2 different mechanical cleaning methods and 2 overnight storage conditions were considered: (i) brushing and immersion in water without a cleansing tablet, (ii) brushing and immersion in water with a cleansing tablet, (iii) ultrasonic cleaning and immersion in water without a cleansing tablet, and (iv) ultrasonic cleaning and immersion in water with a cleansing tablet. Each test condition was performed for 5 consecutive days, preceded by a 2-days wash-out period. Biofilm samples were taken at baseline (control) and at the end of each test period from a standardized region. Total and individual levels of selected oral bacteria (n = 20), and of Candida albicans were identified using the Polymerase Chain Reaction (PCR) technique. Denture biofilm coverage was scored using an analogue denture plaque score. Paired t-tests and Wilcoxon-signed rank tests were used to compare the test conditions. The level of significance was set at αcleansing tablet significantly reduced the total bacterial count (pcleansing tablets during overnight denture storage in addition to mechanical denture cleaning did not affect Candida albicans count, but reduced the total bacterial count on acrylic removable dentures compared to overnight storage in water. This effect was more pronounced when combined with ultrasonic cleaning compared to brushing. Trial Registration ClinicalTrials.gov NCT02454413 PMID:26730967

  13. External GSM phone calls now made simpler

    CERN Multimedia

    2007-01-01

    On 2 July, the IT/CS Telecom Service introduced a new service making external calls from CERN GSM phones easier. A specific prefix is no longer needed for calls outside CERN. External calls from CERN GSM phones are to be simplified. It is no longer necessary to use a special prefix to call an external number from the CERN GSM network.The Telecom Section of the IT/CS Group is introducing a new system that will make life easier for GSM users. It is no longer necessary to use a special prefix (333) to call an external number from the CERN GSM network. Simply dial the number directly like any other Swiss GSM customer. CERN currently has its own private GSM network with the Swiss mobile operator, Sunrise, covering the whole of Switzerland. This network was initially intended exclusively for calls between CERN numbers (replacing the old beeper system). A special system was later introduced for external calls, allowing them to pass thr...

  14. Performance of Call to Order - photographs

    OpenAIRE

    Ritter, Kathleen; Maxwell, James; PARRC

    2012-01-01

    Call to Order is the translation—into musical sound—of the meeting minutes of the organizations behind Institutions by Artists: The Convention (PAARC, Fillip, and ARCA). Call to Order uses a prosaic form of administration as material for creative production. Musical scores were created from the meeting minutes of each organization by mapping Robert’s Rules of Order onto the implied rules of Piston’s Harmony and using both texts as comparative guides. Call to Order is the musical sound of a...

  15. The impact of therapy for childhood acute lymphoblastic leukaemia on intelligence quotients; results of the risk-stratified randomized central nervous system treatment trial MRC UKALL XI

    Directory of Open Access Journals (Sweden)

    Vargha-Khadem Faraneh

    2011-10-01

    Full Text Available Abstract Background The MRC UKALLXI trial tested the efficacy of different central nervous system (CNS directed therapies in childhood acute lymphoblastic leukaemia (ALL. To evaluate morbidity 555/1826 randomised children underwent prospective psychological evaluations. Full Scale, verbal and performance IQs were measured at 5 months, 3 years and 5 years. Scores were compared in; (1 all patients (n = 555 versus related controls (n = 311, (2 low-risk children (presenting white cell count (WCC 9/l randomised to intrathecal methotrexate (n = 197 versus intrathecal and high-dose intravenous methotrexate (HDM (n = 202, and (3 high-risk children (WCC ≥ 50 × 109/l, age ≥ 2 years randomised to HDM (n = 79 versus cranial irradiation (n = 77. Results There were no significant differences in IQ scores between the treatment arms in either low- or high-risk groups. Despite similar scores at baseline, results at 3 and 5 years showed a significant reduction of between 3.6 and 7.3 points in all three IQ scores in all patient groups compared to controls (P Conclusion Children with ALL are at risk of CNS morbidity, regardless of the mode of CNS-directed therapy. Further work needs to identify individuals at high-risk of adverse CNS outcomes. Trial registration ISRCTN: ISRCTN16757172

  16. The impact of migraine prevention on daily activities: a longitudinal and responder analysis from three topiramate placebo-controlled clinical trials

    Directory of Open Access Journals (Sweden)

    Papadopoulos George

    2007-10-01

    Full Text Available Abstract Background Topiramate is approved for the prophylaxis (prevention of migraine headache in adults. The most common adverse events in the three pivotal, randomized, double-blind, placebo-controlled trials were paresthesia, fatigue, cognitive impairment, anorexia, nausea, and taste alteration. In these trials, topiramate 100 mg/d significantly improved Migraine-Specific Questionnaire (MSQ scores versus placebo (p Methods Mean MSQ and Medical Outcome Study Short Form 36 (SF-36 change scores (baseline to each double-blind assessment point were calculated for pooled intent-to-treat (ITT patients. Additionally, pooled ITT patients receiving topiramate 100 mg/d or placebo were combined and divided into two responder groups according to percent reduction in monthly migraine frequency: Results Of 756 patients (mean age 39.8 years, 86% female, 384 received topiramate 100 mg/d and 372 placebo. Topiramate significantly improved all three MSQ domains throughout the double-blind phase versus placebo (p = 0.024 [week 8], p Conclusion Topiramate 100 mg/d significantly improved daily activities and patient functioning at all time points throughout the double-blind phase. Daily function and health status significantly improved for those achieving a ≥ 50% migraine frequency reduction.

  17. The impact of care pathways for patients with proximal femur fracture: rationale and design of a cluster-randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Vanhaecht Kris

    2012-05-01

    Full Text Available Abstract Background Proximal femur fracture (PFF is associated with considerable morbidity and mortality. The European Quality of Care Pathway (EQCP study on PFF (NCT00962910 was designed to determine how care pathways (CP for hospital treatment of PFF affect consistency of care, adherence to evidence-based key interventions, and clinical outcome. Methods/Design An international cluster-randomized controlled trial (cRCT will be performed in Belgium, Ireland, Italy and Portugal. Based on power analyses, a sample of 44 hospital teams and 437 patients per arm will be included in the study. In the control arm, usual care will be provided. Experimental teams will implement a care pathway which will include three active components: a formative evaluation of quality and organization of the care setting, a set of evidence-based key interventions, and support of the development and implementation of the CP. Main outcome will be the six-month mortality rate. Discussion The EQCP study constitutes the first international cRCT on care pathways. The EQCP project was designed as both a research and a quality improvement project and will provide a real-world framework for process evaluation to improve our understanding of why and when CP can really work. Trial registration number NCT00962910

  18. How Do Clinical Trials Work?

    Science.gov (United States)

    ... Trials Clinical Trial Websites How Do Clinical Trials Work? If you take part in a clinical trial, ... kol). This plan explains how the trial will work. The trial is led by a principal investigator ( ...

  19. Impact of whole-body electromyostimulation on body composition in elderly women at risk for sarcopenia: the Training and ElectroStimulation Trial (TEST-III)

    OpenAIRE

    Kemmler, Wolfgang; Bebenek, Michael; Engelke, Klaus; von Stengel, Simon

    2013-01-01

    Most studies have confirmed the positive impact of resistance training on muscle mass and functional capacity in aging adults. However, due to physical limitation or a simple aversion against regular exercise, the majority of elderly subjects do not reach the exercise doses recommended for impacting strength or muscle mass. This led us to evaluate the effect of whole-body electromyostimulation (WB-EMS), a novel, time-efficient and smooth training technology, on body composition with special r...

  20. Cardio-metabolic and immunological impacts of extra virgin olive oil consumption in overweight and obese older adults: a randomized controlled trial

    OpenAIRE

    Rozati, M; Marcos, Ascensión; Meydani, S N

    2015-01-01

    © 2015 Rozati et al. Background: Both aging and obesity are related to dysregulated immune function, which may be responsible for increased risk of infection and also chronic non-infectious diseases. Dietary lipids have been shown to impact immune and inflammatory responses and cardio-metabolic risk factors. No information on the impact of olive oil on immune responses of overweight and obese older adults is available. Objective: We aimed to determine the effect of replacing oils used in a ty...

  1. Mourning Dove Call-count Survey

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The Mourning Dove (Zenaida macroura) Call-Count Survey was developed to provide an index to population size and to detect annual changes in mourning dove breeding...

  2. Engineers call for US nuclear safety fix

    Science.gov (United States)

    Gwynne, Peter

    2016-04-01

    Seven Nuclear Regulatory Commission (NRC) engineers have called on the commission to force the owners of US nuclear reactors to repair a design flaw that could affect the safe operation of emergency core cooling systems.

  3. 17 CFR 31.18 - Margin calls.

    Science.gov (United States)

    2010-04-01

    ... after contact is effected in which to respond to a margin call. Twenty-four hours, excluding Saturdays... contract for a period of 5 business days at the then prevailing bid price in the case of a long...

  4. 76 FR 4896 - Call for Candidates

    Science.gov (United States)

    2011-01-27

    ... accepted accounting principles for federal government entities. Generally, non-federal Board members are... From the Federal Register Online via the Government Publishing Office FEDERAL ACCOUNTING STANDARDS ADVISORY BOARD Call for Candidates AGENCY: Federal Accounting Standards Advisory Board. ACTION:...

  5. 76 FR 36130 - Call for Candidates

    Science.gov (United States)

    2011-06-21

    ... establish generally accepted accounting principles for federal government entities. Generally, non- federal... From the Federal Register Online via the Government Publishing Office FEDERAL ACCOUNTING STANDARDS ADVISORY BOARD Call for Candidates AGENCY: Federal Accounting Standards Advisory Board. ACTION: Request...

  6. The impact of iron supplementation efficiency in female blood donors with a decreased ferritin level and no anaemia. Rationale and design of a randomised controlled trial: a study protocol

    Directory of Open Access Journals (Sweden)

    Tissot Jean-Daniel

    2009-01-01

    Full Text Available Abstract Background There is no recommendation to screen ferritin level in blood donors, even though several studies have noted the high prevalence of iron deficiency after blood donation, particularly among menstruating females. Furthermore, some clinical trials have shown that non-anaemic women with unexplained fatigue may benefit from iron supplementation. Our objective is to determine the clinical effect of iron supplementation on fatigue in female blood donors without anaemia, but with a mean serum ferritin ≤ 30 ng/ml. Methods/Design In a double blind randomised controlled trial, we will measure blood count and ferritin level of women under age 50 yr, who donate blood to the University Hospital of Lausanne Blood Transfusion Department, at the time of the donation and after 1 week. One hundred and forty donors with a ferritin level ≤ 30 ng/ml and haemoglobin level ≥ 120 g/l (non-anaemic a week after the donation will be included in the study and randomised. A one-month course of oral ferrous sulphate (80 mg/day of elemental iron will be introduced vs. placebo. Self-reported fatigue will be measured using a visual analogue scale. Secondary outcomes are: score of fatigue (Fatigue Severity Scale, maximal aerobic power (Chester Step Test, quality of life (SF-12, and mood disorders (Prime-MD. Haemoglobin and ferritin concentration will be monitored before and after the intervention. Discussion Iron deficiency is a potential problem for all blood donors, especially menstruating women. To our knowledge, no other intervention study has yet evaluated the impact of iron supplementation on subjective symptoms after a blood donation. Trial registration NCT00689793

  7. Calling patterns in human communication dynamics

    OpenAIRE

    Jiang, Zhi-Qiang; Xie, Wen-Jie; Li, Ming-Xia; Podobnik, Boris; Zhou, Wei-Xing; Stanley, H. Eugene

    2013-01-01

    Modern technologies not only provide a variety of communication modes, e.g., texting, cellphone conversation, and online instant messaging, but they also provide detailed electronic traces of these communications between individuals. These electronic traces indicate that the interactions occur in temporal bursts. Here, we study the inter-call durations of the 100,000 most-active cellphone users of a Chinese mobile phone operator. We confirm that the inter-call durations follow a power-law dis...

  8. Malware Classification based on Call Graph Clustering

    OpenAIRE

    Kinable, Joris; Kostakis, Orestis

    2010-01-01

    Each day, anti-virus companies receive tens of thousands samples of potentially harmful executables. Many of the malicious samples are variations of previously encountered malware, created by their authors to evade pattern-based detection. Dealing with these large amounts of data requires robust, automatic detection approaches. This paper studies malware classification based on call graph clustering. By representing malware samples as call graphs, it is possible to abstract certain variations...

  9. Application for call center data analysis

    OpenAIRE

    KLEMENČIČ, DAMJAN

    2015-01-01

    Graduation thesis describes the planning and design of desktop application CTI Server that is used in call and dispatch centers, where they have communication server (PBX) Siemens. Application collects data that is sent from communication server and stores them in data base for subsequent processing. It also displays current status of agents and telephony connections, call history and agent logs for a certain period of time. With the data obtained from communication server the application ...

  10. Towards Building an Intelligent Call Routing System

    OpenAIRE

    Thien Khai Tran; Dung Minh Pham; Binh Van Huynh

    2016-01-01

    This paper presents EduICR - an Intelligent Call Routing system. This system can route calls to the most appropriate agent using routing rules built by the text classifier. EduICR includes the following main components: telephone communication network; Vietnamese speech recognition; Text classifier/ Natural language processor and Vietnamese speech synthesis. To our best knowledge, this is one of the first systems in Vietnam to implement the integration mechanism of text processing and speech ...

  11. Identifying users profiles from mobile calls habits

    OpenAIRE

    Furletti, Barbara; Gabrielli, Lorenzo; Rinzivillo, Salvatore; Renso, Chiara

    2012-01-01

    The huge quantity of positioning data registered by our mobile phones stimulates several research questions, mainly originating from the combination of this huge quantity of data with the extreme heterogeneity of the tracked user and the low granularity of the data. We propose a methodology to partition the users tracked by GSM phone calls into profiles like resident, commuters, in transit and tourists. The methodology analyses the phone calls with a combination of top-down and bottom up tech...

  12. Call-Center-Forschung: Ergebnisse und Theorien

    OpenAIRE

    Holtgrewe, Ursula

    2003-01-01

    "In den letzten Jahren haben sich ForscherInnen aus unterschiedlichen Richtungen der Industrie-, Arbeits- und Organisationssoziologie für Call Center interessiert. Der Grund dafür liegt nicht allein darin, dass es sich um einen schnell expandierenden Bereich der Dienstleistungsarbeit handelt. Es scheint vielmehr, dass sich in den Call Centern exemplarisch eine Reihe von Themen und Tendenzen bündelt, die die Arbeit in Dienstleistungs- und Wissensgesellschaften bestimmen. So s...

  13. Optimal Balanced Control for Call Centers

    OpenAIRE

    Bhulai, Sandjai; Farenhorst-Yuan, Taoying; Heidergott, Bernd; van der Laan, Dinard

    2010-01-01

    In this paper we study a challenging call center operation problem. The goal of our analysis is to identify an optimal policy for allocating tasks to agents. As a first step, we discuss promising randomized policies and use stochastic approximation for finding the optimal randomized policy when implemented via a Bernoulli scheme. As we will show in this paper, the performance of the call center can be improved if the randomized policy is implemented by a deterministic sequence satisfying some...

  14. BUSINESS MODELS FOR EXTENDING OF 112 EMERGENCY CALL CENTER CAPABILITIES WITH E-CALL FUNCTION INSERTION

    OpenAIRE

    Pop Dragos Paul; Botezatu Cornelia Paulina; Botezatu Cezar; Carutasu George

    2010-01-01

    The present article concerns present status of implementation in Romania and Europe of eCall service and the proposed business models regarding eCall function implementation in Romania. eCall system is used for reliable transmission in case of crush between In Vehicle System and Public Service Answering Point, via the voice channel of cellular and Public Switched Telephone Network (PSTN). eCall service could be initiated automatically or manual the driver. All data presented in this article a...

  15. Partition Decomposition for Roll Call Data

    CERN Document Server

    Leibon, Greg; Rockmore, Daniel N; Savell, Robert

    2011-01-01

    In this paper we bring to bear some new tools from statistical learning on the analysis of roll call data. We present a new data-driven model for roll call voting that is geometric in nature. We construct the model by adapting the "Partition Decoupling Method," an unsupervised learning technique originally developed for the analysis of families of time series, to produce a multiscale geometric description of a weighted network associated to a set of roll call votes. Central to this approach is the quantitative notion of a "motivation," a cluster-based and learned basis element that serves as a building block in the representation of roll call data. Motivations enable the formulation of a quantitative description of ideology and their data-dependent nature makes possible a quantitative analysis of the evolution of ideological factors. This approach is generally applicable to roll call data and we apply it in particular to the historical roll call voting of the U.S. House and Senate. This methodology provides a...

  16. Communication cliques in mobile phone calling networks

    Science.gov (United States)

    Li, Ming-Xia; Xie, Wen-Jie; Jiang, Zhi-Qiang; Zhou, Wei-Xing

    2015-11-01

    People in modern societies form different social networks through numerous means of communication. These communication networks reflect different aspects of human's societal structure. The billing records of calls among mobile phone users enable us to construct a directed calling network (DCN) and its Bonferroni network (SVDCN) in which the preferential communications are statistically validated. Here we perform a comparative investigation of the cliques of the original DCN and its SVDCN constructed from the calling records of more than nine million individuals in Shanghai over a period of 110 days. We find that the statistical properties of the cliques of the two calling networks are qualitatively similar and the clique members in the DCN and the SVDCN exhibit idiosyncratic behaviors quantitatively. Members in large cliques are found to be spatially close to each other. Based on the clique degree profile of each mobile phone user, the most active users in the two calling networks can be classified in to several groups. The users in different groups are found to have different calling behaviors. Our study unveils interesting communication behaviors among mobile phone users that are densely connected to each other.

  17. 47 CFR 22.921 - 911 call processing procedures; 911-only calling mode.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false 911 call processing procedures; 911-only calling mode. 22.921 Section 22.921 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON... procedures; 911-only calling mode. Mobile telephones manufactured after February 13, 2000 that are capable...

  18. Behavioral Preferences for Individual Securities : The Case for Call Warrants and Call Options

    NARCIS (Netherlands)

    Ter Horst, J.R.; Veld, C.H.

    2002-01-01

    Since 1998, large investment banks have flooded the European capital markets with issues of call warrants.This has led to a unique situation in the Netherlands, where now call warrants, traded on the stock exchange, and long-term call options, traded on the options exchange, exist.Both entitle their

  19. EFFICIENT CALL PATH DETECTION FOR ANDROID-OS SIZE OF HUGE SOURCE CODE

    OpenAIRE

    Taka Matsutsuka

    2016-01-01

    Today most developers utilize source code written by other parties. Because the code is modified frequently, the developers need to grasp the impact of the modification repeatedly. A call graph and especially its special type, a call path, help the developers comprehend the modification. Source code written by other parties, however, becomes too huge to be held in memory in the form of parsed data for a call graph or path. This paper offers a bidirectional search algorithm for ...

  20. Acoustic Structure and Contextual Use of Calls by Captive Male and Female Cheetahs (Acinonyx jubatus)

    Science.gov (United States)

    Smirnova, Darya S.; Demina, Tatyana S.; Volodina, Elena V.

    2016-01-01

    The vocal repertoire of captive cheetahs (Acinonyx jubatus) and the specific role of meow vocalizations in communication of this species attract research interest about two dozen years. Here, we expand this research focus for the contextual use of call types, sex differences and individual differences at short and long terms. During 457 trials of acoustic recordings, we collected calls (n = 8120) and data on their contextual use for 13 adult cheetahs (6 males and 7 females) in four Russian zoos. The cheetah vocal repertoire comprised 7 call types produced in 8 behavioural contexts. Context-specific call types (chirr, growl, howl and hiss) were related to courting behaviour (chirr) or to aggressive behaviour (growl, howl and hiss). Other call types (chirp, purr and meow) were not context-specific. The values of acoustic variables differed between call types. The meow was the most often call type. Discriminant function analysis revealed a high potential of meows to encode individual identity and sex at short terms, however, the vocal individuality was unstable over years. We discuss the contextual use and acoustic variables of call types, the ratios of individual and sex differences in calls and the pathways of vocal ontogeny in the cheetah with relevant data on vocalization of other animals. PMID:27362643

  1. Acoustic Structure and Contextual Use of Calls by Captive Male and Female Cheetahs (Acinonyx jubatus).

    Science.gov (United States)

    Smirnova, Darya S; Volodin, Ilya A; Demina, Tatyana S; Volodina, Elena V

    2016-01-01

    The vocal repertoire of captive cheetahs (Acinonyx jubatus) and the specific role of meow vocalizations in communication of this species attract research interest about two dozen years. Here, we expand this research focus for the contextual use of call types, sex differences and individual differences at short and long terms. During 457 trials of acoustic recordings, we collected calls (n = 8120) and data on their contextual use for 13 adult cheetahs (6 males and 7 females) in four Russian zoos. The cheetah vocal repertoire comprised 7 call types produced in 8 behavioural contexts. Context-specific call types (chirr, growl, howl and hiss) were related to courting behaviour (chirr) or to aggressive behaviour (growl, howl and hiss). Other call types (chirp, purr and meow) were not context-specific. The values of acoustic variables differed between call types. The meow was the most often call type. Discriminant function analysis revealed a high potential of meows to encode individual identity and sex at short terms, however, the vocal individuality was unstable over years. We discuss the contextual use and acoustic variables of call types, the ratios of individual and sex differences in calls and the pathways of vocal ontogeny in the cheetah with relevant data on vocalization of other animals. PMID:27362643

  2. Acoustic Structure and Contextual Use of Calls by Captive Male and Female Cheetahs (Acinonyx jubatus.

    Directory of Open Access Journals (Sweden)

    Darya S Smirnova

    Full Text Available The vocal repertoire of captive cheetahs (Acinonyx jubatus and the specific role of meow vocalizations in communication of this species attract research interest about two dozen years. Here, we expand this research focus for the contextual use of call types, sex differences and individual differences at short and long terms. During 457 trials of acoustic recordings, we collected calls (n = 8120 and data on their contextual use for 13 adult cheetahs (6 males and 7 females in four Russian zoos. The cheetah vocal repertoire comprised 7 call types produced in 8 behavioural contexts. Context-specific call types (chirr, growl, howl and hiss were related to courting behaviour (chirr or to aggressive behaviour (growl, howl and hiss. Other call types (chirp, purr and meow were not context-specific. The values of acoustic variables differed between call types. The meow was the most often call type. Discriminant function analysis revealed a high potential of meows to encode individual identity and sex at short terms, however, the vocal individuality was unstable over years. We discuss the contextual use and acoustic variables of call types, the ratios of individual and sex differences in calls and the pathways of vocal ontogeny in the cheetah with relevant data on vocalization of other animals.

  3. The impact of radiation dose and fractionation on the risk factor of radiation pneumonitis on four radiation therapy oncology group (RTOG) lung cancer trials

    International Nuclear Information System (INIS)

    Purpose/Objective: To assess the relationship between total dose of radiation delivered, the fractionation scheme used, age, and Karnofsky Performance Status (KPS) on the risk of moderate to severe (≥ Grade 2) radiation pneumonitis in patients treated with radiotherapy alone for lung cancer on four RTOG Trials. Materials and Methods: Between February of 1984 and April of 1989, 1701 patients with clinically localized (I-IIIb) lung cancer were entered on clinical trials employing radiotherapy alone. Twelve hundred and forty-seven patients were entered on RTOG 8311 or 8407 (phase I/II trials) and 454 patients were entered on RTOG 8321 or 8403 (phase III trials). RTOG 8403 and 8321 patients received once-a-day irradiation to 60 Gy. Patients treated on RTOG 8407 were treated with a concomitant boost technique in a non-randomized fashion to 64.8, 69.6, 74.4 or 79.2 Gy. Patients treated on RTOG 8407 were treated with a concomitant boost technique in a non-randomized fashion to 63 Gy or 70.2 Gy. All patients were assessed for the incidence of Grade 2-5, radiation pneumonitis. One hundred and seven (6%) of patients were either ineligible or canceled (n=60), or were excluded because of incomplete data (n=47). The factors evaluated included total dose of radiation, the fractionation scheme, age and pre-treatment KPS. Patients treated to doses ≥ 72 Gy were considered to have received high doses (72.0 - 81.6 Gy), while the remaining patients treated to doses < 72 Gy (57.6 - 71.9 Gy) were considered to have received standard dose radiation. For the this analysis, information regarding field size and baseline pulmonary function was not available. Results: Age, sex, stage distribution, and the percentage of patients with a KPS ≥90 were similar among the patients treated on these four studies. Patients receiving hyperfractionated radiotherapy to doses ≥ 72 Gy experienced a higher incidence of radiation pneumonitis ≥ Grade 2, than patients treated with standard doses < 72

  4. A Multicenter, Randomized, Open-Labeled, Parallel Group Trial of Sildenafil in Alcohol-Associated Erectile Dysfunction: The Impact on Psychosocial Outcomes

    Directory of Open Access Journals (Sweden)

    Alexander Grinshpoon

    2009-09-01

    Full Text Available To examine the effect of sildenafil on erectile dysfunction (ED and psychosocial outcomes in alcohol-dependent (AD men, 108 men with these diagnoses were randomly assigned to either take sildenafil (50 mg as add-on to standard treatment for AD, or the same treatment without sildenafil, for 12 weeks. Only 50 patients in sildenafil group and 51 in control group twice completed the International Index of Erectile Function (IIEF and a battery of self-report questionnaires. IIEF scores and psychosocial functioning, self-esteem and support from friends improved only for sildenafil-treated patients (P < 0.001. The high effect sizes suggest that the observed benefits are unlikely to be a placebo effect, although their unspecific nature could not be ruled out. In men with ED associated with AD, sildenafil improves both ED and psychosocial outcomes. Further placebo-controlled clinical trial is warranted.

  5. Impact of a magnetic resonance imaging-guided treat-to-target strategy on disease activity and progression in patients with rheumatoid arthritis (the IMAGINE-RA trial)

    DEFF Research Database (Denmark)

    Møller-Bisgaard, Signe; Hørslev-Petersen, Kim; Ejbjerg, Bo Jannik;

    2015-01-01

    BACKGROUND: Rheumatoid arthritis (RA) is a chronic, progressive joint disease, which frequently leads to irreversible joint deformity and severe functional impairment. Although patients are treated according to existing guidelines and reach clinical remission, erosive progression still occurs. This....../absence of BME may therefore be clinically beneficial. We present the design of a randomized controlled trial (RCT) aiming to evaluate whether an MRI-guided treatment strategy compared to a conventional treatment strategy in anti-CCP-positive erosive RA is better to prevent progression of erosive joint...... damage and increase the remission rate in patients with low disease activity or clinical remission. METHODS/DESIGN: The study is a non-blinded, multicenter, 2-year RCT with a parallel group design. Two hundred anti-CCP-positive, erosive RA patients characterized by low disease activity or remission, no...

  6. Randomized clinical trial of bedside ultrasound among patients with abdominal pain in the emergency department: impact on patient satisfaction and health care consumption

    Directory of Open Access Journals (Sweden)

    Nilsson Laila

    2009-11-01

    Full Text Available Abstract Background Previous research shows that surgeon-performed ultrasound for patients presenting with abdominal pain in the emergency department leads both to higher diagnostic accuracy and to other benefits. We have evaluated the level of patient satisfaction, health condition and further health care consumption after discharge from the emergency department. Methods A total of 800 patients who attended the emergency department for abdominal pain were randomized to surgeon-performed ultrasound or not as a complement to standard examination. All patients were interviewed by telephone six weeks after the visit to the emergency department using a structured questionnaire including information about health condition, satisfaction and medical examinations. A regional health register was used to check health care consumption over two years and mortality was checked for in the personal data register. Results We found a higher self-rated patient satisfaction in the ultrasound group when leaving the emergency department. After six weeks the figures were equal. There were fewer patients in the ultrasound group with completed or planned complementary examinations after six weeks (31.1% compared with the control group (41.4%, p = 0.004. There was no difference found in the two-year health care consumption or mortality between the groups. Conclusion For patients with acute abdominal pain, bedside ultrasound examination is related to higher satisfaction and decreased short-term health care consumption. No major effects were revealed when evaluating effects on a long-term basis, including mortality. The previously proven benefit together with the lack of adverse effects from the method makes ultrasound well worth considering for implementation in emergency departments. Trial registration The study has been registered in ClinicalTrials.gov ID NCT00550511.

  7. Participating in Clinical Trials

    Medline Plus

    Full Text Available ... Trials About Clinical Trials A Research Study With Human Subjects A clinical trial is a research study ... lifestyle changes, such as exercising more, getting more sleep, keeping mentally active, or eating nutritious foods, can ...

  8. Participating in Clinical Trials

    Medline Plus

    Full Text Available ... Participating in Clinical Trials: About Clinical Trials In This Topic About Clinical Trials Risks and Benefits Terms ... with Your Doctor Taking Medicines The information in this topic was provided by the National Library of ...

  9. Participating in Clinical Trials

    Medline Plus

    Full Text Available ... that could identify a disease in its early stages. Usually, trial participants must show signs of the ... Trials Clinical trials of drugs are usually described based on their phase. The U.S. Food and Drug ...

  10. Participating in Clinical Trials

    Medline Plus

    Full Text Available ... trial is to find out if an experimental drug, therapy, medical device, lifestyle change, or test will ... disease. Phases of Clinical Trials Clinical trials of drugs are usually described based on their phase. The ...

  11. Participating in Clinical Trials

    Medline Plus

    Full Text Available ... Participating in Clinical Trials About Clinical Trials A Research Study With Human Subjects A clinical trial is a research study that involves human subjects. The purpose of ...

  12. Towards sustainable clinical trials

    OpenAIRE

    Group, Sustainable Trials Study

    2007-01-01

    Currently, few researchers think about the carbon footprint of their trial. The Sustainable Trials Study Group reports that clinical trials are carbon intensive and suggests ways to make them more efficient

  13. Participating in Clinical Trials

    Medline Plus

    Full Text Available ... on. Participating in Clinical Trials About Clinical Trials A Research Study With Human Subjects A clinical trial is a research study that involves human subjects. The purpose ...

  14. Mining of Business-Oriented Conversations at a Call Center

    Science.gov (United States)

    Takeuchi, Hironori; Nasukawa, Tetsuya; Watanabe, Hideo

    Recently it has become feasible to transcribe textual records from telephone conversations at call centers by using automatic speech recognition. In this research, we extended a text mining system for call summary records and constructed a conversation mining system for the business-oriented conversations at the call center. To acquire useful business insights from the conversational data through the text mining system, it is critical to identify appropriate textual segments and expressions as the viewpoints to focus on. In the analysis of call summary data using a text mining system, some experts defined the viewpoints for the analysis by looking at some sample records and by preparing the dictionaries based on frequent keywords in the sample dataset. However with conversations it is difficult to identify such viewpoints manually and in advance because the target data consists of complete transcripts that are often lengthy and redundant. In this research, we defined a model of the business-oriented conversations and proposed a mining method to identify segments that have impacts on the outcomes of the conversations and can then extract useful expressions in each of these identified segments. In the experiment, we processed the real datasets from a car rental service center and constructed a mining system. With this system, we show the effectiveness of the method based on the defined conversation model.

  15. Behavioral Preferences for Individual Securities : The Case for Call Warrants and Call Options

    OpenAIRE

    Ter Horst, J.R.; Veld, C.H.

    2002-01-01

    Since 1998, large investment banks have flooded the European capital markets with issues of call warrants.This has led to a unique situation in the Netherlands, where now call warrants, traded on the stock exchange, and long-term call options, traded on the options exchange, exist.Both entitle their holders to buy shares of common stock.We use the long-term call options in order to price the call warrants.Using the model of Black and Scholes (1973), the Square Root model version of the Consta...

  16. Call-by-name, call-by-value, call-by-need and the linear lambda calculus

    OpenAIRE

    Maraist, J.; Odersky, M.; Turner, D.N.; Wadler, P.

    1999-01-01

    Girard described two translations of intuitionistic logic into linear logic, one where A→B maps to (!A⊸B) and another where it maps to !(A⊸B). We detail the action of these translations on terms and show that the first corresponds to a call-by-name calculus, while the second corresponds to call-by-value. We further show that if the target of the translation is taken to be an affine calculus, where! controls contraction but weakening is allowed everywhere, then the second translation correspon...

  17. Call-by-name, Call-by-value, Call-by-need, and the Linear Lambda Calculus

    OpenAIRE

    Maraist, John; Odersky, Martin; Turner, David N.; Wadler, Philip

    1995-01-01

    Girard described two translations of intuitionistic logic into linear logic, one where A -> B maps to (!A) -o B, and another where it maps to !(A -o B). We detail the action of these translations on terms, and show that the first corresponds to a call-by-name calculus, while the second corresponds to call-by-value. We further show that if the target of the translation is taken to be an affine calculus, where ! controls contraction but weakening is allowed everywhere, then the second transl...

  18. Calling patterns in human communication dynamics

    CERN Document Server

    Jiang, Zhi-Qiang; Li, Ming-Xia; Podobnik, Boris; Zhou, Wei-Xing; Stanley, H Eugene; 10.1073/pnas.1220433110

    2013-01-01

    Modern technologies not only provide a variety of communication modes, e.g., texting, cellphone conversation, and online instant messaging, but they also provide detailed electronic traces of these communications between individuals. These electronic traces indicate that the interactions occur in temporal bursts. Here, we study the inter-call durations of the 100,000 most-active cellphone users of a Chinese mobile phone operator. We confirm that the inter-call durations follow a power-law distribution with an exponential cutoff at the population level but find differences when focusing on individual users. We apply statistical tests at the individual level and find that the inter-call durations follow a power-law distribution for only 3460 individuals (3.46%). The inter-call durations for the majority (73.34%) follow a Weibull distribution. We quantify individual users using three measures: out-degree, percentage of outgoing calls, and communication diversity. We find that the cellphone users with a power-law...

  19. Dynamic routing based on call quality

    CERN Document Server

    Hammami, Oussama; Gabrielyan, Emin

    2009-01-01

    The telephony over IP (ToIP) is becoming a new trend in technology widely used nowadays in almost all business sectors. Its concepts rely on transiting the telephone communications through the IP network. Today, this technology is deployed increasingly what the cause of emergence of companies is offering this service as Switzernet. For several highly demanded destinations, recently fake vendors appeared in the market offering voice termination but providing only false answer supervision. The answered signal is returned immediately and calls are being charged without being connected. Different techniques are used to keep the calling party on the line. One of these techniques is to play a record of a ring back tone (while the call is already being charged). Another, more sophisticated technique is to play a human voice randomly picked up from a set of records containing contents similar to: hello, hello, I cannot hear you Apart the fact that the fallaciously established calls are charged at rates of real calls,...

  20. Automated detection of Antarctic blue whale calls.

    Science.gov (United States)

    Socheleau, Francois-Xavier; Leroy, Emmanuelle; Pecci, Andres Carvallo; Samaran, Flore; Bonnel, Julien; Royer, Jean-Yves

    2015-11-01

    This paper addresses the problem of automated detection of Z-calls emitted by Antarctic blue whales (B. m. intermedia). The proposed solution is based on a subspace detector of sigmoidal-frequency signals with unknown time-varying amplitude. This detection strategy takes into account frequency variations of blue whale calls as well as the presence of other transient sounds that can interfere with Z-calls (such as airguns or other whale calls). The proposed method has been tested on more than 105 h of acoustic data containing about 2200 Z-calls (as found by an experienced human operator). This method is shown to have a correct-detection rate of up to more than 15% better than the extensible bioacoustic tool package, a spectrogram-based correlation detector commonly used to study blue whales. Because the proposed method relies on subspace detection, it does not suffer from some drawbacks of correlation-based detectors. In particular, it does not require the choice of an a priori fixed and subjective template. The analytic expression of the detection performance is also derived, which provides crucial information for higher level analyses such as animal density estimation from acoustic data. Finally, the detection threshold automatically adapts to the soundscape in order not to violate a user-specified false alarm rate. PMID:26627784

  1. A School-Randomized Clinical Trial of an Integrated Social-Emotional Learning and Literacy Intervention: Impacts after 1 School Year

    Science.gov (United States)

    Jones, Stephanie M.; Brown, Joshua L.; Hoglund, Wendy L. G.; Aber, J. Lawrence

    2010-01-01

    Objective: To report experimental impacts of a universal, integrated school-based intervention in social-emotional learning and literacy development on change over 1 school year in 3rd-grade children's social-emotional, behavioral, and academic outcomes. Method: This study employed a school-randomized, experimental design and included 942…

  2. The Impact of an Associate's Degree Program for Incarcerated Students: A Randomized Trial of the Correctional Education Association College of the Air Program

    Science.gov (United States)

    Meyer, Stephen J.; Randel, Bruce

    2013-01-01

    This article reports findings from an impact study of a 2-year postsecondary academic program offered in state prisons. Outcomes examined for participants during their 1st year of participation include performance on a standardized test of critical thinking skills, credit acquisition, achievement motivation, educational aspirations, personal…

  3. The Impact on Morbidity and Length of Stay of Early Versus Delayed Complete Lymphadenectomy in Melanoma : Results of the Multicenter Selective Lymphadenectomy Trial (I)

    NARCIS (Netherlands)

    Faries, Mark B.; Thompson, John F.; Cochran, Alistair; Elashoff, Robert; Glass, Edwin C.; Mozzillo, Nicola; Nieweg, Omgo E.; Roses, Daniel F.; Hoekstra, Harold J.; Karakousis, Constantine P.; Reintgen, Douglas S.; Coventry, Brendon J.; Wang, He-Jing; Morton, Donald L.

    2010-01-01

    Complete lymph node dissection, the current standard treatment for nodal metastasis in melanoma, carries the risk of significant morbidity. Clinically apparent nodal tumor is likely to impact both preoperative lymphatic function and extent of soft tissue dissection required to clear the basin. We hy

  4. Cardio metabolic and immunological impacts of extra virgin olive oil consumption in overweight and obese older adults: a randomized controlled trial

    Science.gov (United States)

    Background: Both aging and obesity are related to dysregulated immune function which may be responsible for increased risk of infection and also chronic non-infectious diseases. Dietary lipids have been shown to impact immune and inflammatory responses and cardio-metabolic risk factors. No informati...

  5. Synergistic modeling of call center operations

    Directory of Open Access Journals (Sweden)

    Jon G. Vaver

    2006-05-01

    Full Text Available We synergistically apply queueing theory, integer programming, and stochastic simulation to determine an optimal staffing policy for a repair call handling center. A stationary Markovian queueing model is employed to determine minimal staffing levels for a sequence of time intervals with varying call volumes and mean handling times. These staffing requirements populate an integer program model for determining the mix of call agent shifts that will achieve service quality standards at minimum cost. Since the analytical modeling requires simplifying assumptions, expected performance of the optimal staffing policy is evaluated using stochastic simulation. Computational efficiency of the simulation is improved dramatically by employing the queueing model to generate an analytic control variate.

  6. Malware Classification based on Call Graph Clustering

    CERN Document Server

    Kinable, Joris

    2010-01-01

    Each day, anti-virus companies receive tens of thousands samples of potentially harmful executables. Many of the malicious samples are variations of previously encountered malware, created by their authors to evade pattern-based detection. Dealing with these large amounts of data requires robust, automatic detection approaches. This paper studies malware classification based on call graph clustering. By representing malware samples as call graphs, it is possible to abstract certain variations away, and enable the detection of structural similarities between samples. The ability to cluster similar samples together will make more generic detection techniques possible, thereby targeting the commonalities of the samples within a cluster. To compare call graphs mutually, we compute pairwise graph similarity scores via graph matchings which approximately minimize the graph edit distance. Next, to facilitate the discovery of similar malware samples, we employ several clustering algorithms, including k-medoids and DB...

  7. Call Center 服务创新

    Institute of Scientific and Technical Information of China (English)

    陈克胜

    2001-01-01

    @@ 市场的竞争说道底就是优质服务的竞争,所以提升服务的质量是各商家看好的利润增长点.电子商务被商家认为是减少成本增加收入的利器,而拥有call center 的电子商务才更为完善.call center已成功地在业界尤其是在金融业得到了运用,使客户服务水平有了根本的改观.而且在金融业,call center正在由成本中心向效益中心转型.

  8. Echolocation calls and communication calls are controlled differentially in the brainstem of the bat Phyllostomus discolor

    Directory of Open Access Journals (Sweden)

    Schuller Gerd

    2005-08-01

    Full Text Available Abstract Background Echolocating bats emit vocalizations that can be classified either as echolocation calls or communication calls. Neural control of both types of calls must govern the same pool of motoneurons responsible for vocalizations. Electrical microstimulation in the periaqueductal gray matter (PAG elicits both communication and echolocation calls, whereas stimulation of the paralemniscal area (PLA induces only echolocation calls. In both the PAG and the PLA, the current thresholds for triggering natural vocalizations do not habituate to stimuli and remain low even for long stimulation periods, indicating that these structures have relative direct access to the final common pathway for vocalization. This study intended to clarify whether echolocation calls and communication calls are controlled differentially below the level of the PAG via separate vocal pathways before converging on the motoneurons used in vocalization. Results Both structures were probed simultaneously in a single experimental approach. Two stimulation electrodes were chronically implanted within the PAG in order to elicit either echolocation or communication calls. Blockade of the ipsilateral PLA site with iontophoretically application of the glutamate antagonist kynurenic acid did not impede either echolocation or communication calls elicited from the PAG. However, blockade of the contralateral PLA suppresses PAG-elicited echolocation calls but not communication calls. In both cases the blockade was reversible. Conclusion The neural control of echolocation and communication calls seems to be differentially organized below the level of the PAG. The PLA is an essential functional unit for echolocation call control before the descending pathways share again the final common pathway for vocalization.

  9. Metacognitive knowledge, metacognitive strategies, and CALL

    OpenAIRE

    Hauck, M

    2005-01-01

    CALL Research Perspectives creates a foundation for the study and practice of computer-assisted language learning and provides an overview of ways to conceptualize and to conduct research in CALL. Its core assumptions are that all approaches to research have a place, and that researchers, teachers, and students all have a role to play in the study of computer-enhanced language learning. This is not a how-to-do-research text. Written by top researchers in the field, it offers an open-ended ...

  10. Optimization of Overflow Policies in Call Centers

    DEFF Research Database (Denmark)

    Koole, G.M.; Nielsen, B.F.; Nielsen, T.B.

    2015-01-01

    We examine how overflow policies in a multi-skill call center should be designed to accommodate performance measures that depend on waiting time percentiles such as service level. This is done using a discrete Markovian approximation of the waiting time of the first customers waiting in line. A...... Markov decision chain is used to determine the optimal policy. This policy outperforms considerably the ones used most often in practice, which use a fixed threshold. The present method can be used also for other call-center models and other situations where performance is based on actual waiting times...

  11. Remote Procedures Calls Implementing using Distributed Algorithm

    Directory of Open Access Journals (Sweden)

    G. MURALI

    2011-11-01

    Full Text Available Remote Procedure Call (RPC is a powerful primitive used for communication and synchronization between distributed processes. RPC poses a problem that it reduces the amount of parallelism, because of its synchronous nature. This paper shows how simple processes can be used to find a way of avoiding a difficulty in this problem. The combination of blocking RPC calls and light-weightprocesses provides both simple semantics and efficient exploitation of parallelism.We will describe how two important classes of algorithms, branch and bound can be run in a parallel way using this RPC. The results of some experiments comparing this algorithms on a single processor discussed

  12. Optimal balanced control for call centers

    OpenAIRE

    Bhulai, S.; Farenhorst - Yuan, T.; Heidergott, B.F.; Laan, van der, G.

    2010-01-01

    This discussion paper led to a publication in 'Annals op Operations Research' , 2012, 201(1), 39-62. In this paper we study a challenging call center operation problem. The goal of our analysis is to identify an optimal policy for allocating tasks to agents. As a first step, we discuss promising randomized policies and use stochastic approximation for finding the optimal randomized policy when implemented via a Bernoulli scheme. As we will show in this paper, the performance of the call cente...

  13. Securing Remote Procedure Calls over HTTPS

    CERN Document Server

    Kale, Ajinkya; Pradhan, Sudeep

    2009-01-01

    Remote Procedure Calls (RPC) are widely used over the Internet as they provide a simple and elegant way of interaction between the client and the server. This paper proposes a solution for securing the remote procedure calls (RPC) by tunneling it through HTTPS (Hypertext Transfer Protocol over Secure Socket Layer). RPC over HTTP actually uses the Secure Socket Layer (SSL) protocol as a transport for the traffic. SSL mandates that the server authenticates itself to the client using a digital certificate (and associated private key). SSL is normally configured to encrypt traffic before transmitting it between the server and client and vice versa.

  14. The Impact of Virtual Reality Distraction on Pain and Anxiety during Dental Treatment in 4-6 Year-Old Children: a Randomized Controlled Clinical Trial

    Science.gov (United States)

    Asl Aminabadi, Naser; Erfanparast, Leila; Sohrabi, Azin; Ghertasi Oskouei, Sina; Naghili, Armaghan

    2012-01-01

    Background and aims Dental practitioners have numerous methods to control anxiety and pain in children, and distracting the child appears to be the most common technique used for behavior management during dental procedures. The aim of the present study was to evaluate the influence of using virtual reality eyeglasses on severity of pain and anxiety during dental procedures in pediatric patients. Materials and methods This study included 120 healthy children aged 4-6 years. Children with no previous anxiety disorder were randomly divided into two groups, each consisting of 60 children. The study consisted of 3 consecutive treatment sessions. During the first visit fluoride therapy was carried out in both groups. In the next sessions, the groups received restorative treatment with and without virtual reality eyeglasses in a randomized single-blind-controlled crossover fashion. Then at the end of each session the subjects’ pain severity was assessed using Wong Baker FACES Pain Rating Scale and state anxiety was measured by Faces version of the Modified Child Dental Anxiety Scale [MCDAS (f)]. Results There was a significant decrease in pain perception (P < 0.001) and state anxiety scores (P < 0.001) with the use of virtual reality eyeglasses during dental treatment. Conclusion Results of this study showed that virtual reality eyeglasses can successfully decrease pain perception and state anxiety during dental treatment. Trial registration number: 201103126036N1. PMID:23277857

  15. The impact of two workplace-based health risk appraisal interventions on employee lifestyle parameters, mental health and work ability: results of a randomized controlled trial.

    Science.gov (United States)

    Addley, K; Boyd, S; Kerr, R; McQuillan, P; Houdmont, J; McCrory, M

    2014-04-01

    Health risk appraisals (HRA) are a common type of workplace health promotion programme offered by American employers. In the United Kingdom, evidence of their effectiveness for promoting health behaviour change remains inconclusive. This randomized controlled trial examined the effects of two HRA interventions on lifestyle parameters, mental health and work ability in a UK context. A total of 180 employees were randomized into one of three groups: Group A (HRA augmented with health promotion and education activities), Group B (HRA only) and Group C (control, no intervention). After 12 months, changes in mean scoring in 10 lifestyle, mental health and work ability indices were compared, Groups A and B demonstrated non-significant improvements in 70% and 80%, respectively, compared with controls (40%). Odds ratios revealed that, compared with the control group, Group A was 29.2 (95% CI: 9.22-92.27) times more likely to report a perceived change in lifestyle behaviour; Group B 4.4 times (95% CI: 1.65-11.44). In conclusion, participation in the HRA was associated with a higher likelihood of perceived lifestyle behaviour change which was further increased in the augmented HRA group, thereby providing preliminary evidence that HRA and augmented HRA in particular may help UK employees make positive healthy lifestyle changes. PMID:24399261

  16. Impact Evaluation of Training Natural Leaders during a Community-Led Total Sanitation Intervention: A Cluster-Randomized Field Trial in Ghana.

    Science.gov (United States)

    Crocker, Jonny; Abodoo, Elvis; Asamani, Daniel; Domapielle, William; Gyapong, Benedict; Bartram, Jamie

    2016-08-16

    We used a cluster-randomized field trial to evaluate training natural leaders (NLs) as an addition to a community-led total sanitation (CLTS) intervention in Ghana. NLs are motivated community members who influence their peers' behaviors during CLTS. The outcomes were latrine use and quality, which were assessed from surveys and direct observation. From October 2012, Plan International Ghana (Plan) implemented CLTS in 60 villages in three regions in Ghana. After 5 months, Plan trained eight NLs from a randomly selected half of the villages, then continued implementing CLTS in all villages for 12 more months. The NL training led to increased time spent on CLTS by community members, increased latrine construction, and a 19.9 percentage point reduction in open defecation (p sanitation projects, and may be most effective in socially cohesive villages. For both interventions, latrines built during CLTS were less likely to be constructed of durable materials than pre-existing latrines, but were equally clean, and more often had handwashing materials. CLTS with NL training contributes to three parts of Goal 6 of the Sustainable Development Goals: eliminating open defecation, expanding capacity-building, and strengthening community participation. PMID:27428399

  17. Impact of Preemptive Fibrinogen Concentrate on Transfusion Requirements in Liver Transplantation: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial.

    Science.gov (United States)

    Sabate, A; Gutierrez, R; Beltran, J; Mellado, P; Blasi, A; Acosta, F; Costa, M; Reyes, R; Torres, F

    2016-08-01

    We hypothesized that preemptive fibrinogen administration to obtain an initial plasma level of 2.9 g/L would reduce transfusion requirements in liver transplantation. A randomized, multicenter, hemoglobin-stratified, double-blind, fibrinogen-versus-saline-controlled trial was conducted. The primary end point was the percentage of patients requiring red blood cells. We evaluated 51 patients allocated to fibrinogen and 48 allocated to saline; the primary end point was assessed using data for 92 patients because the electronic record forms were offline for three patients in the fibrinogen group and four in the saline group. We injected a median of 3.54 g fibrinogen preemptively in the fibrinogen group. Nine patients in the saline group (20.9%) required fibrinogen at graft reperfusion (compared with one patient [2.1%] in the fibrinogen group; p = 0.005). Blood was transfused to 52.9% (95% confidence interval [CI] 42.5-63.3%) in the fibrinogen group and 42.74% (95% CI 28.3-57.2%) in the saline group (p = 0.217). Relative risk for blood transfusion was 0.80 (95% CI 0.57-1.13). Thrombotic events occurred in one patient (2.1%) and five patients (11.4%) in the fibrinogen and saline groups, respectively. Seven patients (14.6%) in the fibrinogen group and nine (20.3%) in the saline group required reoperation. Preemptive administration of fibrinogen concentrate did not influence transfusion requirements. PMID:26880105

  18. A Randomised Control Trial of the Impact of a Computer-Based Activity Programme upon the Fitness of Children with Autism

    Directory of Open Access Journals (Sweden)

    Kathleen Dickinson

    2014-01-01

    Full Text Available The poor levels of fitness in children with autism are prompting concern for the children’s future health. This study looked to assess if a computer-based activity programme could improve fitness levels (as reflected in cardiopulmonary function of these children, and achieve a reduction in their body mass index. In a randomised controlled trial, 50 children with autism (of which 33 were under the age of 11 years and 39 were boys were allocated to an intervention group which encouraged them to use the Nintendo Wii and the software package “Mario and Sonics at the Olympics” in addition to their routine physical education classes. 50 children with autism (34 under the age of 11 years and 40 being boys acted as controls. At the end of one year, analysis of the changes in scores using analysis of covariance (ANCOVA on the Eurofit fitness tests showed that the intervention group had made statistically significant improvement on all tests other than flexibility. These improvements were also significantly better than controls. This type of intervention appears to be an effective addition to standard fitness training in order to help children with autism improve their fitness levels.

  19. Long-term results of the Dutch randomized prostate cancer trial: Impact of dose-escalation on local, biochemical, clinical failure, and survival

    International Nuclear Information System (INIS)

    Purpose: Nowadays, advanced irradiation techniques make it possible to escalate safely the dose in prostate cancer. We studied the effect of a higher dose on tumor control in a randomized trial with a median follow-up of 110 months. Patients and methods: Patients with T1b-T4N0 prostate cancer (n = 664) were randomized between 78 Gy and 68 Gy. Primary endpoint was biochemical and/or clinical failure (BCF) according to the American Society for Therapeutic Radiology and Oncology (ASTRO) guidelines (3 consecutive rises), and to Phoenix (nadir plus 2 μg/L). Secondary endpoints were clinical failure (CF), local failure (LF), prostate cancer death (PCD), and overall survival (OS). Explorative subgroup analyses were performed. Results: BCF rate (HR = 0.8; 20% less events) and LF rate (HR = 0.5; 50% less events) were significantly lower in the 78 Gy arm (p < 0.05). CF, PCD and OS were similar in both arms. A significant heterogeneity of treatment effect was found for PSA cutoffs between 7 and 10 μg/L. Conclusion: We observed significantly less BCF and LF in the high-dose arm. This suggests improvement of the therapeutic ratio. However, we observed similar rates of CF and PCD at the current update. More follow-up is needed to investigate which patients benefit in terms of prolonged OS

  20. Impact of physical activity on energy balance, food intake and choice in normal weight and obese children in the setting of acute social stress: a randomized controlled trial

    OpenAIRE

    Horsch A.; Wobmann M.; Kriemler S.; Munsch S.; Borloz S.; Balz A.; Marques-Vidal P.; Borghini A.; Puder J. J.

    2015-01-01

    BACKGROUND: Psychological stress negatively influences food intake and food choices, thereby contributing to the development of childhood obesity. Physical activity can also moderate eating behavior and influence calorie intake. However, it is unknown if acute physical activity influences food intake and overall energy balance after acute stress exposure in children. We therefore investigated the impact of acute physical activity on overall energy balance (food intake minus energy expenditure...

  1. The Impact of Aerobic Exercise on Brain-Derived Neurotrophic Factor and Neurocognition in Individuals With Schizophrenia: A Single-Blind, Randomized Clinical Trial

    OpenAIRE

    Kimhy, David; Vakhrusheva, Julia; Bartels, Matthew N.; Armstrong, Hilary F.; Ballon, Jacob S; Khan, Samira; Chang, Rachel W.; Hansen, Marie C.; Ayanruoh, Lindsey; Lister, Amanda; Castrén, Eero; Smith, Edward E.; Sloan, Richard P.

    2015-01-01

    Individuals with schizophrenia display substantial neurocognitive deficits for which available treatments offer only limited benefits. Yet, findings from studies of animals, clinical and nonclinical populations have linked neurocognitive improvements to increases in aerobic fitness (AF) via aerobic exercise training (AE). Such improvements have been attributed to up-regulation of brain-derived neurotrophic factor (BDNF). However, the impact of AE on neurocognition, and the putative role of BD...

  2. The impact of a self-development coaching programme on medical and dental students’ psychological health and academic performance: a randomised controlled trial

    OpenAIRE

    Aboalshamat, Khalid; Hou, Xiang-Yu; Strodl, Esben

    2015-01-01

    Background Psychological distress is well-documented worldwide among medical and dental students. Few studies have assessed the impact of self-development coaching programs on the students’ psychological health. The aim of the study was to evaluate the effect of a self-development coaching programme on the psychological health and academic performance of preclinical medical and dental students at Umm Al-Qura University, Saudi Arabia. Methods Four-hundred and twenty-two participants (n = 422, ...

  3. Impact of 11C-choline PET/CT on clinical decision making in recurrent prostate cancer: results from a retrospective two-centre trial

    International Nuclear Information System (INIS)

    The aim of this retrospective two-centre study was to investigate the clinical impact of 11C-choline PET/CT on treatment management decisions in patients with recurrent prostate cancer (rPCa) after radical therapy. Enrolled in this retrospective study were 150 patients (95 from Bologna, 55 from Wuerzburg) with rPCa and biochemical relapse (PSA mean ± SD 4.3 ± 5.5 ng/mL, range 0.2-39.4 ng/mL) after radical therapy. The intended treatment before PET/CT was salvage radiotherapy of the prostatic bed in 95 patients and palliative androgen deprivation therapy (ADT) in 55 patients. The effective clinical impact of 11C-choline PET/CT was rated as major (change in therapeutic approach), minor (same treatment, but modified therapeutic strategy) or none. Multivariate binary logistic regression analysis included PSA level, PSA kinetics, ongoing ADT, Gleason score, TNM, age and time to relapse. Changes in therapy after 11C-choline PET/CT were implemented in 70 of the 150 patients (46.7 %). A major clinical impact was observed in 27 patients (18 %) and a minor clinical impact in 43 (28.7 %). 11C-choline PET/CT was positive in 109 patients (72.7 %) detecting local relapse (prostate bed and/or iliac lymph nodes and/or pararectal lymph nodes) in 64 patients (42.7 %). Distant relapse (paraaortic and/or retroperitoneal lymph nodes and/or bone lesions) was seen in 31 patients (20.7 %), and both local and distant relapse in 14 (9.3 %). A significant difference was observed in PSA level and PSA kinetics between PET-positive and PET-negative patients (p 0.05). In both centres the same criteria to validate PET-positive findings were used: in 17.3 % of patients by histology and in 82.7 % of patients by correlative imaging and/or clinical follow-up (follow-up mean 20.5 months, median 18.3 months, range 6.2-60 months). 11C-Choline PET/CT had a significant impact on therapeutic management in rPCa patients. It led to an overall change in 46.7 % of patients, with a major clinical change

  4. Protocol for the Proactive Or Reactive Telephone Smoking CeSsation Support (PORTSSS trial

    Directory of Open Access Journals (Sweden)

    Lorgelly Paula

    2009-04-01

    Full Text Available Abstract Background Telephone quit lines are accessible to many smokers and are used to engage motivated smokers to make quit attempts. Smoking cessation counselling provided via telephone can either be reactive (i.e. primarily involving the provision of evidence-based information, or proactive (i.e. primarily involving repeated, sequenced calls from and interaction with trained cessation counsellors. Some studies have found proactive telephone counselling more effective and this trial will investigate whether or not proactive telephone support for smoking cessation, delivered through the National Health Service (NHS Smoking Helpline is more effective or cost-effective than reactive support. It will also investigate whether or not providing nicotine replacement therapy (NRT, in addition to telephone counselling, has an adjunctive impact on smoking cessation rates and whether or not this is cost effective. Methods This will be a parallel group, factorial design RCT, conducted through the English national NHS Smoking Helpline which is run from headquarters in Glasgow. Participants will be smokers who call the helpline from any location in England and who wish to stop smoking. If 644 participants are recruited to four equally-sized trial groups (total sample size = 2576, the trial will have 90% power for detecting a treatment effect (Odds Ratio of 1.5 for each of the two interventions: i proactive versus reactive support and ii the offer of NRT versus no offer. The primary outcome measure for the study is self-reported, prolonged abstinence from smoking for at least six months following an agreed quit date. A concurrent health economic evaluation will investigate the cost effectiveness of the two interventions when delivered via a telephone helpline. Discussion The PORTSSS trial will provide high quality evidence to determine the most appropriate kind of counselling which should be provided via the NHS Smoking Helpline and also whether or not an

  5. Don't Call It School

    Science.gov (United States)

    Robb, Daniel

    2006-01-01

    "Homeschooling," "deschooling," and "unschooling" are commonly used terms in the alternative-education world, but each lacks specificity. In this article, the author describes what he discovered during several visits to North Star. Known officially as North Star: Self-Directed Learning for Teens, it is not as structured as a so-called "free"…

  6. 76 FR 17934 - Infrastructure Protection Data Call

    Science.gov (United States)

    2011-03-31

    ... SECURITY Infrastructure Protection Data Call AGENCY: National Protection and Programs Directorate, DHS... of Infrastructure Protection (IP), will submit the following Information Collection Request to the... infrastructure and key resources (CIKR). At DHS, this responsibility is managed by IP within NPPD. Beginning...

  7. Using Software Design Methods in CALL

    Science.gov (United States)

    Ward, Monica

    2006-01-01

    The phrase "software design" is not one that arouses the interest of many CALL practitioners, particularly those from a humanities background. However, software design essentials are simply logical ways of going about designing a system. The fundamentals include modularity, anticipation of change, generality and an incremental approach. While CALL…

  8. Modeling and simulation of call centers.

    OpenAIRE

    Avramidis, A.N.; L'Ecuyer, P.

    2006-01-01

    In this review, we introduce key notions and describe the decision problems commonly encountered in call center management. Main themes are the central role of uncertainty throughout the decision hierarchy and the many operational complexities and relationships between decisions. We make connections to analytical models in the literature, emphasizing insights gained and model limitations. The high operational complexity and the prevalent uncertainty suggest th...

  9. Authenticity in CALL: Three Domains of "Realness"

    Science.gov (United States)

    Buendgens-Kosten, Judith

    2013-01-01

    This paper discusses the role of authenticity and authenticity claims in computer assisted language learning (CALL). It considers authenticity as the result of a social negotiation process rather than an innate feature of a text, object, person, or activity. From this basis, it argues that authenticity claims play an important role in both second…

  10. Make a 21st century phone call

    CERN Document Server

    Katarina Anthony

    2014-01-01

    Want to avoid roaming charges? Click to call anyone at CERN? How about merging your CERN landline with your existing smartphone? That's all easily done with Lync, CERN's new opt-in service that can take your calls to the next level.   The Lync application on Windows (left) and iPhone (right). Lync unites CERN's traditional telephone service with the digital sphere. "Lync gives you the gift of mobility, by letting you access your CERN landline on the go," explains Pawel Grzywaczewski, service manager of the Lync system. "Once you've registered your CERN telephone with the service, you can run the Lync application and make calls from a range of supported devices. No matter where you are in the world - be it simply out to lunch or off at an international conference - you can make a CERN call as though you were in the office. All you need is an Internet connection!" Following a recent upgrade, CERN's Lync service now has...

  11. Looking Back: Tracing Trends in Canadian CALL

    Science.gov (United States)

    Craven, Mary-Louise; Sinyor, Roberta

    2011-01-01

    "CCALLNET" ("The Canadian Computer-Assisted Language Learning Network at the Post-Secondary Level") was a semi-annual newsletter published from 1987 to 2002 that was distributed to colleagues across Canada who taught languages to university students. Its objective was to create a network of Canadian faculty interested in CALL by informing them…

  12. A Call for School Counseling Practitioner Research

    Science.gov (United States)

    Kaffenberger, Carol J.

    2012-01-01

    Despite the repeated call to increase the number of practitioner research manuscripts being published in counseling publications, practitioner research accounts for less than five percent of all manuscripts published. This article describes the challenges faced by practitioners seeking to publish their research, defines practitioner research, and…

  13. Long-distance calls in Neotropical primates

    Directory of Open Access Journals (Sweden)

    Dilmar A.G. Oliveira

    2004-06-01

    Full Text Available Long-distance calls are widespread among primates. Several studies concentrate on such calls in just one or in few species, while few studies have treated more general trends within the order. The common features that usually characterize these vocalizations are related to long-distance propagation of sounds. The proposed functions of primate long-distance calls can be divided into extragroup and intragroup ones. Extragroup functions relate to mate defense, mate attraction or resource defense, while intragroup functions involve group coordination or alarm. Among Neotropical primates, several species perform long-distance calls that seem more related to intragroup coordination, markedly in atelines. Callitrichids present long-distance calls that are employed both in intragroup coordination and intergroup contests or spacing. Examples of extragroup directed long-distance calls are the duets of titi monkeys and the roars and barks of howler monkeys. Considerable complexity and gradation exist in the long-distance call repertoires of some Neotropical primates, and female long-distance calls are probably more important in non-duetting species than usually thought. Future research must focus on larger trends in the evolution of primate long-distance calls, including the phylogeny of calling repertoires and the relationships between form and function in these signals.Chamados de longo alcance são comuns em primatas. Muitas pesquisas enfocaram tais vocalizações em uma única ou em poucas espécies, enquanto poucos estudos lidaram com padrões mais gerais dentro da ordem. As características comuns que geralmente distinguem estas vocalizações são relacionadas com a transmissão de sons a longa distância. As funções propostas para estas vocalizações podem ser divididas entre intragrupais e extragrupais. Funções extragrupais se relacionam com a defesa e atração de parceiros sexuais ou com a defesa de recursos, enquanto as fun

  14. Impact of efalizumab on patient-reported outcomes in high-need psoriasis patients: results of the international, randomized, placebo-controlled Phase III Clinical Experience Acquired with Raptiva (CLEAR trial [NCT00256139

    Directory of Open Access Journals (Sweden)

    Shumack Stephen

    2005-12-01

    Full Text Available Abstract Background Chronic psoriasis can negatively affect patients' lives. Assessing the impact of treatment on different aspects of a patient's health-related quality of life (HRQOL is therefore important and relevant in trials of anti-psoriasis agents. The recombinant humanized IgG1 monoclonal antibody efalizumab targets multiple T-cell-dependent steps in the immunopathogenesis of psoriasis. Efalizumab has demonstrated safety and efficacy in several clinical trials, and improves patients' quality of life. Objective: To evaluate the impact of efalizumab on HRQOL and other patient-reported outcomes in patients with moderate to severe plaque psoriasis, including a large cohort of High-Need patients for whom at least 2 other systemic therapies were unsuitable because of lack of efficacy, intolerance, or contraindication. Methods A total of 793 patients were randomized in a 2:1 ratio to receive efalizumab 1 mg/kg/wk (n = 529 or placebo (n = 264 for 12 weeks. The study population included 526 High-Need patients (342 efalizumab, 184 placebo. The treatment was evaluated by patients using the HRQOL assessment tools Short Form-36 (SF-36 and Dermatology Life Quality Index (DLQI. Other patient-reported assessments included the Psoriasis Symptom Assessment (PSA, a visual analog scale (VAS for itching, and the Patient's Global Psoriasis Assessment (PGPA. Results Efalizumab was associated with improvements at Week 12 from baseline in patient-reported outcomes, both in the total study population and in the High-Need cohort. Among all efalizumab-treated patients, the DLQI improved by 5.7 points from baseline to Week 12, relative to an improvement of 2.3 points for placebo patients (P P Conclusion A 12-week course of efalizumab improved HRQOL and other patient-reported outcomes in patients with moderate to severe plaque psoriasis. The benefits of efalizumab therapy in High-Need patients were similar to those observed in the total study population, indicating

  15. Observer bias in randomised clinical trials with binary outcomes

    DEFF Research Database (Denmark)

    Hróbjartsson, Asbjørn; Thomsen, Ann Sofia Skou; Emanuelsson, Frida; Tendal, Britta; Hilden, Jørgen; Boutron, Isabelle; Ravaud, Philippe; Brorson, Stig

    2012-01-01

    To evaluate the impact of non-blinded outcome assessment on estimated treatment effects in randomised clinical trials with binary outcomes.......To evaluate the impact of non-blinded outcome assessment on estimated treatment effects in randomised clinical trials with binary outcomes....

  16. Participating in Clinical Trials

    Medline Plus

    Full Text Available ... this page please turn Javascript on. Participating in Clinical Trials About Clinical Trials A Research Study With Human Subjects A clinical ... to treat or cure a disease. Phases of Clinical Trials Clinical trials of drugs are usually described based ...

  17. Impact of post operative intensity modulated radiotherapy on acute gastro-intestinal toxicity for patients with endometrial cancer: Results of the phase II RTCMIENDOMETRE French multicentre trial

    International Nuclear Information System (INIS)

    Purpose/objective: Whole “conventional” pelvic irradiation (up to 45–50 Gy) following hysterectomy is associated with a high rate of adverse gastro-intestinal (GI) adverse events, of which around 60% correspond to acute grade 2 toxicity. The phase II RTCMIENDOMETRE trial was designed to test the hypothesis that IMRT could reduce the incidence of grade 2 or more acute GI toxicity to less than 30% in patients irradiated post-operatively for an endometrial cancer. Materials/methods: Patients with post-operative stage Ib G3, Ic or II endometrial carcinomas with no history of chronic inflammatory bowel disease were eligible. Guidelines for volume delineation and dose prescription were detailed in the protocol. The investigators were advised to use a web-based atlas developed for the RTOG 0418 study. The dose of the vaginal and nodal PTV was 45 Gy in 25 fractions. To assess the ability of the participating centres to comply with the protocol guidelines, they were requested to complete a dummy run procedure before inclusion of their 1st patient. GI and genito-urinary (GU) toxicity were graded according to the CTCAE V 3.0 classification and were prospectively recorded every week during irradiation, as well as at time of brachytherapy insertions and during the follow-up visit at week 15 (W15). Special attention was given to note any changes to the grade of adverse events between W5 and W15. Results: From May 2008 to April 2010, 49 patients from 6 centres were recruited for the trial. One patient could not be treated, one patient died of vascular stroke at W3 without toxicity, and 1 patient refused to be followed-up after treatment. Thus, 46 cases were available for analysis at W15. The distribution by stage was as follows: Ib 16.3%, Ic 64.2%, II 20.4%. Thirty six patients (75%) received an additional vaginal vault boost of 6–10 Gy delivered by HDR brachytherapy in 1 or 2 fractions. Among the 47 patients who completed IMRT, 27% (95% CI 14.5–39.7%) developed at

  18. How Health Professionals Conceptualize and Represent Placebo Treatment in Clinical Trials and How Their Patients Understand It: Impact on Validity of Informed Consent

    Science.gov (United States)

    Keller, Pascal-Henri; Grondin, Olivier; Tison, François; Gonon, Francois

    2016-01-01

    Context Previous studies suggested that many patients, who have given their informed consent to participate in randomized controlled trials (RCT), have somewhat limited understanding of what a placebo treatment is. We hypothesized that the relationship between patients and their health professionals plays a central role in this understanding. Methods We interviewed 12 patients included in RCTs (nine suffering from Parkinson’s disease and three from Huntington’s disease) and 18 health professionals involved with RCTs (eight principal investigators, four associated physicians and six clinical research associates). Semi-structured interviews were conducted after the RCTs had ended but before the treatment allocation was revealed. Results Only two patients clearly understood the aim of placebo-controlled RCTs. Only one principal investigator said she asks all her patients whether they agree to participate in RCTs. The seven others said they only ask patients who seem more likely to be compliant. Their selection criteria included docility and personality traits associated in other studies with enhanced placebo responses. According to 13 of the 18 health professionals, their relationship with patients may influence the amplitude of the placebo response. All but one clinical research associates added that the placebo response could result from a “maternal” type of care. All principal investigators said they have a strong influence on their patient's decision to participate. Finally, when interviewees were asked to narrate a memory of a medically unexplained healing, in eight of 11 physicians' narratives the beneficiary was a child while in 10 of 12 patients' narratives it was an adult. Conclusion Our observations suggest that the interrelationship between health professionals and patients involved in RCTs could be compared to that between parents and children. Therefore, adherence to formal rules regarding informed consent does not ensure a balanced relationship

  19. Impact of complementary mistletoe extract treatment on quality of life in breast, ovarian and non-small cell lung cancer patients. A prospective randomized controlled clinical trial.

    Science.gov (United States)

    Piao, B K; Wang, Y X; Xie, G R; Mansmann, U; Matthes, H; Beuth, J; Lin, H S

    2004-01-01

    Standardized aqueous mistletoe extracts have been applied to cancer patients for several decades as complementary medicine. A multicentric, randomized, open, prospective clinical trial was conducted in three oncological centers in the People's Republic of China in Bejing, Shenyang and Tianjin. Following the guidelines of "Good Clinical Practice" (GCP) this study was performed to get information on efficacy safety and side-effects of the standardized mistletoe extract (sME). Two hundred and thirty-three patients with breast (n=68), ovarian (n=71) and non-small cell lung cancer (NSCLC; n=94) were enrolled into this study. Two hundred and twenty-four patients fulfilled the requirements for final analysis (n=115 treated with sME HELIXOR A; n=109 comprising the control group being treated with the approved immunomodulating phytopharmacon Lentinan). All patients were provided with standard tumor-destructive treatment schedules and complementarily treated with sME or Lentinan during chemotherapy according to treatment protocol. Biometrically, the patients of the control and sME treatment group were comparable regarding distribution, clinical classification (WHO) and treatment protocols. Analysis was performed according to the "Intention to treat principle". Quality of life (QoL) was significantly (pcontrol group. Additionally, the occurrence of adverse events (AEs) was less frequent in the sME than in the control group (total number of AEs 52 versus 90 and number of serious AEs 5 versus 10 in study and control group, most of them due to chemotherapy). Only one serious AE was allocated to complementary treatment in each group (1 angioedema in sME group). All other side-effects of the sME (7 harmless local inflammatory reactions at subcutaneous injection site, 4 cases with fever) were self-limiting and did not demand therapeutic intervention. This study showed that complementary treatment with sME can beneficially reduce the side-effects of chemotherapy in cancer patients

  20. The Impact of a Low Glycemic Index Diet on Inflammatory Markers and Serum Adiponectin Concentration in Adolescent Overweight and Obese Girls: A Randomized Clinical Trial.

    Science.gov (United States)

    Rouhani, M H; Kelishadi, R; Hashemipour, M; Esmaillzadeh, A; Surkan, P J; Keshavarz, A; Azadbakht, L

    2016-04-01

    Although the effects of dietary glycemic index (GI) on insulin resistance are well documented in adults, the complex interaction among glucose intolerance, inflammatory markers, and adipokine concentration has not been well studied, especially among adolescents. We investigated the effect of a low glycemic index (LGI) diet on insulin concentration, fasting blood sugar (FBS), inflammatory markers, and serum adiponectin concentration among healthy obese/overweight adolescent females. In this parallel randomized clinical trial, 2 different diets, an LGI diet and a healthy nutritional recommendation diet (HNRD) with similar macronutrient composition were prescribed to 50 obese and overweight adolescent girls with the same pubertal status. Biochemical markers FBS, serum insulin concentration, high sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), and adiponectin were measured before and after a 10 week intervention. Using an intention-to-treat analysis, data from 50 subjects were analyzed. According to a dietary assessment, GI in the LGI group was 43.22±0.54. While the mean for FBS, serum insulin concentration, the homeostasis model assessment (HOMA), the quantitative insulin sensitivity check index (QUICKI), and adiponectin concentration did not differ significantly within each group, the average hs-CRP and IL-6 decreased significantly in the LGI diet group after the 10 week intervention (p=0.009 and p=0.001; respectively). Comparing percent changes, we found a marginally significant decrease in hs-CRP in the LGI group compared with the HNRD group after adjusting for confounders. Compliance with an LGI diet may have favorable effect on inflammation among overweight and obese adolescent girls. PMID:27065462

  1. Impact of a participatory intervention with women's groups on psychological distress among mothers in rural Bangladesh: secondary analysis of a cluster-randomised controlled trial.

    Directory of Open Access Journals (Sweden)

    Kelly Clarke

    Full Text Available Perinatal common mental disorders (PCMDs are a major cause of disability among women and disproportionately affect lower income countries. Interventions to address PCMDs are urgently needed in these settings, and group-based and peer-led approaches are potential strategies to increase access to mental health interventions. Participatory women's health groups led by local women previously reduced postpartum psychological distress in eastern India. We assessed the effect of a similar intervention on postpartum psychological distress in rural Bangladesh.We conducted a secondary analysis of data from a cluster-randomised controlled trial with 18 clusters and an estimated population of 532,996. Nine clusters received an intervention comprising monthly meetings during which women's groups worked through a participatory learning and action cycle to develop strategies for improving women's and children's health. There was one group for every 309 individuals in the population, 810 groups in total. Mothers in nine control clusters had access to usual perinatal care. Postpartum psychological distress was measured with the 20-item Self Reporting Questionnaire (SRQ-20 between six and 52 weeks after delivery, during the months of January to April, in 2010 and 2011.We analysed outcomes for 6275 mothers. Although the cluster mean SRQ-20 score was lower in the intervention arm (mean 5.2, standard deviation 1.8 compared to control (5.3, 1.2, the difference was not significant (β 1.44, 95% CI 0.28, 3.08.Despite promising results in India, participatory women's groups focused on women's and children's health had no significant effect on postpartum psychological distress in rural Bangladesh.

  2. Clinical Trials in Vision Research

    Science.gov (United States)

    ... Eye Health Information > Clinical Trials in Vision Research Clinical Trials in Vision Research Listen Clinical studies depend on ... vision research in the United States. Basics of Clinical Trials What is a clinical trial? Clinical trials are ...

  3. Impact of community-based interventions on maternal and neonatal health indicators: Results from a community randomized trial in rural Balochistan, Pakistan

    Directory of Open Access Journals (Sweden)

    Becker Stan

    2010-11-01

    Full Text Available Abstract Background Pakistan has high maternal mortality, particularly in the rural areas. The delay in decision making to seek medical care during obstetric emergencies remains a significant factor in maternal mortality. Methods We present results from an experimental study in rural Pakistan. Village clusters were randomly assigned to intervention and control arms (16 clusters each. In the intervention clusters, women were provided information on safe motherhood through pictorial booklets and audiocassettes; traditional birth attendants were trained in clean delivery and recognition of obstetric and newborn complications; and emergency transportation systems were set up. In eight of the 16 intervention clusters, husbands also received specially designed education materials on safe motherhood and family planning. Pre- and post-intervention surveys on selected maternal and neonatal health indicators were conducted in all 32 clusters. A district-wide survey was conducted two years after project completion to measure any residual impact of the interventions. Results Pregnant women in intervention clusters received prenatal care and prophylactic iron therapy more frequently than pregnant women in control clusters. Providing safe motherhood education to husbands resulted in further improvement of some indicators. There was a small but significant increase in percent of hospital deliveries but no impact on the use of skilled birth attendants. Perinatal mortality reduced significantly in clusters where only wives received information and education in safe motherhood. The survey to assess residual impact showed similar results. Conclusions We conclude that providing safe motherhood education increased the probability of pregnant women having prenatal care and utilization of health services for obstetric complications.

  4. Clinical trials of homoeopathy.

    OpenAIRE

    Kleijnen, J.; Knipschild, P; ter Riet, G

    1991-01-01

    OBJECTIVE--To establish whether there is evidence of the efficacy of homoeopathy from controlled trials in humans. DESIGN--Criteria based meta-analysis. Assessment of the methodological quality of 107 controlled trials in 96 published reports found after an extensive search. Trials were scored using a list of predefined criteria of good methodology, and the outcome of the trials was interpreted in relation to their quality. SETTING--Controlled trials published world wide. MAIN OUTCOME MEASURE...

  5. How does the impact of a community trial on cardio-metabolic risk factors differ in terms of gender and living area? Findings from the Isfahan healthy heart program

    Directory of Open Access Journals (Sweden)

    Nizal Sarrafzadegan

    2012-01-01

    Full Text Available Objective: To assess the impact of gender and living area on cardiovascular risk factors in the context of a comprehensive lifestyle intervention program. Design: Data from independent sample surveys before (2000--2001 and after (2007 a community trial, entitled the Isfahan Healthy Heart Program (IHHP were used to compare differences in the intervention area (IA and reference area (RA by gender and living area. Setting: The interventions targeted the population living in Isfahan and Najaf-Abad counties as IA and Arak as RA. Participants: Overall, 12 514 individuals who were more than 19 years of age were studied at baseline, and 9570 were studied in postintervention phase. Interventions: Multiple activities were conducted in connection with each of the four main strategies of healthy nutrition, increasing physical activity, tobacco control, and coping with stress. Main Outcomes: Comparing serum lipids levels, blood pressure, blood glucose and obesity indices changes between IA and RA based on sex and living areas during the study. Results: In IA, while the prevalence of hypertension declined in urban and rural females (P < 0.05. In IA, the prevalence of hypercholesterolemia and hypertriglyceridemia decreased in both females and males of urban and rural areas except for hypercholesterolemia in rural males (P < 0.01. In RA, the significant changes include both decrease in the hypercholesterolemia among rural males (P < 0.001 and hypertriglyceridemia in urban females (P < 0.01, while hypertriglyceridemia was significantly increased in rural females (P < 0.01. Conclusions: This comprehensive community trial was effective in controlling many risk factors in both sexes in urban and rural areas. These findings also reflect the transitional status of rural population in adopting urban lifestyle behaviors.

  6. Impact of {sup 11}C-choline PET/CT on clinical decision making in recurrent prostate cancer: results from a retrospective two-centre trial

    Energy Technology Data Exchange (ETDEWEB)

    Ceci, Francesco [University of Bologna, Service of Nuclear Medicine, Policlinico S. Orsola-Malpighi, Bologna (Italy); Universitaetsklinikum Wuerzburg, Department of Nuclear Medicine, Wuerzburg (Germany); Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna (Italy); Herrmann, Ken; Bluemel, Christina; Droll, Sabine; Buck, Andreas K. [Universitaetsklinikum Wuerzburg, Department of Nuclear Medicine, Wuerzburg (Germany); Castellucci, Paolo; Graziani, Tiziano; Fanti, Stefano [University of Bologna, Service of Nuclear Medicine, Policlinico S. Orsola-Malpighi, Bologna (Italy); Schiavina, Riccardo; Brunocilla, Eugenio [University of Bologna, Department of Urology, Policlinico S. Orsola-Malpighi, Bologna (Italy); Vollmer, Christian [Universitaetsklinikum Wuerzburg, Department of Urology, Wuerzburg (Germany); Mazzarotto, Renzo [University of Bologna, Service of Radiotherapy, Policlinico S. Orsola-Malpighi, Bologna (Italy)

    2014-12-15

    The aim of this retrospective two-centre study was to investigate the clinical impact of {sup 11}C-choline PET/CT on treatment management decisions in patients with recurrent prostate cancer (rPCa) after radical therapy. Enrolled in this retrospective study were 150 patients (95 from Bologna, 55 from Wuerzburg) with rPCa and biochemical relapse (PSA mean ± SD 4.3 ± 5.5 ng/mL, range 0.2-39.4 ng/mL) after radical therapy. The intended treatment before PET/CT was salvage radiotherapy of the prostatic bed in 95 patients and palliative androgen deprivation therapy (ADT) in 55 patients. The effective clinical impact of {sup 11}C-choline PET/CT was rated as major (change in therapeutic approach), minor (same treatment, but modified therapeutic strategy) or none. Multivariate binary logistic regression analysis included PSA level, PSA kinetics, ongoing ADT, Gleason score, TNM, age and time to relapse. Changes in therapy after {sup 11}C-choline PET/CT were implemented in 70 of the 150 patients (46.7 %). A major clinical impact was observed in 27 patients (18 %) and a minor clinical impact in 43 (28.7 %). {sup 11}C-choline PET/CT was positive in 109 patients (72.7 %) detecting local relapse (prostate bed and/or iliac lymph nodes and/or pararectal lymph nodes) in 64 patients (42.7 %). Distant relapse (paraaortic and/or retroperitoneal lymph nodes and/or bone lesions) was seen in 31 patients (20.7 %), and both local and distant relapse in 14 (9.3 %). A significant difference was observed in PSA level and PSA kinetics between PET-positive and PET-negative patients (p < 0.05). In multivariate analysis, PSA level, PSA doubling time and ongoing ADT were significant predictors of a positive scan (p < 0.05). In statistical analysis no significant differences were observed between the Bologna and Wuerzburg patients (p > 0.05). In both centres the same criteria to validate PET-positive findings were used: in 17.3 % of patients by histology and in 82.7 % of patients by correlative

  7. A cluster randomized trial to assess the impact of clinical pathways for patients with stroke: rationale and design of the Clinical Pathways for Effective and Appropriate Care Study [NCT00673491

    Directory of Open Access Journals (Sweden)

    Barbieri Antonella

    2008-11-01

    Full Text Available Abstract Background Patients with stroke should have access to a continuum of care from organized stroke units in the acute phase, to appropriate rehabilitation and secondary prevention measures. Moreover to improve the outcomes for acute stroke patients from an organizational perspective, the use of multidisciplinary teams and the delivery of continuous stroke education both to the professionals and to the public, and the implementation of evidence-based stroke care are recommended. Clinical pathways are complex interventions that can be used for this purpose. However in stroke care the use of clinical pathways remains questionable because little prospective controlled data has demonstrated their effectiveness. The purpose of this study is to determine whether clinical pathways could improve the quality of the care provided to the patients affected by stroke in hospital and through the continuum of the care. Methods Two-arm, cluster-randomized trial with hospitals and rehabilitation long-term care facilities as randomization units. 14 units will be randomized either to arm 1 (clinical pathway or to arm 2 (no intervention, usual care. The sample will include 238 in each group, this gives a power of 80%, at 5% significance level. The primary outcome measure is 30-days mortality. The impact of the clinical pathways along the continuum of care will also be analyzed by comparing the length of hospital stay, the hospital re-admissions rates, the institutionalization rates after hospital discharge, the patients' dependency levels, and complication rates. The quality of the care provided to the patients will be assessed by monitoring the use of diagnostic and therapeutic procedures during hospital stay and rehabilitation, and by the use of key quality indicators at discharge. The implementation of organized care will be also evaluated. Conclusion The management of patients affected by stroke involves the expertise of several professionals, which can

  8. SNP calling, genotype calling, and sample allele frequency estimation from new-generation sequencing data

    DEFF Research Database (Denmark)

    Nielsen, Rasmus; Korneliussen, Thorfinn Sand; Albrechtsen, Anders;

    2012-01-01

    calculated using a dynamic programming algorithm and numerically optimized using analytical derivatives. We then use a bayesian method for estimating the sample allele frequency in a single site, and show how the method can be used for genotype calling and SNP calling. We also show how the method can be...

  9. Impact of metabolic syndrome and its components on cardiovascular disease event rates in 4900 patients with type 2 diabetes assigned to placebo in the field randomised trial

    Directory of Open Access Journals (Sweden)

    Scott Russell

    2011-11-01

    Full Text Available Abstract Background Patients with the metabolic syndrome are more likely to develop type 2 diabetes and may have an increased risk of cardiovascular disease (CVD events.We aimed to establish whether CVD event rates were influenced by the metabolic syndrome as defined by the World Health Organisation (WHO, the National Cholesterol Education Program (NCEP Adult Treatment Panel III (ATP III and the International Diabetes Federation (IDF and to determine which component(s of the metabolic syndrome (MS conferred the highest cardiovascular risk in in 4900 patients with type 2 diabetes allocated to placebo in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD trial. Research design and methods We determined the influence of MS variables, as defined by NCEP ATPIII, IDF and WHO, on CVD risk over 5 years, after adjustment for CVD, sex, HbA1c, creatinine, and age, and interactions between the MS variables in a Cox proportional-hazards model. Results About 80% had hypertension, and about half had other features of the metabolic syndrome (IDF, ATPIII. There was no difference in the prevalence of metabolic syndrome variables between those with and without CVD at study entry. The WHO definition identified those at higher CVD risk across both sexes, all ages, and in those without prior CVD, while the ATPIII definition predicted risk only in those aged over 65 years and in men but not in women. Patients meeting the IDF definition did not have higher risk than those without IDF MS. CVD risk was strongly influenced by prior CVD, sex, age (particularly in women, baseline HbA1c, renal dysfunction, hypertension, and dyslipidemia (low HDL-c, triglycerides > 1.7 mmol/L. The combination of low HDL-c and marked hypertriglyceridemia (> 2.3 mmol/L increased CVD risk by 41%. Baseline systolic blood pressure increased risk by 16% per 10 mmHg in those with no prior CVD, but had no effect in those with CVD. In those without prior CVD, increasing numbers of

  10. Assessing the Impact of Community Engagement Interventions on Health Worker Motivation and Experiences with Clients in Primary Health Facilities in Ghana: A Randomized Cluster Trial

    Science.gov (United States)

    Alhassan, Robert Kaba; Nketiah-Amponsah, Edward; Spieker, Nicole; Arhinful, Daniel Kojo; Rinke de Wit, Tobias F.

    2016-01-01

    Background Health worker density per 1000 population in Ghana is one of the lowest in the world estimated to be 2.3, below the global average of 9.3. Low health worker motivation induced by poor working conditions partly explain this challenge. Albeit the wage bill for public sector health workers is about 90% of domestic government expenditure on health in countries such as Ghana, staff motivation and performance output remain a challenge, suggesting the need to complement financial incentives with non-financial incentives through a community-based approach. In this study, a systematic community engagement (SCE) intervention was implemented to engage community groups in healthcare quality assessment to promote mutual collaboration between clients and healthcare providers, and enhance health worker motivation levels. SCE involves structured use of existing community groups and associations to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements made and rewards given to best performing facilities for closing quality care gaps. Purpose To evaluate the effect of SCE interventions on health worker motivation and experiences with clients. Methods The study is a cluster randomized trial involving health workers in private (n = 38) and public (n = 26) primary healthcare facilities in two administrative regions in Ghana. Out of 324 clinical and non-clinical staff randomly interviewed at baseline, 234 (72%) were successfully followed at end-line and interviewed on workplace motivation factors and personal experiences with clients. Propensity score matching and difference-in-difference estimations were used to estimate treatment effect of the interventions on staff motivation. Results Intrinsic (non-financial) work incentives including cordiality with clients and perceived career prospects appeared to be prime sources of motivation for health staff interviewed in intervention health facilities while

  11. Impact of vitamin D on chronic kidney diseases in non-dialysis patients: a meta-analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Lijuan Xu

    Full Text Available BACKGROUND AND OBJECTIVES: Recent studies have supported a role for both newer and more established vitamin D compounds in improving proteinuria, although systematic evaluation is lacking. Furthermore, concerns remain regarding the influence of vitamin D on the progression of renal function. We analyzed the efficacy and safety of vitamin D in non-dialysis patients and compared the use of newer versus established vitamin D compounds by performing a meta-analysis of randomized controlled trials. DESIGN: A literature search of PubMed (1975 to September, 2012, EMBASE.com (1966 to September, 2012 and Ovid EBM Reviews (through September, 2012 was conducted. RESULTS: Eighteen studies were eligible for final inclusion; of these, six explored the effects of vitamin D on proteinuria, twelve studied the effects of supplementation on renal function, and fifteen discussed the incidence of hypercalcemia. Compared to the placebo or no interference, both the newer and established vitamin D sterols reduced proteinuria to a similar extent (RR, 2.00; 95% CI, 1.42 to 2.81. No decrease in the glomerular filter rate was observed (SMD, -0.10; 95%CI, -0.24 to 0.03, and the risk for dialysis initiation was 1.48 (95% CI, 0.54 to 4.03 with vitamin D treatment. Additionally, there was an increased risk of hypercalcemia for patients treated with either newer or established vitamin D compounds as compared with the controls (RR, 4.78; 95% CI, 2.20 to 10.37. The head-to-head studies showed no differences in the effects of either newer or established compounds on proteinuria or the risk of hypercalcemia. No serious adverse events were associated with the administration of vitamin D. CONCLUSIONS: Vitamin D therapy appears to decrease proteinuria and have no negative influence on renal function in non-dialysis patients. But the occurrence of hypercalcemia should be evaluated when vitamin D is provided. No superiority for newer versus established vitamin D analogue is found.

  12. Randomized controlled trial on impacts of dairy meal feeding interventions on early lactation milk production in smallholder dairy farms of Central Kenya.

    Science.gov (United States)

    Richards, Shauna; VanLeeuwen, John A; Shepelo, Getrude; Gitau, George Karuoya; Wichtel, Jeff; Kamunde, Collins; Uehlinger, Fabienne

    2016-03-01

    There is limited field-based research and recommendations on the effect of cattle feeding management practices on smallholder dairy farms (SDF) for the growing dairy industry in Kenya. This controlled trial aimed to determine the effect of feeding locally produced dairy meal (DM) on early lactation daily milk production (DMP) on Kenyan SDF, controlling for other factors associated with DMP. Privately owned, recently calved cows (n=111) were randomly assigned to one of three groups of feeding recommendations for DM (meeting predicted DM requirements by: (1) 100%; (2) 50%; or (3) feeding by the farmer's discretion). DM was provided for free to groups 1 and 2 to ensure they had sufficient DM to feed to the recommendations. Data collection on cow and farm characteristics occurred biweekly for a 60-day period post-calving starting in June 2013. A repeated measures multivariable linear regression model was used on the DMP outcome variable. With variability in DM consumption within feeding groups due to variability in DMP, actual DM fed was assessed as an independent variable rather than assigned feeding groups. DMP was positively associated with each kg/day of DM fed (0.53kg/day), cow weight (0.13kg/day), feeding DM in the month prior to calving (1.42kg/day), and feeding high protein forage (0.41kg/day), and was negatively associated with having mastitis (-0.30kg/day). In interaction terms, taller cows had higher DMP than shorter cows, whereas heifers (first parity cows) had similar DMP regardless of height. Also, thin cows (2+ parity with body condition score<2.5 out of 5) produced less milk (1.0kg/day less) than cows with a better body condition score at calving,whereas thin heifers produced more milk (2.0kg/day more) than heifers in better body condition-this association is possibly due to a small unrepresentative sample size of heifers. In conclusion, feeding DM in the month prior to calving, improving body condition in cows prior to calving, and enhancing dietary DM

  13. Impact of resistance and aerobic exercise on sarcopenia and dynapenia in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial.

    Science.gov (United States)

    Adams, Scott C; Segal, Roanne J; McKenzie, Donald C; Vallerand, James R; Morielli, Andria R; Mackey, John R; Gelmon, Karen; Friedenreich, Christine M; Reid, Robert D; Courneya, Kerry S

    2016-08-01

    The purpose of this study was to conduct an exploratory analysis of the START examining the effects of resistance exercise training (RET) and aerobic exercise training (AET) on sarcopenia, dynapenia, and associated quality of life (QoL) changes in breast cancer (BC) patients receiving adjuvant chemotherapy. Participants were randomized to usual care (UC) (n = 70), AET (n = 64), or RET (n = 66) for the duration of chemotherapy. Measures of sarcopenia [skeletal muscle index (SMI)] and dynapenia [upper extremity (UE) and lower extremity (LE) muscle dysfunction (MD)] were normalized relative to age-/sex-based clinical cut-points. QoL was assessed by the Functional Assessment of Cancer Therapy-Anemia (FACT-An) scales. At baseline, 25.5 % of BC patients were sarcopenic and 54.5 % were dynapenic with both conditions associated with poorer QoL. ANCOVAs showed significant differences favoring RET over UC for SMI (0.32 kg/m(2); p = 0.017), UE-MD (0.12 kg/kg; p < 0.001), and LE-MD (0.27 kg/kg; p < 0.001). Chi-square analyses revealed significant effects of RET, compared to UC/AET combined, on reversing sarcopenia (p = 0.039) and dynapenia (p = 0.019). The reversal of sarcopenia was associated with clinically relevant improvements in the FACT-An (11.7 points [95 % confidence interval (CI) -4.2 to 27.6]), the Trial Outcome Index-Anemia (10.0 points [95 % CI -4.0 to 24.1]), and fatigue (5.3 points [95 % CI -1.5 to 12.1]). Early-stage BC patients initiating adjuvant chemotherapy have higher than expected rates of sarcopenia and dynapenia which are associated with poorer QoL. RET during adjuvant chemotherapy resulted in the reversal of both sarcopenia and dynapenia; however, only the reversal of sarcopenia was associated with clinically meaningful improvements in QoL. PMID:27394134

  14. Impact of Vitamin D on Chronic Kidney Diseases in Non-Dialysis Patients: A Meta-Analysis of Randomized Controlled Trials

    Science.gov (United States)

    Xu, Lijuan; Wan, Xuesi; Huang, Zhimin; Zeng, Fangfang; Wei, Guohong; Fang, Donghong; Deng, Wanping; Li, Yanbing

    2013-01-01

    Background and Objectives Recent studies have supported a role for both newer and more established vitamin D compounds in improving proteinuria, although systematic evaluation is lacking. Furthermore, concerns remain regarding the influence of vitamin D on the progression of renal function. We analyzed the efficacy and safety of vitamin D in non-dialysis patients and compared the use of newer versus established vitamin D compounds by performing a meta-analysis of randomized controlled trials. Design A literature search of PubMed (1975 to September, 2012), EMBASE.com (1966 to September, 2012) and Ovid EBM Reviews (through September, 2012) was conducted. Results Eighteen studies were eligible for final inclusion; of these, six explored the effects of vitamin D on proteinuria, twelve studied the effects of supplementation on renal function, and fifteen discussed the incidence of hypercalcemia. Compared to the placebo or no interference, both the newer and established vitamin D sterols reduced proteinuria to a similar extent (RR, 2.00; 95% CI, 1.42 to 2.81). No decrease in the glomerular filter rate was observed (SMD, −0.10; 95%CI, −0.24 to 0.03), and the risk for dialysis initiation was 1.48 (95% CI, 0.54 to 4.03) with vitamin D treatment. Additionally, there was an increased risk of hypercalcemia for patients treated with either newer or established vitamin D compounds as compared with the controls (RR, 4.78; 95% CI, 2.20 to 10.37). The head-to-head studies showed no differences in the effects of either newer or established compounds on proteinuria or the risk of hypercalcemia. No serious adverse events were associated with the administration of vitamin D. Conclusions Vitamin D therapy appears to decrease proteinuria and have no negative influence on renal function in non-dialysis patients. But the occurrence of hypercalcemia should be evaluated when vitamin D is provided. No superiority for newer versus established vitamin D analogue is found. PMID:23626678

  15. Randomised controlled trials for evaluating the prescribing impact of information meetings led by pharmacists and of new information formats, in General Practice in Italy

    Directory of Open Access Journals (Sweden)

    Magnano Lucia

    2007-09-01

    to evaluate the organisational feasibility and barriers to the implementation of independent information programs led by NHS pharmacists. The objective to assess a 10 or 15% decreases in the prescription of the targeted drugs is quite ambitious in such 'natural' settings, which will be minimally altered by the interventions themselves; this in spite of the quite large sample sizes used comparing to other studies of these kind. Complex interventions like these are not easy to evaluate, given the many different variables into play. Anyway, the pragmatic nature of the two RCTs appears to be also one of their major strengths, helping to provide a deeper insight on what is possible to achieve – in terms of independent information – in a National Health System, with special reference to Italy. Trial registration ISRCTN05866587 (cluster RCT and ISRCTN28525676 (single GPs RCT

  16. Exploring the variation in implementation of a COPD disease management programme and its impact on health outcomes: a post hoc analysis of the RECODE cluster randomised trial.

    Science.gov (United States)

    Boland, Melinde R S; Kruis, Annemarije L; Huygens, Simone A; Tsiachristas, Apostolos; Assendelft, Willem J J; Gussekloo, Jacobijn; Blom, Coert M G; Chavannes, Niels H; Rutten-van Mölken, Maureen P M H

    2015-01-01

    This study aims to (1) examine the variation in implementation of a 2-year chronic obstructive pulmonary disease (COPD) management programme called RECODE, (2) analyse the facilitators and barriers to implementation and (3) investigate the influence of this variation on health outcomes. Implementation variation among the 20 primary-care teams was measured directly using a self-developed scale and indirectly through the level of care integration as measured with the Patient Assessment of Chronic Illness Care (PACIC) and the Assessment of Chronic Illness Care (ACIC). Interviews were held to obtain detailed information regarding the facilitators and barriers to implementation. Multilevel models were used to investigate the association between variation in implementation and change in outcomes. The teams implemented, on average, eight of the 19 interventions, and the specific package of interventions varied widely. Important barriers and facilitators of implementation were (in)sufficient motivation of healthcare provider and patient, the high starting level of COPD care, the small size of the COPD population per team, the mild COPD population, practicalities of the information and communication technology (ICT) system, and hurdles in reimbursement. Level of implementation as measured with our own scale and the ACIC was not associated with health outcomes. A higher level of implementation measured with the PACIC was positively associated with improved self-management capabilities, but this association was not found for other outcomes. There was a wide variety in the implementation of RECODE, associated with barriers at individual, social, organisational and societal level. There was little association between extent of implementation and health outcomes. PMID:26677770

  17. BUSINESS MODELS FOR EXTENDING OF 112 EMERGENCY CALL CENTER CAPABILITIES WITH E-CALL FUNCTION INSERTION

    Directory of Open Access Journals (Sweden)

    Pop Dragos Paul

    2010-12-01

    Full Text Available The present article concerns present status of implementation in Romania and Europe of eCall service and the proposed business models regarding eCall function implementation in Romania. eCall system is used for reliable transmission in case of crush between In Vehicle System and Public Service Answering Point, via the voice channel of cellular and Public Switched Telephone Network (PSTN. eCall service could be initiated automatically or manual the driver. All data presented in this article are part of researches made by authors in the Sectorial Contract Implementation study regarding eCall system, having as partners ITS Romania and Electronic Solution, with the Romanian Ministry of Communication and Information Technology as beneficiary.

  18. Calling Card Analysis in Budding Yeast.

    Science.gov (United States)

    Mayhew, David; Mitra, Robi D

    2016-02-01

    Calling card analysis is a high-throughput method for identifying the genomic binding sites of multiple transcription factors in a single experiment in budding yeast. By tagging a DNA-binding protein with a targeting domain that directs the insertion of the Ty5 retrotransposon, the genomic binding sites for that transcription factor are marked. The transposition locations are then identified en masse by Illumina sequencing. The calling card protocol allows for simultaneous analysis of multiple transcription factors. By cloning barcodes into the Ty5 transposon, it is possible to pair a unique barcode with every transcription factor in the experiment. The method presented here uses expression of transcription factors from their native loci; however, it can also be altered to measure binding sites of transcription factors overexpressed from a plasmid. PMID:26832687

  19. Towards Building an Intelligent Call Routing System

    Directory of Open Access Journals (Sweden)

    Thien Khai Tran

    2016-01-01

    Full Text Available This paper presents EduICR - an Intelligent Call Routing system. This system can route calls to the most appropriate agent using routing rules built by the text classifier. EduICR includes the following main components: telephone communication network; Vietnamese speech recognition; Text classifier/ Natural language processor and Vietnamese speech synthesis. To our best knowledge, this is one of the first systems in Vietnam to implement the integration mechanism of text processing and speech processing. This allows voice applications to be more intelligent, able to communicate with humans in natural language with high accuracy and reasonable speed. Having been built and tested in real environment, our system proves its accuracy attaining more than 95%.

  20. Multidisciplinary rehabilitation can impact on health-related quality of life outcome in radical cystectomy: secondary reported outcome of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Jensen BT

    2014-07-01

    Full Text Available Bente Thoft Jensen,1,2 Jørgen Bjerggaard Jensen,1,2 Sussie Laustsen,2,3 Annemette Krintel Petersen,2,4 Ingrid Søndergaard,2 Michael Borre1,2 1Department of Urology, 2Department of Clinical Medicine, Centre of Research in Rehabilitation, 3Department of Cardiothoracic and Vascular Surgery, 4Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark Purpose: Health related quality of life (HRQoL is an important outcome in cancer care, although it is not well reported in surgical uro-oncology. Radical cystectomy (RC with lymph-node dissection is the standard treatment of muscle-invasive bladder cancer and high-risk noninvasive bladder cancer. A wide range of impairments are reported postsurgery. The aims were to evaluate whether a standardized pre- and postoperative physical exercise program and enhanced mobilization can impact on HRQoL and inpatient satisfaction in RC, as defined by the European Organisation for Research and Treatment of Cancer (EORTC. Materials and methods: Patients were randomized to fast-track RC and intervention (nI=50 or fast-track standard treatment (ns=57. HRQoL and inpatient satisfaction was measured using valid questionnaires: EORTC Quality of Life Questionnaire Core 30 (QLQ-C30 combined with the disease-specific EORTC BLS24 (baseline, and EORTC BLM30 (follow-up, and IN-PATSAT32 inpatient-satisfaction survey at discharge. Efficacy was defined as the differences in HRQoL-scores between treatment groups at the 4-month follow-up. Results: The intervention group significantly improved HRQoL scores in dyspnea (P≤0.05, constipation (P<0.02, and abdominal flatulence (P≤0.05 compared to the standard group. In contrast, the standard group reported significantly reduced symptoms in sleeping pattern (P≤0.04 and clinically relevant differences in role function, body function, and fatigue. The intervention did not compromise inpatient satisfaction. Conclusion: We found no overall impact

  1. Impact of whole-body electromyostimulation on body composition in elderly women at risk for sarcopenia: the Training and ElectroStimulation Trial (TEST-III).

    Science.gov (United States)

    Kemmler, Wolfgang; Bebenek, Michael; Engelke, Klaus; von Stengel, Simon

    2014-02-01

    Most studies have confirmed the positive impact of resistance training on muscle mass and functional capacity in aging adults. However, due to physical limitation or a simple aversion against regular exercise, the majority of elderly subjects do not reach the exercise doses recommended for impacting strength or muscle mass. This led us to evaluate the effect of whole-body electromyostimulation (WB-EMS), a novel, time-efficient and smooth training technology, on body composition with special regard to sarcopenia. Seventy-six lean, non-sportive women (75 ± 4 years) were randomly assigned to either a WB-EMS group (WB-EMS, n = 38) that performed 18 min of WB-EMS (bipolar, 85 Hz) 3 sessions in 14 days (1.5 sessions/week) or a semi-active control group (aCG, n = 38). Body composition was assessed by dual-energy X-ray absorptiometry and maximum strength was evaluated using isometric techniques for trunk and legs. After 54 weeks of intervention, significant inter-group differences were determined for appendicular skeletal muscle mass (WB-EMS, 0.4 ± 2.2 % vs. aCG, -1.5 ± 3.1 %; p = 0.009), lean body mass (WB-EMS, 0.8 ± 1.8 % vs. aCG, -0.8 ± 2.7 %; p = 0.008) and maximum isometric strength (leg extensors, 9.8 ± 12.9 % vs. 0.2 ± 10.4 %; p = 0.003; trunk extensors, 10.1 ± 12.7 vs. -1.6 ± 8.6 %; p = 0.001). Although borderline significant for abdominal fat mass (WB-EMS, -2.9 ± 8.3 vs. aCG, 1.5 ± 10.7 %; p = 0.069), differences did not reach statistically significant levels for body fat parameters. Considering the clinical effectiveness for impacting sarcopenia and the good acceptance of this technology by this non-sportive cohort of elderly women, we conclude that for elderly subjects unable or unwilling to perform dynamic strength exercises, electromyostimulation may be a less off-putting alternative to maintain lean body mass and strength. PMID:23949160

  2. NEWHINTS cluster randomised trial to evaluate the impact on neonatal mortality in rural Ghana of routine home visits to provide a package of essential newborn care interventions in the third trimester of pregnancy and the first week of life: trial protocol

    Directory of Open Access Journals (Sweden)

    Pitt Catherine

    2010-05-01

    Full Text Available Abstract Background Tackling neonatal mortality is essential for the achievement of the child survival millennium development goal. There are just under 4 million neonatal deaths, accounting for 38% of the 10.8 million deaths among children younger than 5 years of age taking place each year; 99% of these occur in low- and middle-income countries where a large proportion of births take place at home, and where postnatal care for mothers and neonates is either not available or is of poor quality. WHO and UNICEF have issued a joint statement calling for governments to implement "Home visits for the newborn child: a strategy to improve survival", following several studies in South Asia which achieved substantial reductions in neonatal mortality through community-based approaches. However, their feasibility and effectiveness have not yet been evaluated in Africa. The Newhints study aims to do this in Ghana and to develop a feasible and sustainable community-based approach to improve newborn care practices, and by so doing improve neonatal survival. Methods Newhints is an integrated intervention package based on extensive formative research, and developed in close collaboration with seven District Health Management Teams (DHMTs in Brong Ahafo Region. The core component is training the existing community based surveillance volunteers (CBSVs to identify pregnant women and to conduct two home visits during pregnancy and three in the first week of life to address essential care practices, and to assess and refer very low birth weight and sick babies. CBSVs are supported by a set of materials, regular supervisory visits, incentives, sensitisation activities with TBAs, health facility staff and communities, and providing training for essential newborn care in health facilities. Newhints is being evaluated through a cluster randomised controlled trial, and intention to treat analyses. The clusters are 98 supervisory zones; 49 have been randomised for

  3. CALL Implementation Strategies:A Case Study

    OpenAIRE

    BRIERLEY, Mark; Orlandini, Andrea

    2010-01-01

    This paper will begin by discussing changes in CALL (Computer Assisted Language Learning) over the past decade, identifying three modes: computers as teachers; computers used for communication between teachers and students; and communication among students. Next, we will investigate how key components of the Moodle LMS (Learning Management System), such as quizzes, forums and wikis can contribute to language acquisition by facilitating comprehensible input through task-based, communicative le...

  4. Sustainability Science: A Call to Collaborative Action

    OpenAIRE

    David D. Hart; Bell, Kathleen P.

    2013-01-01

    Sustainability science is an emerging field directed at advancing sustainable development. Informed by recent scholarship and institutional experiments, we identify key roles for economists and encourage their greater participation in this research. Our call to collaborative action comes from positive experiences with the Sustainability Solutions Initiative based at the University of Maine, where economists collaborate with other experts and diverse stakeholders on real-world problems involvi...

  5. First Class Call Stacks: Exploring Head Reduction

    OpenAIRE

    Johnson-Freyd, Philip; Downen, Paul; Ariola, Zena M.

    2016-01-01

    Weak-head normalization is inconsistent with functional extensionality in the call-by-name $\\lambda$-calculus. We explore this problem from a new angle via the conflict between extensionality and effects. Leveraging ideas from work on the $\\lambda$-calculus with control, we derive and justify alternative operational semantics and a sequence of abstract machines for performing head reduction. Head reduction avoids the problems with weak-head reduction and extensionality, while our operational ...

  6. Parental alarm calls suppress nestling vocalization.

    OpenAIRE

    Platzen, Dirk; Magrath, Robert D.

    2004-01-01

    Evolutionary models suggest that the cost of a signal can ensure its honesty. Empirical studies of nestling begging imply that predator attraction can impose such a cost. However, parents might reduce or abolish this cost by warning young of the presence of danger. We tested, in a controlled field playback experiment, whether alarm calls cause 5-, 8- and 11-day-old nestlings of the white-browed scrubwren, Sericornis frontalis, to suppress vocalization. In this species, nestlings vocalize when...

  7. Message Classification in the Call Center

    OpenAIRE

    Busemann, Stephan; Schmeier, Sven; Arens, Roman G.

    2000-01-01

    Customer care in technical domains is increasingly based on e-mail communication, allowing for the reproduction of approved solutions. Identifying the customer's problem is often time-consuming, as the problem space changes if new products are launched. This paper describes a new approach to the classification of e-mail requests based on shallow text processing and machine learning techniques. It is implemented within an assistance system for call center agents that is used in a commercial se...

  8. Orangutan Night-Time Long Call Behavior: Sleep Quality Costs Associated with Vocalizations in Captive Pongo

    Directory of Open Access Journals (Sweden)

    David R. Samson

    2014-01-01

    Full Text Available Researchers have suggested that the ability of male primates to emit long-distance vocalizations is energetically costly and potentially incurring important adaptive consequences upon the calling individuals. Here, we present the first preliminary data on captive orangutan (Pongo spp. nocturnal long calls, generated at the Indianapolis Zoo. We used videography to characterize long calls with observed behavioral contexts for 48 nights (816 observed hours totaling 83 long calls. We generated somnographic data for a subset of the long calls. Overall measures of sleep quality generated by infrared videography were then compared to the somnographic, nocturnal long call data. We tested hypotheses related to the proximate mechanisms involved in the initialization of vocalization and the potential costs of emitting long calls to overall sleep quality. We found that (1 performed long calls were conscious and premeditated in nature and (2 greater number of night-time long calls shared a positive relationship with arousability and sleep fragmentation and a negative relationship with total sleep time and sleep quality. These findings strongly suggest that only several minutes of total time invested in long calls throughout the night disproportionately cost the caller by negatively impacting overall sleep quality.

  9. A cluster randomised controlled trial in primary dental care based intervention to improve professional performance on routine oral examinations and the management of asymptomatic impacted third molars: study protocol

    Directory of Open Access Journals (Sweden)

    Grol Richard PTM

    2007-04-01

    Full Text Available Abstract Background Routine oral examination (ROE refers to periodic monitoring of the general and oral health status of patients. In most developed Western countries a decreasing prevalence of oral diseases underpins the need for a more individualised approach in assigning individualised recall intervals for regular attendees instead of systematic fixed intervals. From a quality-of-care perspective, the effectiveness of the widespread prophylactic removal of mandibular impacted asymptomatic third molars (MIM in adolescents and adults is also questionable. Data on the effectiveness of appropriate interventions to tackle such problems, and for promoting continuing professional development in oral health care are rare. Methods/design This study is a cluster randomised controlled trial with groups of GDPs as the unit of randomisation. The aim is to determine the effectiveness and efficiency of small group quality improvement on professional decision-making of general dental practitioners (GDPs in daily practice. Six peer groups ('IQual-groups' shall be randomised either to the intervention arm I or arm II. Groups of GDPs allocated to either of these arms act as each other's control group. An IQual peer group consists of eight to ten GDPs who meet in monthly structured sessions scheduled for discussion on practice-related topics. GDPs in both trial arms receive recently developed evidence-based clinical practice guidelines (CPG on ROE or MIM. The implementation strategy consists of one interactive IQual group meeting of two to three hours. In addition, both groups of GDPs receive feedback on personal and group characteristics, and are invited to make use of web-based patient risk vignettes for further individual training on risk assessment policy. Reminders (flow charts will be sent by mail several weeks after the meeting. The main outcome measure for the ROE intervention arm is the use and appropriateness of individualised risk assessment in

  10. It's never too late to publish an abandoned trial

    Science.gov (United States)

    Shiles, Celia; Sinclair, Julia

    2015-01-01

    It is estimated that half of all trials have never been published which can lead to patients being denied the most effective treatment and being exposed to unnecessary side effects.  Furthermore the trial participants have been misinformed since the trial results have not contributed to the care of future patients. However the non-publication of trials is often not due to a deliberate decision to cover up results.  Commonly in academia it is due to more understandable reasons such as researchers having busy clinical posts, moving onto other more demanding projects, changing research areas or starting a family.  This is called the “file drawer” problem. The examples in this editorial demonstrate that it is possible to go back, even decades later, and make the results available to inform future evidence based medicine.  We call on others to look into their “file drawer” for unpublished trials. PMID:26097695

  11. Call for standardized definitions of osteoarthritis and risk stratification for clinical trials and clinical use

    DEFF Research Database (Denmark)

    Kraus, V B; Blanco, F J; Englund, M;

    2015-01-01

    Osteoarthritis (OA) is a heterogeneous disorder. The goals of this review are (1) To stimulate use of standardized nomenclature for OA that could serve as building blocks for describing OA and defining OA phenotypes, in short to provide unifying disease concepts for a heterogeneous disorder; and ...

  12. Unenhanced helical computed tomography vs intravenous urography in patients with acute flank pain: accuracy and economic impact in a randomized prospective trial

    Energy Technology Data Exchange (ETDEWEB)

    Pfister, S.A. [Department of Radiology, University Hospital, Petersgraben 4, 4031, Basel (Switzerland); Medical Imaging Lucerne, Theaterstrasse 7, 6003, Lucerne (Switzerland); Deckart, A.; Laschke, S.; Gasser, T.C. [Department of Urology, University Hospital, Petersgraben 4, 4031, Basel (Switzerland); Dellas, S.; Otto, U.; Buitrago, C.; Wiesner, W.; Bongartz, G. [Department of Radiology, University Hospital, Petersgraben 4, 4031, Basel (Switzerland); Roth, J. [Department of Radiologic Physics, University Hospital, Petersgraben 4, 4031, Basel (Switzerland)

    2003-11-01

    Unenhanced helical computed tomography (UHCT) has evolved into a well-accepted alternative to intravenous urography (IVU) in patients with acute flank pain and suspected ureterolithiasis. The purpose of our randomized prospective study was to analyse the diagnostic accuracy of UHCT vs IVU in the normal clinical setting with special interest on economic impact, applied radiation dose and time savings in patient management. A total of 122 consecutive patients with acute flank pain suggestive of urolithiasis were randomized for UHCT (n=59) or IVU (n=63). Patient management (time, contrast media), costs and radiation dose were analysed. The films were independently interpreted by four radiologists, unaware of previous findings, clinical history and clinical outcome. Alternative diagnoses if present were assessed. Direct costs of UHCT and IVU are nearly identical (310/309 Euro). Indirect costs are much lower for UHCT because it saves examination time and when performed immediately initial abdominal plain film (KUB) and sonography are not necessary. Time delay between access to the emergency room and start of the imaging procedure was 32 h 7 min for UHCT and 36 h 55 min for IVU. The UHCT took an average in-room time of 23 min vs 1 h 21 min for IVU. Mild to moderate adverse reactions for contrast material were seen in 3 (5%) patients. The UHCT was safe, as no contrast material was needed. The mean applied radiation dose was 3.3 mSv for IVU and 6.5 mSv for UHCT. Alternative diagnoses were identified in 4 (7%) UHCT patients and 3 (5%) IVU patients. Sensitivity and specificity of UHCT and IVU was 94.1 and 94.2%, and 85.2 and 90.4%, respectively. In patients with suspected renal colic KUB and US may be the least expensive and most easily accessable modalities; however, if needed and available, UHCT can be considered a better alternative than IVU because it has a higher diagnostic accuracy and a better economic impact since it is more effective, faster, less expensive and less

  13. Unenhanced helical computed tomography vs intravenous urography in patients with acute flank pain: accuracy and economic impact in a randomized prospective trial

    International Nuclear Information System (INIS)

    Unenhanced helical computed tomography (UHCT) has evolved into a well-accepted alternative to intravenous urography (IVU) in patients with acute flank pain and suspected ureterolithiasis. The purpose of our randomized prospective study was to analyse the diagnostic accuracy of UHCT vs IVU in the normal clinical setting with special interest on economic impact, applied radiation dose and time savings in patient management. A total of 122 consecutive patients with acute flank pain suggestive of urolithiasis were randomized for UHCT (n=59) or IVU (n=63). Patient management (time, contrast media), costs and radiation dose were analysed. The films were independently interpreted by four radiologists, unaware of previous findings, clinical history and clinical outcome. Alternative diagnoses if present were assessed. Direct costs of UHCT and IVU are nearly identical (310/309 Euro). Indirect costs are much lower for UHCT because it saves examination time and when performed immediately initial abdominal plain film (KUB) and sonography are not necessary. Time delay between access to the emergency room and start of the imaging procedure was 32 h 7 min for UHCT and 36 h 55 min for IVU. The UHCT took an average in-room time of 23 min vs 1 h 21 min for IVU. Mild to moderate adverse reactions for contrast material were seen in 3 (5%) patients. The UHCT was safe, as no contrast material was needed. The mean applied radiation dose was 3.3 mSv for IVU and 6.5 mSv for UHCT. Alternative diagnoses were identified in 4 (7%) UHCT patients and 3 (5%) IVU patients. Sensitivity and specificity of UHCT and IVU was 94.1 and 94.2%, and 85.2 and 90.4%, respectively. In patients with suspected renal colic KUB and US may be the least expensive and most easily accessable modalities; however, if needed and available, UHCT can be considered a better alternative than IVU because it has a higher diagnostic accuracy and a better economic impact since it is more effective, faster, less expensive and less

  14. Impact of the prophylactic gastrostomy for unresectable squamous cell head and neck carcinomas treated with radio-chemotherapy on quality of life: Prospective randomized trial

    International Nuclear Information System (INIS)

    Background and purpose: Concomitant radio-chemotherapy is the gold standard treatment for unresectable head and neck carcinomas. Placement of prophylactic gastrostomy has been proposed to provide adequate nutrition during the therapeutic sequence. The objectives of this study were to assess the impact of prophylactic gastrostomy on the 6-month quality of life, and to determine the factors related to this quality of life. Materials and methods: Design. randomized, controlled, open study ('systematic percutaneous gastrostomy' versus 'no systematic gastrostomy'). Patients. squamous cell head and neck carcinoma (stages III and IV, UICC 1997). Setting. oncological departments of French university teaching hospitals. Treatment. optimal concomitant radio-chemotherapy. Evaluations. T0 baseline evaluation, T1 during the treatment, T2 end of the treatment, and T3 6-month post-inclusion. Primary endpoint. 6-month quality of life (Qol) assessed using SF36, EORTC QLQ-C30, EORTC QLQ H and N35 questionnaires. Results: The Qol changes from baseline included a decline (T1 and T2) followed by an improvement (T3). Qol at 6 months was significantly higher in the group receiving systematic prophylactic gastrostomy (p = 10-3). Higher initial BMI and lower initial Karnofsky index were significant factors related to a higher 6-month Qol. Conclusions: The study results suggest that prophylactic gastrostomy improves post-treatment quality of life for unresectable head and neck cancer patients, after adjusting for other potential predictive quality of life factors.

  15. Impact assessment of nutritional education and motivation of mothers in food supplementation of malnourished 2-5 years old in an urban slum of Ludhiana: A field trial

    Directory of Open Access Journals (Sweden)

    Ragini .

    2014-12-01

    Full Text Available Background: Malnutrition in all its forms remains a major public health problem throughout the developing world and is an underlying factor in child mortality. India is home to 40 percent of the world’s malnourished children. 2 million children die in India, accounting for one in five child deaths in the world. More than half of these deaths could be prevented if children were well nourished.  Objectives: To assess the impact of maternal education and motivation in the nutritional supplementation of malnourished 2-5 years olds in an urban slum area of Ludhiana. Methodology: A community-based interventional study was carried out in 101 eligible children in an urban slum of Ludhiana. The mothers were given nutritional and health education and were also taught how to prepare different types of low cost energy-dense supplementary foodstuffs for the children. The results were seen in terms of continuation of the practice after educating and motivating the mothers of malnourished under-fives to provide the supplementary nutrition. The data was analyzed using Epi-Info version-6 software and SPSS version 16. Result: Post intervention showed that number of days in a month the mother gave nutritional supplement declined from mean 17.5 days to 10.5 days from first to sixth month follow up. Conclusion: Nutritional status of the children improves with continued nutrition and health education of the mothers.

  16. Impact of weight loss on survival after chemoradiation for locally advanced head and neck Cancer: secondary results of a randomized phase III trial (SAKK 10/94)

    International Nuclear Information System (INIS)

    To analyze the impact of weight loss before and during chemoradiation on survival outcomes in patients with locally advanced head and neck cancer. From 07/1994-07/2000 a total of 224 patients with squamous cell carcinoma of the head and neck were randomized to either hyperfractionated radiation therapy alone or the same radiation therapy combined with two cycles of concomitant cisplatin. The primary endpoint was time to any treatment failure (TTF); secondary endpoints were locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS) and overall survival (OS). Patient weight was measured 6 months before treatment, at treatment start and treatment end. The proportion of patients with >5% weight loss was 32% before, and 51% during treatment, and the proportion of patients with >10% weight loss was 12% before, and 17% during treatment. After a median follow-up of 9.5 years (range, 0.1 – 15.4 years) weight loss before treatment was associated with decreased TTF, LRRFS, DMFS, cancer specific survival and OS in a multivariable analysis. However, weight loss during treatment was not associated with survival outcomes. Weight loss before and during chemoradiation was commonly observed. Weight loss before but not during treatment was associated with worse survival

  17. Randomized Trial Evaluating the Impact of Ribavirin Mono-Therapy and Double Dosing on Viral Kinetics, Ribavirin Pharmacokinetics and Anemia in Hepatitis C Virus Genotype 1 Infection.

    Directory of Open Access Journals (Sweden)

    Jesper Waldenström

    Full Text Available In this pilot study (RibaC, 58 hepatitis C virus (HCV genotype 1 infected treatment-naïve patients were randomized to (i 2 weeks ribavirin double dosing concomitant with pegylated interferon-α (pegIFN-α, (ii 4 weeks ribavirin mono-therapy prior to adding pegIFN-α, or (iii standard-of-care (SOC ribavirin dosing concurrent with pegIFN-α. Four weeks of ribavirin mono-therapy resulted in a mean 0.46 log(10 IU/mL HCV RNA reduction differentially regulated across IL28B genotypes (0.89 vs. 0.21 log(10 IU/mL for CC and CT/TT respectively; P = 0.006, increased likelihood of undetectable HCV RNA week 4 after initiating pegIFN-α and thus shortened treatment duration (P<0.05, and decreased median IP-10 concentration from 550 to 345 pg/mL (P<0.001. Both experimental strategies impacted on ribavirin concentrations, and high levels were achieved after one week of double dosing. However, by day 14, double dosing entailed a greater hemoglobin decline as compared to SOC (2.2 vs. 1.4 g/dL; P = 0.03. Conclusion: Ribavirin down-regulates IP-10, and may have an anti-viral effect differently regulated across IL28B genotypes.

  18. Una propuesta urbana para la Calle Mayor

    OpenAIRE

    Sambricio, Carlos

    1996-01-01

    Estudiar el desarrollo y la configuración de la Calle Mayor de Madrid supone enfrentarse a uno de los hechos originarios en configuración urbana. La historia urbana -diferenciada de lo que tras entienden como "Historia de la ciudad"- se ha planteado generalmente desde el análisis del desarrollo, transformación e intervención en el hecho histórico. Frente a las políticas de vivienda, a la contraposición entre Ensanche o Extrarradio, a la definición de operaciones de reforma interior o propuest...

  19. Designing a Call Center with Impatient Customers

    OpenAIRE

    O. Garnet; Mandelbaum, A.; M. Reiman

    2002-01-01

    The most common model to support workforce management of telephone call centers is the M/M/N/B model, in particular its special cases M/M/N (Erlang C, which models out busy signals) and M/M/N/N (Erlang B, disallowing waiting). All of these models lack a central prevalent feature, namely, that impatient customers might decide to leave (abandon) before their service begins. In this paper, we analyze the simplest abandonment model, in which customers' patience is exponentially distributed and th...

  20. The so-called nuclear waste affair

    International Nuclear Information System (INIS)

    The so-called nuclear waste affair has placed the Hanau nuclear fuel company NUKEM and its daughter Transnuklear in the centre of public discussions about nuclear safety. The disclosed and alleged irregularities have led to preliminary investigation by the public prosecutor, a parliamentary inquiry commission has been set in, and the Hanau companies have been re-organised by order of the state: Transnuklear has been dissolved, and NUKEM will discontinue fuel element fabrication. The article in hand explains the foundation and the history of the NUKEM company and its daughter companies in order to reveal the significance of the current events. (orig./DG)