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Sample records for clinical investigation program

  1. Clinical Investigation Program.

    Science.gov (United States)

    1985-10-01

    Tracheoesophageal Fistula: Diagnosis with CT. Pediatr Radiol 15:134-135, 1985 Sueoka BL, Johnson JF, Enzenauer RW, Kolina JS: Infantile Infectious Sacroiliitis...C) Stokes WS: Spontaneous Diabetes Mellitus in a Baboon (Papio anubis). 35th Annual Session, American Association for Laboratory Animal Science...Summary Sheet Prot No: 21H/85 Status: Ongoing TITLE: Efficacy of Cholestyramine in Acute Infantile Diarrhea Principal Investigator: CPT George M. Maher

  2. Clinical Investigation Program, RCS MED-300 (RI).

    Science.gov (United States)

    1984-10-01

    protocol is a clinical validation study uti - lizing the BIOTRONIK DIPLOS 04 Dual Chamber Pulse Generator. This study is being conducted under an...recurrence-rates, survival-rates, and pattern of recurrence for patients receiving therapy uti - lizing surgery and postoperative radiation vs combined...placed in the treatment qroup or control aroup by the pharmacist . Progress: Terminate. Both the principal and associate investigators have ETS d. 7

  3. Clinical Investigation Program: Annual Progress Report

    Science.gov (United States)

    1992-09-30

    Diamminedichloroplatinum (II), Methotrexate and Bleomycin in the Treatment of Advanced Epidermoid Carcinoma of the Penis , Phase II...II), Methotrexate and Bleomycin in the Treatment of Advanced Epidermoid Carcinoma of the Penis , Phase II (5) Start Date: (6) Est Compl Date: (7...Associate Investigators (11) Key Words: constitutional delay delayed puberty (12) Accumulative MEDCASE:* (13) Est Accum OKA Cost:* *Refer to Unit Summary

  4. Clinical Investigation Program Annual Progress Report

    Science.gov (United States)

    1993-09-30

    The assigned staff of the Molecular Biology Service are Dr. Anthony G. Gutierrez , Chef , GSl3, Ph. D. in Molecular Genetics, and Ms. Judith O’Brien...Node-Negative Breast Cancer Patients Using a Panel of Prognostic Factors. A Companion Protocol to SWOG 8897 ................................ . 103 91...of Prog- nostic Factors. A companion protocol to 8897 (5) Start Date: 1991 (6) Est Compl Date: (7) Principal Investigator: (8) Facility: FAMC Thomas

  5. Clinical Investigation Program Annual Progress Report

    Science.gov (United States)

    1988-10-20

    Presented: Interna- tional Symposium on Orthopedics, Mexico , September 1987. Publications: In preparation. 147 FAMC A.P.R. (RCS MED 300) Detail Summary...Infection: A Prospective Study. Presented: 2nd Annual Symposium of the Rocky Moun- tain Flow Cytometry Users Group, Albuquerque, New Mexico , 10-11...Podgore, COL, MC (9) Dept/ISvc: Pediatrics (10) Associate Investigators (11) Key Words: Myron J. Levin, M.D. varicella vaccine U Co. HSC (12

  6. 59th Medical Wing Clinical Research Division Clinical Investigations Program Pathology Poster

    Science.gov (United States)

    2017-04-28

    59 MDW/SGVU SUBJECT: Professional Presentation Approval 1. Your paper, entitled 59th Medical Wing Clinical Research Division Clinical Investigations...Program Pathology Poster presented at/published to For hanging in a hallway of the 591h Medical Wing Clinical Research Division, Bldg 4430 in...Graduate Health Sciences Education student and your department has told you they cannot fund your publication, the 59th Clinical Research Division may

  7. Clinical Investigation Program. Annual Progress Report. Volume 1

    Science.gov (United States)

    1994-01-20

    Components Surgical Day, Bethesda, MD, in April 1993. 2. Planned for FY-94 The Department of Clinical Investigation hopes to maintain the essence of the...sclerosing cholangitis after choledochojejun- ostomy : radiographic and biochemical improvement with antibiotic therapN. Am J Gastroenterol 1993;88:1635

  8. Clinical Investigation Program Report, RCS MED-300 (R1).

    Science.gov (United States)

    1986-10-31

    handpieces . Technical Approach: The study will be conducted in vitro using the palatal roots of human maxillary molar teeth which previously extracted due...109 1985 Histoplasmosis Seroconversion Study. (T) 110 1986 A Comparative Study of Fetal Movement Perceptions in the Third Trimester of Multiparous and...Hartwell G, Portell FR: Clinical management of middle mesial root canals in mandibular molars : Two case reports. Submitted to J Am Dent Assn. DeFiore

  9. Clinical Investigation Program RCS-MED-300 (R1)

    Science.gov (United States)

    1988-09-30

    deprivation noted in the history or physical. Subjects agree to participate in the study. The independent variable is touch which if present is administered...INVESTIGATORS: MAJ Lynn Whittington , MC KEY WORDS: Intubation, pediatric training Study Objective: This training is designed to teach physicians and other health...with a high stress job are medical interns. Interns are sleep deprived , eat poorly, and have a high degree of emotional stress due to the novelty of

  10. 59th Medical Wing Clinical Research Division Clinical Investigations Program Posters (Count: 2)

    Science.gov (United States)

    2017-05-08

    Investigations Program Posters (Count: 2) presented at/published to Graduate School Faculty Development and Research Symposium, Gateway Club, JBSA...copy of your abstract, paper. poster and other supporting documentation. 5. Save and forward, via email, the processing form and all supporting...you a final letter of approval or disapproval. g, Once your manuscript, poster or presentation has been approved for a one-lime public release, you may

  11. Clinical Investigations

    Science.gov (United States)

    1977-09-30

    conducted at WBAV’S is categorized as t basic experimental medicine or trials and testing of clinical medicine pro- cedures using the indigenous population...Unit No. 77/20 (FY77, 0) An Analysis of Ameloblastic Fibro-odontoma ....................... 27 Department of Medicine Nork Unit No, 69/338 (FY69, T...Unit No. 71/38 (FY71, T) Injected Marihuana : Effects of Cannabinol ....................... 71 Department of Pediatrics Wfork Unit No. 74/23 (FY74, T

  12. Clinical Investigation.

    Science.gov (United States)

    1979-09-30

    Zbylski, LaRossa, Cullington: A Simple Method of Rapid Assessment of Malar Depression . Annals of Plastic Surgery, Aug 79. Urology Service Fauver, H.E...J.R.: ST Depression Suggesting Subendocardial Ischemia in Neonates with PDA. Presented: Eighth Annual Army Association of Cardiok yy tt,eting, Tacoma...79/100 Investigation of the Tumor Reduction Effect of Combined Sodium-L-Ascorbate and 5FU Chemotherapy in Transplanted B16 Melanoma of Mice. (O

  13. Annual Progress Report FY 93 (Walter Reed Army Medical Center, Department of Clinical Investigation). Clinical Investigation Program. Volume 2

    Science.gov (United States)

    1993-01-01

    129 REPORT DATE: 03/04/93 WORK UNIT a 1332-91 DETAIL SUMMARY SHEET TITLE: Thermogenic Agent Promotion of Weight Loss in Obese Soldiers KEYWORDS...thermogenic, promotion, obese PRINCIPAL INVESTIGATOR: Solomon, Barbara DNSc DEPARTMENT: Department of Medicine STATUS: Completed SERVICE: Endocrine...are: possible variance between adult and chilhood forms of HD, patterns of previous infectious disease exposure, socioeconomic patterns, familial

  14. Investigation - Derived Waste Program

    International Nuclear Information System (INIS)

    Beardsley, C.; Anderson, R.

    1998-06-01

    The Investigation-Derived Waste Program is a software application that was developed to identify the groundwater monitoring wells at the Savannah River Site that require containerization and treatment for purge water generated during sampling

  15. Clinical Investigation Program.

    Science.gov (United States)

    1981-10-01

    0. Effect of VaStUS Medialis £1 Obliquus Strength on Chondromalacia Patella. (0) 17,󈨒 Kearney, J. 3. Human Irplantation of Intraocular q, Lenses. (C...to: . 8i I - rot rlo Sat : Te (,t- i ricl teo TI~i:I valuation of Iowor caitruiitctiral leediro (I o occpy Wie v,, I(V O V as an /’.,i~nct Lu Lori!;i...ntrations. Pht [l /, ’A ,,T-: ipididyral fat pads arc re ovcd fr . ra ;vit’ rI.1 . I -l fat cells are -repared Ly shakir c at 7 t for (f, "i. ,tcs iv

  16. Clinical Investigation Program Report.

    Science.gov (United States)

    1981-10-01

    Resident Surgical Instructional Experience. (T) 41 1979 Routine Use of Serum Uric Acid Levels at 36 Weeks Gestation as Screening Test for Preeclampsia as...Occup Med, 23(l):49-51, Jan 1981. Kleyn, J.G., Johnson, W.M. and Wetzler, T.F.: Microbial Aerosols and Actinomycetes in Etiological Considerations of...severe) complication in patients with fractures of the long bones and/or severe trauma. The etiological mechanism of this syndrome is still unsettled

  17. Clinical Investigation Program Report.

    Science.gov (United States)

    1983-10-01

    blood cell function in 48 noninsulin dependent diabetes melitus during improved control after treatment with insulin and after treatment using a m...underway comparing the activity of normal leukocytes with those from diabetic patients. ൦ -A2’ r,. L ") Detail Sum mary Sheet Date: 1 Oct83 Prot. No.: C...white blood cell function in non-insulin depeldent diabetes mellitus during improved control after treatment with insulin and after treatment using a

  18. Clinical Investigation Program

    Science.gov (United States)

    1990-09-30

    87/351 C GOG 85 - Comparison of Hydroxyurea versus Cis- platinum and 5FU as an Adjunct to Radiation Therapy in Patients with Advanced Carcinoma of The...ST segment depression . Two patients have completed the study. These two individuals responded well to the study druq with marked improvement in

  19. Clinical Investigation Program.

    Science.gov (United States)

    1982-09-30

    J.J., Collins, M.T., Mc’Clatchy, J.K.: Urease Testing of Mycobacteria with BPCTK Radiometric Instrumentation. J Clin Micro 15:478-480, 1982.(C) Darato...on mnrT male dops. Three week-, later a two layer microsurgical anastr~mo-is isini 1l)-O nylon is completed. Three weeks later the dog i sacrific-ee...Human tumor cell lines are established in mono- layer culture. After purification and cell type varification, replicate cultures are subjected to

  20. Clinical Investigation Program.

    Science.gov (United States)

    1987-09-30

    Mexico , September 1987. Publications: None ! ~t 4, FAMC A.P.R. (RCS MED 300) Detail Summary Sheet (HSCR 40-23 as amended) (1) Date: 30 Sep 87 (2...Infection: A Prospective Study. Presented: 2nd Annual Symposium of the Rocky Moun-tain Flow Cytometry Users Group, Albuquerque, New Mexico , 10-11...COL, MC (9) Dept/Sv:Pe-at (10) Associate Tnvestigators (lI) Tey WoJr--s: Myron J. Levin, M.D. varicella vaccine U Co. HSC (12) Accumu tEve MEDCASE:* 1

  1. Clinical Investigation Program Report

    Science.gov (United States)

    1992-10-01

    alchemists claim of transmutation of metals by asserting the fundamental differen- ii ces of metals. His medical masterwork was the Canon which remained an...1992. Blount BW: Sexually transmitted disease update. Am Acad Fam Phy, Washington, DC, Oct 1991. Blount BW: A comparison of Family Practice content

  2. Clinical Investigation Program.

    Science.gov (United States)

    1979-10-01

    sympathomimetic amines (alpha, beta and dopamine , vasodilators, dextran, and diuretics). PROGRESS: The project has progressed well, and a preliminary...treatment of childhood psychosis (infantile autism , childhood schizophrenia, atypical development). TECHNICAL APPROACH: Children stabilized on a

  3. Future requirements. Clinical investigations

    DEFF Research Database (Denmark)

    Qvist, V.

    2002-01-01

    Biocompatability, Cariology, Clinical trials, Dental materials, Helath services research, Human, Pedodontics......Biocompatability, Cariology, Clinical trials, Dental materials, Helath services research, Human, Pedodontics...

  4. Clinical Investigator Inspector List (CLIIL)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Clinical Investigator Inspection List (CLIIL) contains names, addresses, and other pertinent information gathered from inspections of clinical investigators who...

  5. Teaching Translational Research to Medical Students: The New York University School of Medicine's Master's of Science in Clinical Investigation Dual‐Degree Program

    Science.gov (United States)

    Pillinger, Michael; Plottel, Claudia S.; Galeano, Claudia; Maddalo, Scott; Hochman, Judith S.; Cronstein, Bruce N.; Gold‐von Simson, Gabrielle

    2015-01-01

    Abstract To develop the next generation of translational investigators, New York University School of Medicine (NYUSOM) and the NYU‐NYC Health and Hospitals Corporation Clinical and Translational Science Institute (NYU‐HHC CTSI) developed the Master's of Science in Clinical Investigation dual‐degree (MD/MSCI) program. This 5‐year program dedicates 1 year to coursework and biomedical research, followed by a medical school/research overlap year, to prepare students for academic research careers. This paper details the MD/MSCI program's curriculum and approach to mentorship, describes the research/professional interests of students, and reports student productivity. In the first 4 years of the program (2010–2014) 20 students were matriculated; 7 (35%) were women, and 12 (60%) research projects were in surgical specialties. To date, 14 students have applied to residency, and half pursued surgical residency programs. Our students have produced 68 accepted abstracts, 15 abstracts in submission, 38 accepted papers, and 24 papers in submission. Despite the time‐limited nature of this program, additional training in research design and implementation has promoted a high level of productivity. We conclude that dual‐degree training in medicine and translational research is feasible for medical students and allows for meaningful participation in valuable projects. Follow‐up is warranted to evaluate the academic trajectory of these students. PMID:26365704

  6. Teaching Translational Research to Medical Students: The New York University School of Medicine's Master's of Science in Clinical Investigation Dual-Degree Program.

    Science.gov (United States)

    Gillman, Jennifer; Pillinger, Michael; Plottel, Claudia S; Galeano, Claudia; Maddalo, Scott; Hochman, Judith S; Cronstein, Bruce N; Gold-von Simson, Gabrielle

    2015-12-01

    To develop the next generation of translational investigators, New York University School of Medicine (NYUSOM) and the NYU-NYC Health and Hospitals Corporation Clinical and Translational Science Institute (NYU-HHC CTSI) developed the Master's of Science in Clinical Investigation dual-degree (MD/MSCI) program. This 5-year program dedicates 1 year to coursework and biomedical research, followed by a medical school/research overlap year, to prepare students for academic research careers. This paper details the MD/MSCI program's curriculum and approach to mentorship, describes the research/professional interests of students, and reports student productivity. In the first 4 years of the program (2010-2014) 20 students were matriculated; 7 (35%) were women, and 12 (60%) research projects were in surgical specialties. To date, 14 students have applied to residency, and half pursued surgical residency programs. Our students have produced 68 accepted abstracts, 15 abstracts in submission, 38 accepted papers, and 24 papers in submission. Despite the time-limited nature of this program, additional training in research design and implementation has promoted a high level of productivity. We conclude that dual-degree training in medicine and translational research is feasible for medical students and allows for meaningful participation in valuable projects. Follow-up is warranted to evaluate the academic trajectory of these students. © 2015 Wiley Periodicals, Inc.

  7. Clinic Health Awareness Program Subsystem -

    Data.gov (United States)

    Department of Transportation — Clinic Health Awareness Program Subystem (CHAPS) is a comprehensive system for recording, reporting, and analyzing a patient’s medical information and managing an...

  8. Report on an Investigation into an Entry Level Clinical Doctorate for the Genetic Counseling Profession and a Survey of the Association of Genetic Counseling Program Directors.

    Science.gov (United States)

    Reiser, Catherine; LeRoy, Bonnie; Grubs, Robin; Walton, Carol

    2015-10-01

    The master's degree is the required entry-level degree for the genetic counseling profession in the US and Canada. In 2012 the Association of Genetic Counseling Program Directors (AGCPD) passed resolutions supporting retention of the master's as the entry-level and terminal degree and opposing introduction of an entry-level clinical doctorate (CD) degree. An AGCPD workgroup surveyed directors of all 34 accredited training programs with the objective of providing the Genetic Counseling Advanced Degrees Task Force (GCADTF) with information regarding potential challenges if master's programs were required to transition to an entry-level CD. Program demographics, projected ability to transition to an entry-level CD, factors influencing ability to transition, and potential effects of transition on programs, students and the genetic counseling workforce were characterized. Two programs would definitely be able to transition, four programs would close, thirteen programs would be at risk to close and fourteen programs would probably be able to transition with varying degrees of difficulty. The most frequently cited limiting factors were economic, stress on clinical sites, and administrative approval of a new degree/program. Student enrollment under an entry-level CD model was projected to decrease by 26.2 %, negatively impacting the workforce pipeline. The results further illuminate and justify AGCPD's position to maintain the master's as the entry-level degree.

  9. 77 FR 60440 - Clinical Investigator Training Course

    Science.gov (United States)

    2012-10-03

    ... concerns, adverse event monitoring, compliance with the legal and ethical obligations of clinical research... with knowledge, experience, and commitment to investigational medicine; Promote communication between clinical investigators and FDA; Enhance investigators' understanding of FDA's role in experimental medicine...

  10. 76 FR 45577 - Clinical Investigator Training Course

    Science.gov (United States)

    2011-07-29

    ... concerns, adverse event monitoring, compliance with the legal and ethical obligations of clinical research... knowledge, experience, and commitment to investigational medicine; Promote communication between clinical investigators and FDA; Enhance investigators' understanding of FDA's role in experimental medicine; and Improve...

  11. Overview of the trastuzumab (Herceptin) anti-HER2 monoclonal antibody clinical program in HER2-overexpressing metastatic breast cancer. Herceptin Multinational Investigator Study Group.

    Science.gov (United States)

    Shak, S

    1999-08-01

    The recombinant humanized anti-HER2 monoclonal antibody trastuzumab (Herceptin; Genentech, San Francisco, CA) was evaluated in human clinical trials for treatment of women with metastatic breast cancer who have tumors that overexpress HER2. The trastuzumab clinical program consisted of a series of phase I, phase II, and phase III clinical trials. Clinical experience with this novel biologic has been obtained in more than 1,000 women with HER2-overexpressing metastatic breast cancer. Two pivotal trials were performed to evaluate trastuzumab efficacy and safety: (1) trastuzumab in combination with chemotherapy as first-line therapy and (2) trastuzumab as a single agent in second- and third-line chemotherapy. Preliminary results of the pivotal clinical trials that have been presented at national meetings are summarized below. The data suggest that trastuzumab will be an important new treatment option for women with HER2-overexpressing metastatic breast cancer.

  12. A marketing clinical doctorate programs.

    Science.gov (United States)

    Montoya, Isaac D; Kimball, Olive M

    2007-01-01

    Over the past decade, clinical doctorate programs in health disciplines have proliferated amid both support and controversy among educators, professional organizations, practitioners, administrators, and third-party payers. Supporters argue that the explosion of new knowledge and increasing sophistication of technology have created a need for advanced practice models to enhance patient care and safety and to reduce costs. Critics argue that necessary technological advances can be incorporated into existing programs and believe that clinical doctorates will increase health care costs, not reduce them. Despite the controversy, many health disciplines have advanced the clinical doctorate (the most recent is the doctor of nursing practice in 2004), with some professions mandating the doctorate as the entry-level degree (i.e., psychology, pharmacy, audiology, and so on). One aspect of the introduction of clinical doctoral degrees has been largely overlooked, and that is the marketing aspect. Because of marketing considerations, some clinical doctorates have been more successfully implemented and accepted than others. Marketing is composed of variables commonly known as "the four P's of marketing": product, price, promotion, and place. This report explores these four P's within the context of clinical doctorates in the health disciplines.

  13. Clinical investigation of thyroid disorders

    International Nuclear Information System (INIS)

    Miller, J.L.

    1981-01-01

    Current investigations of thyroid dysfunction available to the clinician are reviewed and correlated with disease processes. The aim is to provide a simplified guide to the investigation of thyroid disorders

  14. Clinical investigation in Wilson's disease

    International Nuclear Information System (INIS)

    Mizutani, Naoki; Maehara, Mitsuo; Negoro, Tamiko; Watanabe, Kazuyoshi

    1983-01-01

    Wilson's disease of cerebral type with a chief complaint of tremor occurred in 3 brothers and sisters of a certain family line. Treatment with D-penicillamine produced remarkable clinical improvement as shown by the disappearance of tremor and Kayser-Fleischer ring. Cranial CT scans made before the treatment revealed abnormal findings such as low density areas in the (bilateral) thalamus and the lenticular nucleus, atrophy of the cerebral cortex, and enlargement of the ventricles. After the treatment, cranial CT revealed that the low density areas in the thalamus and the lenticular nucleus disappeared corresponding to the clinical improvement. However, the atrophy of the cerebral cortex and the enlargement of the ventricles were not ameliorated. (Ueda, J.)

  15. 78 FR 63988 - Clinical Investigator Training Course

    Science.gov (United States)

    2013-10-25

    ... communication between clinical investigators and FDA; Enhance investigators' understanding of FDA's role in... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2013-N-1214... support regulatory decisions. This course is intended to assist clinical investigators in understanding...

  16. 75 FR 57472 - Clinical Investigator Training Course

    Science.gov (United States)

    2010-09-21

    ... days in advance. SUPPLEMENTARY INFORMATION: Clinical trial investigators play a critical role in the... toxicological, pharmacological, and manufacturing data to support investigational use in humans; Fundamental issues in the design and conduct of clinical trials; Statistical and analytic considerations in the...

  17. Site investigations for the disposal of spent fuel - investigation program

    International Nuclear Information System (INIS)

    Aeikaes, Timo

    1985-11-01

    The Industrial Power Company Ltd (TVO) is making preparations for the final disposal of spent nuclear fuel into the Finnish bedrock. The revised site investigation program for the years 1986-2010 is presented in this report. The objectives and activities in the near future are described in more detail. The main objectives and frame programs for the investigations in the more distant future are described. The program planning of these investigations are being developed in the preceding site investigations. The investigations for the site selection are divided into four phases: 1983-1985 selection of the investigation areas, preparations for the field investigations, drilling and investigations in a deep test borehole; 1986-1992 preliminary site investigations in 5-10 investigation areas; 1993-2000 detailed site investigations in 2-3 investigation areas. Site selection in the year 2000; 2001-2010 complementary investigations on the selected site. The first investigation phase will be carried out as planned. In this phase a 1001 m deep test borehole was drilled at Lavia in western Finland. With the investigations in the borehole and related development work, preparations were made for the future field investigations. The equipment and investigation methods are being developed during the site investigations. The equipment for taking groundwater samples and the unit for hydraulic testing have been developed. In the future the emphasis in the work will be in developing equipment for monitoring of the hydraulic head and measuring the volumetric flow. In groundwater sampling the present procedure can be improved by adding the test for the in-situ measurements. The results of the field investigations will be stored and processed in a centralized data base. The data base will transmit the results for the interpretation and then the interpreted results transmitted for model calculations and reporting. The cost estimate for the investigations in 1986-2010 is 110-125 million

  18. Cohesion to the Group and Its Association with Attendance and Early Treatment Response in an Adult Day-Hospital Program for Eating Disorders: A Preliminary Clinical Investigation

    Science.gov (United States)

    Crino, Natalie; Djokvucic, Ivana

    2010-01-01

    Treatment outcome studies demonstrate that day-hospital programs are effective in the treatment of eating disorders. Few descriptions are available on the specifics of treatment, particularly the process of therapy. The group therapy modality is thought to provide important therapeutic benefits. The present study aimed to examine the association…

  19. 75 FR 4827 - Submission for OMB Review; Comment Request Clinical Trials Reporting Program (CTRP) Database (NCI)

    Science.gov (United States)

    2010-01-29

    ... subsequent comment concerning corruption in clinical trials conducted by large pharmaceutical companies. The... Collection: Title: Clinical Trials Reporting Program (CTRP) Database. Type of Information Collection Request... institutions. Type of Respondents: Clinical research administrators on behalf of clinical investigators. The...

  20. The status of temporomandibular and cervical spine education in post-professional physical therapy training programs recognized by Member Organizations of IFOMPT: an investigation of didactic and clinical education.

    Science.gov (United States)

    Shaffer, Stephen M; Stuhr, Sarah H; Sizer, Phillip S; Courtney, Carol A; Brismée, Jean-Michel

    2018-05-01

    The purpose of this investigation was to establish an international baseline of the quantity of physical therapist education on temporomandibular disorders (TMD) during post-professional Orthopedic Manual Physical Therapy (OMPT) education. An electronically distributed survey was sent to programs and data analyzed for trends, including a comparison of TMD and cervical spine disorders education. Current data were compared to pre-existing data from the United States. For the current data-set, the Mann-Whitney U test demonstrated statistical significance when comparing TMD and cervical spine disorders education for both the hours of didactic training provided ( p  didactic ( p  didactic ( p  = 0.23) or clinical education ( p  = 0.15) of cervical spine topics. These data again indicate a lack of uniformity between post-professional training programs in OMPT with respect to TMD education. There is, however, consistency in that most programs provided more training on cervical spine disorders than TMD. Based on these findings, further investigations are appropriate to determine if TMD education is adequate during post-professional OMPT education.

  1. Developing a mentoring program in clinical nutrition.

    Science.gov (United States)

    Martindale, Robert G; McClave, Stephen; Heyland, Daren; August, David

    2010-01-01

    Mentoring programs in nutrition are essential to the survival of clinical nutrition as we know it today. The best method known to maintain an influx of talent to a discipline is by developing an active mentoring program. This paper describes 1 concept for development of a viable mentor program. Mentoring should be flexible and based on mentees' training background. Realistic goals should be set, with written and verbal feedback, to sustain a successful program. Programs should incorporate the Socratic Method whenever possible. Factors that leave doubt about the survival of nutrition as a viable area of focus for physicians include the inability to generate adequate funds to support oneself and limited numbers of mentors available with dedicated time to be a mentor. A healthy, sustainable mentoring program in clinical nutrition will ensure survival of physician-based nutrition programs.

  2. An Empirical Investigation into Programming Language Syntax

    Science.gov (United States)

    Stefik, Andreas; Siebert, Susanna

    2013-01-01

    Recent studies in the literature have shown that syntax remains a significant barrier to novice computer science students in the field. While this syntax barrier is known to exist, whether and how it varies across programming languages has not been carefully investigated. For this article, we conducted four empirical studies on programming…

  3. Cleveland Clinic Rehabilitation Research Program

    Science.gov (United States)

    2015-12-01

    Study 1: The penicillin-induced seizure animal model has been generated by acute focal intracortical injection of penicillin in the motor cortex of rats ... motor cortex of rats . The effects of transcranial magnetic stimulation (TMS) on penicillin-induced seizure have been investigated using behavioral...electroencephalographic (EEG) recording. Study 2: The motor cortex (M1) and the corticospinal tracts (CST) will be directly modulated using brain stimulation

  4. Clinical investigation of radioallergosorbent test (RAST)

    International Nuclear Information System (INIS)

    Okuda, Minoru; Usami, Atsushi

    1974-01-01

    Relationship of radioallergosorbent test (RAST), intracutaneous reaction, serum IgE determination and RMCD (Rat Mast Cell Degranulation Test) in subjects with tick allergy was compared in order to investigate clinical application for nasal allergy. 1. RAST is suitable for clinical examinations as determination of IgE. Because it is simple in technique, a technical expert can treat many subjects within a short time, and the result can be decleared within 2 days. 2. RAST was high in specificity and was consistent with clinical findings. RAST positive was thought to be allergy by the antigen, but RAST negative could not deny allergy by the antigen. 3. Correlation of some degree was found to exist between RAST and intracutaneous reaction or degree of induced reaction or threshold value of antigen intracutaneous reaction. But degree of intracutaneous reaction and induced reaction and threshold value of intracutaneous reaction could not be determined from the result of RAST. 4. Determination of IgE antibody by RAST was more useful in clinical study than that of IgE or IgE antibody by RMCD. (Oyama, S.)

  5. A clinical and investigational study of donovanosis

    Directory of Open Access Journals (Sweden)

    Veeranna S

    2003-03-01

    Full Text Available A clinical and investigational study of 25 cases of Donovanosis was undertaken. The incidence was found to be 1.53% of all STD cases and 2.9% of GUD. M:F ratio was 2.12:1. Incidence was more in unmarried people. Fleshy exuberant type was seen in 88% of cases. Two patients (8% had extragenital ulcers. Donovan bodies were found in 88%. Pseudo elephantiasis was seen in 8 patients. Biopsy was done in 8 cases and showed ocanthosis, plasma cell infiltration and pseudo epitheliomatous hyperplasia. One patient developed squamous cell carcinoma of vulva.

  6. Clinical Investigation Program Fiscal Year 1987.

    Science.gov (United States)

    1987-10-01

    Cervical Dysphagia : Criteria for Patient Selection. Gary P. Wratten Surg Symposium, El Paso, TX, Apr 1987 Kreder KJ: A Massive Testicular Tumor in a...Academy of Otolaryngology-Head and Neck Surgery Ann Meeting, Chicago, IL, Sep 1987 Parkinson DW, Reinker KA: Slipped Capital Femoral Epiphysis and Renal...Osteodystrophy: A Case Report with Five Years Follow-Up, 28th Ann Society of Military Orthopaedic Surgeons, Colorado Springs, CO, Nov 1986 Parkinson

  7. Clinical Investigation Program Annual Progress Report

    Science.gov (United States)

    1989-10-01

    Meeting, Washington DC, September 1989 Parsons MK: Acute Shift of Right Ventricular Distensibility After Balloon Pulmonary Vavuloplasty. American Heart...selected range of motion using both concentric and eccentric muscular contractions. PROGRESS: No. of Subjects Enrolled - To Date: 8 Reporting Period: 8 1

  8. Clinical Investigation Program. Annual Research Progress Report.

    Science.gov (United States)

    1980-09-30

    protocol H , .. . . .. . . .. Department of Pediactics - continued Way, G.L., Pierce, J.R., Wolfe, R.R., McGrath, R., Merenstein, G.B.: ST Depression ...Tg F3 aiIitLY : FjxMC N. J. MARTIN, MD, MAJ, MIC -) et / Se c: HEM-ONC, Medicine (10) -Assoc Invc2stigators,: (Mi Key Words: 5FU , Ascorbic tcid WILSON...range of mouse death. This was 75,000 cell/ CU.1m. In ac~dition to this, the maximum s:afe dlose range for 5FU was established in the BFI)1 hybrid

  9. Clinical Investigation Program (Tripler Army Medical Center)

    Science.gov (United States)

    1991-10-01

    8217 I have learned an immense amount during this last year. Clinicians have no idea of the real world of medical research, finance, and politics. We (I...91. 10 Pfanner TP, Person DA, Berenberg JL, Lockett LJ: Eosinophilia Myalgia Syndrome: A Case Report and One Year Follow-Up. American College of ...protocol as yet. This is a non therapeutic study designed to gather epidemiologic and late effects data on long term (>Syrs) survivors of Wilms’ tumor

  10. Clinical Investigation Program Annual Progress Report.

    Science.gov (United States)

    1985-09-30

    Development of Subsensitivity to Chlorpheniramine. J Allergy Clin Immunol 76:103, 1985. (C) Weber, R.W. and Simon, P.J.: Eosinophilia , Mental Status Changes...Fourteenth Aspen Coiference on Pediatric Research, Aspen, CO, July 1985. (C) Opel, S.M., Cannady, P.B., Asp, A.A. and Morse, P.L.: The Epidemiology of ...Cholesteatoma of the Infratemporal Fossa. Presented: XIII World Congress of Otorhinolaryngology, Miami Beach, Florida, May 1985. Uroloqy Service Fauver

  11. Clinical Investigation Program Annual Progress Report

    Science.gov (United States)

    1989-09-30

    of Stuttering and Maintenance of Fluency by Means of Airflow, Tension Reduction, and Discriminative Stimulus Control Procedures. J Fluency Disorders...244 body fat .............................. 331 bone cement ...................... 36 density ............................. 121,152

  12. Clinical Investigation Program, Fiscal Year 1991

    Science.gov (United States)

    1992-02-03

    exposure to C. immitis (1) California (2) Arizona (3) New Mexico b.1 for moderate possibility of exposure to C. immitis (1) Texas (2) Utah (3) Nevada c...44 of 45 interns had blood drawn. P1 has serology on Rubeola, Rubella varicella on 44 of 44 and anti.HBSAG on 41/44. PI notified C, Infect Dis of

  13. Clinical Investigation Program Report FY90

    Science.gov (United States)

    1990-10-01

    carious tooth. Mandrake, poppy, and cannabis were popular recommendations for relief also. The curious idea of a relationship between worms and caries...enzyme-linked immunosorbent assay data reduction. J Mil Med Lab Sci 1990; 19:10-16. Sutherland DE, Robinson MD: Urine caffeine levels in patients on a...nuclei in a cell-free system. Soc Armed Forces Med Lah Sci, Baltimore, MD, Mar 1990. Sutherland DE, Robinson MD: Urine caffeine levels in patients on a

  14. Clinical Investigation Program. Annual Progress Report.

    Science.gov (United States)

    1981-09-30

    Cachexia : Beneficial Response to combination Therapy with Amitripty- line and Fluphenazine. JAMA 243:1160, 1980. Georgitis, W.T., Kidd, G.S., and Hofeldt...1981, 27A. Hofeldt, F.D.: Studies of the Metabolic Basis for Hypermetabolic States: Nutritional Support of the Patient: Research Directions for the 1980...hypoglycemia. A baseline 5-hr oral glucose tolerance test (GTT) using 100 grams of glucose and a 3-day 150 gram carbohydrate preparatory diet will be obtained

  15. Clinical Investigation Program Annual Progress Report.

    Science.gov (United States)

    1983-09-30

    DEPARTMENT OF OB-GYN i ~Brady, W.K., Hill, J.M., and Sarno, A.P.: Sporadic Puerperal Mastitis - Review and Update. Presented: OB-GYN Armed Forces...Technically, we have finally worked out variou problems, to include; acquisition of fresh media from Dr. Ham’s Lab, a new CO7 regulated incubator, whole bovine ...Ham’s medium fron the University of Colorado, whole bovine pituitary extract, and the various sup- plements needed for the media. We are now in the

  16. Clinical Investigation Program Annual Progress Report.

    Science.gov (United States)

    1984-09-30

    Clark, J.R.: Cecal Volvulus : Report of 10 Cases and a Review of the Literature. Presented: Gary Wratten Surgical Symposium/Workshop, Walter Reed Army...1984. (C). DEPARTMENT OF SURGERY General Surgery Service Allen, J.J. and Clark, J.R.: Cecal Volvulus : Report of 10 Cases *and a Review of the

  17. Transcranial magnetic stimulation techniques in clinical investigation.

    Science.gov (United States)

    Currà, A; Modugno, N; Inghilleri, M; Manfredi, M; Hallett, M; Berardelli, A

    2002-12-24

    Transcranial magnetic stimulation (TMS) is a technique that can activate cortical motor areas and the corticospinal tract without causing the subject discomfort. Since TMS was introduced, numerous applications of the technique have been developed for the evaluation of neurologic diseases. Standard TMS applications (central motor conduction time, threshold and amplitude of motor evoked potentials) allow the evaluation of motor conduction in the CNS. Conduction studies provide specific information in neurologic conditions characterized by clinical and subclinical upper motor neuron involvement. In addition, they have proved useful in monitoring motor abnormalities and the recovery of motor function. TMS also gives information on the pathophysiology of the processes underlying the various clinical conditions. More complex TMS applications (paired-pulse stimulation, silent period, ipsilateral silent period, input-output curve, and evaluation of central fatigue) allow investigation into the mechanisms of diseases causing changes in the excitability of cortical motor areas. These techniques are also useful in monitoring the effects of neurotrophic drugs on cortical activity. TMS applications have an important place among the investigative tools to study patients with motor disorders.

  18. TMI-2 Vessel Investigation Project Metallurgical Program

    International Nuclear Information System (INIS)

    Diercks, D.R.; Neimark, L.A.

    1990-01-01

    The TMI-2 [Three Mile Island unit 2] Vessel Investigation Project Metallurgical Program at Argonne National Laboratory is a part of the international TMI-2 Vessel Investigation Project being conducted jointly by the U.S. Nuclear Regulatory Commission and the Organization for Economic Co-operation and Development (OECD). The overall project consists of three phases, namely (1) recovery of material samples from the lower head of the TMI-2 reactor, (2) examination and analysis of the lower head samples and the preparation and testing of archive material subjected to a similar thermal history, and (3) procurement, examination, and analysis of companion core material located adjacent to or near the lower head material. The specific objectives of the ANL Metallurgical Program, which accounts for a major portion of Phase 2, are to prepare metallographic and mechanical test specimen blanks from the TMI-2 lower head material, prepare similar test specimen blanks from suitable archive material subjected to the appropriate thermal processing, determine the mechanical properties of the lower vessel head and archive materials under the conditions of the core-melt accident, and assess the lower head integrity and margin-to-failure during the accident. The ANL work consists of three tasks: (1) archive materials program, (2) fabrication of metallurgical and mechanical test specimens from the TMI-2 pressure vessel samples, and (3) mechanical property characterization of TMI-2 lower pressure vessel head and archive material

  19. Clinical training: a simulation program for phlebotomy

    Directory of Open Access Journals (Sweden)

    Araki Toshitaka

    2008-01-01

    Full Text Available Abstract Background Basic clinical skills training in the Japanese medical education system has traditionally incorporated on-the-job training with patients. Recently, the complementary use of simulation techniques as part of this training has gained popularity. It is not known, however, whether the participants view this new type of education program favorably; nor is the impact of this program known. In this study we developed a new simulation-based training program in phlebotomy for new medical residents and assessed their satisfaction with the program Methods The education program comprised two main components: simulator exercise sessions and the actual drawing of blood from other trainees. At the end of the session, we surveyed participant sentiment regarding the program. Results There were 43 participants in total. In general, they were highly satisfied with the education program, with all survey questions receiving scores of 3 or more on a scale of 1–5 (mean range: 4.3 – 4.8, with 5 indicating the highest level of satisfaction. Additionally, their participation as a 'patient' for their co-trainees was undertaken willingly and was deemed to be a valuable experience. Conclusion We developed and tested an education program using a simulator for blood collection. We demonstrated a high satisfaction level among the participants for this unique educational program and expect that it will improve medical training, patient safety, and quality of care. The development and dissemination of similar educational programs involving simulation for other basic clinical skills will be undertaken in the future.

  20. Clinical investigation of proximate exposed group, 1

    International Nuclear Information System (INIS)

    Ito, Chikako; Hasegawa, Kazuyo; Kato, Masafumi; Kumasawa, Toshihiko

    1984-01-01

    In order to investigate effects of the A-bombing on prevalence of diabetes mellitus, follow-up studies were made on 5907 A-bomb survivors who received glucose tolerance test (GTT) during 20 years between 1963 and 1983. The A-bomb survivors were divided into the group A (1899 men and 1165 women exposed within 1.9 km from the hypocenter) and the group B (1725 men and 1118 women exposed 3.0 km or farther from it). Among non-obese survivors, 21.9% and 21.8% were being treated for diabetes mellitus or were evaluated as having diabetic type on GTT in the group A and the group B, respectively; while this was seen in 52.1% of obese survivors in the group A and 49.9% in the group B. There was no difference between the groups. In non-obese survivors, the annual development rate from the normal type to the diabetic type was 0.89% in the group A and 0.65% in the group B; the annual development rate from the borderline type to the diabetic type was 5.73% in the group A and 5.49% in the group B, showing no differences between the groups. The annual development rate from the normal or borderline type to the diabetic type was two times or higher in obese survivors than in non-obese survivors irrespective of exposure status. Regarding the number of diabetic survivors who became non-diabetic type in spite of having no treatment, and prevalence of diabetic complications, no difference was seen between the groups. These results suggest that the A-bombing has scarcely influenced the prevalence of diabetes mellitus and clinical course. (Namekawa, K.)

  1. An Investigation into the Clinical Reasoning Development of Veterinary Students.

    Science.gov (United States)

    Vinten, Claire E K; Cobb, Kate A; Freeman, Sarah L; Mossop, Liz H

    Clinical reasoning is a fundamental skill for veterinary clinicians and a competency required of graduates by the Royal College of Veterinary Surgeons. However, it is unknown how veterinary students develop reasoning skills and where strengths and shortcomings of curricula lie. This research aimed to use the University of Nottingham School of Veterinary Medicine and Science (SVMS) as a case study to investigate the development of clinical reasoning among veterinary students. The analysis was framed in consideration of the taught, learned, and declared curricula. Sixteen staff and sixteen students from the SVMS participated separately in a total of four focus groups. In addition, five interviews were conducted with recent SVMS graduates. Audio transcriptions were used to conduct a thematic analysis. A content analysis was performed on all curriculum documentation. It was found that SVMS graduates feel they have a good level of reasoning ability, but they still experience a deficit in their reasoning capabilities when starting their first job. Overarching themes arising from the data suggest that a lack of responsibility for clinical decisions during the program and the embedded nature of the clinical reasoning skill within the curriculum could be restricting development. In addition, SVMS students would benefit from clinical reasoning training where factors influencing "real life" decisions (e.g., finances) are explored in more depth. Integrating these factors into the curriculum could lead to improved decision-making ability among SVMS graduates and better prepare students for the stressful transition to practice. These findings are likely to have implications for other veterinary curricula.

  2. Investigating Integer Restrictions in Linear Programming

    Science.gov (United States)

    Edwards, Thomas G.; Chelst, Kenneth R.; Principato, Angela M.; Wilhelm, Thad L.

    2015-01-01

    Linear programming (LP) is an application of graphing linear systems that appears in many Algebra 2 textbooks. Although not explicitly mentioned in the Common Core State Standards for Mathematics, linear programming blends seamlessly into modeling with mathematics, the fourth Standard for Mathematical Practice (CCSSI 2010, p. 7). In solving a…

  3. Clinical Investigation of Benign Asbestos Pleural Effusion

    Directory of Open Access Journals (Sweden)

    Nobukazu Fujimoto

    2015-01-01

    Full Text Available There is no detailed information about benign asbestos pleural effusion (BAPE. The aim of the study was to clarify the clinical features of BAPE. The criteria of enrolled patients were as follows: (1 history of asbestos exposure; (2 presence of pleural effusion determined by chest X-ray, CT, and thoracentesis; and (3 the absence of other causes of effusion. Clinical information was retrospectively analysed and the radiological images were reviewed. There were 110 BAPE patients between 1991 and 2012. All were males and the median age at diagnosis was 74 years. The median duration of asbestos exposure and period of latency for disease onset of BAPE were 31 and 48 years, respectively. Mean values of hyaluronic acid, adenosine deaminase, and carcinoembryonic antigen in the pleural fluid were 39,840 ng/mL, 23.9 IU/L, and 1.8 ng/mL, respectively. Pleural plaques were detected in 98 cases (89.1%. Asbestosis was present in 6 (5.5% cases, rounded atelectasis was detected in 41 (37.3% cases, and diffuse pleural thickening (DPT was detected in 30 (27.3% cases. One case developed lung cancer (LC before and after BAPE. None of the cases developed malignant pleural mesothelioma (MPM during the follow-up.

  4. An interactive data management and analysis system for clinical investigators.

    Science.gov (United States)

    Groner, G F; Hopwood, M D; Palley, N A; Sibley, W L; Baker, W R; Christopher, T G; Thompson, H K

    1978-09-01

    An interactive minicomputer-based system has been developed that enables the clinical research investigator to personally explore and analyze his research data and, as a consequence of these explorations, to acquire more information. This system, which does not require extensive training or computer programming, enables the investigator to describe his data interactively in his own terms, enter data values while having them checked for validity, store time-oriented patient data in a carefully controlled on-line data base, retrieve data by patient, variable, and time, create subsets of patients with common characteristics, perform statistical analyses, and produce tables and graphs. It also permits data to be transferred to and from other computers. The system is well accepted and is being used by a variety of medical specialists at the three clinical research centers where it is operational. Reported benefits include less elapsed and nonproductive time, more thorough analysis of more data, greater and earlier insight into the meaning of research data, and increased publishable results.

  5. Measurements of body protein for clinical investigation

    International Nuclear Information System (INIS)

    Mernagh, J.R.; Harrison, J.E.; McNeill, M.G.; Jeejeebhoy, K.N.; Krishnan, S.S.

    1986-01-01

    Body protein (nitrogen) is determined by bilaterally irradiating the body with neutrons using Pu-Be sources and measuring the resultant 10.8 MeV gamma rays from the reaction 14 N(n,8) 15 N. In the authors lab the whole body can be scanned or separate segments of the body can be measured independently. A nitrogen index has been developed based on body size and is used as a predictor of normal total body nitrogen (TBN). They have found that TBN, when normalized to body size in this way, provides a reliable index of protein status which cannot be accurately determined by body weight, anthropometry, or body potassium measurements. Changes in body composition with age were studied by measuring the composition of 56 healthy female volunteers aged 20-80. Measurements were made for K( 40 K), Ca and N. It was shown that protein and bone mineral decrease with age but that this is not reflected in K or anthropometry measurements. Results of other studies to be presented include: body protein measurements pre and post TPN (total parenteral nutrition), nutritional status of patients on long term CAPD (continuous ambulatory peritoneal dialysis) and changes in body composition as a result of TPN in patients with small cell lung cancer receiving chemotherapy. Clinical results show that indirect measurements of body protein based on weight, potassium, or anthropometry, do not give an accurate measure of body protein. For an accurate measurement, direct measurement of body protein is necessary

  6. [Support Team for Investigator-Initiated Clinical Research].

    Science.gov (United States)

    Fujii, Hisako

    2017-07-01

    Investigator-initiated clinical research is that in which investigators plan and carry out their own clinical research in academia. For large-scale clinical research, a team should be organized and implemented. This team should include investigators and supporting staff, who will promote smooth research performance by fulfilling their respective roles. The supporting staff should include project managers, administrative personnel, billing personnel, data managers, and clinical research coordinators. In this article, I will present the current status of clinical research support and introduce the research organization of the Dominantly Inherited Alzheimer Network (DIAN) study, an investigator-initiated international clinical research study, with particular emphasis on the role of the project management staff and clinical research coordinators.

  7. Clinical investigation of fatty liver by CT

    International Nuclear Information System (INIS)

    Kato, Katsumoto; Takayama, Tetsuo; Sano, Hiroshi; Katada, Naoyuki; Takeichi, Masayuki

    1984-01-01

    CT findings of 56 cases of diffuse fatty infiltration comfirmed by liver biopsy were investigated and compared with those of chronic hepatitis and liver cirrhosis. We found that the diagnosis of severe fatty infiltration (fatty liver) can be specifically possible when the ratios of CT values of liver to those of spleen are less than 0.85 and it is reasonable criterion for diagnosis of fatty liver by CT. This criterion was satisfied by 197 studies (2.9%), 169 cases with fatty liver (diffuse: 141 cases, focal: 28 cases) of 6800 CT studies of liver. Obesity, diabetes and alcohol abuse were main causative factors in both diffuse and focal fatty liver. The percentage of cases showing no abnormal results in blood chemistry tests was great compared with the previous report based on liver biopsy. The changes of CT values of liver faithfully reflected the improvement of each causal factor and reciprocal changes were observed between diffuse and focal fatty liver in repeated CT examination. So, CT is useful in estimating the effect of treatment as well as in diagnosis of fatty liver. Focal fatty liver is temporary manifestation during the proscess of development or improvement of fatty liver. (author)

  8. An Investigation of Teaching and Learning Programs in Pharmacy Education.

    Science.gov (United States)

    Strang, Aimee F; Baia, Patricia

    2016-05-25

    Objective. To investigate published, peer-reviewed literature on pharmacy teaching and learning development programs and to synthesize existing data, examine reported efficacy and identify future areas for research. Methods. Medline and ERIC databases were searched for studies on teaching development programs published between 2001 and 2015. Results. Nineteen publications were included, representing 21 programs. Twenty programs were resident teaching programs, one program described faculty development. The majority of programs spanned one year and delivered instruction on teaching methodologies and assessment measures. All except one program included experiential components. Thirteen publications presented outcomes data; most measured satisfaction and self-perceived improvement. Conclusion. Published literature on teacher development in pharmacy is focused more on training residents than on developing faculty members. Although programs are considered important and highly valued by program directors and participants, little data substantiates that these programs improve teaching. Future research could focus on measurement of program outcomes and documentation of teaching development for existing faculty members.

  9. Honeywell optical investigations on FLASH program

    Science.gov (United States)

    O'Rourke, Ken; Peterson, Eric; Yount, Larry

    1995-05-01

    The increasing performance and reduction of life cycle cost requirements placed on commercial and military transport aircraft are resulting in more complex, highly integrated aircraft control and management systems. The use of fiber optic data transmission media can make significant contributions in achieving these performance and cost goals. The Honeywell portion of Task 2A on the Fly-by-Light Advanced System Hardware (FLASH) program is evaluating a Primary Flight Control System (PFCS) using pilot and copilot inputs from Active Hand Controllers (AHC) which are optically linked to the primary flight Control Computers (PFCC). Customer involvement is an important element of the Task 2A activity. Establishing customer requirements and perspectives on productization of systems developed under FLASH are key to future product success. The Honeywell elements of the PFCS demonstrator provide a command path that is optically interfaced from crew inputs to commands of distributed, smart actuation subsystems commands. Optical communication architectures are implemented using several protocols including the new AS-1773A 20 Mbps data bus standard. The interconnecting fiber optic cable plant is provided by our Task 1A teammate McDonnell Douglas Aerospace (West). Fiber optic cable plant fabrication uses processed, tools and materials reflecting necessary advances in manufacturing required to make fly-by-light avionics systems marketable.

  10. Redesigning a clinical mentoring program for improved outcomes in the clinical training of clerks

    OpenAIRE

    Lin, Chia-Der; Lin, Blossom Yen-Ju; Lin, Cheng-Chieh; Lee, Cheng-Chun

    2015-01-01

    Introduction: Mentorship has been noted as critical to medical students adapting to clinical training in the medical workplace. A lack of infrastructure in a mentoring program might deter relationship building between mentors and mentees. This study assessed the effect of a redesigned clinical mentoring program from the perspective of clerks. The objective was to assess the benefits of the redesigned program and identify potential improvements.Methods: A redesigned clinical mentoring program ...

  11. Clinical Investigation of Treatment Failure in Type 2 Diabetic ...

    African Journals Online (AJOL)

    Clinical Investigation of Treatment Failure in Type 2 Diabetic Patients ... Purpose: To examine body mass index (BMI), occupation, sex, age, and ... development of secondary failure in type 2 diabetics receiving metformin and glibenclamide.

  12. Disclosure of investigators' recruitment performance in multicenter clinical trials

    DEFF Research Database (Denmark)

    Dal-Ré, Rafael; Moher, David; Gluud, Christian

    2011-01-01

    Rafael Dal-Ré and colleagues argue that the recruitment targets and performance of all site investigators in multi-centre clinical trials should be disclosed in trial registration sites before a trial starts, and when it ends.......Rafael Dal-Ré and colleagues argue that the recruitment targets and performance of all site investigators in multi-centre clinical trials should be disclosed in trial registration sites before a trial starts, and when it ends....

  13. A Leadership Education and Development Program for Clinical Nurses.

    Science.gov (United States)

    Fitzpatrick, Joyce J; Modic, Mary Beth; Van Dyk, Jennifer; Hancock, K Kelly

    2016-11-01

    The Leadership Education and Development (LEAD) Program was designed to transform care at the bedside by empowering clinical nurses as leaders. The heart of LEAD was enhancing communication skills of clinical nurses with clinical colleagues and, most importantly, patients and families. Key concepts of leadership/management were included: personal awareness, personal leadership skills/abilities, leading change, leading others individually and in teams, enhancing the patient/provider experience, and the leadership role in outcomes management. A quantitative, longitudinal, survey design was used with 2 cohorts. The program consisted of six 4-hour sessions for 3 to 6 months. Leadership practices were measured before program implementation, at the end of the program, and 3 months after program completion. There were significant increases in leadership practices sustained 3 months after program completion. A range of other outcome measures was included. There is a need for additional leadership development programs for clinical nurses.

  14. Infectious Disease Clinical Research Program (IDCRP)

    Data.gov (United States)

    Federal Laboratory Consortium — Our mission is to conduct infectious disease clinical research of importance to the military through a unique, adaptive, and collaborative network, to inform health...

  15. Clinical investigations for SUS, the Brazilian public health system.

    Science.gov (United States)

    Paula, Ana Patrícia de; Giozza, Silvana Pereira; Pereira, Michelle Zanon; Boaventura, Patrícia Souza; Santos, Leonor Maria Pacheco; Sachetti, Camile Giaretta; Tamayo, César Omar Carranza; Kowalski, Clarissa Campos Guaragna; Elias, Flavia Tavares Silva; Serruya, Suzanne Jacob; Guimarães, Reinaldo

    2012-01-01

    Scientific and technological development is crucial for advancing the Brazilian health system and for promoting quality of life. The way in which the Brazilian Ministry of Health has supported clinical research to provide autonomy, self-sufficiency, competitiveness and innovation for the healthcare industrial production complex, in accordance with the National Policy on Science, Technology and Innovation in Healthcare, was analyzed. Descriptive investigation, based on secondary data, conducted at the Department of Science and Technology, Ministry of Health. The Ministry of Health's research management database, PesquisaSaúde, was analyzed from 2002 to 2009, using the key word "clinical research" in the fields "primary sub-agenda" or "secondary sub-agenda". The 368 projects retrieved were sorted into six categories: basic biomedical research, preclinical studies, expanded clinical research, clinical trials, infrastructure support and health technology assessment. From a structured review on "clinical research funding", results from selected countries are presented and discussed. The amount invested was R$ 140 million. The largest number of projects supported "basic biomedical research", while the highest amounts invested were in "clinical trials" and "infrastructure support". The southeastern region had the greatest proportion of projects and financial resources. In some respects, Brazil is ahead of other BRICS countries (Russia, India, China and South Africa), especially with regard to establishing a National Clinical Research Network. The Ministry of Health ensured investments to encourage clinical research in Brazil and contributed towards promoting cohesion between investigators, health policies and the healthcare industrial production complex.

  16. Psychological Assessment Training in Clinical Psychology Doctoral Programs.

    Science.gov (United States)

    Mihura, Joni L; Roy, Manali; Graceffo, Robert A

    2017-01-01

    We surveyed American Psychological Association-accredited clinical psychology doctoral programs' (n = 83) training in psychological assessment-specifically, their coverage of various assessment topics and tests in courses and practica, and whether the training was optional or required. We report results overall and separately per training model (clinical science, scientist-practitioner, and practitioner-focused). Overall, our results suggest that psychological assessment training is as active, or even more active, than in previous years. Areas of increased emphasis include clinical interviewing and psychometrics; multimethod, outcomes, health, and collaborative or therapeutic assessment; and different types of cognitive and self-report personality tests. All or almost all practice-focused programs offered training with the Thematic Apperception Test and Rorschach compared to about half of the scientist-practitioner programs and a third of the clinical science programs. Although almost all programs reported teaching multimethod assessment, what constitutes different methods of assessing psychopathology should be clarified in future studies because many programs appear to rely on one method-self-report (especially clinical science programs). Although doctoral programs covered many assessment topics and tests in didactic courses, there appears to be a shortage of program-run opportunities for students to obtain applied assessment training. Finally, we encourage doctoral programs to be familiar with (a) internships' assessment expectations and opportunities, (b) the professional guidelines for assessment training, and (c) the American Psychological Association's requirements for preinternship assessment competencies.

  17. Investigating antibiotic resistance in non-clinical environments

    Directory of Open Access Journals (Sweden)

    Fiona eWalsh

    2013-02-01

    Full Text Available There have been many calls for more information about the natural resistome and these have also highlighted the importance of understanding the soil resistome in the preservation of antibiotics for the treatment of infections. However, to date there have been few studies which have investigated the culturable soil resistome, which highlights the difficulties faced by microbiologists in designing these experiments to produce meaningful data. The World Health Organization definition of resistance is the most fitting to non-clinical environmental studies: Antimicrobial resistance is resistance of a microorganism to an antimicrobial medicine to which it was previously sensitive. The ideal investigation of non-clinical environments for antibiotic resistance of clinical relevance would be using standardized guidelines and breakpoints. This review outlines different definitions and methodologies used to understand antibiotic resistance and suggests how this can be performed outside of the clinical environment.

  18. Interactive house investigation and radon diagnostics computer program

    International Nuclear Information System (INIS)

    Gillette, L.M.

    1990-01-01

    This paper reports on the interactive computer program called Dungeons and Radon which was developed as part of the Environmental Protection Agency's (EPA's) Radon Contractor Proficiency (RCP) Program's Radon Technology for Mitigators (RTM) course which is currently being offered in the Regional Radon Training Centers (RRTCs). The program was designed by Terry Brennan to be used in training radon mitigation contractors. The Macintosh based program consists of a series of animated, sound and voice enhanced house scenes. The participants choose where and what to investigate and where to perform diagnostic tests in order to gather enough information to design a successful mitigation system

  19. Bimodal Programming: A Survey of Current Clinical Practice.

    Science.gov (United States)

    Siburt, Hannah W; Holmes, Alice E

    2015-06-01

    The purpose of this study was to determine the current clinical practice in approaches to bimodal programming in the United States. To be specific, if clinicians are recommending bimodal stimulation, who programs the hearing aid in the bimodal condition, and what method is used for programming the hearing aid? An 11-question online survey was created and sent via email to a comprehensive list of cochlear implant programming centers in the United States. The survey was sent to 360 recipients. Respondents in this study represented a diverse group of clinical settings (response rate: 26%). Results indicate little agreement about who programs the hearing aids, when they are programmed, and how they are programmed in the bimodal condition. Analysis of small versus large implant centers indicated small centers are less likely to add a device to the contralateral ear. Although a growing number of cochlear implant recipients choose to wear a hearing aid on the contralateral ear, there is inconsistency in the current clinical approach to bimodal programming. These survey results provide evidence of large variability in the current bimodal programming practices and indicate a need for more structured clinical recommendations and programming approaches.

  20. 76 FR 20575 - Disqualification of a Clinical Investigator

    Science.gov (United States)

    2011-04-13

    ... research or marketing permit for products regulated by FDA. This proposal is based in part upon.... SUPPLEMENTARY INFORMATION: Table of Contents I. Introduction II. Background III. Description of the Proposed.... References I. Introduction Under current regulations, a clinical investigator disqualified by the...

  1. [An Investigation of the Role Responsibilities of Clinical Research Nurses in Conducting Clinical Trials].

    Science.gov (United States)

    Kao, Chi-Yin; Huang, Guey-Shiun; Dai, Yu-Tzu; Pai, Ya-Ying; Hu, Wen-Yu

    2015-06-01

    Clinical research nurses (CRNs) play an important role in improving the quality of clinical trials. In Taiwan, the increasing number of clinical trials has increased the number of practicing CRNs. Understanding the role responsibilities of CRNs is necessary to promote professionalism in this nursing category. This study investigates the role responsibilities of CRNs in conducting clinical trials / research. A questionnaire survey was conducted in a medical center in Taipei City, Taiwan. Eighty CRNs that were registered to facilitate and conduct clinical trials at this research site completed the survey. "Subject protection" was the CRN role responsibility most recognized by participants, followed by "research coordination and management", "subject clinical care", and "advanced professional nursing". Higher recognition scores were associated with higher importance scores and lower difficulty scores. Participants with trial training had significantly higher difficulty scores for "subject clinical care" and "research coordination and management" than their peers without this training (p research coordination and management" (p clinical practice.

  2. Clinical investigations for SUS, the Brazilian public health system

    Directory of Open Access Journals (Sweden)

    Ana Patrícia de Paula

    Full Text Available CONTEXT AND OBJECTIVE: Scientific and technological development is crucial for advancing the Brazilian health system and for promoting quality of life. The way in which the Brazilian Ministry of Health has supported clinical research to provide autonomy, self-sufficiency, competitiveness and innovation for the healthcare industrial production complex, in accordance with the National Policy on Science, Technology and Innovation in Healthcare, was analyzed. DESIGN AND SETTING: Descriptive investigation, based on secondary data, conducted at the Department of Science and Technology, Ministry of Health. METHODS: The Ministry of Health's research management database, PesquisaSaúde, was analyzed from 2002 to 2009, using the key word "clinical research" in the fields "primary sub-agenda" or "secondary sub-agenda". The 368 projects retrieved were sorted into six categories: basic biomedical research, preclinical studies, expanded clinical research, clinical trials, infrastructure support and health technology assessment. From a structured review on "clinical research funding", results from selected countries are presented and discussed. RESULTS: The amount invested was R$ 140 million. The largest number of projects supported "basic biomedical research", while the highest amounts invested were in "clinical trials" and "infrastructure support". The southeastern region had the greatest proportion of projects and financial resources. In some respects, Brazil is ahead of other BRICS countries (Russia, India, China and South Africa, especially with regard to establishing a National Clinical Research Network. CONCLUSION: The Ministry of Health ensured investments to encourage clinical research in Brazil and contributed towards promoting cohesion between investigators, health policies and the healthcare industrial production complex.

  3. Innovation in Rehabilitation Services and Clinical Programs for Health Care

    Directory of Open Access Journals (Sweden)

    Asghar Dadkhah

    2014-06-01

    Full Text Available Rehabilitation program is a critical piece of clinical care strategy in order to accelerate healing and improve quality of life to the fullest extent possible. An innovated program should have 3 inspiring concepts: Seek inspire and Advance. Seeking and evaluating is a breakthrough technology, innovative methodology and emerging trend in the healthcare industry. The program should inspire clinicians to critically evaluate and implement the highest standards of care. Also an innovated program should advance clinical program development to maximize opportunities for first to market positioning and community partnerships. The scope of program can be from psycho-rehabilitation to predictor in addiction (1-3, Cognitive and motor rehabilitation researchers are quite concerned about system wide biases that may impair development of innovative rehabilitation techniques. In this issue ....

  4. Program grants for black lung clinics--PHS. Final rule.

    Science.gov (United States)

    1985-02-27

    The Public Health Service hereby revises the regulations governing the grants program for black lung clinics established under section 427(a) of the Federal Mine Safety and Health Act of 1977. The revision is in keeping with the Department of Health and Human Services' desire to remove as many programmatic burdens and restrictions from grantees as possible, while maintaining program integrity.

  5. A history of the American Society for Clinical Investigation

    Science.gov (United States)

    Howell, Joel D.

    2009-01-01

    One hundred years ago, in 1909, the American Society for Clinical Investigation (ASCI) held its first annual meeting. The founding members based this new society on a revolutionary approach to research that emphasized newer physiological methods. In 1924 the ASCI started a new journal, the Journal of Clinical Investigation. The ASCI has also held an annual meeting almost every year. The society has long debated who could be a member, with discussions about whether members must be physicians, what sorts of research they could do, and the role of women within the society. The ASCI has also grappled with what else the society should do, especially whether it ought to take a stand on policy issues. ASCI history has reflected changing social, political, and economic contexts, including several wars, concerns about the ethics of biomedical research, massive increases in federal research funding, and an increasingly large and specialized medical environment. PMID:19348041

  6. Clinical program leadership: skill requirements for contemporary leaders.

    Science.gov (United States)

    Spallina, Joseph M

    2002-01-01

    With knowledge of these leadership requirements and a shrinking base of experienced managers, healthcare organizations and professional societies have little choice in their approach to prepare for the leadership development challenges of the future. Organizations will focus leadership development, training, and continuing management education on integrating business tools and skills into clinical program management. The management requirements for clinical programs will continue to grow in complexity and the number of qualified managers will continue to diminish, New approaches to solving this shortage will evolve. Professional, forprofit companies, healthcare provider organizations, and academic programs will develop clinical program management training tracks. Organizations that create solutions to this management imperative will maintain their competitive edge in the challenging times that will greet the industry in the future.

  7. Comparative clinical, roentgenological, scintigraphic and thermographic investigations in psoriasis arthropathica

    International Nuclear Information System (INIS)

    Loreck, D.; Lips, H.; Schulze, P.

    1988-01-01

    20 patients with psoriasis arthropatica and different duration of the articular symptoms were examined. Besides clinical investigation radiographs of both hands and feet (central and phalanges), scintigraphy of hands, feet and the sacroiliac joints as well as liquid crystal thermograhy of both hands were performed and the results are compared. The conclusions drawn characterize the diagnostic value of the methods. Scintigraphy as well as thermography are very good means for the early detection of psoriasis arthropathica. (author)

  8. A national clinical quality program for Veterans Affairs catheterization laboratories (from the Veterans Affairs clinical assessment, reporting, and tracking program).

    Science.gov (United States)

    Maddox, Thomas M; Plomondon, Mary E; Petrich, Megan; Tsai, Thomas T; Gethoffer, Hans; Noonan, Gregory; Gillespie, Brian; Box, Tamara; Fihn, Stephen D; Jesse, Robert L; Rumsfeld, John S

    2014-12-01

    A "learning health care system", as outlined in a recent Institute of Medicine report, harnesses real-time clinical data to continuously measure and improve clinical care. However, most current efforts to understand and improve the quality of care rely on retrospective chart abstractions complied long after the provision of clinical care. To align more closely with the goals of a learning health care system, we present the novel design and initial results of the Veterans Affairs (VA) Clinical Assessment, Reporting, and Tracking (CART) program-a national clinical quality program for VA cardiac catheterization laboratories that harnesses real-time clinical data to support clinical care and quality-monitoring efforts. Integrated within the VA electronic health record, the CART program uses a specialized software platform to collect real-time patient and procedural data for all VA patients undergoing coronary procedures in VA catheterization laboratories. The program began in 2005 and currently contains data on 434,967 catheterization laboratory procedures, including 272,097 coronary angiograms and 86,481 percutaneous coronary interventions, performed by 801 clinicians on 246,967 patients. We present the initial data from the CART program and describe 3 quality-monitoring programs that use its unique characteristics-procedural and complications feedback to individual labs, coronary device surveillance, and major adverse event peer review. The VA CART program is a novel approach to electronic health record design that supports clinical care, quality, and safety in VA catheterization laboratories. Its approach holds promise in achieving the goals of a learning health care system. Published by Elsevier Inc.

  9. Tobacco training in clinical social work graduate programs.

    Science.gov (United States)

    Kleinfelder, JoAnn; Price, James H; Dake, Joseph A; Jordan, Timothy R; Price, Joy A

    2013-08-01

    The leading cause of preventable death, in the most vulnerable segments of society, whom social workers often counsel, is cigarette smoking. The purpose of this study was to assess tobacco smoking cessation training in clinical social work programs. A valid 21-item questionnaire was sent to the entire population of 189 clinical graduate social work programs identified by the Council on Social Work Education. A three-wave mailing process was used to maximize the return rate. Directors from 112 clinical social work programs returned completed questionnaires (61 percent). The majority (91 percent) of directors reported having never thought about offering formal smoking cessation training, and only nine of the programs (8 percent) currently provided formal smoking cessation education. The three leading barriers to offering smoking cessation education were as follows: not a priority (60 percent), not enough time (55 percent), and not required by the accrediting body (41 percent). These findings indicate that clinical social work students are not receiving standardized smoking cessation education to assist in improving the well-being of their clients. The national accrediting body for graduate clinical social work programs should consider implementing guidelines for smoking cessation training in the curriculums.

  10. Adaptation of an asthma management program to a small clinic.

    Science.gov (United States)

    Kwong, Kenny Yat-Choi; Redjal, Nasser; Scott, Lyne; Li, Marilyn; Thobani, Salima; Yang, Brian

    2017-07-01

    Asthma management programs, such as the Breathmobile program, have been extremely effective in reducing asthma morbidity and increasing disease control; however, their high start-up costs may preclude their implementation in smaller health systems. In this study, we extended validated asthma disease management principles from the Breathmobile program to a smaller clinic system utilizing existing resources and compared clinical outcomes. Cox-regression analyses were conducted to determine the cumulative probability that a new patient entering the program would achieve improved clinical control of asthma with each subsequent visit to the program. A weekly asthma disease management clinic was initiated in an existing multi-specialty pediatric clinic in collaboration with the Breathmobile program. Existing nursing staff was utilized in conjunction with an asthma specialist provider. Patients were referred from a regional healthcare maintenance organization and patients were evaluated and treated every 2 months. Reduction in emergency department (ED) visits and hospitalizations, and improvements in asthma control were assessed at the end of 1 year. A total of 116 patients were enrolled over a period of 1 year. Mean patient age was 6.4 years at the time of their first visit. Patient ethnicity was self-described predominantly as Hispanic or African American. Initial asthma severity for most patients, classified in accordance with national guidelines, was "moderate persistent." After 1 year of enrollment, there was a 69% and 92% reduction in ED/urgent care visits and hospitalizations, respectively, compared with the year before enrollment. Up to 70% of patients achieved asthma control by the third visit. Thirty-six different patients were seen during 1 year for a total of $15,938.70 in contracted reimbursements. A large-scale successful asthma management program can be adapted to a stationary clinic system and achieve comparable results.

  11. Investigating the effects of counseling programs on runaway youth

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Iravani

    2014-04-01

    Full Text Available This paper presents an empirical investigation to study the effects of counseling programs on reducing the runaway youth in Iran. The study selects a sample of 30 students and divides them into two groups of control and experiment. The first group is kept under eight sessions of social skills training and a questionnaire consists of various questions including confidence items is distributed among both groups after the training ends. The implementation of Kolmogorov-Smirnov has revealed that both pre and post-test data are normally distributed. In addition, the result of ANOVA test has revealed that training program could significantly improve runaway youth’s confidence.

  12. A program for dynamic noise investigations of reactor systems

    International Nuclear Information System (INIS)

    Antonov, N.A.; Yaneva, N.B.

    1980-01-01

    A stochastic process analysis in nuclear reactors is used for the state diagnosis and dynamic characteristic investigation of the reactor system. A program DENSITY adapted and tested on an IBM 360 ES type computer is developed. The program is adjusted for fast processing of long series exploiting a relatively small memory. The testing procedure is discussed and the method of the periodic sequences corresponding to characteristic reactivity perturbations of the reactor systems is considered. The program is written for calculating the auto-power spectral density and the cross-power spectral density, as well as the coherence function of stationary statistical time series using the advantages of the fast Fourier transformation. In particular, it is shown that the multi-frequency binary sequences are very useful with respect to the signal-to-noise ratio and the frequency distribution in view of the frequency reactor test

  13. Practitioner perspectives on extended clinical placement programs in optometry.

    Science.gov (United States)

    Bentley, Sharon A; Cartledge, Amy; Guest, Daryl J; Cappuccio, Skye; Woods, Craig A

    2016-05-01

    Some universities are looking to provide a more diverse range of clinical learning experiences through extended clinical placement programs. This approach will potentially have a significant impact on practitioners. The aim of this study was to conduct a national survey of optometrists to ascertain their perspectives on participating in extended clinical placement programs. Members of Optometry Australia were invited to participate in a survey conducted during June and July 2014. A total of 268 practitioners participated (six per cent of registered Australian optometrists): 159 were predominantly employees or locums and 109 were owners or managers who identified as the key representative of a practice or organisation for the purpose of this survey. Almost two-thirds (65 per cent) of participants, who were employees or locums were supportive of extended clinical placement programs. Among this group, females were more likely to be supportive than males (p = 0.033). In comparison, just over one-third (34 per cent) of participants who were key decision-makers were supportive, with 30 per cent possibly supportive and 36 per cent not supportive. Among key decision-makers, males were more likely to be supportive (p = 0.009). The top three perceived advantages of supervising a student were: opportunity to mentor early career development, opportunity to give back to the profession and future recruitment. The top three perceived disadvantages were: burden on time, decrease in number of patients examined and burden on support staff. Suggested incentives for supervising students were credit for continuing professional development and financial remuneration. There appears to be moderate support for extended clinical placement programs; however, there are incentives that might engage a larger proportion of the profession in the future. These findings can inform the development of effective and sustainable clinical training programs for optometry students. Additionally

  14. Healthcare reform from the inside: A neurosurgical clinical quality program

    OpenAIRE

    Afsar-Manesh, Nasim; Martin, Neil A.

    2012-01-01

    During the past decade, the U.S. health care system has faced increasing challenges in delivering high quality of care, ensuring patient safety, providing access to care, and maintaining manageable costs. While reform progresses at a national level, health care providers have a responsibility and obligation to advance quality and safety. In 2009, the authors implemented a department-wide Clinical Quality Program. This Program comprised of an inter-disciplinary group of providers and staff wor...

  15. Redesigning a clinical mentoring program for improved outcomes in the clinical training of clerks

    Directory of Open Access Journals (Sweden)

    Chia-Der Lin

    2015-09-01

    Full Text Available Introduction: Mentorship has been noted as critical to medical students adapting to clinical training in the medical workplace. A lack of infrastructure in a mentoring program might deter relationship building between mentors and mentees. This study assessed the effect of a redesigned clinical mentoring program from the perspective of clerks. The objective was to assess the benefits of the redesigned program and identify potential improvements. Methods: A redesigned clinical mentoring program was launched in a medical center according to previous theoretical and practical studies on clinical training workplaces, including the elements of mentor qualifications, positive and active enhancers for mentor–mentee relationship building, the timing of mentoring performance evaluation, and financial and professional incentives. A four-wave web survey was conducted, comprising one evaluation of the former mentoring program and three evaluations of the redesigned clinical mentoring program. Sixty-four fifth-year medical students in clerkships who responded to the first wave and to at least two of the three following waves were included in the study. A structured and validated questionnaire encompassing 15 items on mentor performance and the personal characteristics of the clerks was used. Mixed linear models were developed for repeated measurements and to adjust for personal characteristics. Results: The results revealed that the redesigned mentoring program improved the mentors’ performance over time for most evaluated items regarding professional development and personal support provided to the mentees. Conclusions: Our findings serve as an improved framework for the role of the institution and demonstrate how institutional policies, programs, and structures can shape a clinical mentoring program. We recommend the adoption of mentorship schemes for other cohorts of medical students and for different learning and training stages involved in becoming a

  16. Redesigning a clinical mentoring program for improved outcomes in the clinical training of clerks

    Science.gov (United States)

    Lin, Chia-Der; Lin, Blossom Yen-Ju; Lin, Cheng-Chieh; Lee, Cheng-Chun

    2015-01-01

    Introduction Mentorship has been noted as critical to medical students adapting to clinical training in the medical workplace. A lack of infrastructure in a mentoring program might deter relationship building between mentors and mentees. This study assessed the effect of a redesigned clinical mentoring program from the perspective of clerks. The objective was to assess the benefits of the redesigned program and identify potential improvements. Methods A redesigned clinical mentoring program was launched in a medical center according to previous theoretical and practical studies on clinical training workplaces, including the elements of mentor qualifications, positive and active enhancers for mentor–mentee relationship building, the timing of mentoring performance evaluation, and financial and professional incentives. A four-wave web survey was conducted, comprising one evaluation of the former mentoring program and three evaluations of the redesigned clinical mentoring program. Sixty-four fifth-year medical students in clerkships who responded to the first wave and to at least two of the three following waves were included in the study. A structured and validated questionnaire encompassing 15 items on mentor performance and the personal characteristics of the clerks was used. Mixed linear models were developed for repeated measurements and to adjust for personal characteristics. Results The results revealed that the redesigned mentoring program improved the mentors’ performance over time for most evaluated items regarding professional development and personal support provided to the mentees. Conclusions Our findings serve as an improved framework for the role of the institution and demonstrate how institutional policies, programs, and structures can shape a clinical mentoring program. We recommend the adoption of mentorship schemes for other cohorts of medical students and for different learning and training stages involved in becoming a physician. PMID

  17. Clinical investigation on RBE estimation for heavy particle radiotherapy

    International Nuclear Information System (INIS)

    Tsuji, Hiroshi; Kamada, Tadashi; Yanagi, Takeshi; Mizoe, Junetsu; Tsujii, Hirohiko

    2004-01-01

    Analysis of the clinical updated data of the prostate cancer patients treated with carbon-ions was performed for the purpose of investigating the clinical relative biological effectiveness (RBE) values of carbon ion beams. Most of the patients received the carbon ion radiotherapy (C-ion RT) with the dose of 66.0 GyE/20 fractions. Probabilities of the late urethral morbidity and biochemical tumor control with this dose fractionation were calculated using the actual updated clinical data. The linear energy transfer (LET) values and physical carbon ion doses of urethra were obtained from treatment planning data. RBE values were calculated from the ratio of average carbon physical doses and photon doses which cause the same grade of urethra reaction with the same probabilities. Obtained RBE values were compared with the values that are being used in actual carbon ion radiotherapy in National Institute of Radiological Sciences (NIRS). In addition, relative RBE of carbon ion beams for biochemical tumor control was calculated using the data from the literature. As a result, the RBE values being used for the treatment were thought to be proper enough for both the urethra reaction and tumor control. (author)

  18. Clinical trials in orthopaedics and the future direction of clinical investigations for femoroacetabular impingement

    DEFF Research Database (Denmark)

    Clohisy, John C; Kim, Young-Jo; Lurie, Jon

    2013-01-01

    to be further defined. To date, clinical research reports have included primarily surgical case series. Future clinical investigations are needed to establish improved clinical evidence to guide patient care. Most urgent is the need to better understand the potential role of standardized nonsurgical treatment......Femoroacetabular impingement (FAI) represents a heterogeneous group of disorders that affect a diverse patient population. The natural history of the disease, the role of nonsurgical management, the indications for surgery, optimal surgical techniques, and the predictors of treatment outcomes need...... options for FAI and to define the predictors of surgical and nonsurgical outcomes. Future randomized controlled trials and large observational cohort studies targeted at these clinical research deficiencies will strengthen the evidence and improve informed decision making regarding the management...

  19. Program Description: Physical Therapy in a Heart Failure Clinic

    OpenAIRE

    Knocke, Ann

    2012-01-01

    Aerobic exercise and resistance training have been proven to be beneficial for patients with heart failure. Current reimbursement guidelines exclude these patients from our traditional cardiac rehabilitation program, so at Newton Wellesley Hospital a clinic model was developed for the disease management and exercise of heart failure patients.

  20. Optical projects in the Clinic program at Harvey Mudd College

    Science.gov (United States)

    Yang, Q.

    2017-08-01

    Clinic program is the senior capstone program at Harvey Mudd College (HMC). Multidisciplinary and industry-sponsored projects allow a team of students to solve a real-world problem over one academic year. Over its 50 plus years, Clinic program has completed numerous optics related projects. This report gives an overview of the Clinic program, reviews recent optical projects and discusses how this program supports the learning of the HMC engineering students. A few sample optical projects with more details are presented to provide an insight of what challenges that undergraduates can overcome. Students achieve learning within the optics discipline and the related engineering disciplines. The experiences in these optical projects indicate the great potential to bringing optical hands-on projects into the undergraduate level. Because of the general engineering curriculum at HMC, these projects often work the best with a multidisciplinary nature even if the core of the project is optically focused. Students gain leadership training, oral and written communication skills and experiences in team work. Close relationship with the sponsor liaisons allows for the students to gain skills in professional conduct, management of tight schedule and a specified budget, and it well prepares the students to their engineering practice. Optical projects have their own sets of specific challenges, so it needs to be chosen properly to match the undergraduate skill sets such as those of HMC engineering students.

  1. Characteristics of Volunteer Coaches in a Clinical Process Improvement Program.

    Science.gov (United States)

    Morley, Katharine E; Barysauskas, Constance M; Carballo, Victoria; Kalibatas, Orinta; Rao, Sandhya K; Jacobson, Joseph O; Cummings, Brian M

    The Partners Clinical Process Improvement Leadership Program provides quality improvement training for clinicians and administrators, utilizing graduates as volunteer peer coaches for mentorship. We sought to understand the factors associated with volunteer coach participation and gain insight into how to improve and sustain this program. Review of coach characteristics from course database and survey of frequent coaches. Out of 516 Partners Clinical Process Improvement Leadership Program graduates from March 2010 to June 2015, 117 (23%) individuals volunteered as coaches. Sixty-one (52%) individuals coached once, 31 (27%) coached twice, and 25 (21%) coached 3 or more times. There were statistically significant associations between coaching and occupation (P = .005), Partners Clinical Process Improvement Leadership Program course taken (P = .001), and course location (P = .007). Administrators were more likely to coach than physicians (odds ratio: 1.75, P = .04). Reasons for volunteering as a coach included further development of skills, desire to stay involved with program, and enjoying mentoring. Reasons for repeated coaching included maintaining quality improvement skills, expanding skills to a wider variety of projects, and networking. A peer graduate volunteer coach model is a viable strategy for interprofessional quality improvement mentorship. Strategies that support repeat coaching and engage clinicians should be promoted to ensure an experienced and diversified group of coaches.

  2. TMI-2 Vessel Investigation Project (VIP) Metallurgical Program

    International Nuclear Information System (INIS)

    Diercks, D.R.; Neimark, L.A.

    1990-06-01

    The TMI-2 Vessel Investigation Project (VIP) Metallurgical Program is a part of the international TMI-2 Vessel Investigation Project being conducting jointly by the US Nuclear Regulatory Commission and the Organization for Economic Co-operation and Development (OECD). The overall project consists of three phases, namely (1) recovery of material samples from the lower head of the TMI-2 reactor, (2) examination and analysis of the lower head samples and the preparation and testing of archive material subjected to a similar thermal history, and (3) procurement, examination, and analysis of companion core material located adjacent to or near the lower head material. The specific objectives of the ANL Metallurgical Program, which comprises a major portion of Phase 2, are to prepare metallographic and mechanical test specimen blanks from the TMI-2 lower head material, prepare similar test specimen blanks from suitable archive material subjected to the appropriate thermal processing, determine the mechanical properties of the lower vessel head and archive materials under the conditions of the core-melt accident, and assess the lower head integrity and margin-to-failure during the accident. The ANL work consists of three tasks: (1) archive materials program, (2) fabrication of metallurgical and mechanical test specimens from the TMI-2 pressure vessel samples, and (3) mechanical property characterization of TMI-2 lower pressure vessel head and archive material

  3. Summary of multi-core hardware and programming model investigations

    Energy Technology Data Exchange (ETDEWEB)

    Kelly, Suzanne Marie; Pedretti, Kevin Thomas Tauke; Levenhagen, Michael J.

    2008-05-01

    This report summarizes our investigations into multi-core processors and programming models for parallel scientific applications. The motivation for this study was to better understand the landscape of multi-core hardware, future trends, and the implications on system software for capability supercomputers. The results of this study are being used as input into the design of a new open-source light-weight kernel operating system being targeted at future capability supercomputers made up of multi-core processors. A goal of this effort is to create an agile system that is able to adapt to and efficiently support whatever multi-core hardware and programming models gain acceptance by the community.

  4. Using Blogging to Promote Clinical Reasoning and Metacognition in Undergraduate Physiotherapy Fieldwork Programs

    Science.gov (United States)

    Tan, Shuyan Melissa; Ladyshewsky, Richard K.; Gardner, Peter

    2010-01-01

    This qualitative study investigated the impact of using blogs on the clinical reasoning and meta-cognitive skills of undergraduate physiotherapy students in a fieldwork education program. A blog is a web based document that enables individuals to enter comments and read each others' comments in a dynamic and interactive manner. In this study,…

  5. Sesame seed allergy: Clinical manifestations and laboratory investigations

    Directory of Open Access Journals (Sweden)

    Fazlollahi MR.

    2007-10-01

    Full Text Available Background: Plant-origin foods are among the most important sources of food allergic reactions. An increase in the incidence of sesame seed allergy among children and adults has been reported in recent years. The aim of this preliminary study was to investigate the prevalence, importance and clinical manifestations of sesame allergy among Iranian patients.Methods: In a cross-sectional survey, 250 patients with suspected IgE-mediated food allergies completed a questionnaire and underwent skin prick tests with sesame extract as well as cross-reacting foods (walnut, soya and peanut. Total IgE and sesame-specific IgE levels were measured. Patients with positive skin test reactions and/or IgE specific for sesame without clinical symptoms were considered sensitive to sesame. The patients who also had clinical symptoms with sesame consumption were diagnosed as allergic to sesame.Results: Of the 250 patients enrolled in this study, 129 were male and 121 female, with a mean age of 11.7 years. The most common food allergens were cow's milk, egg, curry, tomato and sesame. Sesame sensitivity was found in 35 patients (14.1%. Only five patients (2% had sesame allergy. Sesame-sensitive patients had a significantly higher frequency of positive prick test to cross-reacting foods when compared to non-sensitized patients (p=0.00. The type of symptom was independent of gender and age of the patients, but urticaria and dermatitis-eczema were significantly more frequent in sensitized patients (p=0.008.Conclusions: This is the first study addressing the prevalence of sesame seed allergy in Iranian population. We found sesame to be a common and important cause of food allergy. The panel of foods recommended for use in diagnostic allergy tests should be adjusted.

  6. [Clinical investigation of the positioning accuracy of acute pulpitis pain].

    Science.gov (United States)

    Wang, Jin; Sun, Wei; Ji, Aiping

    2013-10-01

    This study aims to investigate the positioning accuracy of acute pulpitis pain and its possible factors. The clinical symptoms and physical signs of 3 432 cases of acute pulpitis were recorded and analyzed by using questionnaire forms, which included age, gender, tooth position, infection origin, pain history, time of acute attack, duration and nature of pain, pain frequency, referred pain areas, percussion examination, temperature pulp test, pulp bleeding, and positioning accuracy. Univariate analysis and multivariate stepwise regression analysis were used for data processing. Pain location was accurately identified by 39.1% of the patients with acute pulpitis. Referred pain could reduce the positioning accuracy of pain (P 0.05). Some cases of acute pulpitis pain can be located accurately. Referred pain and periodontium infection origin are related to the positioning accuracy of acute pulpitis pain. The exact cause of this correlation needs further study.

  7. Clinical Investigation of Radiation Retinopathy Fundus and Fluorescein Angiographic Features

    Institute of Scientific and Technical Information of China (English)

    LiMei; QiuGT

    1999-01-01

    Purpose:To investigate the fundus and fluorescein angiographic features in the patients with radiation retinopathy.Clinical Materials:Color fundus photography and/or fluorescein angiography from 13 patients with nasopharyngeal carcinomas received external beam radiation were retrospectively analyzed.Reslts:In this study,26 damaged eyes of 13 patients eveloped some degree of radiation retinopathy.The earliest and most common finding was macular microvascular changes (microaneurysms and/or telangiectasia),which was observed in 100%(26/26)of the eyes.Intraretinal hemorrhages,macular capillary nonperfusion,and macular edema were noted in 84%,50%,and 42% of the eyes,respectively.Conclusions:Radiation retinopathy is common after external beam radiation of nasopharyngeal carcinomas.The prominent changes include maular microvascular changes,intraretinal hemorrhages and macular capillary nonperfusion.

  8. [The role of gonadal peptides in clinical investigation].

    Science.gov (United States)

    Lahlou, N; Bouvattier, C; Linglart, A; Rodrigue, D; Teinturier, C

    2009-01-01

    Inhibins, activins, and anti-Mullerian hormone (AMH) are gonadal dimeric peptides produced in ovaries and testes by homologous cells, granulosa cells and Sertoli cells, respectively. The production of inhibins is driven by FSH, that of AMH may indirectly depends on FSH, while it is down regulated, at least in the male, by testosterone. In the past decade, measurements of serum inhibin and AMH have provided useful tools for clinical investigation in gonadal disorders: pseudohermaphroditism, androgen insensitivity, anorchidism, gonadal dysgenesis, disorders of pubertal developpement. Inhibins, activins, and AMH are also reliable markers of gonadal tumors. They are extensively used as indexes of fertility: in the male the production of inhibin B reflects the spermatogenetic activity, in women both inhibin B and AMH levels are correlated with the number of preantral and early antral follicles and reflect the ovarian reserve of follicles available for recruitment.

  9. Clinical investigation of 14C-urea breath test

    International Nuclear Information System (INIS)

    Yu Yongli; Zhu Ruisen; Ji Hong; Luo Quanyong

    2000-01-01

    To investigate clinical value of 14 C-urea breath test ( 14 C-UBT) for the diagnosis of Helicobacter pylori(Hp), 70 patients were both performed gastroscopy (taking gastric mucosae biopsy for rapid urease test and histology) and 14 C-UBT (some patients by Hp-IgG or DNAHp test also) within two days. The positive cases of both rapid urease test and histology was defined as 'gold standard' of Hp-positive, whereas the negative cases of both rapid urease test and histology as 'gold standard' of Hp-negative. The sensitivity of 14 C-UBT was 93.2%, the specificity 73.1%, and the diagnostic accuracy 85.7%. The difference (comparing with 'gold standard') was not marked (x 2 = 0.9 0.05(1) 2 = 3.84, P>0.05). But the diagnostic accuracy of 14 C-UBT (85.7%) and Hp-IgG (50%) had a marked difference (x 2 13.80>x 0.01(1) 2 = 6.64, P 14 C-UBT was easy to operate, reliable and suitable for clinical application

  10. Basic and clinical investigation of T3 immunoassay kit

    International Nuclear Information System (INIS)

    Konishi, Junji; Nakajima, Akiko; Morita, Rikushi; Endo, Keigo; Ikekubo, Katsuji

    1976-01-01

    T 3 immunoassay kit was investigated basically and clinically. A good result was obtained at the prescribed incubation temperature and for 16 hours of incubation time. Moreover, it was thought to be possible that incubation time could be shortened to 1 - 4 hours at 37 0 C. Specificity of antibody was good. Recovery of added T 3 was 100+-5 (S.D.) % on an average and parallel of dilution curve of high T 3 serum was also good. Variation coefficient of accuracy of this kit was 1.5 - 2.1 % and that of reproducibility was 1.3 - 6.6 %. Mild hemolysis did not affect measurement value. Serum T 3 level in normals, untreated patients with Basedow's disease and patients with primary hypothyroidism was 142+-21 ng/100 ml, 452+-156 ng/100 ml and 67+-17 ng/100 ml, respectively. Serum T 3 level in patients with Hashimoto's disease was distributed to a wide extent, but that of patients with goiter and simple goiter ranged within normal range. On the other side, serum T 3 level of normal pregnant woman was high and that of patients with anorexia nervosa showed low level. From the above mentioned results, it was concluded that this kit was simple in method and good in sensitivity, specificity and reproducibility and it was also useful for clinical applications. (M. Tsunoda)

  11. Legal aspects associated with dismissal from clinical laboratory education programs.

    Science.gov (United States)

    Legrys, V A; Beck, S J; Laudicina, R J

    1995-01-01

    To review academic dismissals, students' rights in dismissal cases, and several key cases involving academic and disciplinary dismissals. Recent academic literature and legal precedents. Not applicable. Not applicable. Students involved in dismissals are protected under the principles of constitutional law and/or contract law, depending on whether the institution is public or private. The basis for dismissal from educational programs is either academic or disciplinary in nature. In academic dismissals, a student has failed to meet either the cognitive or the noncognitive academic standards of the program. In disciplinary dismissals, a student has violated the institutional rules governing conduct. Policies that affect progress in the program and the dismissal process should be published and distributed to students, as well as reviewed for consistency with institutional policies. The amount of documentation needed in the defense of a dismissal decision has not been specified, but, in general, more is better. Procedures are suggested as a guide to dismissals in clinical laboratory programs.

  12. Whistleblowers ask Congress to investigate TVA's nuclear power program

    International Nuclear Information System (INIS)

    Lane, E.

    1993-01-01

    Congress should investigate the Tennessee Valley Authority's nuclear power plant construction and operations programs as soon as possible, a coalition of Tennessee environmentalists and whistleblowers told reporters at a press conference in Washington, DC. The Foundation for Global Sustainability and four employees of TVA nuclear plants called for congressional action because they contend the Nuclear Regulatory Commission and the Department of Labor have failed to act to protect whistleblowers who report nuclear safety problems. The foundation contends the economics of nuclear plant construction by TVA do not make sense and in the rush to finish the Watts Bar nuclear plant, which has been under construction for 20 years, TVA has ignored safety issues

  13. Driving Organizational Change From the Bedside: The AACN Clinical Scene Investigator Academy.

    Science.gov (United States)

    Lacey, Susan R; Goodyear-Bruch, Caryl; Olney, Adrienne; Hanson, Dave; Altman, Marian S; Varn-Davis, Natasha S; Brinker, Debbie; Lavandero, Ramón; Cox, Karen S

    2017-08-01

    Staff nurses are pivotal in leading change related to quality improvement efforts, although many lack skills to steer change from the bedside. The American Association of Critical-Care Nurses (AACN) staff nurse leadership program, Clinical Scene Investigator (CSI) Academy, teaches and empowers staff nurses in leadership skills and change concepts to translate evidence into practice affecting patient outcomes. To describe the curriculum of the AACN CSI Academy that provides staff nurses with the leadership skills required to create unit-based change projects that positively impact patient/family outcomes. The curriculum of the Academy included leadership topics, communication, change concepts, quality improvement methods, project management, and data management and analysis. Each team of participants collected project data to show improvements in patient care. The program evaluation used many data sources to assess the program effectiveness, relating to the professional growth of the participant nurses. The participants assessed project patient outcomes, sustainability, and spread. The first cohort of CSI participants included 164 direct care nurses from 42 hospitals in 6 cities. They rated the Academy highly in the program evaluation, and they reported that the Academy contributed to their professional development. The individual hospital quality improvement projects resulted in positive patient and estimated fiscal outcomes that were generally sustained 1 year after the program. With the skills, tools, and support obtained from participation in the CSI Academy, staff nurses can make substantial contributions to their organizations in clinical and possibly fiscal outcomes. ©2017 American Association of Critical-Care Nurses.

  14. Clinical Investigation Program Report Control Symbol MED 300.

    Science.gov (United States)

    1982-10-01

    Preeclampsia as an Aid to Further Management. (C) (PR) 41 1961 Use of C-Reactive Protein in Prediction of ARD Prog- nosiS, (C) (PR) 42 1981 The Assessment...with fTactures of the long bones and/or severe trauma. The etiological mechanism of this syndrome is still unsettled. The two mechanisms most widely...37 Status: Completed * Title: Routine Use of Serum Uric Acid Levels at 36 Weeks Gestation as Screening Test for Preeclampsia as an Aid to Further

  15. Clinical Investigation Program Report Control Symbol MED 300.

    Science.gov (United States)

    1983-10-01

    delayed initially in Triton fed rats. The sustained increased levels of gastrin in Triton fed rats is due to the pro- longed gastric distension due to...Study Objective: To determine whether increasing the amount of information about muscle tension given to patients with muscular control problems will...pain, and tension as well as evaluate the effectiveness of muscular relaxation training as a treatment for these problems. The relative effectiveness of

  16. Clinical Investigation Program, RCS MED-300 (R1)

    Science.gov (United States)

    1987-10-31

    cholesterolemai. J Fam Pract 1987; 24:54-56. Manness DL, Rogers DY: Hemorrhagic complications of varicella . Am FP Feb 1987; pp. 151-155. Madlon-Kay 0J...carotid artery occlusion. Hospital Central Militar, Mexico City, Mexico , Jun 1987, Ebert FR: Ipsilateral concomitant fractures of femoral neck and femoral

  17. Clinical Investigation Program RCS-MED-300(R1).

    Science.gov (United States)

    1984-09-30

    Auditory Processing Ability of Children....... 236 Work Unit No. 82/43 (FY82,O) (P) Adolescent Immunity to Varicella and Cytomegalovirus.. .... .... 238...GB: Neonatal intensive care at Fitzsimons Army Medical Center. Military Medicine 149:555-560, 1984. Schydlower M, Lampe RM: Varicella and herpes...gastrointestinal bleeding. Presented at the Amer College of Surgeons, New Mexico Chapter, Las Cruces, NM, June 1984. *Graham GD, Lundy MM, Frederick RJ

  18. Clinical Investigation Program Report, RCS MED-300 (R-1).

    Science.gov (United States)

    1985-10-31

    Application of Screening Procedure to Determine the Etiology of Microcytosis with or without Anemia . (T) 150 1983 Remarried Families, Adaptability and...Hospital Militar Central, Lima, Peru ; Naval Hospital, Lima, Peru , 16 May 1985. Gregory GA: Spectrum of disorders in combat reactions. Hospital Militar...Central, Lima, Peru ; Naval Hospital, Lima, Peru , 23 May 1985. Gregory GAs Motivation for combat. Hospital Militar Central, Lima, Peru ; Naval Hospital

  19. Clinical Investigation Program RCS MED-300 (R1).

    Science.gov (United States)

    1985-09-30

    snacks pose choking hazard to young passengers. National Safety Council Air Transport Newsletter 2:6, 1985 Ting B, Knott MD, Mansfield LE, Ting S...complete. A paper entitled Replacement of Contaminated Extruded Bone Segments was presented at the Western Orthopaedic Association and received the Vernon P

  20. Investigation Clinical Competence and Its Relationship with Professional Ethics and Spiritual Health in Nurses

    Directory of Open Access Journals (Sweden)

    Elahe Ramezanzade Tabriz

    2017-03-01

    Full Text Available Abstract Background and Objectives: Study of clinical competence in nursing helps determine the quality of health care delivered to patients. Given the priority of observance of principles over caretaking and necessity of spirituality existence at the core of health care provision, this study was conducted to investigate clinical competence and its relationship with professional ethics and spiritual health in nurses. Methods: In this cross-sectional, descriptive, and correlational study, 281 nurses were enrolled by consensus sampling. Sampling was conducted from February, 2016 till June, 2016. The data were gathered by a demographics questionnaire, a self-assessment scale of clinical competence, a nursing ethics questionnaire, and a spiritual health questionnaire, and analyzed by descriptive statistics and t-test, Pearson's correlation coefficient, ANOVA, and linear regression analysis in SPSS 21. Results: The total scores for self-assessment scale of nurses' clinical competence, professional ethics, and spiritual health were moderate. In the light of the results of Spearman's correlation coefficient, there was a significant and positive correlation between clinical competence and spiritual health. Moreover, a significant positive correlation was observed between professional ethics and spiritual health but there was no correlation between professional ethics and clinical competence. Conclusion: Managers' and personnel's Knowledge about the level of nurses clinical competence, professional ethics, and spiritual health in teaching health care centers provides valuable information to develop in-service and efficacious education programs and ultimately to improve the quality of nursing services.

  1. TMI-2 Vessel Investigation Project (VIP) Metallurgical Program

    International Nuclear Information System (INIS)

    Diercks, D.R.; Neimark, L.A.

    1991-01-01

    The Three Mile Island Unite 2 (TMI-2) Vessel Investigation Project Metallurgical Program is a part of the international TMI-2 Vessel Investigation Project being conducted jointly by the U.S. Nuclear Regulatory Commission and the Organization for Economic Cooperation and Development. The objectives of the metallurgical program are to deduce the temperatures of, determine the mechanical properties of, and assess the integrity of the TMI-2 lower head during the loss-of-coolant accident. Fifteen samples have been removed from the lower head and are being examined. In addition, archive material from the lower head of the Midland nuclear reactor has been procured for conducting supplemental metallurgical evaluations and mechanical property determinations. Evaluations of the microstructure and mechanical properties of the as-received archive material have been completed, and a series of heat treatment experiments has been conducted to develop standard microstructures to be compared with those present in the TMI-2 samples. Results have been obtained from examinations of two of the fifteen TMI-2 lower head samples. These results indicate that one of these two samples, which contained cracks in the weld cladding extending ∼3 mm into the underlying base metal, apparently reached temperatures on the order of 1000 to 1100C during the accident. A preliminary examination of the core debris deposited on this sample has been performed. The other sample, from an area away from the region of core relocation, did not exceed 727C during the accident

  2. Atomoxetine for hoarding disorder: A pre-clinical and clinical investigation.

    Science.gov (United States)

    Grassi, Giacomo; Micheli, Laura; Di Cesare Mannelli, Lorenzo; Compagno, Elisa; Righi, Lorenzo; Ghelardini, Carla; Pallanti, Stefano

    2016-12-01

    Despite several studies suggested that inattention and impulsivity-compulsivity could represent two core dimensions of hoarding disorder (HD), only a small case series study investigated the effectiveness of attention-deficit-hyperactivity-disorder (ADHD) medications in HD. The aim of the present study was to target attentional and inhibitory control networks in HD patients through the ADHD medication atomoxetine, moving from a preclinical investigation on an animal model of compulsive-like behavior (marble burying test) to a clinical investigation on both medicated and unmedicated patients with a primary diagnosis of HD without ADHD. Our preclinical investigation showed that acute administration of atomoxetine significantly reduced the compulsive-like behaviours of mice in the marble burying test without affecting neither locomotor activity and coordination nor exploration behaviours. When compared, atomoxetine and fluoxetine showed similar effects on the marble burying test. However, fluoxetine impaired both locomotor and exploratory activity. In our clinical investigation 12 patients were enrolled and 11 patients completed an open trial with atomoxetine at flexible dose (40-80 mg) for 12 weeks. At the endpoint the mean UCLA Hoarding Severity Scale score decreased by 41.3% for the whole group (p = 0003). Six patients were classified as full responders (mean symptom reduction of 57.2%) and three patients as partial responders (mean symptom reduction of 27.3%). Inattentive and impulsivity symptoms showed a significant mean score reduction of 18.5% from baseline to the endpoint (F (1,9) = 20.9, p = 0.0013). Hoarding symptoms improvement was correlated to reduction of patients' disability and increased in their global functioning. These preclinical and clinical data suggest that atomoxetine may be effective for HD and therefore should be considered for future controlled trials. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Enhancing clinical skills education: University of Virginia School of Medicine's Clerkship Clinical Skills Workshop Program.

    Science.gov (United States)

    Corbett, Eugene C; Payne, Nancy J; Bradley, Elizabeth B; Maughan, Karen L; Heald, Evan B; Wang, Xin Qun

    2007-07-01

    In 1993, the University of Virginia School of Medicine began a clinical skills workshop program in an effort to improve the preparation of all clerkship students to participate in clinical care. This program involved the teaching of selected basic clinical skills by interested faculty to small groups of third-year medical students. Over the past 14 years, the number of workshops has increased from 11 to 31, and they now involve clerkship faculty from family medicine, internal medicine, and pediatrics. Workshops include a variety of common skills from the communication, physical examination, and clinical test and procedure domains such as pediatric phone triage, shoulder examination, ECG interpretation, and suturing. Workshop sessions allow students to practice skills on each other, with standardized patients, or with models, with the goal of improving competence and confidence in the performance of basic clinical skills. Students receive direct feedback from faculty on their skill performance. The style and content of these workshops are guided by an explicit set of educational criteria.A formal evaluation process ensures that faculty receive regular feedback from student evaluation comments so that adherence to workshop criteria is continuously reinforced. Student evaluations confirm that these workshops meet their skill-learning needs. Preliminary outcome measures suggest that workshop teaching can be linked to student assessment data and may improve students' skill performance. This program represents a work-in-progress toward the goal of providing a more comprehensive and developmental clinical skills curriculum in the school of medicine.

  4. Dosimetry investigation of MOSFET for clinical IMRT dose verification.

    Science.gov (United States)

    Deshpande, Sudesh; Kumar, Rajesh; Ghadi, Yogesh; Neharu, R M; Kannan, V

    2013-06-01

    In IMRT, patient-specific dose verification is followed regularly at each centre. Simple and efficient dosimetry techniques play a very important role in routine clinical dosimetry QA. The MOSFET dosimeter offers several advantages over the conventional dosimeters such as its small detector size, immediate readout, immediate reuse, multiple point dose measurements. To use the MOSFET as routine clinical dosimetry system for pre-treatment dose verification in IMRT, a comprehensive set of experiments has been conducted, to investigate its linearity, reproducibility, dose rate effect and angular dependence for 6 MV x-ray beam. The MOSFETs shows a linear response with linearity coefficient of 0.992 for a dose range of 35 cGy to 427 cGy. The reproducibility of the MOSFET was measured by irradiating the MOSFET for ten consecutive irradiations in the dose range of 35 cGy to 427 cGy. The measured reproducibility of MOSFET was found to be within 4% up to 70 cGy and within 1.4% above 70 cGy. The dose rate effect on the MOSFET was investigated in the dose rate range 100 MU/min to 600 MU/min. The response of the MOSFET varies from -1.7% to 2.1%. The angular responses of the MOSFETs were measured at 10 degrees intervals from 90 to 270 degrees in an anticlockwise direction and normalized at gantry angle zero and it was found to be in the range of 0.98 ± 0.014 to 1.01 ± 0.014. The MOSFETs were calibrated in a phantom which was later used for IMRT verification. The measured calibration coefficients were found to be 1 mV/cGy and 2.995 mV/cGy in standard and high sensitivity mode respectively. The MOSFETs were used for pre-treatment dose verification in IMRT. Nine dosimeters were used for each patient to measure the dose in different plane. The average variation between calculated and measured dose at any location was within 3%. Dose verification using MOSFET and IMRT phantom was found to quick and efficient and well suited for a busy radiotherapy

  5. Clinical dosimetry in photon radiotherapy. A Monte Carlo based investigation

    International Nuclear Information System (INIS)

    Wulff, Joerg

    2010-01-01

    Practical clinical dosimetry is a fundamental step within the radiation therapy process and aims at quantifying the absorbed radiation dose within a 1-2% uncertainty. To achieve this level of accuracy, corrections are needed for calibrated and air-filled ionization chambers, which are used for dose measurement. The procedures of correction are based on cavity theory of Spencer-Attix and are defined in current dosimetry protocols. Energy dependent corrections for deviations from calibration beams account for changed ionization chamber response in the treatment beam. The corrections applied are usually based on semi-analytical models or measurements and are generally hard to determine due to their magnitude of only a few percents or even less. Furthermore the corrections are defined for fixed geometrical reference-conditions and do not apply to non-reference conditions in modern radiotherapy applications. The stochastic Monte Carlo method for the simulation of radiation transport is becoming a valuable tool in the field of Medical Physics. As a suitable tool for calculation of these corrections with high accuracy the simulations enable the investigation of ionization chambers under various conditions. The aim of this work is the consistent investigation of ionization chamber dosimetry in photon radiation therapy with the use of Monte Carlo methods. Nowadays Monte Carlo systems exist, which enable the accurate calculation of ionization chamber response in principle. Still, their bare use for studies of this type is limited due to the long calculation times needed for a meaningful result with a small statistical uncertainty, inherent to every result of a Monte Carlo simulation. Besides heavy use of computer hardware, techniques methods of variance reduction to reduce the needed calculation time can be applied. Methods for increasing the efficiency in the results of simulation were developed and incorporated in a modern and established Monte Carlo simulation environment

  6. Smoking cessation results in a clinical lung cancer screening program.

    Science.gov (United States)

    Borondy Kitts, Andrea K; McKee, Andrea B; Regis, Shawn M; Wald, Christoph; Flacke, Sebastian; McKee, Brady J

    2016-07-01

    Lung cancer screening may provide a "teachable moment" for promoting smoking cessation. This study assessed smoking cessation and relapse rates among individuals undergoing follow-up low-dose chest computed tomography (CT) in a clinical CT lung screening program and assessed the influence of initial screening results on smoking behavior. Self-reported smoking status for individuals enrolled in a clinical CT lung screening program undergoing a follow-up CT lung screening exam between 1st February, 2014 and 31st March, 2015 was retrospectively reviewed and compared to self-reported smoking status using a standardized questionnaire at program entry. Point prevalence smoking cessation and relapse rates were calculated across the entire population and compared with exam results. All individuals undergoing screening fulfilled the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Lung Cancer Screening v1.2012(®) high-risk criteria and had an order for CT lung screening. A total of 1,483 individuals underwent a follow-up CT lung screening exam during the study interval. Smoking status at time of follow-up exam was available for 1,461/1,483 (98.5%). A total of 46% (678/1,461) were active smokers at program entry. The overall point prevalence smoking cessation and relapse rates were 20.8% and 9.3%, respectively. Prior positive screening exam results were not predictive of smoking cessation (OR 1.092; 95% CI, 0.715-1.693) but were predictive of reduced relapse among former smokers who had stopped smoking for 2 years or less (OR 0.330; 95% CI, 0.143-0.710). Duration of program enrollment was predictive of smoking cessation (OR 0.647; 95% CI, 0.477-0.877). Smoking cessation and relapse rates in a clinical CT lung screening program rates are more favorable than those observed in the general population. Duration of participation in the screening program correlated with increased smoking cessation rates. A positive exam result correlated with reduced

  7. Report of Animal Investigation Program activities for the Baneberry Event

    International Nuclear Information System (INIS)

    Smith, D.D.; Black, S.C.; Giles, K.R.; Moghissi, A.A.

    1975-11-01

    On December 18, 1970, an underground nuclear test, conducted at the Nevada Test Site, released radioactive materials into the atmosphere with resultant on-site and off-site contamination. The Animal Investigation Program of the National Environmental Research Center, Las Vegas developed studies to document the distribution of fission and activation products in the tissue of domestic and wild animals residing within contaminated areas on and surrounding the Nevada Test Site. A study of radioiodine secretion in milk from cows at the experimental dairy farm, including urine and fecal excretion from four of them, was started about 24 hours after the venting. A grazing intake study, which utilized fistulated steers, was also carried out. The analytical data collected from these studies are presented in this report

  8. The impact of family planning clinic programs on adolescent pregnancy.

    Science.gov (United States)

    Forrest, J D; Hermalin, A I; Henshaw, S K

    1981-01-01

    During the 1970s, there was a decline in adolescent childbearing in the United States and, among teenagers who were sexually active, there was a decline in pregnancy rates as well. To what extent was increased enrollment by teenagers in federally funded family planning clinics responsible for these declines? Areal multivariate analysis reveals that adolescent birthrates were reduced between 1970 and 1975 as the result of enrollment by teenagers in family planning clinics, independent of the effects of other factors also affecting fertility, such as poverty status, education and urbanization. Using a model which controls for differences in adolescent sexual activity in different areas in 1970 and 1975, the analysis found that for every 10 teenage patients enrolled in family planning clinics in 1975, about one birth was averted in 1976. Other multivariate models, which did not control for differences in sexual activity, showed changes in the same direction, though of smaller dimension. Since the family planning program averts not only births but also pregnancies that result in abortions and miscarriages, an estimate was made of the total number of pregnancies averted by the program. Based on the proportion of unintended pregnancies among adolescents that resulted in live births in 1976 (36 percent), it was estimated that for every 10 teen patients enrolled in 1975, almost three pregnancies were averted in the following year. Over the 1970s, an estimated 2.6 million unintended adolescent pregnancies were averted by the program--944,000 births, 1,376,000 abortions and 326,000 miscarriages. In 1979 alone, an estimated 417,000 unintended pregnancies were prevented by the program.

  9. PWM CONTROLLER'S MODELS FOR INVESTIGATION ACS IN SPICEFAMILY ECAD PROGRAMS

    Directory of Open Access Journals (Sweden)

    O. V. VASYLENKO

    2018-05-01

    Full Text Available Purpose. To improve simulation and design of Automatic Control Systems in the SPICE-compatible programs and to obtain separate economic and universal macromodels of PWM controller. Development of an PWM controller economical macromodel for the study of automatic control systems (ACS in computer-aided design (ECAD  programs, which does not generate algorithmic failures in comparison with the existing models of PWM. Findings. Analysis of SPICE-family applications’ mathematical basis allowed to classifying existing models of PWM-controllers, defining their suitability for ACS simulation. The criteria for the synthesis of new models have been defined. For the SPICE 3G algorithms, the Switch and Averaged models based on behavioral elements has been developed. Universal and economical PWM controller macromodel based on the simple algorithm for determining the output signal with minimum numbers of input parameters has been designed. For the Automated Measuring magnetic susceptibility System, the macromodel of quasi-PWM signal generator have been designed, which is used in the compensation subsystem. This model is different from the existing ones: it synthesizes the staircase output signal instead the pulse one, thus, there is direct control of the amplitude of the output signal, which is taken averaged. The adequacy of the models is confirmed as comparison of the simulation results during investigations of the model already existing in the SPICE program, as well as the results of experiments with real ACS. The modeling of the PWM controller was carried out on the basis of behavioral elements from the ECAD library, simulation (solution of algebra-differential equations systems with programming elements is based on SPICE algorithms. The object of the study was the simulation process of ACS with the pulse-width principle of adjusting the output value. The subject of the research are the models of PWM controllers. Originality. The new macromodel of PWM

  10. 78 FR 13070 - Guidance for Clinical Investigators, Industry, and Food and Drug Administration Staff: Financial...

    Science.gov (United States)

    2013-02-26

    ... marketing applications, (2) what is meant by ``due diligence'' in obtaining financial disclosures from...: Financial Disclosure by Clinical Investigators; Availability AGENCY: Food and Drug Administration, HHS... guidance entitled ``Guidance for Clinical Investigators, Industry, and FDA Staff: Financial Disclosure by...

  11. Using information management to implement a clinical resource management program.

    Science.gov (United States)

    Rosenstein, A H

    1997-12-01

    This article provides a consultant's account of a 250-bed community hospital's experience in implementing the Clinical Resource Management (CRM) program, a four-stage process of using information to identify opportunities for improvement, developing an effective resource management team, implementing process improvement activities, and measuring the impact on outcomes of care. CASE STUDY EXAMPLE--CONGESTIVE HEART FAILURE: The chair of the departments of internal medicine and family practice selected congestive heart failure for in-depth study. A task force focused on treatment and patient disposition in the emergency room (ER), where most of the nonelective admissions originated. A set of standardized ER orders was developed that emphasized rapid and effective diuresis through the initiation of a progressive diuretic dosing schedule directly linked to patient response. Factors critical to the success of the CRM program included allocating adequate time to promote and sell the value and importance of the program, as well as securing the support of both information systems and physicians. The main barriers to success involved limitations in the information system infrastructure and delays attributable to committee review. Short-term results from the CRM program were encouraging, with average lengths of stay reduced by 0.5 days and average costs of care reduced by 12% for the ten diagnoses studied with no adverse results. Nonstudy diagnoses showed no notable improvement. Recognizing the growing importance of information management not only for clinical decision support but for accommodating all the necessary internal and external reporting requirements will require a significant commitment and investment in technology and personnel resources.

  12. Clinical and financial considerations for implementing an ICU telemedicine program.

    Science.gov (United States)

    Kruklitis, Robert J; Tracy, Joseph A; McCambridge, Matthew M

    2014-06-01

    As the population in the United States increases and ages, the need to provide high-quality, safe, and cost-effective care to the most critically ill patients will be of great importance. With the projected shortage of intensivists, innovative changes to improve efficiency and increase productivity will be necessary. Telemedicine programs in the ICUs (tele-ICUs) are a successful strategy to improve intensivist access to critically ill patients. Although significant capital and maintenance costs are associated with tele-ICUs, these costs can be offset by indirect financial benefits, such as decreased length of stay. To achieve the positive clinical outcomes desired, tele-ICUs must be carefully designed and implemented. In this article, we discuss the clinical benefits of tele-ICUs. We review the financial considerations, including direct and indirect reimbursement and development and maintenance costs. Finally, we review design and implementation considerations for tele-ICUs.

  13. Investigating Students' Beliefs about Arabic Language Programs at Kuwait University

    Science.gov (United States)

    Al-Shaye, Shaye S.

    2009-01-01

    The current study attempted to identify students' of Arabic programs beliefs about their chosen programs. To achieve this purpose, a survey was developed to collect the data from randomly selected students in liberal-arts and education-based programs at Kuwait University. The results showed that students were statistically differentiated as a…

  14. Clinical Investigations and Management of Refractive Changes in ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    Pregnancy: A Case Report ... condition therefore requires clinical observation and monitoring until the resolution of the serous detachment is ... bilateral involvement in 40% cases of CSCR. .... edema, acute hypertensive retinopathy, retinal.

  15. Proteogenomic Investigation of Strain Variation in Clinical Mycobacterium tuberculosis Isolates

    KAUST Repository

    Heunis, Tiaan; Dippenaar, Anzaan; Warren, Robin M.; van Helden, Paul D.; van der Merwe, Ruben G.; Gey van Pittius, Nicolaas C.; Pain, Arnab; Sampson, Samantha L.; Tabb, David L.

    2017-01-01

    Mycobacterium tuberculosis consists of a large number of different strains that display unique virulence characteristics. Whole-genome sequencing has revealed substantial genetic diversity among clinical M. tuberculosis isolates, and elucidating the phenotypic variation encoded by this genetic diversity will be of utmost importance to fully understand M. tuberculosis biology and pathogenicity. In this study we integrated whole-genome sequencing and mass spectrometry (GeLC-MS/MS) to reveal strain-specific characteristics in the proteomes of two clinical M. tuberculosis Latin American-Mediterranean isolates. Using this approach we identified 59 peptides containing single amino acid variants, which covered ~9% of all total coding nonsynonymous single nucleotide variants detected by whole-genome sequencing. Furthermore, we identified 29 distinct peptides that mapped to a hypothetical protein not present in the M. tuberculosis H37Rv reference proteome. Here we provide evidence for the expression of this protein in the clinical M. tuberculosis SAWC3651 isolate. The strain-specific databases enabled confirmation of genomic differences (i.e. large genomic regions of difference and nonsynonymous single nucleotide variants) in these two clinical M. tuberculosis isolates and allowed strain differentiation at the proteome level. Our results contribute to the growing field of clinical microbial proteogenomics and can improve our understanding of phenotypic variation in clinical M. tuberculosis isolates.

  16. Proteogenomic Investigation of Strain Variation in Clinical Mycobacterium tuberculosis Isolates

    KAUST Repository

    Heunis, Tiaan

    2017-08-18

    Mycobacterium tuberculosis consists of a large number of different strains that display unique virulence characteristics. Whole-genome sequencing has revealed substantial genetic diversity among clinical M. tuberculosis isolates, and elucidating the phenotypic variation encoded by this genetic diversity will be of utmost importance to fully understand M. tuberculosis biology and pathogenicity. In this study we integrated whole-genome sequencing and mass spectrometry (GeLC-MS/MS) to reveal strain-specific characteristics in the proteomes of two clinical M. tuberculosis Latin American-Mediterranean isolates. Using this approach we identified 59 peptides containing single amino acid variants, which covered ~9% of all total coding nonsynonymous single nucleotide variants detected by whole-genome sequencing. Furthermore, we identified 29 distinct peptides that mapped to a hypothetical protein not present in the M. tuberculosis H37Rv reference proteome. Here we provide evidence for the expression of this protein in the clinical M. tuberculosis SAWC3651 isolate. The strain-specific databases enabled confirmation of genomic differences (i.e. large genomic regions of difference and nonsynonymous single nucleotide variants) in these two clinical M. tuberculosis isolates and allowed strain differentiation at the proteome level. Our results contribute to the growing field of clinical microbial proteogenomics and can improve our understanding of phenotypic variation in clinical M. tuberculosis isolates.

  17. Proteogenomic Investigation of Strain Variation in Clinical Mycobacterium tuberculosis Isolates.

    Science.gov (United States)

    Heunis, Tiaan; Dippenaar, Anzaan; Warren, Robin M; van Helden, Paul D; van der Merwe, Ruben G; Gey van Pittius, Nicolaas C; Pain, Arnab; Sampson, Samantha L; Tabb, David L

    2017-10-06

    Mycobacterium tuberculosis consists of a large number of different strains that display unique virulence characteristics. Whole-genome sequencing has revealed substantial genetic diversity among clinical M. tuberculosis isolates, and elucidating the phenotypic variation encoded by this genetic diversity will be of the utmost importance to fully understand M. tuberculosis biology and pathogenicity. In this study, we integrated whole-genome sequencing and mass spectrometry (GeLC-MS/MS) to reveal strain-specific characteristics in the proteomes of two clinical M. tuberculosis Latin American-Mediterranean isolates. Using this approach, we identified 59 peptides containing single amino acid variants, which covered ∼9% of all coding nonsynonymous single nucleotide variants detected by whole-genome sequencing. Furthermore, we identified 29 distinct peptides that mapped to a hypothetical protein not present in the M. tuberculosis H37Rv reference proteome. Here, we provide evidence for the expression of this protein in the clinical M. tuberculosis SAWC3651 isolate. The strain-specific databases enabled confirmation of genomic differences (i.e., large genomic regions of difference and nonsynonymous single nucleotide variants) in these two clinical M. tuberculosis isolates and allowed strain differentiation at the proteome level. Our results contribute to the growing field of clinical microbial proteogenomics and can improve our understanding of phenotypic variation in clinical M. tuberculosis isolates.

  18. SP-100 Program: space reactor system and subsystem investigations

    International Nuclear Information System (INIS)

    Harty, R.B.

    1983-01-01

    For a space reactor power system, a comprehensive safety program will be required to assure that no undue risk is present. This report summarizes the nuclear safety review/approval process that will be required for a space reactor system. The documentation requirements are presented along with a summary of the required contents of key documents. Finally, the aerospace safety program conducted for the SNAP-10A reactor system is summarized. The results of this program are presented to show the type of program that can be expected and to provide information that could be usable in future programs

  19. Beyond Readability: Investigating Coherence of Clinical Text for Consumers

    Science.gov (United States)

    Hetzel, Scott; Dalrymple, Prudence; Keselman, Alla

    2011-01-01

    Background A basic tenet of consumer health informatics is that understandable health resources empower the public. Text comprehension holds great promise for helping to characterize consumer problems in understanding health texts. The need for efficient ways to assess consumer-oriented health texts and the availability of computationally supported tools led us to explore the effect of various text characteristics on readers’ understanding of health texts, as well as to develop novel approaches to assessing these characteristics. Objective The goal of this study was to compare the impact of two different approaches to enhancing readability, and three interventions, on individuals’ comprehension of short, complex passages of health text. Methods Participants were 80 university staff, faculty, or students. Each participant was asked to “retell” the content of two health texts: one a clinical trial in the domain of diabetes mellitus, and the other typical Visit Notes. These texts were transformed for the intervention arms of the study. Two interventions provided terminology support via (1) standard dictionary or (2) contextualized vocabulary definitions. The third intervention provided coherence improvement. We assessed participants’ comprehension of the clinical texts through propositional analysis, an open-ended questionnaire, and analysis of the number of errors made. Results For the clinical trial text, the effect of text condition was not significant in any of the comparisons, suggesting no differences in recall, despite the varying levels of support (P = .84). For the Visit Note, however, the difference in the median total propositions recalled between the Coherent and the (Original + Dictionary) conditions was significant (P = .04). This suggests that participants in the Coherent condition recalled more of the original Visit Notes content than did participants in the Original and the Dictionary conditions combined. However, no difference was seen

  20. Investigation system for the study of computer programs structure

    International Nuclear Information System (INIS)

    Aboulker, Francis

    1968-10-01

    This document describes a set of three programs allowing to obtain the symbolic list of a machine loaded program with comments for each reconstitution. These programs are as follows: - TRAD makes the dump of the program to be rebuilt with a decomposition of each instruction when possible; - RETAB uses TRAD's result and data cards to implement the information (symbolic names) and comments. Several runs can be done as the appropriate elements are progressively determined. - TASS uses RETAB results to eliminate the duplicate information and to implement the definitive information. It establishes the reference table of symbols. These programs are written in META-SYMBOL language. They are self-loadable and translatable. They do not use programmed operators. They are defined to process the SYMBOL or META-SYMBOL programs of the 90-40 machine but their principles remain global and can apply to any machine [fr

  1. Challenges in Measuring Benefit of Clinical Research Training Programs--the ASH Clinical Research Training Institute Example.

    Science.gov (United States)

    Sung, Lillian; Crowther, Mark; Byrd, John; Gitlin, Scott D; Basso, Joe; Burns, Linda

    2015-12-01

    The American Society of Hematology developed the Clinical Research Training Institute (CRTI) to address the lack of training in patient-oriented research among hematologists. As the program continues, we need to consider metrics for measuring the benefits of such a training program. This article addresses the benefits of clinical research training programs. The fundamental and key components are education and mentorship. However, there are several other benefits including promotion of collaboration, job and advancement opportunities, and promotion of work-life balance. The benefits of clinical research training programs need to be measured so that funders and society can judge if they are worth the investment in time and resources. Identification of elements that are important to program benefit is essential to measuring the benefit of the program as well as program planning. Future work should focus on the constructs which contribute to benefits of clinical research training programs such as CRTI.

  2. Department of Clinical Investigation Annual Progress Report: Fiscal Year 1989

    Science.gov (United States)

    1989-01-01

    program runs in 4 month increment with randomly selected healthy elderly men & women. Walking is performed at a mild level, 100 to 120 beat /min for heart...Audiology). Surgical and prosthetic restoration of binaural hearing in an 88-year-old man. (Case study article submitted to the journal Ear and Hearing

  3. MRI for clinically suspected pediatric appendicitis: an implemented program

    Energy Technology Data Exchange (ETDEWEB)

    Moore, Michael M.; Gustas, Cristy N.; Choudhary, Arabinda K.; Methratta, Sosamma T.; Hulse, Michael A.; Eggli, Kathleen D.; Boal, Danielle K.B. [Penn State Milton S. Hershey Medical Center, Department of Radiology, Mail Code H066, 500 University Drive, P.O. Box 850, Hershey, PA (United States); Geeting, Glenn [Penn State Milton S. Hershey Medical Center, Department of Emergency Medicine, Hershey, PA (United States)

    2012-09-15

    Emergent MRI is now a viable alternative to CT for evaluating appendicitis while avoiding the detrimental effects of ionizing radiation. However, primary employment of MRI in the setting of clinically suspected pediatric appendicitis has remained significantly underutilized. To describe our institution's development and the results of a fully implemented clinical program using MRI as the primary imaging evaluation for children with suspected appendicitis. A four-sequence MRI protocol consisting of coronal and axial single-shot turbo spin-echo (SS-TSE) T2, coronal spectral adiabatic inversion recovery (SPAIR), and axial SS-TSE T2 with fat saturation was performed on 208 children, ages 3 to 17 years, with clinically suspected appendicitis. No intravenous or oral contrast material was administered. No sedation was administered. Data collection includes two separate areas: time parameter analysis and MRI diagnostic results. Diagnostic accuracy of MRI for pediatric appendicitis indicated a sensitivity of 97.6% (CI: 87.1-99.9%), specificity 97.0% (CI: 93.2-99.0%), positive predictive value 88.9% (CI: 76.0-96.3%), and negative predictive value 99.4% (CI: 96.6-99.9%). Time parameter analysis indicated clinical feasibility, with time requested to first sequence obtained mean of 78.7 +/- 52.5 min, median 65 min; first-to-last sequence time stamp mean 14.2 +/- 8.8 min, median 12 min; last sequence to report mean 57.4 +/- 35.2 min, median 46 min. Mean age was 11.2 +/- 3.6 years old. Girls represented 57% of patients. MRI is an effective and efficient method of imaging children with clinically suspected appendicitis. Using an expedited four-sequence protocol, sensitivity and specificity are comparable to CT while avoiding the detrimental effects of ionizing radiation. (orig.)

  4. 2014 Rural Clinical School Training and Support Program Snapshot survey.

    Science.gov (United States)

    Mendis, Kumara; Greenhill, Jennene; Walker, Judi; Bailey, Jannine; Croft, Amanda; Doyle, Zelda; McCrossin, Timothy; Stevens, Wendy

    2015-01-01

    The Rural Clinical Training and Support (RCTS) program is an Australian Government initiative to address the shortage of medical practitioners within rural and remote Australia. There is a large amount of published information about the RCTS program and rural medical student cohorts who have undertaken short- and long-term rotations. However, very little is known about the academic and professional staff involved in the program, a knowledge gap that may impact workforce and succession planning. To address this, the Federation of Rural Australian Medical Educators (FRAME) initiated the pilot 2014 RCTS Snapshot survey to obtain data on the current RCTS workforce. All professional, academic and clinical academic staff (fixed-term and continuing, regardless of fraction) employed through the RCTS program were invited to complete a short, web-based survey. The survey was conducted from March to June 2014. The quantitative variables in the survey included demographics (age and gender), rural background and exposure, employment history in rural/regional areas and at rural clinical schools (RCS), experience and expertise, reasons for working at RCS, and future employment intentions. The last three questions also were of a qualitative open-ended format to allow respondents to provide additional details regarding their reasons for working at RCSs and their future intentions. The estimated total RCTS workforce was 970. A total of 413 responses were received and 316 (40.9%) complete responses analysed. The majority of respondents were female (71%), the 40-60-year age group was predominant (28%), and professional staff constituted the majority (62%). The below 40-year age group had more professionals than academics (21% vs 12%) and more than 62% of academics were aged above 50 years. Notably, there were no academics aged less than 30 years. The percentage of professional staff with a rural background was higher (62%) than that of academics with a rural background (42%). However

  5. 77 FR 25353 - Disqualification of a Clinical Investigator

    Science.gov (United States)

    2012-04-30

    .... * * * * * Sec. 312.70, relating to whether an investigator is eligible to receive test articles under part 312... ineligible to receive one kind of test article (drugs, devices or new animal drugs), the investigator also... marketing permit for other kinds of products regulated by FDA. This final rule is based in part upon...

  6. Investigating Difficulties of Learning Computer Programming in Saudi Arabia

    Science.gov (United States)

    Alakeel, Ali M.

    2015-01-01

    Learning computer programming is one of the main requirements of many educational study plans in higher education. Research has shown that many students face difficulties acquiring reasonable programming skills during their first year of college. In Saudi Arabia, there are twenty-three state-owned universities scattered around the country that…

  7. Department of Clinical Investigation Annual Research Progress Report, FY 1992

    Science.gov (United States)

    1992-09-30

    parameters in a group of residents over the course of their first year Graduate Medical Education training to follow changes in diet and exercise habits... hypocaloric state. This study would analyze the serum from these nine men collected before and after their training to correlate declines in body...ideal body weight, and % usual body weight. A clinical assessment (history and physical exam) will be done and a diet history taken. Patients will be

  8. Clinical investigation of set-shifting subtypes in anorexia nervosa.

    Science.gov (United States)

    Abbate-Daga, Giovanni; Buzzichelli, Sara; Marzola, Enrica; Amianto, Federico; Fassino, Secondo

    2014-11-30

    While evidence continues to accumulate on the relevance of cognitive inflexibility in anorexia nervosa (AN), its clinical correlates remain unclear. We aimed at examining the relationship between set-shifting and clinical variables (i.e., eating psychopathology, depression, and personality) in AN. Ninety-four individuals affected by AN and 59 healthy controls (HC) were recruited. All participants were assessed using: Eating Disorders Inventory-2 (EDI-2), Temperament and Character Inventory (TCI), Beck Depression Inventory (BDI), and Wisconsin Card Sorting Test (WCST). The AN group scored worse than HCs on set-shifting. According to their neuropsychological performances, AN patients were split into two groups corresponding to poor (N=30) and intact (N=64) set-shifting subtypes. Interoceptive awareness, impulse regulation, and maturity fears on the EDI-2 and depression on the BDI differed across all groups (HC, intact, and poor set-shifting subtype). Self-directedness on the TCI differed significantly among all groups. Cooperativeness and reward dependence differed instead only between HC and AN poor set-shifting subtype. After controlling for depression, only interoceptive awareness remained significant with reward dependence showing a trend towards statistical significance. These findings suggest that multiple clinical variables may be correlated with set-shifting performances in AN. The factors contributing to impaired cognitive inflexibility could be more complex than heretofore generally considered. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  9. Using a new, free spectrograph program to critically investigate acoustics

    Science.gov (United States)

    Ball, Edward; Ruiz, Michael J.

    2016-11-01

    We have developed an online spectrograph program with a bank of over 30 audio clips to visualise a variety of sounds. Our audio library includes everyday sounds such as speech, singing, musical instruments, birds, a baby, cat, dog, sirens, a jet, thunder, and screaming. We provide a link to a video of the sound sources superimposed with their respective spectrograms in real time. Readers can use our spectrograph program to view our library, open their own desktop audio files, and use the program in real time with a computer microphone.

  10. 76 FR 30175 - Draft Guidance for Clinical Investigators, Industry, and FDA Staff: Financial Disclosure by...

    Science.gov (United States)

    2011-05-24

    ... consider public release of financial disclosure information related to an approved marketing application...] (Formerly FDA-1999-D-0792) Draft Guidance for Clinical Investigators, Industry, and FDA Staff: Financial... entitled ``Guidance for Clinical Investigators, Industry, and FDA Staff: Financial Disclosure by Clinical...

  11. An Investigation into the Effects of the Hangar Queen Program

    National Research Council Canada - National Science Library

    Larson, Kelly

    2002-01-01

    .... By consolidating the studies performed on cannibalizations (CANNs) and the HQ program, this paper attempts to provide an understanding of the rationale and effects/benefits of the different HQ thresholds...

  12. Developing independent investigators for clinical research relevant for Africa

    LENUS (Irish Health Repository)

    Manabe, Yukari C

    2011-12-29

    Abstract Sustainable research capacity building requires training individuals at multiple levels within a supportive institutional infrastructure to develop a critical mass of independent researchers. At many African medical institutions, a PhD is important for academic promotion and is, therefore, an important focal area for capacity building programs. We examine the training at the Infectious Diseases Institute (IDI) as a model for in-country training based on systems capacity building and attention to the academic environment. PhD training in Africa should provide a strong research foundation for individuals to perform independent, original research and to mentor others. Training the next generation of researchers within excellent indigenous academic centers of excellence with strong institutional infrastructure will empower trainees to ask regionally relevant research questions that will benefit Africans.

  13. Case file audit of Lidcombe program outcomes in a student-led stuttering clinic.

    Science.gov (United States)

    McCulloch, Julia; Swift, Michelle C; Wagnitz, Bianca

    2017-04-01

    The current study aimed to benchmark clinical outcomes for preschool-aged clients (2;0-5;11 years old) that attended a student-led clinic and undertook the Lidcombe Program. A case file audit was undertaken for all preschool clients who attended the clinic between February 2008 and February 2013 and commenced the Lidcombe Program. Clients were grouped according to Stage 1 completion. A mixed ANOVA was used to test for differences between the groups in initial and final percentage syllables stuttered (%SS). Associations between case variable factors and treatment duration were investigated using Pearson correlations. Clients who completed Stage 1 had final %SS and severity rating (SR) scores comparable to the literature; however, the median Stage 1 duration was greater. Over half of the clients (57%) withdrew prior to completing Stage 1. These clients had a significantly higher %SS at final treatment session than their completing peers. Initial %SS and SR scores were the only case variables associated with treatment duration. Students can achieve the same short-term treatment outcomes for children who stutter using the Lidcombe Program as the current published literature; however, treatment duration is greater and may impact completion. Implications of this for clinical education are discussed.

  14. Grepafloxacin Clinical Program for Lower Respiratory Tract Infections

    Directory of Open Access Journals (Sweden)

    Arne C Rodloff

    1998-01-01

    Full Text Available The present paper evaluates the clinical trial program in lower respiratory tract infections treated with a new fluoroquinolone antibiotic, grepafloxacin. Unlike older quinolones, grepafloxacin has excellent activity against Gram-positive organisms, which include Streptococcus pneumoniae and “atypical” pathogens Legionella species. Mycoplasma pneumoniae and Chlamydia pneumoniae. Grepafloxacin has a long half-life of 12 to 15 h, which allows once daily dosing. Six studies have been conducted regarding community-acquired lower respiratory tract infections (LRTls, four about community-acquired pneumonia (CAP and two about acute bacterial exacerbations of chronic bronchitis (ABECB . In these studies, grepafloxacin demonstrated clinical equivalence with standard therapies. but, in patients with documented infections. grepafloxacin was statistically superior to amoxycillin in both CAP and ABECB. The new fluoroquinolone has a good safety profile, comparable with that of ciprofloxacin. The most common adverse effects of grepafloxacin were nausea and a metallic taste; however, these effects resulted in only a few discontinuations of therapy. With the increasing prevalence of resistance in pathogens isolated from community-acquired LRTIs, grepafloxacin offers a good alternative for monotherapy in these patients.

  15. Preliminary clinical pharmacological investigations of tylosin and tiamulin in chickens.

    Science.gov (United States)

    Ziv, G

    1980-10-15

    The minimal inhibitory concentrations (MIC) of tiamulin and tylosin for mycoplasma, Gram-positive, and Gram-negative micro-organisms isolated from chickens were determinated by the agar dilution method. Median MIC values for tiamulin against Mycoplasma gallisepticum (0.05 microgram/ml) and Mycoplasma synoviae (0.10 microgram/ml) were 2 to 4 times lower than the corresponding values for tylosin. Tiamulin was also slightly more effective in vitro in inhibiting Escherichia coli, Pasteurella multocida, and beta-haemolytic streptococci than was tylosin. Groups of chicken were offered tiamulin medicated drinking water at rates of 125 and 250 mg/litre for 48 hours. Average serum tiamulin concentrations were 0.38 and 0.78 microgram/ml, respectively. When tylosin tartrate was added to the drinking water at 500 and 700 mg/litre, average serum drug levels were 0.12 and 0.17 microgram/ml, respectively. Tiamulin was 45% bound in chicken serum, as against 30% serum protein binding for tylosin. Correlations were made between free (non protein bound) serum drug levels and the MIC values of the two drugs. Such comparisons suggest that when tiamulin is given in the drinking water at rates of 125 to 250 mg/litre, better antimycoplasmal activity is to be expected in vivo than by giving tylosin tartrate in the drinking water at 500 to 700 mg/litre. Based on these data, no clinical efficacy of these dose rates can be expected in flocks infected by gram-negative micro-organisms such as E. coli or P. multocida. The tylosin tartrate rate of 500 to 700 mg/litre, may be clinical ineffective the treatment of Staphylococcus aureus infections.

  16. The GEOTREF program, a new approach for geothermal investigation

    Science.gov (United States)

    Gérard, Frédéric; Viard, Simon; Garcia, Michel

    2017-04-01

    The GEOTREF is an R&D program supported by the ADEME, French environmental agency and by the «Investissement d'Avenir », a French government program to found innovative projects. The GEOTREF program aims to develop an integrated analysis of high temperature geothermal reservoir in volcanic context. It is a collaborative program between nine research laboratories and two industrial partners. This program is supported for four years and funds 12 PhDs and 5 post-doctoral grants in various fields: geology, petrography, petrophysics, geophysics, geochemistry, reservoir modelling. The first three years are dedicated to the exploration phases that will lead to the drilling implantation. The project has two main objectives. 1.- Developing innovative and interactive methods and workflows leading to develop prospection and exploration in per volcanic geothermal target. This objective implicates: Optimization of the targeting to mitigate financial risks Adapting oil and gas exploration methods to geothermal energy, especially in peri-volcanic context. 2.- Applying this concept to different prospects in the Caribbean and South America The first target zone is located in Guadeloupe, an island of the active arc of the subduction zone where the Atlantic plate subducts under the Caribbean one. The GEOTREF prospect zone is on the Basse Terre Island in its south part closed to the Soufriere volcano, the active volcanic system. On the same island a geothermal field is exploited in Bouillante, just northward from the GEOTREF targeting area.

  17. Segmented fuel irradiation program: investigation on advanced materials

    International Nuclear Information System (INIS)

    Uchida, H.; Goto, K.; Sabate, R.; Abeta, S.; Baba, T.; Matias, E. de; Alonso, J.

    1999-01-01

    The Segmented Fuel Irradiation Program, started in 1991, is a collaboration between the Japanese organisations Nuclear Power Engineering Corporation (NUPEC), the Kansai Electric Power Co., Inc. (KEPCO) representing other Japanese utilities, and Mitsubishi Heavy Industries, Ltd. (MHI); and the Spanish Organisations Empresa Nacional de Electricidad, S.A. (ENDESA) representing A.N. Vandellos 2, and Empresa Nacional Uranio, S.A. (ENUSA); with the collaboration of Westinghouse. The objective of the Program is to make substantial contribution to the development of advanced cladding and fuel materials for better performance at high burn-up and under operational power transients. For this Program, segmented fuel rods were selected as the most appropriate vehicle to accomplish the aforementioned objective. Thus, a large number of fuel and cladding combinations are provided while minimising the total amount of new material, at the same time, facilitating an eventual irradiation extension in a test reactor. The Program consists of three major phases: phase I: design, licensing, fabrication and characterisation of the assemblies carrying the segmented rods (1991 - 1994); phase II: base irradiation of the assemblies at Vandellos 2 NPP, and on-site examination at the end of four cycles (1994-1999). Phase III: ramp testing at the Studsvik facilities and hot cell PIE (1996-2001). The main fuel design features whose effects on fuel behaviour are being analysed are: alloy composition (MDA and ZIRLO vs. Zircaloy-4); tubing texture; pellet grain size. The Program is progressing satisfactorily as planned. The base irradiation is completed in the first quarter of 1999, and so far, tests and inspections already carried out are providing useful information on the behaviour of the new materials. Also, the Program is delivering a well characterized fuel material, irradiated in a commercial reactor, which can be further used in other fuel behaviour experiments. The paper presents the main

  18. Clinical investigations of receptive and expressive musical functions after stroke

    Directory of Open Access Journals (Sweden)

    Ken eRosslau

    2015-06-01

    Full Text Available There is a long tradition of investigating various disorders of musical abilities after stroke. These impairments, associated with acquired amusia, can be highly selective, affecting only music perception (i.e., receptive abilities/functions or expression (music production abilities, and some patients report that these may dramatically influence their emotional state. The aim of this study was to systematically test both the melodic and rhythmic domains of music perception and expression in left- and right-sided stroke patients compared to healthy subjects. Music perception was assessed using rhythmic and melodic discrimination tasks, while tests of expressive function involved the vocal or instrumental reproduction of rhythms and melodies. Our approach revealed deficits in receptive and expressive functions in stroke patients, mediated by musical expertise. Those patients who had experienced a short period of musical training in childhood and adolescence performed better in the receptive and expressive subtests compared to those without any previous musical training. While discrimination of specific musical patterns was unimpaired after a right-sided stroke, patients with a left-sided stroke had worse results for fine melodic and rhythmic analysis. In terms of expressive testing, the most consistent results were obtained from a test that required patients to reproduce sung melodies. This implies that the means of investigating production abilities can impact the identification of deficits.

  19. Clinical investigations of receptive and expressive musical functions after stroke.

    Science.gov (United States)

    Rosslau, Ken; Steinwede, Daniel; Schröder, C; Herholz, Sibylle C; Lappe, Claudia; Dobel, Christian; Altenmüller, Eckart

    2015-01-01

    There is a long tradition of investigating various disorders of musical abilities after stroke. These impairments, associated with acquired amusia, can be highly selective, affecting only music perception (i.e., receptive abilities/functions) or expression (music production abilities), and some patients report that these may dramatically influence their emotional state. The aim of this study was to systematically test both the melodic and rhythmic domains of music perception and expression in left- and right-sided stroke patients compared to healthy subjects. Music perception was assessed using rhythmic and melodic discrimination tasks, while tests of expressive function involved the vocal or instrumental reproduction of rhythms and melodies. Our approach revealed deficits in receptive and expressive functions in stroke patients, mediated by musical expertise. Those patients who had experienced a short period of musical training in childhood and adolescence performed better in the receptive and expressive subtests compared to those without any previous musical training. While discrimination of specific musical patterns was unimpaired after a left-sided stroke, patients with a right-sided stroke had worse results for fine melodic and rhythmic analysis. In terms of expressive testing, the most consistent results were obtained from a test that required patients to reproduce sung melodies. This implies that the means of investigating production abilities can impact the identification of deficits.

  20. Employee Assistance Programs: A Systemic Investigation of Their Use.

    Science.gov (United States)

    Gerstein, Lawrence H.; Bayer, Gregory A.

    1988-01-01

    Reviews three articles from the EAP Digest which discuss the low employee-penetration rate of employee assistance programs. Claims low rates may be a result of environmental, employee, and supervisory attitudes about referral and intervention responsibilities. Concludes future of counselors as feasible service providers hinges partly on successful…

  1. Patient engagement: an investigation at a primary care clinic

    Science.gov (United States)

    Gill, Preetinder Singh

    2013-01-01

    Background Engaged employees are an asset to any organization. They are instrumental in ensuring good commercial outcomes through continuous innovation and incremental improvement. A health care facility is similar to a regular work setting in many ways. A health care provider and a patient have roles akin to a team leader and a team member/stakeholder, respectively. Hence it can be argued that the concept of employee engagement can be applied to patients in health care settings in order to improve health outcomes. Methods Patient engagement data were collected using a survey instrument from a primary care clinic in the northern Indian state of Punjab. Canonical correlation equations were formulated to identify combinations which were strongly related to each other. In addition, the cause-effect relationship between patient engagement and patient-perceived health outcomes was described using structural equation modeling. Results Canonical correlation analysis showed that the first set of canonical variables had a fairly strong relationship, ie, a magnitude > 0.80 at the 95% confidence interval, for five dimensions of patient engagement. Structural equation modeling analysis yielded a β ≥ 0.10 and a Student’s t statistic ≥ 2.96 for these five dimensions. The threshold Student’s t statistic was 1.99. Hence it was found the β values were significant at the 95% confidence interval for all census regions. Conclusion A scaled reliable survey instrument was developed to measured patient engagement. Better patient engagement is associated with better patient-perceived health outcomes. This study provides preliminary evidence that patient engagement has a causal relationship with patient-perceived health outcomes. PMID:23515133

  2. Clinical investigation on application of water swallowing to MR esophagography

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Jinping, E-mail: zjpmri@163.com [Department of Radiology, Tongling People' s Hospital, Bijiashan Road 468, Tongling 244000, Anhui (China); Hu, Weijian; Zang, Lin [Department of Cardiothoracic Surgery, Tongling People' s Hospital, Bijiashan Road 468, Tongling 244000, Anhui (China); Yao, Yibin; Tang, Yongxiang; Qian, Zhen; Gao, Ping; Wu, Xiaoyan; Li, Shijian [Department of Radiology, Tongling People' s Hospital, Bijiashan Road 468, Tongling 244000, Anhui (China); Xie, Zhenlan; Yuan, Xiaoqing [Department of Pathology, Tongling People' s Hospital, Bijiashan Road 468, Tongling 244000, Anhui (China)

    2012-09-15

    Objective: To verify the clinical outcomes of applying water swallowing to MR esophagography. Methods: Thirty patients confirmed postoperatively or histopathologically with thoracic esophageal carcinoma by endoscopic biopsy and 10 healthy volunteers with normal esophagus underwent respectively conventional magnetic resonance imaging (MRI) detection and water swallowing MR esophagography. Of those patients, 4 underwent second examination after radiotherapy. Assessment on imaging effects of MR esophagography was performed. Assessment on definition on MR esophagography of the tumor in both upper and lower ends, specific localization, tumor size finally measured, coincidence with the gross pathologic types and tumor staging were respectively performed by comparison with conventional MRI. Additionally, we evaluated the outcomes of radiotherapy by comparing the previous MR esophagography with the second one with interventional technique. Results: Of the total 44 images of MR esophagography, 97.7% (43/44) were in high resolution by sagittal view and 81.8% (36/44) by cross-section. 93.3% (56/60) of the MR esophagography were clearly defined with the neoplastic lesion ends in the 30 patients with thoracic esophageal carcinoma, compared with 11.7% (7/60) by conventional MRI. The results were totally different in statistics (P < 0.005). Preoperative conventional MRI detection of the 22 cases in 25 undergone radical resection suggested vague diameter of the primary tumor and impossibly identified it at middle-lower thoracic esophagus in 5, and even failed to confirm gross pathologic types in 19 cases. Yet, MR esophagography with water swallowing represented accurate tumor length (graded as excellent) in 88% (22/25), localization in 100% (25/25), exact gross pathologic types in 88% (22/25), and accuracy for tumor staging in 80.8% (21/26) compared to 92.3% (24/26) by conventional MRI. Therapeutic effects achieved in 4 patients with radiotherapy. Conclusions: MR esophagography

  3. Good clinical practice regulatory inspections: Lessons for Indian investigator sites

    Directory of Open Access Journals (Sweden)

    R Marwah

    2010-01-01

    Full Text Available Regulatory inspections are important to evaluate the integrity of the data submitted to health authorities (HAs, protect patient safety, and assess adequacy of site/sponsor quality systems to achieve the same. Inspections generally occur after submission of data for marketing approval of an investigational drug. In recent years, there has been a significant increase in number of inspections by different HAs, including in India. The assessors/inspectors generally do a thorough review of site data before inspections. All aspects of ICH-GCP, site infrastructure, and quality control systems are assessed during the inspection. Findings are discussed during the close out meeting and a detailed inspection report issued afterward, which has to be responded to within 15-30 days with effective Corrective and Preventive Action Plan (CAPA. Protocol noncompliance, inadequate/inaccurate records, inadequate drug accountability, informed consent issues, and adverse event reporting were some of the most common findings observed during recent Food and Drug Administration (FDA inspections. Drug development is being increasingly globalized and an increased number of patients enrolled in studies submitted as part of applications come from all over the world including India. Because of the steep increase in research activity in the country, inexperienced sites, and more stakeholders, increased efforts will be required to ensure continuous quality and compliance. HAs have also made clear that enforcement will be increased and be swift, aggressive, and effective.

  4. NON-COMMUNICABLE DISEASE PROGRAM IN AMPANGAN HEALTH CLINIC

    Directory of Open Access Journals (Sweden)

    MASTURA I

    2010-01-01

    Full Text Available Non-communicable diseases (NCDs represent among the most common and debilitating conditions seen in primary care. Patients’ care will often involves multiple providers and follow-up requires persistence by patients and clinicians alike, therefore ideal outcomes are often difficult to achieve. The need for better disease management policies and practice is growing. This is due to the changing demographic profile of the population, the increasing cost of managing people in acute care hospitals and the availability of new technologies and services. All these changes enable a different care paradigm which is more cost effective and provides people with chronic conditions an improved quality of life. Management of the NCDs therefore offers an excellent opportunity to practice chronic disease management - a systems approach designed to ensure excellent care. The NCD team has developed a comprehensive approach to chronic disease care. We would like to describe the NCD Program in Ampangan Health Clinic which represents many typical government health clinics in Malaysia and the processes by which it was developed. Included are specific examples of the tools and how they can be used by individual clinicians incaring for patients. The integration of Chronic Disease Management Services into health care systems is the direction being undertaken to tackle the burden of chronic disease. Disease management supports the shift in healthcare from an emphasis on managing the acute episode to managing the entire disease course, highlighting both prevention and maintenance of wellbeing for patients with chronic diseases. Disease management promotes better integration and coordination of care across all aspects of the health sector.

  5. Aquatic Species Program review: proceedings of principal investigators meeting

    Energy Technology Data Exchange (ETDEWEB)

    1985-06-01

    The purpose of the Aquatic Species Program is to improve the productivity, conversion to fuels, and cost efficiency of aquatic plant culture technologies. The emphasis of the program is on developing a mass culture technology for cultivating oil-yielding microalgae in the American southwest. A technical and economic analysis indicated that such a concept would be feasible if (1) lipid yields from microalgae are improved, (2) there is sufficient saline water for large-scale development, and (3) microalgal lipids can be economically converted to conventional fuels. It was determined that fuels from microalgal lipids presented better options than converting the microalgal biomass to either alcohols or methane. All lipids can potentially be catalytically converted to gasoline, or the fatty acids can be converted to substitute diesel fuels. The Southwest has the necessary low, flat, underutilized lands, and carbon dioxide is available from either natural deposits or flue gas from industrial plants. The amount of saline water available will probably determine how much fuel can be produced from aquatic species, and this question should be answered during 1985. The largest constraint of this technology is the economical production of an oil-rich microalgal feedstock. The agenda for the review was divided into four sections: species selection and characterization, applied physiological studies, outdoor mass cultivation, and systems design and analysis. Papers from these presentations are included in these proceedings. Program advances were reported in the areas of species collection and selection, modulated light physiology, mass culture yields, harvesting of microalgae, mass culture facility design and analysis, and assessments on fuel options from microalgae. Separate abstracts have been prepared for each paper for inclusion in the Energy Data Base.

  6. Why providers participate in clinical trials: considering the National Cancer Institute's Community Clinical Oncology Program.

    Science.gov (United States)

    McAlearney, Ann Scheck; Song, Paula H; Reiter, Kristin L

    2012-11-01

    The translation of research evidence into practice is facilitated by clinical trials such as those sponsored by the National Cancer Institute's Community Clinical Oncology Program (CCOP) that help disseminate cancer care innovations to community-based physicians and provider organizations. However, CCOP participation involves unsubsidized costs and organizational challenges that raise concerns about sustained provider participation in clinical trials. This study was designed to improve our understanding of why providers participate in the CCOP in order to inform the decision-making process of administrators, clinicians, organizations, and policy-makers considering CCOP participation. We conducted a multi-site qualitative study of five provider organizations engaged with the CCOP. We interviewed 41 administrative and clinician key informants, asking about what motivated CCOP participation, and what benefits they associated with involvement. We deductively and inductively analyzed verbatim interview transcripts, and explored themes that emerged. Interviewees expressed both "altruistic" and "self-interested" motives for CCOP participation. Altruistic reasons included a desire to increase access to clinical trials and feeling an obligation to patients. Self-interested reasons included the desire to enhance reputation, and a need to integrate disparate cancer care activities. Perceived benefits largely matched expressed motives for CCOP participation, and included internal and external benefits to the organization, and quality of care benefits for both patients and participating physicians. The motives and benefits providers attributed to CCOP participation are consistent with translational research goals, offering evidence that participation can contribute value to providers by expanding access to innovative medical care for patients in need. Copyright © 2012 Elsevier Inc. All rights reserved.

  7. Optimizing Implementation of Obesity Prevention Programs: A Qualitative Investigation Within a Large-Scale Randomized Controlled Trial.

    Science.gov (United States)

    Kozica, Samantha L; Teede, Helena J; Harrison, Cheryce L; Klein, Ruth; Lombard, Catherine B

    2016-01-01

    The prevalence of obesity in rural and remote areas is elevated in comparison to urban populations, highlighting the need for interventions targeting obesity prevention in these settings. Implementing evidence-based obesity prevention programs is challenging. This study aimed to investigate factors influencing the implementation of obesity prevention programs, including adoption, program delivery, community uptake, and continuation, specifically within rural settings. Nested within a large-scale randomized controlled trial, a qualitative exploratory approach was adopted, with purposive sampling techniques utilized, to recruit stakeholders from 41 small rural towns in Australia. In-depth semistructured interviews were conducted with clinical health professionals, health service managers, and local government employees. Open coding was completed independently by 2 investigators and thematic analysis undertaken. In-depth interviews revealed that obesity prevention programs were valued by the rural workforce. Program implementation is influenced by interrelated factors across: (1) contextual factors and (2) organizational capacity. Key recommendations to manage the challenges of implementing evidence-based programs focused on reducing program delivery costs, aided by the provision of a suite of implementation and evaluation resources. Informing the scale-up of future prevention programs, stakeholders highlighted the need to build local rural capacity through developing supportive university partnerships, generating local program ownership and promoting active feedback to all program partners. We demonstrate that the rural workforce places a high value on obesity prevention programs. Our results inform the future scale-up of obesity prevention programs, providing an improved understanding of strategies to optimize implementation of evidence-based prevention programs. © 2015 National Rural Health Association.

  8. Horonobe underground research program. Research report of 2002 FY investigation

    International Nuclear Information System (INIS)

    2003-06-01

    Main results of investigation about Horonobe deep underground research center in 2002 FY were reported. It consists of six chapters: introduction, main results, selection of research center area, underground science research, R and D of geological disposal, and the environmental survey and research center on the ground. The research center area at about 3 km north of Horonobe (B1) was selected in the four areas: A, B1, B2 and C on the basis of data, researches in the sky, aboveground and underground and other conditions. The model of geological environment was constructed by physical, geological, surface water supply researches. Development of geological environment monitoring techniques, investigation of long stabilization of geological environment and design of underground facilities are reported. The basic design of preparation of research center was investigated. (S.Y.)

  9. Selecting Television Programs for Language Learning: Investigating Television Programs from the Same Genre

    Science.gov (United States)

    Webb, Stuart

    2011-01-01

    The scripts of 288 television episodes were analysed to determine the extent to which vocabulary reoccurs in television programs from the same subgenres and unrelated television programs from different genres. Episodes from two programs from each of the following three subgenres of the American drama genre: medical, spy/action, and criminal…

  10. 76 FR 70151 - Draft Guidance for Industry, Clinical Investigators, Institutional Review Boards, and Food and...

    Science.gov (United States)

    2011-11-10

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-D-0790] Draft Guidance for Industry, Clinical Investigators, Institutional Review Boards, and Food and Drug Administration Staff; Food and Drug Administration Decisions for Investigational Device Exemption Clinical...

  11. Clinical trials using a radiopharmaceutical investigational drug: What legal environment and what authorizations required?

    International Nuclear Information System (INIS)

    El-Deeb, G.; Nguon, B.; Tibi, A.; Rizzo-Padoin, N.

    2009-01-01

    Recent revision of the legal environment for clinical research in France provided an opportunity to review what a hospital needs to carry out clinical trials using a radiopharmaceutical investigational drug. Legal measures concerning radiopharmaceutical investigational drugs are indeed more complex than those of classical clinical trials because of the additional legal provisions governing the use of ionizing radiation. Thus, requirements by the concerned staff (sponsor, pharmacist, person in charge of the nuclear activity) are described here. (authors) [fr

  12. Research Program to Investigate the Fundamental Chemistry of Technetium

    International Nuclear Information System (INIS)

    Edelstein, Norman M.; Burns, Carol J.; Shuh, David D.; Lukens, Wayne

    2000-01-01

    Technetium (99Tc, half-life = 2.13x105 years, b-emitter) is one of the radionuclides of major concern for nuclear waste disposal. This concern is due to the long half-life of 99Tc, the ease with which pertechnetate, TcO4 -, migrates in the geosphere, and the corresponding regulatory considerations. The problem of mobility of pertechnetate in the environment is compounded by the fact that pertechnetate is the thermodynamically stable form of technetium in aerobic environments. These two factors present challenges for the safe, long term immobilization of technetium in waste forms. Because of the stability of pertechnetate, technetium has been assumed to exist as pertechnetate in the aqueous phase of nuclear waste tanks. However, recent studies indicate that a significant fraction of the technetium is in a different chemical form. This program addresses the fundamental solution chemistry of technetium in the waste tank environment, and in a second part, the stability of technetium in various waste forms. The chemistry of this element will be studied in aqueous solutions at high pH, with various added salts such as nitrate, nitrite, and organic complexants, and as a function of radiation dose, to determine whether radiolysis effects can reduce TcO4 -. A separate facet of this research is the search for chemical forms of technetium that may be thermodynamically and/or kinetically stable and may be incorporated in various waste forms for long term storage. This phase of the program will address the problem of the possible oxidation of lower valent technetium species in various waste form matrices and the subsequent leaching of the highly soluble TcO4 -

  13. Physician to investigator: clinical practice to clinical research--ethical, operational, and financial considerations.

    Science.gov (United States)

    Pierre, Christine

    2008-01-01

    Physicians who participate in clinical research studies gain benefits for themselves, their practice, and their patients. Historically, private practice physicians have chosen to defer to their counterparts in academic medicine when it comes to contributing to scientific advancement through clinical studies. A growing number of private practice physicians are now taking a serious second look and deciding that there are unique benefits for both the practice and the patient. Physicians who decide to participate in clinical research should give serious consideration to the time and resources that are required to meet both federal regulations and industry standards. In addition, ethical and scientific principles for assuring the protection of human research subjects must be a paramount commitment.

  14. Young Investigator Program: Modular Paradigm for Scalable Quantum Information

    Science.gov (United States)

    2016-03-04

    actuator When both direct driving and a quantum controller are available, one can take advantage of both to achieve faster driving of the qubit. In...pointing to advantages to be found in particular geometries for larger quantum information architectures. • We investigated the effect of dephasing and...Montangero, T. Calarco, F. Nori, and M. B. Plenio, “Scal- able quantum computation via local control of only two qubits,” Phys. Rev. A, vol. 81, no. 4, p

  15. The Off-Campus Clinical Program of the College of Optometry, Ferris State College.

    Science.gov (United States)

    Paramore, James E.

    1982-01-01

    The clinical education program at Ferris State College, College of Optometry, and the various clinics affiliated with the college are described. To ensure quality, all individuals with the responsibility of teaching the students are faculty of Ferris State. (MLW)

  16. I Scratch and Sense but Can I Program? An Investigation of Learning with a Block Based Programming Language

    Science.gov (United States)

    Simpkins, N. K.

    2014-01-01

    This article reports an investigation into undergraduate student experiences and views of a visual or "blocks" based programming language and its environment. An additional and central aspect of this enquiry is to substantiate the perceived degree of transferability of programming skills learnt within the visual environment to a typical…

  17. MRI assessment program. Consensus statement on clinical efficacy of MRI

    International Nuclear Information System (INIS)

    1998-05-01

    This consensus statement is largely based on the experience gained at the MRI units at the four hospitals which have operated scanners in the MRI program. It reflects the considered opinion of the radiologists responsible for the MRI services at those hospitals. Account has also been taken of relevant overseas data. This collection of opinion relates particularly to comparison with other imaging modalities. The specific comments will require further consideration as technical developments with MRI become available, additional experience is gained with gadolinium contrast material and additional data are obtained on the influence of MRI on patient management. MRI, at present, is used either to improve diagnostic accuracy when other tests are negative or equivocal, when there is strong clinical suspicion of disease, or to improve surgical or other management planning when the diagnosis known. In some situations (eg syringomyelia, congenital spinal disease, posterior fossa/cerebello-pontine angle tumours) it may entirely replace other tests (eg myelography, air contrast, CT) which are substantially less accurate and/or more invasive. In other situations (eg hemispheric brain tumours, lumbar disc protrusions) when other tests, such as CT, can be as accurate, MRI is not usually or initially indicated because it is currently more expensive and of limited availability. However, balanced against this is the fact that it does not expose the patient to potentially harmful ionising radiation. It is also stressed that MRI images depend on complex, widely variable and, as yet, incompletely understood parameters. There is concern that this may result in false positive diagnoses, especially where MRI is used alone as a screening test, or used as the initial test. For several reasons (availability, cost, medical and diagnostic efficacy), the specific comments on indications for MRI presented are based upon the assumption that MRI is a tertiary and complementary imaging examination

  18. Investigation of ADAMO performance in the ZEUS calorimeter reconstruction program

    International Nuclear Information System (INIS)

    Kowalski, H.; Poser, T.; Stanco, L.; Tscheslog, E.

    1989-01-01

    The ADAMO package has been investigated for the reconstruction of jets simulated in the ZEUS calorimeter. The feasibility of ADAMO routines was tested under various aspects. The study was based on different versions of a cluster algorithm using ADAMO tools or direct BOS memory management tools. In particular, the amount of CPU time needed by each of the versions was determined. Results are quite promising and support an extensive use of the ADAMO package in the software development of high energy physics experiments. (orig.)

  19. Investigating GEAR-Up College Readiness Program's Influence on Postsecondary Decisions of Rural Hispanic Youth

    Science.gov (United States)

    Boydstun, Kelli Dawn

    2016-01-01

    This qualitative case study investigated how the GEAR-Up college readiness program influenced the postsecondary decisions of Hispanic students who participated in the GEAR-Up program for the recommended six-year period in a rural school district in Texas. It was not known how long-term participation in the GEAR-Up program at a rural school…

  20. Pre-Clinical and Clinical Investigation of the Impact of Obesity on Ovarian Cancer Pathogenesis

    Science.gov (United States)

    2015-12-01

    clinical cancer drug discovery , including 10 years as a Research Assistant Professor in the Department of Surgery at Duke University Medical Center...cancer therapy. Nature chemical biology . 2015;11(1):9-15. Epub 2014/12/18. doi: 10.1038/nchembio.1712. PubMed PMID: 25517383; PubMed Central PMCID...Assistant Professor of Nutrition, a member of the Nutrition Obesity Research Center, Center for Gastrointestinal Biology and Disease, McCallister Heart

  1. Comparative clinical and haematological investigations in lactating cows with subclinical and clinical ketosis

    Directory of Open Access Journals (Sweden)

    Vania Marutsova

    2015-10-01

    Full Text Available Ketosis of lactating cows is among the most common metabolic diseases in modern dairy farms. The economic importance of the disease is caused by the reduced milk yield and body weight loss, poor feed conversion, lower conception rates, culling and increased mortality of affected animals. In the present study, a total of 47 high-yielding dairy cows up to 45 days in milk (DIM are included. All animals were submitted to physical examination wich included checking the rectal body temperature, heart rate, respiratory and rumen contraction rates, and inspection of visible mucous coats. The body condition was scored, and blood β-hydroxybutyrate (BHBA concentrations were assayed. The cows were divided into 3 groups: first group (control (n=24 with blood β-hydroxybutyrate level 2.6 mmol/l (clinical ketosis. Whole blood samples were obtained and analyzed for Red Blood Cell (RBC, 1012/l, Hemoglobin (HGB, g/l, Hematocrit (HCT, %, Mean Corpuscular Volume (MCV, fl, Mean Corpuscular Hemoglobin (MCH, pg, Mean Corpuscular Hemoglobin Concentration (MCHC, g/l, White Blood Cell (WBC, 109/l, Lymphocytes (LYM, 109/l, Monocytes (MON, 109/l, Granulocytes (GRA, 109/l, Red Blood Distribution Width (RDW, %, Red Blood Cell Distribution Width Absolute (RDWa, fl, Platelets (PLT, 109/l and Mean Platelet Volume (MPV, fl. In this study, deviations in the clinical parameters in the control group and in those with subclinical ketosis were not identified. The cows from the third group (clinical ketosis exhibited hypotonia, anorexia and body weight loss vs. control group. Hematological analysis showed leukocytosis and lymphocytosis in cows with subclinical ketosis vs. control group. In cows with clinical ketosis WBC counts decreased (leukopenia, while hemoglobin content and hematocrit values are higher vs. control group. Blood BHBA values are higher in both groups of ketotic cows vs. the control group. The other analyzed parameters (RBC, MCH, MCHC, MCV, RDW, RDWa, MON, GRA, PLT

  2. A clinical clerkship collaborative program in Taiwan: Acquiring core clinical competencies through patient care responsibility

    Directory of Open Access Journals (Sweden)

    Yong A. Wang

    2016-06-01

    Conclusion: This pilot collaborative program presented a successful model for clinical education in the teaching of core clinical competencies through direct patient care responsibilities at the clerkship stage. It is hoped that the project will become a catalyst for medical education reform in Taiwan and regions with similar traditions.

  3. A diabetes management mentor program: outcomes of a clinical nurse specialist initiative to empower staff nurses.

    Science.gov (United States)

    Modic, Mary Beth; Canfield, Christina; Kaser, Nancy; Sauvey, Rebecca; Kukla, Aniko

    2012-01-01

    The purpose of this project was to enhance the knowledge of the bedside nurse in diabetes management. A forum for ongoing support and exploration of clinical problems, along with the distribution of educational tools were the components of this program. Diabetes accounts for 30% of patients admitted to the hospital. It has become more challenging to manage as the treatment choices have increased. There are a number of researchers who have identified nurse and physician knowledge of diabetes management principles as suboptimal. DESCRIPTION OF THE INNOVATION: Staff nurses are educated for a role as a Diabetes Management Mentor and are expected to educate/dialogue with peers monthly, model advocacy and diabetes patient education skills, facilitate referrals for diabetes education, and direct staff to resources for diabetes management. Diabetes Management Mentors feel more confident in their knowledge of diabetes and their ability to resolve clinical issues as they arise. The Diabetes Management Mentor role is another avenue for nurses to refine their clinical knowledge base and acquire skills to share with colleagues while remaining at the bedside. The clinical nurse specialist is expertly prepared to foster the professional development of bedside nurses while simultaneously making a positive impact on disease management. Opportunity for future investigation includes efficacy of teaching tools on diabetes mastery, the effect of clinical nurse specialist mentoring on a select group of bedside nurses, and the Diabetes Management Mentor's impact on prevention of near-miss events.

  4. Seismic investigations of the HDR Safety Program. Summary report

    International Nuclear Information System (INIS)

    Malcher, L.; Schrammel, D.; Steinhilber, H.; Kot, C.A.

    1994-08-01

    The primary objective of the seismic investigations, performed at the HDR facility in Kahl/Main, FRG was to validate calculational methods for the seismic evaluation of nuclear-reactor systems, using experimental data from an actual nuclear plant. Using eccentric mass shaker excitation the HDR soil/structure system was tested to incipient failure, exhibiting highly nonlinear response and demonstrating that structures not seismically designed can sustain loads equivalent to a design basin earthquake (DBE). Load transmission from the structure to piping/equipment indicated significant response amplifications and shifts to higher frequencies, while the response of tanks/vessels depended mainly on their support conditions. The evaluation of various piping support configurations demonstrated that proper system design (for a given spectrum) rather than number of supports or system stiffness is important to limiting pipe greens. Piping at loads exceeding the DBE eightfold still had significant margins and failure is improbable inspite of multiple support failures. The mean value for pipe damping, even under extreme loads, was found to be about 4%. Comparison of linear and nonlinear computational results with piping response measurements showed that predictions have a wide scatter and do not necessarily yield conservative responses underpredicting, in particular, peak support forces. For the soil/structure system the quality of the predictions did not depend so much on the complexity of the modeling, but rather on whether the model captured the salient features and nonlinearities of the system

  5. An institutional review board-based clinical research quality assurance program.

    Science.gov (United States)

    Lad, Pramod M; Dahl, Rebecca

    2013-01-01

    Despite the acknowledged importance of quality assurance in the clinical research process, the problem of how such a program should be implemented at the level of an academic teaching hospital or a similar institution has not been addressed in the literature. Despite the fact that quality assurance is expected in programs which certify and accredit Institutional Review Boards (IRBs), very little is known about the role of the IRB in programs of clinical research quality assurance. In this article we consider the definition of clinical research quality assurance, and describe a program designed to achieve it. The key elements of such a program are education at the site level, which has both mandatory and voluntary components, and an auditing and monitoring program, which reinforces the education on quality assurance. The role of the IRB in achieving the program goals and the organizational placement of the quality assurance program within the IRB structure and function are important items of discussion.

  6. Geophysical investigation program Northern Switzerland: Refraction-seismic measurements 84

    International Nuclear Information System (INIS)

    Fromm, G.; Driessen, L.; Lehnen, I.

    1985-01-01

    Acting on instructions from the SGPK/Nagra working group (Baden, Switzerland), PRAKLA-SEISMOS GmbH, Hanover, planned, processed and interpreted seismic refraction measurements in northern Switzerland; CGG, Massy (France) was responsible for carrying out the field work. The aim of the survey was to investigate the shape and depth of a regional, WSW-ENE striking Permocarboniferous trough which underlays the mesozoic sediments of the Tabular Jura. The crystalline basement surface and possibly other geological boundaries were to be identified on the basis of refractor velocities. The recording arrangement included a 36 km spread in the assumed trough axis and four 12 km long spreads perpendicular to the axis (broad side 'T') which covered the trough edges. The resulting good quality data indicated two refractors: horizon H5 which is attributable to the lower Permocarboniferous could only be detected in the western half of the spread with any certainty. Horizon H6 probably represents the crystalline basement surface. If anisotropy is taken into account, the refractor velocity closely corresponds to the Gneiss of the WEIACH- and the Granite 3 of the BOETTSTEIN-borehole. This horizon was clearly discernible on all recordings and allowed the approximate mapping of the trough's shape. The assumed strike direction and depth was largely confirmed. In the WSW section the trough is more than 3300 m deep, it rises to - 3000 m in the ESE section and shows only in the east of the survey area a tendency towards a narrower width and shallower depth (depth data relate to the seismic reference datum at 500 m above MSL). (author)

  7. [Methods of investigation in clinical cardiology. VIII. Socioeconomic evaluation of clinical cardiology practice].

    Science.gov (United States)

    Lázaro de Mercado, P

    1997-06-01

    Health services are systems whose mission is to improve the health status of both individuals and society in general. In recent decades, these systems have faced challenges such as their increasing complexity, limited resources, rapid innovation and diffusion of medical technologies, pressures on demand from society and professionals, and the lack of knowledge of the effects of these factors on costs and society's health. In addition, health care expenditures have grown twice as fast as wealth in industrialized countries during the last 25 years. These problems have prompted cost containment as a key issue in health policy and, at the same time, have promoted the development of socioeconomic evaluation as a scientific activity in the frame of health services research. Socioeconomic evaluation tries to determine if the sacrifice made by society, which devotes part of its limited resources to health care, maximizes the outcomes for population. This article describes basic concepts and methods of economic appraisal in health services which are illustrated with examples of clinical practice in cardiology. Common methods of evaluation are described; the relation between the clinical outcome of a procedure and its associated costs is emphasized in explaining the types of efficiency analysis (cost-efficacy, cost-effectiveness, cost-utility, and cost-benefit); and finally a guide for socioeconomic evaluation is provided.

  8. Applicable or non-applicable: investigations of clinical heterogeneity in systematic reviews

    Directory of Open Access Journals (Sweden)

    Laura E. Chess

    2016-02-01

    Full Text Available Abstract Background Clinical heterogeneity can be defined as differences in participant characteristics, types or timing of outcome measurements and intervention characteristics. Clinical heterogeneity in systematic reviews has the possibility to significantly affect statistical heterogeneity leading to inaccurate conclusions and misled decision making. The aim of this study is to identify to what extent investigators are assessing clinical heterogeneity in both Cochrane and non-Cochrane systematic reviews. Methods The most recent 100 systematic reviews from the top five journals in medicine—JAMA, Archives of Internal Medicine, British Medical Journal, The Lancet, and PLOS Medicine—and the 100 most recently published and/or updated systematic reviews from Cochrane were collected. Various defined items of clinical heterogeneity were extracted from the included reviews. Investigators used chi-squared tests, logarithmic modeling and linear regressions to determine if the presence of such items served as a predictor for clinical heterogeneity when comparing Cochrane to non-Cochrane reviews. Extracted variables include number of studies, number of participants, presence of quantitative synthesis, exploration of clinical heterogeneity, heterogeneous characteristics explored, basis and methods used for investigating clinical heterogeneity, plotting/visual aids, author contact, inferences from clinical heterogeneity investigation, reporting assessment, and the presence of a priori or post-hoc analysis. Results A total of 317 systematic reviews were considered, of which 199 were in the final analysis. A total of 81 % of Cochrane reviews and 90 % of non-Cochrane reviews explored characteristics that are considered aspects of clinical heterogeneity and also described the methods they planned to use to investigate the influence of those characteristics. Only 1 % of non-Cochrane reviews and 8 % of Cochrane reviews explored the clinical

  9. Investigators' viewpoint of clinical trials in India: Past, present and future

    Directory of Open Access Journals (Sweden)

    Mohandas K Mallath

    2017-01-01

    Full Text Available India's success in producing food and milk for its population (Green Revolution and White Revolution happened because of scientific research and field trials. Likewise improving the health of Indians needs clinical research and clinical trials. A Large proportion of the sick Indians are poor, illiterate with no access to good health care. They are highly vulnerable to inducement and exploitation in clinical trials. The past two decades saw the rise and fall of clinical trials in India. The rise happened when our regulators created a favorable environment, and Indian investigators were invited to participate in global clinical trials. The gap between the demand and supply resulted in inadequate protection of the trial participants. Reports of abuses of the vulnerable trial participants followed by public interest litigations led to strengthening of regulations by the regulators. The stringent new regulations made the conduct of clinical trials more laborious and increased the cost of clinical trials in India. There was a loss of interest in sponsored clinical trials resulting in the fall in global clinical trials in India. Following repeated appeals by the investigators, the Indian regulators have recently relaxed some of the stringent regulations, while continuing to ensure the adequate patient protection. Clinical trials that are relevant to our population and conducted by well-trained investigators and monitored by trained and registered Ethics Committees will increase in the future. We must remain vigilant, avoid previous mistakes, and strive hard to protect the trial participants in the future trials.

  10. Guest investigator program study: Physics of equatorial plasma bubbles

    Science.gov (United States)

    Tsunoda, Roland T.

    1994-01-01

    -shaped plasma bubbles. The second topic was pursued because the inability to predict the day-to-day occurrence of plasma bubbles indicated inadequate knowledge of the physics of plasma bubbles. An understanding of bubble formation requires an understanding of the roles of the various terms in the linearized growth rate of the collisional Rayleigh-Taylor instability. In our study, we examined electric-field perturbations found in SM-D EFI data and found that the seeding is more likely to be produced in the E region rather than the F region. The results of this investigation are presented in the Appendix of this report and will be submitted for publication in the Journal of Geophysical Research.

  11. Development of a Clinical Pharmacology Graduate Program at the University of Kentucky.

    Science.gov (United States)

    Blouin, Robert A.; And Others

    1994-01-01

    The structure, components, and anticipated outcomes of a University of Kentucky doctoral program in pharmacology are described. The program is designed to develop pharmacy-trained specialists who are interested in rigorous, intensive clinical experience, state-of-the-art coursework, and integrated laboratory-based and clinical dissertation…

  12. Clinical pharmacology quality assurance program: models for longitudinal analysis of antiretroviral proficiency testing for international laboratories.

    Science.gov (United States)

    DiFrancesco, Robin; Rosenkranz, Susan L; Taylor, Charlene R; Pande, Poonam G; Siminski, Suzanne M; Jenny, Richard W; Morse, Gene D

    2013-10-01

    Among National Institutes of Health HIV Research Networks conducting multicenter trials, samples from protocols that span several years are analyzed at multiple clinical pharmacology laboratories (CPLs) for multiple antiretrovirals. Drug assay data are, in turn, entered into study-specific data sets that are used for pharmacokinetic analyses, merged to conduct cross-protocol pharmacokinetic analysis, and integrated with pharmacogenomics research to investigate pharmacokinetic-pharmacogenetic associations. The CPLs participate in a semiannual proficiency testing (PT) program implemented by the Clinical Pharmacology Quality Assurance program. Using results from multiple PT rounds, longitudinal analyses of recovery are reflective of accuracy and precision within/across laboratories. The objectives of this longitudinal analysis of PT across multiple CPLs were to develop and test statistical models that longitudinally: (1) assess the precision and accuracy of concentrations reported by individual CPLs and (2) determine factors associated with round-specific and long-term assay accuracy, precision, and bias using a new regression model. A measure of absolute recovery is explored as a simultaneous measure of accuracy and precision. Overall, the analysis outcomes assured 97% accuracy (±20% of the final target concentration of all (21) drug concentration results reported for clinical trial samples by multiple CPLs). Using the Clinical Laboratory Improvement Act acceptance of meeting criteria for ≥2/3 consecutive rounds, all 10 laboratories that participated in 3 or more rounds per analyte maintained Clinical Laboratory Improvement Act proficiency. Significant associations were present between magnitude of error and CPL (Kruskal-Wallis P Kruskal-Wallis P < 0.001).

  13. Effects of an experiential learning program on the clinical reasoning and critical thinking skills of occupational therapy students.

    Science.gov (United States)

    Coker, Patty

    2010-01-01

    This study examined the effects of participation in a 1-week, experiential, hands-on learning program on the critical thinking and clinical reasoning skills of occupational therapy students. A quasi-experimental, nonrandomized pre- and post-test design was used with a sample of 25 students. The students had completed three semesters of didactic lecture coursework in a master's level OT educational program prior to participation in a hands-on therapy program for children with hemiplegic cerebral palsy. Changes in critical thinking and clinical reasoning skills were evaluated using the following dependent measures: Self-Assessment of Clinical Reflection and Reasoning (SACRR) and the California Critical Thinking Skills Test (CCTST). Changes in pretest and posttest scores on the SACRR and the CCTST were statistically significant (p>0.05) following completion of the experiential learning program. This study supports the use of hands-on learning to develop clinical reasoning and critical thinking skills in healthcare students, who face ever more diverse patient populations upon entry-level practice. Further qualitative and quantitative investigations are needed to support the results of this study and determine which components of experiential learning programs are essential for developing clinical reasoning and critical thinking skills in future allied health professionals.

  14. Object Oriented Programming Systems (OOPS) and frame representations: An investigation of programming paradigms

    Science.gov (United States)

    Auty, David

    1988-01-01

    The project was initiated to research Object Oriented Programming Systems (OOPS) and frame representation systems, their significance and applicability, and their implementation in or relationship to Ada. Object orientated is currently a very popular conceptual adjective. Object oriented programming, in particular, is promoted as a particularly productive approach to programming; an approach which maximizes opportunities for code reuse and lends itself to the definition of convenient and well-developed units. Such units are thus expected to be usable in a variety of situations, beyond the typical highly specific unit development of other approaches. Frame represenation systems share a common heritage and similar conceptual foundations. Together they represent a quickly emerging alternative approach to programming. The approach is to first define the terms, starting with relevant concepts and using these to put bounds on what is meant by OOPS and Frames. From this the possibilities were pursued to merge OOPS with Ada which will further elucidate the significant characteristics which make up this programming approach. Finally, some of the merits and demerits of OOPS were briefly considered as a way of addressing the applicability of OOPS to various programming tasks.

  15. Clinically speaking: A communication skills program for students from non-English speaking backgrounds.

    Science.gov (United States)

    Miguel, Caroline San; Rogan, Fran; Kilstoff, Kathleen; Brown, Di

    2006-09-01

    This paper reports on the design, delivery and evaluation of an innovative oral communication skills program for first year students in a Bachelor of Nursing degree at an Australian university. This program was introduced in 2004 to meet the needs of first year undergraduate students from non-English speaking backgrounds who had experienced difficulties with spoken English while on clinical placement. The program consisted of early identification of students in need of communication development, a series of classes incorporated into the degree program to address students' needs, followed by a clinical placement block. This paper describes the structure of the program, discusses some of the major problems encountered by students in the clinical setting and presents some of the teaching strategies used to address these problems. Evaluations of the program suggest that students' communication skills and confidence improved, resulting in a more positive clinical experience for the majority of students.

  16. Stochastic integer programming for multi-disciplinary outpatient clinic planning

    NARCIS (Netherlands)

    Leeftink, A. G.; Vliegen, I. M.H.; Hans, E. W.

    2017-01-01

    Scheduling appointments in a multi-disciplinary clinic is complex, since coordination between disciplines is required. The design of a blueprint schedule for a multi-disciplinary clinic with open access requirements requires an integrated optimization approach, in which all appointment schedules are

  17. Designing and Implementing INTREPID, an Intensive Program in Translational Research Methodologies for New Investigators

    Science.gov (United States)

    Aphinyanaphongs, Yindalon; Shao, Yongzhao; Micoli, Keith J.; Fang, Yixin; Goldberg, Judith D.; Galeano, Claudia R.; Stangel, Jessica H.; Chavis‐Keeling, Deborah; Hochman, Judith S.; Cronstein, Bruce N.; Pillinger, Michael H.

    2014-01-01

    Abstract Senior housestaff and junior faculty are often expected to perform clinical research, yet may not always have the requisite knowledge and skills to do so successfully. Formal degree programs provide such knowledge, but require a significant commitment of time and money. Short‐term training programs (days to weeks) provide alternative ways to accrue essential information and acquire fundamental methodological skills. Unfortunately, published information about short‐term programs is sparse. To encourage discussion and exchange of ideas regarding such programs, we here share our experience developing and implementing INtensive Training in Research Statistics, Ethics, and Protocol Informatics and Design (INTREPID), a 24‐day immersion training program in clinical research methodologies. Designing, planning, and offering INTREPID was feasible, and required significant faculty commitment, support personnel and infrastructure, as well as committed trainees. PMID:25066862

  18. 78 FR 66941 - Design Considerations for Pivotal Clinical Investigations for Medical Devices; Guidance for...

    Science.gov (United States)

    2013-11-07

    .... 66, rm. 2110, Silver Spring, MD 20993-0002, 301- 796-5750. For devices regulated by CBER: Stephen... the best clinical and statistical practices for investigational medical device studies. A medical...

  19. Clinical investigation of CT-guided ozone-blowing and fumigation ...

    African Journals Online (AJOL)

    Clinical investigation of CT-guided ozone-blowing and fumigation therapy for the chronic ... African Journal of Biotechnology ... In control group, seven patients were completely cured in 45 days after being treated by traditional surgery.

  20. Trends in the Medical Knowledge and Clinical Competence of Graduates of Internal Medicine Residency Training Programs.

    Science.gov (United States)

    Norcini, John J.; And Others

    1991-01-01

    A study assessed the effectiveness of medical resident training programs during 1983-88 by evaluating students' certification scores and comparing them to the program's evaluation of students' clinical competence. Results are reported and analyzed for top-rated, university-affiliated, and non-university-affiliated programs, focusing on trends over…

  1. Designing and Implementing a Mentoring Program to Support Clinically-Based Teacher Education

    Science.gov (United States)

    Henning, John E.; Gut, Dianne; Beam, Pamela

    2015-01-01

    This article describes one teacher preparation program's approach to designing and implementing a mentoring program to support clinically-based teacher education. The design for the program is based on an interview study that compared the mentoring experiences of 18 teachers across three different contexts: student teaching, early field…

  2. Comparison of international guideline programs to evaluate and update the Dutch program for clinical guideline development in physical therapy.

    Science.gov (United States)

    Van der Wees, Philip J; Hendriks, Erik J M; Custers, Jan W H; Burgers, Jako S; Dekker, Joost; de Bie, Rob A

    2007-11-23

    Clinical guidelines are considered important instruments to improve quality in health care. Since 1998 the Royal Dutch Society for Physical Therapy (KNGF) produced evidence-based clinical guidelines, based on a standardized program. New developments in the field of guideline research raised the need to evaluate and update the KNGF guideline program. Purpose of this study is to compare different guideline development programs and review the KNGF guideline program for physical therapy in the Netherlands, in order to update the program. Six international guideline development programs were selected, and the 23 criteria of the AGREE Instrument were used to evaluate the guideline programs. Information about the programs was retrieved from published handbooks of the organizations. Also, the Dutch program for guideline development in physical therapy was evaluated using the AGREE criteria. Further comparison the six guideline programs was carried out using the following elements of the guideline development processes: Structure and organization; Preparation and initiation; Development; Validation; Dissemination and implementation; Evaluation and update. Compliance with the AGREE criteria of the guideline programs was high. Four programs addressed 22 AGREE criteria, and two programs addressed 20 AGREE criteria. The previous Dutch program for guideline development in physical therapy lacked in compliance with the AGREE criteria, meeting only 13 criteria. Further comparison showed that all guideline programs perform systematic literature searches to identify the available evidence. Recommendations are formulated and graded, based on evidence and other relevant factors. It is not clear how decisions in the development process are made. In particular, the process of translating evidence into practice recommendations can be improved. As a result of international developments and consensus, the described processes for developing clinical practice guidelines have much in common

  3. Comparison of international guideline programs to evaluate and update the Dutch program for clinical guideline development in physical therapy

    Directory of Open Access Journals (Sweden)

    Burgers Jako S

    2007-11-01

    Full Text Available Abstract Background Clinical guidelines are considered important instruments to improve quality in health care. Since 1998 the Royal Dutch Society for Physical Therapy (KNGF produced evidence-based clinical guidelines, based on a standardized program. New developments in the field of guideline research raised the need to evaluate and update the KNGF guideline program. Purpose of this study is to compare different guideline development programs and review the KNGF guideline program for physical therapy in the Netherlands, in order to update the program. Method Six international guideline development programs were selected, and the 23 criteria of the AGREE Instrument were used to evaluate the guideline programs. Information about the programs was retrieved from published handbooks of the organizations. Also, the Dutch program for guideline development in physical therapy was evaluated using the AGREE criteria. Further comparison the six guideline programs was carried out using the following elements of the guideline development processes: Structure and organization; Preparation and initiation; Development; Validation; Dissemination and implementation; Evaluation and update. Results Compliance with the AGREE criteria of the guideline programs was high. Four programs addressed 22 AGREE criteria, and two programs addressed 20 AGREE criteria. The previous Dutch program for guideline development in physical therapy lacked in compliance with the AGREE criteria, meeting only 13 criteria. Further comparison showed that all guideline programs perform systematic literature searches to identify the available evidence. Recommendations are formulated and graded, based on evidence and other relevant factors. It is not clear how decisions in the development process are made. In particular, the process of translating evidence into practice recommendations can be improved. Conclusion As a result of international developments and consensus, the described processes

  4. Facilitating programming comprehension for novice learners with multimedia approach: A preliminary investigation

    Science.gov (United States)

    Annamalai, Subashini; Salam, Sobihatun Nur Abdul

    2017-10-01

    This research paper presents the preliminary investigation on the use of an interactive multimedia courseware named MAFPro, to facilitate C Programming lessons for novice learners. The courseware utilizes the elements of multimedia that focus on enhancing learners' programming comprehension. Among the aspects that were examined were the students' programming comprehension and their perceived motivation of MAFPro. This study was carried out in a survey design method with the participation of 30 undergraduates who are novice learners. The data analysis indicates that the multimedia courseware, MAFPro that has been used in the C programming classroom has a significant difference on the undergraduates' programming comprehension. The students also perceived MAFPro as motivating and engaging.

  5. Current status of clinical education in paramedic programs: a descriptive research project.

    Science.gov (United States)

    Grubbs, K C

    1997-01-01

    Development of competence in exercising therapeutic judgment skills represents the goal of clinical education. Time (clock hours) is not a valid predictor of attainment of competence in paramedic clinical education. Quantity of patient contact experiences facilitates development of judgment skills, and offers a valid measure of progress toward competence. This project uses national survey data from accredited programs to describe the availability and accessibility of patient contact experiences within paramedic clinical education. Data from this local program supplements the national survey results. The components of clinical judgment are enumerated, and strategies to teach and evaluate clinical judgment skills are discussed.

  6. The Effect of Peer-Mentoring Program on Nursing Students’ Clinical Environment Stressors

    Directory of Open Access Journals (Sweden)

    F Sardari Kashkooli

    2014-01-01

    Results: There was a significant difference between stress scores before and after of the intervention in both groups (p=0.00. Mean difference of clinical environment stress factors in two groups were not statistically significant (p=0.99. Conclusions: Peer-mentoring program is not significant effective on clinical environment stress reduction. Key Words: Nursing Education, Peer Mentoring, Clinical Environment Stressors

  7. A clinical scoring system to prioritise investigation for tuberculosis among adults attending HIV clinics in South Africa.

    Directory of Open Access Journals (Sweden)

    Yasmeen Hanifa

    Full Text Available The World Health Organization (WHO recommendation for regular tuberculosis (TB screening of HIV-positive individuals with Xpert MTB/RIF as the first diagnostic test has major resource implications.To develop a diagnostic prediction model for TB, for symptomatic adults attending for routine HIV care, to prioritise TB investigation.Cohort study exploring a TB testing algorithm.HIV clinics, South Africa.Representative sample of adult HIV clinic attendees; data from participants reporting ≥1 symptom on the WHO screening tool were split 50:50 to derive, then internally validate, a prediction model.TB, defined as "confirmed" if Xpert MTB/RIF, line probe assay or M. tuberculosis culture were positive; and "clinical" if TB treatment started without microbiological confirmation, within six months of enrolment.Overall, 79/2602 (3.0% participants on ART fulfilled TB case definitions, compared to 65/906 (7.2% pre-ART. Among 1133/3508 (32.3% participants screening positive on the WHO tool, 1048 met inclusion criteria for this analysis: 52/515 (10.1% in the derivation and 58/533 (10.9% in the validation dataset had TB. Our final model comprised ART status (on ART > 3 months vs. pre-ART or ART 1 symptom. We converted this to a clinical score, using clinically-relevant CD4 and BMI categories. A cut-off score of ≥3 identified those with TB with sensitivity and specificity of 91.8% and 34.3% respectively. If investigation was prioritised for individuals with score of ≥3, 68% (717/1048 symptomatic individuals would be tested, among whom the prevalence of TB would be 14.1% (101/717; 32% (331/1048 of tests would be avoided, but 3% (9/331 with TB would be missed amongst those not tested.Our clinical score may help prioritise TB investigation among symptomatic individuals.

  8. Cleveland Clinic Lerner College of Medicine: an innovative approach to medical education and the training of physician investigators.

    Science.gov (United States)

    Fishleder, Andrew J; Henson, Lindsey C; Hull, Alan L

    2007-04-01

    Cleveland Clinic Lerner College of Medicine (CCLCM) is an innovative, five-year medical education track within Case Western Reserve University School of Medicine (Case) with a focused mission to attract and educate a limited number of highly qualified persons who seek to become physician investigators. CCLCM curriculum governance, faculty appointments and promotions, and admissions committees are integrated with respective Case committees. The CCLCM curriculum is based on faculty-defined professional attributes that graduates are expected to develop. These attributes were used to create curricular and assessment principles that guided the development of an integrated basic science, clinical science, and research curriculum, conducted in an active learning environment. An organ-system approach is used to solidify an understanding of basic science discipline threads in the context of relevant clinical problems presented in PBL and case-based discussion formats. Clinical skills are introduced in the first year as part of the two-year longitudinal experience with a family practice or internal medicine physician. The research program provides all students with opportunities to learn and experience basic and translational research and clinical research before selecting a research topic for their 12- to 15-month master-level thesis project. All Case students participate in required and elective clinical curriculum after the second year, but CCLCM students return to the Cleveland Clinic on selected Friday afternoons for program-specific research and professionalism-learning activities. A unique portfolio-based assessment system is used to assess student achievements in nine competency areas, seven of which reflect the Accreditation Council for Graduate Medical Education competencies.

  9. [THE RESULTS OF CLINICAL AND PSYCHOPATHOLOGICAL AND PSYCHOLOGICAL DIAGNOSTIC INVESTIGATIONS EMPLOYEES OF FINANCIAL INSTITUTIONS WHICH WERE IDENTIFIED NEUROTIC DISORDERS].

    Science.gov (United States)

    Solovyova, M

    2014-12-01

    The article presents the results of the clinical and psychopathological and psychological diagnostic, investigations mental health employees of financial institutions, description and analysis of clinical forms identified disorders.

  10. Implementing effective and sustainable multidisciplinary clinical thoracic oncology programs.

    Science.gov (United States)

    Osarogiagbon, Raymond U; Freeman, Richard K; Krasna, Mark J

    2015-08-01

    Three models of care are described, including two models of multidisciplinary care for thoracic malignancies. The pros and cons of each model are discussed, the evidence supporting each is reviewed, and the need for more (and better) research into care delivery models is highlighted. Key stakeholders in thoracic oncology care delivery outcomes are identified, and the need to consider stakeholder perspectives in designing, validating and implementing multidisciplinary programs as a vehicle for quality improvement in thoracic oncology is emphasized. The importance of reconciling stakeholder perspectives, and identify meaningful stakeholder-relevant benchmarks is also emphasized. Metrics for measuring program implementation and overall success are proposed.

  11. Diagnostic investigation of patients with chronic polyneuropathy: evaluation of a clinical guideline

    NARCIS (Netherlands)

    Rosenberg, N. R.; Portegies, P.; de Visser, M.; Vermeulen, M.

    2001-01-01

    OBJECTIVE: (1) To evaluate a clinical guideline for the diagnostic investigation of patients presenting with signs and symptoms (present for longer than 6 weeks) suggesting a chronic polyneuropathy. (2) To investigate the contribution of electrophysiological studies to a focused search for aetiology

  12. Assessing Clinical Trial-Associated Workload in Community-Based Research Programs Using the ASCO Clinical Trial Workload Assessment Tool.

    Science.gov (United States)

    Good, Marjorie J; Hurley, Patricia; Woo, Kaitlin M; Szczepanek, Connie; Stewart, Teresa; Robert, Nicholas; Lyss, Alan; Gönen, Mithat; Lilenbaum, Rogerio

    2016-05-01

    Clinical research program managers are regularly faced with the quandary of determining how much of a workload research staff members can manage while they balance clinical practice and still achieve clinical trial accrual goals, maintain data quality and protocol compliance, and stay within budget. A tool was developed to measure clinical trial-associated workload, to apply objective metrics toward documentation of work, and to provide clearer insight to better meet clinical research program challenges and aid in balancing staff workloads. A project was conducted to assess the feasibility and utility of using this tool in diverse research settings. Community-based research programs were recruited to collect and enter clinical trial-associated monthly workload data into a web-based tool for 6 consecutive months. Descriptive statistics were computed for self-reported program characteristics and workload data, including staff acuity scores and number of patient encounters. Fifty-one research programs that represented 30 states participated. Median staff acuity scores were highest for staff with patients enrolled in studies and receiving treatment, relative to staff with patients in follow-up status. Treatment trials typically resulted in higher median staff acuity, relative to cancer control, observational/registry, and prevention trials. Industry trials exhibited higher median staff acuity scores than trials sponsored by the National Institutes of Health/National Cancer Institute, academic institutions, or others. The results from this project demonstrate that trial-specific acuity measurement is a better measure of workload than simply counting the number of patients. The tool was shown to be feasible and useable in diverse community-based research settings. Copyright © 2016 by American Society of Clinical Oncology.

  13. Relationship Between the Number of Clinical Sites in Radiography Programs and Job Placement Rates of Graduates.

    Science.gov (United States)

    Harrell, Angela; Matthews, Eric

    2016-07-01

    To determine whether a relationship exists between the number of clinical sites available in radiography programs accredited by the Joint Review Committee on Education in Radiologic Technology and the job placement rates of graduates. We performed a secondary analysis of data on job placement rates and the number of clinical sites available in 438 degree-granting radiography programs from January 2015 to March 2015. A weak, negative, nonsignificant correlation existed between the number of clinical sites and the job placement rate (Spearman's rho = -.113, n = 438, P = .018). The coefficient of determination was 1.28%.Discussion Research evaluating factors contributing to graduate employability is limited but indicates no need for radiography program administrators to adjust clinical site numbers solely on the basis of improving graduate employability. The number of clinical sites available in a radiography program is not related to the job placement rate of its graduates. ©2016 American Society of Radiologic Technologists.

  14. 76 FR 31613 - NIOSH Fire Fighter Fatality Investigation and Prevention Program (FFFIPP)

    Science.gov (United States)

    2011-06-01

    ... Control and Prevention (CDC) requests stakeholder input on the progress and future directions of the NIOSH Fire Fighter Fatality Investigation and Prevention Program (FFFIPP). NIOSH is seeking stakeholder input... service, and to identify ways in which the program can be improved to increase its impact on the safety...

  15. A Preliminary Investigation into Parents' Concerns about Programming Education in Japanese Primary Schools

    Science.gov (United States)

    Maruyama, Yukiko; Kanoh, Hiroko; Adachi, Kinya

    2017-01-01

    To investigate parents' concerns about programming education in primary school, a preliminary online survey was carried out as a first step of the study. The result of the survey shows that parents seem to think that aim of programming education in primary school is not only learning coding. [For the complete proceedings, see ED579395.

  16. 75 FR 52976 - Issuance of Revised Users' Manual for Commission Mediation Program for Investigations Under...

    Science.gov (United States)

    2010-08-30

    ... INTERNATIONAL TRADE COMMISSION Issuance of Revised Users' Manual for Commission Mediation Program... 65615 (Nov. 8, 2008). The Commission has determined to issue a revised Users' Manual for its program for the mediation of investigations under section 337 of the Tariff Act of 1930. The revised Users' Manual...

  17. A Self-Ethnographic Investigation of Continuing Education Program in Engineering Arising from Economic Structural Change

    Science.gov (United States)

    Kaihlavirta, Auri; Isomöttönen, Ville; Kärkkäinen, Tommi

    2015-01-01

    This paper provides a self-ethnographic investigation of a continuing education program in engineering in Central Finland. The program was initiated as a response to local economic structural change, in order to offer re-education possibilities for a higher educated workforce currently under unemployment threat. We encountered considerable…

  18. Clinical improvements are not explained by changes in tendon structure on UTC following an exercise program for patellar tendinopathy.

    Science.gov (United States)

    van Ark, Mathijs; Rio, Ebonie; Cook, Jill; van den Akker-Scheek, Inge; Gaida, James E; Zwerver, Johannes; Docking, Sean

    2018-04-11

    The aim of this study was to investigate the effects of a 4-week in-season exercise program of isometric or isotonic exercises on tendon structure and dimensions as quantified by Ultrasound Tissue Characterization (UTC). Randomized clinical trial. Volleyball and basketball players (16-31 years, n=29) with clinically diagnosed patellar tendinopathy were randomized to a 4-week isometric or isotonic exercise program. The programs were designed to decrease patellar tendon pain. A baseline and 4-week UTC scan was used to evaluate change in tendon structure. No significant change in tendon structure or dimensions on UTC was detected after the exercise program, despite patellar tendinopathy symptoms improving. The percentage and mean cross-sectional area (mCSA) of aligned fibrillar structure (echo-types I+II) (Z=-0.414,p=0.679) as well as disorganized structure (echo-types III + IV) (Z=-0.370,p=0.711) did not change over the 4-week exercise program. Change in tendon structure and dimensions on UTC did not differ significantly between the groups. Structural properties and dimensions of the patellar tendon on UTC did not change after a 4-week isometric or isotonic exercise program for athletes with patellar tendinopathy in-season, despite an improvement of symptoms. It seems that structural improvements are not required for a positive clinical outcome.

  19. Clinical capabilities of graduates of an outcomes-based integrated medical program

    Directory of Open Access Journals (Sweden)

    Scicluna Helen A

    2012-06-01

    Full Text Available Abstract Background The University of New South Wales (UNSW Faculty of Medicine replaced its old content-based curriculum with an innovative new 6-year undergraduate entry outcomes-based integrated program in 2004. This paper is an initial evaluation of the perceived and assessed clinical capabilities of recent graduates of the new outcomes-based integrated medical program compared to benchmarks from traditional content-based or process-based programs. Method Self-perceived capability in a range of clinical tasks and assessment of medical education as preparation for hospital practice were evaluated in recent graduates after 3 months working as junior doctors. Responses of the 2009 graduates of the UNSW’s new outcomes-based integrated medical education program were compared to those of the 2007 graduates of UNSW’s previous content-based program, to published data from other Australian medical schools, and to hospital-based supervisor evaluations of their clinical competence. Results Three months into internship, graduates from UNSW’s new outcomes-based integrated program rated themselves to have good clinical and procedural skills, with ratings that indicated significantly greater capability than graduates of the previous UNSW content-based program. New program graduates rated themselves significantly more prepared for hospital practice in the confidence (reflective practice, prevention (social aspects of health, interpersonal skills (communication, and collaboration (teamwork subscales than old program students, and significantly better or equivalent to published benchmarks of graduates from other Australian medical schools. Clinical supervisors rated new program graduates highly capable for teamwork, reflective practice and communication. Conclusions Medical students from an outcomes-based integrated program graduate with excellent self-rated and supervisor-evaluated capabilities in a range of clinically-relevant outcomes. The program

  20. An investigation of scale effects in family substance abuse treatment programs

    Directory of Open Access Journals (Sweden)

    Lee A James

    2010-07-01

    Full Text Available Abstract This short report investigates scale effects in family substance abuse treatment programs. In Massachusetts, the family substance abuse treatment programs were much more costly than other adult residential treatment models. State officials were concerned that the "scale" or size of these programs (averaging just eight families was too small to be economical. Although the sample size (just nine programs was too small to permit reliable inference, the data clearly signalled the importance of "scale effects" in these family substance abuse treatment programs. To further investigate scale effects in family substance abuse treatment programs, data from the Center for Substance Abuse Treatment's (CSAT's Residential Women and Children and Pregnant and Postpartum Women (RWC-PPW Demonstration were re-analyzed, focusing on the relationship between cost per family-day and the estimated average family census. This analysis indicates strong economies of scale up until an average family census of about 14, and less apparent scale effects beyond that point. In consideration of these and other study findings, a multidisciplinary interagency team redesigned the Massachusetts' family treatment program model. The new programs are larger than the former family treatment programs, with each new program having capacity to treat 11 to 15 families depending on family makeup.

  1. Working program for deep borehole investigations. HDB-6,7,8, borehole

    International Nuclear Information System (INIS)

    Hama, Katsuhiro; Takahashi, Kazuharu; Ishii, Eiichi; Takeuchi, Ryuji; Sasaki, Manabu; Kunimaru, Takanori; Eki, Nobuhiro; Matsui, Hiroya

    2003-08-01

    optimized program for deep borehole (HDB-6, 7, 8) investigations has been drawn-up. This program addresses the general issues and provides input to the subsequent investigation programs and design for the shaft and experimental drifts. This document mainly describes the planned working program for the HDB-6, 7, 8 borehole investigations including associated laboratory programs during and after drilling. The working program is divided into the following investigation fields: borehole drilling geology, geophysics, hydrogeology, hydrochemistry, rock mechanics and long-term monitoring. Post-HDB borehole investigations; a VSP (Vertical Seismic Profiling) survey are planned in the surface-based investigations phase. (author)

  2. A mentor training program improves mentoring competency for researchers working with early-career investigators from underrepresented backgrounds.

    Science.gov (United States)

    Johnson, Mallory O; Gandhi, Monica

    2015-08-01

    Mentoring is increasingly recognized as a critical element in supporting successful careers in academic research in medicine and related disciplines, particularly for trainees and early career investigators from underrepresented backgrounds. Mentoring is often executed ad hoc; there are limited programs to train faculty to become more effective mentors, and the few that exist have a dearth of empirical support of their impact. In 2013, we recruited 34 faculty from across the US engaged in HIV-related clinical research to participate in a 2-day Mentoring the Mentors workshop. The workshop included didactic and interactive content focused on a range of topics, such as mentor-mentee communication, leadership styles, emotional intelligence, understanding the impact of diversity (unconscious bias, microaggressions, discrimination, tokenism) for mentees, and specific tools and techniques for effective mentoring. Pre- and post-workshop online evaluations documented high rates of satisfaction with the program and statistically significant improvements in self-appraised mentoring skills (e.g. addressing diversity in mentoring, communication with mentees, aligning mentor-mentee expectations), as assessed via a validated mentoring competency tool. This is the first mentoring training program focused on enhancing mentors' abilities to nurture investigators of diversity, filling an important gap, and evaluation results offer support for its effectiveness. Results suggest a need for refinement and expansion of the program and for more comprehensive, long-term evaluation of distal mentoring outcomes for those who participate in the program.

  3. Clinical implementation of a quality assurance program in HDR brachytherapy by in vivo dosimetry with diodes

    International Nuclear Information System (INIS)

    Alecu, R.; Feldmeier, J.J.; Court, W.S.; Alecu, M.; Orton, C.G.

    1996-01-01

    Despite the possibilities of in vivo dosimetry with diodes (e.g. control of dose to organs at risk, recorded confirmational measurements of the dose actually delivered, check of the whole treatment chain, avoidance of misadministrations, etc.) and the fact that it has proven to be very useful as part of a departmental QA program in external beam therapy, few attempts to implement it for HDR brachytherapy procedures have been reported. The reason for this is probably that there are significant technical challenges that must be met prior to its clinical use. The purpose of this study is to investigate the practicability and usefulness of dose measurements for brachytherapy patients in daily clinical practice. In our clinic a high precision patient dosimetry method has been developed, based on the use of silicon diodes. First, calibration factors have been determined under 'reference' irradiation conditions. Secondly, correction factors have been evaluated for situations deviating from the reference conditions, i.e. for different distances from the implanted sources, tissue heterogeneities, presence of different type of applicators, etc. For certain intracavitary, interstitial and surface mold applications this procedure has proven to be sufficiently accurate to allow dose determinations with diodes to be in good agreement with the expected values, i.e. calculated by the treatment planning system (VariSource unit) and checked by ion chamber measurements. The results of in vivo measurements are discussed along with the possibilities and limitations of the employed techniques

  4. Differentiating progress in a clinical group of fibromyalgia patients during and following a multicomponent treatment program.

    Science.gov (United States)

    Van Den Houte, Maaike; Luyckx, Koen; Van Oudenhove, Lukas; Bogaerts, Katleen; Van Diest, Ilse; De Bie, Jozef; Van den Bergh, Omer

    2017-07-01

    Treatments including multiple nonpharmacological components have beneficial effects on the key symptoms of fibromyalgia, although effects are limited and often do not persist. In this study, we examined different patterns of clinical progress and the dynamic interplay between predictors and outcomes over time. Fibromyalgia patients (N=153; 135 women) followed a multidisciplinary group program spanning 12weeks, aimed at "regaining control over daily functioning". Anxiety, depression, pain coping and kinesiophobia were used as predictor variables. Outcome variables were pain severity, pain-related disability, physical functioning and functional interference. All variables were assessed at 3 moments: on the first and last day of treatment, and 12weeks after the last day of treatment. Overall treatment effects were analyzed using mixed model analyses. Latent class growth analysis identifying different treatment trajectory classes was used to investigate individual differences in treatment effects. Finally, cross-lagged structural equation models were used to investigate the dynamic interplay between predictors and outcomes over time. Only a fourth to a third of the total group showed improvement on the outcome variables. These patients had lower baseline anxiety, depression and kinesiophobia, and improved more on anxiety, depression and kinesiophobia. Physical well-being had a stronger effect on anxiety and depression than vice versa. Physical functioning predicted relative changes in kinesiophobia, while kinesiophobia predicted relative changes in pain-related disability. The results emphasize the importance of tailoring treatments to individual needs in order to improve overall effectiveness of treatment programs. Copyright © 2017. Published by Elsevier Inc.

  5. Shyness Clinic: A Social Development Program for Adolescents and Young Adults.

    Science.gov (United States)

    Barrow, John; Hayashi, Judy

    1980-01-01

    Shyness clinic groups were offered in a university counseling center. The program focused on anxiety management, assertiveness in social relationships, and development of conversational skills. Participants improved in social skills and ability to manage anxiety. (Author)

  6. Addiction Competencies in the 2009 CACREP Clinical Mental Health Counseling Program Standards

    Science.gov (United States)

    Lee, Tiffany K.; Craig, Stephen E.; Fetherson, Bianca T. L.; Simpson, C. Dennis

    2013-01-01

    The Council for Accreditation of Counseling and Related Educational Programs developed addiction competencies for clinical mental health counseling students. This article highlights these competencies, provides an overview of current addiction training, and describes methods to integrate addiction education into curricula.

  7. Faculty Perceptions of Characteristics Needed for Clinical Success at Military Nurse Anesthesia Programs

    National Research Council Canada - National Science Library

    Clayton, Brian

    1998-01-01

    In this exploratory descriptive study an investigator-developed survey tool was used to describe military clinical faculty's perception of characteristics nurse anesthesia students need for success...

  8. A short version of the revised 'experience of close relationships questionnaire': investigating non-clinical and clinical samples.

    Science.gov (United States)

    Wongpakaran, Tinakon; Wongpakaran, Nahathai

    2012-01-01

    This study seeks to investigate the psychometric properties of the short version of the revised 'Experience of Close Relationships' questionnaire, comparing non-clinical and clinical samples. In total 702 subjects participated in this study, of whom 531 were non-clinical participants and 171 were psychiatric patients. They completed the short version of the revised 'Experience of Close Relationships' questionnaire (ECR-R-18), the Perceived Stress Scale-10(PSS-10), the Rosenberg Self-Esteem Scale (RSES) and the UCLA Loneliness scale. A retest of the ECR-R-18 was then performed at four-week intervals. Then, confirmatory factor analyses were performed to test the validity of the new scale. The ECR-R-18 showed a fair to good internal consistency (α 0.77 to 0.87) for both samples, and the test-retest reliability was found to be satisfactory (ICC = 0.75). The anxiety sub-scale demonstrated concurrent validity with PSS-10 and RSES, while the avoidance sub-scale showed concurrent validity with the UCLA Loneliness Scale. Confirmatory factor analysis using method factors yielded two factors with an acceptable model fit for both groups. An invariance test revealed that the ECR-R-18 when used on the clinical group differed from when used with the non-clinical group. The ECR-R-18 questionnaire revealed an overall better level of fit than the original 36 item questionnaire, indicating its suitability for use with a broader group of samples, including clinical samples. The reliability of the ECR-R- 18 might be increased if a modified scoring system is used and if our suggestions with regard to future studies are followed up.

  9. Developing an evaluation framework for clinical redesign programs: lessons learnt.

    Science.gov (United States)

    Samaranayake, Premaratne; Dadich, Ann; Fitzgerald, Anneke; Zeitz, Kathryn

    2016-09-19

    Purpose The purpose of this paper is to present lessons learnt through the development of an evaluation framework for a clinical redesign programme - the aim of which was to improve the patient journey through improved discharge practices within an Australian public hospital. Design/methodology/approach The development of the evaluation framework involved three stages - namely, the analysis of secondary data relating to the discharge planning pathway; the analysis of primary data including field-notes and interview transcripts on hospital processes; and the triangulation of these data sets to devise the framework. The evaluation framework ensured that resource use, process management, patient satisfaction, and staff well-being and productivity were each connected with measures, targets, and the aim of clinical redesign programme. Findings The application of business process management and a balanced scorecard enabled a different way of framing the evaluation, ensuring measurable outcomes were connected to inputs and outputs. Lessons learnt include: first, the importance of mixed-methods research to devise the framework and evaluate the redesigned processes; second, the need for appropriate tools and resources to adequately capture change across the different domains of the redesign programme; and third, the value of developing and applying an evaluative framework progressively. Research limitations/implications The evaluation framework is limited by its retrospective application to a clinical process redesign programme. Originality/value This research supports benchmarking with national and international practices in relation to best practice healthcare redesign processes. Additionally, it provides a theoretical contribution on evaluating health services improvement and redesign initiatives.

  10. Investigation of newborns with abnormal results in a newborn screening program for four lysosomal storage diseases in Brazil

    Directory of Open Access Journals (Sweden)

    Heydy Bravo

    2017-09-01

    Full Text Available Lysosomal storage diseases (LSDs are genetic disorders, clinically heterogeneous, mainly caused by defects in genes encoding lysosomal enzymes that degrade macromolecules. Several LSDs already have specific therapies that may improve clinical outcomes, especially if introduced early in life. With this aim, screening methods have been established and newborn screening (NBS for some LSDs has been developed. Such programs should include additional procedures for the confirmation (or not of the cases that had an abnormal result in the initial screening. We present here the methods and results of the additional investigation performed in four babies with positive initial screening results in a program of NBS for LSDs performed by a private laboratory in over 10,000 newborns in Brazil. The suspicion in these cases was of Mucopolysaccharidosis I - MPS I (in two babies, Pompe disease and Gaucher disease (one baby each. One case of pseudodeficiency for MPS I, 1 carrier for MPS I, 1 case of pseudodeficiency for Pompe disease and 1 carrier for Gaucher disease were identified. This report illustrates the challenges that may be encountered by NBS programs for LSDs, and the need of a comprehensive protocol for the rapid and precise investigation of the babies who have an abnormal screening result.

  11. System of automated processing of radionuclide investigations (SAPRI-01) in clinical practice

    International Nuclear Information System (INIS)

    Sivachenko, T.P.; Mechev, D.S.; Krupka, I.N.

    1988-01-01

    The author described the results of clinical testing of a system SAPRI-01 designed for automated collection, storage and processing of data on radionuclide investigations. He gave examples of automated processing of RCG and the results of positive scintigraphy of tumors of different sites using 67 Ga-citrate and 99m Tc pertechnetate in statistical and dynamic investigations. Short-comings and ways for updating 4 the system during its serial production were pointed out. The introduction of the system into clinical practice on a wide scale was shown to hold promise

  12. An independent investigation into the deployment of the federal communications commissions' rural health care pilot program.

    Science.gov (United States)

    Whitten, Pamela; Holtz, Bree; Laplante, Carolyn; Alverson, Dale; Krupinski, Elizabeth

    2010-12-01

    the goal of this study was to provide an independent and objective evaluation of the implementation of the Federal Communications Commission's Rural Health Care Pilot Program. thirty-nine of the programs that were provided funding through this program were interviewed and asked about their project deployment, network planning, and the involvement of their state in implementation. RESULTS showed that programs recruited project team members from a variety of fields to fulfill different roles. Network partners were often chosen because they were stakeholders in the outcome of the project and because they had a past working relationship with the grant-receiving programs. In terms of deployment, many programs had made progress in filling out necessary paperwork and were tracking milestones, but had experienced changes since first receiving funding, such as losing participants. Additionally, many encountered challenges that inhibited deployment, such as coping with rule fluctuations. Many of the programs received support from their respective state governments in project development, often through matching funds, but few states were involved in the actual management of projects. as rural healthcare facilities often lack the information technology infrastructure compared with many urban facilities, it is important to understand the implementation process for programs such as the Rural Health Care Pilot Program and to examine what contributes to progress, stagnation, or disintegration. Although the programs reported some success, almost all had encountered challenges that inhibited implementation. A follow-up study is planned to further investigate deployment and determine the implications of Federal Communications Commission funding.

  13. Year-End Clinic Handoffs: A National Survey of Academic Internal Medicine Programs.

    Science.gov (United States)

    Phillips, Erica; Harris, Christina; Lee, Wei Wei; Pincavage, Amber T; Ouchida, Karin; Miller, Rachel K; Chaudhry, Saima; Arora, Vineet M

    2017-06-01

    While there has been increasing emphasis and innovation nationwide in training residents in inpatient handoffs, very little is known about the practice and preparation for year-end clinic handoffs of residency outpatient continuity practices. Thus, the latter remains an identified, yet nationally unaddressed, patient safety concern. The 2014 annual Association of Program Directors in Internal Medicine (APDIM) survey included seven items for assessing the current year-end clinic handoff practices of internal medicine residency programs throughout the country. Nationwide survey. All internal medicine program directors registered with APDIM. Descriptive statistics of programs and tools used to formulate a year-end handoff in the ambulatory setting, methods for evaluating the process, patient safety and quality measures incorporated within the process, and barriers to conducting year-end handoffs. Of the 361 APDIM member programs, 214 (59%) completed the Transitions of Care Year-End Clinic Handoffs section of the survey. Only 34% of respondent programs reported having a year-end ambulatory handoff system, and 4% reported assessing residents for competency in this area. The top three barriers to developing a year-end handoff system were insufficient overlap between graduating and incoming residents, inability to schedule patients with new residents in advance, and time constraints for residents, attendings, and support staff. Most internal medicine programs do not have a year-end clinic handoff system in place. Greater attention to clinic handoffs and resident assessment of this care transition is needed.

  14. Investigating the role of feedback and motivation in clinical reaction time assessment.

    Science.gov (United States)

    Eckner, James T; Chandran, Srikrishna; Richardson, James K

    2011-12-01

    To investigate the influence of performance feedback and motivation during 2 tests of simple visuomotor reaction time (RT). Cross-sectional, observational study. Outpatient academic physiatry clinic. Thirty-one healthy adults (mean [SD], 54 ± 15 years). Participants completed a clinical test of RT (RT(clin)) and a computerized test of RT with and without performance feedback (RT(compFB) and RT(compNoFB), respectively) in randomly assigned order. They then ranked their degree of motivation during each test. RT(clin) measured the time required to catch a suspended vertical shaft by hand closure after release of the shaft by the examiner. RT(compFB) and RT(compNoFB) both measured the time required to press a computer key in response to a visual cue displayed on a computer monitor. Performance feedback (visual display of the previous trial and summary results) was provided for RT(compFB), but not for RT(compNoFB). Means and standard deviations of RT(clin), RT(compFB), and RT(compNoFB) and participants' self-reported motivation on a 5-point Likert scale for each test. There were significant differences in both the means and standard deviations of RT(clin), RT(compFB), and RT(compNoFB) (F(2,60) = 81.66, P motivation between RT(clin) and RT(compFB), both of which were reported to be more motivating than RT(compNoFB). The stronger correlation between RT(clin) and RT(compFB) as well as the higher reported motivation during RT(clin) and RT(compFB) testing suggest that performance feedback is a positive motivating factor that is inherent to RT(clin) testing. RT(clin) is a simple, inexpensive technique for measuring RT and appears to be an intrinsically motivating task. This motivation may promote faster, more consistent RT performance compared with currently available computerized programs, which do not typically provide performance feedback. Copyright © 2011 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  15. Teaching Statistics in APA-Accredited Doctoral Programs in Clinical and Counseling Psychology: A Syllabi Review

    Science.gov (United States)

    Ord, Anna S.; Ripley, Jennifer S.; Hook, Joshua; Erspamer, Tiffany

    2016-01-01

    Although statistical methods and research design are crucial areas of competency for psychologists, few studies explore how statistics are taught across doctoral programs in psychology in the United States. The present study examined 153 American Psychological Association-accredited doctoral programs in clinical and counseling psychology and aimed…

  16. Program grants for black lung clinics--PHS. Notice of proposed rulemaking.

    Science.gov (United States)

    1983-11-01

    The Public Health Service proposed to revise the regulations governing the grants program for black lung clinics established under section 427(a) of the Federal Mine Safety and Health Act of 1977. The revision is in keeping with the Department of Health and Human Services' desire to remove as many programmatic burdens and restrictions from grantees as possible, while maintaining program integrity.

  17. The relevance of qualitative research for clinical programs in psychiatry.

    Science.gov (United States)

    Goering, Paula; Boydell, Katherine M; Pignatiello, Antonio

    2008-03-01

    It is time to move beyond education about qualitative research theory and methods to using them to understand and improve psychiatric practice. There is a good fit between this agenda and current thinking about research use that broadens definitions of evidence beyond the results of experiments. This paper describes a qualitative program evaluation to illustrate what kind of useful knowledge is generated and how it can be created through a clinician-researcher partnership. The linkage and exchange model of effective knowledge translation described involves interaction between clinicians and researchers throughout the research process and results in mutual learning through the planning, disseminating, and application of existing or new qualitative research in decision making.

  18. Developing educators, investigators, and leaders during internal medicine residency: the area of distinction program.

    Science.gov (United States)

    Kohlwes, R Jeffrey; Cornett, Patricia; Dandu, Madhavi; Julian, Katherine; Vidyarthi, Arpana; Minichiello, Tracy; Shunk, Rebecca; Jain, Sharad; Harleman, Elizabeth; Ranji, Sumant; Sharpe, Brad; O'Sullivan, Patricia; Hollander, Harry

    2011-12-01

    Professional organizations have called for individualized training approaches, as well as for opportunities for resident scholarship, to ensure that internal medicine residents have sufficient knowledge and experience to make informed career choices. To address these training issues within the University of California, San Francisco, internal medicine program, we created the Areas of Distinction (AoD) program to supplement regular clinical duties with specialized curricula designed to engage residents in clinical research, global health, health equities, medical education, molecular medicine, or physician leadership. We describe our AoD program and present this initiative's evaluation data. METHODS AND PROGRAM EVALUATION: We evaluated features of our AoD program, including program enrollment, resident satisfaction, recruitment surveys, quantity of scholarly products, and the results of our resident's certifying examination scores. Finally, we described the costs of implementing and maintaining the AoDs. AoD enrollment increased from 81% to 98% during the past 5 years. Both quantitative and qualitative data demonstrated a positive effect on recruitment and improved resident satisfaction with the program, and the number and breadth of scholarly presentations have increased without an adverse effect on our board certification pass rate. The AoD system led to favorable outcomes in the domains of resident recruitment, satisfaction, scholarship, and board performance. Our intervention showed that residents can successfully obtain clinical training while engaging in specialized education beyond the bounds of core medicine training. Nurturing these interests 5 empower residents to better shape their careers by providing earlier insight into internist roles that transcend classic internal medicine training.

  19. Implementing an Assessment Clinic in a Residential PTSD Program

    Directory of Open Access Journals (Sweden)

    Joan McDowell

    2014-08-01

    Full Text Available Creating useful treatment plans can help improve services to consumers of mental health services. As more evidence-based practices are implemented, deciding what treatment, at what time, for whom becomes an important factor in facilitating positive outcomes. Readiness for trauma-focused treatments for Posttraumatic Stress Disorder (PTSD such as Cognitive Processing Therapy or Prolonged Exposure Therapy may influence whether an individual can successfully complete either protocol. In addition, components of adjunctive therapies such as Acceptance and Commitment Therapy or Dialectical Behavior Therapy may be useful in moving a particular patient toward readiness and successful completion of treatment. Psychological assessment adds valuable data to inform these types of treatment decisions. This paper describes the implementation of a psychological assessment clinic in a residential PTSD treatment setting. Barriers to implementation, use of the data, and Veterans’ reactions to the feedback provided to them are included.

  20. 77 FR 59930 - Clinical Development Programs for Disease-Modifying Agents for Peripheral Neuropathy; Public...

    Science.gov (United States)

    2012-10-01

    ...] Clinical Development Programs for Disease-Modifying Agents for Peripheral Neuropathy; Public Workshop... to the clinical development of disease-modifying agents for the treatment of peripheral neuropathy... disease-modifying products for the management of peripheral neuropathy. Date and Time: The public workshop...

  1. Modeling Clinic for Industrial Mathematics: A Collaborative Project Under Erasmus+ Program

    DEFF Research Database (Denmark)

    Jurlewicz, Agnieszka; Nunes, Claudia; Russo, Giovanni

    2018-01-01

    Modeling Clinic for Industrial Mathematics (MODCLIM) is a Strategic Partnership for the Development of Training Workshops and Modeling Clinic for Industrial Mathematics, funded through the European Commission under the Erasmus Plus Program, Key Action 2: Cooperation for innovation and the exchang...

  2. Monetary Value of a Prescription Assistance Program Service in a Rural Family Medicine Clinic

    Science.gov (United States)

    Whitley, Heather P.

    2011-01-01

    Purpose: To quantify the monetary value of medications provided to rural Alabamians through provision of pharmaceutical manufacturer-sponsored prescription assistance programs (PAPs) provided by a clinical pharmacist in a private Black Belt family medicine clinic during 2007 and 2008. Methods: Patients struggling to afford prescription medications…

  3. EM-GE-5 Regulation. Standard for the first-rate application clinical practices in the execution of the clinical investigations for medical teams' evaluation

    International Nuclear Information System (INIS)

    2015-01-01

    This guide has the following objectives: a) To guide methodologically the implementation of Good Clinical Practice for the execution of clinical research with medical devices that need to be evaluated, in addition to the Regulation E R-6. Requirements for the Conduct of Clinical Trials for Medical Devices , b) Provide the fundamental aspects to be taken into count for quality control to clinical investigations.

  4. 75 FR 1790 - Draft Guidance for Institutional Review Boards, Clinical Investigators, and Sponsors: IRB...

    Science.gov (United States)

    2010-01-13

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2009-D-0605... clinical investigators and sponsors better understand their responsibilities related to continuing review...-463-6332 or 301-796-3400); or the Office of Communication, Outreach and Development (HFM-40), Center...

  5. Naa Technique for Clinical Investigation of Mice Immunized with BOTHROP Venom

    Science.gov (United States)

    Zamboni, C. B.; Aguiar, R. O.; Kovacs, L.; Suzuki, M.; Sant'Anna, O. A.

    2009-06-01

    In the present study Neutron Activation Analysis (NAA) technique was used to determine sodium concentration in whole blood of mice immunized with Bothrops venom. With this value it was possible to perform clinical investigation in this animal model using whole blood.

  6. Using Hermeneutic Phenomenology to Investigate How Experienced Practitioners Learn to Communicate Clinical Reasoning

    Science.gov (United States)

    Ajjawi, Rola; Higgs, Joy

    2007-01-01

    This paper is primarily targeted at doctoral students and other researchers considering using hermeneutic phenomenology as a research strategy. We present interpretive paradigm research designed to investigate how experienced practitioners learn to communicate their clinical reasoning in professional practice. Twelve experienced physiotherapy…

  7. 21 CFR 50.54 - Clinical investigations not otherwise approvable that present an opportunity to understand...

    Science.gov (United States)

    2010-04-01

    ... that present an opportunity to understand, prevent, or alleviate a serious problem affecting the health... opportunity to understand, prevent, or alleviate a serious problem affecting the health or welfare of children... clinical investigation presents a reasonable opportunity to further the understanding, prevention, or...

  8. 77 FR 11555 - Guidance for Institutional Review Boards, Clinical Investigators, and Sponsors: Institutional...

    Science.gov (United States)

    2012-02-27

    ..., Office for Human Research Protections (OHRP) and FDA have been actively working to harmonize the Agencies... criteria, process, and frequency of continuing review to assure the protection of the rights and welfare of... review to assure the protection of the rights and welfare of subjects in clinical investigations. The...

  9. 76 FR 12742 - Guidance for Industry and Food and Drug Administration Staff; Clinical Investigations of Devices...

    Science.gov (United States)

    2011-03-08

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2008-D-0457] Guidance for Industry and Food and Drug Administration Staff; Clinical Investigations of Devices Indicated... other electrical continence devices; protective garment for incontinence; surgical mesh; electrosurgical...

  10. Father participation with mothers in the Signposts program: an initial investigation.

    Science.gov (United States)

    May, Fiona S; McLean, Louise A; Anderson, Angelika; Hudson, Alan; Cameron, Christine; Matthews, Jan

    2013-03-01

    The Signposts program is an evidence-based intervention system for parents of children with intellectual disability and problem behaviours. This study provided an initial investigation of the outcomes for mothers associated with father participation in Signposts, using data collected from the Signposts Statewide project, conducted in Victoria, Australia. Data from Signposts Statewide were analysed, with the effect size Cohen's d and 95% confidence interval around d calculated for pre- to post-program changes for 134 mothers who participated in Signposts with fathers and 483 mothers who participated without fathers. Although mothers in both groups benefitted from the program, as evidenced by pre- to post-program improvements across all measures, the mean effect size was notably larger for mothers who participated in Signposts with fathers. These results highlight possible further program benefits for mothers who participate in Signposts with fathers, and are of particular significance in light of research describing the increased stress experienced by mothers of children with a disability.

  11. Five-year review of an international clinical research-training program

    Science.gov (United States)

    Suemoto, Claudia Kimie; Ismail, Sherine; Corrêa, Paulo César Rodrigues Pinto; Khawaja, Faiza; Jerves, Teodoro; Pesantez, Laura; Germani, Ana Claudia Camargo Gonçalves; Zaina, Fabio; dos Santos, Augusto Cesar Soares; de Oliveira Ferreira, Ricardo Jorge; Singh, Priyamvada; Paulo, Judy Vicente; Matsubayashi, Suely Reiko; Vidor, Liliane Pinto; Andretta, Guilherme; Tomás, Rita; Illigens, Ben MW; Fregni, Felipe

    2015-01-01

    The exponential increase in clinical research has profoundly changed medical sciences. Evidence that has accumulated in the past three decades from clinical trials has led to the proposal that clinical care should not be based solely on clinical expertise and patient values, and should integrate robust data from systematic research. As a consequence, clinical research has become more complex and methods have become more rigorous, and evidence is usually not easily translated into clinical practice. Therefore, the instruction of clinical research methods for scientists and clinicians must adapt to this new reality. To address this challenge, a global distance-learning clinical research-training program was developed, based on collaborative learning, the pedagogical goal of which was to develop critical thinking skills in clinical research. We describe and analyze the challenges and possible solutions of this course after 5 years of experience (2008–2012) with this program. Through evaluation by students and faculty, we identified and reviewed the following challenges of our program: 1) student engagement and motivation, 2) impact of heterogeneous audience on learning, 3) learning in large groups, 4) enhancing group learning, 5) enhancing social presence, 6) dropouts, 7) quality control, and 8) course management. We discuss these issues and potential alternatives with regard to our research and background. PMID:25878518

  12. Five-year review of an international clinical research-training program.

    Science.gov (United States)

    Suemoto, Claudia Kimie; Ismail, Sherine; Corrêa, Paulo César Rodrigues Pinto; Khawaja, Faiza; Jerves, Teodoro; Pesantez, Laura; Germani, Ana Claudia Camargo Gonçalves; Zaina, Fabio; Dos Santos, Augusto Cesar Soares; de Oliveira Ferreira, Ricardo Jorge; Singh, Priyamvada; Paulo, Judy Vicente; Matsubayashi, Suely Reiko; Vidor, Liliane Pinto; Andretta, Guilherme; Tomás, Rita; Illigens, Ben Mw; Fregni, Felipe

    2015-01-01

    The exponential increase in clinical research has profoundly changed medical sciences. Evidence that has accumulated in the past three decades from clinical trials has led to the proposal that clinical care should not be based solely on clinical expertise and patient values, and should integrate robust data from systematic research. As a consequence, clinical research has become more complex and methods have become more rigorous, and evidence is usually not easily translated into clinical practice. Therefore, the instruction of clinical research methods for scientists and clinicians must adapt to this new reality. To address this challenge, a global distance-learning clinical research-training program was developed, based on collaborative learning, the pedagogical goal of which was to develop critical thinking skills in clinical research. We describe and analyze the challenges and possible solutions of this course after 5 years of experience (2008-2012) with this program. Through evaluation by students and faculty, we identified and reviewed the following challenges of our program: 1) student engagement and motivation, 2) impact of heterogeneous audience on learning, 3) learning in large groups, 4) enhancing group learning, 5) enhancing social presence, 6) dropouts, 7) quality control, and 8) course management. We discuss these issues and potential alternatives with regard to our research and background.

  13. Clinic-based intervention projects: STD and family planning programs get involved. Intervention model.

    Science.gov (United States)

    Finger, W R

    1991-06-01

    The sexually transmitted disease (STD) program in Udorn, a popular Thai tourist city, has worked closely with 750 prostitutes for 15 years, incorporating the concerns of brothel managers and prostitutes into service delivery. The program in Udorn is part of a nationwide network of STD clinics. The level of person-to-person interaction was increased once it was determined by 1989 that HIV had infected 6% of prostitutes in the city's brothels. Outreach educators were recruited and trained to ensure that all prostitutes in Udorn had the basic facts about HIV and AIDS. Over the last 2 years, the STD program has trained outreach educators to work in 8 brothels, started a local AIDS prevention foundation supported by local businessmen, and taken other steps to incorporate AIDS prevention into its clinic structure. Such clinic-based programs are an important way of targeting groups at high risk of HIV transmission.

  14. Genomic investigation of Staphylococcus aureus isolates from bulk tank milk and dairy cows with clinical mastitis.

    Science.gov (United States)

    Ronco, Troels; Klaas, Ilka C; Stegger, Marc; Svennesen, Line; Astrup, Lærke B; Farre, Michael; Pedersen, Karl

    2018-02-01

    Staphylococcus aureus is one of the most common pathogens that cause mastitis in dairy cows. Various subtypes, virulence genes and mobile genetic elements have been associated with isolates from bulk tank milk and clinical mastitis. So far, no Danish cattle associated S. aureus isolates have been whole-genome sequenced and further analyzed. Thus, the main objective was to investigate the population structure and genomic content of isolates from bulk tank milk and clinical mastitis, using whole-genome sequencing. This may reveal the origin of strains that cause clinical mastitis. S. aureus isolates from bulk tank milk (n = 94) and clinical mastitis (n = 63) were collected from 91 and 24 different farms, respectively and whole-genome sequenced. The genomic content was analyzed and a phylogenetic tree based on single nucleotide polymorphisms was constructed. In general, the isolates from both bulk tank milk and clinical mastitis were of similar genetic background. This suggests that dairy cows are natural carriers of the S. aureus subtypes that cause clinical mastitis if the right conditions are present and that a broad range of subtypes cause mastitis. A phylogenetic cluster that mostly consisted of ST151 isolates carried three mobile genetic elements that were primarily found in this group. The prevalence of resistance genes was generally low. However, the first ST398 methicillin resistant S. aureus isolate from a Danish dairy cow with clinical mastitis was detected. Copyright © 2018 Elsevier B.V. All rights reserved.

  15. The relationship between senior management team culture and clinical governance: Empirical investigation and managerial implications.

    Science.gov (United States)

    Prenestini, Anna; Calciolari, Stefano; Lega, Federico; Grilli, Roberto

    2015-01-01

    Health care organizations are pressured to improve the cost-effectiveness of service delivery. Clinical governance is an important trigger to improve care quality and safety and rank high in the reform agenda of health systems. The senior management team culture plays a major role in establishing clinical governance practices, because it strongly influences the values, attitudes, and behaviors of the members of an organization. The aim of this study was to investigate the relationship between senior management team culture and clinical governance in the public health care organizations of three Italian regions. The assessment of senior management culture was conducted using the Competing Values Framework and a corresponding instrument adapted for the Italian context. Clinical governance was assessed using an ad hoc instrument focused on the senior management team's perception and attitude toward clinical governance. The survey achieved a 54% response rate. The results of four different models demonstrate that organizations characterized by different dominant cultures are associated with significant differences in attitudes toward clinical governance. In particular, on average, dominant cultures with a prevailing external focus are associated with a more positive attitude toward clinical governance. The selection and appointments of top managers should consider the style of leadership that is most apt to facilitate the growth of rational and developmental cultures. Furthermore, the training of top managers and leading doctors should reinforce leadership aptitude and approaches that are consistent with the desired organizational cultures.

  16. An investigation of nurse educator's perceptions and experiences of undertaking clinical practice.

    Science.gov (United States)

    Williams, Angela; Taylor, Cathy

    2008-11-01

    Educational policy (DOH, 1999. Making a difference: strengthening the nursing, midwifery and health visiting contribution to health and healthcare. Department of Health, London; UKCC, 1999. Fitness for Practice. United Kingdom Central Council for Nursing, Midwifery and Health Visiting, London; Nursing and Midwifery Council, 2006. Standards to support learning and assessment in practice. Nursing and Midwifery Council, London) and current nursing literature (Griscti, O., Jacono, B., Jacono, J., 2005. The nurse educator's clinical role. Journal of Advanced Nursing 50 (1), 84-92; Owen, S., Ferguson, K., Baguley, I., 2005. The clinical activity of mental health nurse lecturers. Journal of Psychiatric and Mental Health Nursing 12, 310-316), place increasing emphasis on nurse educators undertaking clinical practice to facilitate their clinical confidence and competence. This study investigated nurse educators' perceptions and experiences of undertaking clinical practice. A qualitative design and descriptive, exploratory approach were used. A purposive sample of 11 nurse educators in one nursing department, took part in two focus group interviews, one with 5 and the other with 6 respondents, to identify and discuss their perceptions and experiences of undertaking clinical practice. A process of thematic content analysis revealed three broad themes relating to the meaning and importance of clinical practice, perceived benefits and barriers which are examined and discussed. The paper concludes that despite policy recommendations, barriers highlighted in this study such as insufficient time, heavy workload and a lack of valuing of the clinical role have been raised over the past few decades. The effect of undertaking clinical practice, particularly on the quality of teaching is argued to be valuable armoury in the battle to secure sufficient resources to support engagement in clinical practice. Financial and organisational commitment; valuing of clinical practice and research

  17. Developing an Interdisciplinary, Team-Based Quality Improvement Leadership Training Program for Clinicians: The Partners Clinical Process Improvement Leadership Program.

    Science.gov (United States)

    Rao, Sandhya K; Carballo, Victoria; Cummings, Brian M; Millham, Frederick; Jacobson, Joseph O

    Although there has been tremendous progress in quality improvement (QI) education for students and trainees in recent years, much less has been published regarding the training of active clinicians in QI. The Partners Clinical Process Improvement Leadership Program (CPIP) is a 6-day experiential program. Interdisciplinary teams complete a QI project framed by didactic sessions, interactive exercises, case-based problem sessions, and a final presentation. A total of 239 teams composed of 516 individuals have graduated CPIP. On completion, participant satisfaction scores average 4.52 (scale 1-5) and self-reported understanding of QI concepts improved. At 6 months after graduation, 66% of survey respondents reported sustained QI activity. Three opportunities to improve the program have been identified: (1) increasing faculty participation through online and tiered course offerings, (2) integrating the faculty-focused program with the trainee curriculum, and (3) developing a postgraduate curriculum to address the challenges of sustained improvement.

  18. [Update of clinical programs using hadrontherapy 2008-2012].

    Science.gov (United States)

    Habrand, J-L; Datchary, J; Alapetite, C; Bolle, S; Calugaru, V; Feuvret, L; Helfre, S; Stefan, D; Delacroix, S; Demarzi, L; Dendale, R

    2013-10-01

    Hadrontherapy, a type of radiation therapy dealing with heavy charged particles, has become for the past decade one of the most sophisticated and attractive approach in the management of cancer. This is related with major technological innovations that have made available, at a relatively cheap cost, compact proton accelerators equipped with rotational gantries. The implementation of pencil beam scanning should also make treatment planning and delivery much easier and faster than conventional approaches. Until now, approximately 100,000 patients have been treated with protons worldwide. Due to more complex technological and biological challenges, light ion therapy - mainly carbon ions - has developed at a lower pace, except in Japan where most of the 15,000 treated patients have been enrolled. Current indications for protons include firstly, locally aggressive tumours non or incompletely resected, that are located close to critical normal structures: ocular melanomas, skull base and spinal canal low grade sarcomas, selected ENT carcinomas (like adenoid cystic); secondly, improvement of tolerance to radiations: delayed, mainly in paediatric malignancies, due to the exquisite sensitivity of organs under development (including to carcinogenesis); immediate, on bone marrow, mucosae… mainly in concomitant radiation-chemotherapy interactions (tested in esophagus, and lung). Most promising indications for carbon ions include inoperable highly radioresistant primaries, such as mucosal melanomas, high grade bone and soft part sarcomas, and pancreatic carcinomas. Altered fractionations are also of interests that could translate in clinical and economical benefits. Controversies have risen whether more common indications, like prostate, should also be explored. Copyright © 2013. Published by Elsevier SAS.

  19. 'You find yourself.' Perceptions of nursing students from non-English speaking backgrounds of the effect of an intensive language support program on their oral clinical communication skills.

    Science.gov (United States)

    Rogan, Fran; San Miguel, Caroline; Brown, Di; Kilstoff, Kathleen

    2006-10-01

    Nurses of ethnically diverse backgrounds are essential in providing multicultural populations in western societies with culturally and linguistically competent health care. However, many nurses from non-English speaking backgrounds (NESB) are at high risk of failure in university programs particularly during clinical placements. Few studies investigate the clinical experiences of students from NESB and strategies to support their learning. This study describes perceptions of fifteen undergraduate nursing students from NESB about their first clinical placement in an Australian university program and the effect of a language support program on their oral clinical communication skills. Three categories arose: *Wanting to belong but feeling excluded; *Wanting to learn how to...; and *You find yourself. While many students find clinical placement challenging, it appeared difficult for students in this study as language and cultural adjustments required some modification of their usual ways of thinking and communicating, often without coping strategies available to other students.

  20. Access to Investigational Drugs: FDA Expanded Access Programs or “Right‐to‐Try” Legislation?

    Science.gov (United States)

    Berglund, Jelena P.; Weatherwax, Kevin; Gerber, David E.; Adamo, Joan E.

    2015-01-01

    Abstract Purpose The Food and Drug Administration Expanded Access (EA) program and “Right‐to‐Try” legislation aim to provide seriously ill patients who have no other comparable treatment options to gain access to investigational drugs and biological agents. Physicians and institutions need to understand these programs to respond to questions and requests for access. Methods FDA EA programs and state and federal legislative efforts to provide investigational products to patients by circumventing FDA regulations were summarized and compared. Results The FDA EA program includes Single Patient‐Investigational New Drug (SP‐IND), Emergency SP‐IND, Intermediate Sized Population IND, and Treatment IND. Approval rates for all categories exceed 99%. Approval requires FDA and Institutional Review Board (IRB) approval, and cooperation of the pharmaceutical partner is essential. “Right‐to‐Try” legislation bypasses some of these steps, but provides no regulatory or safety oversight. Conclusion The FDA EA program is a reasonable option for patients for whom all other therapeutic interventions have failed. The SP‐IND not only provides patient access to new drugs, but also maintains a balance between immediacy and necessary patient protection. Rather than circumventing existing FDA regulations through proposed legislation, it seems more judicious to provide the knowledge and means to meet the EA requirements. PMID:25588691

  1. Access to Investigational Drugs: FDA Expanded Access Programs or "Right-to-Try" Legislation?

    Science.gov (United States)

    Holbein, M E Blair; Berglund, Jelena P; Weatherwax, Kevin; Gerber, David E; Adamo, Joan E

    2015-10-01

    The Food and Drug Administration Expanded Access (EA) program and "Right-to-Try" legislation aim to provide seriously ill patients who have no other comparable treatment options to gain access to investigational drugs and biological agents. Physicians and institutions need to understand these programs to respond to questions and requests for access. FDA EA programs and state and federal legislative efforts to provide investigational products to patients by circumventing FDA regulations were summarized and compared. The FDA EA program includes Single Patient-Investigational New Drug (SP-IND), Emergency SP-IND, Intermediate Sized Population IND, and Treatment IND. Approval rates for all categories exceed 99%. Approval requires FDA and Institutional Review Board (IRB) approval, and cooperation of the pharmaceutical partner is essential. "Right-to-Try" legislation bypasses some of these steps, but provides no regulatory or safety oversight. The FDA EA program is a reasonable option for patients for whom all other therapeutic interventions have failed. The SP-IND not only provides patient access to new drugs, but also maintains a balance between immediacy and necessary patient protection. Rather than circumventing existing FDA regulations through proposed legislation, it seems more judicious to provide the knowledge and means to meet the EA requirements. © 2015 Wiley Periodicals, Inc.

  2. Residency Programs and Clinical Leadership Skills Among New Saudi Graduate Nurses.

    Science.gov (United States)

    Al-Dossary, Reem Nassar; Kitsantas, Panagiota; Maddox, P J

    2016-01-01

    Nurse residency programs have been adopted by health care organizations to assist new graduate nurses with daily challenges such as intense working environments, increasing patient acuity, and complex technologies. Overall, nurse residency programs are proven beneficial in helping nurses transition from the student role to independent practitioners and bedside leaders. The purpose of this study was to assess the impact of residency programs on leadership skills of new Saudi graduate nurses who completed a residency program compared to new Saudi graduate nurses who did not participate in residency programs. The study design was cross-sectional involving a convenience sample (n = 98) of new graduate nurses from three hospitals in Saudi Arabia. The Clinical Leadership Survey was used to measure the new graduate nurses' clinical leadership skills based on whether they completed a residency program or not. Descriptive statistics, correlation, and multiple linear regression analyses were conducted to examine leadership skills in this sample of new Saudi graduate nurses. A significant difference was found between residents and nonresidents in their leadership skills (t = 10.48, P = .000). Specifically, residents were significantly more likely to show higher levels of leadership skills compared to their counterparts. Attending a residency program was associated with a significant increase in clinical leadership skills. The findings of this study indicate that there is a need to implement more residency programs in hospitals of Saudi Arabia. It is imperative that nurse managers and policy makers in Saudi Arabia consider these findings to improve nurses' leadership skills, which will in turn improve patient care. Further research should examine how residency programs influence new graduate nurses' transition from student to practitioner with regard to clinical leadership skills in Saudi Arabia. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. An Investigation of Classroom Practices in Teaching Listening Comprehension at English Education Program

    Science.gov (United States)

    Siregar, Nurhafni

    2017-01-01

    The objective of this study is to investigate how the classroom practice in teaching listening comprehension at English Education Program of STKIP Tapanuli Selatan in 2016/2017 Academic Year is. The informants of this research were all of second semester students of STKIP Tapanuli Selatan in 2016/2017 academic year and a lecturer of listening…

  4. Investigating the Relationship between Iranian EFL Teachers' Autonomy and Their Neuro-Linguistic Programming

    Science.gov (United States)

    Hosseinzadeh, Ehsan; Baradaran, Abdollah

    2015-01-01

    The present study was an attempt to investigate the relationship between English Language Teachers' autonomy and their Neuro-linguistic Programming (NLP). To this end, a group of 200 experienced English language teachers at various language schools in Tehran, inter alia, Asre Zaban Language Academy, were given two questionnaires namely Teaching…

  5. Investigating the Role of Mobile Devices in a Blended Pre-Service Teacher Education Program

    Science.gov (United States)

    Vaughan, Norman; Lawrence, Kimberley

    2013-01-01

    The purpose of this research study was to investigate if and how mobile devices could be used to support the required program outcomes in a blended pre-service teacher education degree. All students enrolled in an educational technology course during the fall 2011 semester were provided with ViewSonic tablets. Through faculty interviews, student…

  6. INVESTIGATING THE OPINIONS OF MoNE STAFF ABOUT INSET PROGRAMS VIA DISTANCE EDUCATION

    Directory of Open Access Journals (Sweden)

    Rasit OZEN

    2009-10-01

    Full Text Available The aim of this study is to investigate the opinions of the Ministry of National Education (MoNE staff about in-service training (INSET programs via distance education. The subjects of this study were the staff (n=15 of the Inservice Training Department of MoNE in 2008. During the study, the qualitative data were collected through semi-structured interviews held with the (MoNE staff by the researcher. The results of the interviews revealed the importance of needs assessment, the relationship between INSET program course content and participants’ school curriculum, support mechanism in INSET programs via distance education, the application of what is learned and providing various opportunities to them that lead to their active involvement to the application of these programs, the characteristics of learning environments for these programs, INSET instructors’ teaching competencies and skills to fulfill various roles in online learning environments, of measuring and evaluating the performance of teachers during INSET programs via distance education and of the effectiveness of INSET programs via distance education.

  7. Investigating audiences’ attitudes towards local radio programs: A case study of city of Esfahan

    Directory of Open Access Journals (Sweden)

    Faezeh Taghipour

    2013-02-01

    Full Text Available For almost a century, radio stations have been some primary sources for presenting arts, entertainment, news, etc. and the primary concern on many studies is to understand audience attitude on this media. This paper attempts to investigate audience attitude on radio programs broadcasted in city of Esfahan, Iran. The proposed study selects random sample of 600 out of 1,745,428 residence of this city where 345 people actively were listening to these programs, actively. All questions were designed in Likert scale and Cronbach alpha was 0.941, which was well above the desirable level and validated the survey. According our survey, the most popular part of radio programs was associated with news where 78.3% of the audiences were listening to these programs. According to our survey, audiences were mostly satisfied with family oriented programs and the mean score was 4.05. The other observation indicates that people have good attitude towards educational guidance programs (mean=3.37 and programs related to people and officials (mean=3.41. The results of Freedman test with Chi-Square value of 52.507 determines that there is meaningful difference among different components (mean difference = -0.23 and P-value =0.022. We have also performed an investigation to find out whether there is any difference between different components of this survey in terms of participants’ personal characteristics such as age, gender, educational background and job. Our survey only confirms the mean difference in terms of job specifications and other personal characteristics did not have any impact on people’s attitude. The other observation in our survey indicates that there is a difference between students and people with no job or housekeeper on their attitudes towards educational programs.

  8. Anatomical-clinical investigations of variations of the human coronary arteries

    OpenAIRE

    Aida Hasanović; Faruk Dilberović; Fehim Ovčina

    2003-01-01

    Variations of the human coronary arteries have always attracted the attention of many researchers. A review of the literature shows that variations can cause ischemic heart disease or sudden cardiac death. The aim of the investigations was to examine the existence and clinical significance of variations of the human coronary arteries. Special attention has been focused on myocardial bridging of the coronary arteries and coronary arteriovenous fistula. Our investigations were carried out on th...

  9. Promising and Established Investigators' Experiences Participating in the National Athletic Trainers' Association Foundation Research Mentor Program.

    Science.gov (United States)

    Nottingham, Sara L; Mazerolle, Stephanie M; Barrett, Jessica L

    2017-04-01

      Mentorship is a helpful resource for individuals who transition from doctoral student to tenure-track faculty member. The National Athletic Trainers' Association (NATA) Research & Education Foundation offers a Research Mentor Program to provide mentorship to promising investigators, particularly as they work to establish independent lines of research.   To gain the perspectives of promising and established investigators on their participation in the NATA Foundation Research Mentor Program.   Qualitative, phenomenological research.   Higher education institutions.   Seven promising investigators (5 women, 2 men) and 7 established investigators (2 women, 5 men), all of whom had completed the NATA Foundation Research Mentor Program. Data Collection and Analysis We developed and piloted intervi: ew guides designed to gain participants' perspectives on their experiences participating in the NATA Foundation Research Mentor Program. Semistructured telephone interviews were completed with each individual and transcribed verbatim. Data were analyzed using a phenomenological approach, and saturation was obtained. Trustworthiness was established with the use of member checking, multiple-analyst triangulation, and data-source triangulation.   Three themes emerged from the interviews: (1) motivation, (2) collaboration, and (3) resources. Participants were motivated to become involved because they saw the value of mentorship, and mentees desired guidance in their research. Participants believed that collaboration on a project contributed to a positive relationship, and they also desired additional program and professional resources to support novice faculty.   Promising and established investigators should be encouraged to engage in mentoring relationships to facilitate mentees' research agendas and professional development. The NATA Foundation and athletic training profession may consider providing additional resources for novice faculty, such as training on

  10. Department of Clinical Investigation: Annual Research Progress Report for Fiscal Year 1992. Volume 2

    Science.gov (United States)

    1993-01-01

    A-5-90 Production of Mouse Positive and Negative Control Slides for 295 Use in Rabies FRA Test. (0) A-7-90 Clinical Investigation on the...Dose Intensification of Methotrexate and 519 6- Mercaptopurine for ALL in Childhood. (0) POG 9006 ALinC 15: Up-Front 6-MP/MTX vs. Up-Front Alternating 520...for the mouse bioassay as a means for detecting Clostridium botulinum toxin in cultures, food products , serum and fecal specimens. Technical Approach

  11. Impact of a Comprehensive Early Clinical Exposure Program for Preclinical Year Medical Students

    Directory of Open Access Journals (Sweden)

    Sumitra Govindarajan

    2018-06-01

    Full Text Available Purpose: To study the impact of an early clinical exposure program designed to provide a wide variety (cognitive, affective and psychomotor of learning experiences for the preclinical year students. Method: One hundred and fifty preclinical students were posted in small groups to selected departments – Transfusion medicine, Catheterization lab, Simulation lab, Radiology, Neurology, Nephrology, Respiratory medicine and General surgery. Each student had atleast ten hours  of clinical exposure under this program. The program was evaluated through a series of pre and post-test questionnaires, which were designed based on the learning objectives of each session. Students who wished to participate in the program evaluation gave informed consent, took up the pre / post test and were also asked to give their written open comments about the program. Results: There was a significant increase in the post-test scores (ranging from 9.14±2.67 to 36.65±6.62 when compared to the pre-test scores (ranging from 7.94±2.31 to 28.69±6.11 for all the sessions (p value <0.001, n=144. Analysis of the open feedback showed that the program had significant impact on the cognitive, psychomotor and affective domains. “Application of basic sciences in clinical practice”, “motivation to learn”, “got familiar with various specialties”, “insight about what the patient undergoes” were the themes identified from the open comments. Conclusion: The innovative use of early clinical exposure program to teach/learn clinical skills like phlebotomy and Basic Life Support had been well appreciated by the students. The present design involving a variety of learning experiences has been successful in introducing the various dimensions of medical profession like scientific, ethical, interpersonal, professional and social to the new entrants in addition to enhancing their motivation to learn. Keywords: Attitude, Learning, Simulation lab, Medical education, Curriculum

  12. New Clinical Faculty Training Program: Transforming Practicing Dentists into Part-Time Dental Faculty Members.

    Science.gov (United States)

    Adams, Brooke N; Kirkup, Michele L; Willis, Lisa H; Reifeis, Paul E

    2017-06-01

    At Indiana University School of Dentistry, a New Clinical Faculty Training (NCFT) program was created with the primary goals of informing new part-time faculty members of clinical policies and assessment guidelines and thus developing qualified and satisfied faculty members. The aim of this study was to determine if participation in the training program improved the participants' satisfaction and competence in comparison to their colleagues who did not participate in the program. Two cohorts were compared: a control group of part-time faculty members who did not receive formal training when they were hired (n=21; response rate 58.3%); and the intervention group, who had participated in the NCFT program (n=12; response rate 80%). A survey of faculty members in the control group gathered information on their experiences when initially hired, and a pretest was administered to measure their knowledge of clinical policies. After the control group was given an overview of the program, their feedback was collected through post surveys, and a posttest identical to the pretest was given that found statistically significant increases on questions one (p=0.003) and four (p=0.025). In February 2014, 15 new faculty members participated in the pilot implementation of the NCFT program. Of those 15, 12 (the intervention group) completed follow-up surveys identical to the pre survey used with the control group. Statistically significant differences were found for the factors clinical teaching (p=0.005) and assessment training (p=0.008) with better responses for the NCFT group. These results suggest that participation in the program was associated with improved clinical teaching knowledge and job satisfaction.

  13. Electrochemical impedance spectroscopy investigation on the clinical lifetime of ProTaper rotary file system.

    Science.gov (United States)

    Penta, Virgil; Pirvu, Cristian; Demetrescu, Ioana

    2014-01-01

    The main objective of the current paper is to show that electrochemical impedance spectroscopy (EIS) could be a method for evaluating and predicting of ProTaper rotary file system clinical lifespan. This particular aspect of everyday use of the endodontic files is of great importance in each dental practice and has profound clinical implications. The method used for quantification resides in the electrochemical impedance spectroscopy theory and has in its main focus the characteristics of the surface titanium oxide layer. This electrochemical technique has been adapted successfully to identify the quality of the Ni-Ti files oxide layer. The modification of this protective layer induces changes in corrosion behavior of the alloy modifying the impedance value of the file. In order to assess the method, 14 ProTaper sets utilized on different patients in a dental clinic have been submitted for testing using EIS. The information obtained in regard to the surface oxide layer has offered an indication of use and proves that the said layer evolves with each clinical application. The novelty of this research is related to an electrochemical technique successfully adapted for Ni-Ti file investigation and correlation with surface and clinical aspects.

  14. [ISO 9001certification of a quality management system in a clinical investigation center].

    Science.gov (United States)

    Chesnais, Jimmy; Fougerou-Leurent, Claire; Laforest, Claire; Renault, Alain; Bellissant, Eric; Laviolle, Bruno

    2018-05-03

    Beyond the application of legal requirements, clinical trials must have a permanent approach of quality control. The clinical investigation centers (CICs) are academic structures of clinical research certified by the French National institute of health and medical research (Inserm) and whose functioning relies on recommendations of good practice. It is important to accompany this standardization of practices by the implementation of a quality management system. This article presents the process that enabled the CIC of Rennes to become certified ISO 9001 by French standards association (Afnor) certification in May, 2016. The application of the fundamental principles of the standard ISO 9001 in the domain of clinical research is approached. The problem of the perimeter for the certification and the related process mapping are exposed. The activities of methodology, management and analysis of clinical studies were chosen for the initial certification of the CIC of Rennes. The perspectives for the extension of the perimeter of certification are also approached at the end of article. Copyright © 2018 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.

  15. Demonstration of SLUMIS: a clinical database and management information system for a multi organ transplant program.

    OpenAIRE

    Kurtz, M.; Bennett, T.; Garvin, P.; Manuel, F.; Williams, M.; Langreder, S.

    1991-01-01

    Because of the rapid evolution of the heart, heart/lung, liver, kidney and kidney/pancreas transplant programs at our institution, and because of a lack of an existing comprehensive database, we were required to develop a computerized management information system capable of supporting both clinical and research requirements of a multifaceted transplant program. SLUMIS (ST. LOUIS UNIVERSITY MULTI-ORGAN INFORMATION SYSTEM) was developed for the following reasons: 1) to comply with the reportin...

  16. A review of standardized patients in clinical education: Implications for speech-language pathology programs.

    Science.gov (United States)

    Hill, Anne E; Davidson, Bronwyn J; Theodoros, Deborah G

    2010-06-01

    The use of standardized patients has been reported as a viable addition to traditional models of professional practice education in medicine, nursing and allied health programs. Educational programs rely on the inclusion of work-integrated learning components in order to graduate competent practitioners. Allied health programs world-wide have reported increasing difficulty in attaining sufficient traditional placements for students within the workplace. In response to this, allied health professionals are challenged to be innovative and problem-solving in the development and maintenance of clinical education placements and to consider potential alternative learning opportunities for students. Whilst there is a bank of literature describing the use of standardized patients in medicine and nursing, reports of its use in speech-language pathology clinical education are limited. Therefore, this paper aims to (1) provide a review of literature reporting on the use of standardized patients within medical and allied health professions with particular reference to use in speech-language pathology, (2) discuss methodological and practical issues involved in establishing and maintaining a standardized patient program and (3) identify future directions for research and clinical programs using standardized patients to build foundation clinical skills such as communication, interpersonal interaction and interviewing.

  17. Environmental Restoration Program pollution prevention performance measures for FY 1993 and 1994 remedial investigations

    International Nuclear Information System (INIS)

    1993-03-01

    The Martin Marietta Energy Systems, Inc., Environmental Restoration (ER) Program adopted a Pollution Prevention Program in March 1991. The program's mission is to minimize waste and prevent pollution in remedial investigations (RI), feasibility studies (FS), decontamination and decommissioning (D ampersand D), and surveillance and maintenance (S ampersand M) site program activities. Mission success will result in volume and/or toxicity reduction of generated waste. Energy Systems is producing a fully developed a Numerical Scoring System (NSS) and actually scoring the generators of Investigation Derived Waste (IDW) at six ER sites: Oak Ridge National Laboratory (ORNL), the Oak Ridge Y-12 Plant, the Oak Ridge K-25 site, Paducah Gaseous Diffusion Plant (Paducah), and Portsmouth Uranium Enrichment Complex (Portsmouth). This report summarizes the findings of this initial numerical scoring evaluation and shows where improvements in the overall ER Pollution prevention program may be required. This report identifies a number of recommendations that, if implemented, would help to improve site-performance measures. The continued development of the NSS will support generators in maximizing their Pollution Prevention/Waste Minimization efforts. Further refinements of the NSS, as applicable suggest comments and/or recommendations for improvement

  18. 200 Areas Remedial Investigation/Feasibility Study Implementation Plan - Environmental Restoration Program

    International Nuclear Information System (INIS)

    Knepp, A. J.

    1999-01-01

    The 200 Areas Remedial Investigation/Feasibility Study Implementation Plan - Environmental Restoration Program (Implementation Plan) addresses approximately 700 soil waste sites (and associated structures such as pipelines) resulting from the discharge of liquids and solids from processing facilities to the ground (e.g., ponds, ditches, cribs,burial grounds) in the 200 Areas and assigned to the Environmental Restoration Program. The Implementation Plan outlines the framework for implementing assessment activities in the 200 Areas to ensure consistency in documentation, level of characterization, and decision making. The Implementation Plan also consolidates background information and other typical work plan materials, to serve as a single referenceable source for this type of information

  19. Investigation on physiological and clinical effects of different light sources in TMJ photobiomodulation therapy

    Science.gov (United States)

    Kamenoff, J.

    2017-02-01

    Introduction Laser light Electromagnetic energy has some typical properties for discussions on laser irradiation abilities to control the acute and chronic disorders in TMJ. Material and Methods During the last six years we have been completed well controlled clinical trials based on the criteria of the American Academy of orofacial pain. The study over the 600 patients (300 women and 300 men), mean age of 47 years have been developed. Patients have been selected on the main clinical sign of TMJ pain and have been divided into four main groups according to the type of PDT method. Based on the action spectra, various wavelengths have been used for TMJ Photodynamic Therapy. Constant dose and time of exposition, as well as various range of frequencies have been applied. In this way the Laser biostimulation response has been directly proportional to the total energy dose, depending of light intensity. Physiological and clinical effects of the followed "active regions"- 660 - 680, 760 - 780, 810 - 830 and 904 - 987 nm have been valued by method of comparative analysis. Methods applied: LLLT - TENS - red surface laser acupuncture (LA), PIPBM - LA, Laser bioenergetics approach, Complex therapeutic program (CTP). Results evaluation will be demonstrated by comparative digital ortopantomograph analysis, EEG brain maps, VAS, a metric analysis of the level of the maximum active Mandible opening and EPST through electrophysiological signal evaluation of the patient's body.

  20. Horonobe Underground Research Laboratory project. Investigation program for the 2008 fiscal year

    International Nuclear Information System (INIS)

    Nakayama, Masashi; Sanada, Hiroyuki; Yamaguchi, Takehiro; Sugita, Yutaka

    2008-09-01

    As part of the research and development program on geological disposal of high-level radioactive waste (HLW), the Horonobe Underground Research Center, a division of the Japan Atomic Energy Agency (JAEA), is implementing the Horonobe Underground Research Laboratory Project (Horonobe URL Project) with the aim at investigating sedimentary rock formations. According to the research plan described in the Midterm Plan of JAEA, geological investigations are to be carried out during the drilling of a shaft down to intermediate depth, while research and development in the areas of engineering technology and safety assessment are to be promoted by collaboration with other research organizations. The results of the R and D activities will be systematized as a 'knowledge base' that supports a wide range of arguments related to the safety of geological disposal. The Horonobe URL Project is planned to extend over a period of 20 years. The investigations will be conducted in three phases, namely 'Phase 1: Surface-based investigations', 'Phase 2: Construction phase' (investigations during construction of the underground facilities) and 'Phase 3: Operation phase' (research in the underground facilities). This report summarizes the investigation program for the 2008 fiscal year (2008/2009), the 4th year of the Phase 2 investigations. In the 2008 fiscal year, investigations in geoscientific research', including 'development of techniques for investigating the geological environment', 'development of techniques for long-term monitoring of the geological environment', 'development of engineering techniques for use in the deep underground environment' and studies on the long-term stability of the geological environment', are continuously carried out. Investigations in 'research and development on geological disposal technology', including 'improving the reliability of disposal technologies' and 'enhancement of safety assessment methodologies', are also continuously carried out

  1. Encountering aged care: a mixed methods investigation of medical students' clinical placement experiences.

    Science.gov (United States)

    Annear, Michael J; Lea, Emma; Lo, Amanda; Tierney, Laura; Robinson, Andrew

    2016-02-04

    Residential aged care is an increasingly important health setting due to population ageing and the increase in age-related conditions, such as dementia. However, medical education has limited engagement with this fast-growing sector and undergraduate training remains primarily focussed on acute presentations in hospital settings. Additionally, concerns have been raised about the adequacy of dementia-related content in undergraduate medical curricula, while research has found mixed attitudes among students towards the care of older people. This study explores how medical students engage with the learning experiences accessible in clinical placements in residential aged care facilities (RACFs), particularly exposure to multiple comorbidity, cognitive impairment, and palliative care. Fifth-year medical students (N = 61) completed five-day clinical placements at two Australian aged care facilities in 2013 and 2014. The placements were supported by an iterative yet structured program and academic teaching staff to ensure appropriate educational experiences and oversight. Mixed methods data were collected before and after the clinical placement. Quantitative data included surveys of dementia knowledge and questions about attitudes to the aged care sector and working with older adults. Qualitative data were collected from focus group discussions concerning medical student expectations, learning opportunities, and challenges to engagement. Pre-placement surveys identified good dementia knowledge, but poor attitudes towards aged care and older adults. Negative placement experiences were associated with a struggle to discern case complexity and a perception of an aged care placement as an opportunity cost associated with reduced hospital training time. Irrespective of negative sentiment, post-placement survey data showed significant improvements in attitudes to working with older people and dementia knowledge. Positive student experiences were explained by in

  2. Investigation of the Concussion Goggle™ Education Program with Secondary School Athletic Teams: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Ellen K. Payne

    2017-04-01

    Full Text Available Background: Researchers have investigated different types of concussion education programs within various populations with mixed results. To date, no research has been published using the Concussion Goggles™ educational program Objective: To compare secondary school student-athletes’ knowledge about concussions before and after attending a concussion education program using the Concussion Goggles™. Design: Pre- posttest. Setting: Public secondary school. Patients or Other Participants: 41 secondary school students (14 girls soccer players, 14 boys basketball players, and 13 girls basketball players with a mean age of 15.37 ± 1.22 years. Intervention(s: Participants completed the Concussion Goggles™ concussion educational program consisting of PowerPoint slides with 3 activities and short video segments within the presentation. Participants completed a test developed by the manufacturers of the Concussion Goggles™ educational program prior to and following the intervention to measure change in concussion knowledge. Main Outcome Measure(s: A 3-way mixed factorial analysis of variance (sport x grade level x gender for repeated measures was utilized to determine statistical significance. Results: A statistically significant difference between the overall pretest (9.37 ± 1.20 and posttest (9.63 ± 1.04 scores was not found (p = 0.28. Repeated measures analysis did not indicate significant interaction effects for test score x grade (p = 0.18, test score x sport (p = 0.63, nor test score x grade x sport (p = 0.96. Conclusion: The Concussion Goggle™ education program did not affect participant knowledge of concussions in the posttest. In its current form, the Concussion Goggle™ program may not be an effective concussion education program.

  3. An Exploratory Study Investigating the Non-Clinical Benefits of Evidence-Based Veterinary Medicine

    Directory of Open Access Journals (Sweden)

    Elizabeth Jackson

    2017-05-01

    Full Text Available Objective: As little prior research exists about the non-clinical benefits of evidence-based veterinary medicine (EBVM, this exploratory study was conducted to identify non-clinical benefits of EBVM to veterinary practices, as well as highlighting the barriers to further implementation, and ways to overcome them.Background: A PICO-based literature review (Hauser and Jackson, 2016 was conducted to establish current knowledge about the non-clinical benefits of EBVM. It found that while there are some papers suggesting a link between the practice of EBVM and better non-clinical benefits such as client satisfaction and client retention, a single study, focusing on the non-clinical benefits of EBVM, had yet to be conducted.Evidentiary value: This exploratory study provides a solid basis for the further development of a confirmatory study of the themes identified in the interviews. The impact on practice from our findings is significant as it details the key areas where the use of EBVM can yield commercial benefits from the perspective of a group of EBVM experts via interview. It is entirely possible that international veterinary environments which mirror that of the UK will find this research beneficial.Methods: Due to the paucity of data about the non-clinical benefits of EBVM, an exploratory, qualitative approach was taken to this research in order to build a platform for further confirmatory, quantitative investigation (Zikmund, 2003. In February and March 2016 interviews with 16 RCVS Knowledge Group chairs[1] were conducted. The interview guide contained broad, open-ended questions to explore existing tacit knowledge about the non-commercial benefits of EBVM. The interviews were audio recorded and transcribed verbatim and subsequently analysed using NVivo 11 software.Results: This qualitative enquiry showed that the key areas where the use of EBVM can yield non-clinical benefits are through increased client satisfaction and retention, improved

  4. Clinical neurophysiology and quantitative sensory testing in the investigation of orofacial pain and sensory function.

    Science.gov (United States)

    Jääskeläinen, Satu K

    2004-01-01

    Chronic orofacial pain represents a diagnostic and treatment challenge for the clinician. Some conditions, such as atypical facial pain, still lack proper diagnostic criteria, and their etiology is not known. The recent development of neurophysiological methods and quantitative sensory testing for the examination of the trigeminal somatosensory system offers several tools for diagnostic and etiological investigation of orofacial pain. This review presents some of these techniques and the results of their application in studies on orofacial pain and sensory dysfunction. Clinical neurophysiological investigation has greater diagnostic accuracy and sensitivity than clinical examination in the detection of the neurogenic abnormalities of either peripheral or central origin that may underlie symptoms of orofacial pain and sensory dysfunction. Neurophysiological testing may also reveal trigeminal pathology when magnetic resonance imaging has failed to detect it, so these methods should be considered complementary to each other in the investigation of orofacial pain patients. The blink reflex, corneal reflex, jaw jerk, sensory neurography of the inferior alveolar nerve, and the recording of trigeminal somatosensory-evoked potentials with near-nerve stimulation have all proved to be sensitive and reliable in the detection of dysfunction of the myelinated sensory fibers of the trigeminal nerve or its central connections within the brainstem. With appropriately small thermodes, thermal quantitative sensory testing is useful for the detection of trigeminal small-fiber dysfunction (Adelta and C). In neuropathic conditions, it is most sensitive to lesions causing axonal injury. By combining different techniques for investigation of the trigeminal system, an accurate topographical diagnosis and profile of sensory fiber pathology can be determined. Neurophysiological and quantitative sensory tests have already highlighted some similarities among various orofacial pain conditions

  5. The Economic and Clinical Impact of Sustained Use of a Progressive Mobility Program in a Neuro-ICU.

    Science.gov (United States)

    Hester, Jeannette M; Guin, Peggy R; Danek, Gale D; Thomas, Jaime R; Titsworth, William L; Reed, Richard K; Vasilopoulos, Terrie; Fahy, Brenda G

    2017-06-01

    To investigate a progressive mobility program in a neurocritical care population with the hypothesis that the benefits and outcomes of the program (e.g., decreased length of stay) would have a significant positive economic impact. Retrospective analysis of economic and clinical outcome data before, immediately following, and 2 years after implementation of the Progressive Upright Mobility Protocol Plus program (UF Health Shands Hospital, Gainesville, FL) involving a series of planned movements in a sequential manner with an additional six levels of rehabilitation in the neuro-ICU at UF Health Shands Hospital. Thirty-bed neuro-ICU in an academic medical center. Adult neurologic and neurosurgical patients: 1,118 patients in the pre period, 731 patients in the post period, and 796 patients in the sustained period. Implementation of Progressive Upright Mobility Protocol Plus. ICU length of stay decreased from 6.5 to 5.8 days in the immediate post period and 5.9 days in the sustained period (F(2,2641) = 3.1; p = 0.045). Hospital length of stay was reduced from 11.3 ± 14.1 days to 8.6 ± 8.8 post days and 8.8 ± 9.3 days sustained (F(2,2641) = 13.0; p mobility program in the neurocritical care population has clinical and financial benefits associated with its implementation and should be considered.

  6. Effectiveness of a structured training program in psychotherapeutic skills used in clinical interviews for psychiatry and clinical psychology residents.

    Science.gov (United States)

    Fernandez-Liria, Alberto; Rodriguez-Vega, Beatriz; Ortiz-Sanchez, Deborah; Baldor Tubet, Isabel; Gonzalez-Juarez, Carlos

    2010-01-01

    The authors evaluated a training program based on a structured manual of psychotherapeutic skills, using a randomized controlled design. The experimental group consisted of 135 residents from 12 teaching units in Spain. To control the improvement in therapeutic skills that could be attributed to the training received during the residency, the authors compared the experimental group with a control group of 35 residents from three teaching units. Two types of assessment instruments were used: a paper-and-pencil questionnaire based on clinical cases and a videotape of a role-playing interview. Both were given before and after the experimental group attended the training program. The experimental group shows a statistically significant improvement compared with the control group in both measurements.

  7. Animal investigation program 1980 annual report: Nevada Test Site and vicinity

    International Nuclear Information System (INIS)

    Smith, D.D.; Bernhardt, D.E.; Giles, K.R.

    1982-07-01

    This report summarizes the data collected through the Animal Investigation Program during 1980. A major goal of the Program is to assess the radionuclide burden in the tissues of wild and domesticated animals around the Nevada Test Site and to detect pathological effects resulting from the burdens. Other than naturally occurring potassium-40, gamma emitting radionuclides were detected infrequently. Strontium-90 and plutonium concentrations in tissues from deer, cattle, and desert bighorn sheep were similar to those found in samples collected during recent years. Lesions found in necropsied animals were similar to those found in animals from other areas of the U.S. and would not be attributable to ionizing radiation exposure. The report also describes other activities of the program, including the deer migration study and census

  8. An empirical investigation of incompleteness in a large clinical sample of obsessive compulsive disorder.

    Science.gov (United States)

    Sibrava, Nicholas J; Boisseau, Christina L; Eisen, Jane L; Mancebo, Maria C; Rasmussen, Steven A

    2016-08-01

    Obsessive Compulsive Disorder (OCD) is a disorder with heterogeneous clinical presentations. To advance our understanding of this heterogeneity we investigated the prevalence and clinical features associated with incompleteness (INC), a putative underlying core feature of OCD. We predicted INC would be prominent in individuals with OCD and associated with greater severity and impairment. We examined the impact of INC in 307 adults with primary OCD. Participants with clinically significant INC (22.8% of the sample) had significantly greater OCD severity, greater rates of comorbidity, poorer ratings of functioning, lower quality of life, and higher rates of unemployment and disability. Participants with clinically significant INC were also more likely to be diagnosed with OCPD and to endorse symmetry/exactness obsessions and ordering/arranging compulsions than those who reported low INC. Our findings provide evidence that INC is associated with greater severity, comorbidity, and impairment, highlighting the need for improved assessment and treatment of INC in OCD. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. [Clinical investigation of basophil activation test as a complementary test for house dust mite allergen].

    Science.gov (United States)

    Ren, H L; Li, J D; Miao, Y H; Xu, T

    2018-03-01

    Objective: To investigate the clinical application of glass micro fiber basophil activation test (BAT) used as a complementary test for house dust mite allergen. Method: Forty patients with clinical diagnosed allergic rhinitis was test by three methods for house dust mite allergen, skin prick test(SPT),Immuno CAP sIgE, and BAT in vitro. The sensitivity and specificity of glass micro fiber were accessed, and the consistency between BAT, SPT, and Immuno sIgE was analyzed. As in vivo provocation was not performed, gold standard is regarded as the combination of medical history and positive reports of SPT and/or ImmunoCAP sIgE test. Result: Twentythree patients are diagnosed as house dust mite allergic rhinitis by gold standard. The sensitivity and specificity of glass micro fiber BAT were 60.9% and 88.2%, the sensitivity of SPT and sIgE was 87.0% and sIgE 73.9%. The correlation rates between BAT with SPT is 0.67( P house dust mite allergic rhinitis, BAT have a good consistency with SPT and sIgE, while as it has only moderate consistency with "gold standard", further studies are needed to prove its clinical significance. Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.

  10. [What role for paraclinical investigations within clinical trials conducted in psychiatric patients?

    Science.gov (United States)

    Kaladjian, A; Adida, M; Simon, N; Belzeaux, R; Blin, O; Fakra, E; Azorin, J-M

    2016-12-01

    As in the usual care of patients, paraclinical investigations have today only a very modest role in clinical trials in psychiatry, mainly to complete the pre-therapeutical assessments prior to inclusion of subjects or to monitor treatment tolerance. Yet, the accumulation of data in neurosciences suggests the next emergence of biomarkers, whose interest is that they are closely associated to the biological disturbances underlying psychiatric illnesses, and that they are accessible by means of technological tools such as imaging devices. These tools allow to explore the effects on brain of psychotropic medications, such as antidepressants, antipsychotics, or mood stabilizers, in relation to their therapeutic action. The obtained results allow to consider the use of such biomarkers in clinical trials in addition to more conventional approaches. In particular, they could be used as targets to measure brain response to treatment in association with clinical response, to predict a therapeutic response from the neurofunctional characteristics of patients, or to establish the safety profile of drugs on the nervous system. The use of such biomarkers in clinical trials would help to better define the explored populations and their characteristics, as well as the variables to assess, and to better measure the impact of the treatments and their potential harmful effects on the nervous system. © L’Encéphale, Paris, 2016.

  11. The effect of nursing management development program on clinical competency in coronary care unit

    Directory of Open Access Journals (Sweden)

    Ali Akbar Vaezi

    2011-03-01

    Full Text Available Background: Nurses are the main members in nursing cares and nursing managers can improve their clinical competency by applying better leadership skills. This study carried out to determine the effect of nursing management program on clinical competency of nurses in a coronary care unit (CCU.Methods: A quasi-experimental study was carried out in two educational hospitals in Yazd- Iran. These hospitals were allocated randomly in case and control hospitals. 25 matched nurses were selected by convenience sampling from both case and control hospitals. The clinical competency of nurses was measured by related questioners consisted of two dimensions caring and care management behaviors by self-evaluation and head nurse evaluation in case and control groups. Then, the intervention was implemented in four stages including nurse's development, managers' development, adaptation and supervision period during four months in the case group. After intervention, clinical competency of nurses was measured in both groups.Results: The results showed that before intervention more than 80% of nurses in two groups was in the moderate clinical competency level and they were proficient based on Benner's skill acquisition model. After intervention, nurses' clinical competency improved to higher level in case group but it didn't change in control group (P<0.05. Conclusion: Creating necessary modifications in nursing environments through the management development program by head nurses may improve nurses' clinical competency.

  12. Student and faculty perceptions of effective clinical instructors in ADN programs.

    Science.gov (United States)

    Gignac-Caille, A M; Oermann, M H

    2001-11-01

    The purpose of this study was to identify the perceptions of associate degree nursing (ADN) students and faculty of characteristics of effective clinical teachers and determine whether there were differences between these two groups. A survey was conducted of 292 students in various levels of their ADN programs and 59 faculty members from the same five programs, which were randomly selected from across Michigan. Data were collected using the Nursing Clinical Effectiveness Inventory, which includes 48 characteristics of effective clinical instructors arranged in five subscales. Students identified "demonstrates clinical skills and judgment" as the most important characteristic of effective clinical instructors, while faculty identified "explains clearly" as the most important characteristic. There was agreement on 6 of the top 10 characteristics identified by both groups. Both groups rated "directs student to useful literature in nursing" as the least important characteristic of effective clinical instructors. The students' and faculty's perceptions of effective clinical instructors differed by subscales, with students identifying evaluation characteristics as most important (mean = 4.73, SD = .42) and faculty identifying interpersonal relationships as most important (mean = 4.72, SD = .31). A t test indicated a significant difference between student and faculty means for the interpersonal relationships subscales, with faculty rating this group of characteristics as more important than students did (t = 2.49, p = .0 14).

  13. Of Course: Prerequisite Courses for Admission into APA-Accredited Clinical and Counseling Psychology Programs

    Science.gov (United States)

    Norcross, John C.; Sayette, Michael A.; Stratigis, Katerina Y.; Zimmerman, Barrett E.

    2014-01-01

    Students often inquire about which psychology courses to complete in preparation for graduate school. This study provides data that enable students and their advisors to make research-informed decisions. We surveyed the directors of the 304 American Psychological Association-accredited doctoral programs in clinical and counseling psychology (97%…

  14. 77 FR 25787 - Low Income Taxpayer Clinic Grant Program; Availability of 2013 Grant Application Package

    Science.gov (United States)

    2012-05-01

    ... DEPARTMENT OF THE TREASURY Internal Revenue Service Low Income Taxpayer Clinic Grant Program... Package and Guidelines (Publication 3319) for organizations interested in applying for a Low Income... nominal fee to low income taxpayers involved in tax controversies with the IRS, or inform individuals for...

  15. Mentoring in Clinical-Translational Research: A Study of Participants in Master’s Degree Programs

    OpenAIRE

    McGinn, Aileen P; Lee, Linda S; Baez, Adriana; Zwanziger, Jack; Anderson, Karl E; Seely, Ellen W; Schoenbaum, Ellie

    2015-01-01

    Research projects in translational science are increasingly complex and require interdisciplinary collaborations. In the context of training translational researchers, this suggests that multiple mentors may be needed in different content areas. This study explored mentoring structure as it relates to perceived mentoring effectiveness and other characteristics of masters-level trainees in clinical-translational research training programs.

  16. Using thermographic cameras to investigate eye temperature and clinical severity in depression

    Science.gov (United States)

    Maller, Jerome J.; George, Shefin Sam; Viswanathan, Rekha Puzhavakkathumadom; Fitzgerald, Paul B.; Junor, Paul

    2016-02-01

    Previous studies suggest that altered corneal temperature may be a feature of schizophrenia, but the association between major depressive disorder (MDD) and corneal temperature has yet to be assessed. The aim of this study is to investigate whether eye temperature is different among MDD patients than among healthy individuals. We used a thermographic camera to measure and compare the temperature profile across the corneas of 16 patients with MDD and 16 age- and sex-matched healthy subjects. We found that the average corneal temperature between the two groups did not differ statistically, although clinical severity correlated positively with right corneal temperature. Corneal temperature may be an indicator of clinical severity in psychiatric disorders, including depression.

  17. Clinical investigation of large perfusion defect cases with 201Tl exercise myocardial scintigraphy

    International Nuclear Information System (INIS)

    Morota, Motoi; Kobayashi, Yasuhiko

    1999-01-01

    We investigated retrospectively the clinical significance of large perfusion defect on 201 Thallium myocardial scintigraphy from the records of 833 patients during the past 3 years from 1991 to 1994. The patients were divided into 3 groups according to the extent of perfusion defect; cases with normal perfusion (n=561), with small perfusion defect (n=211) and with large perfusion defect (n=61). We found that the proportions of cases with large perfusion defect was significantly larger than that of cases with small perfusion defect in myocardial disease (MD; hypertrophic cardiomyopathy, dilated cardiomyopathy, and post myocarditis combined) (P 201 Thallium myocardial scintigraphy and that complication of diabetes mellitus and clinical symptoms may be useful in differentiating IHD from MD. (author)

  18. Investigating the connections between health lean management and clinical risk management.

    Science.gov (United States)

    Crema, Maria; Verbano, Chiara

    2015-01-01

    The purpose of this paper is to investigate connections and overlaps between health lean management (HLM) and clinical risk management (CRM) understanding whether and how these two approaches can be combined together to pursue efficiency and patient safety improvements simultaneously. A systematic literature review has been carried out. Searching in academic databases, papers that focus not only on HLM, but also on clinical errors and risk reduction, were included. The general characteristics of the selected papers were analysed and a content analysis was conducted. In most of the papers, pursing objectives of HLM and CRM and adopting tools and practices of both approaches, results of quality and, particularly, of safety improvements were obtained. A two-way arrow between HLM and CRM emerged but so far, none of the studies has been focused on the relationship between HLM and CRM. Results highlight an emerging research stream, with many useful theoretical and practical implications and opportunities for further research.

  19. Research Capacity at Traditional Chinese Medicine (TCM) Centers in China: A Survey of Clinical Investigators.

    Science.gov (United States)

    Feng, Shuo; Han, Mei; Lai, Lily; Wang, Si-Cheng; Liu, Jian-Ping

    2017-01-01

    Background. The development of an evidence-based approach to traditional Chinese medicine (TCM), which depends on the generation of good quality evidence, requires an adequate workforce. However, the research capacity of TCM investigators is not known. Study Design. This cross-sectional study was conducted to describe the research capacity of TCM clinical investigators in China. Participants. A total of 584 participants from TCM hospitals and research centers were included. They were asked about the academic and research characteristics, needs for research capacity building, and barriers to clinical research. Results. The majority (80.82%) were qualified to at least a Master's degree, whilst a smaller proportion (40.24%) held a senior professional title. We found that academic outputs were low with the majority (62.16%) authoring less than five publications in total. The most pressing needs for building research capacity identified were training in research methodology (97.43%) and identification of research questions (86.81%), whilst the highest ranking barriers to conducting research were limited motivation, funding (40.72%), and time (37.15%). Conclusion. The methodology training, along with investment in the research workforce, needs to be urgently addressed to improve investigators' research capacity and the development of an evidence-based approach of TCM.

  20. [Introduction of a Clinical Research Experience Program in Hospital Practical Training for Pharmacy Students and Its Evaluation].

    Science.gov (United States)

    Takahashi, Katsuyuki; Suda, Yasuki; Kawaguchi, Hiroshi; Nakamura, Yasutaka; Kawabata, Shiho; Kawakami, Noriko; Nishikawa, Takeshi; Nagayama, Katsuya

    2015-01-01

    Long-term clinical training based on a model core curriculum was conducted to nurture highly competent pharmacists in the clinical field. Pharmacists' responsibilities are expanding, and a system has been developed to help pharmacists gain accreditation, identify specialties, and improve their training. However, this system requires research competency. Therefore clinical research should be considered a part of clinical training to encourage high competency among pharmacists. Because the model core curriculum does not include a section on clinical research. Osaka City University Hospital introduced a hands-on clinical research experience program and evaluated its usefulness. A significant improvement in the level of knowledge and awareness of clinical research was seen among students who underwent the clinical research experience program. In addition, the level of student satisfaction was higher. These findings suggest that a clinical research experience program may be useful to nurture a greater awareness of clinical research and knowledge acquisition among pharmacists.

  1. Sustaining the Clinical and Translational Research Workforce: Training and Empowering the Next Generation of Investigators.

    Science.gov (United States)

    Yin, Helen L; Gabrilove, Janice; Jackson, Rebecca; Sweeney, Carol; Fair, Alecia M; Toto, Robert

    2015-07-01

    There is mounting concern that clinician-scientists are a vanishing species and that the pipeline for clinical and translational research (CTR) investigators is in jeopardy. For the majority of current junior CTR investigators, the career path involves first obtaining a National Institutes of Health (NIH)-funded K-type career development award, particularly K08 and K23, and subsequently an NIH R01. This transition, popularly referred to as K2R, is a major hurdle with a low success rate and gaps in funding. In this Perspective, the authors identify factors that facilitate K2R transition and important aspects of increasing and sustaining the pipeline of CTR investigators. They also highlight significant differences in success rates of women and those underrepresented in biomedical research. Early career exposure to research methodology, protected time, multidisciplinary mentoring, and institutional "culture shift" are important for fostering and rewarding team science. Mentoring is the single most important contributor to K2R success, and emerging evidence suggests that formal mentor training and team mentoring are effective. Leadership training can empower junior investigators to thrive as independent CTR investigators. Future research should focus on delineating the difference between essential and supplemental factors to achieve this transition, and mentoring methods that foster success, including those that promote K2R transition of women and those underrepresented in biomedical research. The Clinical and Translational Science Awards National Consortium is well positioned to test existing models aimed at shortening the time frame, increasing the rate of K2R transition, and identifying strategies that improve success.

  2. Investigation of administrative obstacles to family physician program in urban areas of Iran

    Directory of Open Access Journals (Sweden)

    Javad Javan noughabi

    2017-06-01

    Full Text Available Health is regarded as one of the basic rights of each person in society; so governments are obligated to provide it equally for everyone. The best way to achieve this goal is the establishment of health insurance with the orientation of family physician and the strategic referral system. Yet, such programs will not be successful without encouraging people to participate and changing social behaviors. The aim of the present study was to investigate the administrative obstacles and problems to family physician program in urban areas of Iran. This study was a qualitative research conducted. A purposive sampling method was employed and the data were gathered via semi-structured interview with open-ended questions and document examination. All the interviews were recorded digitally and immediately transcribed verbatim. They were finally analyzed based on framework analysis. The participants' detailed descriptions showed that systemic, environmental, and human related factors were the main obstacles to the implementation of family physician plan. Since the success and performance of each program effectively cannot be obtained without people’s acceptance and collaboration, the necessity of training and giving information rapidly and timely to the residents in urban areas is felt more than ever. Also, making authorities aware of the obstacles expressed by people can be helpful in harmonizing the program with people’s requests; and can result in overcoming the challenges and obstacles facing the program.

  3. Anatomy and history of an external quality assessment program for interpretative comments in clinical biochemistry.

    Science.gov (United States)

    Vasikaran, Samuel D

    2015-05-01

    The provision of clinical interpretation of results, either verbally or in the printed report, may be considered an integral part of clinical biochemistry diagnostic service. Proficiency testing or external quality assessment (EQA) of such activity may be useful in education, training, continuing professional development and ensuring the quality of such service. Details of the Patient Report Comments Program (RPCProgram) developed by the Royal College of Pathologists of Australasia (RCPA) Chemical Pathology Quality Assurance Programs Pty Ltd (QAP) is described in this review. The program is aimed at pathologists, clinical scientists and trainees. Registered participants are provided a report with case details and a set of clinical biochemistry results at monthly intervals and submit an interpretative comment for the report. Comments received are broken up into components that are translated into common key phrases. An expert panel evaluates the key phrases, classifies them according to appropriateness and drafts a suggested comment, a case summary and a rationale, which are included in a summary report returned to participants. There is considerable diversity in the quality of interpretative comments received from participants of the PRCProgram. The primary purpose of EQA of interpretative commenting is educational self-assessment, and they are recognized as a continuing professional development activity. Whilst there is some evidence for the utility of interpretative comments in improving patient outcomes, evidence for the utility of EQA in improving quality of comments is awaited. Copyright © 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  4. Perceptions of medical graduates and their workplace supervisors towards a medical school clinical audit program.

    Science.gov (United States)

    Davis, Stephanie; O'Ferrall, Ilse; Hoare, Samuel; Caroline, Bulsara; Mak, Donna B

    2017-07-07

    This study explores how medical graduates and their workplace supervisors perceive the value of a structured clinical audit program (CAP) undertaken during medical school. Medical students at the University of Notre Dame Fremantle complete a structured clinical audit program in their final year of medical school.  Semi-structured interviews were conducted with 12 Notre Dame graduates (who had all completed the CAP), and seven workplace supervisors (quality and safety staff and clinical supervisors).  Purposeful sampling was used to recruit participants and data were analysed using thematic analysis. Both graduates and workplace supervisors perceived the CAP to be valuable. A major theme was that the CAP made a contribution to individual graduate's medical practice, including improved knowledge in some areas of patient care as well as awareness of healthcare systems issues and preparedness to undertake scientifically rigorous quality improvement activities. Graduates perceived that as a result of the CAP, they were confident in undertaking a clinical audit after graduation.  Workplace supervisors perceived the value of the CAP beyond an educational experience and felt that the audits undertaken by students improved quality and safety of patient care. It is vital that health professionals, including medical graduates, be able to carry out quality and safety activities in the workplace. This study provides evidence that completing a structured clinical audit during medical school prepares graduates to undertake quality and safety activities upon workplace entry. Other health professional faculties may be interested in incorporating a similar program in their curricula.

  5. Impact of a Pelvic Floor Training Program Among Women with Multiple Sclerosis: A Controlled Clinical Trial.

    Science.gov (United States)

    Ferreira, Ana Paula Silva; Pegorare, Ana Beatriz Gomes de Souza; Salgado, Pedro Rippel; Casafus, Filemón Silva; Christofoletti, Gustavo

    2016-01-01

    The objective of this study was to investigate the effects of two programs for strengthening the pelvic floor on the urinary incontinence of patients with multiple sclerosis (MS). This is a prospective study of the clinical trial type, monitored for 6 mos, in which 24 women in the moderate stage of MS participated in a program of exercises for strengthening the pelvic floor-associated (experimental group) or not (control group) with electrotherapy. The variables analyzed were as follows: quality-of-life, overactivity of the bladder, perineal contraction, and level of anxiety and depression. The statistical procedures involved multivariate analyses of repeated measurements, with a significance of 5%. Initial homogeneity being observed in the anthropometric and clinical variables, both protocols resulted in improvements in quality-of-life (P = 0.001), overactive bladder (P = 0.001), perineal contraction (P = 0.004), and level of anxiety (P = 0.001) and depression (P = 0.001), in relation to the initial comparison. The association of electrotherapy with strengthening exercises increased the improvement of the patients regarding overactive bladder (P = 0.039) and perineal contraction (P = 0.001), in comparison with the control group. The results reinforce the benefit of exercises for strengthening the musculature of the pelvic floor in women with overactive bladder in MS and demonstrate a potential of the action when associated with electrotherapy. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this article, the reader should be able to: (1) Identify common dysfunctions of the lower urinary tract in women with multiple sclerosis; (2) Discuss the relationship between quality-of-life, level of anxiety and depression, degree of perineal contraction, and overactive bladder; and (3) Recognize the benefits promoted by physical therapy for strengthening the pelvic floor in patients with

  6. Clinical investigations of the therapeutic potential of ayahuasca: rationale and regulatory challenges.

    Science.gov (United States)

    McKenna, Dennis J

    2004-05-01

    Ayahuasca is a hallucinogenic beverage that is prominent in the ethnomedicine and shamanism of indigenous Amazonian tribes. Its unique pharmacology depends on the oral activity of the hallucinogen, N,N-dimethyltryptamine (DMT), which results from inhibition of monoamine oxidase (MAO) by beta-carboline alkaloids. MAO is the enzyme that normally degrades DMT in the liver and gut. Ayahuasca has long been integrated into mestizo folk medicine in the northwest Amazon. In Brazil, it is used as a sacrament by several syncretic churches. Some of these organizations have incorporated in the United States. The recreational and religious use of ayahuasca in the United States, as well as "ayahuasca tourism" in the Amazon, is increasing. The current legal status of ayahuasca or its source plants in the United States is unclear, although DMT is a Schedule I controlled substance. One ayahuasca church has received favorable rulings in 2 federal courts in response to its petition to the Department of Justice for the right to use ayahuasca under the Religious Freedom Restoration Act. A biomedical study of one of the churches, the Uñiao do Vegetal (UDV), indicated that ayahuasca may have therapeutic applications for the treatment of alcoholism, substance abuse, and possibly other disorders. Clinical studies conducted in Spain have demonstrated that ayahuasca can be used safely in normal healthy adults, but have done little to clarify its potential therapeutic uses. Because of ayahuasca's ill-defined legal status and variable botanical and chemical composition, clinical investigations in the United States, ideally under an approved Investigational New Drug (IND) protocol, are complicated by both regulatory and methodological issues. This article provides an overview of ayahuasca and discusses some of the challenges that must be overcome before it can be clinically investigated in the United States.

  7. Preemptive clinical pharmacogenetics implementation: current programs in five US medical centers.

    Science.gov (United States)

    Dunnenberger, Henry M; Crews, Kristine R; Hoffman, James M; Caudle, Kelly E; Broeckel, Ulrich; Howard, Scott C; Hunkler, Robert J; Klein, Teri E; Evans, William E; Relling, Mary V

    2015-01-01

    Although the field of pharmacogenetics has existed for decades, practioners have been slow to implement pharmacogenetic testing in clinical care. Numerous publications describe the barriers to clinical implementation of pharmacogenetics. Recently, several freely available resources have been developed to help address these barriers. In this review, we discuss current programs that use preemptive genotyping to optimize the pharmacotherapy of patients. Array-based preemptive testing includes a large number of relevant pharmacogenes that impact multiple high-risk drugs. Using a preemptive approach allows genotyping results to be available prior to any prescribing decision so that genomic variation may be considered as an inherent patient characteristic in the planning of therapy. This review describes the common elements among programs that have implemented preemptive genotyping and highlights key processes for implementation, including clinical decision support.

  8. Preemptive Clinical Pharmacogenetics Implementation: Current programs in five United States medical centers

    Science.gov (United States)

    Dunnenberger, Henry M.; Crews, Kristine R.; Hoffman, James M.; Caudle, Kelly E.; Broeckel, Ulrich; Howard, Scott C.; Hunkler, Robert J.; Klein, Teri E.; Evans, William E.; Relling, Mary V.

    2015-01-01

    Although the field of pharmacogenetics has existed for decades, the implementation of, pharmacogenetic testing in clinical care has been slow. There are numerous publications, describing the barriers to clinical implementation of pharmacogenetics. Recently, several freely, available resources have been developed to help address these barriers. In this review we, discuss current programs that use preemptive genotyping to optimize the pharmacotherapy of, patients. Array-based preemptive testing includes a large number of relevant pharmacogenes, that impact multiple high-risk drugs. Using a preemptive approach allows genotyping results to, be available prior to any prescribing decision so that genomic variation may be considered as, an inherent patient characteristic in the planning of therapy. This review describes the common, elements among programs that have implemented preemptive genotyping and highlights key, processes for implementation, including clinical decision support. PMID:25292429

  9. Duplex investigations in children: Are clinical signs in children with venous disorders relevant?

    Science.gov (United States)

    Birgitte Maessen-Visch, M; Smeets, L; van Vleuten, C

    2015-12-01

    Ultra sound colored duplex sonography is the preferred method in diagnosing chronic venous disease. Data in children on incidence, indications, and results are lacking. From the total of 9180 duplex investigations performed in our hospital from 2009 to 2012, data on indication and results of the investigation as well as patient characteristics were evaluated retrospectively for the proportion of pediatric patients. Duplex investigations were performed 49 times in 38 children (6-18 years), with an average of 1.3 times (1-6 times) per child. Forty percent showed abnormalities: 17 times deep venous thrombosis was suspected; deep venous thrombosis was objectified in 18%. In the 21 investigations performed for varicosis-related complaints, varicose veins or venous malformations were objectified in 57%. Edema was never a symptom of chronic venous disease. Duplex investigation is not often performed in children. In children with established deep venous thrombosis, a family history with deep venous thrombosis is common. In general, edema was not seen in children with varicose veins and, therefore, does not seem a reliable clinical sign at young age. © The Author(s) 2014.

  10. Current good manufacturing practice and investigational new drugs intended for use in clinical trials. Final rule.

    Science.gov (United States)

    2008-07-15

    The Food and Drug Administration (FDA) is amending the current good manufacturing practice (CGMP) regulations for human drugs, including biological products, to exempt most phase 1 investigational drugs from complying with the regulatory CGMP requirements. FDA will continue to exercise oversight of the manufacture of these drugs under FDA's general statutory CGMP authority and through review of the investigational new drug applications (IND). In addition, elsewhere in this issue of the Federal Register, FDA is announcing the availability of a guidance document entitled "Guidance for Industry: CGMP for Phase 1 Investigational Drugs" dated November 2007 (the companion guidance). This guidance document sets forth recommendations on approaches to compliance with statutory CGMP for the exempted phase 1 investigational drugs. FDA is taking this action to focus a manufacturer's effort on applying CGMP that is appropriate and meaningful for the manufacture of the earliest stage investigational drug products intended for use in phase 1 clinical trials while ensuring safety and quality. This action will also streamline and promote the drug development process.

  11. Study protocol: a randomized controlled trial investigating the effects of a psychosexual training program for adolescents with autism spectrum disorder.

    Science.gov (United States)

    Visser, Kirsten; Greaves-Lord, Kirstin; Tick, Nouchka T; Verhulst, Frank C; Maras, Athanasios; van der Vegt, Esther J M

    2015-08-28

    Previous research shows that adolescents with autism spectrum disorder (ASD) run several risks in their psychosexual development and that these adolescents can have limited access to reliable information on puberty and sexuality, emphasizing the need for specific guidance of adolescents with ASD in their psychosexual development. Few studies have investigated the effects of psychosexual training programs for adolescents with ASD and to date no randomized controlled trials are available to study the effects of psychosexual interventions for this target group. The randomized controlled trial (RCT) described in this study protocol aims to investigate the effects of the Tackling Teenage Training (TTT) program on the psychosexual development of adolescents with ASD. This parallel clinical trial, conducted in the South-West of the Netherlands, has a simple equal randomization design with an intervention and a waiting-list control condition. Two hundred adolescents and their parents participate in this study. We assess the participants in both conditions using self-report as well as parent-report questionnaires at three time points during 1 year: at baseline (T1), post-treatment (T2), and for follow-up (T3). To our knowledge, the current study is the first that uses a randomized controlled design to study the effects of a psychosexual training program for adolescents with ASD. It has a number of methodological strengths, namely a large sample size, a wide range of functionally relevant outcome measures, the use of multiple informants, and a standardized research and intervention protocol. Also some limitations of the described study are identified, for instance not making a comparison between two treatment conditions, and no use of blinded observational measures to investigate the ecological validity of the research results. Dutch Trial Register NTR2860. Registered on 20 April 2011.

  12. A descriptive survey investigating pre-registration student nurses' perceptions of clinical skill development in clinical placements.

    Science.gov (United States)

    Stayt, Louise C; Merriman, Clair

    2013-04-01

    Clinical skill development is essential to nurse education. Clinical skills are frequently taught in higher education institutions using clinical simulation. It is unclear if clinical skills are subsequently consolidated and developed in clinical placements. The aim of this survey was to evaluate pre-registration student nurses perceptions of the frequency of opportunities to practise, the level of supervision and assessment of, clinical skills in their clinical placements. This was a cross-sectional survey design using an online, self-report questionnaire including a Likert-type scale and open ended comments. Four hundred and twenty one students, from all year groups, from a university in the south of England on a wide variety of clinical placements participated. Participants evaluated the frequency of opportunity to practise, level of supervision and assessment of and feedback on performance of specific clinical skills. Clinical skills evaluated were measurement of vital signs, aseptic non-touch technique, assisting with eating and drinking, and assisting with comfort and hygiene. Data were analysed utilising Statistical Package for the Social Sciences Version 19. The frequency of opportunities to practise skills in clinical placement was variable with some participants reporting that they never had opportunity to practise essential skills. Similarly the level of supervision and assessment was also inconsistent suggesting that participants frequently practised clinical skills unsupervised without being assessed as competent. Inconsistencies in clinical skill development may lead to graduates who are not work ready and as a result, insufficient clinical competence potentially leads to unsafe practice and poor patient care. This calls for stronger partnerships between educators and clinical areas and the prioritisation of mentor preparation and education as well as organisational support in terms of mentor workload planning. Copyright © 2012 Elsevier Ltd. All

  13. Non-physician providers as clinical providers in cystic fibrosis: survey of U.S. programs.

    Science.gov (United States)

    Brown, Rebekah F; Willey-Courand, Donna Beth; George, Cindy; McMullen, Ann; Dunitz, Jordan; Slovis, Bonnie; Perkett, Elizabeth

    2013-04-01

    Non-physician providers (NPPs) including nurse practitioners (NPs) and physician assistants (PAs) are important members of CF care teams, but limited data exist about the extent NPPs are involved in CF care. A subcommittee was established by the CF Foundation to gather information about current involvement of NPPs. Surveys were sent to adult, pediatric and affiliate CF program directors (PDs) and NPPs working in US CF programs. Responses were received from 108 PDs (49% pediatric, 34% adult, 17% affiliate). Overall, 53% of the 108 programs had NPPs and 70% had or planned to hire NPPs. Reasons for NPP use included ideal clinical role (75%), expansion of services (72%), and physician shortage (40%). The survey collected 73 responses from NPPs (96% NPs, 4% PAs) who worked in pediatric (49%), adult (29%), affiliate (3%), or multiple programs (19%). Training occurred on the job in 88% and from prior CF experience in 21%. NPPs provided coverage in outpatient clinics (82%), inpatient care (64%), and weekend and/or night call (22%). In addition to clinical roles, NPPs are involved in education (95%), research (81%), and leadership (55%). The major obstacle reported by PDs and NPPs was billing with only 12% of programs reporting NPP salaries covered by billing revenue alone. Salary support included hospital support (67%), billing (39%), center grant (35%), and other grant/contract (25%). NPPs bill for outpatient and inpatient care in 65% and 28% of programs, respectively. NPPs are working with physicians in many centers and have the potential to help meet the increasing clinical workforce demands. Further evaluation of financial issues is indicated to continue the support of NPP jobs in CF. Roles and expectations need to be clearly defined. Initial and ongoing training standards and opportunities should be explored. Copyright © 2012 Wiley Periodicals, Inc.

  14. Clinical and ECG investigations in subjects with acute carbon monoxide poisoning

    Energy Technology Data Exchange (ETDEWEB)

    Capellini, A; Tomasini, M; Limonta, A

    1974-01-01

    Research carried out on more than 100 workers hospitalized for acute CO poisoning at the Milan Clinica del Lavoro and some 50 subjects undergoing treatment at the Milan polyclinic. The purpose of the research was to investigate the incidence and frequency of myocardial and coronary impairment in cases of acute CO poisoning. The authors concluded from their clinical and ECG findings that myocardial and coronary impairment in subjects suffering from acute CO poisoning was rarely serious or irreversible unless there was preexistent coronary disease. (CIS Abstr. Vol. 2)

  15. Department of Clinical Investigation Annual Research Progress Report, Fiscal Year 1993. Volume 2

    Science.gov (United States)

    1993-10-01

    A-5-90 Production of Mouse Positive and Negative Control Slides for 382 Use in Rabies FRA Test. (0) A-7-90 Clinical Investigation on the...Possible 402 Diagnostic and Therapeutic Manuever as Tested in a Mouse Model Utilizing PET Scanning. (0) A-93-04 Production of Monoclonal Antibodies to...xlv Project Page Number POG 9005 ALinC 15: Dose Intensification of Methotrexate and 583 6- Mercaptopurine for ALL in Childhood. (0) P00 9006 ALinC 15

  16. Hysterosalpingographic picture encountered during the investigation of female infertility clinic has Lemba of Saint Raphael

    International Nuclear Information System (INIS)

    Kitenge, N.; Nzeza, N.; Mbanzulu, P.; Ndaye, B.

    2010-01-01

    A cross-sectional study was conducted at the St Raphael Lemba Clinic on a sample of 115 patients suspected of infertility during the period from june 1 1997 in 1 march 2003 (6 years). The technique of hysterosalpingography has allowed the identification of female infertility presents images that can diagnose one or more causes utero-tubal. Men also carry a significant responsibility in the genesis of the sterility of the couple: thus, they must also undergo exploration. Hormonal factors also have an important contribution in the investigation of infertility in women and must be taken in addition to hysterosalpingography

  17. Assessing the Effectiveness of a School-Based Dental Clinic on the Oral Health of Children Who Lack Access to Dental Care: A Program Evaluation

    Science.gov (United States)

    Carpino, Rachel; Walker, Mary P.; Liu, Ying; Simmer-Beck, Melanie

    2017-01-01

    This program evaluation examines the effectiveness of a school-based dental clinic. A repeated-measures design was used to longitudinally examine secondary data from participants (N = 293). Encounter intensity was developed to normalize data. Multivariate analysis of variance and Kruskal-Wallis test were used to investigate the effect of encounter…

  18. Self-study program on HTML browser--application to Clinical Nursing General Remarks Course.

    Science.gov (United States)

    Ochiai, N; Sota, Y; Ezumi, H

    1997-01-01

    We created a self-study program using HTML browser on the Clinical Nursing General Remarks Course, Eighty-three students each selected a published book on a personal history (written personal reflections from individuals who had undergone medical treatment and hospitalization), read it and submitted reports of their impressions of the histories. Their reports were arranged from a nursing perspective and entered on the home page of our college using HTML browser. We intended that the students would become more interested in reading of the personal histories, and that they would acquire new self-study skills and increase their interest in Internet through use of our program. In addition, we hoped that this program would encourage positive communication and mutual sharing of information. The students were able to easily refer to a personal history according to their interest from a nursing perspective. Therefore this program realized the mutual learning among students and other users.

  19. Clinical coaching in forensic psychiatry: an innovative program to recruit and retain nurses.

    Science.gov (United States)

    Thorpe, Gail; Moorhouse, Pamela; Antonello, Carolyn

    2009-05-01

    Ontario is currently experiencing a nursing shortage crisis. Recruitment and retention of nursing staff are critical issues. In response, retention strategies have been developed by the Ontario Ministry of Health and Long-Term Care. The Late Career Nurse Initiative is one such strategy. This innovative program encourages nurses age 55 and older to remain in the workforce by providing opportunities to use their nursing experience in less physically demanding alternate roles for a portion of their time. The Royal Ottawa Health Care Group has developed a clinical coach program in forensics that matches these veteran nurses with new graduates or nurses new to forensic psychiatric nursing. The program has resulted in retention rates of more than 91% after 1 year. This article provides background about the program and highlights its outcomes.

  20. Effect modification, interaction and mediation: an overview of theoretical insights for clinical investigators

    Directory of Open Access Journals (Sweden)

    Corraini P

    2017-06-01

    Full Text Available Priscila Corraini,1 Morten Olsen,1 Lars Pedersen,1 Olaf M Dekkers,1,2 Jan P Vandenbroucke1–3 1Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; 2Leiden University Medical Center, Leiden, the Netherlands; 3Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK Abstract: We revisited the three interrelated epidemiological concepts of effect modification, interaction and mediation for clinical investigators and examined their applicability when using research databases. The standard methods that are available to assess interaction, effect modification and mediation are explained and exemplified. For each concept, we first give a simple “best-case” example from a randomized controlled trial, followed by a structurally similar example from an observational study using research databases. Our explanation of the examples is based on recent theoretical developments and insights in the context of large health care databases. Terminology is sometimes ambiguous for what constitutes effect modification and interaction. The strong assumptions underlying the assessment of interaction, and particularly mediation, require clinicians and epidemiologists to take extra care when conducting observational studies in the context of health care databases. These strong assumptions may limit the applicability of interaction and mediation assessments, at least until the biases and limitations of these assessments when using large research databases are clarified. Keywords: methods, epidemiology, effect modifiers, stratified analyses, health care administrative claims

  1. Investigation of clinical pharmacokinetic variability of an opioid antagonist through physiologically based absorption modeling.

    Science.gov (United States)

    Ding, Xuan; He, Minxia; Kulkarni, Rajesh; Patel, Nita; Zhang, Xiaoyu

    2013-08-01

    Identifying the source of inter- and/or intrasubject variability in pharmacokinetics (PK) provides fundamental information in understanding the pharmacokinetics-pharmacodynamics relationship of a drug and project its efficacy and safety in clinical populations. This identification process can be challenging given that a large number of potential causes could lead to PK variability. Here we present an integrated approach of physiologically based absorption modeling to investigate the root cause of unexpectedly high PK variability of a Phase I clinical trial drug. LY2196044 exhibited high intersubject variability in the absorption phase of plasma concentration-time profiles in humans. This could not be explained by in vitro measurements of drug properties and excellent bioavailability with low variability observed in preclinical species. GastroPlus™ modeling suggested that the compound's optimal solubility and permeability characteristics would enable rapid and complete absorption in preclinical species and in humans. However, simulations of human plasma concentration-time profiles indicated that despite sufficient solubility and rapid dissolution of LY2196044 in humans, permeability and/or transit in the gastrointestinal (GI) tract may have been negatively affected. It was concluded that clinical PK variability was potentially due to the drug's antagonism on opioid receptors that affected its transit and absorption in the GI tract. Copyright © 2013 Wiley Periodicals, Inc.

  2. Students' clinical learning in an emerging dental school: an investigation in international collaboration between Michigan and Ghana.

    Science.gov (United States)

    Peters, Mathilde C; Adu-Ababio, Francis; Jarrett-Ananaba, Nejay P; Johnson, Lynn A

    2013-12-01

    The dearth of dental faculty members is a widely known problem that is exacerbated in countries that are attempting to begin dental education programs. This collaboration between Kwame Nkrumah University of Science and Technology and the University of Michigan investigated if dental students who have just started their clinical dental education can learn the knowledge and skills required for identifying and restoring cavitated caries lesions through compact course delivery. There were three instructional blocks: 1) didactic seminar; 2) seminar, simulated hands-on skills instruction, and clinical observation/assisting with treatment of schoolchildren; and 3) seminar, simulated skills training, and application to schoolchildren. Each dental student completed a questionnaire measuring knowledge and perceptions of knowledge, experience, and confidence at five points in time. The dental students' knowledge increased significantly as well as their perceived knowledge, experience, and confidence (p<0.0001). In general, the students showed proficiency in delivering simple treatments. The project showed that an integrated compact course delivery model may assist emerging dental schools to cope with the challenging shortage of resident faculty members.

  3. Research Capacity at Traditional Chinese Medicine (TCM Centers in China: A Survey of Clinical Investigators

    Directory of Open Access Journals (Sweden)

    Shuo Feng

    2017-01-01

    Full Text Available Background. The development of an evidence-based approach to traditional Chinese medicine (TCM, which depends on the generation of good quality evidence, requires an adequate workforce. However, the research capacity of TCM investigators is not known. Study Design. This cross-sectional study was conducted to describe the research capacity of TCM clinical investigators in China. Participants. A total of 584 participants from TCM hospitals and research centers were included. They were asked about the academic and research characteristics, needs for research capacity building, and barriers to clinical research. Results. The majority (80.82% were qualified to at least a Master’s degree, whilst a smaller proportion (40.24% held a senior professional title. We found that academic outputs were low with the majority (62.16% authoring less than five publications in total. The most pressing needs for building research capacity identified were training in research methodology (97.43% and identification of research questions (86.81%, whilst the highest ranking barriers to conducting research were limited motivation, funding (40.72%, and time (37.15%. Conclusion. The methodology training, along with investment in the research workforce, needs to be urgently addressed to improve investigators’ research capacity and the development of an evidence-based approach of TCM.

  4. Electron probe microanalysis for clinical investigations: Microdrop and soft tissue analysis

    International Nuclear Information System (INIS)

    Ingram, M.J.; Ingram, F.D.

    1984-01-01

    The most important advantage offered by electron probe microanalysis (EPA) for clinical investigations is the ability to analyze smaller volumes of tissue than is possible with conventional techniques. The sample can be a biological soft tissue specimen, which involves subcellular localization, or a picoliter fluid droplet. In either case, the analysis can be nondestructive and permit multiple analyses for a number of elements in a given sample. The most highly developed electron microprobe analytical technique is fluid drop analysis, popularly referred to as microdrop analysis. This method provides the investigator with an analytic capability that has an accuracy of measurement often 1% or better on 20 to 30 picoliter fluid droplets. Electron microprobe techniques have been used for studies of animal hard tissue and for studies that involve insoluble inclusions. However, the development of techniques for studies of labile constituents in animal soft tissue has been much slower. It has been necessary not only to develop appropriate methods of tissue preparation, but also to establish sound techniques for tissue collection. Although there are adequate methods for collection of most types of tissue from laboratory animals, many of these methods are not suitable for human subjects. In order to provide the reader with a better understanding of the capabilities and potential for the application of electron microprobe methodology to problems in clinical medicine, the authors discuss some of their experiences with liquid droplet analysis and quantitative electrolyte distribution measurements in animal soft tissue

  5. Methods to reduce medication errors in a clinical trial of an investigational parenteral medication

    Directory of Open Access Journals (Sweden)

    Gillian L. Fell

    2016-12-01

    Full Text Available There are few evidence-based guidelines to inform optimal design of complex clinical trials, such as those assessing the safety and efficacy of intravenous drugs administered daily with infusion times over many hours per day and treatment durations that may span years. This study is a retrospective review of inpatient administration deviation reports for an investigational drug that is administered daily with infusion times of 8–24 h, and variable treatment durations for each patient. We report study design modifications made in 2007–2008 aimed at minimizing deviations from an investigational drug infusion protocol approved by an institutional review board and the United States Food and Drug Administration. Modifications were specifically aimed at minimizing errors of infusion rate, incorrect dose, incorrect patient, or wrong drug administered. We found that the rate of these types of administration errors of the study drug was significantly decreased following adoption of the specific study design changes. This report provides guidance in the design of clinical trials testing the safety and efficacy of study drugs administered via intravenous infusion in an inpatient setting so as to minimize drug administration protocol deviations and optimize patient safety.

  6. [Etiological, clinical and neuroradiological investigation of deaf children with additional neuropsychiatric disabilities].

    Science.gov (United States)

    Chilosi, A M; Scusa, M F; Comparini, A; Genovese, E; Forli, F; Berrettini, S; Cipriani, P

    2012-04-01

    Sensorineural hearing loss (SNHL) is complicated by additional disabilities in about 30% of cases, but the epidemiology of associated disorders, in terms of type, frequency and aetiology is still not clearly defined. Additional disabilities in a deaf child have important consequences in assessing and choosing a therapeutic treatment, in particular when considering cochlear implantation (CI) or hearing aids (HA). The aim of this paper was to evaluate frequency, type and severity of additional neurodevelopmental disabilities in children with profound bilateral sensorineural hearing loss and to investigate the relationship between disability and the etiology of deafness. Eighty children with profound bilateral sensorineural hearing loss (mean age 5.4 years) were investigated by means of a diagnostic protocol including clinical, neurodevelopmental, and audiological procedures together with genetic and neurometabolic tests and neuroradiological investigation by brain MRI. Fifty-five percent of the sample exhibited one or more disabilities in addition to deafness, with cognitive, behavioural-emotional and motor disorders being the most frequent. The risk of additional disabilities varied according to aetiology, with a higher incidence in hereditary syndromic deafness, in cases due to pre-perinatal pathology (in comparison to unknown and hereditary non syndromic forms) and in the presence of major brain abnormalities at MRI. Our results suggest that the aetiology of deafness may be a significant risk indicator for the presence of neuropsychiatric disorders. A multidimensional evaluation, including aetiological, neurodevelopmental and MRI investigation is needed for formulating prognosis and for planning therapeutic intervention, especially in those children candidated to cochlear implant.

  7. Investigation of paramedics' compliance with clinical practice guidelines for the management of chest pain.

    LENUS (Irish Health Repository)

    Figgis, Ken

    2012-01-31

    BACKGROUND: Acute coronary syndromes remain a leading cause of preventable early deaths. However, previous studies have indicated that paramedics\\' compliance with chest pain protocols is suboptimal and that many patients do not receive the benefits of appropriate prehospital treatment. AIMS: To evaluate paramedics\\' level of compliance with national clinical practice guidelines and to investigate why, in certain circumstances, they may deviate from the clinical guidelines. SETTING: The Health Service Executive Mid-Western Regional Ambulance Service which serves a mixed urban and rural population across three counties in the west of Ireland. METHOD: A retrospective review of completed ambulance Patient Care Report Forms was conducted for all adult patients with non-traumatic chest pain treated between 1 December 2007 and 31 March 2008. During the same study period, paramedics were asked to complete a prospective questionnaire survey investigating the rationale behind their treatment decisions, their estimation of patient risk and their attitudes towards the clinical practice guidelines and training. RESULTS: 382 completed Patient Care Report Forms were identified for patients with chest pain, of whom 84.8% received ECG monitoring, 75.9% were given oxygen, 44.8% were treated with sublingual glyceryl trinitrate (GTN) and 50.8% were treated with aspirin. Only 20.4% of patients had a prehospital 12-lead ECG recorded. 58 completed questionnaires were returned (response rate 15%); 64% of respondents said they had received insufficient training to identify ECG abnormalities. CONCLUSIONS: Prehospital treatment with oxygen, aspirin, sublingual GTN and ECG monitoring remains underused by paramedics, even though only a small number of patients had documented contraindications to their use. The small number of patients who received a prehospital 12-lead ECG is a cause of particular concern and suggests that incomplete patient assessment may contribute to undertreatment

  8. Understanding Career Success and Its Contributing Factors for Clinical and Translational Investigators

    Science.gov (United States)

    Robinson, Georgeanna F.W.B.; Schwartz, Lisa S.; DiMeglio, Linda A.; Ahluwalia, Jasjit S.; Gabrilove, Janice L.

    2015-01-01

    Purpose To understand the factors that facilitate career success for career development awardees in clinical and translational science and to reconceptualize understanding of career success for this population. Method In 2013–2014, the authors conducted semi-structured interviews with former NIH KL2 or K12 scholars from nine Clinical and Translational Science Award-funded institutions. Participants either had or had not secured independent funding at least two years after the end of their last K award. Questions covered the factors that facilitate or hinder junior investigators’ transition to independent funding. Interviews were recorded and transcribed and the transcripts analyzed thematically. Results Forty individuals participated, with equal representation by men and women and by independently and not independently funded investigators. Personal factors that facilitated success included: networks, persistence and resilience, initiative, autonomy, and personal and professional balance. Organizational factors included: appropriate mentorship, protected research time, and institutional resources and support. Even independently funded participants described challenges regarding career direction. Five participants without independent funding modeled a broad spectrum of successful career paths, having assumed leadership positions not reliant on grant funding. Alternative definitions of career success included: improving public health, enjoying work, seeing mentees succeed, and receiving external acknowledgement of successes. Conclusions Awareness of the factors that facilitate or hinder career success can help junior faculty, mentors, and institutional leaders support career development in clinical and translational science. New definitions of career success are needed, as are career paths for faculty who want to engage in research in roles other than principal investigator. PMID:26509600

  9. Research fellowship programs as a pathway for training independent clinical pharmacy scientists.

    Science.gov (United States)

    Mueller, Eric W; Bishop, Jeffrey R; Kanaan, Abir O; Kiser, Tyree H; Phan, Hanna; Yang, Katherine Y

    2015-03-01

    The American College of Clinical Pharmacy (ACCP) Research Affairs Committee published a commentary in 2013 on training clinical pharmacy scientists in the context of changes in economic, professional, political, and research environments. The commentary centered on the opportunities for pharmacists in clinical/translational research including strategies for ACCP, colleges of pharmacy, and the profession to increase the number and impact of clinical pharmacy scientists. A postdoctoral fellowship is cited as a current training pathway, capable of producing independent and productive pharmacy researchers. However, a decline in the number of programs, decreased funding availability, and variability in fellowship program activities and research focus have brought into question the relevance of this research training pathway to meet demand and opportunities. In response to these points, this commentary examines the state of research fellowship training including the current ACCP research fellowship review process, the need for standardization of research fellowship programs, and strategies to strengthen and promote research fellowships as relevant researcher training pathways. © 2015 Pharmacotherapy Publications, Inc.

  10. Mentoring in Clinical-Translational Research: A Study of Participants in Master's Degree Programs.

    Science.gov (United States)

    McGinn, Aileen P; Lee, Linda S; Baez, Adriana; Zwanziger, Jack; Anderson, Karl E; Seely, Ellen W; Schoenbaum, Ellie

    2015-12-01

    Research projects in translational science are increasingly complex and require interdisciplinary collaborations. In the context of training translational researchers, this suggests that multiple mentors may be needed in different content areas. This study explored mentoring structure as it relates to perceived mentoring effectiveness and other characteristics of master's-level trainees in clinical-translational research training programs. A cross-sectional online survey of recent graduates of clinical research master's program was conducted. Of 73 surveys distributed, 56.2% (n = 41) complete responses were analyzed. Trainees were overwhelmingly positive about participation in their master's programs and the impact it had on their professional development. Overall the majority (≥75%) of trainees perceived they had effective mentoring in terms of developing skills needed for conducting clinical-translational research. Fewer trainees perceived effective mentoring in career development and work-life balance. In all 15 areas of mentoring effectiveness assessed, higher rates of perceived mentor effectiveness was seen among trainees with ≥2 mentors compared to those with solo mentoring (SM). In addition, trainees with ≥2 mentors perceived having effective mentoring in more mentoring aspects (median: 14.0; IQR: 12.0-15.0) than trainees with SM (median: 10.5; IQR: 8.0-14.5). Results from this survey suggest having ≥2 mentors may be beneficial in fulfilling trainee expectations for mentoring in clinical-translational training. © 2015 Wiley Periodicals, Inc.

  11. Experiences of burnout among drug counselors in a large opioid treatment program: A qualitative investigation.

    Science.gov (United States)

    Beitel, Mark; Oberleitner, Lindsay; Muthulingam, Dharushana; Oberleitner, David; Madden, Lynn M; Marcus, Ruthanne; Eller, Anthony; Bono, Madeline H; Barry, Declan T

    2018-03-09

    Little is known about possible experiences of burnout among drug counselors in opioid treatment programs that are scaling up capacity to address the current opioid treatment gap. Participants in this quality improvement study were 31 drug counselors employed by large opioid treatment programs whose treatment capacities were expanding. Experiences of burnout and approaches for managing and/or preventing burnout were examined using individual semi-structured interviews, which were audiotaped, transcribed, and systematically coded by a multidisciplinary team using grounded theory. Rates of reported burnout (in response to an open-ended question) were lower than expected, with approximately 26% of participants reporting burnout. Counselor descriptions of burnout included cognitive, affective, behavioral, and physiological symptoms; and job-related demands were identified as a frequent cause. Participants described both self-initiated (e.g., engaging in pleasurable activities, exercising, taking breaks during workday) and system-supported strategies for managing or preventing burnout (e.g., availing of supervision and paid time off). Counselors provided recommendations for system-level changes to attenuate counselor risk of burnout (e.g., increased staff-wide encounters, improved communication, accessible paid time off, and increased clinical supervision). Findings suggest that drug counselor burnout is not inevitable, even in opioid treatment program settings whose treatment capacities are expanding. Organizations might benefit from routinely assessing counselor feedback about burnout and implementing feasible recommendations to attenuate burnout and promote work engagement.

  12. [Clinical and genetic investigation of families with Waardenburg syndrome type 2].

    Science.gov (United States)

    Chen, H S; Liao, X B; Liu, Y L; He, C F; Zhang, H; Jiang, L; Feng, Y; Mei, L Y

    2016-12-01

    Objective: To investigate the clinical chacteration and molecular pathology of Waardenburg syndrome type 2 in seven families, and provide genetic diagnosis and hereditary counseling for family members. Method: Clinical data of seven families with WS2(14 patients)were collected. Peripheral blood samples of the probands and related family members were collected and genomic DNA was extracted. The coding sequences of microphthalmia associated transcription factor (MITF), sex-determining region Y-box 10(SOX10), snail family zinc finger 2 (SNAI2) and endothelin receptor type B(EDNRB)were analyzed by polymerase chain reaction and DNA sequencing. Then the raw data was analyzed. Result: The most common manifestations of WS2 are sensorineural hearing loss(10/14,71.4%), freckle(7/14, 50.0%),heterochromia iridis(6/14, 42.9%) and premature greying(5/14,35.7%). All the deafness phenotype is congenital, bilateral profound sensorineural hearing loss. Freckles phenotype is different from cutaneous pigment abnormalities of WS in Westerners. The heterozygous mutation, c.328C>T in exon 3 of the MITF gene was detected in the proband and all patients of pedigree 2. However, no pathological mutation of the relevant genes (SOX10,SNAI2 and EDNRB) was detected in other pedigrees. Conclusion: There are obvious variations in clinical features of WS, while freckles may be a special subtype of cutaneous pigment disturbances. The MITF gene mutation, R110X,is therefore considered the disease causing mutation in pedigree WS02.However, there are novel disease causing genes or copy number variations in Waardenburg syndrome type 2, which require further research. Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.

  13. Investigation of roughing machining simulation by using visual basic programming in NX CAM system

    Science.gov (United States)

    Hafiz Mohamad, Mohamad; Nafis Osman Zahid, Muhammed

    2018-03-01

    This paper outlines a simulation study to investigate the characteristic of roughing machining simulation in 4th axis milling processes by utilizing visual basic programming in NX CAM systems. The selection and optimization of cutting orientation in rough milling operation is critical in 4th axis machining. The main purpose of roughing operation is to approximately shape the machined parts into finished form by removing the bulk of material from workpieces. In this paper, the simulations are executed by manipulating a set of different cutting orientation to generate estimated volume removed from the machine parts. The cutting orientation with high volume removal is denoted as an optimum value and chosen to execute a roughing operation. In order to run the simulation, customized software is developed to assist the routines. Operations build-up instructions in NX CAM interface are translated into programming codes via advanced tool available in the Visual Basic Studio. The codes is customized and equipped with decision making tools to run and control the simulations. It permits the integration with any independent program files to execute specific operations. This paper aims to discuss about the simulation program and identifies optimum cutting orientations for roughing processes. The output of this study will broaden up the simulation routines performed in NX CAM systems.

  14. Cleveland Clinic's summer research program in reproductive medicine: an inside look at the class of 2014

    Directory of Open Access Journals (Sweden)

    Damayanthi Durairajanayagam

    2015-11-01

    Full Text Available Background: The American Center for Reproductive Medicine's summer internship course in reproductive medicine and research at Cleveland Clinic is a rigorous, results-oriented annual program that began in 2008 to train both local and international students in the fundamentals of scientific research and writing. The foremost goal of the program is to encourage premedical and medical students to aspire toward a career as a physician–scientist. The internship provides participants with an opportunity to engage in original bench research and scientific writing while developing theoretical knowledge and soft skills. This study describes selected survey responses from interns who participated in the 2014 internship program. The objective of these surveys was to elicit the interns' perspective on the internship program, its strengths and weaknesses, and to obtain insight into potential areas for improvement. Methods: Questionnaires were structured around the five fundamental aspects of the program: 1 theoretical knowledge, 2 bench research, 3 scientific writing, 4 mentorship, and 5 soft skills. In addition, an exit survey gathered information on factors that attracted the interns to the program, communication with mentors, and overall impression of the research program. Results: The opportunity to experience hands-on bench research and scientific writing, personalized mentorship, and the reputation of the institution were appreciated and ranked highly among the interns. Nearly 90% of the interns responded that the program was beneficial and well worth the time and effort invested by both interns and faculty. Conclusion: The outcomes portrayed in this study will be useful in the implementation of new programs or refinement of existing medical research training programs.

  15. Cleveland Clinic's summer research program in reproductive medicine: an inside look at the class of 2014.

    Science.gov (United States)

    Durairajanayagam, Damayanthi; Kashou, Anthony H; Tatagari, Sindhuja; Vitale, Joseph; Cirenza, Caroline; Agarwal, Ashok

    2015-01-01

    The American Center for Reproductive Medicine's summer internship course in reproductive medicine and research at Cleveland Clinic is a rigorous, results-oriented annual program that began in 2008 to train both local and international students in the fundamentals of scientific research and writing. The foremost goal of the program is to encourage premedical and medical students to aspire toward a career as a physician-scientist. The internship provides participants with an opportunity to engage in original bench research and scientific writing while developing theoretical knowledge and soft skills. This study describes selected survey responses from interns who participated in the 2014 internship program. The objective of these surveys was to elicit the interns' perspective on the internship program, its strengths and weaknesses, and to obtain insight into potential areas for improvement. Questionnaires were structured around the five fundamental aspects of the program: 1) theoretical knowledge, 2) bench research, 3) scientific writing, 4) mentorship, and 5) soft skills. In addition, an exit survey gathered information on factors that attracted the interns to the program, communication with mentors, and overall impression of the research program. The opportunity to experience hands-on bench research and scientific writing, personalized mentorship, and the reputation of the institution were appreciated and ranked highly among the interns. Nearly 90% of the interns responded that the program was beneficial and well worth the time and effort invested by both interns and faculty. The outcomes portrayed in this study will be useful in the implementation of new programs or refinement of existing medical research training programs.

  16. Cost-benefit analysis of childhood asthma management through school-based clinic programs.

    Science.gov (United States)

    Tai, Teresa; Bame, Sherry I

    2011-04-01

    Asthma is a leading chronic illness among American children. School-based health clinics (SBHCs) reduced expensive ER visits and hospitalizations through better healthcare access and monitoring in select case studies. The purpose of this study was to examine the cost-benefit of SBHC programs in managing childhood asthma nationwide for reduction in medical costs of ER, hospital and outpatient physician care and savings in opportunity social costs of lowing absenteeism and work loss and of future earnings due to premature deaths. Eight public data sources were used to compare costs of delivering primary and preventive care for childhood asthma in the US via SBHC programs, including direct medical and indirect opportunity costs for children and their parents. The costs of nurse staffing for a nationwide SBHC program were estimated at $4.55 billion compared to the estimated medical savings of $1.69 billion, including ER, hospital, and outpatient care. In contrast, estimated total savings for opportunity costs of work loss and premature death were $23.13 billion. Medical savings alone would not offset the expense of implementing a SBHC program for prevention and monitoring childhood asthma. However, even modest estimates of reducing opportunity costs of parents' work loss would be far greater than the expense of this program. Although SBHC programs would not be expected to affect the increasing prevalence of childhood asthma, these programs would be designed to reduce the severity of asthma condition with ongoing monitoring, disease prevention and patient compliance.

  17. Training and education in religion/spirituality within APA-accredited clinical psychology programs: 8 years later.

    Science.gov (United States)

    Schafer, Rachel M; Handal, Paul J; Brawer, Peter A; Ubinger, Megan

    2011-06-01

    This study was a follow up investigation of Brawer et al.'s (Prof Psychol Res Pr 33(2):203-206, 2002) survey of education and training of clinical psychologists in religion/spirituality. Directors of clinical training were surveyed to determine whether changes had occurred in the coverage of religion and spirituality through course work, research, supervision, and in the systematic coverage of the content area. Results indicated an increased coverage in the areas of supervision, dedicated courses, inclusion as part of another course, and research. There was no increase in systematic coverage, but significantly more programs provided at least some coverage. The current study also assesses other areas of incorporation as well as directors' opinions regarding the importance of religion/spirituality in the field of psychology.

  18. Investigation of MONE Preschool Program for 36-72 Months Old Children (2006) According to Children Rights

    Science.gov (United States)

    Batur Musaoglu, Ebru; Haktanir, Gelengul

    2012-01-01

    In Turkey, the preschoolers are being schooled under the guidelines of MONE (Ministry of National Education) Preschool Program for 36-72 Months Old Children (2006). The aim of this research is to investigate how children's rights are involved in this program. In this qualitative research based on document analysis, program book and Teacher Guide…

  19. Horonobe Underground Research Laboratory project investigation program for the 2007 fiscal year (Translated document)

    International Nuclear Information System (INIS)

    Matsui, Hiroya; Nakayama, Masashi; Sanada, Hiroyuki; Yamaguchi, Takehiro

    2008-09-01

    As past of the research and development program on the geological disposal of high-level radioactive waste (HLW), the Horonobe Underground Research Center, a division of the Japan Atomic Energy Agency (JAEA), is implementing the Horonobe Underground Research Laboratory Project (Horonobe URL Project) with the aim at investigating sedimentary rock formations. According to the research plan described in the Midterm Plan of JAEA, geological investigations are to be carried out during the drilling of a shaft down to intermediate depth, while research and development in the areas of engineering technology and safety assessment are to be promoted by collaboration with other research organizations. The results of the R and D activities will be systematized as a 'knowledge base' that supports a wide range of arguments related to the safety of geological disposal. The Horonobe URL Project is planned to extend over a period of 20 years. The investigations will be conducted in three phases, namely 'Phase 1: Surface-based investigations', 'Phase 2: Construction phase' (investigations during construction of the underground facilities) and 'Phase 3: Operation phase' (research in the underground facilities). This report summarizes the investigation program for the 2007 fiscal year (2007/2008), the third year of the Phase 2 investigations. In the 2007 fiscal year, investigations in geoscientific research', including 'development of techniques for investigating the geological environment', 'development of techniques for use in the deep underground environment' and 'studies on the long-term stability of the geological environment', is continuously carried out. Investigations in 'research and development on geological disposal technology', including improving the reliability of disposal technologies' and 'enhancement of safety assessment methodologies' are also continuously carried out. Construction of the underground facilities is ongoing at the Ventilation Shaft and the East Shaft

  20. Learning clinical communication skills: outcomes of a program for professional practitioners.

    Science.gov (United States)

    Carvalho, Irene P; Pais, Vanessa G; Almeida, Susana S; Ribeiro-Silva, Raquel; Figueiredo-Braga, Margarida; Teles, Ana; Castro-Vale, Ivone; Mota-Cardoso, Rui

    2011-07-01

    To assess the effects of a communication skills program on professional practitioners' performance and self-confidence in clinical interviewing. Twenty-five health professionals took 3 months of basic communication skills followed by 3 months of advanced communication skills. An additional quarter dealt with self-awareness and communication in special situations. Participants' performances were evaluated in clinical interviews with standardized patients before, during and after the program by external observers and standardized patients, using standardized instruments. Participants assessed their own confidence in their communication skills before and after the program. Data were analysed using GLM repeated-measures procedures in SPSS. Basic communication skills and self-confidence improved throughout the 6 months; competencies declined but self-confidence continued to increase 4 months later. Compared with taking no course, differences were statistically significant after the 6 months (external observers only) and 4 months later (external observers and participants). The program effectively improved communication skills, although significantly only when assessed by external observers. Four months later, effects were significant in communication skills (external observers), despite the decline and in self-confidence. While periodical enrollment in programs for the practice of communication skills may help maintain performance, more knowledge on communication and self-awareness may enhance self-confidence. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  1. Investigation of Factors Affecting Body Temperature Changes During Routine Clinical Head Magnetic Resonance Imaging

    Science.gov (United States)

    Kim, Myeong Seong

    2016-01-01

    Background Pulsed radiofrequency (RF) magnetic fields, required to produce magnetic resonance imaging (MRI) signals from tissue during the MRI procedure have been shown to heat tissues. Objectives To investigate the relationship between body temperature rise and the RF power deposited during routine clinical MRI procedures, and to determine the correlation between this effect and the body’s physiological response. Patients and Methods We investigated 69 patients from the Korean national cancer center to identify the main factors that contribute to an increase in body temperature (external factors and the body’s response) during a clinical brain MRI. A routine protocol sequence of MRI scans (1.5 T and 3.0 T) was performed. The patient’s tympanic temperature was recorded before and immediately after the MRI procedure and compared with changes in variables related to the body’s physiological response to heat. Results Our investigation of the physiological response to RF heating indicated a link between increasing age and body temperature. A higher increase in body temperature was observed in older patients after a 3.0-T MRI (r = 0.07, P = 0.29 for 1.5-T MRI; r = 0.45, P = 0.002 for 3.0-T MRI). The relationship between age and body heat was related to the heart rate (HR) and changes in HR during the MRI procedure; a higher RF power combined with a reduction in HR resulted in an increase in body temperature. Conclusion A higher magnetic field strength and a decrease in the HR resulted in an increase in body temperature during the MRI procedure. PMID:27895872

  2. 42 CFR 68a.1 - What is the scope and purpose of the NIH Clinical Research Loan Repayment Program for Individuals...

    Science.gov (United States)

    2010-10-01

    ..., INTERNSHIPS, TRAINING NATIONAL INSTITUTES OF HEALTH (NIH) CLINICAL RESEARCH LOAN REPAYMENT PROGRAM FOR... to the award of educational loan payments under the NIH Clinical Research Loan Repayment Program for... relative to income, to conduct clinical research as NIH employees. ...

  3. Investigating an Intervention Program Linking Writing and Vocabulary Development for Homeless Children

    Directory of Open Access Journals (Sweden)

    Richard Sinatra

    2010-03-01

    Full Text Available The presented study investigated the effects of a four-week academic and activity – enriched summer program on vocabulary development and writing achievement of homeless children residing in traditional shelter facilities. When compared to controls the experimental students did not reveal gains in vocabulary and spelling as measured by two norm referenced tests. They did however demonstrate highly significant gains in writing ability based on the New York State standards criteria, reflecting five qualities of writing. On two project-developed instruments designed to measure improvement in book vocabulary and tennis skills, they showed significant increases based on analyses of their pre- and posttest scores. The program closed achievement gaps, fulfilled standards criteria, and may be the first of its kind in the homeless literature whereby students’ writing development was compared to matched controls as vocabulary development occurred based on literary readings.

  4. Investigating the Utilization of Research Evidence in the 4-H Youth Development Program

    Directory of Open Access Journals (Sweden)

    Lynette H. Bikos

    2011-06-01

    Full Text Available This study investigated the acquisition, interpretation, and utilization of research evidence in the 4-H Youth Development Program from the frame of Social Cognitive Theory. Utilizing Consensual Qualitative Research, we interviewed twenty 4-H faculty, staff, and volunteers from seven states. Results indicated four domains, which covered participants’ definitions of research utilization, their experiences utilizing research, the process of acquiring and distributing research, and barriers and facilitators to research utilization. Participants described research use primarily in terms of improving 4-H programs. They discussed their level of confidence (i.e. self-efficacy in finding and applying research evidence and their beliefs about the outcomes of research utilization (i.e. outcomes expectancy. Participants mentioned such barriers as not knowing where to look for research, lack of time, lack of funding, and difficulty applying research findings to their work. The facilitators included support from other 4-H colleagues and availability of 4-H specific conferences, publications, and curriculum databases.

  5. The NIAID Division of AIDS enterprise information system: integrated decision support for global clinical research programs

    Science.gov (United States)

    Gupta, Nitin; Varghese, Suresh; Virkar, Hemant

    2011-01-01

    The National Institute of Allergy and Infectious Diseases (NIAID) Division of AIDS (DAIDS) Enterprise Information System (DAIDS-ES) is a web-based system that supports NIAID in the scientific, strategic, and tactical management of its global clinical research programs for HIV/AIDS vaccines, prevention, and therapeutics. Different from most commercial clinical trials information systems, which are typically protocol-driven, the DAIDS-ES was built to exchange information with those types of systems and integrate it in ways that help scientific program directors lead the research effort and keep pace with the complex and ever-changing global HIV/AIDS pandemic. Whereas commercially available clinical trials support systems are not usually disease-focused, DAIDS-ES was specifically designed to capture and incorporate unique scientific, demographic, and logistical aspects of HIV/AIDS treatment, prevention, and vaccine research in order to provide a rich source of information to guide informed decision-making. Sharing data across its internal components and with external systems, using defined vocabularies, open standards and flexible interfaces, the DAIDS-ES enables NIAID, its global collaborators and stakeholders, access to timely, quality information about NIAID-supported clinical trials which is utilized to: (1) analyze the research portfolio, assess capacity, identify opportunities, and avoid redundancies; (2) help support study safety, quality, ethics, and regulatory compliance; (3) conduct evidence-based policy analysis and business process re-engineering for improved efficiency. This report summarizes how the DAIDS-ES was conceptualized, how it differs from typical clinical trial support systems, the rationale for key design choices, and examples of how it is being used to advance the efficiency and effectiveness of NIAID's HIV/AIDS clinical research programs. PMID:21816958

  6. cp-R, an interface the R programming language for clinical laboratory method comparisons.

    Science.gov (United States)

    Holmes, Daniel T

    2015-02-01

    Clinical scientists frequently need to compare two different bioanalytical methods as part of assay validation/monitoring. As a matter necessity, regression methods for quantitative comparison in clinical chemistry, hematology and other clinical laboratory disciplines must allow for error in both the x and y variables. Traditionally the methods popularized by 1) Deming and 2) Passing and Bablok have been recommended. While commercial tools exist, no simple open source tool is available. The purpose of this work was to develop and entirely open-source GUI-driven program for bioanalytical method comparisons capable of performing these regression methods and able to produce highly customized graphical output. The GUI is written in python and PyQt4 with R scripts performing regression and graphical functions. The program can be run from source code or as a pre-compiled binary executable. The software performs three forms of regression and offers weighting where applicable. Confidence bands of the regression are calculated using bootstrapping for Deming and Passing Bablok methods. Users can customize regression plots according to the tools available in R and can produced output in any of: jpg, png, tiff, bmp at any desired resolution or ps and pdf vector formats. Bland Altman plots and some regression diagnostic plots are also generated. Correctness of regression parameter estimates was confirmed against existing R packages. The program allows for rapid and highly customizable graphical output capable of conforming to the publication requirements of any clinical chemistry journal. Quick method comparisons can also be performed and cut and paste into spreadsheet or word processing applications. We present a simple and intuitive open source tool for quantitative method comparison in a clinical laboratory environment. Copyright © 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  7. Why Providers Participate in Clinical Trials: Considering the National Cancer Institute’s Community Clinical Oncology Program

    Science.gov (United States)

    McAlearney, Ann Scheck; Song, Paula H.; Reiter, Kristin L.

    2012-01-01

    Background The translation of research evidence into practice is facilitated by clinical trials such as those sponsored by the National Cancer Institute’s Community Clinical Oncology Program (CCOP) that help disseminate cancer care innovations to community-based physicians and provider organizations. However, CCOP participation involves unsubsidized costs and organizational challenges that raise concerns about sustained provider participation in clinical trials. Objectives This study was designed to improve our understanding of why providers participate in the CCOP in order to inform the decision-making process of administrators, clinicians, organizations, and policy-makers considering CCOP participation. Research Methods We conducted a multi-site qualitative study of five provider organizations engaged with the CCOP. We interviewed 41 administrative and clinician key informants, asking about what motivated CCOP participation, and what benefits they associated with involvement. We deductively and inductively analyzed verbatim interview transcripts, and explored themes that emerged. Results Interviewees expressed both “altruistic” and “self-interested” motives for CCOP participation. Altruistic reasons included a desire to increase access to clinical trials and feeling an obligation to patients. Self-interested reasons included the desire to enhance reputation, and a need to integrate disparate cancer care activities. Perceived benefits largely matched expressed motives for CCOP participation, and included internal and external benefits to the organization, and quality of care benefits for both patients and participating physicians. Conclusion The motives and benefits providers attributed to CCOP participation are consistent with translational research goals, offering evidence that participation can contribute value to providers by expanding access to innovative medical care for patients in need. PMID:22925970

  8. Investigation program on PWR-steel-containment behavior under accident conditions

    International Nuclear Information System (INIS)

    Krieg, R.; Eberle, F.; Goeller, B.; Gulden, W.; Kadlec, J.; Messemer, G.; Mueller, S.; Wolf, E.

    1983-10-01

    This report is a first documentation of the KfK/PNS activities and plans to investigate the behaviour of steel containments under accident conditions. The investigations will deal with a free standing spherical containment shell built for the latest type of a German pressurized water reactor. The diameter of the containment shell is 56 m. The minimum wall thickness is 38 mm. The material used is the ferritic steel 15MnNi63. According to the actual planning the program is concerned with four different problems which are beyond the common design and licensing practice: Containment behavior under quasi-static pressure increase up to containment failure. Containment behavior under high transient pressures. Containment oscillations due to earthquake loadings; consideration of shell imperfections. Containment buckling due to earthquake loadings. The investigation program consists of both theoretical and experimental activities including membrane tests allowing for very high plastic strains and oscillation tests with a thin-walled, high-accurate spherical shell. (orig.) [de

  9. Clinical skills assessment of procedural and advanced communication skills: performance expectations of residency program directors

    Science.gov (United States)

    Langenau, Erik E.; Zhang, Xiuyuan; Roberts, William L.; DeChamplain, Andre F.; Boulet, John R.

    2012-01-01

    Background High stakes medical licensing programs are planning to augment and adapt current examinations to be relevant for a two-decision point model for licensure: entry into supervised practice and entry into unsupervised practice. Therefore, identifying which skills should be assessed at each decision point is critical for informing examination development, and gathering input from residency program directors is important. Methods Using data from previously developed surveys and expert panels, a web-delivered survey was distributed to 3,443 residency program directors. For each of the 28 procedural and 18 advanced communication skills, program directors were asked which clinical skills should be assessed, by whom, when, and how. Descriptive statistics were collected, and Intraclass Correlations (ICC) were conducted to determine consistency across different specialties. Results Among 347 respondents, program directors reported that all advanced communication and some procedural tasks are important to assess. The following procedures were considered ‘important’ or ‘extremely important’ to assess: sterile technique (93.8%), advanced cardiovascular life support (ACLS) (91.1%), basic life support (BLS) (90.0%), interpretation of electrocardiogram (89.4%) and blood gas (88.7%). Program directors reported that most clinical skills should be assessed at the end of the first year of residency (or later) and not before graduation from medical school. A minority were considered important to assess prior to the start of residency training: demonstration of respectfulness (64%), sterile technique (67.2%), BLS (68.9%), ACLS (65.9%) and phlebotomy (63.5%). Discussion Results from this study support that assessing procedural skills such as cardiac resuscitation, sterile technique, and phlebotomy would be amenable to assessment at the end of medical school, but most procedural and advanced communications skills would be amenable to assessment at the end of the first

  10. Investigating the Efficacy of an Intensive English Program and the L2 Learners’ Learning Styles

    Directory of Open Access Journals (Sweden)

    Rebecca Lee Su Ping

    2014-12-01

    Full Text Available Past research has found that many pre-university L2 learners, having completed an Intensive English Program (IEP still have difficulty in undertaking various disciplines in English-speaking tertiary institutions and continue to exhibit numerous linguistic problems (Bialystok, 2001, Celce Murcia 2001. The purpose of this paper is to present the findings on the investigation of L2 learners’ English proficiency in reading, writing, grammar, listening and speaking upon their completion of an Intensive English (IE program using their IELTS (Academic, in-house exams and English Placement Tests (EPT scores, and the efficacy of IE program.  IELTS test is chosen for this study due to its increasing popularity in Malaysia and its internationally recognised value and quality.  The study was conducted in two parts. In Part One, all 72 Level 4 IE students were given an in-house EPT (English Placement Test pre-test on their entry and another EPT post-test on their exit, and then their pre-test and post-test results were compared.  In Part Two, 22 volunteers sat the IELTS test at the end of the program. The IELTS results of the 22 volunteers were compared with those who did not.  Data were analyzed using both quantitative and qualitative methods. This paper hopes to shed some light on (i whether or not L2 learners’ English language proficiency can be significantly enhanced and influenced by an intensive English program and (ii how leaners’ perception of their own learning strategies influence their learning progress.

  11. Adapting Cognitive Task Analysis to Investigate Clinical Decision Making and Medication Safety Incidents.

    Science.gov (United States)

    Russ, Alissa L; Militello, Laura G; Glassman, Peter A; Arthur, Karen J; Zillich, Alan J; Weiner, Michael

    2017-05-03

    Cognitive task analysis (CTA) can yield valuable insights into healthcare professionals' cognition and inform system design to promote safe, quality care. Our objective was to adapt CTA-the critical decision method, specifically-to investigate patient safety incidents, overcome barriers to implementing this method, and facilitate more widespread use of cognitive task analysis in healthcare. We adapted CTA to facilitate recruitment of healthcare professionals and developed a data collection tool to capture incidents as they occurred. We also leveraged the electronic health record (EHR) to expand data capture and used EHR-stimulated recall to aid reconstruction of safety incidents. We investigated 3 categories of medication-related incidents: adverse drug reactions, drug-drug interactions, and drug-disease interactions. Healthcare professionals submitted incidents, and a subset of incidents was selected for CTA. We analyzed several outcomes to characterize incident capture and completed CTA interviews. We captured 101 incidents. Eighty incidents (79%) met eligibility criteria. We completed 60 CTA interviews, 20 for each incident category. Capturing incidents before interviews allowed us to shorten the interview duration and reduced reliance on healthcare professionals' recall. Incorporating the EHR into CTA enriched data collection. The adapted CTA technique was successful in capturing specific categories of safety incidents. Our approach may be especially useful for investigating safety incidents that healthcare professionals "fix and forget." Our innovations to CTA are expected to expand the application of this method in healthcare and inform a wide range of studies on clinical decision making and patient safety.

  12. 75 FR 30041 - Medicare Program; Public Meeting in Calendar Year 2010 for New Clinical Laboratory Tests Payment...

    Science.gov (United States)

    2010-05-28

    ... specified list of new Clinical Procedural Terminology (CPT) codes for clinical laboratory tests in calendar... are codified at 42 CFR part 414, subpart G. A newly created Current Procedural Terminology (CPT) code..., Medicare--Hospital Insurance; and Program No. 93.774, Medicare-- Supplementary Medical Insurance Program...

  13. User’s Guide: Computer Program for Design or Investigation of Orthogonal Culverts (CORTCUL).

    Science.gov (United States)

    1981-03-01

    This report is divided into the following parts: a. Part II describes the general culvert and soil system to be designed or investigated by the...Note that cover dimensions do not affect internal forces calculated by the program. 119. Attention is directed to the reinfor-t ismnt informat ion j...h iug the distribution of special loads. T. ft Waiter Loads a..’ia I water loads are permitted only i n the I NV11S’l IGATIN mode wi th Stanidard

  14. When Veterinarians Support Canine Therapy: Bidirectional Benefits for Clinics and Therapy Programs

    Directory of Open Access Journals (Sweden)

    John-Tyler Binfet

    2018-01-01

    Full Text Available This paper proposes a mutually beneficial model of collaboration between veterinarians and canine therapy programs. Veterinarians and the clinics for whom they work routinely establish collaborations with multiple and varied stakeholders. This might include a laboratory for processing samples and the corresponding courier company needed to deliver samples to the lab or a partnership with a local dog rescue organization for whom discounted rates are offered. One community partnership that stands to benefit both the clinic and the community agency, is for veterinarians to work in tandem with a local canine-assisted therapy program. The benefits to such an alliance are multifold and address aspects of veterinary medicine including client recruitment, community education, and access to a network of devoted dog enthusiasts.

  15. Characteristics of Biostatistics, Epidemiology, and Research Design Programs in Institutions With Clinical and Translational Science Awards.

    Science.gov (United States)

    Rahbar, Mohammad H; Dickerson, Aisha S; Ahn, Chul; Carter, Rickey E; Hessabi, Manouchehr; Lindsell, Christopher J; Nietert, Paul J; Oster, Robert A; Pollock, Brad H; Welty, Leah J

    2017-02-01

    To learn the size, composition, and scholarly output of biostatistics, epidemiology, and research design (BERD) units in U.S. academic health centers (AHCs). Each year for four years, the authors surveyed all BERD units in U.S. AHCs that were members of the Clinical and Translational Science Award (CTSA) Consortium. In 2010, 46 BERD units were surveyed; in 2011, 55; in 2012, 60; and in 2013, 61. Response rates to the 2010, 2011, 2012, and 2013 surveys were 93.5%, 98.2%, 98.3%, and 86.9%, respectively. Overall, the size of BERD units ranged from 3 to 86 individuals. The median FTE in BERD units remained similar and ranged from 3.0 to 3.5 FTEs over the years. BERD units reported more availability of doctoral-level biostatisticians than doctoral-level epidemiologists. In 2011, 2012, and 2013, more than a third of BERD units provided consulting support on 101 to 200 projects. A majority of BERD units reported that between 25% and 75% (in 2011) and 31% to 70% (in 2012) of their consulting was to junior investigators. More than two-thirds of BERD units reported their contributions to the submission of 20 or more non-BERD grant or contract applications annually. Nearly half of BERD units reported 1 to 10 manuscripts submitted annually with a BERD practitioner as the first or corresponding author. The findings regarding BERD units provide a benchmark against which to compare BERD resources and may be particularly useful for institutions planning to develop new units to support programs such as the CTSA.

  16. Integrating an internet-mediated walking program into family medicine clinical practice: a pilot feasibility study

    Directory of Open Access Journals (Sweden)

    Sen Ananda

    2011-06-01

    Full Text Available Abstract Background Regular participation in physical activity can prevent many chronic health conditions. Computerized self-management programs are effective clinical tools to support patient participation in physical activity. This pilot study sought to develop and evaluate an online interface for primary care providers to refer patients to an Internet-mediated walking program called Stepping Up to Health (SUH and to monitor participant progress in the program. Methods In Phase I of the study, we recruited six pairs of physicians and medical assistants from two family practice clinics to assist with the design of a clinical interface. During Phase II, providers used the developed interface to refer patients to a six-week pilot intervention. Provider perspectives were assessed regarding the feasibility of integrating the program into routine care. Assessment tools included quantitative and qualitative data gathered from semi-structured interviews, surveys, and online usage logs. Results In Phase I, 13 providers used SUH and participated in two interviews. Providers emphasized the need for alerts flagging patients who were not doing well and the ability to review participant progress. Additionally, providers asked for summary views of data across all enrolled clinic patients as well as advertising materials for intervention recruitment. In response to this input, an interface was developed containing three pages: 1 a recruitment page, 2 a summary page, and 3 a detailed patient page. In Phase II, providers used the interface to refer 139 patients to SUH and 37 (27% enrolled in the intervention. Providers rarely used the interface to monitor enrolled patients. Barriers to regular use of the intervention included lack of integration with the medical record system, competing priorities, patient disinterest, and physician unease with exercise referrals. Intention-to-treat analyses showed that patients increased walking by an average of 1493 steps

  17. An international basic science and clinical research summer program for medical students.

    Science.gov (United States)

    Ramjiawan, Bram; Pierce, Grant N; Anindo, Mohammad Iffat Kabir; Alkukhun, Abedalrazaq; Alshammari, Abdullah; Chamsi, Ahmad Talal; Abousaleh, Mohannad; Alkhani, Anas; Ganguly, Pallab K

    2012-03-01

    An important part of training the next generation of physicians is ensuring that they are exposed to the integral role that research plays in improving medical treatment. However, medical students often do not have sufficient time to be trained to carry out any projects in biomedical and clinical research. Many medical students also fail to understand and grasp translational research as an important concept today. In addition, since medical training is often an international affair whereby a medical student/resident/fellow will likely train in many different countries during his/her early training years, it is important to provide a learning environment whereby a young medical student experiences the unique challenges and value of an international educational experience. This article describes a program that bridges the gap between the basic and clinical research concepts in a unique international educational experience. After completing two semester curricula at Alfaisal University in Riyadh, Kingdom of Saudi Arabia, six medical students undertook a summer program at St. Boniface Hospital Research Centre, in Winnipeg, MB, Canada. The program lasted for 2 mo and addressed advanced training in basic science research topics in medicine such as cell isolation, functional assessment, and molecular techniques of analysis and manipulation as well as sessions on the conduct of clinical research trials, ethics, and intellectual property management. Programs such as these are essential to provide a base from which medical students can decide if research is an attractive career choice for them during their clinical practice in subsequent years. An innovative international summer research course for medical students is necessary to cater to the needs of the medical students in the 21st century.

  18. Idiopathic Canalicular Inflammatory Disease: New Disease Description of Clinical Patterns, Investigations, Management, and Outcomes.

    Science.gov (United States)

    Ali, Mohammad Javed

    2018-01-25

    The objective of this perspective is to present a separate disease description of "idiopathic canalicular inflammatory disease" and outline the diagnostic criteria and early experiences with its investigations and management. Retrospective case series of 44 canaliculi of 22 eyes of 11 patients presenting at a tertiary care Dacryology service over a period of 2 years with typical clinical patterns of inflammatory canaliculitis and its outcomes were studied. All the patients underwent microbiological work-up with culture and sensitivity, dacryoendoscopy imaging, serial Fourier domain ocular coherence tomography, and collagen vascular profiles. Stages in the evolution of the disease were studied. All patients were treated initially with topical steroids followed by punctal dilatation and placement of mini-monoka stents. Five patients in addition had a small biopsy from the inflamed portion of the vertical canaliculus. Stents were extubated at 6 weeks. Forty-four canaliculi were diagnosed to have idiopathic canalicular inflammatory disease during the study period. There was a female preponderance (81.8%, 9/11) and the mean age at presentation was 57 years. All patients presented with unilateral epiphora without any discharge, pain, or swelling. Collagen vascular profiles and screening for autoimmune diseases were negative. Clinical picture ranged from stages 1 to 5, consisting of edema, progressive centripetal vascularization, pouting of vascularized mucosa, membrane formation, and progressive scarring. The presentation begins in 1 eye and usually involves the other eye at a mean of 6 months. Ocular coherence tomography and dacryoendoscopy were of adjunctive value in the diagnosis. Histopathological examination was suggestive of a chronic inflammation. All patients had relentless progression to end-stage disease, although delayed significantly by steroids and monoka intubation. Idiopathic canalicular inflammatory disease has a distinct and typical clinical behavior and

  19. An Investigation of Factors Influencing Nurses' Clinical Decision-Making Skills.

    Science.gov (United States)

    Wu, Min; Yang, Jinqiu; Liu, Lingying; Ye, Benlan

    2016-08-01

    This study aims to investigate the influencing factors on nurses' clinical decision-making (CDM) skills. A cross-sectional nonexperimental research design was conducted in the medical, surgical, and emergency departments of two university hospitals, between May and June 2014. We used a quantile regression method to identify the influencing factors across different quantiles of the CDM skills distribution and compared the results with the corresponding ordinary least squares (OLS) estimates. Our findings revealed that nurses were best at the skills of managing oneself. Educational level, experience, and the total structural empowerment had significant positive impacts on nurses' CDM skills, while the nurse-patient relationship, patient care and interaction, formal empowerment, and information empowerment were negatively correlated with nurses' CDM skills. These variables explained no more than 30% of the variance in nurses' CDM skills and mainly explained the lower quantiles of nurses' CDM skills distribution. © The Author(s) 2016.

  20. Investigation of Clinical Characteristics and Etiological Factors in Children with Molar Incisor Hypomineralization

    Directory of Open Access Journals (Sweden)

    Maria Rita Giuca

    2018-01-01

    Full Text Available Aim. The purpose of the present study was to evaluate the clinical defects and etiological factors potentially involved in the onset of MIH in a pediatric sample. Methods. 120 children, selected from the university dental clinic, were included: 60 children (25 boys and 35 girls; average age: 9.8 ± 1.8 years with MIH formed the test group and 60 children (27 boys and 33 girls; average age: 10.1 ± 2 years without MIH constituted the control group. Distribution and severity of MIH defects were evaluated, and a questionnaire was used to investigate the etiological variables; chi-square, univariate, and multivariate statistical tests were performed (significance level set at p<0.05. Results. A total of 186 molars and 98 incisors exhibited MIH defects: 55 molars and 75 incisors showed mild defects, 91 molars and 20 incisors had moderate lesions, and 40 molars and 3 incisors showed severe lesions. Univariate and multivariate statistical analysis showed a significant association (p<0.05 between MIH and ear, nose, and throat (ENT disorders and the antibiotics used during pregnancy (0.019. Conclusions. Moderate defects were more frequent in the molars, while mild lesions were more frequent in the incisors. Antibiotics used during pregnancy and ENT may be directly involved in the etiology of MIH in children.

  1. Investigation of Clinical Characteristics and Etiological Factors in Children with Molar Incisor Hypomineralization

    Science.gov (United States)

    Giuca, Maria Rita; Cappè, Maria; Carli, Elisabetta; Lardani, Lisa

    2018-01-01

    Aim The purpose of the present study was to evaluate the clinical defects and etiological factors potentially involved in the onset of MIH in a pediatric sample. Methods 120 children, selected from the university dental clinic, were included: 60 children (25 boys and 35 girls; average age: 9.8 ± 1.8 years) with MIH formed the test group and 60 children (27 boys and 33 girls; average age: 10.1 ± 2 years) without MIH constituted the control group. Distribution and severity of MIH defects were evaluated, and a questionnaire was used to investigate the etiological variables; chi-square, univariate, and multivariate statistical tests were performed (significance level set at p MIH defects: 55 molars and 75 incisors showed mild defects, 91 molars and 20 incisors had moderate lesions, and 40 molars and 3 incisors showed severe lesions. Univariate and multivariate statistical analysis showed a significant association (p MIH and ear, nose, and throat (ENT) disorders and the antibiotics used during pregnancy (0.019). Conclusions Moderate defects were more frequent in the molars, while mild lesions were more frequent in the incisors. Antibiotics used during pregnancy and ENT may be directly involved in the etiology of MIH in children. PMID:29861729

  2. Phase II drugs under clinical investigation for the treatment of chronic constipation.

    Science.gov (United States)

    Mozaffari, Shilan; Didari, Tina; Nikfar, Shekoufeh; Abdollahi, Mohammad

    2014-11-01

    Chronic constipation (CC) is a common gastrointestinal (GI) motility disorder that significantly impairs the quality of life in affected subjects. As almost half of the patients suffering from CC are not satisfied with currently available medicines, there is a need to develop new molecules with better effectiveness and tolerability. The authors include all experimental and clinical trials (up to Phase II) about new investigational drugs for the treatment of CC. The article identifies nine new agents: mitemcinal, TD-8954, YKP10811, itopride, RM-131, KWA-0711, elobixibat, velusetrag, and naronapride. All nine agents have shown prokinetic effects in different stages of the development. The mechanisms of new developing drugs include: the activation of 5-hydroxytryptamine type-4 (5-HT4), ghrelin and motilin receptors, antagonizing dopamine type-2 (D2) receptors, inhibition of ileal bile acid reabsorption and acetylcholine esterase, as well as water absorption from the GI tract. At this current point in time, new generations of 5-HT4 receptor agonists (velusetrag, noranopride and YKP10811) are hoped to progress, further in the future, due to better efficiency and safety. However, it is not possible to make a concise conclusion at this current time due to a lack of evidence. Further clinical trials with a longer duration and a larger sample size are warranted.

  3. The fetal programming of food preferences: current clinical and experimental evidence.

    Science.gov (United States)

    Dalle Molle, R; Bischoff, A R; Portella, A K; Silveira, P P

    2015-09-28

    Increased energy consumption is one of the major factors implicated in the epidemic of obesity. There is compelling evidence, both clinical and experimental, that fetal paucity of nutrients may have programming effects on feeding preferences and behaviors that can contribute to the development of diseases. Clinical studies in different age groups show that individuals born small for their gestational age (SGA) have preferences towards highly caloric foods such as carbohydrates and fats. Some studies have also shown altered eating behaviors in SGA children. Despite an apparent discrepancy in different age groups, all studies seem to converge to an increased intake of palatable foods in SGA individuals. Small nutrient imbalances across lifespan increase the risk of noncommunicable diseases in adult life. Homeostatic factors such as altered responses to leptin and insulin and alterations in neuropeptides associated with appetite and satiety are likely involved. Imbalances between homeostatic and hedonic signaling are another proposed mechanism, with the mesocorticolimbic dopaminergic pathway having differential reward and pleasure responses when facing palatable foods. Early exposure to undernutrition also programs hypothalamic-pituitary-adrenal axis, with SGA having higher levels of cortisol in different ages, leading to chronic hyperactivity of this neuroendocrine axis. This review summarizes the clinical and experimental evidence related to fetal programming of feeding preferences by SGA.

  4. Animal investigation program 1974 annual report: Nevada Test Site and vicinity

    International Nuclear Information System (INIS)

    Smith, D.D.; Giles, K.R.; Bernhardt, D.E.; Brown, K.R.

    1977-06-01

    Data are presented from the radioanalysis of tissues collected from cattle, deer, desert bighorn sheep, and other wildlife that resided on or near the Nevada Test Site during 1974. Routine activities and special investigations of the Animal Investigation Program are also discussed. Other than the naturally occurring potassium-40, gamma-emitting radionuclides were detected infrequently. For example, cesium-137 was found only in the muscle tissues from 3 of the 12 Nevada Test Site cattle sampled during 1974. Tritium concentrations in the tissues from most of the animals sampled are at background levels. Animals from the experimental farm tended to have slightly higher concentrations than those sampled at other locations on the Nevada Test Site. Strontium-90 levels in bones from deer, desert bighorn sheep, and cattle were slightly lower than those reported for the preceding year. A graph depicts the average levels found in the bones of the three species from 1956 through 1974

  5. Does clinical exposure matter? Pilot assessment of patient visits in an urban family medicine residency program.

    Science.gov (United States)

    Iglar, Karl; Murdoch, Stuart; Meaney, Christopher; Krueger, Paul

    2018-01-01

    To determine the number of patient visits, patient demographic information, and diagnoses in an urban ambulatory care setting in a family medicine residency program, and assess the correlation between the number of patient visits and residents' in-training examination (ITE) scores. Retrospective analysis of data from resident practice profiles, electronic medical records, and residents' final ITE scores. Family medicine teaching unit in a community hospital in Barrie, Ont. Practice profile data were from family medicine residents enrolled in the program from July 1, 2013, to June 30, 2014, and electronic medical record and ITE data were from those enrolled in the program from July 1, 2010, to June 30, 2015. Number of patient visits, patient characteristics (eg, sex, age), priority topics addressed in clinic, resident characteristics (eg, age, sex, level of residency), and residents' final ITE scores. Between July 1, 2013, and June 30, 2014, there were 11 115 patient visits. First-year residents had a mean of 5.48 patient visits per clinic, and second-year residents had a mean of 5.98 patient visits per clinic. A Pearson correlation coefficient of 0.68 was found to exist between the number of patients seen and the final ITE scores, with a 10.5% difference in mean score between residents who had 1251 or more visits and those who had 1150 or fewer visits. Three diagnoses (ie, epistaxis, meningitis, and neck pain) deemed important for Certification by the College of Family Physicians of Canada were not seen by any of the residents in clinic. There is a moderate correlation between the number of patients seen by residents in ambulatory care and ITE scores in family medicine. It is important to assess patients' demographic information and diagnoses made in resident practices to ensure an adequate clinical experience. Copyright© the College of Family Physicians of Canada.

  6. Implementation and Clinical Outcomes of an Employer-Sponsored, Pharmacist-Provided Medication Therapy Management Program.

    Science.gov (United States)

    Theising, Katie M; Fritschle, Traci L; Scholfield, Angelina M; Hicks, Emily L; Schymik, Michelle L

    2015-11-01

    Our objective was to describe the implementation and clinical outcomes of an employer-sponsored, pharmacist-provided medication therapy management (MTM) program for health plan beneficiaries with diabetes mellitus and/or hypertension. We conducted a single-center retrospective medical record review. The setting was a Pharmacy MTM Clinic at a self-insured health system consisting of six hospitals and several ancillary facilities. A total of 161 health plan beneficiaries with diabetes identified during annual wellness screenings for the health plan in 2012 and 225 health plan beneficiaries with diabetes and/or hypertension identified during annual wellness screenings for the health plan in 2013 were referred to the MTM clinic based on specific criteria. In 2012 the health system expanded its existing wellness program by implementing a voluntary diabetes care program for health plan beneficiaries with uncontrolled diabetes (hemoglobin A(1c) [A1C] 7% or higher); a similar program was added for hypertension for the 2013 plan year. All participants' A1C and blood pressure results were tracked from the date of their wellness screening through the end of the plan year. The pharmacists involved had the capability to directly implement drug regimen changes according to hospital protocol or provide recommendations to the physician, as specified by the referring physician. For the 2012-2013 plan year, the mean difference in A1C from baseline to program completion was -0.38% (95% confidence interval [CI] -0.58 to -0.18%, p<0.05). For beneficiaries with a baseline A1C of 7% or higher, the mean difference was -0.69% (95% CI -0.99 to -0.39%, p<0.05). For the 2013-2014 plan year, the mean difference in A1C from baseline to program completion was -0.62% (95% CI -0.81 to -0.44%, p<0.05). In that year, the mean difference in A1C for beneficiaries with A1C 7% or higher was -0.97% (95% CI -1.23 to -0.72%, p<0.05). For those referred for hypertension, a mean difference of -13 mm Hg (95

  7. A study to investigate the effectiveness of successful intelligence training program to increase academic hope

    Directory of Open Access Journals (Sweden)

    Mahbobeh Samavatian

    2014-02-01

    Full Text Available The purpose of this study is to investigate the effectiveness of successful intelligence training program on academic hopefulness of probation students of Esfahan University of Technology. The research is semi-experimental of pre-test, post-test type with control group. Research population includes all probation students of Esfahan University of Technology. The study chooses 30 female and male students and assigns them randomly into two groups of experimental and control. Experimental group participate in 13 successful intelligence-training sessions for 13 weeks. Research tools consists of, Hope in certain aspects. Statistical analysis is conducted using SPSS18 on inferential statistics level proportionate to data analysis level. Statistical test hypothesis are analyzed through univariate covariance and multivariate covariance analysis. The results show that successful intelligence program training was effective to enhance hopefulness of probation students (p < 0.05. Given the results of present research, successful intelligence program training can be used as an intervention method in order to decrease harms because of dormitory and student life.

  8. Development, implementation and evaluation of a clinical research engagement and leadership capacity building program in a large Australian health care service.

    Science.gov (United States)

    Misso, Marie L; Ilic, Dragan; Haines, Terry P; Hutchinson, Alison M; East, Christine E; Teede, Helena J

    2016-01-14

    Health professionals need to be integrated more effectively in clinical research to ensure that research addresses clinical needs and provides practical solutions at the coal face of care. In light of limited evidence on how best to achieve this, evaluation of strategies to introduce, adapt and sustain evidence-based practices across different populations and settings is required. This project aims to address this gap through the co-design, development, implementation, evaluation, refinement and ultimately scale-up of a clinical research engagement and leadership capacity building program in a clinical setting with little to no co-ordinated approach to clinical research engagement and education. The protocol is based on principles of research capacity building and on a six-step framework, which have previously led to successful implementation and long-term sustainability. A mixed methods study design will be used. Methods will include: (1) a review of the literature about strategies that engage health professionals in research through capacity building and/or education in research methods; (2) a review of existing local research education and support elements; (3) a needs assessment in the local clinical setting, including an online cross-sectional survey and semi-structured interviews; (4) co-design and development of an educational and support program; (5) implementation of the program in the clinical environment; and (6) pre- and post-implementation evaluation and ultimately program scale-up. The evaluation focuses on research activity and knowledge, attitudes and preferences about clinical research, evidence-based practice and leadership and post implementation, about their satisfaction with the program. The investigators will evaluate the feasibility and effect of the program according to capacity building measures and will revise where appropriate prior to scale-up. It is anticipated that this clinical research engagement and leadership capacity building

  9. Meeting the challenge of assessing clinical competence of occupational therapists within a program management environment.

    Science.gov (United States)

    Salvatori, Penny; Simonavicius, Nijole; Moore, Joan; Rimmer, Georgina; Patterson, Michele

    2008-02-01

    Program management models have raised concerns among occupational therapists about professional standards related to clinical competence, performance review procedures, and quality improvement initiatives. This paper describes how a chart-stimulated recall (CSR) peer-review process and interview tool was revised, implemented, and evaluated as a pilot project to assess the clinical competence of occupational therapy staff at a large urban health centre in southern Ontario. Fourteen pairs (n=28) of occupational therapists representing various practice areas participated in this project. Half served as peer assessors and half as interviewees. Peer assessors conducted an independent chart review followed by a one-hour personal interview with a peer partner to discuss clinical management issues related to the client cases. Each interviewer rated his or her partner's clinical competence in eight areas of performance using a 7-point Likert scale. Results indicated that the CSR tool could discriminate among occupational therapists in terms of overall levels of clinical competence and also identify specific areas of concern that could be targeted for professional development. Feedback from participants was positive. The CSR tool was found to be useful for assessing clinical competence of occupational therapists in this large health centre as a quality improvement initiative within that discipline group. Further research is needed to establish the reliability and validity of the CSR tool.

  10. Investigational Clinical Trial of a Prototype Optoelectronic Computer-Aided Navigation Device for Dental Implant Surgery.

    Science.gov (United States)

    Jokstad, Asbjørn; Winnett, Brenton; Fava, Joseph; Powell, David; Somogyi-Ganss, Eszter

    New digital technologies enable real-time computer-aided (CA) three-dimensional (3D) guidance during dental implant surgery. The aim of this investigational clinical trial was to demonstrate the safety and effectiveness of a prototype optoelectronic CA-navigation device in comparison with the conventional approach for planning and effecting dental implant surgery. Study participants with up to four missing teeth were recruited from the pool of patients referred to the University of Toronto Graduate Prosthodontics clinic. The first 10 participants were allocated to either a conventional or a prototype device study arm in a randomized trial. The next 10 participants received implants using the prototype device. All study participants were restored with fixed dental prostheses after 3 (mandible) or 6 (maxilla) months healing, and monitored over 12 months. The primary outcome was the incidence of any surgical, biologic, or prosthetic adverse events or device-related complications. Secondary outcomes were the incidence of positioning of implants not considered suitable for straightforward prosthetic restoration (yes/no); the perception of the ease of use of the prototype device by the two oral surgeons, recorded by use of a Likert-type questionnaire; and the clinical performance of the implant and superstructure after 1 year in function. Positioning of the implants was appraised on periapical radiographs and clinical photographs by four independent blinded examiners. Peri-implant bone loss was measured on periapical radiographs by a blinded examiner. No adverse events occurred related to placing any implants. Four device-related complications led to a switch from using the prototype device to the conventional method. All implants placed by use of the prototype device were in a position considered suitable for straightforward prosthetic restoration (n = 21). The qualitative evaluation by the surgeons was generally positive, although ergonomic challenges were identified

  11. Investigating Clinically and Scientifically Useful Cut Points on the Compulsive Sexual Behavior Inventory.

    Science.gov (United States)

    Miner, Michael H; Raymond, Nancy; Coleman, Eli; Swinburne Romine, Rebecca

    2017-05-01

    clinical screening tool and the other, more conservative measurement that is useful for etiologic and epidemiologic research. Miner MH, Raymond N, Coleman E, Swinburne Romine R. Investigating Clinically and Scientifically Useful Cut Points on the Compulsive Sexual Behavior Inventory. J Sex Med 2017;14:715-720. Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

  12. A screening tool to enhance clinical trial participation at a community center involved in a radiation oncology disparities program.

    Science.gov (United States)

    Proctor, Julian W; Martz, Elaine; Schenken, Larry L; Rainville, Rebecca; Marlowe, Ursula

    2011-05-01

    To investigate the effectiveness of a screening tool to enhance clinical trial participation at a community radiation oncology center involved in a National Cancer Institute-funded disparities program but lacking on-site clinical trials personnel. The screening form was pasted to the front of the charts and filled out for all new patients over the 9-month period of the study, during which time five external beam radiation therapy (EBRT) trials and a patient perception study were open for accrual. Patient consent was obtained by assorted personnel at several different sites. Patients potentially eligible for a trial were identified and approached by one of the clinic staff. Patients who were under- or uninsured, age > 80 years, members of an racial/ethnic minority, or recipients of medical assistance were identified as at risk for health care disparities and were offered patient navigator services. Of 196 patients consulted during the study, 144 were treated with EBRT. Of the 24 patients eligible for EBRT trials, 23 were approached (one had an incomplete screening form), and 15 accepted. Of 77 patients eligible for a patient perception trial, 72 were approached (five had incomplete forms), and 45 accepted. The eligibility and acceptance rates for EBRT trials were similar for disparities and nondisparities patients. Screening was completed for 96 patients (67%). When completed, the screening tool ensured clinical trial accrual. The major factor limiting overall accrual was a shortage of available trials.

  13. The Role of Ethnographic Interviewing in Climate Change Evaluation Research: Investigating Intended and Unintended program effects

    Science.gov (United States)

    Lloro-Bidart, T.

    2012-12-01

    Ethnographic interviewing is an under-utilized tool in climate change evaluation research, even though it has the potential to serve as a powerful method of data collection. The utility of the ethnographic interview lies in its ability to elicit responses from program participants describing what a program is in practice, shedding light on both intended and unintended program impacts. Drawing on evaluation work involving a federally-funded climate change grant at the University of California, Riverside, I will discuss how to design an ethnographic interview protocol in an effort to share "best practices" with other climate change evaluators. Particular attention will be given to applying ethnographic approaches to various program types, even those differing from the one discussed. I will share some of the concrete findings from my work on this grant, to serve as examples of the kinds of data evaluators can collect when employing an ethnographic approach to interviewing. UC Riverside's climate change grant is multi-faceted, however the component studied ethnographically was a science fair mentoring program. About twenty K-12 students from high poverty, ethnically diverse schools who expressed an interest in participating in science fair were paired up with graduate student mentors to simultaneously research climate change and design authentic science fair projects to compete at various levels. Since one of the stated goals of the grant is to "stimulate…students to consider climate science as a career track through experiential education activities" I was particularly interested in how student experiences with the project might differ from school science which has historically "pushed out" ethnically diverse students like those in many of Riverside's schools. (In the program students are able to interact one-on-one with a mentor and in school settings there is typically one teacher for more than thirty students). I also sought to understand student perceptions of

  14. Clinical investigation of TROP-2 as an independent biomarker and potential therapeutic target in colon cancer.

    Science.gov (United States)

    Zhao, Peng; Yu, Hai-Zheng; Cai, Jian-Hui

    2015-09-01

    Colon cancer is associated with a severe demographic and economic burden worldwide. The pathogenesis of colon cancer is highly complex and involves sequential genetic and epigenetic mechanisms. Despite extensive investigation, the pathogenesis of colon cancer remains to be elucidated. As the third most common type of cancer worldwide, the treatment options for colon cancer are currently limited. Human trophoblast cell‑surface marker (TROP‑2), is a cell‑surface transmembrane glycoprotein overexpressed by several types of epithelial carcinoma. In addition, TROP‑2 has been demonstrated to be associated with tumorigenesis and invasiveness in solid types of tumor. The aim of the present study was to investigate the protein expression of TROP‑2 in colon cancer tissues, and further explore the association between the expression of TROP‑2 and clinicopathological features of patients with colon cancer. The expression and localization of the TROP‑2 protein was examined using western blot analysis and immunofluorescence staining. Finally, the expression of TROP‑2 expression was correlated to conventional clinicopathological features of colon cancer using a χ2 test. The results revealed that TROP‑2 protein was expressed at high levels in the colon cancer tissues, which was associated with the development and pathological process of colon cancer. Therefore, TROP‑2 may be used as a biomarker to determine the clinical prognosis, and as a potential therapeutic target in colon cancer.

  15. Investigations with FDG-PET Scanning in Prostate Cancer Show Limited Value for Clinical Practice

    Energy Technology Data Exchange (ETDEWEB)

    Salminen, Eeva [Univ. of Turku (Finland). Department of Oncology and Radiotherapy; Hogg, Annette; Binns, David; Hicks, Rodney [The Peter MacCallum Cancer Institute, East Melbourne, Vic (Australia). Dept. of Diagnostic Imaging; Frydenberg, Mark [Monash Medical Centre, Clayton, Vic (Australia)

    2002-09-01

    The aim of this study was to investigate FDG-PET (fluorodeoxyglucose positron emission tomography) imaging in the management of prostate cancer. Twenty-two patients were studied during different disease phases of prostate cancer, for staging or restaging to clarify specific clinical questions. FDG-PET was performed encompassing the thorax, abdomen and pelvis using the Penn PET 300H scanner. Scanning was begun 60 min after {sup 18}F fluorodeoxyglucose marker. Patients were catheterized and administered diuretics to minimize urinary activity. Information obtained with FDG-PET was concordant with findings from other investigations in 7/22 (32%) patients, discordant in 15/22 (68%) patients and equivalent in one patient (4%). PET indicated progressive disease in five patients with prostate-specific antigen (PSA) <4 ng/L. The impact on management of the patients was high in 46% of cases, low in 41% and for 14% there was no impact on management. The accuracy of FDG-PET was 72% (95% CI 50-89) as confirmed by invasive diagnostics/follow-up. FDG-PET can provide useful information and improve the clinician's decision on further management procedures in selected patients with low PSA and bone or lymph node changes. A negative PET scan in prostate cancer should be interpreted with caution.

  16. Methodology optimization and diversification for the investigation of virulence potential in Haemophilus influenzae clinical strains.

    Science.gov (United States)

    Giucă, Mihaela Cristina; Străuţ, Monica; Surdeanu, Maria; Nica, Maria; Ungureanu, Vasilica; Mihăescu, Grigore

    2011-01-01

    Ten Haemophilus influenzae strains were isolated from patients aged between 1.6 - 24 years, with various diagnoses (acute meningitis, acute upper respiratory infection, otitis media and acute sinusitis). Identification was based on phenotypic and molecular characteristics; antibiotic susceptibility testing was performed by diffusion method according to CLSI standards 2011 for seven antibiotics. The results of molecular testing showed that all the studied strains produced an amplicon of 1000 bp with ompP2 primers indicating that all strains were H. influenzae. For six strains, the PCR amplicon obtained with bexA specific primers, proving that the strains were capsulated. The results of phenotypic testing showed that four strains were ampicillin nonsusceptible and (beta-lactamase-positive. The virulence potential of H. influenzae clinical strains was investigated by phenotypic methods, including the assessment of the soluble virulence factors on specific media containing the biochemical substratum for the investigated enzymatic factor, as well as the adherence and invasion capacity to HeLa cells monolayer using Cravioto modified method. The studied strains exhibited mainly a diffuse adherence pattern and different adherence indexes. Interestingly, two strains isolated from the same pacient (blood and CSF) showed a different degree of invasiveness, the strain isolated from blood being 20 times more invasive than the one isolated from CSF.

  17. Perceived Workforce Challenges among Clinical Social Workers in Hematopoietic Cell Transplantation Programs.

    Science.gov (United States)

    Stickney Ferguson, Stacy; Randall, Jill; Dabney, Jane; Kalbacker, Marion E; Boyle, Nancy; Thao, Viengneesee; Murphy, Elizabeth A; Denzen, Ellen M

    2018-05-01

    Clinical social workers are psychosocial care experts who provide interventions that aim to address the emotional, relational, financial, and logistical challenges that arise throughout the hematopoietic cell transplantation (HCT) treatment and recovery process. Interventions that contribute to better patient outcomes can include cognitive behavioral therapy and counseling for adaptation to illness, family planning for 24/7 caregiver availability and strategies to support patient activities of daily living, instruction on guided imagery and relaxation techniques for symptom management and to decrease anxiety, psychoeducation on the treatment trajectory, and linkage with financial resources. A Social Work Workforce Group (SWG) was established through the System Capacity Initiative, led by the National Marrow Donor Program/Be The Match, to characterize the current social work workforce capacity and challenges. The SWG conducted a web-based survey of HCT clinical social workers in the United States. The response rate was 57% (n = 90), representing 76 transplant centers. Survey results indicated that the clinical social worker role and scope of practice varies significantly between centers; less than half of respondents reported that their clinical social work expertise was used to its fullest potential. With an estimated 3-fold increase in HCT patient volume by 2020, the need for specialized psychosocial health services will increase. The SWG makes recommendations to build capacity for the psychosocial care of HCT patients and to more fully integrate the social worker as a core member of the HCT team. The SWG created a Blood and Marrow Transplant (BMT) Clinical Social Worker role description that can be used by transplant centers to educate healthcare professionals, benchmark utilization of clinical social workers, and improve comprehensive psychosocial health programs. Copyright © 2018 The American Society for Blood and Marrow Transplantation. Published by

  18. Preparing for Graduate-Level Training in Professional Psychology: Comparisons across Clinical PhD, Counseling PhD, and Clinical PsyD Programs

    Science.gov (United States)

    Karazsia, Bryan T.; Smith, Lena

    2016-01-01

    In the present study, faculty who teach in clinical and counseling doctor of philosophy (PhD) or doctor of psychology (PsyD) programs completed surveys regarding preferences for prospective student preparations to graduate programs. Faculty expectations of minimum and ideal undergraduate training were highest for scientific methods, though…

  19. River and river-related drainage area parameters for site investigation program

    International Nuclear Information System (INIS)

    Blomqvist, P.; Brunberg, A.K.; Brydsten, L.

    2001-05-01

    In this paper, a number of parameters of importance to a determination of the function of running waters as transport channels for material from the continents to the sea are presented. We have assumed that retention mechanisms of material in the river and in the riparian zone will be covered by special investigations but tried to create a platform for such investigations by quantification of the extension of different main habitats. The choice of parameters has been made so that also the nature conservation value of the river can be preliminary established, and includes a general description of the river type and the inherent ecosystem. The material links directly to that presented in a previous report concerning site investigation programmes for lakes. The parameters have been divided into five groups: 1) The location of the object relative important gradients in the surrounding nature; 2) The river catchment area and its major constituents; 3) The river morphometry; 4) The river ecosystem; 5) Human-induced damages to the river ecosystem. The first two groups, principally based on the climate, hydrology, geology and vegetation of the catchment area, represent parameters that can be used to establish the rarity and representativity of the system, and will in the context of site investigation program be used as a basis for generalisation of the results. The third group, the river morphometry parameters, are standard parameters for the outline of sampling programmes and for calculations of the physical extension of key habitats in the system. The fourth group, the ecosystem of the river, includes physical, chemical and biological parameters required for determination of the influence from the terrestrial ecosystem of the catchment area, nutrient status, distribution of different habitats, and presence of fish in the system. In the context of site investigation program, the parameters in these two groups will be used for budget calculations of the flow of energy and

  20. River and river-related drainage area parameters for site investigation program

    Energy Technology Data Exchange (ETDEWEB)

    Blomqvist, P.; Brunberg, A.K. [Uppsala Univ. (Sweden). Dept. of Limnology; Brydsten, L. [Umeaa Univ. (Sweden). Dept. of Ecology and Environmental Science

    2001-05-01

    In this paper, a number of parameters of importance to a determination of the function of running waters as transport channels for material from the continents to the sea are presented. We have assumed that retention mechanisms of material in the river and in the riparian zone will be covered by special investigations but tried to create a platform for such investigations by quantification of the extension of different main habitats. The choice of parameters has been made so that also the nature conservation value of the river can be preliminary established, and includes a general description of the river type and the inherent ecosystem. The material links directly to that presented in a previous report concerning site investigation programmes for lakes. The parameters have been divided into five groups: 1) The location of the object relative important gradients in the surrounding nature; 2) The river catchment area and its major constituents; 3) The river morphometry; 4) The river ecosystem; 5) Human-induced damages to the river ecosystem. The first two groups, principally based on the climate, hydrology, geology and vegetation of the catchment area, represent parameters that can be used to establish the rarity and representativity of the system, and will in the context of site investigation program be used as a basis for generalisation of the results. The third group, the river morphometry parameters, are standard parameters for the outline of sampling programmes and for calculations of the physical extension of key habitats in the system. The fourth group, the ecosystem of the river, includes physical, chemical and biological parameters required for determination of the influence from the terrestrial ecosystem of the catchment area, nutrient status, distribution of different habitats, and presence of fish in the system. In the context of site investigation program, the parameters in these two groups will be used for budget calculations of the flow of energy and

  1. Investigations of portable cadmium telluride (CdTe(Cl)) detectors for clinical studies with radioactive indicators

    International Nuclear Information System (INIS)

    Bojsen, J.

    1985-01-01

    The combination of small, portable γ-radiation-sensitive Cadmium Telluride (CdTE(Cl)) crystal detectors and portable solid state data storage memories makes it feasible to extend the measuring period in a number of clinical investigations based on the use of various radioisotopes and external detection. Blood sampling can be avoided in some cases. Continuous ambulatory monitoring of relevant physiological parameters is practicable, e.g. kidney function (GFR), left ventricular ejection fraction, subcutaneous blood flow, muscle blood flow and insulin absorption in diabetic patients. In the present methodological study the applicability of the 133-Xe washout technique to subcutaneous (s.c.) adipose tissue blood flow (SBF) has been investigated and adapted to the use of CdTe(Cl) detectors attached to the skin surface for the measurement of local 133-Xe-disappearance rate constants (k). Physical characterization of CdTe(Cl) detectors as γ-sensitive devices has been performed, and adequate counting sensitivities were found without detector energy-resolution properties. The CdTe(Cl) detectors are therefore suitable for single indicator studies. The measuring geometry of CdTe(Cl) detectors was studied and compared with that of stationary Sodium Iodide (NaI(Tl)) detectors in both phantom and in vivo investigations. The spatial properties of CdTe(Cl) detectors could to some extent be adjusted by pulse height discrimination and lead collimation. When long-term measurements were complicated by for instance physical activity of the patients, the small CdTe(Cl) detectors in general showed equal or better performance than the heavy and voluminous NaI(Tl) detectors. The free movement of the ambulatory patient and the avoidance of cable connections to stationary data-collecting systems gave improved possibilities for measurements of the relevant parameters. From this point of view, portable CdTe(Cl) detectors must be considered an important advance for radioactivity studies in

  2. The Effect of an Extramural Program on the Perceived Clinical Competence of Dental Hygiene Students.

    Science.gov (United States)

    Butters, Janice M.; Vaught, Randall L.

    1999-01-01

    A study investigated the effect of an extramural rotation on dental-hygiene students' self-perceptions of competence in specific clinical areas. Results indicate student perceptions of competence improved significantly on six of 19 dimensions of dental-hygiene practice over the course of the rotation, suggesting that rotation is a valuable…

  3. Clinical evaluation of automated processing of electrocardiograms by the Veterans Administration program (AVA 3.4).

    Science.gov (United States)

    Brohet, C R; Richman, H G

    1979-06-01

    Automated processing of electrocardiograms by the Veterans Administration program was evaluated for both agreement with physician interpretation and interpretative accuracy as assessed with nonelectrocardiographic criteria. One thousand unselected electrocardiograms were analyzed by two reviewer groups, one familiar and the other unfamiliar with the computer program. A significant number of measurement errors involving repolarization changes and left axis deviation occurred; however, interpretative disagreements related to statistical decision were largely language-related. Use of a printout with a more traditional format resulted in agreement with physician interpretation by both reviewer groups in more than 80 percent of cases. Overall sensitivity based on agreement with nonelectrocardiographic criteria was significantly greater with use of the computer program than with use of the conventional criteria utilized by the reviewers. This difference was particularly evident in the subgroup analysis of myocardial infarction and left ventricular hypertrophy. The degree of overdiagnosis of left ventricular hypertrophy and posteroinferior infarction was initially unacceptable, but this difficulty was corrected by adjustment of probabilities. Clinical acceptability of the Veterans Administration program appears to require greater physician education than that needed for other computer programs of electrocardiographic analysis; the flexibility of interpretation by statistical decision offers the potential for better diagnostic accuracy.

  4. Integrating interdisciplinary pain management into primary care: development and implementation of a novel clinical program.

    Science.gov (United States)

    Dorflinger, Lindsey M; Ruser, Christopher; Sellinger, John; Edens, Ellen L; Kerns, Robert D; Becker, William C

    2014-12-01

    The aims of this study were to develop and implement an interdisciplinary pain program integrated in primary care to address stakeholder-identified gaps. Program development and evaluation project utilizing a Plan-Do-Study-Act (PDSA) approach to address the identified problem of insufficient pain management resources within primary care. A large Healthcare System within the Veterans Health Administration, consisting of two academically affiliated medical centers and six community-based outpatients clinics. An interprofessional group of stakeholders participated in a Rapid Process Improvement Workshop (RPIW), a consensus-building process to identify systems-level gaps and feasible solutions and obtain buy-in. Changes were implemented in 2012, and in a 1-year follow-up, we examined indicators of engagement in specialty and multimodal pain care services as well as patient and provider satisfaction. In response to identified barriers, RPIW participants proposed and outlined two readily implementable, interdisciplinary clinics embedded within primary care: 1) the Integrated Pain Clinic, providing in-depth assessment and triage to targeted resources; and 2) the Opioid Reassessment Clinic, providing assessment and structured monitoring of patients with evidence of safety, efficacy, or misuse problems with opioids. Implementation of these programs led to higher rates of engagement in specialty and multimodal pain care services; patients and providers reported satisfaction with these services. Our PDSA cycle engaged an interprofessional group of stakeholders that recommended introduction of new systems-based interventions to better integrate pain resources into primary care to address reported barriers. Early data suggest improved outcomes; examination of additional outcomes is planned. Wiley Periodicals, Inc.

  5. Typical investigational medicinal products follow relatively uniform regulations in 10 European Clinical Research Infrastructures Network (ECRIN) countries

    DEFF Research Database (Denmark)

    Gluud, Christian; Kubiak, Christine; Whitfield, Kate

    2012-01-01

    In order to facilitate multinational clinical research, regulatory requirements need to become international and harmonised. The EU introduced the Directive 2001/20/EC in 2004, regulating investigational medicinal products in Europe.......In order to facilitate multinational clinical research, regulatory requirements need to become international and harmonised. The EU introduced the Directive 2001/20/EC in 2004, regulating investigational medicinal products in Europe....

  6. Economic Return of Clinical Trials Performed Under the Pediatric Exclusivity Program

    Science.gov (United States)

    Li, Jennifer S.; Eisenstein, Eric L.; Grabowski, Henry G.; Reid, Elizabeth D.; Mangum, Barry; Schulman, Kevin A.; Goldsmith, John V.; Murphy, M. Dianne; Califf, Robert M.; Benjamin, Daniel K.

    2009-01-01

    Context In 1997, Congress authorized the Food and Drug Administration (FDA) to grant 6 month extensions of marketing rights through the Pediatric Exclusivity program if industry sponsors complete FDA-requested pediatric trials. The program has been praised for creating incentives for studies in children; it has been criticized as a “windfall” to the innovator drug industry. This critique has been a substantial part of Congressional debate on the program, which is due to sunset in 2007. Objective To quantify the economic return to industry for completing Pediatric Exclusivity. Design Cohort study of programs conducted for Pediatric Exclusivity. We selected 9 drugs that were granted Pediatric Exclusivity. From the final study reports submitted to FDA, we obtained key elements of the clinical trial design and study operations. We estimated the cost of performing each study and converted these into estimates of after-tax cash outflows. We obtained 3-year market sales and converted these into estimates of after-tax cash inflows based upon 6 months of additional market protection. We then calculated the net economic return (cash inflows less outflows) and ratio net return to costs (net economic return divided by cash outflows) for each product. Main Outcome Measures Net economic return and ratio of net return to cost. Results The indications studied reflected a broad representation of the program: asthma, tumors, attention deficit disorder, hypertension, depression/generalized anxiety disorder, diabetes, gastroesophageal reflux, bacterial infection, and bone mineralization. The distribution of net economic return for 6 months of exclusivity varied substantially among products [net return ranged from (−)$8.9 million to (+)$507.9 million; ratio of return to cost ranged from −0.68 to 73.6] Conclusions The economic return for pediatric exclusivity is highly variable. Pediatric Exclusivity, as an incentive to complete much-needed clinical trials in children, can

  7. Investigating predictors of visiting, using, and revisiting an online health-communication program: a longitudinal study.

    Science.gov (United States)

    Van 't Riet, Jonathan; Crutzen, Rik; De Vries, Hein

    2010-09-02

    Online health communication has the potential to reach large audiences, with the additional advantages that it can be operational at all times and that the costs per visitor are low. Furthermore, research shows that Internet-delivered interventions can be effective in changing health behaviors. However, exposure to Internet-delivered health-communication programs is generally low. Research investigating predictors of exposure is needed to be able to effectively disseminate online interventions. In the present study, the authors used a longitudinal design with the aim of identifying demographic, psychological, and behavioral predictors of visiting, using, and revisiting an online program promoting physical activity in the general population. A webpage was created providing the public with information about health and healthy behavior. The website included a "physical activity check," which consisted of a physical activity computer-tailoring expert system where visitors could check whether their physical activity levels were in line with recommendations. Visitors who consented to participate in the present study (n = 489) filled in a questionnaire that assessed demographics, mode of recruitment, current physical activity levels, and health motivation. Immediately after, participants received tailored feedback concerning their current physical activity levels and completed a questionnaire assessing affective and cognitive user experience, attitude toward being sufficiently physically active, and intention to be sufficiently physically active. Three months later, participants received an email inviting them once more to check whether their physical activity level had changed. Analyses of visiting showed that more women (67.5%) than men (32.5%) visited the program. With regard to continued use, native Dutch participants (odds ratio [OR] = 2.81, 95% confidence interval [CI] = 1.16-6.81, P = .02) and participants with a strong motivation to be healthy (OR = 1.46, CI = 1

  8. A curated transcriptome dataset collection to investigate the functional programming of human hematopoietic cells in early life.

    Science.gov (United States)

    Rahman, Mahbuba; Boughorbel, Sabri; Presnell, Scott; Quinn, Charlie; Cugno, Chiara; Chaussabel, Damien; Marr, Nico

    2016-01-01

    Compendia of large-scale datasets made available in public repositories provide an opportunity to identify and fill gaps in biomedical knowledge. But first, these data need to be made readily accessible to research investigators for interpretation. Here we make available a collection of transcriptome datasets to investigate the functional programming of human hematopoietic cells in early life. Thirty two datasets were retrieved from the NCBI Gene Expression Omnibus (GEO) and loaded in a custom web application called the Gene Expression Browser (GXB), which was designed for interactive query and visualization of integrated large-scale data. Quality control checks were performed. Multiple sample groupings and gene rank lists were created allowing users to reveal age-related differences in transcriptome profiles, changes in the gene expression of neonatal hematopoietic cells to a variety of immune stimulators and modulators, as well as during cell differentiation. Available demographic, clinical, and cell phenotypic information can be overlaid with the gene expression data and used to sort samples. Web links to customized graphical views can be generated and subsequently inserted in manuscripts to report novel findings. GXB also enables browsing of a single gene across projects, thereby providing new perspectives on age- and developmental stage-specific expression of a given gene across the human hematopoietic system. This dataset collection is available at: http://developmentalimmunology.gxbsidra.org/dm3/geneBrowser/list.

  9. An investigation of high-temperature irradiation test program of new ceramic materials

    International Nuclear Information System (INIS)

    Ishino, Shiori; Terai, Takayuki; Oku, Tatsuo

    1999-08-01

    The Japan Atomic Energy Research Institute entrusted the Atomic Energy Society of Japan with an investigation into the trend of irradiation processing/damage research on new ceramic materials. The present report describes the result of the investigation, which was aimed at effective execution of irradiation programs using the High Temperature Engineering Test Reactor (HTTR) by examining preferential research subjects and their concrete research methods. Objects of the investigation were currently on-going preliminary tests of functional materials (high-temperature oxide superconductor and high-temperature semiconductor) and structural materials (carbon/carbon and SiC/SiC composite materials), together with newly proposed subjects of, e.g., radiation effects on ceramics-coated materials and super-plastic ceramic materials as well as microscopic computer simulation of deformation and fracture of ceramics. These works have revealed 1) the background of each research subject, 2) its objective and significance from viewpoints of science and engineering, 3) research methodology in stages from preliminary tests to real HTTR irradiation, and 4) concrete HTTR-irradiation methods which include main specifications of test specimens, irradiation facilities and post-irradiation examination facilities and apparatuses. The present efforts have constructed the important fundamentals in the new ceramic materials field for further planning and execution of the innovative basic research on high-temperature engineering. (author)

  10. Elucidation of salvage laryngectomy pathologic and clinical variables to guide further treatment intensification investigation.

    Science.gov (United States)

    Scharpf, Joseph; Ward, Matthew; Adelstein, David; Koyfman, Shlomo; Li, Mingsi

    2018-04-01

    There are limited treatment options beyond surgical salvage for patients who fail nonoperative treatment for laryngeal squamous cell carcinoma. In this study, we examine the failure patterns after surgical salvage and the potential pathologic and clinical prognostic variables that might guide further postoperative intensification investigation. Retrospective analysis at a tertiary academic referral center. From an institutional review board-approved institutional head and neck cancer registry, a consecutive series of 147 patients who underwent salvage laryngectomy for squamous cell cancer recurrence or persistence after radiotherapy with or without chemotherapy between May 1995 and May 2016 were identified. Variables potentially associated with oncologic outcome after surgical salvage were then collected and retrospectively evaluated. The projected 2-year locoregional failure rate was 21.8% (95% confidence interval [CI], 14.6%-29.0%]), and the overall survival 65% (95% CI, 57.5%-74.3%) for the entire cohort after salvage laryngectomy. On multivariable analysis, sarcomatoid/spindle cell pathology (hazard ratio [HR], 3.147; 95% CI, 1.181-8.386; P = 0.022), lymphovascular space invasion (LVSI) (positive vs. negative; HR, 2.31; 95% CI, 1.21-4.42; P = 0.011), and advanced initial American Joint Committee on Cancer 7th Edition grouped stage (stages III-IVB vs. stages I-II; HR, 1.64; 95% CI, 1.04-2.6; P = 0.035) were found to be independently associated with inferior disease-free survival. No other clinical or pathologic variables predicted failure. Salvage laryngectomy after nonoperative treatment failure results in successful locoregional control rates and survival in the majority of patients failing initial therapy. This should temper enthusiasm for routine treatment intensification with postoperative re-irradiation and/or other systemic treatments for the vast majority of patients. Sarcomatoid pathology, LVSI, and an advanced initial stage are associated with inferior

  11. Investigating the congruence of crowdsourced information with official government data: the case of pediatric clinics.

    Science.gov (United States)

    Kim, Minki; Jung, Yuchul; Jung, Dain; Hur, Cinyoung

    2014-02-03

    Health 2.0 is a benefit to society by helping patients acquire knowledge about health care by harnessing collective intelligence. However, any misleading information can directly affect patients' choices of hospitals and drugs, and potentially exacerbate their health condition. This study investigates the congruence between crowdsourced information and official government data in the health care domain and identifies the determinants of low congruence where it exists. In-line with infodemiology, we suggest measures to help the patients in the regions vulnerable to inaccurate health information. We text-mined multiple online health communities in South Korea to construct the data for crowdsourced information on public health services (173,748 messages). Kendall tau and Spearman rank order correlation coefficients were used to compute the differences in 2 ranking systems of health care quality: actual government evaluations of 779 hospitals and mining results of geospecific online health communities. Then we estimated the effect of sociodemographic characteristics on the level of congruence by using an ordinary least squares regression. The regression results indicated that the standard deviation of married women's education (P=.046), population density (P=.01), number of doctors per pediatric clinic (P=.048), and birthrate (P=.002) have a significant effect on the congruence of crowdsourced data (adjusted R²=.33). Specifically, (1) the higher the birthrate in a given region, (2) the larger the variance in educational attainment, (3) the higher the population density, and (4) the greater the number of doctors per clinic, the more likely that crowdsourced information from online communities is congruent with official government data. To investigate the cause of the spread of misleading health information in the online world, we adopted a unique approach by associating mining results on hospitals from geospecific online health communities with the sociodemographic

  12. Comparing Faculty and Students Perceptions on Clinical Competency Achievement in Rehabilitation Programs

    Directory of Open Access Journals (Sweden)

    Foroozan Shokooh

    2009-10-01

    Full Text Available Objectives: Clinical competencies are learning outcomes the student should display by the end of the program and competency based instruction measures what participants have learned as opposed to what instructors think they have thought. Objective of this study was to compare student and faculty perceptions of the importance and achievement of clinical competencies in rehabilitation programs. Methods: The survey instrument was a dual-response 5-point Likert-type questionnaire consisting of 29 competencies based on content and skill areas in the management of patient with chronic illnesses. The instrument was administered to all faculty members and final year undergraduate students of three rehabilitation programs including Speech therapy, physiotherapy and occupational therapy at the University of Rehabilitation and Social Welfare in Iran. Results: 45 students and 19 faculty members participated in the study. Overall, most of the students (81% rated themselves as moderately competent (mean between 2 to 4. Perceived self-efficacy of male students was significantly higher than female students. (P=0.014 Differences between perceived importance and perceived achievement were statistically significant in each subject group. (P=0.000. Discussion: Faculty members and students shared very similar perceptions on the importance & achievement of competencies. Difference between importance and achievement of competencies may suggest a failure in consideration of required competencies or successful implementation of them in the current curriculum.

  13. WE-D-207-01: Background and Clinical Implementation of a Screening Program

    International Nuclear Information System (INIS)

    Aberle, D.

    2015-01-01

    In the United States, Lung Cancer is responsible for more cancer deaths than the next four cancers combined. In addition, the 5 year survival rate for lung cancer patients has not improved over the past 40 to 50 years. To combat this deadly disease, in 2002 the National Cancer Institute launched a very large Randomized Control Trial called the National Lung Screening Trial (NLST). This trial would randomize subjects who had substantial risk of lung cancer (due to age and smoking history) into either a Chest X-ray arm or a low dose CT arm. In November 2010, the National Cancer Institute announced that the NLST had demonstrated 20% fewer lung cancer deaths among those who were screened with low-dose CT than with chest X-ray. In December 2013, the US Preventive Services Task Force recommended the use of Lung Cancer Screening using low dose CT and a little over a year later (Feb. 2015), CMS announced that Medicare would also cover Lung Cancer Screening using low dose CT. Thus private and public insurers are required to provide Lung Cancer Screening programs using CT to the appropriate population(s). The purpose of this Symposium is to inform medical physicists and prepare them to support the implementation of Lung Screening programs. This Symposium will focus on the clinical aspects of lung cancer screening, requirements of a screening registry for systematically capturing and tracking screening patients and results (such as required Medicare data elements) as well as the role of the medical physicist in screening programs, including the development of low dose CT screening protocols. Learning Objectives: To understand the clinical basis and clinical components of a lung cancer screening program, including eligibility criteria and other requirements. To understand the data collection requirements, workflow, and informatics infrastructure needed to support the tracking and reporting components of a screening program. To understand the role of the medical physicist in

  14. Using electronic clinical practice audits as needs assessment to produce effective continuing medical education programming.

    Science.gov (United States)

    Klein, Doug; Staples, John; Pittman, Carmen; Stepanko, Cheryl

    2012-01-01

    The traditional needs assessment used in developing continuing medical education programs typically relies on surveying physicians and tends to only capture perceived learning needs. Instead, using tools available in electronic medical record systems to perform a clinical audit on a physician's practice highlights physician-specific practice patterns. The purpose of this study was to test the feasibility of implementing an electronic clinical audit needs assessment process for family physicians in Canada. A clinical audit of 10 preventative care interventions and 10 chronic disease interventions was performed on family physician practices in Alberta, Canada. The physicians used the results from the audit to produce personalized learning needs, which were then translated into educational programming. A total of 26 family practices and 4489 patient records were audited. Documented completion rates for interventions ranged from 13% for ensuring a patient's tetanus vaccine is current to 97% of pregnant patients receiving the recommended prenatal vitamins. Electronic medical record-based needs assessments may provide a better basis for developing continuing medical education than a more traditional survey-based needs assessment. This electronic needs assessment uses the physician's own patient outcome information to assist in determining learning objectives that reflect both perceived and unperceived needs.

  15. On-site management of investigational products and drug delivery systems in conformity with Good Clinical Practices (GCPs).

    Science.gov (United States)

    Méthot, Julie; Brisson, Diane; Gaudet, Daniel

    2012-04-01

    Investigators and research teams participating in clinical trials have to deal with complex investigational products, study designs, and research environments. The emergence of new drug delivery systems and investigational products combining more than one drug and the development of biodrugs such as monoclonal antibodies, peptides, siRNA, and gene therapy to treat orphan or common diseases constitute a new challenge for investigators and clinical sites. We describe the requirements and challenges of drug management in conformity with Good Clinical Practices (GCPs) for investigators and sites participating in clinical trials. Review At all sites participating in clinical trials, standard operating procedures (SOPs) covering the critical path of drug and drug delivery systems management are required. All steps should be auditable, including reception, validation, storage, access, preparation, distribution, techniques of administration, use, return, and destruction of research products. Biodrugs require traceability and specific SOPs on the management of potential immune reactions. Investigational products must be stored under standard auditable conditions. The traceability of storage conditions (including temperature) requires these conditions to be monitored on a continuous basis. A dedicated space with restricted access limited to authorized qualified personnel facilitates the monitoring. The development of standardized, auditable settings and the application of dedicated, site-specific SOPs for the management of investigational products and drug delivery systems contribute to guarantee the compliance to GCP requirements.

  16. Non-inflammatory destructive periodontal disease: a clinical, microbiological, immunological and genetic investigation

    Directory of Open Access Journals (Sweden)

    Carlos Eduardo Repeke

    2012-02-01

    Full Text Available Periodontitis comprises a group of multifactorial diseases in which periodontopathogens accumulate in dental plaque and trigger host chronic inflammatory and immune responses against periodontal structures, which are determinant to the disease outcome. Although unusual cases of non-inflammatory destructive periodontal disease (NIDPD are described, their pathogenesis remains unknown. A unique NIDPD case was investigated by clinical, microbiological, immunological and genetic tools. The patient, a non-smoking dental surgeon with excessive oral hygiene practice, presented a generalized bone resorption and tooth mobility, but not gingival inflammation or occlusion problems. No hematological, immunological or endocrine alterations were found. No periodontopathogens (A. actinomycetemcomitans, P. gingivalis, F. nucleatum and T. denticola or viruses (HCMV, EBV-1 and HSV-1 were detected, along with levels of IL-1β and TNF-a in GCF compatible with healthy tissues. Conversely ALP, ACP and RANKL GCF levels were similar to diseased periodontal sites. Genetic investigation demonstrated that the patient carried some SNPs, as well HLA-DR4 (*0404 and HLA-B27 alleles, considered risk factors for bone loss. Then, a less vigorous and diminished frequency of toothbrushing was recommended to the patient, resulting in the arrest of alveolar bone loss, associated with the return of ALP, ACP and RANKL in GCF to normality levels. In conclusion, the unusual case presented here is compatible with the previous description of NIDPD, and the results that a possible combination of excessive force and frequency of mechanical stimulation with a potentially bone loss prone genotype could result in the alveolar bone loss seen in NIDPD.

  17. Quality assurance in ultrasound screening for hepatocellular carcinoma using a standardized phantom and standard clinical images: a 3-year national investigation in Korea.

    Science.gov (United States)

    Choi, Joon-Il; Jung, Seung Eun; Kim, Pyo Nyun; Cha, Sang Hoon; Jun, Jae Kwan; Lee, Hoo-Yeon; Park, Eun-Cheol

    2014-06-01

    The purpose of this study was to investigate the quality of ultrasound (US) imaging for hepatocellular carcinoma screening. The investigation was performed at all medical institutes participating in the National Cancer Screening Program in Korea. For assessment of personnel, we inquired who was performing the US screenings. For phantom image evaluation, the dead zone, vertical and horizontal measurements, axial and lateral resolution, sensitivity, and gray scale/dynamic range were evaluated. For clinical image evaluation, US images of patients were evaluated in terms of the standard images, technical information, overall image quality, appropriateness of depth, foci, annotations, and the presence of any artifacts. Failure rates for phantom and clinical image evaluations at general hospitals, smaller hospitals, and private clinics were 20.9%, 24.5%, 24.1% and 5.5%, and 14.8% and 9.5%, respectively. No statistically significant difference was observed in the failure rates for the phantom images among groups of different years of manufacture. For the clinical image evaluation, the results of radiologists were significantly better than those of other professional groups (P = .0001 and .0004 versus nonradiology physicians and nonphysicians, respectively). The failure rate was also higher when the storage format was analog versus digital (P quality of the clinical images obtained by radiologists was the best. © 2014 by the American Institute of Ultrasound in Medicine.

  18. Dose level investigation in tests with gastrointestinal fluoroscopy as a part of a quality control program

    International Nuclear Information System (INIS)

    Canevaro, L.V.; Borges, J.C.; Kocj, H.A.

    1995-01-01

    The Radiation Protection and Dosimetry Institute of the National Nuclear Energy Commission (IRD/CNEN) Brazilian and the Radiodiagnostic Service of the Rio de Janeiro Federal University Hospital, (Brazil), have been engaged in the development of quality control programs applied to radiodiagnostics, one of them concerning gastrointestinal fluoroscopy. Since fluoroscopic examinations normally deals with high doses, they represent an important fraction of public exposure. They deserve special attention and risks to patients should be considered individually, not only as a population statistics. This work describes steps followed and results obtained in the estimation of doses for patients and physicians. Examinations investigated were esofagography, gastroduodenal seriography and colon with double contrast media, using conventional equipment with fluorescent screens, carried on by physicians engaged in the first year of medical residence. (author). 14 refs., 2 tabs

  19. Investigating Employee-Reported Benefits of Participation in a Comprehensive Australian Workplace Health Promotion Program.

    Science.gov (United States)

    Kilpatrick, Michelle; Blizzard, Leigh; Sanderson, Kristy; Teale, Brook; Nelson, Mark; Chappell, Kate; Venn, Alison

    2016-05-01

    To investigate employee-reported benefits of participation, employee organizational commitment, and health-related behaviors and body mass index (BMI) following implementation of a comprehensive workplace health promotion (WHP) program. State government employees from Tasmania, Australia, completed surveys in 2010 (n = 3408) and 2013 (n = 3228). Repeated cross-sectional data were collected on sociodemographic, health, and work characteristics. Participation in WHP activities, employee-reported organizational commitment, and benefits of participation were collected in 2013. Respondents who participated in multiple activities were more likely to agree that participation had motivated them, or helped them to address a range of health and work factors (trends: P employee organizational commitment. No differences were observed in health-related behaviors and BMI between 2010 and 2013. Healthy@Work (pH@W) was either ineffective, or insufficient time had elapsed to detect a population-level change in employee lifestyle factors.

  20. Recent drilling program to investigate radionuclide migration at the Nevada Test Site

    International Nuclear Information System (INIS)

    Smith, D.K.

    1997-01-01

    Recent drilling affords new opportunities to investigate the occurrence, distribution and transport of radionuclides in the unsaturated and saturated zone at the Nevada Test Site (NTS), Nye County, Nevada. This program is unique becmise of the elevated activities of radionuclides encountered during drilling (> 3.7E+6 Bq/L 3H), extreme completion depths (> 950 m), the expense of constructing new wells (> $IE+6/borehole), and collaboration of government, academic, and industrial partners in the planning and execution of the program. The recent chilling is significant because it substantively augments earlier field of radionuclide migration at NTS, most notably the 1974 CAMBRIC RNM experiment Sites of five nuclear tests fired below or adjacent to the saturated zone have been drilled. Three of the events were fired in Yucca Flat which is a hydrologically closed basin and two were fired in fractured volcanics of Pahute Mesa. Results from Yucca Flat indicate that volatile and refractory radionuclides, fractionated at zero time, we not highly mobile under sawmted conditions. In contrast, borcholes completed on Pahute Mesa indicate Wgh concentrations of tritium (> 3.7E+6 Bq/L 3H) and other radionuclides may be rted more than 300 m from event cavities as dissolved species or as colloids

  1. Recent drilling program to investigate radionuclide migration at the Nevada Test Site

    Energy Technology Data Exchange (ETDEWEB)

    Smith, D.K.

    1997-04-01

    Recent drilling affords new opportunities to investigate the occurrence, distribution and transport of radionuclides in the unsaturated and saturated zone at the Nevada Test Site (NTS), Nye County, Nevada. This program is unique becmise of the elevated activities of radionuclides encountered during drilling (> 3.7E+6 Bq/L 3H), extreme completion depths (> 950 m), the expense of constructing new wells (> $IE+6/borehole), and collaboration of government, academic, and industrial partners in the planning and execution of the program. The recent chilling is significant because it substantively augments earlier field of radionuclide migration at NTS, most notably the 1974 CAMBRIC RNM experiment Sites of five nuclear tests fired below or adjacent to the saturated zone have been drilled. Three of the events were fired in Yucca Flat which is a hydrologically closed basin and two were fired in fractured volcanics of Pahute Mesa. Results from Yucca Flat indicate that volatile and refractory radionuclides, fractionated at zero time, we not highly mobile under sawmted conditions. In contrast, borcholes completed on Pahute Mesa indicate Wgh concentrations of tritium (> 3.7E+6 Bq/L 3H) and other radionuclides may be rted more than 300 m from event cavities as dissolved species or as colloids.

  2. The GLOBE Program's Student Climate Research Campaign: Empowering Students to Measure, Investigate, and Understand Climate

    Science.gov (United States)

    Mackaro, J.; Andersen, T.; Malmberg, J.; Randolph, J. G.; Wegner, K.; Tessendorf, S. A.

    2012-12-01

    The GLOBE Program's Student Climate Research Campaign (SCRC) is a two-year campaign focused on empowering students to measure, investigate, and understand the climate system in their local community and around the world. Schools can participate in the campaign via three mechanisms: climate foundations, intensive observing periods (IOPs), and research investigations. Participation in the first year of the SCRC focused on increasing student understanding and awareness of climate. Students in 49 countries participated by joining a quarterly webinar, completing the online climate learning activity, collecting and entering data during IOPs, or completing an online join survey. The year also included a video competition with the theme of Earth Day 2012, as well as a virtual student conference in conjunction with The GLOBE Program's From Learning to Research Project. As the SCRC continues into its second year, the goal is for students to increase their understanding of and ability to conduct scientific research focused on climate. Furthermore, year two of the SCRC seeks to improve students' global awareness by encouraging collaborations among students, teachers and scientists focused on understanding the Earth as a system. In addition to the continuation of activities from year one, year two will have even more webinars offered, two competitions, the introduction of two new IOPs, and a culminating virtual student conference. It is anticipated that this virtual conference will showcase research by students who are enthusiastic and dedicated to understanding climate and mitigating impacts of climate change in their communities. This presentation will highlight examples of how the SCRC is engaging students all over the world in hands-on and locally relevant climate research.

  3. Instructors of psychotherapy in M.A. and Ph.D. clinical programs.

    Science.gov (United States)

    Stevens, H B

    1996-08-01

    The present study investigated the characteristics and orientations of the instructors of the initial psychotherapy course of the 44 members and affiliates of the Council of Applied Master's Programs in Psychology. Also examined were the focus of instruction in the course and the teachers' style of instruction. Responses for 26 completed surveys (58%) were compared with responses from instructors of initial psychotherapy courses in 69 of the 170 APA accredited doctoral programs. Five general theoretical orientations were represented by the M.A. instructors with 28% self-identifying as humanistic, 24% as dynamic, 20% as cognitive behavioral, 16% as interpersonal, and 12% as behavioral. No significant differences were found on demographic characteristics, theoretical orientation, focus of instruction, or method of instruction between instructors in M.A. and those in Ph.D. programs.

  4. Clinical and genetic investigation of families with type II Waardenburg syndrome.

    Science.gov (United States)

    Chen, Yong; Yang, Fuwei; Zheng, Hexin; Zhou, Jianda; Zhu, Ganghua; Hu, Peng; Wu, Weijing

    2016-03-01

    The present study aimed to investigate the molecular pathology of Waardenburg syndrome type II in three families, in order to provide genetic diagnosis and hereditary counseling for family members. Relevant clinical examinations were conducted on the probands of the three pedigrees. Peripheral blood samples of the probands and related family members were collected and genomic DNA was extracted. The coding sequences of paired box 3 (PAX3), microphthalmia‑associated transcription factor (MITF), sex‑determining region Y‑box 10 (SOX10) and snail family zinc finger 2 (SNAI2) were analyzed by polymerase chain reaction and DNA sequencing. The heterozygous mutation, c.649_651delAGA in exon 7 of the MITF gene was detected in the proband and all patients of pedigree 1; however, no pathological mutation of the relevant genes (MITF, SNAI2, SOX10 or PAX3) was detected in pedigrees 2 and 3. The heterozygous mutation c.649_651delAGA in exon 7 of the MITF gene is therefore considered the disease‑causing mutation in pedigree 1. However, there are novel disease‑causing genes in Waardenburg syndrome type II, which require further research.

  5. Ischaemic memory imaging using metabolic radiopharmaceuticals: overview of clinical settings and ongoing investigations

    Energy Technology Data Exchange (ETDEWEB)

    Yoshinaga, Keiichiro [Hokkaido University Graduate School of Medicine, Department of Molecular Imaging, Sapporo (Japan); Naya, Masanao [Hokkaido University Graduate School of Medicine, Department of Cardiology, Sapporo (Japan); Shiga, Tohru; Suzuki, Eriko; Tamaki, Nagara [Hokkaido University Graduate School of Medicine, Department of Nuclear Medicine, Sapporo (Japan)

    2014-02-15

    ''Ischaemic memory'' is defined as a prolonged functional and/or biochemical alteration remaining after a particular episode of severe myocardial ischaemia. The biochemical alteration has been reported as metabolic stunning. Metabolic imaging has been used to detect the footprint left by previous ischaemic episodes evident due to delayed recovery of myocardial metabolism (persistent dominant glucose utilization with suppression of fatty acid oxidation). β-Methyl-p-[{sup 123}I]iodophenylpentadecanoic acid (BMIPP) is a single-photon emission computed tomography (SPECT) radiotracer widely used for metabolic imaging in clinical settings in Japan. In patients with suspected coronary artery disease but no previous myocardial infarction, BMIPP has shown acceptable diagnostic accuracy. In particular, BMIPP plays an important role in the identification of prior ischaemic insult in patients arriving at emergency departments with acute chest pain syndrome. Recent data also show the usefulness of {sup 123}I-BMIPP SPECT for predicting cardiovascular events in patients undergoing haemodialysis. Similarly, SPECT or PET imaging with {sup 18}F-FDG injected during peak exercise or after exercise under fasting conditions shows an increase in FDG uptake in postischaemic areas. This article will overview the roles of ischaemic memory imaging both under established indications and in ongoing investigations. (orig.)

  6. Variability of intraductal papillomas of the mammary gland: Clinical, roentgenologic and morphologic investigations

    International Nuclear Information System (INIS)

    Rummel, W.

    1974-01-01

    The radiodiagnostical method of choice is the galactographic technique. However, a specific X-ray image of the papilloma does not exist. The galactographic technique has to be adapted to the surgical and histologic one. Only by combining these three techniques good results can be achieved. It is not possible to draw conclusions from the colour of the pathologic discharge about the type and character of the pathologic process. Contrary to the findings documented in the literature, we were able to diagnose with our technique not only small tumours, but also tumours situated in the periphery of the lactiferous duct. Because of our investigations it is no longer possible to maintain and keep the strict division of the proliferative changes occurring at the lactiferous duct walls. In this study, the most significant morphologic results are described in detail. In all patients with pathologic discharge of the mammary gland, the so-called papillo-carcinoma was found only in one case. As clinical consequence it has therefore to be demanded that in all women with the symptom of pathologic mamillary discharge first of all the origin of this discharge has to be localised by means of galactography. Only the individual morphologic picture of a proliferative change of the lactiferous duct provides some prognostic value. The prerequisites for such an individual assessment are differentiated roentgenologic, surgical and histological techniques. (orig./MG) [de

  7. Clinical investigation of 131I therapy combined with low-dose lithium carbonate for Graves disease

    International Nuclear Information System (INIS)

    Xu Haiqing; Wu Bian

    2006-01-01

    Objective: To investigate the clinical curative effects of 131 I therapy combined with low-dose lithium carbonate for Graves disease. Methods: Patients with Graves disease took lithium carbonate (250 mg, once per day) orally for 5 weeks. Then they were treated with 131 I (doses=3.15 MBq(80 uCi)/g, based on 60%-70% of the thyroid size). We kept track from 6 to 24 months (averaging 14 months) and classified the results into three: cured, improved or no effect. Results: After a single cycle of 131 I therapy combined with low-dose lithium carbonate, 106 patients with Graves disease were cured, 28 were improved and 8 saw no effects, respectively 74.6%, 19.7% and 5.6% among the 142 patients. We then treated 23 of them with another 131 I therapy (without lithium carbonate). 10 of such were cured (43.5%), 8 were improved (34.8%) and the other 5 saw no effects. Among all patients, hypothyroidism was observed from 25(17.6%), 6 months after the first 131 I therapy. Conclusions: Notable curative results were observed from 131 I therapy combined with low-dose lithium carbonate for Graves disease. Moreover, the dosage of 131 I was therefore decreased, which also lowered the toxicity response. (authors)

  8. Investigation of Exon 1 in FXN Gene in Patients with Clinical Symptomatic of Friedreich Ataxia

    Directory of Open Access Journals (Sweden)

    Naseroleslami M

    2013-01-01

    Full Text Available Background and Objectives: Friedreich’s ataxia (FRDA is an autosomal recessive disorder that is typically associated with dysarthria, muscle weakness, spasticity in the lower limbs, scoliosis, bladder dysfunction, absent lower limb reflexes, and loss of position and vibration sense. Approximately two-thirds of these patients suffer from cardiomyopathy and more than 30% have diabetes mellitus. Individuals with FRDA have identifiable mutations in the FXN gene. The most common type of mutation which is observed on both alleles in more than 98% of patients is an expansion of a GAA triplet-repeat in intron of FXN gene. Approximately 2% of individuals with FRDA are compound heterozygotes, who have a GAA expansion in the disease-causing range in one FXN allele and an inactivating FXN mutation in another allele. Aim of the present study was to investigate exon 1 in FRDA gene in patients with clinical symptoms of Friedreich’s Ataxia that have not GAA triplet-repeat expansion in intron 1 of FXN gene.Methods: In this study, exon 1 in 5 patients suspected of FRDA analyzed using PCR and sequencing. Results: An A to G transition at nucleotide number 815284, in exon 1 was observed in all patients. Conclusion: The results of this study showed that disease-causing homozygous mutations could be because of consanguinity marriage in Iran. Therefore, sequencing of all exons of the gene is necessary.

  9. Clinical distinctions between selective mutism and social phobia: an investigation of childhood psychopathology.

    Science.gov (United States)

    Yeganeh, Robin; Beidel, Deborah C; Turner, Samuel M; Pina, Armando A; Silverman, Wendy K

    2003-09-01

    To investigate the hypothesis that children with selective mutism are more socially anxious than children with social anxiety disorder but who are not selectively mute. Twenty-three children with comorbid selective mutism and social phobia and 23 age-matched controls with social phobia alone and their parents participated in a comprehensive assessment of social anxiety and related aspects of psychopathology. The results do not uniformly support previous suggestions that children with selective mutism refuse speech because they are "frozen with fear." Although clinician and observer ratings for children with selective mutism revealed higher ratings of social distress than for children with social phobia alone, self-report data do not support this conclusion. Furthermore, although there were no group differences on measures of trait anxiety, general fears, or scores on the Child Behavior Checklist broadband Internalizing or Externalizing scales, children with selective mutism scored higher than children with social phobia alone on the Child Behavior Checklist Delinquency subscale, suggesting the presence of a broader clinical syndrome. It remains unclear whether children with selective mutism have extreme levels of social anxiety. Potential areas that might shed further light on this interesting disorder are discussed.

  10. Ischaemic memory imaging using metabolic radiopharmaceuticals: overview of clinical settings and ongoing investigations

    International Nuclear Information System (INIS)

    Yoshinaga, Keiichiro; Naya, Masanao; Shiga, Tohru; Suzuki, Eriko; Tamaki, Nagara

    2014-01-01

    ''Ischaemic memory'' is defined as a prolonged functional and/or biochemical alteration remaining after a particular episode of severe myocardial ischaemia. The biochemical alteration has been reported as metabolic stunning. Metabolic imaging has been used to detect the footprint left by previous ischaemic episodes evident due to delayed recovery of myocardial metabolism (persistent dominant glucose utilization with suppression of fatty acid oxidation). β-Methyl-p-[ 123 I]iodophenylpentadecanoic acid (BMIPP) is a single-photon emission computed tomography (SPECT) radiotracer widely used for metabolic imaging in clinical settings in Japan. In patients with suspected coronary artery disease but no previous myocardial infarction, BMIPP has shown acceptable diagnostic accuracy. In particular, BMIPP plays an important role in the identification of prior ischaemic insult in patients arriving at emergency departments with acute chest pain syndrome. Recent data also show the usefulness of 123 I-BMIPP SPECT for predicting cardiovascular events in patients undergoing haemodialysis. Similarly, SPECT or PET imaging with 18 F-FDG injected during peak exercise or after exercise under fasting conditions shows an increase in FDG uptake in postischaemic areas. This article will overview the roles of ischaemic memory imaging both under established indications and in ongoing investigations. (orig.)

  11. Clinical Investigation of the Dopaminergic System with PET and FLUORINE-18-FLUORO-L-DOPA.

    Science.gov (United States)

    Oakes, Terrence Rayford

    1995-01-01

    Positron Emission Tomography (PET) is a tool that provides quantitative physiological information. It is valuable both in a clinical environment, where information is sought for an individual, and in a research environment, to answer more fundamental questions about physiology and disease states. PET is particularly attractive compared to other nuclear medicine imaging techniques in cases where the anatomical regions of interest are small or when true metabolic rate constants are required. One example with both of these requirements is the investigation of Parkinson's Disease, which is characterized as a presynaptic motor function deficit affecting the striatum. As dopaminergic neurons die, the ability of the striatum to affect motor function decreases. The extent of functional neuronal damage in the small sub-structures may be ascertained by measuring the ability of the caudate and putamen to trap and store dopamine, a neurotransmitter. PET is able to utilize a tracer of dopamine activity, ^ {18}F- scL-DOPA, to quantitate the viability of the striatum. This thesis work deals with implementing and optimizing the many different elements that compose a PET study of the dopaminergic system, including: radioisotope production; conversion of aqueous ^{18}F ^-into [^ {18}F]-F2; synthesis of ^{18}F- scL -DOPA; details of the PET scan itself; measurements to estimate the radiation dosimetry; accurate measurement of a plasma input function; and the quantitation of dopaminergic activity in normal human subjects as well as in Parkinson's Disease patients.

  12. The investigation of genetic and clinical features in Chinese patients with juvenile amyotrophic lateral sclerosis.

    Science.gov (United States)

    Liu, Z-J; Lin, H-X; Liu, G-L; Tao, Q-Q; Ni, W; Xiao, B-G; Wu, Z-Y

    2017-09-01

    Juvenile amyotrophic lateral sclerosis (JALS) occurs at an age of onset below 25 years with a heterogeneous disease onset location, variable progression and survival time. To investigate whether an ALS gene profile could resolve any aspects of clinical symptom heterogeneity, we have used targeted sequencing technology in a cohort of 12 JALS patients of Chinese descent. We detected 5 likely pathogenic mutations, 2 in familial probands and 3 in sporadic patients. One was a known TARDBP mutation (p.G348V) and 4 were FUS frameshift mutations including a known p.Gln519Ilefs*9 mutation and 3 novel mutations, p.Gly515Valfs*14, p.Gly486Profs*30, and p.Arg498Alafs*32. Of the 4 FUS mutations, 2 were able to be confirmed as de novo mutations. The TARDBP mutation carrier showed a classic ALS phenotype. All patients with FUS mutations experienced limb weakness at an early age and developed bulbar symptoms during the disease course. FUS mutations have previously been associated with increased JALS disease progression, however, we found a large range 12 to 84 months in disease survival (mean 58.2 months). Our results justify future screening for variants in FUS as it remains the most frequent genetic determinant of early onset, JALS (found in 30% of our patients). © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Ischaemic memory imaging using metabolic radiopharmaceuticals: overview of clinical settings and ongoing investigations.

    Science.gov (United States)

    Yoshinaga, Keiichiro; Naya, Masanao; Shiga, Tohru; Suzuki, Eriko; Tamaki, Nagara

    2014-02-01

    "Ischaemic memory" is defined as a prolonged functional and/or biochemical alteration remaining after a particular episode of severe myocardial ischaemia. The biochemical alteration has been reported as metabolic stunning. Metabolic imaging has been used to detect the footprint left by previous ischaemic episodes evident due to delayed recovery of myocardial metabolism (persistent dominant glucose utilization with suppression of fatty acid oxidation). β-Methyl-p-[(123)I]iodophenylpentadecanoic acid (BMIPP) is a single-photon emission computed tomography (SPECT) radiotracer widely used for metabolic imaging in clinical settings in Japan. In patients with suspected coronary artery disease but no previous myocardial infarction, BMIPP has shown acceptable diagnostic accuracy. In particular, BMIPP plays an important role in the identification of prior ischaemic insult in patients arriving at emergency departments with acute chest pain syndrome. Recent data also show the usefulness of (123)I-BMIPP SPECT for predicting cardiovascular events in patients undergoing haemodialysis. Similarly, SPECT or PET imaging with (18)F-FDG injected during peak exercise or after exercise under fasting conditions shows an increase in FDG uptake in postischaemic areas. This article will overview the roles of ischaemic memory imaging both under established indications and in ongoing investigations.

  14. New approaches to chemotherapy-induced nausea and vomiting: from neuropharmacology to clinical investigations.

    Science.gov (United States)

    Rubenstein, Edward B; Slusher, Barbara S; Rojas, Camilo; Navari, Rudolph M

    2006-01-01

    Nausea and vomiting are considered to be among the most distressing consequences of cytotoxic chemotherapies. Currently, there are several novel 5-HT(3) receptor antagonists for the treatment of chemotherapy-induced nausea and vomiting (CINV), including ondansetron, granisetron, and dolasetron. These agents provide significant improvement in the management of acute emesis but are ineffective at preventing delayed emesis. In 2003, a new 5-HT(3) receptor antagonist, palonosetron HCL (Aloxi), was introduced to the U.S. market. Palonosetron was found to be effective in preventing delayed CINV. Indeed, palonosetron was the first and only 5-HT(3) receptor antagonist approved by the FDA for the prevention of both acute and delayed CINV. More recently, studies on the role of substance P in the emetic process led to the development of aprepitant (Emend) for the prevention of delayed emesis in combination with 5-HT(3) receptor antagonists. Despite these major advances, CINV remains uncontrolled in some patients. Current efforts are focused on treating refractory emesis and include both the clinical evaluation of compounds marketed for other indications and the preclinical evaluation of novel molecules targeting other transmitters in the emetic pathway. Ongoing work in pharmacogenomics has postulated several candidate genes that could be involved in emetic sensitivity and responsiveness to antiemetic therapy. Investigations into the pharmacogenomics of CINV may someday be able to aid in the identification of high risk patients and patients unlikely to respond to conventional therapies.

  15. Investigating Treatment Outcomes Across OCD Symptom Dimensions in a Clinical Sample of OCD Patients.

    Science.gov (United States)

    Chase, Tannah; Wetterneck, Chad T; Bartsch, Robert A; Leonard, Rachel C; Riemann, Bradley C

    2015-01-01

    Despite the heterogeneous nature of obsessive-compulsive disorder (OCD), many self-report assessments do not adequately capture the clinical picture presenting within each symptom dimension, particularly unacceptable thoughts (UTs). In addition, obsessions and ordering/arranging compulsions are often underrepresented in samples of treatment outcome studies for OCD. Such methodological discrepancies may obscure research findings comparing treatment outcomes across OCD symptom dimensions. This study aimed to improve upon previous research by investigating treatment outcomes across OCD symptom dimensions using the Dimensional Obsessive-Compulsive Scale, which offers a more comprehensive assessment of UTs. The study included a primarily residential sample of 134 OCD patients. Results indicated that there were no significant differences in treatment outcomes across symptom dimensions. However, the severity of UTs remained significantly greater than other symptom dimensions at both admission and discharge. Thus, it is possible that UTs may exhibit uniquely impairing features, compared with other symptom dimensions. It is also possible that these findings may reflect the characteristics of the residential OCD samples. These speculations as well as implications for OCD treatment and future research are discussed.

  16. Recognition of food-allergic patients and their allergens by RAST technique and clinical investigation

    International Nuclear Information System (INIS)

    Wraith, D.G.; Merrett, J.; Roth, A.; Yman, L.; Merrett, T.G.

    1979-01-01

    Sera from 119 patients with possible food allergies were tested against a panel of thirteen food allergens by the RAST method. The results were compared with in vivo tests. 79% of foods causing symptoms gave a positive RAST to the specific food. Symptoms were grouped according to their time of appearance after taking the food 'immediate' up to 1 hr and 'non-immediate' more than 1 hr afterwards. Almost all those with 'immediate' symptoms were already aware of the foods causing them and there was a 100% correlation of the RAST results with these. Only a few of those with 'non-immediate' symptoms were previously aware that these foods were responsible, and 64% of these gave a positive RAST. The majority of patients with a positive RAST result had total IgE in excess of 300 u/ml, had specific IgE antibodies against one or more common inhalant allergens, were under the age of 30 years and had a combination of asthma and eczema. The RAST method was found to be a useful and safe guide upon which to base a clinical investigation of food allergy, especially for patients whose symptoms appeared more than 1 hr after the food and in whom the relationship between their symptoms and food was not apparent. The RAST technique was surprisingly successful in identifying the foods which caused these 'non-immediate' symptoms. (author)

  17. How Do Emergency Medicine Residency Programs Structure Their Clinical Competency Committees? A Survey.

    Science.gov (United States)

    Doty, Christopher I; Roppolo, Lynn P; Asher, Shellie; Seamon, Jason P; Bhat, Rahul; Taft, Stephanie; Graham, Autumn; Willis, James

    2015-11-01

    The Accreditation Council for Graduate Medical Education (ACGME) recently has mandated the formation of a clinical competency committee (CCC) to evaluate residents across the newly defined milestone continuum. The ACGME has been nonproscriptive of how these CCCs are to be structured in order to provide flexibility to the programs. No best practices for the formation of CCCs currently exist. We seek to determine common structures of CCCs recently formed in the Council of Emergency Medicine Residency Directors (CORD) member programs and identify unique structures that have been developed. In this descriptive study, an 18-question survey was distributed via the CORD listserv in the late fall of 2013. Each member program was asked questions about the structure of its CCC. These responses were analyzed with simple descriptive statistics. A total of 116 of the 160 programs responded, giving a 73% response rate. Of responders, most (71.6%) CCCs are chaired by the associate or assistant program director, while a small number (14.7%) are chaired by a core faculty member. Program directors (PDs) chair 12.1% of CCCs. Most CCCs are attended by the PD (85.3%) and selected core faculty members (78.5%), leaving the remaining committees attended by any core faculty. Voting members of the CCC consist of the residency leadership either with the PD (53.9%) or without the PD (36.5%) as a voting member. CCCs have an average attendance of 7.4 members with a range of three to 15 members. Of respondents, 53.1% of CCCs meet quarterly while 37% meet monthly. The majority of programs (76.4%) report a system to match residents with a faculty mentor or advisor. Of respondents, 36% include the resident's faculty mentor or advisor to discuss a particular resident. Milestone summaries (determination of level for each milestone) are the primary focus of discussion (93.8%), utilizing multiple sources of information. The substantial variability and diversity found in our CORD survey of CCC structure

  18. An investigation of the role of parental request for self-correction of stuttering in the Lidcombe Program.

    Science.gov (United States)

    Donaghy, Michelle; Harrison, Elisabeth; O'Brian, Sue; Menzies, Ross; Onslow, Mark; Packman, Ann; Jones, Mark

    2015-01-01

    The Lidcombe Program is a behavioural treatment for stuttering in children younger than 6 years that is supported by evidence of efficacy and effectiveness. The treatment incorporates parent verbal contingencies for stutter-free speech and for stuttering. However, the contribution of those contingencies to reductions in stuttering in the program is unclear. Thirty-four parent-child dyads were randomized to two treatment groups. The control group received standard Lidcombe Program and the experimental group received Lidcombe Program without instruction to parents to use the verbal contingency request for self-correction. Treatment responsiveness was measured as time to 50% stuttering severity reduction. No differences were found between groups on primary outcome measures of the number of weeks and clinic visits to 50% reduction in stuttering severity. This clinical experiment challenges the assumption that the verbal contingency request for self-correction contributes to treatment efficacy. Results suggest the need for further research to explore this issue.

  19. Use of a Relational Database to Support Clinical Research: Application in a Diabetes Program

    Science.gov (United States)

    Lomatch, Diane; Truax, Terry; Savage, Peter

    1981-01-01

    A database has been established to support conduct of clinical research and monitor delivery of medical care for 1200 diabetic patients as part of the Michigan Diabetes Research and Training Center (MDRTC). Use of an intelligent microcomputer to enter and retrieve the data and use of a relational database management system (DBMS) to store and manage data have provided a flexible, efficient method of achieving both support of small projects and monitoring overall activity of the Diabetes Center Unit (DCU). Simplicity of access to data, efficiency in providing data for unanticipated requests, ease of manipulations of relations, security and “logical data independence” were important factors in choosing a relational DBMS. The ability to interface with an interactive statistical program and a graphics program is a major advantage of this system. Out database currently provides support for the operation and analysis of several ongoing research projects.

  20. Patients' and physicians' satisfaction with a pharmacist managed anticoagulation program in a family medicine clinic.

    Science.gov (United States)

    Bishop, Lisa; Young, Stephanie; Twells, Laurie; Dillon, Carla; Hawboldt, John

    2015-06-09

    A pharmacist managed anticoagulation service was initiated in a multi-physician family medicine clinic in December 2006. In order to determine the patient and physician satisfaction with the service, a study was designed to describe the patients' satisfaction with the warfarin education and management they received from the pharmacist, and to describe the physicians' satisfaction with the level of care provided by the pharmacist for patients taking warfarin. A self-administered survey was completed by both eligible patients receiving warfarin and physicians prescribing warfarin between December 2006 and May 2008. The patient survey collected information on patient demographics, satisfaction with warfarin education and daily warfarin management. The physician survey collected data about the satisfaction with patient education and daily anticoagulation management by the pharmacist. Seventy-six of 94 (81%) patients completed the survey. Fifty-nine percent were male with a mean age of 65 years (range 24-90). Ninety-six percent agreed/strongly agreed the pharmacist did a good job teaching the importance of warfarin adherence, the necessity of INR testing and the risks of bleeding. Eighty-five percent agreed/strongly agreed the risk of blood clots was well explained, 79% felt the pharmacist did a good job teaching about dietary considerations and 77% agreed/strongly agreed the pharmacist explained when to see a doctor. All patients felt the pharmacist gave clear instructions on warfarin dosing and INR testing. Four of nine physicians (44%) completed the survey. All agreed/strongly agreed the pharmacist was competent in the care provided, were confident in the care their patients received, would like the pharmacist to continue the service, and would recommend this program to other clinics. Patients and family physicians were satisfied with the pharmacist managed anticoagulation program and recommended continuation of the program. These results support the role of the

  1. A Systematic Review of the Effects of Continuing Education Programs on Providing Clinical Community Pharmacy Services

    Science.gov (United States)

    Marques dos Reis, Tiago; Guidoni, Camilo Molino; Girotto, Edmarlon; Guerra, Marisabelle Lima; de Oliveira Baldoni, André; Leira Pereira, Leonardo Régis

    2016-01-01

    Objective. To summarize the effects of media methods used in continuing education (CE) programs on providing clinical community pharmacy services and the methods used to evaluate the effectiveness of these programs. Methods. A systematic review was performed using Medline, SciELO, and Scopus databases. The timeline of the search was 1990 to 2013. Searches were conducted in English, Portuguese, and Spanish. Results. Nineteen articles of 3990 were included. Fourteen studies used only one media method, and the live method (n=11) was the most frequent (alone or in combination). Only two studies found that the CE program was ineffective or partially effective; these studies used only the live method. Most studies used nonrobust, nonvalidated, and nonstandardized methods to measure effectiveness. The majority of studies focused on the effect of the CE program on modifying the knowledge and skills of the pharmacists. One study assessed the CE program’s benefits to patients or clients. Conclusion. No evidence was obtained regarding which media methods are the most effective. Robust and validated methods, as well as assessment standardization, are required to clearly determine whether a particular media method is effective. PMID:27402991

  2. Adherence to Radiology Recommendations in a Clinical CT Lung Screening Program.

    Science.gov (United States)

    Alshora, Sama; McKee, Brady J; Regis, Shawn M; Borondy Kitts, Andrea K; Bolus, Christopher C; McKee, Andrea B; French, Robert J; Flacke, Sebastian; Wald, Christoph

    2018-02-01

    Assess patient adherence to radiologist recommendations in a clinical CT lung cancer screening program. Patients undergoing CT lung cancer screening between January 12, 2012, and June 12, 2013, were included in this institutional review board-approved retrospective review. Patients referred from outside our institution were excluded. All patients met National Comprehensive Cancer Network Guidelines Lung Cancer Screening high-risk criteria. Full-time program navigators used a CT lung screening program management system to schedule patient appointments, generate patient result notification letters detailing the radiologist follow-up recommendation, and track patient and referring physician notification of missed appointments at 30, 60, and 90 days. To be considered adherent, patients could be no more than 90 days past due for their next recommended examination as of September 12, 2014. Patients who died, were diagnosed with cancer, or otherwise became ineligible for screening were considered adherent. Adherence rates were assessed across multiple variables. During the study interval, 1,162 high-risk patients were screened, and 261 of 1,162 (22.5%) outside referrals were excluded. Of the remaining 901 patients, 503 (55.8%) were male, 414 (45.9%) were active smokers, 377 (41.8%) were aged 65 to 73, and >95% were white. Of the 901 patients, 772 (85.7%) were adherent. Most common reasons for nonadherence were patient refusal of follow-up exam (66.7%), inability to successfully contact the patient (20.9%), and inability to obtain the follow-up order from the referring provider (7.8%); 23 of 901 (2.6%) were discharged for other reasons. High rates of adherence to radiologist recommendations are achievable for in-network patients enrolled in a clinical CT lung screening program. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  3. Derivation of cell population kinetic parameters from clinical statistical data (program RAD3)

    International Nuclear Information System (INIS)

    Cohen, L.

    1978-01-01

    Cellular lethality models generally require up to 6 parameters to simulate a clinical course of fractionated radiation therapy and to derive an estimate of the cellular surviving fraction for a given treatment scheme. These parameters are the mean cellular lethal dose, the extrapolation number, the ratio of sublethal to irreparable events, the regeneration rate, the repopulation limit (cell cycles), and a field-size or tumor-volume factor. A computer program (RAD3) was designed to derive best-fitting values for these parameters in relation to available clinical data based on the assumption that if a number of different fractionation schemes yield similar reactions, the cellular surviving fractions will be about equal in each instance. Parameters were derived for a variety of human tissues from which realistic iso-effect functions could be generated

  4. Reconciling pairs of concurrently used clinical practice guidelines using Constraint Logic Programming.

    Science.gov (United States)

    Wilk, Szymon; Michalowski, Martin; Michalowski, Wojtek; Hing, Marisela Mainegra; Farion, Ken

    2011-01-01

    This paper describes a new methodological approach to reconciling adverse and contradictory activities (called points of contention) occurring when a patient is managed according to two or more concurrently used clinical practice guidelines (CPGs). The need to address these inconsistencies occurs when a patient with more than one disease, each of which is a comorbid condition, has to be managed according to different treatment regimens. We propose an automatic procedure that constructs a mathematical guideline model using the Constraint Logic Programming (CLP) methodology, uses this model to identify and mitigate encountered points of contention, and revises the considered CPGs accordingly. The proposed procedure is used as an alerting mechanism and coupled with a guideline execution engine warns the physician about potential problems with the concurrent application of two or more guidelines. We illustrate the operation of our procedure in a clinical scenario describing simultaneous use of CPGs for duodenal ulcer and transient ischemic attack.

  5. Clinical observations of a Cantonese cognitive-behavioral treatment program for Chinese immigrants.

    Science.gov (United States)

    Shen, Edward K; Alden, Lynn E; Söchting, Ingrid; Tsang, Pheobe

    2006-01-01

    In this article, the authors describe our clinical observations about the process of delivering a Cantonese-language cognitive- behavioral therapy program to treat depression in Hong Kong immigrants to Vancouver, Canada. Our experiences indicated that standard referral and assessment procedures were not optimal for this population. Other factors that required consideration were how to convert Cantonese terms for dysphoric affect into English equivalents and how to implement cognitive modification strategies when dealing with culture-syntonic beliefs about social relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

  6. Clinical, Bacteriologic, and Geographic Stratification of Melioidosis Emerges from the Sri Lankan National Surveillance Program.

    Science.gov (United States)

    Sathkumara, Harindra D; Merritt, Adam J; Corea, Enoka M; Krishnananthasivam, Shivankari; Natesan, Mohan; Inglis, Timothy J J; De Silva, Aruna Dharshan

    2018-02-01

    Melioidosis, a potentially fatal tropical infection, is said to be underdiagnosed in low-income countries. An increase in melioidosis cases in Sri Lanka allowed us to analyze the relationship among clinical outcome, bacteriology, epidemiology, and geography in the first 108 laboratory-confirmed cases of melioidosis from a nationwide surveillance program. The additional 76 cases of laboratory-confirmed melioidosis confirmed further associations between Burkholderia pseudomallei multilocus sequence typing (MLST) and infection phenotype; ST1137/unifocal bacteremic infection (χ 2 = 3.86, P national genotyping-supported melioidosis registry will improve melioidosis diagnosis, treatment, and prevention where underdiagnosis and mortality rates remain high.

  7. Clinical Investigation Program, Reports Control Symbol MED-300(R1), Fiscal Year 1988

    Science.gov (United States)

    1988-10-01

    MOREAU GORDON A, BOUCEK ROBERT Jr, GRAHAM THOMAS P Jr: "Acute shift of right ventricular distensibility after balloon pulmonary valvuloplasty"/Washington...allowing dynamic torsional forces to be recorded at set velocities throughout a pre-selected range of motion using both concentric and eccentric muscular

  8. Bioethics of life programs: taking seriously moral pluralism in clinical settings.

    Science.gov (United States)

    Niebroj, Leslaw

    2010-11-04

    In the more and more globalized world, the experience of moral pluralism (often related to, or based upon, religious pluralism) has become a common issue which ethical importance is undeniable. Potential conflicts between patients' and therapeutic teams' moral views and between moral beliefs of the particular member of this team are being resolved in the light of bioethical theories, among which principlism remains the mainstream approach to biomedical ethics. The question arises, however, whether this approach, in itself, as being strictly bound to the specific and distinct American philosophical tradition, is to be considered the tool for so called ?moral imperialism'. Also architectures of principlism, in particular by elaborating the concept of common morality, defend the applicability of their theory to the pluralistic settings, it should be emphasized that the idea that some norms and standards of moral character are shared by all morally serious people in every culture has attracted criticism both from empirical as well as theoretical backgrounds. This paper aims at reconsidering principlism so that it would be more suitable for resolving moral dilemma in ethically pluralistic clinical settings. Lakatos' sophisticated methodological falsification is used into two different ways: (1) to construct a concept of 'life programs' and (2) to confront a newly elaborated ethical theory with principlism. The reflection is limited to the norms related to the key issue in clinical ethics, i.e., respecting the patient's autonomy. The concepts of common morality and particular moralities are interpreted (in the light of Lakatos' philosophy of sciences) as "hard core" and "protective belt" of life programs, respectively. Accepting diversity of research programs, Lakatos maintains the idea of the objectivity of truth. Analogously, the plurality of life programs does not put into question the objectivity of moral values. The plurality of moral norms not only respects the

  9. Older Adults' Perceptions of Clinical Fall Prevention Programs: A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Rebecca Calhoun

    2011-01-01

    Full Text Available Objective. To investigate motivational factors and barriers to participating in fall risk assessment and management programs among diverse, low-income, community-dwelling older adults who had experienced a fall. Methods. Face-to-face interviews with 20 elderly who had accepted and 19 who had not accepted an invitation to an assessment by one of two fall prevention programs. Interviews covered healthy aging, core values, attributions/consequences of the fall, and barriers/benefits of fall prevention strategies and programs. Results. Joiners and nonjoiners of fall prevention programs were similar in their experience of loss associated with aging, core values they expressed, and emotional response to falling. One difference was that those who participated endorsed that they “needed” the program, while those who did not participate expressed a lack of need. Conclusions. Interventions targeted at a high-risk group need to address individual beliefs as well as structural and social factors (transportation issues, social networks to enhance participation.

  10. Evaluation of a clinic-based cholinesterase test kit for the Washington State Cholinesterase Monitoring Program.

    Science.gov (United States)

    Hofmann, Jonathan N; Carden, Angela; Fenske, Richard A; Ruark, Harold E; Keifer, Matthew C

    2008-07-01

    The Washington State Cholinesterase Monitoring Program for pesticide handlers requires blood draws at local clinics, with samples tested at a central laboratory. At present, workers with inhibited cholinesterase activity may be re-exposed before they can be removed from work. In this study we explored the option of on-site testing at local clinics using the EQM Test-mate Kittrade mark, a portable cholinesterase test kit. Test kit cholinesterase activity measurements were performed on 50 blood samples by our research staff, and compared to measurements on the same samples by the Washington State Public Health Laboratory. Another set of samples was also analyzed with the test kit by medical staff at an eastern Washington clinic. Triplicate measurements with the test kit had a 3.3% average coefficient of variation (CV) for plasma cholinesterase (PChE), and a 3.5% average CV for erythrocyte cholinesterase (AChE) measurements. The kit's PChE measurements were similar to PHL measurements (average ratio of 0.98) when performed in the laboratory, but had a tendency to underestimate activity when used in the clinic setting (average ratio of 0.87). The kit systematically overestimated AChE activity by 42-48% relative to the PHL measurements, regardless of where the samples were analyzed. This easy-to-use test kit appeared to be a viable method for clinic-based PChE measurements, but was less consistent for AChE measurements performed in the clinic. Absolute measurements with the kit need to be evaluated carefully relative to standardized methods. (c) 2008 Wiley-Liss, Inc.

  11. Augmenting Predictive Modeling Tools with Clinical Insights for Care Coordination Program Design and Implementation.

    Science.gov (United States)

    Johnson, Tracy L; Brewer, Daniel; Estacio, Raymond; Vlasimsky, Tara; Durfee, Michael J; Thompson, Kathy R; Everhart, Rachel M; Rinehart, Deborath J; Batal, Holly

    2015-01-01

    The Center for Medicare and Medicaid Innovation (CMMI) awarded Denver Health's (DH) integrated, safety net health care system $19.8 million to implement a "population health" approach into the delivery of primary care. This major practice transformation builds on the Patient Centered Medical Home (PCMH) and Wagner's Chronic Care Model (CCM) to achieve the "Triple Aim": improved health for populations, care to individuals, and lower per capita costs. This paper presents a case study of how DH integrated published predictive models and front-line clinical judgment to implement a clinically actionable, risk stratification of patients. This population segmentation approach was used to deploy enhanced care team staff resources and to tailor care-management services to patient need, especially for patients at high risk of avoidable hospitalization. Developing, implementing, and gaining clinical acceptance of the Health Information Technology (HIT) solution for patient risk stratification was a major grant objective. In addition to describing the Information Technology (IT) solution itself, we focus on the leadership and organizational processes that facilitated its multidisciplinary development and ongoing iterative refinement, including the following: team composition, target population definition, algorithm rule development, performance assessment, and clinical-workflow optimization. We provide examples of how dynamic business intelligence tools facilitated clinical accessibility for program design decisions by enabling real-time data views from a population perspective down to patient-specific variables. We conclude that population segmentation approaches that integrate clinical perspectives with predictive modeling results can better identify high opportunity patients amenable to medical home-based, enhanced care team interventions.

  12. Clinical integration and how it affects student retention in undergraduate athletic training programs.

    Science.gov (United States)

    Young, Allison; Klossner, Joanne; Docherty, Carrie L; Dodge, Thomas M; Mensch, James M

    2013-01-01

    A better understanding of why students leave an undergraduate athletic training education program (ATEP), as well as why they persist, is critical in determining the future membership of our profession. To better understand how clinical experiences affect student retention in undergraduate ATEPs. Survey-based research using a quantitative and qualitative mixed-methods approach. Three-year undergraduate ATEPs across District 4 of the National Athletic Trainers' Association. Seventy-one persistent students and 23 students who left the ATEP prematurely. Data were collected using a modified version of the Athletic Training Education Program Student Retention Questionnaire. Multivariate analysis of variance was performed on the quantitative data, followed by a univariate analysis of variance on any significant findings. The qualitative data were analyzed through inductive content analysis. A difference was identified between the persister and dropout groups (Pillai trace = 0.42, F(1,92) = 12.95, P = .01). The follow-up analysis of variance revealed that the persister and dropout groups differed on the anticipatory factors (F(1,92) = 4.29, P = .04), clinical integration (F(1,92) = 6.99, P = .01), and motivation (F(1,92) = 43.12, P = .01) scales. Several themes emerged in the qualitative data, including networks of support, authentic experiential learning, role identity, time commitment, and major or career change. A perceived difference exists in how athletic training students are integrated into their clinical experiences between those students who leave an ATEP and those who stay. Educators may improve retention by emphasizing authentic experiential learning opportunities rather than hours worked, by allowing students to take on more responsibility, and by facilitating networks of support within clinical education experiences.

  13. Clinical Integration and How It Affects Student Retention in Undergraduate Athletic Training Programs

    Science.gov (United States)

    Young, Allison; Klossner, Joanne; Docherty, Carrie L; Dodge, Thomas M; Mensch, James M

    2013-01-01

    Context A better understanding of why students leave an undergraduate athletic training education program (ATEP), as well as why they persist, is critical in determining the future membership of our profession. Objective To better understand how clinical experiences affect student retention in undergraduate ATEPs. Design Survey-based research using a quantitative and qualitative mixed-methods approach. Setting Three-year undergraduate ATEPs across District 4 of the National Athletic Trainers' Association. Patients or Other Participants Seventy-one persistent students and 23 students who left the ATEP prematurely. Data Collection and Analysis Data were collected using a modified version of the Athletic Training Education Program Student Retention Questionnaire. Multivariate analysis of variance was performed on the quantitative data, followed by a univariate analysis of variance on any significant findings. The qualitative data were analyzed through inductive content analysis. Results A difference was identified between the persister and dropout groups (Pillai trace = 0.42, F1,92 = 12.95, P = .01). The follow-up analysis of variance revealed that the persister and dropout groups differed on the anticipatory factors (F1,92 = 4.29, P = .04), clinical integration (F1,92 = 6.99, P = .01), and motivation (F1,92 = 43.12, P = .01) scales. Several themes emerged in the qualitative data, including networks of support, authentic experiential learning, role identity, time commitment, and major or career change. Conclusions A perceived difference exists in how athletic training students are integrated into their clinical experiences between those students who leave an ATEP and those who stay. Educators may improve retention by emphasizing authentic experiential learning opportunities rather than hours worked, by allowing students to take on more responsibility, and by facilitating networks of support within clinical education experiences. PMID:23672327

  14. Animal investigation program 1975 annual report: Nevada Test Site and vicinity

    International Nuclear Information System (INIS)

    Smith, D.D.; Giles, K.R.; Bernhardt, D.E.; Brown, K.W.

    1978-02-01

    Data are presented from the radioanalysis of tissues collected from cattle, deer, desert bighorn sheep, and other wildlife that resided on or near the Nevada Test Site during 1975. Routine activities and special investigations of the Animal Investigation Program are also discussed. Other than the naturally occurring potassium-40, gamma-emitting radionuclides are detected infrequently. Tritium concentrations in the tissues from most of the animals sampled were at background levels. Strontium-90 levels in bones from deer and cattle were slightly lower than those reported for the preceding year while levels in desert bighorn sheep bones were elevated. A graph depicts the average levels found in the bones of the three species from 1956 through 1975. The gross and microscopic lesions found in necropsied animals are discussed. In general, these lesions are consistent with the physical condition of the animal and type of population sampled. No gross or microscopic lesions were detected that could be directly attributed to the effects of ionizing radiation

  15. Molecular typing and epidemiological investigation of clinical populations of Pseudomonas aeruginosa using an oligonucleotide-microarray

    Directory of Open Access Journals (Sweden)

    Ballarini Annalisa

    2012-07-01

    Full Text Available Abstract Background Pseudomonas aeruginosa is an opportunistic pathogen which has the potential to become extremely harmful in the nosocomial environment, especially for cystic fibrosis (CF patients, who are easily affected by chronic lung infections. For epidemiological purposes, discriminating P.aeruginosa isolates is a critical step, to define distribution of clones among hospital departments, to predict occurring microevolution events and to correlate clones to their source. A collection of 182 P. aeruginosa clinical strains isolated within Italian hospitals from patients with chronic infections, i.e. cystic fibrosis (CF patients, and with acute infections were genotyped. Molecular typing was performed with the ArrayTube (AT multimarker microarray (Alere Technologies GmbH, Jena, Germany, a cost-effective, time-saving and standardized method, which addresses genes from both the core and accessory P.aeruginosa genome. Pulsed-field gel electrophoresis (PFGE and multilocus sequence typing (MLST were employed as reference genotyping techniques to estimate the ArrayTube resolution power. Results 41 AT-genotypes were identified within our collection, among which 14 were novel and 27 had been previously described in publicly available AT-databases. Almost 30% of the genotypes belonged to a main cluster of clones. 4B9A, EC2A, 3C2A were mostly associated to CF-patients whereas F469, 2C1A, 6C22 to non CF. An investigation on co-infections events revealed that almost 40% of CF patients were colonized by more than one genotype, whereas less than 4% were observed in non CF patients. The presence of the exoU gene correlated with non-CF patients within the intensive care unit (ICU whereas the pKLC102-like island appeared to be prevalent in the CF centre. The congruence between the ArrayTube typing and PFGE or MLST was 0.077 and 0.559 (Adjusted Rand coefficient, respectively. AT typing of this Italian collection could be easily integrated with the global P

  16. A clinical investigation of force delivery systems for orthodontic space closure.

    Science.gov (United States)

    Nightingale, C; Jones, S P

    2003-09-01

    To investigate the force retention, and rates of space closure achieved by elastomeric chain and nickel titanium coil springs. Randomized clinical trial. Eastman Dental Hospital, London and Queen Mary's University Hospital, Roehampton, 1998-2000. Twenty-two orthodontic patients, wearing the pre-adjusted edgewise appliance undergoing space closure in opposing quadrants, using sliding mechanics on 0.019 x 0.025-inch posted stainless steel archwires. Medium-spaced elastomeric chain [Durachain, OrthoCare (UK) Ltd., Bradford, UK] and 9-mm nickel titanium coil springs [OrthoCare (UK) Ltd.] were placed in opposing quadrants for 15 patients. Elastomeric chain only was used in a further seven patients. The initial forces on placement and residual forces at the subsequent visit were measured with a dial push-pull gauge [Orthocare (UK) Ltd]. Study models of eight patients were taken before and after space closure, from which measurements were made to establish mean space closure. The forces were measured in grammes and space closure in millimetres. Fifty-nine per cent (31/53) of the elastomeric sample maintained at least 50 per cent of the initial force over a time period of 1-15 weeks. No sample lost all its force, and the mean loss was 47 per cent (range: 0-76 per cent). Nickel titanium coil springs lost force rapidly over 6 weeks, following that force levels plateaued. Forty-six per cent (12/26) maintained at least 50 per cent of their initial force over a time period of 1-22 weeks, and mean force loss was 48 per cent (range: 12-68 per cent). The rate of mean weekly space closure for elastomeric chain was 0.21 mm and for nickel titanium coil springs 0.26 mm. There was no relationship between the initial force applied and rate of space closure. None of the sample failed during the study period giving a 100 per cent response rate. In clinical use, the force retention of elastomeric chain was better than previously concluded. High initial forces resulted in high force decay

  17. [Development of clinical trial education program for pharmaceutical science students through small group discussion and role-playing using protocol].

    Science.gov (United States)

    Imakyure, Osamu; Shuto, Hideki; Nishikawa, Fumi; Hagiwara, Yoshifuka; Inoue, Sachiko; Koyanagi, Taeko; Hirakawa, Masaaki; Kataoka, Yasufumi

    2010-08-01

    The acquirement of basic knowledge of clinical trials and professional attitude in their practices is a general instructional objective in the Model Core Curriculum for Pharmaceutical Education. Unfortunately, the previous program of clinical trial education was not effective in the acquirement of a professional attitude in their practices. Then, we developed the new clinical trial education program using protocol through small group discussion (SGD) and roll-playing. Our program consists of 7 steps of practical training. In step 1, the students find some problems after presentation of the protocol including case and prescription. In step 2, they analyse the extracted problems and share the information obtained in SGD. In steps 3 and 5, five clinical case scenarios are presented to the students and they discuss which case is suitable for entry to the clinical trial or which case corresponds to the discontinuance criteria in the present designed protocol. In steps 4 and 6, the roll-playing is performed by teachers and students as doctors and clinical research coordinators (CRC) respectively. Further, we conducted a trial practice based on this program for the students. In the student's self-evaluation into five grades, the average score of the skill acquisition level in each step was 3.8-4.7 grade. Our clinical trial education program could be effective in educating the candidates for CRC or clinical pharmacists.

  18. Lake and lake-related drainage area parameters for site investigation program

    International Nuclear Information System (INIS)

    Blomqvist, P.; Brunberg, A.K.; Brydsten, L

    2000-09-01

    In this paper, a number of parameters of importance to a preliminary determination of the ecological function of lakes are presented. The choice of parameters have been made with respect to a model for the determination of the nature conservation values of lakes which is currently being developed by the authors of this report, but is also well suited for a general description of the lake type and the functioning of the inherent ecosystem. The parameters have been divided into five groups: 1) The location of the object relative important gradients in the surrounding nature; 2) The lake catchment area and its major constituents; 3) The lake morphometry; 4) The lake ecosystem; 5) Human-induced damages to the lake ecosystem. The first two groups, principally based on the climate, hydrology, geology and vegetation of the catchment area represent parameters that can be used to establish the rarity and representativity of the lake, and will in the context of site investigation program be used as a basis for generalisation of the results. The third group, the lake morphometry parameters, are standard parameters for the outline of sampling programmes and for calculations of the physical extension of different key habitats in the system. The fourth group, the ecosystem of the lake, includes physical, chemical and biological parameters required for determination of the stratification pattern, light climate, influence from the terrestrial ecosystem of the catchment area, trophic status, distribution of key habitats, and presence of fish and rare fauna and flora in the lake. In the context of site investigation program, the parameters in these two groups will be used for budget calculations of the flow of energy and material in the system. The fifth group, finally, describes the degree on anthropogenic influence on the ecosystem and will in the context of site investigation programmes be used to judge eventual malfunctioning within the entire, or parts of, the lake ecosystem

  19. Lake and lake-related drainage area parameters for site investigation program

    Energy Technology Data Exchange (ETDEWEB)

    Blomqvist, P.; Brunberg, A.K. [Uppsala Univ. (Sweden). Dept. of Limnology; Brydsten, L [Umeaa Univ. (Sweden). Dept. of Ecology and Environmental Science

    2000-09-01

    In this paper, a number of parameters of importance to a preliminary determination of the ecological function of lakes are presented. The choice of parameters have been made with respect to a model for the determination of the nature conservation values of lakes which is currently being developed by the authors of this report, but is also well suited for a general description of the lake type and the functioning of the inherent ecosystem. The parameters have been divided into five groups: (1) The location of the object relative important gradients in the surrounding nature; (2) The lake catchment area and its major constituents; (3) The lake morphometry; (4) The lake ecosystem; (5) Human-induced damages to the lake ecosystem. The first two groups, principally based on the climate, hydrology, geology and vegetation of the catchment area represent parameters that can be used to establish the rarity and representativity of the lake, and will in the context of site investigation program be used as a basis for generalisation of the results. The third group, the lake morphometry parameters, are standard parameters for the outline of sampling programmes and for calculations of the physical extension of different key habitats in the system. The fourth group, the ecosystem of the lake, includes physical, chemical and biological parameters required for determination of the stratification pattern, light climate, influence from the terrestrial ecosystem of the catchment area, trophic status, distribution of key habitats, and presence of fish and rare fauna and flora in the lake. In the context of site investigation program, the parameters in these two groups will be used for budget calculations of the flow of energy and material in the system. The fifth group, finally, describes the degree on anthropogenic influence on the ecosystem and will in the context of site investigation programmes be used to judge eventual malfunctioning within the entire, or parts of, the lake

  20. Impact of an educational program on nursing students' caring and self-perception in intensive clinical training in Jordan.

    Science.gov (United States)

    Khouri, Rawda

    2011-01-01

    Framing and development of clinical skills in nursing students during their clinical practice is critical because this can shape their future caring skills. Professional caring empowers patients and contributes to their well-being and health. Education may enhance the capacity of nurses to be effective caring practitioners. Their study program encourages caring behavior in nursing students, consequently affecting their professional self-perception. The present study investigated the effect of an educational program on caring behavior and professional self-perception in nursing students using a controlled pre/post test study design. The study sample consisted of 50 nursing students undertaking their final year in 2010-2011. Subjects were randomly assigned to either an experimental or a control group. The study was conducted in two critical care units affiliated to the Ma'an and Queen Rania hospitals in the south of Jordan. The instruments utilized were the Caring Dimensions Inventory, Nursing Students Attitude Observational Checklist, and Professional Self-Concept of Nurses Instrument. The study findings favor the effect of the educational program because there was increased knowledge and understanding of caring theory and related concepts, a more holistic approach to care, enhanced caring practices, and improved self-perception in the study group compared with the control group during different periods of assessment. The study group showed significantly better caring perception in psychological, technical, and professional terms than the control group during different periods of assessment. There was a significant positive trend of overall professional self-perception for the study group compared with the control group. Nursing curricula should incorporate concepts and principles that guide students in developing caring, safe, competent, and professional behavior. Nursing students must seek educational opportunities to acquire knowledge for role preparation, to

  1. "There are too many, but never enough": qualitative case study investigating routine coding of clinical information in depression.

    Science.gov (United States)

    Cresswell, Kathrin; Morrison, Zoe; Kalra, Dipak; Sheikh, Aziz

    2012-01-01

    We sought to understand how clinical information relating to the management of depression is routinely coded in different clinical settings and the perspectives of and implications for different stakeholders with a view to understanding how these may be aligned. Qualitative investigation exploring the views of a purposefully selected range of healthcare professionals, managers, and clinical coders spanning primary and secondary care. Our dataset comprised 28 semi-structured interviews, a focus group, documents relating to clinical coding standards and participant observation of clinical coding activities. We identified a range of approaches to coding clinical information including templates and order entry systems. The challenges inherent in clearly establishing a diagnosis, identifying appropriate clinical codes and possible implications of diagnoses for patients were particularly prominent in primary care. Although a range of managerial and research benefits were identified, there were no direct benefits from coded clinical data for patients or professionals. Secondary care staff emphasized the role of clinical coders in ensuring data quality, which was at odds with the policy drive to increase real-time clinical coding. There was overall no evidence of clear-cut direct patient care benefits to inform immediate care decisions, even in primary care where data on patients with depression were more extensively coded. A number of important secondary uses were recognized by healthcare staff, but the coding of clinical data to serve these ends was often poorly aligned with clinical practice and patient-centered considerations. The current international drive to encourage clinical coding by healthcare professionals during the clinical encounter may need to be critically examined.

  2. “There Are Too Many, but Never Enough": Qualitative Case Study Investigating Routine Coding of Clinical Information in Depression

    Science.gov (United States)

    Cresswell, Kathrin; Morrison, Zoe; Sheikh, Aziz; Kalra, Dipak

    2012-01-01

    Background We sought to understand how clinical information relating to the management of depression is routinely coded in different clinical settings and the perspectives of and implications for different stakeholders with a view to understanding how these may be aligned. Materials and Methods Qualitative investigation exploring the views of a purposefully selected range of healthcare professionals, managers, and clinical coders spanning primary and secondary care. Results Our dataset comprised 28 semi-structured interviews, a focus group, documents relating to clinical coding standards and participant observation of clinical coding activities. We identified a range of approaches to coding clinical information including templates and order entry systems. The challenges inherent in clearly establishing a diagnosis, identifying appropriate clinical codes and possible implications of diagnoses for patients were particularly prominent in primary care. Although a range of managerial and research benefits were identified, there were no direct benefits from coded clinical data for patients or professionals. Secondary care staff emphasized the role of clinical coders in ensuring data quality, which was at odds with the policy drive to increase real-time clinical coding. Conclusions There was overall no evidence of clear-cut direct patient care benefits to inform immediate care decisions, even in primary care where data on patients with depression were more extensively coded. A number of important secondary uses were recognized by healthcare staff, but the coding of clinical data to serve these ends was often poorly aligned with clinical practice and patient-centered considerations. The current international drive to encourage clinical coding by healthcare professionals during the clinical encounter may need to be critically examined. PMID:22937106

  3. The Air Force Mobile Forward Surgical Team (MFST): Using the Estimating Supplies Program to Validate Clinical Requirement

    National Research Council Canada - National Science Library

    Nix, Ralph E; Onofrio, Kathleen; Konoske, Paula J; Galarneau, Mike R; Hill, Martin

    2004-01-01

    .... The primary objective of the study was to provide the Air Force with the ability to validate clinical requirements of the MFST assemblage, with the goal of using NHRC's Estimating Supplies Program (ESP...

  4. Impact of an educational program on nursing students’ caring and self-perception in intensive clinical training in Jordan

    Directory of Open Access Journals (Sweden)

    Khouri RI

    2011-06-01

    Full Text Available Rawda KhouriAl Hussein Bin Talal University, Princess Aisha Bint Al Hussein College Of Nursing, Ma’an, JordanBackground: Framing and development of clinical skills in nursing students during their clinical practice is critical because this can shape their future caring skills. Professional caring empowers patients and contributes to their well-being and health. Education may enhance the capacity of nurses to be effective caring practitioners. Their study program encourages caring behavior in nursing students, consequently affecting their professional self-perception.Methods: The present study investigated the effect of an educational program on caring behavior and professional self-perception in nursing students using a controlled pre/post test study design. The study sample consisted of 50 nursing students undertaking their final year in 2010–2011. Subjects were randomly assigned to either an experimental or a control group. The study was conducted in two critical care units affiliated to the Ma’an and Queen Rania hospitals in the south of Jordan. The instruments utilized were the Caring Dimensions Inventory, Nursing Students Attitude Observational Checklist, and Professional Self-Concept of Nurses Instrument.Results: The study findings favor the effect of the educational program because there was increased knowledge and understanding of caring theory and related concepts, a more holistic approach to care, enhanced caring practices, and improved self-perception in the study group compared with the control group during different periods of assessment. The study group showed significantly better caring perception in psychological, technical, and professional terms than the control group during different periods of assessment. There was a significant positive trend of overall professional self-perception for the study group compared with the control group.Conclusion: Nursing curricula should incorporate concepts and principles that guide

  5. Model for investigating the benefits of clinical supervision in psychiatric nursing

    DEFF Research Database (Denmark)

    Gonge, Henrik; Buus, Niels

    2011-01-01

    with the effectiveness of clinical supervision, as measured by the Manchester Clinical Supervision Scale (MCSS). Furthermore, MCSS scores were associated with benefits, such as increased job satisfaction, vitality, rational coping and less stress, emotional exhaustion, and depersonalization. Multivariate analyses......The objective of this study was to test a model for analysing the possible benefits of clinical supervision. The model suggested a pathway from participation to effectiveness to benefits of clinical supervision, and included possible influences of individual and workplace factors. The study sample...

  6. Critical role of bioanalytical strategies in investigation of clinical PK observations, a Phase I case study

    Science.gov (United States)

    Peng, Kun; Xu, Keyang; Liu, Luna; Hendricks, Robert; Delarosa, Reginald; Erickson, Rich; Budha, Nageshwar; Leabman, Maya; Song, An; Kaur, Surinder; Fischer, Saloumeh K

    2014-01-01

    RG7652 is a human immunoglobulin 1 (IgG1) monoclonal antibody (mAb) targeting proprotein convertase subtilisin/kexin type 9 (PCSK9) and is designed for the treatment of hypercholesterolemia. A target-binding enzyme-linked immunosorbent assay (ELISA) was developed to measure RG7652 levels in human serum in a Phase I study. Although target-binding assay formats are generally used to quantify free therapeutic, the actual therapeutic species being measured are affected by assay conditions, such as sample dilution and incubation time, and levels of soluble target in the samples. Therefore, in the presence of high concentrations of circulating target, the choice of reagents and assay conditions can have a significant effect on the observed pharmacokinetic (PK) profiles. Phase I RG7652 PK analysis using the ELISA data resulted in a nonlinear dose normalized exposure. An investigation was conducted to characterize the ELISA to determine whether the assay format and reagents may have contributed to the PK observation. In addition, to confirm the ELISA results, a second orthogonal method, liquid chromatography tandem mass spectrometry (LC-MS/MS) using a signature peptide as surrogate, was developed and implemented. A subset of PK samples, randomly selected from half of the subjects in the 6 single ascending dose (SAD) cohorts in the Phase I clinical study, was analyzed with the LC-MS/MS assay, and the data were found to be comparable to the ELISA data. This paper illustrates the importance of reagent characterization, as well as the benefits of using an orthogonal approach to eliminate bioanalytical contributions when encountering unexpected observations. PMID:25484037

  7. Clinical prediction in defined populations: a simulation study investigating when and how to aggregate existing models

    Directory of Open Access Journals (Sweden)

    Glen P. Martin

    2017-01-01

    Full Text Available Abstract Background Clinical prediction models (CPMs are increasingly deployed to support healthcare decisions but they are derived inconsistently, in part due to limited data. An emerging alternative is to aggregate existing CPMs developed for similar settings and outcomes. This simulation study aimed to investigate the impact of between-population-heterogeneity and sample size on aggregating existing CPMs in a defined population, compared with developing a model de novo. Methods Simulations were designed to mimic a scenario in which multiple CPMs for a binary outcome had been derived in distinct, heterogeneous populations, with potentially different predictors available in each. We then generated a new ‘local’ population and compared the performance of CPMs developed for this population by aggregation, using stacked regression, principal component analysis or partial least squares, with redevelopment from scratch using backwards selection and penalised regression. Results While redevelopment approaches resulted in models that were miscalibrated for local datasets of less than 500 observations, model aggregation methods were well calibrated across all simulation scenarios. When the size of local data was less than 1000 observations and between-population-heterogeneity was small, aggregating existing CPMs gave better discrimination and had the lowest mean square error in the predicted risks compared with deriving a new model. Conversely, given greater than 1000 observations and significant between-population-heterogeneity, then redevelopment outperformed the aggregation approaches. In all other scenarios, both aggregation and de novo derivation resulted in similar predictive performance. Conclusion This study demonstrates a pragmatic approach to contextualising CPMs to defined populations. When aiming to develop models in defined populations, modellers should consider existing CPMs, with aggregation approaches being a suitable modelling

  8. Intradiscal electrothermal treatment for discogenic back pain: experimental investigation and preliminary clinical application

    International Nuclear Information System (INIS)

    Fang Wen; Teng Gaojun; He Shicheng; Guo Jinhe; Deng Gang; Zhu Guangyu; Li Guozhao; Ding Huijuan; Shen Zhiping

    2005-01-01

    Objective: To assess the effectiveness and the safety of IDET for chronic discogenic low back pain. Methods: Standard intradiscal electrothermal treatment were performed in two adjacent disc levels (L3-4, L4-5) of two domestic pigs. MRI were available at pretreatment, posttreatment of 1,2 weeks, and then the two animals were killed respectively at 1,2 weeks after the procedure. The specimens were then undergone thin sectioned and subjected to humatoxylin and eosin staining for histological investigation. 23 patients (totally 29 discs, including L2-3 to L5-S1) with chronic symptoms underwent IDET for clinical study. VAS (Visual Analog Scale) pain scores were collected before the treatment, 1 week and 3 months after the procedure. One way ANOVA was used for statistical analysis. Results: 4 discs of standard IDET models have been set up in two pigs showing normal MRI T2W1 signal of nucleus pulposus immediately after the procedure, but the high signal extent of the central part of the nucleo pulposus shrinked with conspicuous peripheral low signal changes during the following 1-2 W. Degeneration and shrinkage of nucleo-pulposus with lecolized fibrous ring thickening were found pathologically but without damage to nurve roots and epidural sac. 29 discs in 23 patients were performed successfully, without complication. The follow-up evaluation of 1 week and 3 months after the treatment showing significant differences with those before the treatment on was scores 65.3% and 78.9% respectively (P<0.0001). Conclusions: IDET is safe and effective for chronic discogenic low back pain. (authors)

  9. Clinical investigation of proximate exposed group. 1. A study for prevalence rate of diabetes mellitus

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Chikako; Hasegawa, Kazuyo; Kato, Masafumi; Kumasawa, Toshihiko

    1984-11-01

    In order to investigate effects of the A-bombing on prevalence of diabetes mellitus, follow-up studies were made on 5907 A-bomb survivors who received glucose tolerance test (GTT) during 20 years between 1963 and 1983. The A-bomb survivors were divided into the group A (1899 men and 1165 women exposed within 1.9 km from the hypocenter) and the group B (1725 men and 1118 women exposed 3.0 km or farther from it). Among non-obese survivors, 21.9% and 21.8% were being treated for diabetes mellitus or were evaluated as having diabetic type on GTT in the group A and the group B, respectively; while this was seen in 52.1% of obese survivors in the group A and 49.9% in the group B. There was no difference between the groups. In non-obese survivors, the annual development rate from the normal type to the diabetic type was 0.89% in the group A and 0.65% in the group B; the annual development rate from the borderline type to the diabetic type was 5.73% in the group A and 5.49% in the group B, showing no differences between the groups. The annual development rate from the normal or borderline type to the diabetic type was two times or higher in obese survivors than in non-obese survivors irrespective of exposure status. Regarding the number of diabetic survivors who became non-diabetic type in spite of having no treatment, and prevalence of diabetic complications, no difference was seen between the groups. These results suggest that the A-bombing has scarcely influenced the prevalence of diabetes mellitus and clinical course.

  10. [Non-commercial clinical trials--who will be the legal sponsor? Sponsorship of investigator-initiated clinical trials according to the German Drug Law].

    Science.gov (United States)

    Benninger-Döring, G; Boos, J

    2006-07-01

    Non-commercial clinical trials may be of great benefit to the patients concerned. The 12th amendment to the German Drug Law (AMG) changed legal liability of the initiators of investigator-initiated clinical trials with extensive consequences for traditional project leaders. The central point under discussion is the sponsor's responsibility according to the AMG. Presently leading management divisions of university hospitals and universities are developing proceedings to assume sponsor responsibility by institutions (institutional sponsorship), which should enable investigator-initiated clinical trials to be conducted according to legal requirements in the future. Detailed problems and special questions can only be resolved in a single-minded fashion, and if necessary political processes should be catalyzed.

  11. Radiochemical studies, pre-clinical investigation and preliminary clinical evaluation of "1"7"0Tm-EDTMP prepared using in-house freeze-dried EDTMP kit

    International Nuclear Information System (INIS)

    Das, Tapas; Shinto, Ajit; Kamaleshwaran, Koramadai K.; Sarma, Haladhar D.; Mohammed, Sahiralam Khan; Mitra, Arpit; Lad, Sangita; Rajan, M.G.R.; Banerjee, Sharmila

    2017-01-01

    The objective of the present work is to formulate "1"7"0Tm-EDTMP using an in-house freeze-dried EDTMP kit and evaluate its potential as a bone pain palliation agent. Patient dose of "1"7"0Tm-EDTMP was prepared with high radiochemical purity using the lyophilized kit at room temperature within 15 min. Pre-clinical evaluation in normal Wistar rats revealed selective skeletal accumulation with extended retention. Preliminary clinical investigation in 8 patients with disseminated skeletal metastases exhibited selective uptake in the bone and retention therein for a long duration. - Highlights: • Formulation of patient dose of "1"7"0Tm-EDTMP using freeze-dried EDTMP kit. • Radiochemical studies and pre-clinical evaluation of the agent in animal model. • Clinical evaluation in eight cancer patients with disseminated skeletal metastases.

  12. Mitigation of adverse interactions in pairs of clinical practice guidelines using constraint logic programming.

    Science.gov (United States)

    Wilk, Szymon; Michalowski, Wojtek; Michalowski, Martin; Farion, Ken; Hing, Marisela Mainegra; Mohapatra, Subhra

    2013-04-01

    We propose a new method to mitigate (identify and address) adverse interactions (drug-drug or drug-disease) that occur when a patient with comorbid diseases is managed according to two concurrently applied clinical practice guidelines (CPGs). A lack of methods to facilitate the concurrent application of CPGs severely limits their use in clinical practice and the development of such methods is one of the grand challenges for clinical decision support. The proposed method responds to this challenge. We introduce and formally define logical models of CPGs and other related concepts, and develop the mitigation algorithm that operates on these concepts. In the algorithm we combine domain knowledge encoded as interaction and revision operators using the constraint logic programming (CLP) paradigm. The operators characterize adverse interactions and describe revisions to logical models required to address these interactions, while CLP allows us to efficiently solve the logical models - a solution represents a feasible therapy that may be safely applied to a patient. The mitigation algorithm accepts two CPGs and available (likely incomplete) patient information. It reports whether mitigation has been successful or not, and on success it gives a feasible therapy and points at identified interactions (if any) together with the revisions that address them. Thus, we consider the mitigation algorithm as an alerting tool to support a physician in the concurrent application of CPGs that can be implemented as a component of a clinical decision support system. We illustrate our method in the context of two clinical scenarios involving a patient with duodenal ulcer who experiences an episode of transient ischemic attack. Copyright © 2013 Elsevier Inc. All rights reserved.

  13. The role of Clinical Trial Units in investigator- and industry-initiated research projects.

    Science.gov (United States)

    von Niederhäusern, Belinda; Fabbro, Thomas; Pauli-Magnus, Christiane

    2015-01-01

    Six multidisciplinary competence centres (Clinical Trial Units, CTUs) in Basel, Berne, Geneva, Lausanne, St. Gallen and Zurich provide professional support to clinical researchers in the planning, implementation, conduct and evaluation of clinical studies. Through their coordinated network, these units promote high-quality, nationally harmonised and internationally standardised clinical research conduct in Switzerland. We will describe why this network has been established, how it has been successful in stilling the growing need for clinical research support, which training and education opportunities it offers, and how it created national awareness for the still-existing hurdles towards clinical research excellence in Switzerland. Taking the CTU Basel as an example, we show that a considerable number (25%) of the studies submitted for regulatory approval in 2013 were supported by the CTU, decreasing the number of findings in ethics reviews by about one-third. We conclude that these achievements, together with a Swiss national funding model for clinical research, and improved national coordination, will be critical factors to successfully position Swiss clinical research at the international forefront.

  14. Clinical impact of diagnostic SPET investigations with a dopamine re-uptake ligand

    DEFF Research Database (Denmark)

    Løkkegaard, Annemette; Werdelin, Lene M; Friberg, Lars

    2002-01-01

    The diagnosis of Parkinson's disease is based on clinical features with pathological verification. However, autopsy has been found to confirm a specialist diagnosis in only about 75% of cases. Especially early in the course of the disease, the clinical diagnosis can be difficult. Imaging of presy...

  15. Does Islamic spiritual program lead to successful aging? A randomized clinical trial.

    Science.gov (United States)

    Moeini, Mahin; Sharifi, Somaye; Zandiyeh, Zahra

    2016-01-01

    Successful aging is a pattern of aging that has gained much attention during recent years. One factor that has a negative impact on successful aging variables is hypertension. The phenomenon of aging when accompanied with hypertension promotes spiritual needs. The aim of this study was to examine the effect of the Islamic spiritual program on successful aging in elderly patients with hypertension who were referred to health centers of Isfahan, Iran, in 2014. This study was a randomized clinical trial. The participants (52 elderly patients with hypertension) were randomly divided into experimental and control groups. While the control group received training related to health promotion, the Islamic spiritual program was implemented in the experimental group for eight sessions in two health centers of Isfahan. The data collection tools consisted of the 12-item General Health Questionnaire developed by Goldberg and the satisfaction with life scale developed by Diener. The questionnaires were completed in three steps; pretest, posttest, and follow-up (1-month). Data were analyzed using SPSS statistical software version 20 and Chi-square, independent t-test, and repeated measures ANOVA. Statistical tests showed that the mean score of general health and life satisfaction of the experiment group had a meaningful difference from that of the control group in the posttest stage (P < 0.001). This difference was also meaningful in the follow-up stage (P < 0.001). The results of the study indicated the effectiveness of an Islamic spiritual program on successful aging variables.

  16. Supporting adherence and healthy lifestyles in leg ulcer patients: systematic development of the Lively Legs program for dermatology outpatient clinics.

    NARCIS (Netherlands)

    Heinen, M.M.; Bartholomew, L.K.; Wensing, M.J.P.; Kerkhof, P.C.M. van de; Achterberg, T. van

    2006-01-01

    OBJECTIVES: The objective of our project was to develop a lifestyle program for leg ulcer patients at outpatient clinics for dermatology. METHODS: We used the intervention-mapping (IM) framework for systematically developing theory and evidence based health promotion programs. We started with a

  17. An Investigation of Factors Related to Self-Efficacy for Java Programming among Engineering Students

    Science.gov (United States)

    Askar, Petek; Davenport, David

    2009-01-01

    The purpose of this study was to examine the factors related to self-efficacy for Java programming among first year engineering students. An instrument assessing Java programming self-efficacy was developed from the computer programming self-efficacy scale of Ramalingam & Wiedenbeck. The instrument was administered at the beginning of the…

  18. Coordinated experimental/analytical program for investigating margins to failure of Category I reinforced concrete structures

    International Nuclear Information System (INIS)

    Endebrock, E.; Dove, R.; Anderson, C.A.

    1981-01-01

    The material presented in this paper deals with a coordinated experimental/analytical program designed to provide information needed for making margins to failure assessments of seismic Category I reinforced concrete structures. The experimental program is emphasized and background information that lead to this particular experimental approach is presented. Analytical tools being developed to supplement the experimental program are discussed. 16 figures

  19. Transfer of communication skills to the workplace during clinical rounds: impact of a program for residents.

    Science.gov (United States)

    Liénard, Aurore; Merckaert, Isabelle; Libert, Yves; Bragard, Isabelle; Delvaux, Nicole; Etienne, Anne-Marie; Marchal, Serge; Meunier, Julie; Reynaert, Christine; Slachmuylder, Jean-Louis; Razavi, Darius

    2010-08-26

    Communication with patients is a core clinical skill in medicine that can be acquired through communication skills training. Meanwhile, the importance of transfer of communication skills to the workplace has not been sufficiently studied. This study aims to assess the efficacy of a 40-hour training program designed to improve patients' satisfaction and residents' communication skills during their daily clinical rounds. Residents were randomly assigned to the training program or to a waiting list. Patients' satisfaction was assessed with a visual analog scale after each visit. Transfer of residents' communication skills was assessed in audiotaped actual inpatient visits during a half-day clinical round. Transcripted audiotapes were analyzed using content analysis software (LaComm). Training effects were tested with Mann-Whitney tests and generalized linear Poisson regression models. Eighty-eight residents were included. First, patients interacting with trained residents reported a higher satisfaction with residents' communication (Median=92) compared to patients interacting with untrained residents (Median=88) (p=.046). Second, trained residents used more assessment utterances (Relative Risk (RR)=1.17; 95% Confidence intervals (95%CI)=1.02-1.34; p=.023). Third, transfer was also observed when residents' training attendance was considered: residents' use of assessment utterances (RR=1.01; 95%CI=1.01-1.02; p=.018) and supportive utterances (RR=0.99; 95%CI=0.98-1.00; p=.042) (respectively 1.15 (RR), 1.08-1.23 (95%CI), ptransfer of residents' communication skills learning to the workplace. Transfer was directly related to training attendance but remained limited. Future studies should therefore focus on the improvement of the efficacy of communication skills training in order to ensure a more important training effect size on transfer.

  20. Predicting the performance of a strategic alliance: an analysis of the Community Clinical Oncology Program.

    Science.gov (United States)

    Kaluzny, A D; Lacey, L M; Warnecke, R; Hynes, D M; Morrissey, J; Ford, L; Sondik, E

    1993-06-01

    This study is designed to examine the effects of environment and structure of the Community Clinical Oncology Program (CCOP) on performance as measured by patient accrual to National Cancer Institute (NCI)-approved treatment protocols. Data and analysis are part of a larger evaluation of the NCI Community Clinical Oncology Program during its second funding cycle, June 1987-May 1990. Data, taken from primary and secondary sources, included a survey of selected informants in CCOPs and research bases, CCOP grant applications, CCOP annual progress reports, and site visits to a subsample of CCOPs (N = 20) and research bases (N = 5). Accrual data were obtained from NCI records. Analysis involved three complementary sets of factors: the local health care resources environment available to the CCOP, the larger policy environment as reflected by the relationship of the CCOP to selected research bases and the NCI, and the operational structure of the CCOP itself. A hierarchical model examined the separate and cumulative effects of local and policy environment and structure on performance. Other things equal, the primary predictors of treatment accrual were: (1) the larger policy environment, as measured by the attendance of nurses at research base meetings; and (2) operational structure, as measured by the number and character of components within participating CCOPs and the number of hours per week worked by data managers. These factors explained 73 percent of the total variance in accrual performance. Findings suggest criteria for selecting the types of organizations to participate in the alliance, as well as for establishing guidelines for managing such alliances. A future challenge is to determine the extent to which factors predicting accrual to cancer treatment clinical trials are equally important as predictors of accrual to cancer prevention and control trials.

  1. Implementing the objective structured clinical examination in a geriatrics fellowship program-a 3-year experience.

    Science.gov (United States)

    Avelino-Silva, Thiago J; Gil, Luiz A; Suemoto, Claudia K; Kikuchi, Elina L; Lin, Sumika M; Farias, Luciana L; Jacob-Filho, Wilson

    2012-07-01

    The Objective Structured Clinical Examination (OSCE) appears to be an effective alternative for assessing not only medical knowledge, but also clinical skills, including effective communication and physical examination skills. The purpose of the current study was to implement an OSCE model in a geriatrics fellowship program and to compare the instrument with traditional essay examination. Seventy first- and second-year geriatric fellows were initially submitted to a traditional essay examination and scored from 0 to 10 by a faculty member. The same fellows subsequently underwent an OSCE with eight 10-minute stations covering a wide range of essential aspects of geriatric knowledge. Each OSCE station had an examiner responsible for its evaluation according to a predefined checklist. Checklist items were classified for analysis purposes as clinical knowledge items (CKI) and communication skills items (CSI); fellow responses were scored from 0 to 10.Although essay examinations took from 30 to 45 minutes to complete, 180-200 minutes were required to evaluate fellows using the proposed OSCE method. Fellows scored an average of 6.2 ± 1.2 on the traditional essay examination and 6.6 ± 1.0 on the OSCE (P examination was similar to their performance on CKI (P = .13). Second-year fellows performed better than first-year fellows on the essay examination (P geriatrics fellowship program. Combining different testing modalities may provide the best assessment of competence for various domains of knowledge, skills, and behavior. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

  2. [Transference Focused Psychotherapy for Borderline-Adolescents in a Day Clinic Treatment Program].

    Science.gov (United States)

    Krischer, Maya; Ponton-Rodriguez, Tamara; Gooran, Ghazal Rostami; Bender, Stephan

    2017-07-01

    Transference Focused Psychotherapy for Borderline-Adolescents in a Day Clinic Treatment Program This paper focuses on the concept of transference focused psychotherapy (TFP) modified for juvenile borderline patients. Adolescents with borderline developmental personality disorder (bpd) have an essential deficit in their personality structure that leads to oscillations in their self-esteem and in a "split" perception of the world. They suffer from a variety of symptoms and severe impairments on their own and their families' quality of life. Their fragmented perception of themselves and others make relationships almost unbearable for them. Relationships are mostly marked by severe anxiety of resentment and rejection. For these patients this causes intolerable trouble at school where every day conflicts take place. Self-mutilation and suicidal thoughts often seem the only way out. By now, there is an agreement that an early specialized assessment and treatment is necessary in order to stop the typical consequences of their self-mutilative and dysfunctional behavior. Still, in contrast to adult age, empirical evidence is missing which proves the effectiveness of treating adolescent borderline patients. In this paper we present a research project on the effectiveness of transference focused psychotherapy with adolescent borderline patients (TFP-A) in a day clinic setting, combining TFP with group skills training as known from dialectic behavior therapy (DBT). Furthermore, we give first results on analyzing the effectiveness of our day clinic treatment program based on TFP-A, focusing on improving core symptoms such as affective problems, aggressive behavior against self and others and interpersonal problems.

  3. Investigations of efficacy of intramammary applied antimicrobials and glucocorticosteroides in the treatment of subclinical and clinical mastitis in cows

    OpenAIRE

    Vakanjac, Slobodanka; Pavlović, Vojislav; Magaš, Vladimir; Pavlović, Miloš; Đurić, Miloje; Maletić, Milan; Nedić, Svetlana; Sočo, Ivan

    2013-01-01

    Inflammation of the mammary gland, mastitis in cows, presents one of the most acute problems in intensive dairy production, inflicting huge economic losses. In the course of one year, 80 samples were taken at investigated farms from udder quarters of cows with clinical mastitis and 160 samples from udder quarters of cows with subclinical mastitis. The efficacy of three preparations, A, B, and C, was examined in the treatment of clinical and subclinical mast...

  4. Relationships between high-stakes clinical skills exam scores and program director global competency ratings of first-year pediatric residents

    Directory of Open Access Journals (Sweden)

    Erik E. Langenau

    2011-09-01

    Full Text Available Responding to mandates from the Accreditation Council for Graduate Medical Education (ACGME and American Osteopathic Association (AOA, residency programs have developed competency-based assessment tools. One such tool is the American College of Osteopathic Pediatricians (ACOP program directors’ annual report. High-stakes clinical skills licensing examinations, such as the Comprehensive Osteopathic Medical Licensing Examination Level 2-Performance Evaluation (COMLEX-USA Level 2-PE, also assess competency in several clinical domains.The purpose of this study is to investigate the relationships between program director competency ratings of first-year osteopathic residents in pediatrics and COMLEX-USA Level 2-PE scores from 2005 to 2009.The sample included all 94 pediatric first-year residents who took COMLEX-USA Level 2-PE and whose training was reviewed by the ACOP for approval of training between 2005 and 2009. Program director competency ratings and COMLEX-USA Level 2-PE scores (domain and component were merged and analyzed for relationships.Biomedical/biomechanical domain scores were positively correlated with overall program director competency ratings. Humanistic domain scores were not significantly correlated with overall program director competency ratings, but did show moderate correlation with ratings for interpersonal and communication skills. The six ACGME or seven AOA competencies assessed empirically by the ACOP program directors’ annual report could not be recovered by principal component analysis; instead, three factors were identified, accounting for 86% of the variance between competency ratings.A few significant correlations were noted between COMLEX-USA Level 2-PE scores and program director competency ratings. Exploring relationships between different clinical skills assessments is inherently difficult because of the heterogeneity of tools used and overlap of constructs within the AOA and ACGME core competencies.

  5. Relationships between high-stakes clinical skills exam scores and program director global competency ratings of first-year pediatric residents

    Science.gov (United States)

    Langenau, Erik E.; Pugliano, Gina; Roberts, William L.

    2011-01-01

    Background Responding to mandates from the Accreditation Council for Graduate Medical Education (ACGME) and American Osteopathic Association (AOA), residency programs have developed competency-based assessment tools. One such tool is the American College of Osteopathic Pediatricians (ACOP) program directors’ annual report. High-stakes clinical skills licensing examinations, such as the Comprehensive Osteopathic Medical Licensing Examination Level 2-Performance Evaluation (COMLEX-USA Level 2-PE), also assess competency in several clinical domains. Objective The purpose of this study is to investigate the relationships between program director competency ratings of first-year osteopathic residents in pediatrics and COMLEX-USA Level 2-PE scores from 2005 to 2009. Methods The sample included all 94 pediatric first-year residents who took COMLEX-USA Level 2-PE and whose training was reviewed by the ACOP for approval of training between 2005 and 2009. Program director competency ratings and COMLEX-USA Level 2-PE scores (domain and component) were merged and analyzed for relationships. Results Biomedical/biomechanical domain scores were positively correlated with overall program director competency ratings. Humanistic domain scores were not significantly correlated with overall program director competency ratings, but did show moderate correlation with ratings for interpersonal and communication skills. The six ACGME or seven AOA competencies assessed empirically by the ACOP program directors’ annual report could not be recovered by principal component analysis; instead, three factors were identified, accounting for 86% of the variance between competency ratings. Discussion A few significant correlations were noted between COMLEX-USA Level 2-PE scores and program director competency ratings. Exploring relationships between different clinical skills assessments is inherently difficult because of the heterogeneity of tools used and overlap of constructs within the AOA

  6. Animal investigation program: Nevada test site and vicinity. Annual report, 1977

    International Nuclear Information System (INIS)

    Smith, D.D.; Crockett, A.B.; Bernhardt, D.E.; Giles, K.R.; Kinnison, R.R.

    1979-07-01

    Data are presented from the radioanalysis of tissues collected from cattle, mule deer, desert bighorn sheep, rabbits, feral horses, and other wildlife that resided on or near the Nevada Test Site. Routine activities and special investigations of the Animal Investigation Program are also discussed. Other than potassium-40, gamma-emitting radionuclides were detected infrequently. Strontium-90 concentrations in bones from deer, cattle, and desert bighorn sheep continued the downward trend of recent years. Tritium concentrations were generally within expected environmental limits with the exception of animals exposed to sources of contamination. Radionuclide tissue concentrations were generally higher in the tissues of animals residing in Area 15 than in other areas. Statistical analyses made of plutonium-239 levels reported in cattle tissue collected from 1971 through 1977 reveal that activity levels in lungs, liver, and bone are significantly related to age. Activity levels did not change significantly in the ingesta and lungs during this time but did tend to increase for bone and liver. Activity levels in the ingesta are significantly higher in the fall than in the spring. Hypothetical dose estimates to man were calculated on the basis of liver or muscle from animals that contained peak radionuclide levels. The highest postulated dose was 8.6 millirems for tritium in tissues from a mule deer. The movements of 17 mule deer were monitored on a weekly basis.During the winter months, all deer left their summer range on the mesas of the Nevada Test Site and migrated 40 to 60 kilometers south and west. A statistical estimate was made of the deer population in selected areas utilizing the marked deer as a basis for this estimate. No gross or microscopic lesions were found in necropsied animals that could be directly attributed to the effects of ionizing radiation

  7. The Solar-Stellar Connection (NAG5-6124: SOHO Guest Investigator Program)

    Science.gov (United States)

    Ayres, Thomas R.

    1997-01-01

    The following is a final report from the SOHO Guest Investigator program to use the SUMER far-UV spectrometer to obtain imaging spectroscopy in support of the goals of the so-called "solar-stellar connection." In particular, a major emphasis was utilization of the long-slit time-resolved maps of the solar surface in bright far-UV emission lines to deduce how particular aspects of the temporally and spatially averaged line profiles trace back to individual structural features of the magnetically disturbed outer atmosphere; to help interpret the unresolved line profiles from high quality stellar observations (say, with the Space Telescope Imaging Spectrograph). The researchers served two tours of duty in the SOHO Operations Center as SUMER planners, during which time we conducted an extensive series of observing programs. These can be divided into three general categories: surface mapping, translimb spectroscopy, and active region diagnostics. We have analyzed some of the large volumes of data to the point where we have presented them in poster papers, and in invited papers at national and international meetings. Listed below are the titles of the preliminary publications we have written, including brief abstracts to indicate the main results. (1) Chromospheric structure and Dynamics-- Observations -- The chromosphere is a highly structured dynamic 'layer' of the solar outer atmosphere. Here, not only are the effects of mechanical heating first evident (moving upward in altitude from the deep photosphere), but also the amount of nonradiative energy deposited is far greater than in the albeit much hotter overlying transition region and corona. Further, the chromosphere is by far the thickest zone of the solar atmosphere with respect to the pressure scale height. A major goal of stellar astrophysics is to understand how the chromosphere is heated and why it adopts its peculiar structure. A cursory examination of solar filtergrams and high-resolution movies demonstrates

  8. New graduate nurse transition programs and clinical leadership skills in novice RNs.

    Science.gov (United States)

    Chappell, Kathy B; Richards, Kathy C; Barnett, Scott D

    2014-12-01

    The objective of this study was to determine predictors of clinical leadership skill (CLS) for RNs with 24 months of clinical experience or less. New graduate nurse transition programs (NGNTPs) have been proposed as a strategy to increase CLS. CLS is associated with positive patient outcomes. Method used was hierarchical regression modeling to evaluate predictors of CLS among individual characteristics of RNs and characteristics of NGNTPs. Perceived overall quality of an NGNTP was the strongest predictor of CLS (R = 0.041, P < .01). Clinical experience and NGNTP characteristics accounted for 6.9% of the variance in CLS and 12.6% of the variance among RNs with assigned mentors (P < .01). RNs participating in NGNTPs for more than 24 weeks were 21 times more likely to remain employed within the organization when compared with NGNTPs of 12 weeks or less, a significant cost-benefit to the organization. Although perceived overall quality of a NGNTP was the strongest predictor of CLS, much of the variance in CLS remains unexplained.

  9. A clinical investigation of motivation to change standards and cognitions about failure in perfectionism.

    Science.gov (United States)

    Egan, Sarah J; Piek, Jan P; Dyck, Murray J; Rees, Clare S; Hagger, Martin S

    2013-10-01

    Clinical perfectionism is a transdiagnostic process that has been found to maintain eating disorders, anxiety disorders and depression. Cognitive behavioural models explaining the maintenance of clinical perfectionism emphasize the contribution of dichotomous thinking and resetting standards higher following both success and failure in meeting their goals. There has been a paucity of research examining the predictions of the models and motivation to change perfectionism. Motivation to change is important as individuals with clinical perfectionism often report many perceived benefits of their perfectionism; they are, therefore, likely to be ambivalent regarding changing perfectionism. The aim was to compare qualitative responses regarding questions about motivation to change standards and cognitions regarding failure to meet a personal standard in two contrasting groups with high and low negative perfectionism. Negative perfectionism refers to concern over not meeting personal standards. A clinical group with a range of axis 1 diagnoses who were elevated on negative perfectionism were compared to a group of athletes who were low on negative perfectionism. Results indicated that the clinical group perceived many negative consequences of their perfectionism. They also, however, reported numerous benefits and the majority stated that they would prefer not to change their perfectionism. The clinical group also reported dichotomous thinking and preferring to either keep standards the same or reset standards higher following failure, whilst the athlete group reported they would keep standards the same or set them lower. The findings support predictions of the cognitive behavioural model of clinical perfectionism.

  10. LJUNGSKILE 1.0 A Computer Program for Investigation of Uncertainties in Chemical Speciation

    International Nuclear Information System (INIS)

    Ekberg, Christian; Oedegaard-Jensen, Arvid

    2002-11-01

    In analysing the long-term safety of nuclear waste disposal, there is a need to investigate uncertainties in chemical speciation calculations. Chemical speciation is of importance in evaluating the solubility of radionuclides, the chemical degradation of engineering materials, and chemical processes controlling groundwater composition. The uncertainties in chemical speciation may for instance be related to uncertainties in thermodynamic data, the groundwater composition, or the extrapolation to the actual temperature and ionic strength. The magnitude of such uncertainties and its implications are seldom explicitly evaluated in any detail. Commonly available chemical speciation programmes normally do not have a build-in option to include uncertainty ranges. The program developed within this project has the capability of incorporating uncertainty ranges in speciation calculations and can be used for graphical presentation of uncertainty ranges for dominant species. The program should be regarded as a starting point for assessing uncertainties in chemical speciation, since it is not yet comprehensive in its capabilities. There may be limitations in its usefulness to address various geochemical problems. The LJUNGSKILE code allows the user to select two approaches: the Monte Carlo (MC) approach and the Latin Hypercube Sampling (LHS). LHS allows to produce a satisfactory statistics with a minimum of CPU time. It is, in general, possible to do a simple theoretical speciation calculation within seconds. There are, admittedly, alternatives to LHS and there is criticism towards the uncritical use of LHS output because commonly correlation between some of the input variables exists. LHS, like MC, is not capable to take these correlations into account. Such a correlation can, i.e. exist between the pH of a solution and the partial pressure of CO 2 : higher pH solutions may absorb larger amounts of CO 2 and can reduce the CO 2 partial pressure. It is therefore of advantage to

  11. An Investigation of Classroom Practices in Teaching Listening Comprehension at English Education Program

    Directory of Open Access Journals (Sweden)

    Nurhafni Siregar

    2017-12-01

    Full Text Available The objective of this study is to investigate how the classroom practice in teaching listening comprehension at English Education Program of STKIP Tapanuli Selatan in 2016/2017 Academic Year is. The informants of this research were all of second semester students of STKIP Tapanuli Selatan in 2016/2017 academic year and a lecturer of listening comprehension at STKIP Tapanuli Selatan (63 students and one lecturer. A descriptive study was used to achieve the objective of the study. The sample was taken by cluster sampling. The data were collected by using interview to know how the lecturer carried out the teaching practice of listening, and questionnaire  for the students and observation were used to find out how the calssroom activities were conducted. The descriptive analysis was used to anayse the data. Based on the data analysis, it was found that: (1 the lecturer carried out listening activities into four parts, they are preparation, prediction stage, listening, and post listening, and (2 the practice of teaching listening was effective related to the teaching pedagogical procedures in teaching listening comprehension. although there were some points that should be practice further. Based on the findings, it was recomended that the lecturer and the students may apply the less activities that had not been done.

  12. Animal Investigation Program: Nevada Test Site and Vicinity. Annual report, 1979

    International Nuclear Information System (INIS)

    Smith, D.D.; Giles, Jr.; Bernhardt, D.E.

    1981-05-01

    Data are presented from the radioanalyses of tissues collected from cattle, mule deer, desert bighorn sheep, rabbits, chukar, golden eagles, and other wildlife that resided on or near the Nevada Test Site during 1979. Routine and special activities of the Animal Investigation Program are also discussed. Other than the naturally occurring potassium-40, gamma-emitting radionuclides were detected infrequently. Strontium-90 concentrations in bones from deer, cattle, and desert bighorn sheep were lower than those of recent years. Tritium concentrations were generally within expected environmental limits with the exception of animals exposed to known sources of contamination; e.g., drainage ponds from Area 12 tunnels or the Sedan Crater. Plutonium levels in all tissues from all species showed little variation to those levels in samples collected in recent years. Radionuclide tissue concentrations were generally higher in the tissues of animals residing in Area 15 than in similar animals collected from other Nevada Test Site areas. Hypothetical annual dose estimates to man were calculated on the basis of the daily consumption of 0.5 kilogra of liver or muscle from animals that contained peak radionuclide levels. The movements of 25 mule deer outfitted with collars containing a radio transmitter unit were monitored on a weekly basis. No gross or microscopic lesions were found in necropsied animals that could be directly attributed to the effects of ionizing radiation

  13. Investigations of the natural fission reactor program. Progress report, October 1977--September 1978

    International Nuclear Information System (INIS)

    Cowan, G.A.; Norris, A.E.

    1978-10-01

    The U.S. study of the Oklo natural reactor began in 1973 with the principal objectives of understanding the processes that produced the reactor and that led to the retention of many of its products. Major facets of the program have been the chemical separation and mass spectrometric analysis of the reactor components and products, the petrological and mineralogical examination of samples taken from the reactor zones, and an interdisciplinary modeling of possible processes consistent with reactor physics, geophysics, and geochemistry. Most of the past work has been on samples taken within the reactor zones. Presently, these studies give greater emphasis to the measurement of mobile products in additional suites of samples collected peripherally and ''downstream'' from the reactor zones. This report summarizes the current status of research and the views of U.S. investigators, with particular reference to the extensive work of the French scientists, concerning the main features of the Oklo natural fission reactor. Also mentioned briefly is the U.S. search for natural fission reactors at other locations

  14. Clinical Investigation of Adrenal Incidentalomas in Japanese Patients of the Fukuoka Region with Updated Diagnostic Criteria for Sub-clinical Cushing's Syndrome.

    Science.gov (United States)

    Abe, Ichiro; Sugimoto, Kaoru; Miyajima, Tetsumasa; Ide, Tomoko; Minezaki, Midori; Takeshita, Kaori; Takahara, Saori; Nakagawa, Midori; Fujimura, Yuki; Kudo, Tadachika; Miyajima, Shigero; Taira, Hiroshi; Ohe, Kenji; Ishii, Tatsu; Yanase, Toshihiko; Kobayashi, Kunihisa

    2018-04-27

    Objectives We retrospectively investigated the clinical and endocrinological characteristics of adrenal incidentalomas. Methods We studied 61 patients who had been diagnosed with adrenal incidentalomas and had undergone detailed clinical and endocrinological evaluations while hospitalized. We used common criteria to diagnose the functional tumors, but for sub-clinical Cushing's syndrome, we used an updated set of diagnosis criteria: serum cortisol ≥1.8 μg/dL after a positive response to a 1-mg dexamethasone suppression test if the patient has a low morning ACTH level (Cushing's syndrome and sub-clinical Cushing's syndrome), and 25 (41.0%) had non-functional tumors. Compared with the non-functional tumor group, the primary aldosteronism group and the cortisol-secreting adenoma group were significantly younger and had significantly lower rates of hypokalemia, whereas the pheochromocytoma group had significantly larger tumors and a significantly lower body mass index. Conclusion Our study found a larger percentage of functional tumors among adrenal incidentalomas than past reports, partly because we used a lower serum cortisol level after a dexamethasone suppression test to diagnose sub-clinical Cushing's syndrome and because all of the patients were hospitalized and could therefore receive more detailed examinations. Young patients with hypokalemia or lean patients with large adrenal tumors warrant particularly careful investigation.

  15. [Investigation of in vitro metronidazole resistance in the clinical isolates of Trichomonas vaginalis].

    Science.gov (United States)

    Ertabaklar, Hatice; Yaman Karadam, Senem; Malatyalı, Erdoğan; Ertuğ, Sema

    2016-10-01

    -sensitive isolates were 27.17 µg/ml in aerobic and 7.75 µg/ml in anaerobic conditions. The rate of metronidazole resistance detected in this study was higher than most of reports from different countries. Despite being limited to the isolates from Aydin province (located at Agean region of Turkey), the present study has a value as it presented the existence of metronidazole-resistant isolates in Turkey for the first time. More research from other parts of Turkey is needed to better understand the metronidazole resistance at a national scale and to investigate novel strategies for the treatment. Moreover, further studies need to be carried out in order to clarify the relationship between clinical treatment response and in vitro metronidazole resistance in trichomoniasis.

  16. Five-year review of an international clinical research-training program

    Directory of Open Access Journals (Sweden)

    Suemoto CK

    2015-04-01

    Full Text Available Claudia Kimie Suemoto,1,2 Sherine Ismail,1,3 Paulo César Rodrigues Pinto Corrêa,1,4,5 Faiza Khawaja,1,6 Teodoro Jerves,1 Laura Pesantez,1 Ana Claudia Camargo Gonçalves Germani,1,7 Fabio Zaina,1,8 Augusto Cesar Soares dos Santos Junior,1,9,10 Ricardo Jorge de Oliveira Ferreira,1,11 Priyamvada Singh,1,12 Judy Vicente Paulo,1,13 Suely Reiko Matsubayashi,1,14 Liliane Pinto Vidor,1,15 Guilherme Andretta,1,16 Rita Tomás,1,17 Ben MW Illigens,1,18 Felipe Fregni1,18,19 1Collaborative Learning in Clinical Research Program, Principles and Practice of Clinical Research (PPCR, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 2Discipline of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil; 3King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Pharmaceutical Care Department, King Khalid Hospital, NGHA, Jeddah, Saudi Arabia; 4Discipline of Internal Medicine and Medical Semiology, Department of Internal Medicine, Federal University of Ouro Preto (UFOP Medical School, Ouro Preto, Brazil; 5Discipline of Pneumology, Department of Internal Medicine, Centro Universitário de Belo Horizonte (Uni-BH, Belo Horizonte, Brazil; 6Canadian Centre for Advanced Eye Therapeutics, Mississauga, ON, Canada; 7Department of Preventive Medicine, University of São Paulo Medical School, São Paulo, Brazil; 8Italian Scientific Spine Institute (ISICO, Milan, Italy; 9Hospital Osvaldo Rezende Franco, Betim, Brazil; 10Nucleo de Avaliação de Tecnologia em Saude, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; 11Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; 12Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA; 13Portuguese Institute of Oncology, Coimbra, Portugal; 14Acupuncture

  17. Clinical characteristics of polycystic ovary syndrome: investigating differences in White and South Asian women.

    Science.gov (United States)

    Mani, Hamidreza; Davies, Melanie J; Bodicoat, Danielle H; Levy, Miles J; Gray, Laura J; Howlett, Trevor A; Khunti, Kamlesh

    2015-10-01

    To understand the phenotypic presentation of women with polycystic ovary syndrome (PCOS) of different ethnicities and at different ages. Cross-sectional, retrospective data analysis (1988 - 2009). Specialist clinic in a University Hospital, Leicestershire, UK. Women with PCOS, n = 1310 (mean age 26·2 years), 70·9% White and 29·1% South Asian (SA) attending a speciality clinic in Leicester UK. Clinical and demographic characteristics of women with PCOS including age at first clinic appointment, signs and symptoms, body mass index (BMI) and blood pressure (BP). Compared to White women, the SA were younger (24·3 vs 27·1 years, P women with PCOS appear to be significantly different depending on ethnicity, obesity and age. This has implications for management strategies in these groups. © 2015 John Wiley & Sons Ltd.

  18. Clinical investigation on Theileria equi and Babesia caballi infections in Italian donkeys.

    Science.gov (United States)

    Laus, Fulvio; Spaterna, Andrea; Faillace, Vanessa; Veronesi, Fabrizia; Ravagnan, Silvia; Beribé, Francesca; Cerquetella, Matteo; Meligrana, Marina; Tesei, Beniamino

    2015-04-28

    Interest in the welfare and diseases of donkeys is constantly increasing in several countries. Despite this, clinical research into donkeys needs to be in continual development since they show different reactions compared to horses in many conditions, including infectious diseases, and need specific clinical and therapeutic approaches. No reports are currently available on clinical and clinical pathology data regarding donkeys with natural piroplasms infection. Venous blood samples were taken from one hundred and thirty eight donkeys and underwent indirect fluorescent antibody test (IFAT) to detect IgG antibodies against Theileria equi and Babesia caballi and real-time polimerase chain reaction (PCR) to detect Babesia spp. and Theileria spp. Clinical examinations, haematological analyses and serum bilirubin evaluation were also performed and compared with positive or negative status. A seroprevalence of 40.6% and 47.8% was found for T. equi and B. caballi, respectively; double positivity was detected in 19.6% of the animals. PCR results showed that 17.4% of the animals tested positive for T.equi and 3.6% for B. caballi with no double positivity. Twelve donkeys (8.7%) had clinical signs consistent with chronic forms of the disease and no acute forms were detected. Fifty-eight donkeys had haematological and serum bilirubin alterations and 56 (96.6%) of them were IFAT and/or PCR positive. Changes in erythrocyte number, packed cell volume, hemoglobin concentration, mean corpuscular hemoglobin, platelets number and total bilirubin were significantly associated with positive and symptomatic animals. Nonspecific clinical presentation seems to be very common in donkeys and several clinical pathology alterations persist after natural infection. Therefore, apparently healthy donkeys can have masked but severe clinical pathology alterations. Acute forms are very seldom observed in donkeys. Clinical monitoring of chronically infected donkeys is recommended since such animals

  19. A Novel Electronic Device for Measuring Urine Flow Rate: A Clinical Investigation

    OpenAIRE

    Aliza Goldman; Hagar Azran; Tal Stern; Mor Grinstein; Dafna Wilner

    2017-01-01

    Objective: Currently, most vital signs in the intensive care unit (ICU) are electronically monitored. However, clinical practice for urine output (UO) measurement, an important vital sign, usually requires manual recording of data that is subject to human errors. In this study, we assessed the ability of a novel electronic UO monitoring device to measure real-time hourly UO versus current clinical practice. Design: Patients were connected to the RenalSense Clarity RMS Sensor Kit with a sensor...

  20. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients

    DEFF Research Database (Denmark)

    Schulman, S; Angerås, U; Bergqvist, D

    2010-01-01

    in several non-surgical trials. A preliminary proposal for a parallel definition for surgical studies was presented at the 54(th) Annual Meeting of the SSC in Vienna, July 2008. Based on those discussions and further consultations with European and North American surgeons with experience from clinical trials...... of this definition from the regulatory authorities to enhance its incorporation into future clinical trial protocols....

  1. Emerging biomarkers in anaplastic oligodendroglioma: implications for clinical investigation and patient management.

    Science.gov (United States)

    Sahebjam, Solmaz; McNamara, Mairéad G; Mason, Warren P

    2013-07-01

    Oligodendrogliomas are heterogeneous tumors with a variable response to treatment. This clinical variability underlines the urgent need for markers that can reliably aid diagnosis and guide clinical decision-making. Long-term follow-up data from the EORTC 26951 and RTOG 9402 clinical trials in newly diagnosed anaplastic oligodendroglioma have established chromosome 1p19q codeletion as a predictive marker of response to procarbazine, lomustine and vincristine chemotherapy in anaplastic oligodendrogliomas. In addition, MGMT promoter hypermethylation has been strongly associated with glioma CpG island hypermethylation phenotype (G-CIMP+) status, this has been suggested as an epiphenomenon of genome-wide methylation, conferring a more favorable prognosis. Molecular profiling of these tumors has identified several other markers with potential clinical significance: mutations of IDH, CIC, FUBP1 and CDKN2A require further validation before they can be implemented as clinical decision-making tools. Additionally, recent data on the clinical significance of intrinsic glioma subtyping appears promising. Indeed, existing evidence suggests that comprehensive analyses such as intrinsic glioma subtyping or G-CIMP status are superior to single molecular markers. Clearly, with evolving treatment strategies and in the era of individualized therapy, broader omics-based molecular evaluations are required to improve outcome prediction and to identify patients who will benefit from specific treatment strategies.

  2. Replacing stressful challenges with positive coping strategies: a resilience program for clinical placement learning.

    Science.gov (United States)

    Delany, C; Miller, K J; El-Ansary, D; Remedios, L; Hosseini, A; McLeod, S

    2015-12-01

    Clinical education is foundational to health professional training. However, it is also a time of increased stress for students. A student's perception of stressors and their capacity to effectively manage them is a legitimate concern for educators, because anxiety and decreased coping strategies can interfere with effective learning, clinical performance and capacity to care for patients. Resilience is emerging as a valuable construct to underpin positive coping strategies for learning and professional practice. We report the development and evaluation of a psycho-education resilience program designed to build practical skills-based resilience capacities in health science (physiotherapy) students. Six final year undergraduate physiotherapy students attended four action research sessions led by a clinical health psychologist. Resilience strategies drawn from cognitive behavioural therapy, and positive and performance psychology were introduced. Students identified personal learning stressors and their beliefs and responses. They chose specific resilience-based strategies to address them, and then reported their impact on learning performance and experiences. Thematic analysis of the audio-recorded and transcribed action research sessions, and students' de identified notes was conducted. Students' initial descriptions of stressors as 'problems' outside their control resulting in poor thinking and communication, low confidence and frustration, changed to a focus on how they managed and recognized learning challenges as normal or at least expected elements of the clinical learning environment. The research suggests that replacing stressful challenges with positive coping strategies offers a potentially powerful tool to build self-efficacy and cognitive control as well as greater self-awareness as a learner and future health practitioner.

  3. Transfer of communication skills to the workplace during clinical rounds: impact of a program for residents.

    Directory of Open Access Journals (Sweden)

    Aurore Liénard

    2010-08-01

    Full Text Available Communication with patients is a core clinical skill in medicine that can be acquired through communication skills training. Meanwhile, the importance of transfer of communication skills to the workplace has not been sufficiently studied. This study aims to assess the efficacy of a 40-hour training program designed to improve patients' satisfaction and residents' communication skills during their daily clinical rounds.Residents were randomly assigned to the training program or to a waiting list. Patients' satisfaction was assessed with a visual analog scale after each visit. Transfer of residents' communication skills was assessed in audiotaped actual inpatient visits during a half-day clinical round. Transcripted audiotapes were analyzed using content analysis software (LaComm. Training effects were tested with Mann-Whitney tests and generalized linear Poisson regression models.Eighty-eight residents were included. First, patients interacting with trained residents reported a higher satisfaction with residents' communication (Median=92 compared to patients interacting with untrained residents (Median=88 (p=.046. Second, trained residents used more assessment utterances (Relative Risk (RR=1.17; 95% Confidence intervals (95%CI=1.02-1.34; p=.023. Third, transfer was also observed when residents' training attendance was considered: residents' use of assessment utterances (RR=1.01; 95%CI=1.01-1.02; p=.018 and supportive utterances (RR=0.99; 95%CI=0.98-1.00; p=.042 (respectively 1.15 (RR, 1.08-1.23 (95%CI, p<.001 for empathy and 0.95 (RR, 0.92-0.99 (95%CI, p=.012 for reassurance was proportional to the number of hours of training attendance.The training program improved patients' satisfaction and allowed the transfer of residents' communication skills learning to the workplace. Transfer was directly related to training attendance but remained limited. Future studies should therefore focus on the improvement of the efficacy of communication skills

  4. Molecular investigation of virulence factors of Brucella melitensis and Brucella abortus strains isolated from clinical and non-clinical samples.

    Science.gov (United States)

    Mirnejad, Reza; Jazi, Faramarz Masjedian; Mostafaei, Shayan; Sedighi, Mansour

    2017-08-01

    Brucella is zoonotic pathogen that induces abortion and sterility in domestic mammals and chronic infections in humans called Malta fever. It is a facultative intracellular potential pathogen with high infectivity. The virulence of Brucella is dependent upon its potential virulence factors such as enzymes and cell envelope associated virulence genes. The aim of this study was to investigate the Brucella virulence factors among strains isolated from humans and animals in different parts of Iran. Seventy eight strains of Brucella species isolated from suspected human and animal cases from several provinces of Iran during 2015-2016 and identified by phenotypic and molecular methods. The multiplex-PCR (M-PCR) assay was performed in order to detect the ure, wbkA, omp19, mviN, manA and perA genes by using gene specific primers. Out of 78 isolates of Brucella spp., 57 (73%) and 21 (27%) isolates were detected as B. melitensis and B. abortus, respectively, by molecular method. The relative frequency of virulence genes ure, wbkA, omp19, mviN, manA and perA were 74.4%, 89.7%, 93.6%, 94.9%, 100% and 92.3%, respectively. Our results indicate that the most of Brucella strains isolated from this region possess high percent of virulence factor genes (ure, wbkA, omp19, mviN, manA and perA) in their genome. So, each step of infection can be mediated by a number of virulence factors and each strain may have a unique combination of these factors that affected the rate of bacterial pathogenesis. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Clinical reasoning in neurology: use of the repertory grid technique to investigate the reasoning of an experienced occupational therapist.

    Science.gov (United States)

    Kuipers, Kathy; Grice, James W

    2009-08-01

    The aim of this paper is to describe the use of a structured interview methodology, the repertory grid technique, for investigating the clinical reasoning of an experienced occupational therapist in the domain of upper limb hypertonia as a result of brain injury. Repertory grid interviews were completed before and after exposure to a protocol designed to guide clinical reasoning and decision-making in relation to upper limb neurological rehabilitation. Data were subjected to both qualitative and quantitative analyses. Qualitative analysis focussed on clinical reasoning content. Common themes across the pre- and post-exposure interviews were the use of theoretical frameworks and practice models, the significance of clinical expertise, and discrimination of 'broad' and 'specific' aspects, as well as differentiation between 'therapist and client-related' aspects of the clinical situation. Quantitative analysis indicated that for both pre- and post-exposure repertory grids, clinical reasoning was structured in terms of two main concepts. In the pre-exposure grid, these were related to the therapist's role, and to the 'scope' of practice tasks (either broad or specific). In the post-exposure grid the two main concepts were upper limb performance, and client-centred aspects of the therapy process. The repertory grid technique is proposed as an effective tool for exploring occupational therapy clinical reasoning, based on its capacity for accessing personal frames of reference, and elucidating both the meaning and the structure supporting clinical reasoning.

  6. Clinical audits in a postgraduate general practice training program: an evaluation of 8 years' experience.

    Directory of Open Access Journals (Sweden)

    Abeer Al-Baho

    Full Text Available BACKGROUND: Clinical audit can be of valuable assistance to any program which aims to improve the quality of health care and its delivery. Yet without a coherent strategy aimed at evaluating audits' effectiveness, valuable opportunities will be overlooked. Clinical audit projects are required as a part of the formative assessment of trainees in the Family Medicine Residency Program (FMRP in Kuwait. This study was undertaken to draw a picture of trainees' understanding of the audit project with attention to the knowledge of audit theory and its educational significance and scrutinize the difficulties confronted during the experience. METHODOLOGY/PRINCIPAL FINDINGS: The materials included the records of 133 audits carried out by trainees and 165 post course questionnaires carried out between 2004 and 2011. They were reviewed and analyzed. The majority of audit projects were performed on diabetic (44.4% and hypertensive (38.3% care. Regarding audits done on diabetic care, they were carried out to assess doctors' awareness about screening for smoking status (8.6%, microalbuminuria (19.3%, hemoglobin A1c (15.5%, retinopathy (10.3%, dyslipidemia (15.8%, peripheral neuropathy (8.8%, and other problems (21.7%. As for audits concerning hypertensive care, they were carried out to assess doctors' awareness about screening for smoking status (38.0%, obesity (26.0%, dyslipidemia (12.0%, microalbuminuria (10.0% and other problems (14.0%. More than half the participants (68.48% who attended the audit course stated that they 'definitely agreed' about understanding the meaning of clinical audit. Most of them (75.8% 'definitely agreed' about realizing the importance of clinical audit in improving patients' care. About half (49.7% of them 'agreed' that they can distinguish between 'criteria' and 'standards'. CONCLUSION: The eight years of experience were beneficial. Trainees showed a good understanding of the idea behind auditing the services provided. They

  7. Patient quality of life in the Mayo Clinic Care Transitions program: a survey study

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    Faucher J

    2016-08-01

    Full Text Available Joshua Faucher,1 Jordan Rosedahl,2 Dawn Finnie,3 Amy Glasgow,3 Paul Takahashi4 1Mayo Medical School, Mayo Clinic College of Medicine, 2Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic, 3Center for the Science of Health Care Delivery, 4Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA Background: Transitional care programs are common interventions aimed at reducing medical complications and associated readmissions for patients recently discharged from the hospital. While organizations strive to reduce readmissions, another important related metric is patient quality of life (QoL. Aims: To compare the relationship between QoL in patients enrolled in the Mayo Clinic Care Transitions (MCCT program versus usual care, and to determine if QoL changed in MCCT participants between baseline and 1-year follow-up. Methods: A baseline survey was mailed to MCCT enrollees in March 2013. Those who completed a baseline survey were sent a follow-up survey 1 year later. A cross-sectional survey of usual care participants was mailed in November 2013. We included in our analysis 199 participants (83 in the MCCT and 116 in usual care aged over 60 years with multiple comorbidities and receiving primary care. Primary outcomes were self-rated QoL; secondary outcomes included self-reported general, physical, and mental health. Intra- and intergroup comparisons of patients were evaluated using Pearson’s chi-squared analysis. Results: MCCT participants had more comorbidities and higher elder risk assessment scores than those receiving usual care. At baseline, 74% of MCCT participants reported responses of good-to-excellent QoL compared to 64% after 1 year (P=0.16. Between MCCT and usual care, there was no significant difference in self-reported QoL (P=0.21. Between baseline and follow-up in MCCT patients, and compared to usual care, there were no significant

  8. Devil is in the details: Using logic models to investigate program process.

    Science.gov (United States)

    Peyton, David J; Scicchitano, Michael

    2017-12-01

    Theory-based logic models are commonly developed as part of requirements for grant funding. As a tool to communicate complex social programs, theory based logic models are an effective visual communication. However, after initial development, theory based logic models are often abandoned and remain in their initial form despite changes in the program process. This paper examines the potential benefits of committing time and resources to revising the initial theory driven logic model and developing detailed logic models that describe key activities to accurately reflect the program and assist in effective program management. The authors use a funded special education teacher preparation program to exemplify the utility of drill down logic models. The paper concludes with lessons learned from the iterative revision process and suggests how the process can lead to more flexible and calibrated program management. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Experimenting Clinical Pathways in General Practice: a Focus Group Investigation with Italian General Practitioners

    Science.gov (United States)

    Zannini, Lucia; Cattaneo, Cesarina; Peduzzi, Paolo; Lopiccoli, Silvia; Auxilia, Francesco

    2012-01-01

    Background Clinical governance is considered crucial in primary care. Since 2005, clinical pathways have been experimentally implemented at the Local Health Authority of Monza Brianza (ASLMB), Italy, to develop general practitioners’ (GPs) care of patients affected by some chronic diseases. The experimentation was aimed at introducing clinical governance in primary care, increasing GPs’ involvement in the care of their patients, and improving both patients’ and professionals’ satisfaction. In the period 2005-2006, 12% of the 763 employed GPs in the ASLMB were involved in the experiment, while this percentage increased to 15-20% in 2007-2008. Design and Methods Twenty-four GPs were purposively sampled, randomly divided into two groups and asked to participate in focus groups (FGs) held in 2008, aimed at evaluating their perception of the experiment. The FGs were audio-recorded, dialogues were typed out and undergone to a thematic analysis, according to the Interpretative Phenomenological Approach. Results Four major themes emerged: i) clinical pathways can result in GPs working in a more efficient and effective fashion; ii) they can assure higher levels of both patient and professional satisfaction, since they sustain a caring approach and strengthen the GPs’ role; iii) nevertheless, clinical pathways increase the bureaucratic workload and problems can arise in relationships among GPs and the LHA; iv) the implementation of clinical pathways can be improved, especially by reducing bureaucracy and by assuring their continuity. Conclusions Managerial aspects should be considered with care in order to experimentally introduce clinical pathways in general practice, and continuity of the experimentation should be guaranteed to improve GPs’ adherence and commitment. Acknowledgments the Authors thank Dr. AP. Cantù and Dr D. Cereda who participated in the two focus groups as observers. PMID:25181354

  10. Clinical endpoint adjudication in a contemporary all-comers coronary stent investigation: methodology and external validation.

    Science.gov (United States)

    Vranckx, Pascal; McFadden, Eugene; Cutlip, Donald E; Mehran, Roxana; Swart, Michael; Kint, P P; Zijlstra, Felix; Silber, Sigmund; Windecker, Stephan; Serruys, Patrick W C J

    2013-01-01

    Globalisation in coronary stent research calls for harmonization of clinical endpoint definitions and event adjudication. Little has been published about the various processes used for event adjudication or their impact on outcome reporting. We performed a validation of the clinical event committee (CEC) adjudication process on 100 suspected events in the RESOLUTE All-comers trial (Resolute-AC). Two experienced Clinical Research Organisations (CRO) that had already extensive internal validation processes in place, participated in the study. After initial adjudication by the primary-CEC, events were cross-adjudicated by an external-CEC using the same definitions. Major discrepancies affecting the primary end point of target-lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction (TV-MI), or clinically-indicated target-lesion revascularization (CI-TLR), were analysed by an independent oversight committee who provided recommendations for harmonization. Discordant adjudications were reconsidered by the primary CEC. Subsequently, the RAC database was interrogated for cases that based on these recommendations merited re-adjudication and these cases were also re-adjudicated by the primary CEC. Final discrepancies in adjudication of individual components of TLF occurred in 7 out of 100 events in 5 patients. Discrepancies for the (hierarchical) primary endpoint occurred in 5 events (2 cardiac deaths and 3 TV-MI). After application of harmonization recommendations to the overall RAC population (n=2292), the primary CEC adjudicated 3 additional clinical-TLRs and considered 1 TV-MI as no event. A harmonization process provided a high level of concordance for event adjudication and improved accuracy for final event reporting. These findings suggest it is feasible to pool clinical event outcome data across clinical trials even when different CECs are responsible for event adjudication. Copyright © 2012 Elsevier Inc. All rights reserved.

  11. Experimenting clinical pathways in general practice: a focus group investigation with Italian general practitioners

    Directory of Open Access Journals (Sweden)

    Lucia Zannini

    2012-07-01

    Full Text Available Background. Clinical governance is considered crucial in primary care. Since 2005, clinical pathways have been experimentally implemented at the Local Health Authority of Monza Brianza (ASLMB, Italy, to develop general practitioners’ (GPs care of patients affected by some chronic diseases. The experimentation was aimed at introducing clinical governance in primary care, increasing GPs’ involvement in the care of their patients, and improving both patients’ and professionals’ satisfaction. In the period 2005-2006, 12% of the 763 employed GPs in the ASLMB were involved in the experiment, while this percentage increased to 15-20% in 2007-2008. Design and Methods. Twenty-four GPs were purposively sampled, randomly divided into two groups and asked to participate in focus groups (FGs held in 2008, aimed at evaluating their perception of the experiment. The FGs were audio-recorded, dialogues were typed out and undergone to a thematic analysis, according to the Interpretative Phenomenological Approach. Results. Four major themes emerged: i clinical pathways can result in GPs working in a more efficient and effective fashion; ii they can assure higher levels of both patient and professional satisfaction, since they sustain a caring approach and strengthen the GPs’ role; iii nevertheless, clinical pathways increase the bureaucratic workload and problems can arise in relationships among GPs and the LHA; iv the implementation of clinical pathways can be improved, especially by reducing bureaucracy and by assuring their continuity. Conclusions. Managerial aspects should be considered with care in order to experimentally introduce clinical pathways in general practice, and continuity of the experimentation should be guaranteed to improve GPs’ adherence and commitment.

  12. Clinical Trial Electronic Portals for Expedited Safety Reporting: Recommendations from the Clinical Trials Transformation Initiative Investigational New Drug Safety Advancement Project.

    Science.gov (United States)

    Perez, Raymond P; Finnigan, Shanda; Patel, Krupa; Whitney, Shanell; Forrest, Annemarie

    2016-12-15

    Use of electronic clinical trial portals has increased in recent years to assist with sponsor-investigator communication, safety reporting, and clinical trial management. Electronic portals can help reduce time and costs associated with processing paperwork and add security measures; however, there is a lack of information on clinical trial investigative staff's perceived challenges and benefits of using portals. The Clinical Trials Transformation Initiative (CTTI) sought to (1) identify challenges to investigator receipt and management of investigational new drug (IND) safety reports at oncologic investigative sites and coordinating centers and (2) facilitate adoption of best practices for communicating and managing IND safety reports using electronic portals. CTTI, a public-private partnership to improve the conduct of clinical trials, distributed surveys and conducted interviews in an opinion-gathering effort to record investigator and research staff views on electronic portals in the context of the new safety reporting requirements described in the US Food and Drug Administration's final rule (Code of Federal Regulations Title 21 Section 312). The project focused on receipt, management, and review of safety reports as opposed to the reporting of adverse events. The top challenge investigators and staff identified in using individual sponsor portals was remembering several complex individual passwords to access each site. Also, certain tasks are time-consuming (eg, downloading reports) due to slow sites or difficulties associated with particular operating systems or software. To improve user experiences, respondents suggested that portals function independently of browsers and operating systems, have intuitive interfaces with easy navigation, and incorporate additional features that would allow users to filter, search, and batch safety reports. Results indicate that an ideal system for sharing expedited IND safety information is through a central portal used by

  13. The rapid access palliative radiotherapy program: blueprint for initiation of a one-stop multidisciplinary bone metastases clinic.

    Science.gov (United States)

    Fairchild, A; Pituskin, E; Rose, B; Ghosh, S; Dutka, J; Driga, A; Tachynski, P; Borschneck, J; Gagnon, L; Macdonnell, S; Middleton, J; Thavone, K; Carstairs, S; Brent, D; Severin, D

    2009-02-01

    Radiotherapy (RT) for palliation of pain due to bone metastases (BM) is effective but underutilized likely due to the traditional practice of separate clinic visits for consultation, treatment planning, and RT delivery. However, recent evidence proves one RT treatment is as effective as multiple for analgesia, enabling investigation of an alternative model of RT delivery, the rapid access palliative radiotherapy program (RAPRP). Prior to the start of the program, needs assessment was performed to determine the composition of the optimal team. Screening tools were implemented to streamline holistic, multidisciplinary assessment. An advertising strategy, treatment and research protocols, and mechanisms for patient feedback were established. After RAPRP implementation, patient outcomes such as symptom relief were tracked. Eighty-six patients with painful BM were referred over the 25-week pilot. Median age was 69.9 years; 64% had prostate cancer, and median performance status was 70. Patient-rated pain was on average 6.1/10 at baseline, improving to 2.6/10 by week 4 post-RT. On average, 6.2 symptoms were reported (baseline) compared to 5.2 (week 4). Team members assessed 10-100% of patients and were successful in stabilizing or improving all symptoms in >75% contacted at week 4. One hundred percent of patients surveyed were satisfied with their experience. Early needs assessment was advantageous in determining the optimal team and methods of assessment for our 'one-stop' BM clinic. This approach was successful in improving pain and other symptoms, and the convenience of seeing multiple providers on 1 day was appreciated by the patients.

  14. Telephone Coaching to Enhance a Home-Based Physical Activity Program for Knee Osteoarthritis: A Randomized Clinical Trial.

    Science.gov (United States)

    Bennell, Kim L; Campbell, Penny K; Egerton, Thorlene; Metcalf, Ben; Kasza, Jessica; Forbes, Andrew; Bills, Caroline; Gale, Janette; Harris, Anthony; Kolt, Gregory S; Bunker, Stephen J; Hunter, David J; Brand, Caroline A; Hinman, Rana S

    2017-01-01

    To investigate whether simultaneous telephone coaching improves the clinical effectiveness of a physiotherapist-prescribed home-based physical activity program for knee osteoarthritis (OA). A total of 168 inactive adults ages ≥50 years with knee pain on a numeric rating scale ≥4 (NRS; range 0-10) and knee OA were recruited from the community and randomly assigned to a physiotherapy (PT) and coaching group (n = 84) or PT-only (n = 84) group. All participants received five 30-minute consultations with a physiotherapist over 6 months for education, home exercise, and physical activity advice. PT+coaching participants also received 6-12 telephone coaching sessions by clinicians trained in behavioral-change support for exercise and physical activity. Primary outcomes were pain (NRS) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC; score range 0-68]) at 6 months. Secondary outcomes were these same measures at 12 and 18 months, as well as physical activity, exercise adherence, other pain and function measures, and quality of life. Analyses were intent-to-treat with multiple imputation for missing data. A total of 142 (85%), 136 (81%), and 128 (76%) participants completed 6-, 12-, and 18-month measurements, respectively. The change in NRS pain (mean difference 0.4 unit [95% confidence interval (95% CI) -0.4, 1.3]) and in WOMAC function (1.8 [95% CI -1.9, 5.5]) did not differ between groups at 6 months, with both groups showing clinically relevant improvements. Some secondary outcomes related to physical activity and exercise behavior favored PT+coaching at 6 months but generally not at 12 or 18 months. There were no between-group differences in most other outcomes. The addition of simultaneous telephone coaching did not augment the pain and function benefits of a physiotherapist-prescribed home-based physical activity program. © 2016, American College of Rheumatology.

  15. [What are Considerations for Clinical Investigation of New Drugs and Treatment Techniques for Major Depressive Disorders?].

    Science.gov (United States)

    Nakabayashi, Tetsuo

    2015-01-01

    Major depressive disorder treatments remain unsatisfactory, and the development of novel antidepressants is continuing. Therefore, not only the establishment of therapeutic strategies to accumulate evidence on existing therapies, but also the development of novel therapies is required in order to improve the medical standards. In principle, parallel, double-blind, randomized, placebo-controlled trials are necessary to assess new compounds for the treatment of major depressive disorders from a scientific perspective. To provide unambiguous evidence of antidepressant activity, well-controlled studies with adequate designs must show efficacy with a statistically significant effect on a clinically meaningful endpoint. For this purpose, it is important to examine all aspects of factors that adversely affect the efficacy and safety assessment in the planning stage of clinical trials and reduce these factors. There are several specific characteristics of clinical trials for neuropsychiatric disorders. Some typical features are as follows: 1) a high and variable response, 2) impact on the effect of the baseline severity of disorders, 3) high dropout rates, 4) biases related to subjective measures of clinical symptoms. In this paper, considerations for the planning and performing of clinical trials for major depressive disorders will be discussed based on these features.

  16. Clinical impact of diagnostic SPET investigations with a dopamine re-uptake ligand

    International Nuclear Information System (INIS)

    Loekkegaard, Annemette; Werdelin, Lene M.; Friberg, Lars

    2002-01-01

    The diagnosis of Parkinson's disease is based on clinical features with pathological verification. However, autopsy has been found to confirm a specialist diagnosis in only about 75% of cases. Especially early in the course of the disease, the clinical diagnosis can be difficult. Imaging of presynaptic dopamine transporters (DAT receptors) has provided a possible diagnostic probe in the evaluation of Parkinson's disease. The cocaine analogue [ 123 I]-2-β-carboxymethoxy-3-β(4-iodophenyl)tropane ([ 123 I]-β-CIT) is one of several radioligands that have been developed for single-photon emission tomography (SPET). The purpose of this study was to evaluate the impact of [ 123 I]-β-CIT SPET on the diagnosis and clinical management of patients with a primary, tentative diagnosis of parkinsonism. We undertook a retrospective evaluation of the clinical records of 90 consecutive patients referred to [ 123 I]-β-CIT SPET from the neurological department, Bispebjerg Hospital. In 58 subjects the scans revealed altered tracer uptake consistent with Parkinson's disease, progressive supranuclear palsy and multiple system atrophy. A significant change in the management or treatment because of the scan was found in 25 patients (28%). The sensitivity of the examination was 97% and the specificity 83%. In conclusion, a significant clinical impact of DAT receptor SPET imaging was found. DAT receptor imaging is a useful diagnostic probe in patients with a possible diagnosis of parkinsonism. (orig.)

  17. Model for investigating the benefits of clinical supervision in psychiatric nursing: a survey study.

    Science.gov (United States)

    Gonge, Henrik; Buus, Niels

    2011-04-01

    The objective of this study was to test a model for analysing the possible benefits of clinical supervision. The model suggested a pathway from participation to effectiveness to benefits of clinical supervision, and included possible influences of individual and workplace factors. The study sample was 136 nursing staff members in permanent employment on nine general psychiatric wards and at four community mental health centres at a Danish psychiatric university hospital. Data were collected by means of a set of questionnaires. Participation in clinical supervision was associated with the effectiveness of clinical supervision, as measured by the Manchester Clinical Supervision Scale (MCSS). Furthermore, MCSS scores were associated with benefits, such as increased job satisfaction, vitality, rational coping and less stress, emotional exhaustion, and depersonalization. Multivariate analyses indicated that certain individual and workplace factors were related to subscales of the MCSS, as well as some of the benefits. The study supported the suggested model, but methodological limitations apply. © 2011 The Authors. International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.

  18. Training the Millennial learner through experiential evolutionary scaffolding: implications for clinical supervision in graduate education programs.

    Science.gov (United States)

    Venne, Vickie L; Coleman, Darrell

    2010-12-01

    They are the Millennials--Generation Y. Over the next few decades, they will be entering genetic counseling graduate training programs and the workforce. As a group, they are unlike previous youth generations in many ways, including the way they learn. Therefore, genetic counselors who teach and supervise need to understand the Millennials and explore new ways of teaching to ensure that the next cohort of genetic counselors has both skills and knowledge to represent our profession well. This paper will summarize the distinguishing traits of the Millennial generation as well as authentic learning and evolutionary scaffolding theories of learning that can enhance teaching and supervision. We will then use specific aspects of case preparation during clinical rotations to demonstrate how incorporating authentic learning theory into evolutionary scaffolding results in experiential evolutionary scaffolding, a method that potentially offers a more effective approach when teaching Millennials. We conclude with suggestions for future research.

  19. Audit of the informed consent process as a part of a clinical research quality assurance program.

    Science.gov (United States)

    Lad, Pramod M; Dahl, Rebecca

    2014-06-01

    Audits of the informed consent process are a key element of a clinical research quality assurance program. A systematic approach to such audits has not been described in the literature. In this paper we describe two components of the audit. The first is the audit of the informed consent document to verify adherence with federal regulations. The second component is comprised of the audit of the informed consent conference, with emphasis on a real time review of the appropriate communication of the key elements of the informed consent. Quality measures may include preparation of an informed consent history log, notes to accompany the informed consent, the use of an informed consent feedback tool, and the use of institutional surveys to assess comprehension of the informed consent process.

  20. [Is the structure of surgical clinics in Germany changing? A current investigation into the structure of surgical clinics in the Federal Republic of Germany].

    Science.gov (United States)

    Lob, G; Lob, T; Bauer, H; Niethard, F; Polonius, J; Siebert, H

    2009-04-01

    Medical developments have led to extensive specialization in the field of surgery. This has already been reflected for many years in altered structure and organization forms of surgical clinics. Indispensable quality standards, statutory general conditions, increasing competition in service providers and health insurance with transpare