WorldWideScience

Sample records for clinical pre-test probability

  1. The predictive validity of the BioMedical Admissions Test for pre-clinical examination performance.

    Science.gov (United States)

    Emery, Joanne L; Bell, John F

    2009-06-01

    Some medical courses in the UK have many more applicants than places and almost all applicants have the highest possible previous and predicted examination grades. The BioMedical Admissions Test (BMAT) was designed to assist in the student selection process specifically for a number of 'traditional' medical courses with clear pre-clinical and clinical phases and a strong focus on science teaching in the early years. It is intended to supplement the information provided by examination results, interviews and personal statements. This paper reports on the predictive validity of the BMAT and its predecessor, the Medical and Veterinary Admissions Test. Results from the earliest 4 years of the test (2000-2003) were matched to the pre-clinical examination results of those accepted onto the medical course at the University of Cambridge. Correlation and logistic regression analyses were performed for each cohort. Section 2 of the test ('Scientific Knowledge') correlated more strongly with examination marks than did Section 1 ('Aptitude and Skills'). It also had a stronger relationship with the probability of achieving the highest examination class. The BMAT and its predecessor demonstrate predictive validity for the pre-clinical years of the medical course at the University of Cambridge. The test identifies important differences in skills and knowledge between candidates, not shown by their previous attainment, which predict their examination performance. It is thus a valid source of additional admissions information for medical courses with a strong scientific emphasis when previous attainment is very high.

  2. Pre-Service Teachers' Conceptions of Probability

    Science.gov (United States)

    Odafe, Victor U.

    2011-01-01

    Probability knowledge and skills are needed in science and in making daily decisions that are sometimes made under uncertain conditions. Hence, there is the need to ensure that the pre-service teachers of our children are well prepared to teach probability. Pre-service teachers' conceptions of probability are identified, and ways of helping them…

  3. Pre-aggregation for Probability Distributions

    DEFF Research Database (Denmark)

    Timko, Igor; Dyreson, Curtis E.; Pedersen, Torben Bach

    Motivated by the increasing need to analyze complex uncertain multidimensional data (e.g., in order to optimize and personalize location-based services), this paper proposes novel types of {\\em probabilistic} OLAP queries that operate on aggregate values that are probability distributions...... and the techniques to process these queries. The paper also presents the methods for computing the probability distributions, which enables pre-aggregation, and for using the pre-aggregated distributions for further aggregation. In order to achieve good time and space efficiency, the methods perform approximate...... multidimensional data analysis that is considered in this paper (i.e., approximate processing of probabilistic OLAP queries over probability distributions)....

  4. The accuracy of clinical and biochemical estimates in defining the pre-test probability of pulmonary embolism

    International Nuclear Information System (INIS)

    Garvie, N.W.; Salehzahi, F.; Kuitert, L.

    2002-01-01

    Full text: The PIOPED survey confirmed the significance of the high probability ventilation/perfusion scan (HP V/Q scan) in establishing the diagnosis of pulmonary embolism (PE). In an interesting sentence, however, the authors indicated that 'the clinicians' assessment of the likelihood of PE (prior probability)' can substantially increase the predictive value of the investigation. The criteria used for this assessment were not published, and this statement conflicts with the belief that the clinical diagnosis of pulmonary embolism is unreliable. A medical history was obtained from 668 patients undergoing V/Q lung scans for suspected PE, and certain clinical features linked to PE were, when present, documented. These included pleuritic chest pain, haemoptysis, dyspnoea, clinical evidence of DVT, recent surgery and right ventricular strain pattern an ECG. D-Dimer levels and initial arterial oxygen saturation (PaO2) levels were also obtained. The prevalence of these clinical and biochemical criteria was then compared between HP (61) and normal (171) scans after exclusion of all equivocal or intermediate scan outcomes (436), (where lung scintigraphy was unable to provide a definite diagnosis). D-Dimer and/or oxygen saturation levels, were similarly compared in each group. A true positive result was scored for each clinical or biochemical criterion when linked with a high probability scan and, conversely, a false positive score when the scan outcome was normal. In this fashion, the positive predictive value (PPV) and, when appropriate, the negative predictive value (NPV) was obtained for each risk factor. In the context of PE, DVT and post-operative status prove the more reliable predictors of a high probability outcome. Where both features were present, the PPV rose to 0.57. A normal D-Dimer level was a better excluder of PE than a normal oxygen saturation level (NPV 0.78-v-0.44). Conversely, a raised D-Dimer, or reduced oxygen saturation, were both a little value in

  5. Assessing the clinical probability of pulmonary embolism

    International Nuclear Information System (INIS)

    Miniati, M.; Pistolesi, M.

    2001-01-01

    Clinical assessment is a cornerstone of the recently validated diagnostic strategies for pulmonary embolism (PE). Although the diagnostic yield of individual symptoms, signs, and common laboratory tests is limited, the combination of these variables, either by empirical assessment or by a prediction rule, can be used to express a clinical probability of PE. The latter may serve as pretest probability to predict the probability of PE after further objective testing (posterior or post-test probability). Over the last few years, attempts have been made to develop structured prediction models for PE. In a Canadian multicenter prospective study, the clinical probability of PE was rated as low, intermediate, or high according to a model which included assessment of presenting symptoms and signs, risk factors, and presence or absence of an alternative diagnosis at least as likely as PE. Recently, a simple clinical score was developed to stratify outpatients with suspected PE into groups with low, intermediate, or high clinical probability. Logistic regression was used to predict parameters associated with PE. A score ≤ 4 identified patients with low probability of whom 10% had PE. The prevalence of PE in patients with intermediate (score 5-8) and high probability (score ≥ 9) was 38 and 81%, respectively. As opposed to the Canadian model, this clinical score is standardized. The predictor variables identified in the model, however, were derived from a database of emergency ward patients. This model may, therefore, not be valid in assessing the clinical probability of PE in inpatients. In the PISA-PED study, a clinical diagnostic algorithm was developed which rests on the identification of three relevant clinical symptoms and on their association with electrocardiographic and/or radiographic abnormalities specific for PE. Among patients who, according to the model, had been rated as having a high clinical probability, the prevalence of proven PE was 97%, while it was 3

  6. Pre-Aggregation with Probability Distributions

    DEFF Research Database (Denmark)

    Timko, Igor; Dyreson, Curtis E.; Pedersen, Torben Bach

    2006-01-01

    Motivated by the increasing need to analyze complex, uncertain multidimensional data this paper proposes probabilistic OLAP queries that are computed using probability distributions rather than atomic values. The paper describes how to create probability distributions from base data, and how...... the distributions can be subsequently used in pre-aggregation. Since the probability distributions can become large, we show how to achieve good time and space efficiency by approximating the distributions. We present the results of several experiments that demonstrate the effectiveness of our methods. The work...... is motivated with a real-world case study, based on our collaboration with a leading Danish vendor of location-based services. This paper is the first to consider the approximate processing of probabilistic OLAP queries over probability distributions....

  7. Impact of controlling the sum of error probability in the sequential probability ratio test

    Directory of Open Access Journals (Sweden)

    Bijoy Kumarr Pradhan

    2013-05-01

    Full Text Available A generalized modified method is proposed to control the sum of error probabilities in sequential probability ratio test to minimize the weighted average of the two average sample numbers under a simple null hypothesis and a simple alternative hypothesis with the restriction that the sum of error probabilities is a pre-assigned constant to find the optimal sample size and finally a comparison is done with the optimal sample size found from fixed sample size procedure. The results are applied to the cases when the random variate follows a normal law as well as Bernoullian law.

  8. Assessment of clinical reasoning: A Script Concordance test designed for pre-clinical medical students.

    Science.gov (United States)

    Humbert, Aloysius J; Johnson, Mary T; Miech, Edward; Friedberg, Fred; Grackin, Janice A; Seidman, Peggy A

    2011-01-01

    The Script Concordance test (SCT) measures clinical reasoning in the context of uncertainty by comparing the responses of examinees and expert clinicians. It uses the level of agreement with a panel of experts to assign credit for the examinee's answers. This study describes the development and validation of a SCT for pre-clinical medical students. Faculty from two US medical schools developed SCT items in the domains of anatomy, biochemistry, physiology, and histology. Scoring procedures utilized data from a panel of 30 expert physicians. Validation focused on internal reliability and the ability of the SCT to distinguish between different cohorts. The SCT was administered to an aggregate of 411 second-year and 70 fourth-year students from both schools. Internal consistency for the 75 test items was satisfactory (Cronbach's alpha = 0.73). The SCT successfully differentiated second- from fourth-year students and both student groups from the expert panel in a one-way analysis of variance (F(2,508) = 120.4; p students from the two schools were not significantly different (p = 0.20). This SCT successfully differentiated pre-clinical medical students from fourth-year medical students and both cohorts of medical students from expert clinicians across different institutions and geographic areas. The SCT shows promise as an easy-to-administer measure of "problem-solving" performance in competency evaluation even in the beginning years of medical education.

  9. [Quality Management and Quality Specifications of Laboratory Tests in Clinical Studies--Challenges in Pre-Analytical Processes in Clinical Laboratories].

    Science.gov (United States)

    Ishibashi, Midori

    2015-01-01

    The cost, speed, and quality are the three important factors recently indicated by the Ministry of Health, Labour and Welfare (MHLW) for the purpose of accelerating clinical studies. Based on this background, the importance of laboratory tests is increasing, especially in the evaluation of clinical study participants' entry and safety, and drug efficacy. To assure the quality of laboratory tests, providing high-quality laboratory tests is mandatory. For providing adequate quality assurance in laboratory tests, quality control in the three fields of pre-analytical, analytical, and post-analytical processes is extremely important. There are, however, no detailed written requirements concerning specimen collection, handling, preparation, storage, and shipping. Most laboratory tests for clinical studies are performed onsite in a local laboratory; however, a part of laboratory tests is done in offsite central laboratories after specimen shipping. As factors affecting laboratory tests, individual and inter-individual variations are well-known. Besides these factors, standardizing the factors of specimen collection, handling, preparation, storage, and shipping, may improve and maintain the high quality of clinical studies in general. Furthermore, the analytical method, units, and reference interval are also important factors. It is concluded that, to overcome the problems derived from pre-analytical processes, it is necessary to standardize specimen handling in a broad sense.

  10. Pre-test probability risk scores and their use in contemporary management of patients with chest pain: One year stress echo cohort study

    Science.gov (United States)

    Demarco, Daniela Cassar; Papachristidis, Alexandros; Roper, Damian; Tsironis, Ioannis; Byrne, Jonathan; Monaghan, Mark

    2015-01-01

    Objectives To compare how patients with chest pain would be investigated, based on the two guidelines available for UK cardiologists, on the management of patients with stable chest pain. The UK National Institute of Clinical Excellence (NICE) guideline which was published in 2010 and the European society of cardiology (ESC) guideline published in 2013. Both guidelines utilise pre-test probability risk scores, to guide the choice of investigation. Design We undertook a large retrospective study to investigate the outcomes of stress echocardiography. Setting A large tertiary centre in the UK in a contemporary clinical practice. Participants Two thirds of the patients in the cohort were referred from our rapid access chest pain clinics. Results We found that the NICE risk score overestimates risk by 20% compared to the ESC Risk score. We also found that based on the NICE guidelines, 44% of the patients presenting with chest pain, in this cohort, would have been investigated invasively, with diagnostic coronary angiography. Using the ESC guidelines, only 0.3% of the patients would be investigated invasively. Conclusion The large discrepancy between the two guidelines can be easily reduced if NICE adopted the ESC risk score. PMID:26673458

  11. Pre-Clinical Testing of Real-Time PCR Assays for Diarrheal Disease Agents of Genera Escherichia and Shigella

    Science.gov (United States)

    2014-05-16

    FOR DIARRHEAL DISEASE AGENTS OF GENERA ESCHERICHIA AND SHIGELLA May 16, 2014 Reporting Period: October 1, 2010 to September 30, 2013...10-2010 - 30-09-2013 PRE-CLINICAL TESTING OF REAL-TIME PCR ASSAYS FOR DIARRHEAL DISEASE AGENTS OF GENERA ESCHERICHIA AND SHIGELLA ...Texas (MOA 2007 - 2013. Agreement No.: DODI 4000.19; AFI 25-201). Pre-clinical test results qualify ETEC and Shigella real-time PCR assays as lead

  12. White blood cell and platelet count as adjuncts to standard clinical evaluation for risk assessment in patients at low probability of acute aortic syndrome.

    Science.gov (United States)

    Morello, Fulvio; Cavalot, Giulia; Giachino, Francesca; Tizzani, Maria; Nazerian, Peiman; Carbone, Federica; Pivetta, Emanuele; Mengozzi, Giulio; Moiraghi, Corrado; Lupia, Enrico

    2017-08-01

    Pre-test probability assessment is key in the approach to suspected acute aortic syndromes (AASs). However, most patients with AAS-compatible symptoms are classified at low probability, warranting further evaluation for decision on aortic imaging. White blood cell count, platelet count and fibrinogen explore pathophysiological pathways mobilized in AASs and are routinely assayed in the workup of AASs. However, the diagnostic performance of these variables for AASs, alone and as a bundle, is unknown. We tested the hypothesis that white blood cell count, platelet count and/or fibrinogen at presentation may be applied as additional tools to standard clinical evaluation for pre-test risk assessment in patients at low probability of AAS. This was a retrospective observational study conducted on consecutive patients managed in our Emergency Department from 2009 to 2014 for suspected AAS. White blood cell count, platelet count and fibrinogen were assayed during evaluation in the Emergency Department. The final diagnosis was obtained by computed tomography angiography. The pre-test probability of AAS was defined according to guidelines. Of 1210 patients with suspected AAS, 1006 (83.1%) were classified at low probability, and 271 (22.4%) were diagnosed with AAS. Within patients at low probability, presence of at least one alteration among white blood cell count >9*10 3 /µl, platelet count probability, white blood cell count >9*10 3 /µl and platelet count probability, the estimated risk of AAS based on the number of alterations amongst white blood cell count >9*10 3 /µl and platelet count probability to fine-tune risk assessment of AAS.

  13. "I Don't Really Understand Probability at All": Final Year Pre-Service Teachers' Understanding of Probability

    Science.gov (United States)

    Maher, Nicole; Muir, Tracey

    2014-01-01

    This paper reports on one aspect of a wider study that investigated a selection of final year pre-service primary teachers' responses to four probability tasks. The tasks focused on foundational ideas of probability including sample space, independence, variation and expectation. Responses suggested that strongly held intuitions appeared to…

  14. A computerized pre-clinical test for cemented hip prostheses based on finite element techniques

    NARCIS (Netherlands)

    Stolk, Jan

    2003-01-01

    Despite the success of cemented total hip replacement (THR), high failure rates are occasionally reported for cemented hip implants that are introduced on the orthopaedic market. Rigorous pre-clinical testing of hip implants could prevent these disasters, by detecting unsafe implant designs at a

  15. Constructing diagnostic likelihood: clinical decisions using subjective versus statistical probability.

    Science.gov (United States)

    Kinnear, John; Jackson, Ruth

    2017-07-01

    Although physicians are highly trained in the application of evidence-based medicine, and are assumed to make rational decisions, there is evidence that their decision making is prone to biases. One of the biases that has been shown to affect accuracy of judgements is that of representativeness and base-rate neglect, where the saliency of a person's features leads to overestimation of their likelihood of belonging to a group. This results in the substitution of 'subjective' probability for statistical probability. This study examines clinicians' propensity to make estimations of subjective probability when presented with clinical information that is considered typical of a medical condition. The strength of the representativeness bias is tested by presenting choices in textual and graphic form. Understanding of statistical probability is also tested by omitting all clinical information. For the questions that included clinical information, 46.7% and 45.5% of clinicians made judgements of statistical probability, respectively. Where the question omitted clinical information, 79.9% of clinicians made a judgement consistent with statistical probability. There was a statistically significant difference in responses to the questions with and without representativeness information (χ2 (1, n=254)=54.45, pprobability. One of the causes for this representativeness bias may be the way clinical medicine is taught where stereotypic presentations are emphasised in diagnostic decision making. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  16. Clinical utility of routine pre-operative axillary ultrasound and fine needle aspiration cytology in patient selection for sentinel lymph node biopsy.

    Science.gov (United States)

    Rattay, T; Muttalib, M; Khalifa, E; Duncan, A; Parker, S J

    2012-04-01

    In patients with operable breast cancer, pre-operative evaluation of the axilla may be of use in the selection of appropriate axillary surgery. Pre-operative axillary ultrasound (US) and fine needle aspiration cytology (FNAC) assessments have become routine practice in many breast units, although the evidence base is still gathering. This study assessed the clinical utility of US+/-FNAC in patient selection for either axillary node clearance (ANC) or sentinel lymph node biopsy (SLNB) in patients undergoing surgery for operable breast cancer. Over a two-year period, 348 patients with a clinically negative axilla underwent axillary US. 67 patients with suspicious nodes on US also underwent FNAC. The sensitivity and specificity of axillary investigations to determine nodal involvement were 56% (confidence interval: 47-64%) and 90% (84-93%) for US alone, and 76% (61-87%) and 100% (65-100%) for FNAC combined with US, respectively. With a positive US, the post-test probability was 78%. A negative US carried a post-test probability of 25%. When FNAC was positive, the post-test probability was greater than unity. A negative FNAC yielded a post-test probability of 52%. All patients with positive FNAC and most patients with suspicious US were listed for axillary node clearance (ANC) after consideration at the multi-disciplinary team (MDT) meeting. With pre-operative axillary US+/-FNAC, 20% of patients were saved a potential second axillary procedure, facilitating a reduction in the overall re-operation rate to 12%. In this study, a positive pre-operative US+/-FNAC directs patients towards ANC. When the result is negative, other clinico-pathological factors need to be taken into account in the selection of the appropriate axillary procedure. Copyright © 2011 Elsevier Ltd. All rights reserved.

  17. Cytologic diagnosis: expression of probability by clinical pathologists.

    Science.gov (United States)

    Christopher, Mary M; Hotz, Christine S

    2004-01-01

    Clinical pathologists use descriptive terms or modifiers to express the probability or likelihood of a cytologic diagnosis. Words are imprecise in meaning, however, and may be used and interpreted differently by pathologists and clinicians. The goals of this study were to 1) assess the frequency of use of 18 modifiers, 2) determine the probability of a positive diagnosis implied by the modifiers, 3) identify preferred modifiers for different levels of probability, 4) ascertain the importance of factors that affect expression of diagnostic certainty, and 5) evaluate differences based on gender, employment, and experience. We surveyed 202 clinical pathologists who were board-certified by the American College of Veterinary Pathologists (Clinical Pathology). Surveys were distributed in October 2001 and returned by e-mail, fax, or surface mail over a 2-month period. Results were analyzed by parametric and nonparametric tests. Survey response rate was 47.5% (n = 96) and primarily included clinical pathologists at veterinary schools (n = 58) and diagnostic laboratories (n = 31). Eleven of 18 terms were used "often" or "sometimes" by >/= 50% of respondents. Broad variability was found in the probability assigned to each term, especially those with median values of 75 to 90%. Preferred modifiers for 7 numerical probabilities ranging from 0 to 100% included 68 unique terms; however, a set of 10 terms was used by >/= 50% of respondents. Cellularity and quality of the sample, experience of the pathologist, and implications of the diagnosis were the most important factors affecting the expression of probability. Because of wide discrepancy in the implied likelihood of a diagnosis using words, defined terminology and controlled vocabulary may be useful in improving communication and the quality of data in cytology reporting.

  18. A highly invasive human glioblastoma pre-clinical model for testing therapeutics

    Directory of Open Access Journals (Sweden)

    Cao Brian

    2008-12-01

    Full Text Available Abstract Animal models greatly facilitate understanding of cancer and importantly, serve pre-clinically for evaluating potential anti-cancer therapies. We developed an invasive orthotopic human glioblastoma multiforme (GBM mouse model that enables real-time tumor ultrasound imaging and pre-clinical evaluation of anti-neoplastic drugs such as 17-(allylamino-17-demethoxy geldanamycin (17AAG. Clinically, GBM metastasis rarely happen, but unexpectedly most human GBM tumor cell lines intrinsically possess metastatic potential. We used an experimental lung metastasis assay (ELM to enrich for metastatic cells and three of four commonly used GBM lines were highly metastatic after repeated ELM selection (M2. These GBM-M2 lines grew more aggressively orthotopically and all showed dramatic multifold increases in IL6, IL8, MCP-1 and GM-CSF expression, cytokines and factors that are associated with GBM and poor prognosis. DBM2 cells, which were derived from the DBTRG-05MG cell line were used to test the efficacy of 17AAG for treatment of intracranial tumors. The DMB2 orthotopic xenografts form highly invasive tumors with areas of central necrosis, vascular hyperplasia and intracranial dissemination. In addition, the orthotopic tumors caused osteolysis and the skull opening correlated to the tumor size, permitting the use of real-time ultrasound imaging to evaluate antitumor drug activity. We show that 17AAG significantly inhibits DBM2 tumor growth with significant drug responses in subcutaneous, lung and orthotopic tumor locations. This model has multiple unique features for investigating the pathobiology of intracranial tumor growth and for monitoring systemic and intracranial responses to antitumor agents.

  19. An assessment of time involved in pre-test case review and counseling for a whole genome sequencing clinical research program.

    Science.gov (United States)

    Williams, Janet L; Faucett, W Andrew; Smith-Packard, Bethanny; Wagner, Monisa; Williams, Marc S

    2014-08-01

    Whole genome sequencing (WGS) is being used for evaluation of individuals with undiagnosed disease of suspected genetic origin. Implementing WGS into clinical practice will place an increased burden upon care teams with regard to pre-test patient education and counseling about results. To quantitate the time needed for appropriate pre-test evaluation of participants in WGS testing, we documented the time spent by our clinical research group on various activities related to program preparation, participant screening, and consent prior to WGS. Participants were children or young adults with autism, intellectual or developmental disability, and/or congenital anomalies, who have remained undiagnosed despite previous evaluation, and their biologic parents. Results showed that significant time was spent in securing allocation of clinical research space to counsel participants and families, and in acquisition and review of participant's medical records. Pre-enrollment chart review identified two individuals with existing diagnoses resulting in savings of $30,000 for the genome sequencing alone, as well as saving hours of personnel time for genome interpretation and communication of WGS results. New WGS programs should plan for costs associated with additional pre-test administrative planning and patient evaluation time that will be required to provide high quality care.

  20. Assessment of clinical utility of 18F-FDG PET in patients with head and neck cancer: a probability analysis

    International Nuclear Information System (INIS)

    Goerres, Gerhard W.; Mosna-Firlejczyk, Katarzyna; Schulthess, Gustav K. von; Steurer, Johann; Bachmann, Lucas M.

    2003-01-01

    The purpose of this study was to calculate disease probabilities based on data of patients with head and neck cancer in the register of our institution and to perform a systematic review of the available data on the accuracy of PET in the primary assessment and follow-up of patients with head and neck cancer. The pre-test probability of head and neck cancer among patients in our institutional data registry was assessed. Then the published literature was selected and appraised according to a standard protocol of systematic reviews. Two reviewers independently selected and extracted data on study characteristics, quality and accuracy. Accuracy data were used to form 2 x 2 contingency tables and were pooled to produce summary receiver operating characteristic (ROC) curves and summary likelihood ratios for positive and negative testing. Finally post-test probabilities were calculated on the basis of the pre-test probabilities of this patient group. All patients had cytologically or histologically proven cancer. The prevalence of additional lymph node metastases on PET in staging examinations was 19.6% (11/56), and that of locoregional recurrence on restaging PET was 28.6% (12/42). In the primary assessment of patients, PET had positive and negative likelihood ratios of 3.9 (2.56-5.93) and 0.24 (0.14-0.41), respectively. Disease probabilities were therefore 49.4% for a positive test result and 5.7% for a negative test result. In the assessment of recurrence these values were 3.96 (2.8-5.6) and 0.16 (0.1-0.25), resulting in probabilities of 49.7% and 3.8%. PET evaluation for involvement of lymph nodes had positive and negative likelihood ratios of 17.26 (10.9-27.3) and 0.19 (0.13-0.27) for primary assessment and 11.0 (2.93-41.24) and 0.14 (0.01-1.88) for detection of recurrence. The probabilities were 81.2% and 4.5% for primary assessment and 73.3% and 3.4% for assessment of recurrence. It is concluded that in this clinical setting the main advantage of PET is the

  1. Bayesian noninferiority test for 2 binomial probabilities as the extension of Fisher exact test.

    Science.gov (United States)

    Doi, Masaaki; Takahashi, Fumihiro; Kawasaki, Yohei

    2017-12-30

    Noninferiority trials have recently gained importance for the clinical trials of drugs and medical devices. In these trials, most statistical methods have been used from a frequentist perspective, and historical data have been used only for the specification of the noninferiority margin Δ>0. In contrast, Bayesian methods, which have been studied recently are advantageous in that they can use historical data to specify prior distributions and are expected to enable more efficient decision making than frequentist methods by borrowing information from historical trials. In the case of noninferiority trials for response probabilities π 1 ,π 2 , Bayesian methods evaluate the posterior probability of H 1 :π 1 >π 2 -Δ being true. To numerically calculate such posterior probability, complicated Appell hypergeometric function or approximation methods are used. Further, the theoretical relationship between Bayesian and frequentist methods is unclear. In this work, we give the exact expression of the posterior probability of the noninferiority under some mild conditions and propose the Bayesian noninferiority test framework which can flexibly incorporate historical data by using the conditional power prior. Further, we show the relationship between Bayesian posterior probability and the P value of the Fisher exact test. From this relationship, our method can be interpreted as the Bayesian noninferior extension of the Fisher exact test, and we can treat superiority and noninferiority in the same framework. Our method is illustrated through Monte Carlo simulations to evaluate the operating characteristics, the application to the real HIV clinical trial data, and the sample size calculation using historical data. Copyright © 2017 John Wiley & Sons, Ltd.

  2. MASTER: a model to improve and standardize clinical breakpoints for antimicrobial susceptibility testing using forecast probabilities.

    Science.gov (United States)

    Blöchliger, Nicolas; Keller, Peter M; Böttger, Erik C; Hombach, Michael

    2017-09-01

    The procedure for setting clinical breakpoints (CBPs) for antimicrobial susceptibility has been poorly standardized with respect to population data, pharmacokinetic parameters and clinical outcome. Tools to standardize CBP setting could result in improved antibiogram forecast probabilities. We propose a model to estimate probabilities for methodological categorization errors and defined zones of methodological uncertainty (ZMUs), i.e. ranges of zone diameters that cannot reliably be classified. The impact of ZMUs on methodological error rates was used for CBP optimization. The model distinguishes theoretical true inhibition zone diameters from observed diameters, which suffer from methodological variation. True diameter distributions are described with a normal mixture model. The model was fitted to observed inhibition zone diameters of clinical Escherichia coli strains. Repeated measurements for a quality control strain were used to quantify methodological variation. For 9 of 13 antibiotics analysed, our model predicted error rates of  0.1% for ampicillin, cefoxitin, cefuroxime and amoxicillin/clavulanic acid. Increasing the susceptible CBP (cefoxitin) and introducing ZMUs (ampicillin, cefuroxime, amoxicillin/clavulanic acid) decreased error rates to < 0.1%. ZMUs contained low numbers of isolates for ampicillin and cefuroxime (3% and 6%), whereas the ZMU for amoxicillin/clavulanic acid contained 41% of all isolates and was considered not practical. We demonstrate that CBPs can be improved and standardized by minimizing methodological categorization error rates. ZMUs may be introduced if an intermediate zone is not appropriate for pharmacokinetic/pharmacodynamic or drug dosing reasons. Optimized CBPs will provide a standardized antibiotic susceptibility testing interpretation at a defined level of probability. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For

  3. Some uses of predictive probability of success in clinical drug development

    Directory of Open Access Journals (Sweden)

    Mauro Gasparini

    2013-03-01

    Full Text Available Predictive probability of success is a (subjective Bayesian evaluation of the prob- ability of a future successful event in a given state of information. In the context of pharmaceutical clinical drug development, successful events relate to the accrual of positive evidence on the therapy which is being developed, like demonstration of su- perior efficacy or ascertainment of safety. Positive evidence will usually be obtained via standard frequentist tools, according to the regulations imposed in the world of pharmaceutical development.Within a single trial, predictive probability of success can be identified with expected power, i.e. the evaluation of the success probability of the trial. Success means, for example, obtaining a significant result of a standard superiority test.Across trials, predictive probability of success can be the probability of a successful completion of an entire part of clinical development, for example a successful phase III development in the presence of phase II data.Calculations of predictive probability of success in the presence of normal data with known variance will be illustrated, both for within-trial and across-trial predictions.

  4. Estimation of post-test probabilities by residents: Bayesian reasoning versus heuristics?

    Science.gov (United States)

    Hall, Stacey; Phang, Sen Han; Schaefer, Jeffrey P; Ghali, William; Wright, Bruce; McLaughlin, Kevin

    2014-08-01

    Although the process of diagnosing invariably begins with a heuristic, we encourage our learners to support their diagnoses by analytical cognitive processes, such as Bayesian reasoning, in an attempt to mitigate the effects of heuristics on diagnosing. There are, however, limited data on the use ± impact of Bayesian reasoning on the accuracy of disease probability estimates. In this study our objective was to explore whether Internal Medicine residents use a Bayesian process to estimate disease probabilities by comparing their disease probability estimates to literature-derived Bayesian post-test probabilities. We gave 35 Internal Medicine residents four clinical vignettes in the form of a referral letter and asked them to estimate the post-test probability of the target condition in each case. We then compared these to literature-derived probabilities. For each vignette the estimated probability was significantly different from the literature-derived probability. For the two cases with low literature-derived probability our participants significantly overestimated the probability of these target conditions being the correct diagnosis, whereas for the two cases with high literature-derived probability the estimated probability was significantly lower than the calculated value. Our results suggest that residents generate inaccurate post-test probability estimates. Possible explanations for this include ineffective application of Bayesian reasoning, attribute substitution whereby a complex cognitive task is replaced by an easier one (e.g., a heuristic), or systematic rater bias, such as central tendency bias. Further studies are needed to identify the reasons for inaccuracy of disease probability estimates and to explore ways of improving accuracy.

  5. An immunologic model for rapid vaccine assessment -- a clinical trial in a test tube.

    Science.gov (United States)

    Higbee, Russell G; Byers, Anthony M; Dhir, Vipra; Drake, Donald; Fahlenkamp, Heather G; Gangur, Jyoti; Kachurin, Anatoly; Kachurina, Olga; Leistritz, Del; Ma, Yifan; Mehta, Riyaz; Mishkin, Eric; Moser, Janice; Mosquera, Luis; Nguyen, Mike; Parkhill, Robert; Pawar, Santosh; Poisson, Louis; Sanchez-Schmitz, Guzman; Schanen, Brian; Singh, Inderpal; Song, Haifeng; Tapia, Tenekua; Warren, William; Wittman, Vaughan

    2009-09-01

    While the duration and size of human clinical trials may be difficult to reduce, there are several parameters in pre-clinical vaccine development that may be possible to further optimise. By increasing the accuracy of the models used for pre-clinical vaccine testing, it should be possible to increase the probability that any particular vaccine candidate will be successful in human trials. In addition, an improved model will allow the collection of increasingly more-informative data in pre-clinical tests, thus aiding the rational design and formulation of candidates entered into clinical evaluation. An acceleration and increase in sophistication of pre-clinical vaccine development will thus require the advent of more physiologically-accurate models of the human immune system, coupled with substantial advances in the mechanistic understanding of vaccine efficacy, achieved by using this model. We believe the best viable option available is to use human cells and/or tissues in a functional in vitro model of human physiology. Not only will this more accurately model human diseases, it will also eliminate any ethical, moral and scientific issues involved with use of live humans and animals. An in vitro model, termed "MIMIC" (Modular IMmune In vitro Construct), was designed and developed to reflect the human immune system in a well-based format. The MIMIC System is a laboratory-based methodology that replicates the human immune system response. It is highly automated, and can be used to simulate a clinical trial for a diverse population, without putting human subjects at risk. The MIMIC System uses the circulating immune cells of individual donors to recapitulate each individual human immune response by maintaining the autonomy of the donor. Thus, an in vitro test system has been created that is functionally equivalent to the donor's own immune system and is designed to respond in a similar manner to the in vivo response. 2009 FRAME.

  6. Same day ART initiation versus clinic-based pre-ART assessment and counselling for individuals newly tested HIV-positive during community-based HIV testing in rural Lesotho - a randomized controlled trial (CASCADE trial).

    Science.gov (United States)

    Labhardt, Niklaus Daniel; Ringera, Isaac; Lejone, Thabo Ishmael; Masethothi, Phofu; Thaanyane, T'sepang; Kamele, Mashaete; Gupta, Ravi Shankar; Thin, Kyaw; Cerutti, Bernard; Klimkait, Thomas; Fritz, Christiane; Glass, Tracy Renée

    2016-04-14

    Achievement of the UNAIDS 90-90-90 targets in Sub-Sahara Africa is challenged by a weak care-cascade with poor linkage to care and retention in care. Community-based HIV testing and counselling (HTC) is widely used in African countries. However, rates of linkage to care and initiation of antiretroviral therapy (ART) in individuals who tested HIV-positive are often very low. A frequently cited reason for non-linkage to care is the time-consuming pre-ART assessment often requiring several clinic visits before ART-initiation. This two-armed open-label randomized controlled trial compares in individuals tested HIV-positive during community-based HTC the proposition of same-day community-based ART-initiation to the standard of care pre-ART assessment at the clinic. Home-based HTC campaigns will be conducted in catchment areas of six clinics in rural Lesotho. Households where at least one individual tested HIV positive will be randomized. In the standard of care group individuals receive post-test counselling and referral to the nearest clinic for pre-ART assessment and counselling. Once they have started ART the follow-up schedule foresees monthly clinic visits. Individuals randomized to the intervention group receive on the spot point-of-care pre-ART assessment and adherence counselling with the proposition to start ART that same day. Once they have started ART, follow-up clinic visits will be less frequent. First primary outcome is linkage to care (individual presents at the clinic at least once within 3 months after the HIV test). The second primary outcome is viral suppression 12 months after enrolment in the study. We plan to enrol a minimum of 260 households with 1:1 allocation and parallel assignment into both arms. This trial will show if in individuals tested HIV-positive during community-based HTC campaigns the proposition of same-day ART initiation in the community, combined with less frequent follow-up visits at the clinic could be a pragmatic approach to

  7. Collaborative learning in pre-clinical dental hygiene education.

    Science.gov (United States)

    Mueller-Joseph, Laura J; Nappo-Dattoma, Luisa

    2013-04-01

    Dental hygiene education continues to move beyond mastery of content material and skill development to learning concepts that promote critical-thinking and problem-solving skills. The purpose of this research was to evaluate the effectiveness of collaborative learning and determine the growth in intellectual development of 54 first-year dental hygiene students. The control group used traditional pre-clinical teaching and the experimental group used collaborative pedagogy for instrument introduction. All students were subjected to a post-test evaluating their ability to apply the principles of instrumentation. Intellectual development was determined using pre- and post-tests based on the Perry Scheme of Intellectual Development. Student attitudes were assessed using daily Classroom Assessment Activities and an end-of-semester departmental course evaluation. Findings indicated no significant difference between collaborative learning and traditional learning in achieving pre-clinical competence as evidenced by the students' ability to apply the principles of instrumentation. Advancement in intellectual development did not differ significantly between groups. Value added benefits of a collaborative learning environment as identified by the evaluation of student attitudes included decreased student reliance on authority, recognition of peers as legitimate sources of learning and increased self-confidence. A significant difference in student responses to daily classroom assessments was evident on the 5 days a collaborative learning environment was employed. Dental hygiene students involved in a pre-clinical collaborative learning environment are more responsible for their own learning and tend to have a more positive attitude toward the subject matter. Future studies evaluating collaborative learning in clinical dental hygiene education need to investigate the cost/benefit ratio of the value added outcomes of collaborative learning.

  8. Impact of the clinical context on the 14-3-3 test for the diagnosis of sporadic CJD

    Directory of Open Access Journals (Sweden)

    Sierra-Moros Maríajosé

    2006-07-01

    Full Text Available Abstract Background The 14-3-3 test appears to be a valuable aid for the clinical diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD in selected populations. However, its usefulness in routine practice has been challenged. In this study, the influence of the clinical context on the performance of the 14-3-3 test for the diagnosis of sCJD is investigated through the analysis of a large prospective clinical series. Methods Six hundred seventy-two Spanish patients with clinically suspected sCJD were analyzed. Clinical classification at sample reception according to the World Health Organization's (WHO criteria (excluding the 14-3-3 test result was used to explore the influence of the clinical context on the pre-test probabilities, and positive (PPV and negative (NPV predictive values of the 14-3-3 test. Results Predictive values of the test varied greatly according to the initial clinical classification: PPV of 98.8%, 96.5% and 45.0%, and NPV of 26.1%, 66.6% and 100% for probable sCJDi (n = 115, possible sCJDi (n = 73 and non-sCJDi (n = 484 cases, respectively. According to multivariate and Bayesian analyses, these values represent an improvement of diagnostic certainty compared to clinical data alone. Conclusion In three different contexts of sCJD suspicion, the 14-3-3 assay provides useful information complementary to clinical and electroencephalographic (EEG data. The test is most useful supporting a clinical impression, whilst it may show deceptive when it is not in agreement with clinical data.

  9. Post-test probability for neonatal hyperbilirubinemia based on umbilical cord blood bilirubin, direct antiglobulin test, and ABO compatibility results.

    Science.gov (United States)

    Peeters, Bart; Geerts, Inge; Van Mullem, Mia; Micalessi, Isabel; Saegeman, Veroniek; Moerman, Jan

    2016-05-01

    Many hospitals opt for early postnatal discharge of newborns with a potential risk of readmission for neonatal hyperbilirubinemia. Assays/algorithms with the possibility to improve prediction of significant neonatal hyperbilirubinemia are needed to optimize screening protocols and safe discharge of neonates. This study investigated the predictive value of umbilical cord blood (UCB) testing for significant hyperbilirubinemia. Neonatal UCB bilirubin, UCB direct antiglobulin test (DAT), and blood group were determined, as well as the maternal blood group and the red blood cell antibody status. Moreover, in newborns with clinically apparent jaundice after visual assessment, plasma total bilirubin (TB) was measured. Clinical factors positively associated with UCB bilirubin were ABO incompatibility, positive DAT, presence of maternal red cell antibodies, alarming visual assessment and significant hyperbilirubinemia in the first 6 days of life. UCB bilirubin performed clinically well with an area under the receiver-operating characteristic curve (AUC) of 0.82 (95 % CI 0.80-0.84). The combined UCB bilirubin, DAT, and blood group analysis outperformed results of these parameters considered separately to detect significant hyperbilirubinemia and correlated exponentially with hyperbilirubinemia post-test probability. Post-test probabilities for neonatal hyperbilirubinemia can be calculated using exponential functions defined by UCB bilirubin, DAT, and ABO compatibility results. • The diagnostic value of the triad umbilical cord blood bilirubin measurement, direct antiglobulin testing and blood group analysis for neonatal hyperbilirubinemia remains unclear in literature. • Currently no guideline recommends screening for hyperbilirubinemia using umbilical cord blood. What is New: • Post-test probability for hyperbilirubinemia correlated exponentially with umbilical cord blood bilirubin in different risk groups defined by direct antiglobulin test and ABO blood group

  10. Multidetector computed tomographic pulmonary angiography in patients with a high clinical probability of pulmonary embolism.

    Science.gov (United States)

    Moores, L; Kline, J; Portillo, A K; Resano, S; Vicente, A; Arrieta, P; Corres, J; Tapson, V; Yusen, R D; Jiménez, D

    2016-01-01

    ESSENTIALS: When high probability of pulmonary embolism (PE), sensitivity of computed tomography (CT) is unclear. We investigated the sensitivity of multidetector CT among 134 patients with a high probability of PE. A normal CT alone may not safely exclude PE in patients with a high clinical pretest probability. In patients with no clear alternative diagnosis after CTPA, further testing should be strongly considered. Whether patients with a negative multidetector computed tomographic pulmonary angiography (CTPA) result and a high clinical pretest probability of pulmonary embolism (PE) should be further investigated is controversial. This was a prospective investigation of the sensitivity of multidetector CTPA among patients with a priori clinical assessment of a high probability of PE according to the Wells criteria. Among patients with a negative CTPA result, the diagnosis of PE required at least one of the following conditions: ventilation/perfusion lung scan showing a high probability of PE in a patient with no history of PE, abnormal findings on venous ultrasonography in a patient without previous deep vein thrombosis at that site, or the occurrence of venous thromboembolism (VTE) in a 3-month follow-up period after anticoagulation was withheld because of a negative multidetector CTPA result. We identified 498 patients with a priori clinical assessment of a high probability of PE and a completed CTPA study. CTPA excluded PE in 134 patients; in these patients, the pooled incidence of VTE was 5.2% (seven of 134 patients; 95% confidence interval [CI] 1.5-9.0). Five patients had VTEs that were confirmed by an additional imaging test despite a negative CTPA result (five of 48 patients; 10.4%; 95% CI 1.8-19.1), and two patients had objectively confirmed VTEs that occurred during clinical follow-up of at least 3 months (two of 86 patients; 2.3%; 95% CI 0-5.5). None of the patients had a fatal PE during follow-up. A normal multidetector CTPA result alone may not safely

  11. Bayesian probability analysis: a prospective demonstration of its clinical utility in diagnosing coronary disease

    International Nuclear Information System (INIS)

    Detrano, R.; Yiannikas, J.; Salcedo, E.E.; Rincon, G.; Go, R.T.; Williams, G.; Leatherman, J.

    1984-01-01

    One hundred fifty-four patients referred for coronary arteriography were prospectively studied with stress electrocardiography, stress thallium scintigraphy, cine fluoroscopy (for coronary calcifications), and coronary angiography. Pretest probabilities of coronary disease were determined based on age, sex, and type of chest pain. These and pooled literature values for the conditional probabilities of test results based on disease state were used in Bayes theorem to calculate posttest probabilities of disease. The results of the three noninvasive tests were compared for statistical independence, a necessary condition for their simultaneous use in Bayes theorem. The test results were found to demonstrate pairwise independence in patients with and those without disease. Some dependencies that were observed between the test results and the clinical variables of age and sex were not sufficient to invalidate application of the theorem. Sixty-eight of the study patients had at least one major coronary artery obstruction of greater than 50%. When these patients were divided into low-, intermediate-, and high-probability subgroups according to their pretest probabilities, noninvasive test results analyzed by Bayesian probability analysis appropriately advanced 17 of them by at least one probability subgroup while only seven were moved backward. Of the 76 patients without disease, 34 were appropriately moved into a lower probability subgroup while 10 were incorrectly moved up. We conclude that posttest probabilities calculated from Bayes theorem more accurately classified patients with and without disease than did pretest probabilities, thus demonstrating the utility of the theorem in this application

  12. In-situ medical simulation for pre-implementation testing of clinical service in a regional hospital in Hong Kong.

    Science.gov (United States)

    Chen, P P; Tsui, N Tk; Fung, A Sw; Chiu, A Hf; Wong, W Cw; Leong, H T; Lee, P Sf; Lau, J Yw

    2017-08-01

    The implementation of a new clinical service is associated with anxiety and challenges that may prevent smooth and safe execution of the service. Unexpected issues may not be apparent until the actual clinical service commences. We present a novel approach to test the new clinical setting before actual implementation of our endovascular aortic repair service. In-situ simulation at the new clinical location would enable identification of potential process and system issues prior to implementation of the service. After preliminary planning, a simulation test utilising a case scenario with actual simulation of the entire care process was carried out to identify any logistic, equipment, settings or clinical workflow issues, and to trial a contingency plan for a surgical complication. All patient care including anaesthetic, surgical, and nursing procedures and processes were simulated and tested. Overall, 17 vital process and system issues were identified during the simulation as potential clinical concerns. They included difficult patient positioning, draping pattern, unsatisfactory equipment setup, inadequate critical surgical instruments, blood products logistics, and inadequate nursing support during crisis. In-situ simulation provides an innovative method to identify critical deficiencies and unexpected issues before implementation of a new clinical service. Life-threatening and serious practical issues can be identified and corrected before formal service commences. This article describes our experience with the use of simulation in pre-implementation testing of a clinical process or service. We found the method useful and would recommend it to others.

  13. Pre-clinical and clinical development of the first placental malaria vaccine

    DEFF Research Database (Denmark)

    Pehrson, Caroline; Salanti, Ali; Theander, Thor G

    2017-01-01

    the condition.  Areas covered: Pub Med was searched using the broad terms 'malaria parasite placenta' to identify studies of interactions between parasite and host, 'prevention of placental malaria' to identify current strategies to prevent placental malaria, and 'placental malaria vaccine' to identify pre-clinical...... vaccine development. However, all papers from these searches were not systematically included.  Expert commentary: The first phase I clinical trials of vaccines are well underway. Trials testing efficacy are more complicated to carry out as only women that are exposed to parasites during pregnancy...

  14. Probability of detection of clinical seizures using heart rate changes.

    Science.gov (United States)

    Osorio, Ivan; Manly, B F J

    2015-08-01

    Heart rate-based seizure detection is a viable complement or alternative to ECoG/EEG. This study investigates the role of various biological factors on the probability of clinical seizure detection using heart rate. Regression models were applied to 266 clinical seizures recorded from 72 subjects to investigate if factors such as age, gender, years with epilepsy, etiology, seizure site origin, seizure class, and data collection centers, among others, shape the probability of EKG-based seizure detection. Clinical seizure detection probability based on heart rate changes, is significantly (pprobability of detecting clinical seizures (>0.8 in the majority of subjects) using heart rate is highest for complex partial seizures, increases with a patient's years with epilepsy, is lower for females than for males and is unrelated to the side of hemisphere origin. Clinical seizure detection probability using heart rate is multi-factorially dependent and sufficiently high (>0.8) in most cases to be clinically useful. Knowledge of the role that these factors play in shaping said probability will enhance its applicability and usefulness. Heart rate is a reliable and practical signal for extra-cerebral detection of clinical seizures originating from or spreading to central autonomic network structures. Copyright © 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  15. ANALYSIS OF EFFECTIVENESS OF METHODOLOGICAL SYSTEM FOR PROBABILITY AND STOCHASTIC PROCESSES COMPUTER-BASED LEARNING FOR PRE-SERVICE ENGINEERS

    Directory of Open Access Journals (Sweden)

    E. Chumak

    2015-04-01

    Full Text Available The author substantiates that only methodological training systems of mathematical disciplines with implementation of information and communication technologies (ICT can meet the requirements of modern educational paradigm and make possible to increase the educational efficiency. Due to this fact, the necessity of developing the methodology of theory of probability and stochastic processes computer-based learning for pre-service engineers is underlined in the paper. The results of the experimental study for analysis of the efficiency of methodological system of theory of probability and stochastic processes computer-based learning for pre-service engineers are shown. The analysis includes three main stages: ascertaining, searching and forming. The key criteria of the efficiency of designed methodological system are the level of probabilistic and stochastic skills of students and their learning motivation. The effect of implementing the methodological system of probability theory and stochastic processes computer-based learning on the level of students’ IT literacy is shown in the paper. The expanding of the range of objectives of ICT applying by students is described by author. The level of formation of students’ learning motivation on the ascertaining and forming stages of the experiment is analyzed. The level of intrinsic learning motivation for pre-service engineers is defined on these stages of the experiment. For this purpose, the methodology of testing the students’ learning motivation in the chosen specialty is presented in the paper. The increasing of intrinsic learning motivation of the experimental group students (E group against the control group students (C group is demonstrated.

  16. 40 CFR 1065.520 - Pre-test verification procedures and pre-test data collection.

    Science.gov (United States)

    2010-07-01

    ... corrective action does not resolve the deficiency, you may request to use the contaminated system as an... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Pre-test verification procedures and pre-test data collection. 1065.520 Section 1065.520 Protection of Environment ENVIRONMENTAL PROTECTION...

  17. Teaching Probability to Pre-Service Teachers with Argumentation Based Science Learning Approach

    Science.gov (United States)

    Can, Ömer Sinan; Isleyen, Tevfik

    2016-01-01

    The aim of this study is to explore the effects of the argumentation based science learning (ABSL) approach on the teaching probability to pre-service teachers. The sample of the study included 41 students studying at the Department of Elementary School Mathematics Education in a public university during the 2014-2015 academic years. The study is…

  18. Simplified Freeman-Tukey test statistics for testing probabilities in ...

    African Journals Online (AJOL)

    This paper presents the simplified version of the Freeman-Tukey test statistic for testing hypothesis about multinomial probabilities in one, two and multidimensional contingency tables that does not require calculating the expected cell frequencies before test of significance. The simplified method established new criteria of ...

  19. Pre-clinical medical student experience in a pediatric pulmonary clinic

    Directory of Open Access Journals (Sweden)

    Thomas G. Saba

    2015-11-01

    Full Text Available Objective: Our objective was to evaluate the educational value of introducing pre-clinical medical students to pediatric patients and their families in a subspecialty clinic setting. Methods: First- and second-year medical students at the University of Michigan seeking clinical experience outside of the classroom attended an outpatient pediatric pulmonary clinic. Evaluation of the experience consisted of pre- and post-clinic student surveys and post-clinic parent surveys with statements employing a four-point Likert scale as well as open-ended questions. Results: Twenty-eight first-year students, 6 second-year students, and 33 parents participated in the study. Post-clinic statement scores significantly increased for statements addressing empathic attitudes, confidence communicating with children and families, comfort in the clinical environment, and social awareness. Scores did not change for statements addressing motivation, a sense of team membership, or confidence with career goals. Students achieved their goals of gaining experience interacting with patients, learning about pulmonary diseases, and observing clinic workflow. Parents felt that they contributed to student education and were not inconvenienced. Conclusions: Students identified several educational benefits of exposure to a single pediatric pulmonary clinic. Patients and families were not inconvenienced by the participation of a student. Additional studies are warranted to further investigate the value of this model of pre-clinical medical student exposure to subspecialty pediatrics.

  20. Marker for the pre-clinical development of bone substitute materials

    Directory of Open Access Journals (Sweden)

    de Wild Michael

    2017-09-01

    Full Text Available Thin mechanically stable Ti-cages have been developed for the in-vivo application as X-ray and histology markers for the optimized evaluation of pre-clinical performance of bone graft materials. A metallic frame defines the region of interest during histological investigations and supports the identification of the defect site. This standardization of the procedure enhances the quality of pre-clinical experiments. Different models of thin metallic frameworks were designed and produced out of titanium by additive manufacturing (Selective Laser Melting. The productibility, the mechanical stability, the handling and suitability of several frame geometries were tested during surgery in artificial and in ex-vivo bone before a series of cages was preclinically investigated in the female Göttingen minipigs model. With our novel approach, a flexible process was established that can be adapted to the requirements of any specific animal model and bone graft testing.

  1. Pre-analytical issues in the haemostasis laboratory: guidance for the clinical laboratories.

    Science.gov (United States)

    Magnette, A; Chatelain, M; Chatelain, B; Ten Cate, H; Mullier, F

    2016-01-01

    Ensuring quality has become a daily requirement in laboratories. In haemostasis, even more than in other disciplines of biology, quality is determined by a pre-analytical step that encompasses all procedures, starting with the formulation of the medical question, and includes patient preparation, sample collection, handling, transportation, processing, and storage until time of analysis. This step, based on a variety of manual activities, is the most vulnerable part of the total testing process and is a major component of the reliability and validity of results in haemostasis and constitutes the most important source of erroneous or un-interpretable results. Pre-analytical errors may occur throughout the testing process and arise from unsuitable, inappropriate or wrongly handled procedures. Problems may arise during the collection of blood specimens such as misidentification of the sample, use of inadequate devices or needles, incorrect order of draw, prolonged tourniquet placing, unsuccessful attempts to locate the vein, incorrect use of additive tubes, collection of unsuitable samples for quality or quantity, inappropriate mixing of a sample, etc. Some factors can alter the result of a sample constituent after collection during transportation, preparation and storage. Laboratory errors can often have serious adverse consequences. Lack of standardized procedures for sample collection accounts for most of the errors encountered within the total testing process. They can also have clinical consequences as well as a significant impact on patient care, especially those related to specialized tests as these are often considered as "diagnostic". Controlling pre-analytical variables is critical since this has a direct influence on the quality of results and on their clinical reliability. The accurate standardization of the pre-analytical phase is of pivotal importance for achieving reliable results of coagulation tests and should reduce the side effects of the influence

  2. [Effectiveness and difficulty of education on nosocomial infection control for pre-clinical practice in the clinic, so-called inclusive clinical practice phase I, for students in the Faculty of Dentistry, Tokyo Medical and Dental University].

    Science.gov (United States)

    Sunakawa, Mitsuhiro; Matsumoto, Hiroyuki

    2009-03-01

    It has been planned to give pre-clinical practice in the clinic, so-called inclusive clinical practice phase I, for fifth-grade students in the School of Dentistry, Faculty of Dentistry, Tokyo Medical and Dental University, to give them the clinical training needed to perform dental practice and clinical practicum for comprehensive patient care, namely inclusive clinical practice phase II. This study analyzed the educative efficiency of the class on nosocomial infection control (NIC) by comparing achievements pre- and post-test, and discussed appropriate education planning on the NIC for dental students. Sixty-two fifth-grade students in the 2007 academic year sat the pre- and post-tests; the mean score and standard deviation of these tests were 5.30 +/- 1.26 (n = 56) and 8.59 +/- 1.18 (n = 59), respectively. There was a statistically significant difference between them (paired t-test, p < 0.01). Another finding was that students with high scores in the post-test did not necessarily achieve high ratings in the pre-test. It is suggested that the introduction of pre- and post-tests and the clarification of main points in the class as a theme of NIC could be a useful tool for increasing the comprehension of students on the theme. Since students at lower grades will attend clinical practice in the university hospital, it is thought that students should be given NIC training early in the clinical course, and the current curriculum should be improved to increase the opportunity for students to study this important issue.

  3. The Importance of Conditional Probability in Diagnostic Reasoning and Clinical Decision Making: A Primer for the Eye Care Practitioner.

    Science.gov (United States)

    Sanfilippo, Paul G; Hewitt, Alex W; Mackey, David A

    2017-04-01

    To outline and detail the importance of conditional probability in clinical decision making and discuss the various diagnostic measures eye care practitioners should be aware of in order to improve the scope of their clinical practice. We conducted a review of the importance of conditional probability in diagnostic testing for the eye care practitioner. Eye care practitioners use diagnostic tests on a daily basis to assist in clinical decision making and optimizing patient care and management. These tests provide probabilistic information that can enable the clinician to increase (or decrease) their level of certainty about the presence of a particular condition. While an understanding of the characteristics of diagnostic tests are essential to facilitate proper interpretation of test results and disease risk, many practitioners either confuse or misinterpret these measures. In the interests of their patients, practitioners should be aware of the basic concepts associated with diagnostic testing and the simple mathematical rule that underpins them. Importantly, the practitioner needs to recognize that the prevalence of a disease in the population greatly determines the clinical value of a diagnostic test.

  4. The prediction and probability for successful completion in medical study based on tests and pre-admission grades

    Czech Academy of Sciences Publication Activity Database

    Štuka, Č.; Martinková, Patrícia; Zvára, Karel; Zvárová, Jana

    2012-01-01

    Roč. 28, č. 2 (2012), s. 138-152 ISSN 1732-6729 R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : education * admission criteria * pre-admission grades * admission test * medical study Subject RIV: BB - Applied Statistics, Operational Research Impact factor: 0.149, year: 2012 http://www. education alrev.us.edu.pl/volume28.htm

  5. Pre-Service Mathematics Teachers' Use of Probability Models in Making Informal Inferences about a Chance Game

    Science.gov (United States)

    Kazak, Sibel; Pratt, Dave

    2017-01-01

    This study considers probability models as tools for both making informal statistical inferences and building stronger conceptual connections between data and chance topics in teaching statistics. In this paper, we aim to explore pre-service mathematics teachers' use of probability models for a chance game, where the sum of two dice matters in…

  6. Clinical target volume delineation in glioblastomas: pre-operative versus post-operative/pre-radiotherapy MRI

    Science.gov (United States)

    Farace, P; Giri, M G; Meliadò, G; Amelio, D; Widesott, L; Ricciardi, G K; Dall'Oglio, S; Rizzotti, A; Sbarbati, A; Beltramello, A; Maluta, S; Amichetti, M

    2011-01-01

    Objectives Delineation of clinical target volume (CTV) is still controversial in glioblastomas. In order to assess the differences in volume and shape of the radiotherapy target, the use of pre-operative vs post-operative/pre-radiotherapy T1 and T2 weighted MRI was compared. Methods 4 CTVs were delineated in 24 patients pre-operatively and post-operatively using T1 contrast-enhanced (T1PRECTV and T1POSTCTV) and T2 weighted images (T2PRECTV and T2POSTCTV). Pre-operative MRI examinations were performed the day before surgery, whereas post-operative examinations were acquired 1 month after surgery and before chemoradiation. A concordance index (CI) was defined as the ratio between the overlapping and composite volumes. Results The volumes of T1PRECTV and T1POSTCTV were not statistically different (248 ± 88 vs 254 ± 101), although volume differences >100 cm3 were observed in 6 out of 24 patients. A marked increase due to tumour progression was shown in three patients. Three patients showed a decrease because of a reduced mass effect. A significant reduction occurred between pre-operative and post-operative T2 volumes (139 ± 68 vs 78 ± 59). Lack of concordance was observed between T1PRECTV and T1POSTCTV (CI = 0.67 ± 0.09), T2PRECTV and T2POSTCTV (CI = 0.39 ± 0.20) and comparing the portion of the T1PRECTV and T1POSTCTV not covered by that defined on T2PRECTV images (CI = 0.45 ± 0.16 and 0.44 ± 0.17, respectively). Conclusion Using T2 MRI, huge variations can be observed in peritumoural oedema, which are probably due to steroid treatment. Using T1 MRI, brain shifts after surgery and possible progressive enhancing lesions produce substantial differences in CTVs. Our data support the use of post-operative/pre-radiotherapy T1 weighted MRI for planning purposes. PMID:21045069

  7. Attitudes of Pre-Clinical and Clinical Medical Students to Psychiatry ...

    African Journals Online (AJOL)

    Attitudes of Pre-Clinical and Clinical Medical Students to Psychiatry. ... Nigerian Hospital Practice ... Abstract. Medical training provides an environment in which proper and professional attitudes towards psychiatric patients can be acquired.

  8. Wald Sequential Probability Ratio Test for Space Object Conjunction Assessment

    Science.gov (United States)

    Carpenter, James R.; Markley, F Landis

    2014-01-01

    This paper shows how satellite owner/operators may use sequential estimates of collision probability, along with a prior assessment of the base risk of collision, in a compound hypothesis ratio test to inform decisions concerning collision risk mitigation maneuvers. The compound hypothesis test reduces to a simple probability ratio test, which appears to be a novel result. The test satisfies tolerances related to targeted false alarm and missed detection rates. This result is independent of the method one uses to compute the probability density that one integrates to compute collision probability. A well-established test case from the literature shows that this test yields acceptable results within the constraints of a typical operational conjunction assessment decision timeline. Another example illustrates the use of the test in a practical conjunction assessment scenario based on operations of the International Space Station.

  9. Pre-clinical cognitive phenotypes for Alzheimer disease: a latent profile approach.

    Science.gov (United States)

    Hayden, Kathleen M; Kuchibhatla, Maragatha; Romero, Heather R; Plassman, Brenda L; Burke, James R; Browndyke, Jeffrey N; Welsh-Bohmer, Kathleen A

    2014-11-01

    Cognitive profiles for pre-clinical Alzheimer disease (AD) can be used to identify groups of individuals at risk for disease and better characterize pre-clinical disease. Profiles or patterns of performance as pre-clinical phenotypes may be more useful than individual test scores or measures of global decline. To evaluate patterns of cognitive performance in cognitively normal individuals to derive latent profiles associated with later onset of disease using a combination of factor analysis and latent profile analysis. The National Alzheimer Coordinating Centers collect data, including a battery of neuropsychological tests, from participants at 29 National Institute on Aging-funded Alzheimer Disease Centers across the United States. Prior factor analyses of this battery demonstrated a four-factor structure comprising memory, attention, language, and executive function. Factor scores from these analyses were used in a latent profile approach to characterize cognition among a group of cognitively normal participants (N = 3,911). Associations between latent profiles and disease outcomes an average of 3 years later were evaluated with multinomial regression models. Similar analyses were used to determine predictors of profile membership. Four groups were identified; each with distinct characteristics and significantly associated with later disease outcomes. Two groups were significantly associated with development of cognitive impairment. In post hoc analyses, both the Trail Making Test Part B, and a contrast score (Delayed Recall - Trails B), significantly predicted group membership and later cognitive impairment. Latent profile analysis is a useful method to evaluate patterns of cognition in large samples for the identification of preclinical AD phenotypes; comparable results, however, can be achieved with very sensitive tests and contrast scores. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  10. Pre-examination factors affecting molecular diagnostic test results and interpretation: A case-based approach.

    Science.gov (United States)

    Payne, Deborah A; Baluchova, Katarina; Peoc'h, Katell H; van Schaik, Ron H N; Chan, K C Allen; Maekawa, Masato; Mamotte, Cyril; Russomando, Graciela; Rousseau, François; Ahmad-Nejad, Parviz

    2017-04-01

    Multiple organizations produce guidance documents that provide opportunities to harmonize quality practices for diagnostic testing. The International Organization for Standardization ISO 15189 standard addresses requirements for quality in management and technical aspects of the clinical laboratory. One technical aspect addresses the complexities of the pre-examination phase prior to diagnostic testing. The Committee for Molecular Diagnostics of the International Federation for Clinical Chemistry and Laboratory Medicine (also known as, IFCC C-MD) conducted a survey of international molecular laboratories and determined ISO 15189 to be the most referenced guidance document. In this review, the IFCC C-MD provides case-based examples illustrating the value of select pre-examination processes as these processes relate to molecular diagnostic testing. Case-based examples in infectious disease, oncology, inherited disease and pharmacogenomics address the utility of: 1) providing information to patients and users, 2) designing requisition forms, 3) obtaining informed consent and 4) maintaining sample integrity prior to testing. The pre-examination phase requires extensive and consistent communication between the laboratory, the healthcare provider and the end user. The clinical vignettes presented in this paper illustrate the value of applying select ISO 15189 recommendations for general laboratory to the more specialized area of Molecular Diagnostics. Copyright © 2016 Elsevier B.V. All rights reserved.

  11. Enhancing translation: guidelines for standard pre-clinical experiments in mdx mice.

    Science.gov (United States)

    Willmann, Raffaella; De Luca, Annamaria; Benatar, Michael; Grounds, Miranda; Dubach, Judith; Raymackers, Jean-Marc; Nagaraju, Kanneboyina

    2012-01-01

    Duchenne Muscular Dystrophy is an X-linked disorder that affects boys and leads to muscle wasting and death due to cardiac involvement and respiratory complications. The cause is the absence of dystrophin, a large structural protein indispensable for muscle cell function and viability. The mdx mouse has become the standard animal model for pre-clinical evaluation of potential therapeutic treatments. Recent years have seen a rapid increase in the number of experimental compounds being evaluated in the mdx mouse. There is, however, much variability in the design of these pre-clinical experimental studies. This has made it difficult to interpret and compare published data from different laboratories and to evaluate the potential of a treatment for application to patients. The authors therefore propose the introduction of a standard study design for the mdx mouse model. Several aspects, including animal care, sampling times and choice of tissues, as well as recommended endpoints and methodologies are addressed and, for each aspect, a standard procedure is proposed. Testing of all new molecules/drugs using a widely accepted and agreed upon standard experimental protocol would greatly improve the power of pre-clinical experimentations and help identifying promising therapies for the translation into clinical trials for boys with Duchenne Muscular Dystrophy. Copyright © 2011 Elsevier B.V. All rights reserved.

  12. Quantifying retention during pre-antiretroviral treatment in a large urban clinic in Uganda.

    Science.gov (United States)

    Castelnuovo, Barbara; Musaazi, Joseph; Musomba, Rachel; Ratanshi, Rosalind Parkes; Kiragga, Agnes N

    2015-07-01

    Retention studies are usually focused on patients on antiretroviral treatment (ART), however in Sub-Saharan Africa many patients get lost to program (LTP) in the pre-ART care period.. We investigated the proportion of patients not retained in care and factors associated with LTP (dead or lost to follow up ≥6 months) in the pre-ART care period. We analyzed data from the Infectious Diseases Institute, Kampala, Uganda. We included all adult patients ≥18 years, ART naïve at program enrollment from 1(st)/Jan/2005. We described the number of patients not retained in care during the 3 steps of enrollment-to-treatment "cascade": Step 1) From enrollment to CD4 count testing, Step 2) ART eligibility assessment. Patients were initially considered eligible if CD4 count was ART start. We described cumulative probability of being LTP by gender and ART eligibility using Kaplan Meier estimates. We used a Cox proportional hazards model to identify factors associated with being LTP at any stage for all patients and for those with a CD4 count available. Factors considered were age, gender, year of enrollment, and WHO stage. After enrollment in our program, cumulatively, a low proportion of patients (30.8 %) were retained and started on ART. The cumulative probability of being LTP was higher in males and patients not eligible for ART. In the multivariable Cox proportional Hazards model, male gender (HR: 1.19 CI 1.12-1.19) and clinical WHO stage 3 and 4 (HR: 1.20 CI 1.13-1.27) were associated with being LTP while older age was protective (HR: 0.98 0.96-0.99). Patients enrolled in the program more recently were also at lower risk of being LTP. In addition, among patients with CD4 count test, patients with higher CD4 count were at higher risk of being LTP. In our program there has been suboptimal retention of patients in pre-ART care, particularly of patients not eligible for ART. Since the proportion of eligible patients has recently increased due to the higher recommended

  13. Figure 1. Associations between pre-ART clinical and laboratory ...

    Indian Academy of Sciences (India)

    First page Back Continue Last page Graphics. Figure 1. Associations between pre-ART clinical and laboratory characteristics with subsequent TB-IRIS events. Figure 1. Associations between pre-ART clinical and laboratory characteristics with subsequent TB-IRIS events.

  14. Pre-employment medical testing in Brazil: ethical challenges.

    Science.gov (United States)

    Palhares, Dario; Laurentino dos Santos, Ivone

    2012-01-01

    Pre-employment medical tests, considered to be a practice within the subspecialty of occupational medicine, are ordered by physicians on behalf of employers. Candidates for a job may be rejected if they are found to suffer from a condition that can be worsened by the job, or one that may put other workers at risk. As the physician who orders pre-employment tests is chosen by the employer, pre-employment tests can violate both the autonomy and the privacy of the individual. This paper discusses ethical conflicts inherent in pre-employment medical testing.

  15. Clinical leadership and pre-registration nursing programmes: A model for clinical leadership and a prospective curriculum implementation and evaluation research strategy.

    Science.gov (United States)

    Brown, Angela; Dewing, Jan; Crookes, Patrick

    2016-07-01

    To present for wider debate a conceptual model for clinical leadership development in pre-registration nursing programmes and a proposed implementation plan. Globally, leadership in nursing has become a significant issue. Whilst there is continued support for leadership preparation in pre-registration nursing programmes, there have been very few published accounts of curriculum content and/or pedagogical approaches that foster clinical leadership development in pre-registration nursing. A doctoral research study has resulted in the creation of an overarching model for clinical leadership. A multi-method research study using theoretical and empirical literature 1974-2015, a focus group, expert opinion and a national on-line survey. A conceptual model of clinical leadership development in pre-registration nursing programme is presented, including the infinity loop of clinical leadership, an integral curriculum thread and a conceptual model: a curriculum-pedagogy nexus for clinical leadership. In order to test out usability and evaluate effectiveness, a multi method programme of research in one school of nursing in Australia is outlined. Implementation of the proposed conceptual model for clinical leadership development in pre-registration nursing programmes and a programme of (post-doctoral) research will contribute to what is known about curriculum content and pedagogy for nurse academics. Importantly, for nursing students and the profession as a whole, there is a clearer expectation of what clinical leadership might look like in the novice registered nurse. For nurse academics a model is offered for consideration in curriculum design and implementation with an evaluation strategy that could be replicated. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Estimation of component failure probability from masked binomial system testing data

    International Nuclear Information System (INIS)

    Tan Zhibin

    2005-01-01

    The component failure probability estimates from analysis of binomial system testing data are very useful because they reflect the operational failure probability of components in the field which is similar to the test environment. In practice, this type of analysis is often confounded by the problem of data masking: the status of tested components is unknown. Methods in considering this type of uncertainty are usually computationally intensive and not practical to solve the problem for complex systems. In this paper, we consider masked binomial system testing data and develop a probabilistic model to efficiently estimate component failure probabilities. In the model, all system tests are classified into test categories based on component coverage. Component coverage of test categories is modeled by a bipartite graph. Test category failure probabilities conditional on the status of covered components are defined. An EM algorithm to estimate component failure probabilities is developed based on a simple but powerful concept: equivalent failures and tests. By simulation we not only demonstrate the convergence and accuracy of the algorithm but also show that the probabilistic model is capable of analyzing systems in series, parallel and any other user defined structures. A case study illustrates an application in test case prioritization

  17. Perspective: Recommendations for benchmarking pre-clinical studies of nanomedicines

    Science.gov (United States)

    Dawidczyk, Charlene M.; Russell, Luisa M.; Searson, Peter C.

    2015-01-01

    Nanoparticle-based delivery systems provide new opportunities to overcome the limitations associated with traditional small molecule drug therapy for cancer, and to achieve both therapeutic and diagnostic functions in the same platform. Pre-clinical trials are generally designed to assess therapeutic potential and not to optimize the design of the delivery platform. Consequently, progress in developing design rules for cancer nanomedicines has been slow, hindering progress in the field. Despite the large number of pre-clinical trials, several factors restrict comparison and benchmarking of different platforms, including variability in experimental design, reporting of results, and the lack of quantitative data. To solve this problem, we review the variables involved in the design of pre-clinical trials and propose a protocol for benchmarking that we recommend be included in in vivo pre-clinical studies of drug delivery platforms for cancer therapy. This strategy will contribute to building the scientific knowledge base that enables development of design rules and accelerates the translation of new technologies. PMID:26249177

  18. A Grading System To Evaluate Objectively the Strength of Pre-Clinical Data of Acute Neuroprotective Therapies for Clinical Translation in Spinal Cord Injury

    Science.gov (United States)

    Okon, Elena B.; Tsai, Eve; Beattie, Michael S.; Bresnahan, Jacqueline C.; Magnuson, David K.; Reier, Paul J.; McTigue, Dana M.; Popovich, Phillip G.; Blight, Andrew R.; Oudega, Martin; Guest, James D.; Weaver, Lynne C.; Fehlings, Michael G.; Tetzlaff, Wolfram

    2011-01-01

    Abstract The past three decades have seen an explosion of research interest in spinal cord injury (SCI) and the development of hundreds of potential therapies that have demonstrated some promise in pre-clinical experimental animal models. A growing number of these treatments are seeking to be translated into human clinical trials. Conducting such a clinical trial, however, is extremely costly, not only for the time and money required to execute it, but also for the limited resources that will then no longer be available to evaluate other promising therapies. The decision about what therapies have sufficient pre-clinical evidence of efficacy to justify testing in humans is therefore of utmost importance. Here, we have developed a scoring system for objectively grading the body of pre-clinical literature on neuroprotective treatments for acute SCI. The components of the system include an evaluation of a number of factors that are thought to be important in considering the “robustness” of a therapy's efficacy, including the animal species and injury models that have been used to test it, the time window of efficacy, the types of functional improvements effected by it, and whether efficacy has been independently replicated. The selection of these factors was based on the results of a questionnaire that was performed within the SCI research community. A modified Delphi consensus-building exercise was then conducted with experts in pre-clinical SCI research to refine the criteria and decide upon how to score them. Finally, the grading system was applied to a series of potential neuroprotective treatments for acute SCI. This represents a systematic approach to developing an objective method of evaluating the extent to which the pre-clinical literature supports the translation of a particular experimental treatment into human trials. PMID:20507235

  19. Light Duty Utility Arm system pre-operational (cold test) test plan

    International Nuclear Information System (INIS)

    Bennett, K.L.

    1995-01-01

    The Light Duty Utility (LDUA) Cold Test Facility, located in the Hanford 400 Area, will be used to support cold testing (pre- operational tests) of LDUA subsystems. Pre-operational testing is composed of subsystem development testing and rework activities, and integrated system qualification testing. Qualification testing will be conducted once development work is complete and documentation is under configuration control. Operational (hot) testing of the LDUA system will follow the testing covered in this plan and will be covered in a separate test plan

  20. Pre-Operative Prediction of Advanced Prostatic Cancer Using Clinical Decision Support Systems: Accuracy Comparison between Support Vector Machine and Artificial Neural Network

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Youn; Moon, Sung Kyoung; Hwang, Sung Il; Sung, Chang Kyu; Cho, Jeong Yeon; Kim, Seung Hyup; Lee, Hak Jong [Seoul National University College of Medicine, Seoul (Korea, Republic of); Jung, Dae Chul [National Cancer Center, Ilsan (Korea, Republic of); Lee, Ji Won [Kangwon National University College of Medicine, Chuncheon (Korea, Republic of)

    2011-10-15

    The purpose of the current study was to develop support vector machine (SVM) and artificial neural network (ANN) models for the pre-operative prediction of advanced prostate cancer by using the parameters acquired from transrectal ultrasound (TRUS)-guided prostate biopsies, and to compare the accuracies between the two models. Five hundred thirty-two consecutive patients who underwent prostate biopsies and prostatectomies for prostate cancer were divided into the training and test groups (n = 300 versus n 232). From the data in the training group, two clinical decision support systems (CDSSs-[SVM and ANN]) were constructed with input (age, prostate specific antigen level, digital rectal examination, and five biopsy parameters) and output data (the probability for advanced prostate cancer [> pT3a]). From the data of the test group, the accuracy of output data was evaluated. The areas under the receiver operating characteristic (ROC) curve (AUC) were calculated to summarize the overall performances, and a comparison of the ROC curves was performed (p < 0.05). The AUC of SVM and ANN is 0.805 and 0.719, respectively (p = 0.020), in the pre-operative prediction of advanced prostate cancer. Te performance of SVM is superior to ANN in the pre-operative prediction of advanced prostate cancer.

  1. Ethnic and social disparities in different types of examinations in undergraduate pre-clinical training.

    Science.gov (United States)

    Stegers-Jager, K M; Brommet, F N; Themmen, A P N

    2016-12-01

    Medical schools are increasingly faced with a more diverse student population. Generally, ethnic minority students are reported to underperform compared with those from the ethnic majority. However, there are inconsistencies in findings in different types of examinations. Additionally, little is known about the performance of first-generation university students and about performance differences across ethnic minority groups. This study aimed to investigate underperformance across ethnic minority groups and by first-generation university students in different types of written tests and clinical skills examinations during pre-clinical training. A longitudinal prospective cohort study of progress on a 3-year Dutch Bachelor of Medicine course was conducted. Participants included 2432 students who entered the course over a consecutive 6-year period (2008-2013). Compared with Dutch students, the three non-Western ethnic minority groups (Turkish/Moroccan/African, Surinamese/Antillean and Asian) underperformed in the clinical problem solving tests, the language test and the OSCEs. Findings on the theoretical end-of-block tests and writing skills tests, and results for Western minority students were less consistent. Age, gender, pre-university grade point average and additional socio-demographic variables (including first-generation university student, first language, and medical doctor parent) could explain the ethnicity-related differences in theoretical examinations, but not in language, clinical and writing skills examinations. First-generation university students only underperformed in the language test. Apparently, underperformance differs both across ethnic subgroups and between different types of written and clinical examinations. Medical schools should ensure their assessment strategies create a level playing field for all students and explore reasons for underperformance in the clinical and writing skills examinations.

  2. Comparison of clinical probability-adjusted D-dimer and age-adjusted D-dimer interpretation to exclude venous thromboembolism.

    Science.gov (United States)

    Takach Lapner, Sarah; Julian, Jim A; Linkins, Lori-Ann; Bates, Shannon; Kearon, Clive

    2017-10-05

    Two new strategies for interpreting D-dimer results have been proposed: i) using a progressively higher D-dimer threshold with increasing age (age-adjusted strategy) and ii) using a D-dimer threshold in patients with low clinical probability that is twice the threshold used in patients with moderate clinical probability (clinical probability-adjusted strategy). Our objective was to compare the diagnostic accuracy of age-adjusted and clinical probability-adjusted D-dimer interpretation in patients with a low or moderate clinical probability of venous thromboembolism (VTE). We performed a retrospective analysis of clinical data and blood samples from two prospective studies. We compared the negative predictive value (NPV) for VTE, and the proportion of patients with a negative D-dimer result, using two D-dimer interpretation strategies: the age-adjusted strategy, which uses a progressively higher D-dimer threshold with increasing age over 50 years (age in years × 10 µg/L FEU); and the clinical probability-adjusted strategy which uses a D-dimer threshold of 1000 µg/L FEU in patients with low clinical probability and 500 µg/L FEU in patients with moderate clinical probability. A total of 1649 outpatients with low or moderate clinical probability for a first suspected deep vein thrombosis or pulmonary embolism were included. The NPV of both the clinical probability-adjusted strategy (99.7 %) and the age-adjusted strategy (99.6 %) were similar. However, the proportion of patients with a negative result was greater with the clinical probability-adjusted strategy (56.1 % vs, 50.9 %; difference 5.2 %; 95 % CI 3.5 % to 6.8 %). These findings suggest that clinical probability-adjusted D-dimer interpretation is a better way of interpreting D-dimer results compared to age-adjusted interpretation.

  3. Offering pre-exposure prophylaxis for HIV prevention to pregnant and postpartum women: a clinical approach.

    Science.gov (United States)

    Seidman, Dominika L; Weber, Shannon; Cohan, Deborah

    2017-03-08

    HIV prevention during pregnancy and lactation is critical for both maternal and child health. Pregnancy provides a critical opportunity for clinicians to elicit women's vulnerabilities to HIV and offer HIV testing, treatment and referral and/or comprehensive HIV prevention options for the current pregnancy, the postpartum period and safer conception options for future pregnancies. In this commentary, we review the safety of oral pre-exposure prophylaxis with tenofovir/emtricitabine in pregnant and lactating women and suggest opportunities to identify pregnant and postpartum women at substantial risk of HIV. We then describe a clinical approach to caring for women who both choose and decline pre-exposure prophylaxis during pregnancy and postpartum, highlighting areas for future research. Evidence suggests that pre-exposure prophylaxis with tenofovir/emtricitabine is safe in pregnancy and lactation. Identifying women vulnerable to HIV and eligible for pre-exposure prophylaxis is challenging in light of the myriad of individual, community, and structural forces impacting HIV acquisition. Validated risk calculators exist for specific populations but have not been used to screen and offer HIV prevention methods. Partner testing and engagement of men living with HIV are additional means of reaching at-risk women. However, women's vulnerabilities to HIV change over time. Combining screening for HIV vulnerability with HIV and/or STI testing at standard intervals during pregnancy is a practical way to prompt providers to incorporate HIV screening and prevention counselling. We suggest using shared decision-making to offer women pre-exposure prophylaxis as one of multiple HIV prevention strategies during pregnancy and postpartum, facilitating open conversations about HIV vulnerabilities, preferences about HIV prevention strategies, and choosing a method that best meets the needs of each woman. Growing evidence suggests that pre-exposure prophylaxis with tenofovir

  4. Concurrency meets probability: theory and practice (abstract)

    NARCIS (Netherlands)

    Katoen, Joost P.

    Treating random phenomena in concurrency theory has a long tradition. Petri nets [18, 10] and process algebras [14] have been extended with probabilities. The same applies to behavioural semantics such as strong and weak (bi)simulation [1], and testing pre-orders [5]. Beautiful connections between

  5. Sequential Probability Ration Tests : Conservative and Robust

    NARCIS (Netherlands)

    Kleijnen, J.P.C.; Shi, Wen

    2017-01-01

    In practice, most computers generate simulation outputs sequentially, so it is attractive to analyze these outputs through sequential statistical methods such as sequential probability ratio tests (SPRTs). We investigate several SPRTs for choosing between two hypothesized values for the mean output

  6. 40 CFR 89.406 - Pre-test procedures.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Pre-test procedures. 89.406 Section 89.406 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED... Procedures § 89.406 Pre-test procedures. (a) Allow a minimum of 30 minutes warmup in the standby or operating...

  7. Error probabilities in default Bayesian hypothesis testing

    NARCIS (Netherlands)

    Gu, Xin; Hoijtink, Herbert; Mulder, J,

    2016-01-01

    This paper investigates the classical type I and type II error probabilities of default Bayes factors for a Bayesian t test. Default Bayes factors quantify the relative evidence between the null hypothesis and the unrestricted alternative hypothesis without needing to specify prior distributions for

  8. Pre-operative clinical assessment for anaesthesia and the effect of ...

    African Journals Online (AJOL)

    Background. HIV infection is common in South Africa, often remaining clinically latent and liable to be missed during clinical pre-operative assessment, despite the patient having a severe degree of immune compromise. Objectives. The primary objective was to determine the pre-operative physical status of patients ...

  9. Assessment of the knowledge and attitudes regarding HIV/AIDS among pre-clinical medical students in Israel

    Science.gov (United States)

    2014-01-01

    Background Today’s medical students are the future physicians of people living with HIV/AIDS (PLWHA). It is therefore essential that medical students possess the appropriate knowledge and attitudes regarding PLWHA. This study aims to evaluate knowledge and attitudes of pre-clinical Israeli medical students and to assess whether their knowledge and attitudes change throughout their pre-clinical studies. Methods A cross-sectional study was conducted among all pre-clinical medical students from the four medical schools in Israel during the academic year of 2010/2011 (a total of 1,470 students). A self-administered questionnaire was distributed. The questionnaire sought student responses pertaining to knowledge of HIV transmission and non-transmission routes, basic knowledge of HIV/AIDS treatment and attitudes towards HIV/AIDS. Results The study’s response rate was 62.24 percent. Knowledge among pre-clinical medical students was generally high and showed a statistically significant improvement as students progressed through their pre-clinical studies. However, there were some misconceptions, mostly regarding HIV transmission via breastfeeding and knowledge of HIV prevention after exposure to the virus. Students’ attitudes were found to include stigmatizing notions. Furthermore, the majority of medical students correlated HIV with shame and fear. In addition, students’ attitudes toward HIV testing and providing confidential medical information were contradictory to health laws, protocols and guidelines. Overall, no positive changes in students’ attitudes were observed during the pre-clinical years of medical school. Conclusion The knowledge of pre-clinical medical students in Israel is generally high, although there are some knowledge inadequacies that require more emphasis in the curricula of the medical schools. Contrary to HIV-related knowledge, medical students’ attitudes are unaffected by their progression through medical school. Therefore, medical

  10. Predictive probability methods for interim monitoring in clinical trials with longitudinal outcomes.

    Science.gov (United States)

    Zhou, Ming; Tang, Qi; Lang, Lixin; Xing, Jun; Tatsuoka, Kay

    2018-04-17

    In clinical research and development, interim monitoring is critical for better decision-making and minimizing the risk of exposing patients to possible ineffective therapies. For interim futility or efficacy monitoring, predictive probability methods are widely adopted in practice. Those methods have been well studied for univariate variables. However, for longitudinal studies, predictive probability methods using univariate information from only completers may not be most efficient, and data from on-going subjects can be utilized to improve efficiency. On the other hand, leveraging information from on-going subjects could allow an interim analysis to be potentially conducted once a sufficient number of subjects reach an earlier time point. For longitudinal outcomes, we derive closed-form formulas for predictive probabilities, including Bayesian predictive probability, predictive power, and conditional power and also give closed-form solutions for predictive probability of success in a future trial and the predictive probability of success of the best dose. When predictive probabilities are used for interim monitoring, we study their distributions and discuss their analytical cutoff values or stopping boundaries that have desired operating characteristics. We show that predictive probabilities utilizing all longitudinal information are more efficient for interim monitoring than that using information from completers only. To illustrate their practical application for longitudinal data, we analyze 2 real data examples from clinical trials. Copyright © 2018 John Wiley & Sons, Ltd.

  11. Pre-test analysis results of a PWR steel lined pre-stressed concrete containment model

    International Nuclear Information System (INIS)

    Basha, S.M.; Ghosh, Barnali; Patnaik, R.; Ramanujam, S.; Singh, R.K.; Kushwaha, H.S.; Venkat Raj, V.

    2000-02-01

    Pre-stressed concrete nuclear containment serves as the ultimate barrier against the release of radioactivity to the environment. This ultimate barrier must be checked for its ultimate load carrying capacity. BARC participated in a Round Robin analysis activity which is co-sponsored by Sandia National Laboratory, USA and Nuclear Power Engineering Corporation Japan for the pre-test prediction of a 1:4 size Pre-stressed Concrete Containment Vessel. In house finite element code ULCA was used to make the test predictions of displacements and strains at the standard output locations. The present report focuses on the important landmarks of the pre-test results, in sequential terms of first crack appearance, loss of pre-stress, first through thickness crack, rebar and liner yielding and finally liner tearing at the ultimate load. Global and local failure modes of the containment have been obtained from the analysis. Finally sensitivity of the numerical results with respect to different types of liners and different constitutive models in terms of bond strength between concrete and steel and tension-stiffening parameters are examined. The report highlights the important features which could be observed during the test and guidelines are given for improving the prediction in the post test computation after the test data is available. (author)

  12. A critique of statistical hypothesis testing in clinical research

    Directory of Open Access Journals (Sweden)

    Somik Raha

    2011-01-01

    Full Text Available Many have documented the difficulty of using the current paradigm of Randomized Controlled Trials (RCTs to test and validate the effectiveness of alternative medical systems such as Ayurveda. This paper critiques the applicability of RCTs for all clinical knowledge-seeking endeavors, of which Ayurveda research is a part. This is done by examining statistical hypothesis testing, the underlying foundation of RCTs, from a practical and philosophical perspective. In the philosophical critique, the two main worldviews of probability are that of the Bayesian and the frequentist. The frequentist worldview is a special case of the Bayesian worldview requiring the unrealistic assumptions of knowing nothing about the universe and believing that all observations are unrelated to each other. Many have claimed that the first belief is necessary for science, and this claim is debunked by comparing variations in learning with different prior beliefs. Moving beyond the Bayesian and frequentist worldviews, the notion of hypothesis testing itself is challenged on the grounds that a hypothesis is an unclear distinction, and assigning a probability on an unclear distinction is an exercise that does not lead to clarity of action. This critique is of the theory itself and not any particular application of statistical hypothesis testing. A decision-making frame is proposed as a way of both addressing this critique and transcending ideological debates on probability. An example of a Bayesian decision-making approach is shown as an alternative to statistical hypothesis testing, utilizing data from a past clinical trial that studied the effect of Aspirin on heart attacks in a sample population of doctors. As a big reason for the prevalence of RCTs in academia is legislation requiring it, the ethics of legislating the use of statistical methods for clinical research is also examined.

  13. Pre-test evaluation of LLTR series II Test A-7

    International Nuclear Information System (INIS)

    Knittle, D.

    1981-03-01

    The purpose of this report is to present pre-test predictions of pressure histories for the A-7 test to be conducted in the Large Leak Test Rig (LLTR) at the Energy Technology Engineering Center (ETEC) in April 1981

  14. Wald Sequential Probability Ratio Test for Analysis of Orbital Conjunction Data

    Science.gov (United States)

    Carpenter, J. Russell; Markley, F. Landis; Gold, Dara

    2013-01-01

    We propose a Wald Sequential Probability Ratio Test for analysis of commonly available predictions associated with spacecraft conjunctions. Such predictions generally consist of a relative state and relative state error covariance at the time of closest approach, under the assumption that prediction errors are Gaussian. We show that under these circumstances, the likelihood ratio of the Wald test reduces to an especially simple form, involving the current best estimate of collision probability, and a similar estimate of collision probability that is based on prior assumptions about the likelihood of collision.

  15. 10 CFR 26.65 - Pre-access drug and alcohol testing.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Pre-access drug and alcohol testing. 26.65 Section 26.65... § 26.65 Pre-access drug and alcohol testing. (a) Purpose. This section contains pre-access testing... days. If an individual has negative results from drug and alcohol tests that were conducted under the...

  16. Further examination of embedded performance validity indicators for the Conners' Continuous Performance Test and Brief Test of Attention in a large outpatient clinical sample.

    Science.gov (United States)

    Sharland, Michael J; Waring, Stephen C; Johnson, Brian P; Taran, Allise M; Rusin, Travis A; Pattock, Andrew M; Palcher, Jeanette A

    2018-01-01

    Assessing test performance validity is a standard clinical practice and although studies have examined the utility of cognitive/memory measures, few have examined attention measures as indicators of performance validity beyond the Reliable Digit Span. The current study further investigates the classification probability of embedded Performance Validity Tests (PVTs) within the Brief Test of Attention (BTA) and the Conners' Continuous Performance Test (CPT-II), in a large clinical sample. This was a retrospective study of 615 patients consecutively referred for comprehensive outpatient neuropsychological evaluation. Non-credible performance was defined two ways: failure on one or more PVTs and failure on two or more PVTs. Classification probability of the BTA and CPT-II into non-credible groups was assessed. Sensitivity, specificity, positive predictive value, and negative predictive value were derived to identify clinically relevant cut-off scores. When using failure on two or more PVTs as the indicator for non-credible responding compared to failure on one or more PVTs, highest classification probability, or area under the curve (AUC), was achieved by the BTA (AUC = .87 vs. .79). CPT-II Omission, Commission, and Total Errors exhibited higher classification probability as well. Overall, these findings corroborate previous findings, extending them to a large clinical sample. BTA and CPT-II are useful embedded performance validity indicators within a clinical battery but should not be used in isolation without other performance validity indicators.

  17. Plasminogen-based capture combined with amplification technology for the detection of PrP(TSE in the pre-clinical phase of infection.

    Directory of Open Access Journals (Sweden)

    Christiane Segarra

    Full Text Available BACKGROUND: Variant Creutzfeldt-Jakob disease (vCJD is a neurodegenerative infectious disorder, characterized by a prominent accumulation of pathological isoforms of the prion protein (PrP(TSE in the brain and lymphoid tissues. Since the publication in the United Kingdom of four apparent vCJD cases following transfusion of red blood cells and one apparent case following treatment with factor VIII, the presence of vCJD infectivity in the blood seems highly probable. For effective blood testing of vCJD individuals in the preclinical or clinical phase of infection, it is considered necessary that assays detect PrP(TSE concentrations in the femtomolar range. METHODOLOGY/PRINCIPAL FINDINGS: We have developed a three-step assay that firstly captures PrP(TSE from infected blood using a plasminogen-coated magnetic-nanobead method prior to its serial amplification via protein misfolding cyclic amplification (PMCA and specific PrP(TSE detection by western blot. We achieved a PrP(TSE capture yield of 95% from scrapie-infected material. We demonstrated the possibility of detecting PrP(TSE in white blood cells, in buffy coat and in plasma isolated from the blood of scrapie-infected sheep collected at the pre-clinical stage of the disease. The test also allowed the detection of PrP(TSE in human plasma spiked with a 10(-8 dilution of vCJD-infected brain homogenate corresponding to the level of sensitivity (femtogram required for the detection of the PrP(TSE in asymptomatic carriers. The 100% specificity of the test was revealed using a blinded panel comprising 96 human plasma samples. CONCLUSION/SIGNIFICANCE: We have developed a sensitive and specific amplification assay allowing the detection of PrP(TSE in the plasma and buffy coat fractions of blood collected at the pre-clinical phase of the disease. This assay represents a good candidate as a confirmatory assay for the presence of PrP(TSE in blood of patients displaying positivity in large scale screening

  18. Kinetic modeling in pre-clinical positron emission tomography

    Energy Technology Data Exchange (ETDEWEB)

    Kuntner, Claudia [AIT Austrian Institute of Technology GmbH, Seibersdorf (Austria). Biomedical Systems, Health and Environment Dept.

    2014-07-01

    Pre-clinical positron emission tomography (PET) has evolved in the last few years from pure visualization of radiotracer uptake and distribution towards quantification of the physiological parameters. For reliable and reproducible quantification the kinetic modeling methods used to obtain relevant parameters of radiotracer tissue interaction are important. Here we present different kinetic modeling techniques with a focus on compartmental models including plasma input models and reference tissue input models. The experimental challenges of deriving the plasma input function in rodents and the effect of anesthesia are discussed. Finally, in vivo application of kinetic modeling in various areas of pre-clinical research is presented and compared to human data.

  19. Clinical Features in a Danish Population-Based Cohort of Probable Multiple System Atrophy Patients

    DEFF Research Database (Denmark)

    Starhof, Charlotte; Korbo, Lise; Lassen, Christina Funch

    2016-01-01

    Background: Multiple system atrophy (MSA) is a rare, sporadic and progressive neurodegenerative disorder. We aimed to describe the clinical features of Danish probable MSA patients, evaluate their initial response to dopaminergic therapy and examine mortality. Methods: From the Danish National...... the criteria for probable MSA. We recorded clinical features, examined differences by MSA subtype and used Kaplan-Meier survival analysis to examine mortality. Results: The mean age at onset of patients with probable MSA was 60.2 years (range 36-75 years) and mean time to wheelchair dependency was 4.7 years...

  20. Comments on the sequential probability ratio testing methods

    Energy Technology Data Exchange (ETDEWEB)

    Racz, A. [Hungarian Academy of Sciences, Budapest (Hungary). Central Research Inst. for Physics

    1996-07-01

    In this paper the classical sequential probability ratio testing method (SPRT) is reconsidered. Every individual boundary crossing event of the SPRT is regarded as a new piece of evidence about the problem under hypothesis testing. The Bayes method is applied for belief updating, i.e. integrating these individual decisions. The procedure is recommended to use when the user (1) would like to be informed about the tested hypothesis continuously and (2) would like to achieve his final conclusion with high confidence level. (Author).

  1. Combined use of clinical pre-test probability and D-dimer test in the diagnosis of preoperative deep venous thrombosis in colorectal cancer patients

    DEFF Research Database (Denmark)

    Stender, Mogens; Frøkjaer, Jens Brøndum; Hagedorn Nielsen, Tina Sandie

    2008-01-01

    The preoperative prevalence of deep venous thrombosis (DVT) in patients with colorectal cancer may be as high as 8%. In order to minimize the risk of pulmonary embolism, it is important to rule out preoperative DVT. A large study has confirmed that a negative D-dimer test in combination with a low...... preoperative DVT in colorectal cancer patients admitted for surgery. Preoperative D-dimer test and compression ultrasonography for DVT were performed in 193 consecutive patients with newly diagnosed colorectal cancer. Diagnostic accuracy indices of the D-dimer test were assessed according to the PTP score...... in ruling out preoperative DVT in colorectal cancer patients admitted for surgery....

  2. Impact of proof test interval and coverage on probability of failure of safety instrumented function

    International Nuclear Information System (INIS)

    Jin, Jianghong; Pang, Lei; Hu, Bin; Wang, Xiaodong

    2016-01-01

    Highlights: • Introduction of proof test coverage makes the calculation of the probability of failure for SIF more accurate. • The probability of failure undetected by proof test is independently defined as P TIF and calculated. • P TIF is quantified using reliability block diagram and simple formula of PFD avg . • Improving proof test coverage and adopting reasonable test period can reduce the probability of failure for SIF. - Abstract: Imperfection of proof test can result in the safety function failure of safety instrumented system (SIS) at any time in its life period. IEC61508 and other references ignored or only elementarily analyzed the imperfection of proof test. In order to further study the impact of the imperfection of proof test on the probability of failure for safety instrumented function (SIF), the necessity of proof test and influence of its imperfection on system performance was first analyzed theoretically. The probability of failure for safety instrumented function resulted from the imperfection of proof test was defined as probability of test independent failures (P TIF ), and P TIF was separately calculated by introducing proof test coverage and adopting reliability block diagram, with reference to the simplified calculation formula of average probability of failure on demand (PFD avg ). Research results show that: the shorter proof test period and the higher proof test coverage indicate the smaller probability of failure for safety instrumented function. The probability of failure for safety instrumented function which is calculated by introducing proof test coverage will be more accurate.

  3. Imperfection detection probability at ultrasonic testing of reactor vessels

    International Nuclear Information System (INIS)

    Kazinczy, F. de; Koernvik, L.Aa.

    1980-02-01

    The report is a lecture given at a symposium organized by the Swedish nuclear power inspectorate on February 1980. Equipments, calibration and testing procedures are reported. The estimation of defect detection probability for ultrasonic tests and the reliability of literature data are discussed. Practical testing of reactor vessels and welded joints are described. Swedish test procedures are compared with other countries. Series of test data for welded joints of the OKG-2 reactor are presented. Future recommendations for testing procedures are made. (GBn)

  4. Log-concave Probability Distributions: Theory and Statistical Testing

    DEFF Research Database (Denmark)

    An, Mark Yuing

    1996-01-01

    This paper studies the broad class of log-concave probability distributions that arise in economics of uncertainty and information. For univariate, continuous, and log-concave random variables we prove useful properties without imposing the differentiability of density functions. Discrete...... and multivariate distributions are also discussed. We propose simple non-parametric testing procedures for log-concavity. The test statistics are constructed to test one of the two implicati ons of log-concavity: increasing hazard rates and new-is-better-than-used (NBU) property. The test for increasing hazard...... rates are based on normalized spacing of the sample order statistics. The tests for NBU property fall into the category of Hoeffding's U-statistics...

  5. Clinical leadership in pre-registration nursing programmes--an international literature review.

    Science.gov (United States)

    Brown, Angela; Crookes, Patrick; Dewing, Jan

    2015-01-01

    Clinical leadership and the safety, quality and efficiency of patient/client care are inextricably linked in government reports, major inquiries and the professional literature. This review explores the literature on clinical leadership development within pre-registration nursing programmes. The literature retrieved from a scoping review was evaluated to identify what is already published on the development of clinical leadership within pre-registration nursing programmes. Twenty-seven publications matched the inclusion criteria and were included in this review, 14 journal articles, one thesis and 11 chapters within one book were analysed and three themes were identified: clinical leadership; curriculum content and pedagogy. RESULTS AND MAIN OUTCOMES: This review identified a paucity of literature specifically relating to clinical leadership and pre-registration nursing programmes and what is available is inconclusive and unconvincing. Academics, curriculum development leaders and accreditation bodies have a responsibility to influence how nurses are prepared for the profession as such clinical leadership and the new graduate should be considered an area of greater importance.

  6. Identification of clinical biomarkers for pre-analytical quality control of blood samples.

    Science.gov (United States)

    Kang, Hyun Ju; Jeon, Soon Young; Park, Jae-Sun; Yun, Ji Young; Kil, Han Na; Hong, Won Kyung; Lee, Mee-Hee; Kim, Jun-Woo; Jeon, Jae-Pil; Han, Bok Ghee

    2013-04-01

    Pre-analytical conditions are key factors in maintaining the high quality of biospecimens. They are necessary for accurate reproducibility of experiments in the field of biomarker discovery as well as achieving optimal specificity of laboratory tests for clinical diagnosis. In research at the National Biobank of Korea, we evaluated the impact of pre-analytical conditions on the stability of biobanked blood samples by measuring biochemical analytes commonly used in clinical laboratory tests. We measured 10 routine laboratory analytes in serum and plasma samples from healthy donors (n = 50) with a chemistry autoanalyzer (Hitachi 7600-110). The analyte measurements were made at different time courses based on delay of blood fractionation, freezing delay of fractionated serum and plasma samples, and at different cycles (0, 1, 3, 6, 9) of freeze-thawing. Statistically significant changes from the reference sample mean were determined using the repeated-measures ANOVA and the significant change limit (SCL). The serum levels of GGT and LDH were changed significantly depending on both the time interval between blood collection and fractionation and the time interval between fractionation and freezing of serum and plasma samples. The glucose level was most sensitive only to the elapsed time between blood collection and centrifugation for blood fractionation. Based on these findings, a simple formula (glucose decrease by 1.387 mg/dL per hour) was derived to estimate the length of time delay after blood collection. In addition, AST, BUN, GGT, and LDH showed sensitive responses to repeated freeze-thaw cycles of serum and plasma samples. These results suggest that GGT and LDH measurements can be used as quality control markers for certain pre-analytical conditions (eg, delayed processing or repeated freeze-thawing) of blood samples which are either directly used in the laboratory tests or stored for future research in the biobank.

  7. Exploring the initial steps of the testing process: frequency and nature of pre-preanalytic errors.

    Science.gov (United States)

    Carraro, Paolo; Zago, Tatiana; Plebani, Mario

    2012-03-01

    Few data are available on the nature of errors in the so-called pre-preanalytic phase, the initial steps of the testing process. We therefore sought to evaluate pre-preanalytic errors using a study design that enabled us to observe the initial procedures performed in the ward, from the physician's test request to the delivery of specimens in the clinical laboratory. After a 1-week direct observational phase designed to identify the operating procedures followed in 3 clinical wards, we recorded all nonconformities and errors occurring over a 6-month period. Overall, the study considered 8547 test requests, for which 15 917 blood sample tubes were collected and 52 982 tests undertaken. No significant differences in error rates were found between the observational phase and the overall study period, but underfilling of coagulation tubes was found to occur more frequently in the direct observational phase (P = 0.043). In the overall study period, the frequency of errors was found to be particularly high regarding order transmission [29 916 parts per million (ppm)] and hemolysed samples (2537 ppm). The frequency of patient misidentification was 352 ppm, and the most frequent nonconformities were test requests recorded in the diary without the patient's name and failure to check the patient's identity at the time of blood draw. The data collected in our study confirm the relative frequency of pre-preanalytic errors and underline the need to consensually prepare and adopt effective standard operating procedures in the initial steps of laboratory testing and to monitor compliance with these procedures over time.

  8. PG4KDS: a model for the clinical implementation of pre-emptive pharmacogenetics.

    Science.gov (United States)

    Hoffman, James M; Haidar, Cyrine E; Wilkinson, Mark R; Crews, Kristine R; Baker, Donald K; Kornegay, Nancy M; Yang, Wenjian; Pui, Ching-Hon; Reiss, Ulrike M; Gaur, Aditya H; Howard, Scott C; Evans, William E; Broeckel, Ulrich; Relling, Mary V

    2014-03-01

    Pharmacogenetics is frequently cited as an area for initial focus of the clinical implementation of genomics. Through the PG4KDS protocol, St. Jude Children's Research Hospital pre-emptively genotypes patients for 230 genes using the Affymetrix Drug Metabolizing Enzymes and Transporters (DMET) Plus array supplemented with a CYP2D6 copy number assay. The PG4KDS protocol provides a rational, stepwise process for implementing gene/drug pairs, organizing data, and obtaining consent from patients and families. Through August 2013, 1,559 patients have been enrolled, and four gene tests have been released into the electronic health record (EHR) for clinical implementation: TPMT, CYP2D6, SLCO1B1, and CYP2C19. These genes are coupled to 12 high-risk drugs. Of the 1,016 patients with genotype test results available, 78% of them had at least one high-risk (i.e., actionable) genotype result placed in their EHR. Each diplotype result released to the EHR is coupled with an interpretive consult that is created in a concise, standardized format. To support-gene based prescribing at the point of care, 55 interruptive clinical decision support (CDS) alerts were developed. Patients are informed of their genotyping result and its relevance to their medication use through a letter. Key elements necessary for our successful implementation have included strong institutional support, a knowledgeable clinical laboratory, a process to manage any incidental findings, a strategy to educate clinicians and patients, a process to return results, and extensive use of informatics, especially CDS. Our approach to pre-emptive clinical pharmacogenetics has proven feasible, clinically useful, and scalable. © 2014 Wiley Periodicals, Inc.

  9. A multi-centre phase IIa clinical study of predictive testing for preeclampsia

    DEFF Research Database (Denmark)

    Navaratnam, Kate; Alfirevic, Zarko; Baker, Philip N

    2013-01-01

    5% of first time pregnancies are complicated by pre-eclampsia, the leading cause of maternal death in Europe. No clinically useful screening test exists; consequentially clinicians are unable to offer targeted surveillance or preventative strategies. IMPROvED Consortium members have pioneered...... a personalised medicine approach to identifying blood-borne biomarkers through recent technological advancements, involving mapping of the blood metabolome and proteome. The key objective is to develop a sensitive, specific, high-throughput and economically viable early pregnancy screening test for pre-eclampsia....

  10. Monte Carlo simulation of the sequential probability ratio test for radiation monitoring

    International Nuclear Information System (INIS)

    Coop, K.L.

    1984-01-01

    A computer program simulates the Sequential Probability Ratio Test (SPRT) using Monte Carlo techniques. The program, SEQTEST, performs random-number sampling of either a Poisson or normal distribution to simulate radiation monitoring data. The results are in terms of the detection probabilities and the average time required for a trial. The computed SPRT results can be compared with tabulated single interval test (SIT) values to determine the better statistical test for particular monitoring applications. Use of the SPRT in a hand-and-foot alpha monitor shows that the SPRT provides better detection probabilities while generally requiring less counting time. Calculations are also performed for a monitor where the SPRT is not permitted to the take longer than the single interval test. Although the performance of the SPRT is degraded by this restriction, the detection probabilities are still similar to the SIT values, and average counting times are always less than 75% of the SIT time. Some optimal conditions for use of the SPRT are described. The SPRT should be the test of choice in many radiation monitoring situations. 6 references, 8 figures, 1 table

  11. The clinical significance of detection of serum Pre-S1 antigen

    International Nuclear Information System (INIS)

    Jiang Xuehua; Huang Zhuqing; Han Yi; Gong Shoujun

    2003-01-01

    To study the clinical significance of detection of serum Pre-S 1 Ag, the serum Pre-S 1 Ag, HBV-marks and HBV-DNA were detected in 338 patients with hepatitis B. The positive rate and the relationship between them were analyzed and compared. In 338 patients, the positive rate of serum Pre-S 1 Ag, HBeAg, HBV-DNA was 63.02%, 48.52%, 68.05% respectively, and the co-positive rate of Pre-S 1 Ag with HBV-DNA, HBeAg was 78.56%, 81.17% respectively. There was a significant correlation between Pre-S 1 Ag, HBeAg and HBV-DNA (P 1 Ag could well reflect the reproductive status of hepatitis B virus, and so it could be used as the clinical marker of the reproductive status of hepatitis B virus

  12. Application of the huff model of shopping probability in the selected stores in Prešov (Prešov, the Slovak Republic

    Directory of Open Access Journals (Sweden)

    Mitríková Jana

    2015-01-01

    Full Text Available The main objective of this article is the calculation of the Huff Model and the comparison of obtained data with the questionnaire survey results. Afterwards, we will try to assess the validity of this theoretical model of shopping probability for practical use as well as its overall objectivity. Calculation of the Huff Model of Probability will be calculated for nine large-scale retail stores in fifteen local regions within the area of the third largest town in the Slovak Republic - Prešov. These results will be compared to results of the questionnaire research which was conducted during the period of November 2013 until March 2014 on a sample of 1,096 respondents. The questionnaire was addressing customers' preference for various large-scale stores as well as their place of residence. Based on the calculation results and the results obtained from the questionnaire survey, cartographic outputs were created, pointing out overall consistency as well as differences in the already mentioned results.

  13. Clinical accuracy of inflationary oscillometry in pregnancy and pre-eclampsia: Omron-MIT Elite.

    Science.gov (United States)

    Chung, Y; Brochut, M C; de Greeff, A; Shennan, A H

    2012-10-01

    To evaluate the accuracy of the Omron MIT Elite in pregnancy and pre-eclampsia according to the British Hypertension Society protocol (BHS). Prospective observational study. Antenatal clinics and wards at St. Thomas' Hospital (London, UK). Forty-five pregnant women including 15 with pre-eclampsia. Nine sequential same arm blood pressure (BP) measurements were taken from each woman by trained observers, alternating between mercury sphygmomanometry and the test device. Grading criteria of the BHS protocol (A/B grade=pass; C/D=fail). The Omron MIT Elite achieved a grade A/A in both pregnancy and pre-eclampsia. The mean difference (SD) between the mercury standard and the device in pregnancy was -1.1 (5.2)mmHg and 1.5 (4.8)mmHg for systolic and diastolic BP respectively compared to 0.2 (5.3)mmHg and 2.2 (5.5)mmHg in pre-eclampsia. The Omron MIT Elite can be recommended for use in pregnancy and pre-eclampsia according to the BHS protocol. To date, this is the most accurate automated BP device validated in pre-eclampsia. Copyright © 2012. Published by Elsevier B.V.

  14. Towards the pre-clinical diagnosis of hypothyroidism caused by iodotyrosine deiodinase (DEHAL1) defects.

    Science.gov (United States)

    Iglesias, Ainhoa; García-Nimo, Laura; Cocho de Juan, José A; Moreno, José C

    2014-03-01

    DEHAL1 (also named IYD) is the thyroidal enzyme that deiodinates mono- and diiodotyrosines (MIT, DIT) and recycles iodine, a scarce element in the environment, for the efficient synthesis of thyroid hormone. Failure of this enzyme leads to the iodotyrosine deiodinase deficiency (ITDD), characterized by hypothyroidism, compressive goiter and variable mental retardation, whose diagnostic hallmark is the elevation of iodotyrosines in serum and urine. However, the specific diagnosis of this type of hypothyroidism is not routinely performed, due to technical and practical difficulties in iodotyrosine determinations. A handful of mutations in the DEHAL1 gene have been identified as the molecular basis for the ITDD. Patients harboring DEHAL1 defects so far described all belong to consanguineous families, and psychomotor deficits were present in some affected individuals. This is probably due to the lack of biochemical expression of the disease at the beginning of life, which causes ITDD being undetected in screening programs for congenital hypothyroidism, as currently performed. This worrying feature calls for efforts to improve pre-clinical detection of iodotyrosine deiodinase deficiency during the neonatal time. Such a challenge poses questions of patho-physiological (natural history of the disease, environmental factors influencing its expression) epidemiological (prevalence of ITDD) and technical nature (development of optimal methodology for safe detection of pre-clinical ITDD), which will be addressed in this review. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. Acceptability of HIV/AIDS testing among pre-marital couples in Iran (2012).

    Science.gov (United States)

    Ayatollahi, Jamshid; Nasab Sarab, Mohammad Ali Bagheri; Sharifi, Mohammad Reza; Shahcheraghi, Seyed Hossein

    2014-07-01

    Human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) is a lifestyle-related disease. This disease is transmitted through unprotected sex, contaminated needles, infected blood transfusion and from mother to child during pregnancy and delivery. Prevention of infection with HIV, mainly through safe sex and needle exchange programmes is a solution to prevent the spread of the disease. Knowledge about HIV state helps to prevent and subsequently reduce the harm to the later generation. The purpose of this study was to assess the willingness rate of couples referred to the family regulation pre-marital counselling centre for performing HIV test before marriage in Yazd. In this descriptive study, a simple random sampling was done among people referred to Akbari clinic. The couples were 1000 men and 1000 women referred to the premarital counselling centre for pre-marital HIV testing in Yazd in the year 2012. They were in situations of pregnancy, delivery or nursing and milking. The data were analyzed using Statistical Package for the Social Sciences (SPSS) software and chi-square statistical test. There was a significant statistical difference between the age groups about willingness for HIV testing before marriage (P marriage was significant. Therefore, HIV testing before marriage as a routine test was suggested.

  16. The importance of pre-planning for large hydrostatic test programs

    Energy Technology Data Exchange (ETDEWEB)

    Bennett, Andrew Keith [WorleyParsons Calgary, Calgary, AB (Canada); Wong, Everett Clementi [Enbridge Pipelines Inc., Edmonton, AB (Canada)

    2010-07-01

    During the design phase of a pipeline project, large hydrostatic test programs are required to locate and secure water sources. Many companies complete hydrostatic test planning through high level desktop analysis, however this technique can result in important unplanned costs and schedule delays. The aim of this paper is to assess the cost benefits of pre-planning large hydrostatic test programs versus the costs of unplanned delays in the execution of hydrostatic testing. This comparison was based on the successful application of pre-planning of 57 mainline hydrostatic tests in the construction of the Line 4 Extension and Alberta Clipper Expansion oil pipelines by Enbridge Pipelines Inc. Results showed that costs of delays and uncertainty during construction far outweigh the costs of pre-planning. This study highlighted that pre-planning for large hydrostatic test programs should be carried out in the execution of large pipeline projects to ensure success.

  17. Pre-screening Discussions and Prostate-Specific Antigen Testing for Prostate Cancer Screening.

    Science.gov (United States)

    Li, Jun; Zhao, Guixiang; Hall, Ingrid J

    2015-08-01

    For many men, the net benefit of prostate cancer screening with prostate-specific antigen (PSA) tests may be small. Many major medical organizations have issued recommendations for prostate cancer screening, stressing the need for shared decision making before ordering a test. The purpose of this study is to better understand associations between discussions about benefits and harms of PSA testing and uptake of the test among men aged ≥40 years. Associations between pre-screening discussions and PSA testing were examined using self-reported data from the 2012 Behavioral Risk Factor Surveillance System. Unadjusted prevalence of PSA testing was estimated and AORs were calculated using logistic regression in 2014. The multivariate analysis showed that men who had ever discussed advantages of PSA testing only or discussed both advantages and disadvantages were more likely, respectively, to report having had a test within the past year than men who had no discussions (ptesting with their healthcare providers were more likely (AOR=2.75, 95% CI=2.00, 3.79) to report getting tested than men who had no discussions. Discussions of the benefits or harms of PSA testing are positively associated with increased uptake of the test. Given the conflicting recommendations for prostate cancer screening and increasing importance of shared decision making, this study points to the need for understanding how pre-screening discussions are being conducted in clinical practice and the role played by patients' values and preferences in decisions about PSA testing. Published by Elsevier Inc.

  18. Further comments on the sequential probability ratio testing methods

    Energy Technology Data Exchange (ETDEWEB)

    Kulacsy, K. [Hungarian Academy of Sciences, Budapest (Hungary). Central Research Inst. for Physics

    1997-05-23

    The Bayesian method for belief updating proposed in Racz (1996) is examined. The interpretation of the belief function introduced therein is found, and the method is compared to the classical binary Sequential Probability Ratio Testing method (SPRT). (author).

  19. Pre-test evaluation of LLTR Series II Test A-6

    International Nuclear Information System (INIS)

    Knittle, D.

    1980-11-01

    Purpose of this report is to present pre-test predictions of pressure histories for the A6 test to be conducted in the Large Leak Test Facility (LLTF) at the Energy Technology Engineering Center. A6 is part of a test program being conducted to evaluate the effects of leaks produced by a double-ended guillotine rupture of a single tube. A6 will provide data on the CRBR prototypical double rupture disc performance

  20. Safeguarding a Lunar Rover with Wald's Sequential Probability Ratio Test

    Science.gov (United States)

    Furlong, Michael; Dille, Michael; Wong, Uland; Nefian, Ara

    2016-01-01

    The virtual bumper is a safeguarding mechanism for autonomous and remotely operated robots. In this paper we take a new approach to the virtual bumper system by using an old statistical test. By using a modified version of Wald's sequential probability ratio test we demonstrate that we can reduce the number of false positive reported by the virtual bumper, thereby saving valuable mission time. We use the concept of sequential probability ratio to control vehicle speed in the presence of possible obstacles in order to increase certainty about whether or not obstacles are present. Our new algorithm reduces the chances of collision by approximately 98 relative to traditional virtual bumper safeguarding without speed control.

  1. Thinking through postoperative cognitive dysfunction: How to bridge the gap between clinical and pre-clinical perspectives.

    Science.gov (United States)

    Hovens, Iris B; Schoemaker, Regien G; van der Zee, Eddy A; Heineman, Erik; Izaks, Gerbrand J; van Leeuwen, Barbara L

    2012-10-01

    Following surgery, patients may experience cognitive decline, which can seriously reduce quality of life. This postoperative cognitive dysfunction (POCD) is mainly seen in the elderly and is thought to be mediated by surgery-induced inflammatory reactions. Clinical studies tend to define POCD as a persisting, generalised decline in cognition, without specifying which cognitive functions are impaired. Pre-clinical research mainly describes early hippocampal dysfunction as a consequence of surgery-induced neuroinflammation. These different approaches to study POCD impede translation between clinical and pre-clinical research outcomes and may hamper the development of appropriate interventions. This article analyses which cognitive domains deteriorate after surgery and which brain areas might be involved. The most important outcomes are: (1) POCD encompasses a wide range of cognitive impairments; (2) POCD affects larger areas of the brain; and (3) individual variation in the vulnerability of neuronal networks to neuroinflammatory mechanisms may determine if and how POCD manifests itself. We argue that, for pre-clinical and clinical research of POCD to advance, the effects of surgery on various cognitive functions and brain areas should be studied. Moreover, in addition to general characteristics, research should take inter-relationships between cognitive complaints and physical and mental characteristics into account. Copyright © 2012 Elsevier Inc. All rights reserved.

  2. Using cognitive pre-testing methods in the development of a new evidenced-based pressure ulcer risk assessment instrument

    Directory of Open Access Journals (Sweden)

    S. Coleman

    2016-11-01

    Full Text Available Abstract Background Variation in development methods of Pressure Ulcer Risk Assessment Instruments has led to inconsistent inclusion of risk factors and concerns about content validity. A new evidenced-based Risk Assessment Instrument, the Pressure Ulcer Risk Primary Or Secondary Evaluation Tool - PURPOSE-T was developed as part of a National Institute for Health Research (NIHR funded Pressure Ulcer Research Programme (PURPOSE: RP-PG-0407-10056. This paper reports the pre-test phase to assess and improve PURPOSE-T acceptability, usability and confirm content validity. Methods A descriptive study incorporating cognitive pre-testing methods and integration of service user views was undertaken over 3 cycles comprising PURPOSE-T training, a focus group and one-to-one think-aloud interviews. Clinical nurses from 2 acute and 2 community NHS Trusts, were grouped according to job role. Focus group participants used 3 vignettes to complete PURPOSE-T assessments and then participated in the focus group. Think-aloud participants were interviewed during their completion of PURPOSE-T. After each pre-test cycle analysis was undertaken and adjustment/improvements made to PURPOSE-T in an iterative process. This incorporated the use of descriptive statistics for data completeness and decision rule compliance and directed content analysis for interview and focus group data. Data were collected April 2012-June 2012. Results Thirty-four nurses participated in 3 pre-test cycles. Data from 3 focus groups, 12 think-aloud interviews incorporating 101 PURPOSE-T assessments led to changes to improve instrument content and design, flow and format, decision support and item-specific wording. Acceptability and usability were demonstrated by improved data completion and appropriate risk pathway allocation. The pre-test also confirmed content validity with clinical nurses. Conclusions The pre-test was an important step in the development of the preliminary PURPOSE-T and the

  3. A generalizable pre-clinical research approach for orphan disease therapy

    Directory of Open Access Journals (Sweden)

    Beaulieu Chandree L

    2012-06-01

    Full Text Available Abstract With the advent of next-generation DNA sequencing, the pace of inherited orphan disease gene identification has increased dramatically, a situation that will continue for at least the next several years. At present, the numbers of such identified disease genes significantly outstrips the number of laboratories available to investigate a given disorder, an asymmetry that will only increase over time. The hope for any genetic disorder is, where possible and in addition to accurate diagnostic test formulation, the development of therapeutic approaches. To this end, we propose here the development of a strategic toolbox and preclinical research pathway for inherited orphan disease. Taking much of what has been learned from rare genetic disease research over the past two decades, we propose generalizable methods utilizing transcriptomic, system-wide chemical biology datasets combined with chemical informatics and, where possible, repurposing of FDA approved drugs for pre-clinical orphan disease therapies. It is hoped that this approach may be of utility for the broader orphan disease research community and provide funding organizations and patient advocacy groups with suggestions for the optimal path forward. In addition to enabling academic pre-clinical research, strategies such as this may also aid in seeding startup companies, as well as further engaging the pharmaceutical industry in the treatment of rare genetic disease.

  4. Safety Evaluation Test on Human for Radiation Pre vulcanised Natural Rubber Latex (RVNRL)

    International Nuclear Information System (INIS)

    Pairu Ibrahim; Wan Manshol Wan Zain; Chai, Chee Keong; Sofian Ibrahim; Saadiah Sulaiman; Sharifah Ismail

    2010-01-01

    This paper discussed about clinical test conducted to determine safety evaluations on human for latex examination gloves and latex films made from Radiation Vulcanized Natural Rubber Latex (RVNRL). Two types of test were being adopted which are i) Modified Draize-95 test and ii) Patch Test on Sensitized Individuals. Modified Draize-95 test was conducted on 200 non-sensitized human subjects and Patch Test on Sensitized Individuals was conducted on 25 individuals who are allergic to the defined major chemical sensitizer presents in natural rubber product. It was found that Modified Draize-95 test has prove that there is no clinical evidence on the presence of residual chemical additives at the level that may induce Type IV allergy in the un sensitized general user population in the RVNRL gloves. Meanwhile Patch Test on Sensitized Individuals has proved that the patch test conducted using the test article on 25 individuals who are allergic to the defined major chemical sensitizers present in natural rubber products, thiuram, carbamates or thiazoles produced a negative response, meeting the pre requirement for the claim of reduced reaction-inducing potential. (author)

  5. Surgeon Involvement in Pre-Clinical Medical Education: Attitudes of Directors of Education

    Directory of Open Access Journals (Sweden)

    Simon Turner

    2012-04-01

    Full Text Available Background: Application rates to surgical residencies have shown a downward trend recently. Introducing students to surgeons early in medical school can increase interest in surgery as a career and enhance the instruction of important surgical topics. Directors of undergraduate medical education have unique insight and influence regarding the participation of surgeons in pre-clinical education. Methods: To understand the attitudes of these educators towards surgeons as teachers in pre-clinical programs, a survey was administered to the directors of undergraduate medical education at each of the English-language medical schools in Canada. Results: Educators estimate the participation of surgeons in all categories of pre-clinical education to be low, despite being valuable, and think that it should be increased. The most significant barrier to participation identified was a lack of surgeons’ time. Conclusions: Despite the value of surgeons participating in pre-clinical education, their rate of participation is low. Steps should be taken to facilitate the involvement of surgeons in this phase of education, which may lead to improved education for students and increased student interest in surgery residencies.

  6. Limited test data: The choice between confidence limits and inverse probability

    International Nuclear Information System (INIS)

    Nichols, P.

    1975-01-01

    For a unit which has been successfully designed to a high standard of reliability, any test programme of reasonable size will result in only a small number of failures. In these circumstances the failure rate estimated from the tests will depend on the statistical treatment applied. When a large number of units is to be manufactured, an unexpected high failure rate will certainly result in a large number of failures, so it is necessary to guard against optimistic unrepresentative test results by using a confidence limit approach. If only a small number of production units is involved, failures may not occur even with a higher than expected failure rate, and so one may be able to accept a method which allows for the possibility of either optimistic or pessimistic test results, and in this case an inverse probability approach, based on Bayes' theorem, might be used. The paper first draws attention to an apparently significant difference in the numerical results from the two methods, particularly for the overall probability of several units arranged in redundant logic. It then discusses a possible objection to the inverse method, followed by a demonstration that, for a large population and a very reasonable choice of prior probability, the inverse probability and confidence limit methods give the same numerical result. Finally, it is argued that a confidence limit approach is overpessimistic when a small number of production units is involved, and that both methods give the same answer for a large population. (author)

  7. Diagnostic accuracy of the gravity stress test and clinical signs in cases of isolated supination-external rotation-type lateral malleolar fractures.

    Science.gov (United States)

    Nortunen, S; Flinkkilä, T; Lantto, I; Kortekangas, T; Niinimäki, J; Ohtonen, P; Pakarinen, H

    2015-08-01

    We prospectively assessed the diagnostic accuracy of the gravity stress test and clinical findings to evaluate the stability of the ankle mortise in patients with supination-external rotation-type fractures of the lateral malleolus without widening of the medial clear space. The cohort included 79 patients with a mean age of 44 years (16 to 82). Two surgeons assessed medial tenderness, swelling and ecchymosis and performed the external rotation (ER) stress test (a reference standard). A diagnostic radiographer performed the gravity stress test. For the gravity stress test, the positive likelihood ratio (LR) was 5.80 with a 95% confidence interval (CI) of 2.75 to 12.27, and the negative LR was 0.15 (95% CI 0.07 to 0.35), suggesting a moderate change from the pre-test probability. Medial tenderness, both alone and in combination with swelling and/or ecchymosis, indicated a small change (positive LR, 2.74 to 3.25; negative LR, 0.38 to 0.47), whereas swelling and ecchymosis indicated only minimal changes (positive LR, 1.41 to 1.65; negative LR, 0.38 to 0.47). In conclusion, when gravity stress test results are in agreement with clinical findings, the result is likely to predict stability of the ankle mortise with an accuracy equivalent to ER stress test results. When clinical examination suggests a medial-side injury, however, the gravity stress test may give a false negative result. ©2015 The British Editorial Society of Bone & Joint Surgery.

  8. Rational clinical evaluation of suspected acute coronary syndromes: The value of more information.

    Science.gov (United States)

    Hancock, David G; Chuang, Ming-Yu Anthony; Bystrom, Rebecca; Halabi, Amera; Jones, Rachel; Horsfall, Matthew; Cullen, Louise; Parsonage, William A; Chew, Derek P

    2017-12-01

    Many meta-analyses have provided synthesised likelihood ratio data to aid clinical decision-making. However, much less has been published on how to safely combine clinical information in practice. We aimed to explore the benefits and risks of pooling clinical information during the ED assessment of suspected acute coronary syndrome. Clinical information on 1776 patients was collected within a randomised trial conducted across five South Australian EDs between July 2011 and March 2013. Bayes theorem was used to calculate patient-specific post-test probabilities using age- and gender-specific pre-test probabilities and likelihood ratios corresponding to the presence or absence of 18 clinical factors. Model performance was assessed as the presence of adverse cardiac outcomes among patients theoretically discharged at a post-test probability less than 1%. Bayes theorem-based models containing high-sensitivity troponin T (hs-troponin) outperformed models excluding hs-troponin, as well as models utilising TIMI and GRACE scores. In models containing hs-troponin, a plateau in improving discharge safety was observed after the inclusion of four clinical factors. Models with fewer clinical factors better approximated the true event rate, tended to be safer and resulted in a smaller standard deviation in post-test probability estimates. We showed that there is a definable point where additional information becomes uninformative and may actually lead to less certainty. This evidence supports the concept that clinical decision-making in the assessment of suspected acute coronary syndrome should be focused on obtaining the least amount of information that provides the highest benefit for informing the decisions of admission or discharge. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  9. Growth/differentiation factor-5: pre-clinical and clinical evaluations of periodontal regeneration and alveolar augmentation--review.

    Science.gov (United States)

    Lee, Jaebum; Wikesjö, Ulf M E

    2014-08-01

    Growth/differentiation factor-5 (GDF-5) plays critical roles in mesenchymal cell differentiation and stimulates human periodontal ligament cell proliferation. Potentially, GDF-5 may also play roles in wound healing including periodontal regeneration and alveolar augmentation. The objective of this review was to provide up-to-date information from pre-clinical/clinical studies evaluating GDF-5 for these indications. A comprehensive search using PubMed and Google search engines was conducted to identify reports on GDF-5 applied to periodontal and alveolar indications. Two reviewers independently screened the titles and abstracts from a total of 479 reports. Full-length articles of 17 pre-clinical and four clinical studies were selected and reviewed. Canine-, porcine- and non-human primate-based models as well as human clinical trials were used in the evaluation of GDF-5 in support of periodontal regeneration and alveolar augmentation. An absorbable collagen sponge (ACS), β-tricalcium phosphate (β-TCP) and a poly(lactic-co-glycolic) acid (PLGA) were evaluated as candidate carriers for GDF-5 using various dose and healing intervals demonstrating significantly enhanced periodontal regeneration/alveolar augmentation including cementum, periodontal ligament and alveolar bone with limited, if any, adverse effects. Growth/differentiation factor-5 supports periodontal regeneration/alveolar augmentation without aberrant healing events documented in qualified pre-clinical models and clinical pilot studies. In perspective, GDF-5 appears a promising technology for periodontal regeneration/alveolar augmentation. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Estimation of the common cause failure probabilities of the components under mixed testing schemes

    International Nuclear Information System (INIS)

    Kang, Dae Il; Hwang, Mee Jeong; Han, Sang Hoon

    2009-01-01

    For the case where trains or channels of standby safety systems consisting of more than two redundant components are tested in a staggered manner, the standby safety components within a train can be tested simultaneously or consecutively. In this case, mixed testing schemes, staggered and non-staggered testing schemes, are used for testing the components. Approximate formulas, based on the basic parameter method, were developed for the estimation of the common cause failure (CCF) probabilities of the components under mixed testing schemes. The developed formulas were applied to the four redundant check valves of the auxiliary feed water system as a demonstration study for their appropriateness. For a comparison, we estimated the CCF probabilities of the four redundant check valves for the mixed, staggered, and non-staggered testing schemes. The CCF probabilities of the four redundant check valves for the mixed testing schemes were estimated to be higher than those for the staggered testing scheme, and lower than those for the non-staggered testing scheme.

  11. Finding upper bounds for software failure probabilities - experiments and results

    International Nuclear Information System (INIS)

    Kristiansen, Monica; Winther, Rune

    2005-09-01

    This report looks into some aspects of using Bayesian hypothesis testing to find upper bounds for software failure probabilities. In the first part, the report evaluates the Bayesian hypothesis testing approach for finding upper bounds for failure probabilities of single software components. The report shows how different choices of prior probability distributions for a software component's failure probability influence the number of tests required to obtain adequate confidence in a software component. In the evaluation, both the effect of the shape of the prior distribution as well as one's prior confidence in the software component were investigated. In addition, different choices of prior probability distributions are discussed based on their relevance in a software context. In the second part, ideas on how the Bayesian hypothesis testing approach can be extended to assess systems consisting of multiple software components are given. One of the main challenges when assessing systems consisting of multiple software components is to include dependency aspects in the software reliability models. However, different types of failure dependencies between software components must be modelled differently. Identifying different types of failure dependencies are therefore an important condition for choosing a prior probability distribution, which correctly reflects one's prior belief in the probability for software components failing dependently. In this report, software components include both general in-house software components, as well as pre-developed software components (e.g. COTS, SOUP, etc). (Author)

  12. The development and validation of a clinical prediction model to determine the probability of MODY in patients with young-onset diabetes.

    Science.gov (United States)

    Shields, B M; McDonald, T J; Ellard, S; Campbell, M J; Hyde, C; Hattersley, A T

    2012-05-01

    Diagnosing MODY is difficult. To date, selection for molecular genetic testing for MODY has used discrete cut-offs of limited clinical characteristics with varying sensitivity and specificity. We aimed to use multiple, weighted, clinical criteria to determine an individual's probability of having MODY, as a crucial tool for rational genetic testing. We developed prediction models using logistic regression on data from 1,191 patients with MODY (n = 594), type 1 diabetes (n = 278) and type 2 diabetes (n = 319). Model performance was assessed by receiver operating characteristic (ROC) curves, cross-validation and validation in a further 350 patients. The models defined an overall probability of MODY using a weighted combination of the most discriminative characteristics. For MODY, compared with type 1 diabetes, these were: lower HbA(1c), parent with diabetes, female sex and older age at diagnosis. MODY was discriminated from type 2 diabetes by: lower BMI, younger age at diagnosis, female sex, lower HbA(1c), parent with diabetes, and not being treated with oral hypoglycaemic agents or insulin. Both models showed excellent discrimination (c-statistic = 0.95 and 0.98, respectively), low rates of cross-validated misclassification (9.2% and 5.3%), and good performance on the external test dataset (c-statistic = 0.95 and 0.94). Using the optimal cut-offs, the probability models improved the sensitivity (91% vs 72%) and specificity (94% vs 91%) for identifying MODY compared with standard criteria of diagnosis MODY. This allows an improved and more rational approach to determine who should have molecular genetic testing.

  13. Psychosocial impact, perceived stress and learning effect in undergraduate dental students during transition from pre-clinical to clinical education.

    Science.gov (United States)

    Frese, C; Wolff, D; Saure, D; Staehle, H J; Schulte, A

    2018-04-10

    This study aimed to develop a suitable instrument for a comprehensive quantitative and qualitative assessment of perceived psychosocial impact, levels of stress and learning effect in undergraduate dental students during the transition from pre-clinical to clinical education. These findings might improve curricular structures and didactic organisation during this period. At the beginning of their first clinical year, undergraduate dental students were asked to complete an anonymous forty-item questionnaire. Two hundred and seventy-six undergraduate dental students were willing to participate and completed the questionnaire and participated during the years 2011-2016. The response rate was between 45% and 96%. Correlational analysis (Spearman-Rho) in the field of psychosocial impact showed the dental teacher to be the most important multiplier of students' feelings. If the students feel that their teacher acts cooperatively, positive items increase and negative items decrease significantly (P < .0001). Also, students who report high levels of stress are affected significantly in their psychosocial interaction (P < .0001). Wilcoxon test yielded highest levels of stress in endodontology during the first weeks (P < .0001). During the same period, the greatest learning increment was seen for diagnostics and caries excavation. In conclusion, teaching of undergraduate dental students during the transition period from pre-clinical to clinical education can be positively influenced by a supportive learning environment and by specific chronological modifications in the curriculum. Students should start their clinical training with diagnostics, preventive dentistry and initial periodontal treatment. Due to high levels of perceived stress, endodontology should be introduced later in the clinical curriculum. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  14. Estimation of the common cause failure probabilities on the component group with mixed testing scheme

    International Nuclear Information System (INIS)

    Hwang, Meejeong; Kang, Dae Il

    2011-01-01

    Highlights: ► This paper presents a method to estimate the common cause failure probabilities on the common cause component group with mixed testing schemes. ► The CCF probabilities are dependent on the testing schemes such as staggered testing or non-staggered testing. ► There are many CCCGs with specific mixed testing schemes in real plant operation. ► Therefore, a general formula which is applicable to both alternate periodic testing scheme and train level mixed testing scheme was derived. - Abstract: This paper presents a method to estimate the common cause failure (CCF) probabilities on the common cause component group (CCCG) with mixed testing schemes such as the train level mixed testing scheme or the alternate periodic testing scheme. In the train level mixed testing scheme, the components are tested in a non-staggered way within the same train, but the components are tested in a staggered way between the trains. The alternate periodic testing scheme indicates that all components in the same CCCG are tested in a non-staggered way during the planned maintenance period, but they are tested in a staggered way during normal plant operation. Since the CCF probabilities are dependent on the testing schemes such as staggered testing or non-staggered testing, CCF estimators have two kinds of formulas in accordance with the testing schemes. Thus, there are general formulas to estimate the CCF probability on the staggered testing scheme and non-staggered testing scheme. However, in real plant operation, there are many CCCGs with specific mixed testing schemes. Recently, Barros () and Kang () proposed a CCF factor estimation method to reflect the alternate periodic testing scheme and the train level mixed testing scheme. In this paper, a general formula which is applicable to both the alternate periodic testing scheme and the train level mixed testing scheme was derived.

  15. Long-term impact of pre-operative physical rehabilitation protocol on the 6-min walk test of patients with adolescent idiopathic scoliosis: A randomized clinical trial

    Directory of Open Access Journals (Sweden)

    V.L. dos Santos Alves

    2015-05-01

    Full Text Available Background: Monitored physical activities in patients with adolescent idiopathic scoliosis (AIS have been shown to improve physical performance, endurance and cardiopulmonary function and may be assessed by the 6-min walk test (6MWT. We aimed to evaluate the long-term results of the 6MWT after a rehabilitation protocol employed before surgical correction for AIS. Methods: This prospective randomized clinical trial studied the impact of a 4-month pre-operative physical rehabilitation protocol on post-operative cardiopulmonary function and physical endurance, by using the 6MWT, in patients with AIS submitted to surgical correction, comparing them to matched controls without physical rehabilitation. Studied variables were heart and respiratory rate, systolic and diastolic blood pressure, peripheral blood oxygen saturation, Borg score, and distance walked. Patients were assessed at baseline, after 4 months of rehabilitation, and 3, 6 and 12 months post-operatively. Results: A total of 50 patients with AIS were included in the study and allocated blindly, by simple randomization, into either one of the two groups, with 25 patients each: study group (pre-operative physical rehabilitation and control group. The physical rehabilitation protocol promoted significant progressive improvement in heart and respiratory rate, peripheral blood oxygen saturation, distance walked, and level of effort assessed by the Borg scale after surgery. Conclusions: Post-surgical recovery, evaluated by 6MWT, was significantly better in patients who underwent a 4-month pre-operative physical rehabilitation protocol. Keywords: Scoliosis, Exercise, Exercise movement techniques, Exercise therapy, Exercise test

  16. Evaluation of Correlation between Pretest Probability for Clostridium difficile Infection and Clostridium difficile Enzyme Immunoassay Results.

    Science.gov (United States)

    Kwon, Jennie H; Reske, Kimberly A; Hink, Tiffany; Burnham, C A; Dubberke, Erik R

    2017-02-01

    The objective of this study was to evaluate the clinical characteristics and outcomes of hospitalized patients tested for Clostridium difficile and determine the correlation between pretest probability for C. difficile infection (CDI) and assay results. Patients with testing ordered for C. difficile were enrolled and assigned a high, medium, or low pretest probability of CDI based on clinical evaluation, laboratory, and imaging results. Stool was tested for C. difficile by toxin enzyme immunoassay (EIA) and toxigenic culture (TC). Chi-square analyses and the log rank test were utilized. Among the 111 patients enrolled, stool samples from nine were TC positive and four were EIA positive. Sixty-one (55%) patients had clinically significant diarrhea, 19 (17%) patients did not, and clinically significant diarrhea could not be determined for 31 (28%) patients. Seventy-two (65%) patients were assessed as having a low pretest probability of having CDI, 34 (31%) as having a medium probability, and 5 (5%) as having a high probability. None of the patients with low pretest probabilities had a positive EIA, but four were TC positive. None of the seven patients with a positive TC but a negative index EIA developed CDI within 30 days after the index test or died within 90 days after the index toxin EIA date. Pretest probability for CDI should be considered prior to ordering C. difficile testing and must be taken into account when interpreting test results. CDI is a clinical diagnosis supported by laboratory data, and the detection of toxigenic C. difficile in stool does not necessarily confirm the diagnosis of CDI. Copyright © 2017 American Society for Microbiology.

  17. Pre-Hospital Fast Positive Cases Identified by DFB Ambulance Paramedics – Final Clinical Diagnosis

    LENUS (Irish Health Repository)

    Feeney, A

    2016-04-01

    Ischaemic stroke clinical outcomes are improved by earlier treatment with intravenous thrombolysis. An existing pathway at the Mater University Hospital for assessment of suspected acute stroke in the Emergency Department was updated, aiming to shorten ‘door to needle time’. This study examines the final clinical diagnosis of Dublin Fire Brigade Ambulance Paramedic identified Face Arm Speech Test (FAST) positive patients presenting to the Emergency Department over a 7 month period. A retrospective analysis was carried out of 177 consecutive FAST positive patients presenting between March and November 2014. The final clinical diagnosis was acute stroke in 57.1% (n=101) of patients. Of these, 76 were ischaemic strokes of whom 56.5% (n=43) were thrombolysed. In the pre-hospital setting Ambulance Paramedics can identify, with reasonable accuracy, acute stroke using the FAST test. Over half of the ischaemic stroke patients presenting via this pathway can be treated with intravenous thrombolysis

  18. Changes in neural circuitry associated with depression at pre-clinical, pre-motor and early motor phases of Parkinson's disease.

    Science.gov (United States)

    Borgonovo, Janina; Allende-Castro, Camilo; Laliena, Almudena; Guerrero, Néstor; Silva, Hernán; Concha, Miguel L

    2017-02-01

    Although Parkinson's Disease (PD) is mostly considered a motor disorder, it can present at early stages as a non-motor pathology. Among the non-motor clinical manifestations, depression shows a high prevalence and can be one of the first clinical signs to appear, even a decade before the onset of motor symptoms. Here, we review the evidence of early dysfunction in neural circuitry associated with depression in the context of PD, focusing on pre-clinical, pre-motor and early motor phases of the disease. In the pre-clinical phase, structural and functional changes in the substantia nigra, basal ganglia and limbic structures are already observed. Some of these changes are linked to motor compensation mechanisms while others correspond to pathological processes common to PD and depression and thus could underlie the appearance of depressive symptoms during the pre-motor phase. Studies of the early motor phase (less than five years post diagnosis) reveal an association between the extent of damage in different monoaminergic systems and the appearance of emotional disorders. We propose that the limbic loop of the basal ganglia and the lateral habenula play key roles in the early genesis of depression in PD. Alterations in the neural circuitry linked with emotional control might be sensitive markers of the ongoing neurodegenerative process and thus may serve to facilitate an early diagnosis of this disease. To take advantage of this, we need to improve the clinical criteria and develop biomarkers to identify depression, which could be used to determine individuals at risk to develop PD. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. What is the value of routinely testing full blood count, electrolytes and urea, and pulmonary function tests before elective surgery in patients with no apparent clinical indication and in subgroups of patients with common comorbidities: a systematic review of the clinical and cost-effective literature.

    Science.gov (United States)

    Czoski-Murray, C; Lloyd Jones, M; McCabe, C; Claxton, K; Oluboyede, Y; Roberts, J; Nicholl, J P; Rees, A; Reilly, C S; Young, D; Fleming, T

    2012-12-01

    The evidence base which supported the National Institute for Health and Clinical Excellence (NICE) published Clinical Guideline 3 was limited and 50% was graded as amber. However, the use of tests as part of pre-operative work-up remains a low-cost but high-volume activity within the NHS, with substantial resource implications. The objective of this study was to identify, evaluate and synthesise the published evidence on the clinical effectiveness and cost-effectiveness of the routine use of three tests, full blood counts (FBCs), urea and electrolytes tests (U&Es) and pulmonary function tests, in the pre-operative work-up of otherwise healthy patients undergoing minor or intermediate surgery in the NHS. The aims of this study were to estimate the clinical effectiveness and cost-effectiveness of routine pre-operative testing of FBC, electrolytes and renal function and pulmonary function in adult patients classified as American Society of Anaesthesiologists (ASA) grades 1 and 2 undergoing elective minor (grade 1) or intermediate (grade 2) surgical procedures; to compare NICE recommendations with current practice; to evaluate the cost-effectiveness of mandating or withdrawing each of these tests in this patient group; and to identify the expected value of information and whether or not it has value to the NHS in commissioning further primary research into the use of these tests in this group of patients. The following electronic bibliographic databases were searched: (1) BIOSIS; (2) Cumulative Index to Nursing and Allied Health Literature; (3) Cochrane Database of Systematic Reviews; (4) Cochrane Central Register of Controlled Trials; (5) EMBASE; (6) MEDLINE; (7) MEDLINE In-Process & Other Non-Indexed Citations; (8) NHS Database of Abstracts of Reviews of Effects; (9) NBS Health Technology Assessment Database; and (10) Science Citation Index. To identify grey and unpublished literature, the Cochrane Register of Controlled Trials, National Research Register Archive

  20. Sequential Probability Ratio Test for Spacecraft Collision Avoidance Maneuver Decisions

    Science.gov (United States)

    Carpenter, J. Russell; Markley, F. Landis

    2013-01-01

    A document discusses sequential probability ratio tests that explicitly allow decision-makers to incorporate false alarm and missed detection risks, and are potentially less sensitive to modeling errors than a procedure that relies solely on a probability of collision threshold. Recent work on constrained Kalman filtering has suggested an approach to formulating such a test for collision avoidance maneuver decisions: a filter bank with two norm-inequality-constrained epoch-state extended Kalman filters. One filter models the null hypotheses that the miss distance is inside the combined hard body radius at the predicted time of closest approach, and one filter models the alternative hypothesis. The epoch-state filter developed for this method explicitly accounts for any process noise present in the system. The method appears to work well using a realistic example based on an upcoming, highly elliptical orbit formation flying mission.

  1. Test the Overall Significance of p-values by Using Joint Tail Probability of Ordered p-values as Test Statistic

    OpenAIRE

    Fang, Yongxiang; Wit, Ernst

    2008-01-01

    Fisher’s combined probability test is the most commonly used method to test the overall significance of a set independent p-values. However, it is very obviously that Fisher’s statistic is more sensitive to smaller p-values than to larger p-value and a small p-value may overrule the other p-values and decide the test result. This is, in some cases, viewed as a flaw. In order to overcome this flaw and improve the power of the test, the joint tail probability of a set p-values is proposed as a ...

  2. Prevalence of Pre-Analytical Errors in Clinical Chemistry Diagnostic Labs in Sulaimani City of Iraqi Kurdistan.

    Science.gov (United States)

    Najat, Dereen

    2017-01-01

    hospitals focus only on the analytical phase, and none of the pre-analytical errors were recorded. Interestingly, none of the labs were internationally accredited; therefore, corrective actions are needed at these hospitals to ensure better health outcomes. Internal and External Quality Assessment Schemes (EQAS) for the pre-analytical phase at Sulaimani clinical laboratories should be implemented at public hospitals. Furthermore, lab personnel, particularly phlebotomists, need continuous training on the importance of sample quality to obtain accurate test results.

  3. Prevalence of Pre-Analytical Errors in Clinical Chemistry Diagnostic Labs in Sulaimani City of Iraqi Kurdistan.

    Directory of Open Access Journals (Sweden)

    Dereen Najat

    at Sulaimani hospitals focus only on the analytical phase, and none of the pre-analytical errors were recorded. Interestingly, none of the labs were internationally accredited; therefore, corrective actions are needed at these hospitals to ensure better health outcomes. Internal and External Quality Assessment Schemes (EQAS for the pre-analytical phase at Sulaimani clinical laboratories should be implemented at public hospitals. Furthermore, lab personnel, particularly phlebotomists, need continuous training on the importance of sample quality to obtain accurate test results.

  4. Over-pressure test on BARCOM pre-stressed concrete containment

    Energy Technology Data Exchange (ETDEWEB)

    Parmar, R.M.; Singh, Tarvinder; Thangamani, I.; Trivedi, Neha; Singh, Ram Kumar, E-mail: rksingh@barc.gov.in

    2014-04-01

    Bhabha Atomic Research Centre (BARC), Trombay has organized an International Round Robin Analysis program to carry out the ultimate load capacity assessment of BARC Containment (BARCOM) test model. The test model located in BARC facilities Tarapur; is a 1:4 scale representation of 540 MWe Pressurized Heavy Water Reactor (PHWR) pre-stressed concrete inner containment structure of Tarapur Atomic Power Station (TAPS) unit 3 and 4. There are a large number of sensors installed in BARCOM that include vibratory wire strain gauges of embedded and spot-welded type, surface mounted electrical resistance strain gauges, dial gauges, earth pressure cells, tilt meters and high resolution digital camera systems for structural response, crack monitoring and fracture parameter measurement to evaluate the local and global behavior of the containment test model. The model has been tested pneumatically during the low pressure tests (LPTs) followed by proof test (PT) and integrated leakage rate test (ILRT) during commissioning. Further the over pressure test (OPT) has been carried out to establish the failure mode of BARCOM Test-Model. The over-pressure test will be completed shortly to reach the functional failure of the test model. Pre-test evaluation of BARCOM was carried out with the results obtained from the registered international round robin participants in January 2009 followed by the post-test assessment in February 2011. The test results along with the various failure modes related to the structural members – concrete, rebars and tendons identified in terms of prescribed milestones are presented in this paper along with the comparison of the pre-test predictions submitted by the registered participants of the Round Robin Analysis for BARCOM test model.

  5. Insights From Pre-Clinical and Clinical Studies on the Role of Innate Inflammation in Atherosclerosis Regression

    Directory of Open Access Journals (Sweden)

    Karishma Rahman

    2018-05-01

    Full Text Available Atherosclerosis, the underlying cause of coronary artery (CAD and other cardiovascular diseases, is initiated by macrophage-mediated immune responses to lipoprotein and cholesterol accumulation in artery walls, which result in the formation of plaques. Unlike at other sites of inflammation, the immune response becomes maladaptive and inflammation fails to resolve. The most common treatment for reducing the risk from atherosclerosis is low density lipoprotein cholesterol (LDL-C lowering. Studies have shown, however, that while significant lowering of LDL-C reduces the risk of heart attacks to some degree, there is still residual risk for the majority of the population. We and others have observed “residual inflammatory risk” of atherosclerosis after plasma cholesterol lowering in pre-clinical studies, and that this phenomenon is clinically relevant has been dramatically reinforced by the recent Canakinumab Anti-inflammatory Thrombosis Outcomes Study (CANTOS trial. This review will summarize the role of the innate immune system, specifically macrophages, in atherosclerosis progression and regression, as well as the pre-clinical and clinical models that have provided significant insights into molecular pathways involved in the resolution of plaque inflammation and plaque regression. Partnered with clinical studies that can be envisioned in the post-CANTOS period, including progress in developing targeted plaque therapies, we expect that pre-clinical studies advancing on the path summarized in this review, already revealing key mechanisms, will continue to be essential contributors to achieve the goals of dampening plaque inflammation and inducing its resolution in order to maximize the therapeutic benefits of conventional risk factor modifications, such as LDL-C lowering.

  6. Internal Medicine residents use heuristics to estimate disease probability

    OpenAIRE

    Phang, Sen Han; Ravani, Pietro; Schaefer, Jeffrey; Wright, Bruce; McLaughlin, Kevin

    2015-01-01

    Background: Training in Bayesian reasoning may have limited impact on accuracy of probability estimates. In this study, our goal was to explore whether residents previously exposed to Bayesian reasoning use heuristics rather than Bayesian reasoning to estimate disease probabilities. We predicted that if residents use heuristics then post-test probability estimates would be increased by non-discriminating clinical features or a high anchor for a target condition. Method: We randomized 55 In...

  7. Panel-Based Clinical Genetic Testing in 85 Children with Inherited Retinal Disease.

    Science.gov (United States)

    Taylor, Rachel L; Parry, Neil R A; Barton, Stephanie J; Campbell, Christopher; Delaney, Claire M; Ellingford, Jamie M; Hall, Georgina; Hardcastle, Claire; Morarji, Jiten; Nichol, Elisabeth J; Williams, Lindsi C; Douzgou, Sofia; Clayton-Smith, Jill; Ramsden, Simon C; Sharma, Vinod; Biswas, Susmito; Lloyd, I Chris; Ashworth, Jane L; Black, Graeme C; Sergouniotis, Panagiotis I

    2017-07-01

    To assess the clinical usefulness of genetic testing in a pediatric population with inherited retinal disease (IRD). Single-center retrospective case series. Eighty-five unrelated children with a diagnosis of isolated or syndromic IRD who were referred for clinical genetic testing between January 2014 and July 2016. Participants underwent a detailed ophthalmic examination, accompanied by electrodiagnostic testing (EDT) and dysmorphologic assessment where appropriate. Ocular and extraocular features were recorded using Human Phenotype Ontology terms. Subsequently, multigene panel testing (105 or 177 IRD-associated genes) was performed in an accredited diagnostic laboratory, followed by clinical variant interpretation. Diagnostic yield and clinical usefulness of genetic testing. Overall, 78.8% of patients (n = 67) received a probable molecular diagnosis; 7.5% (n = 5) of these had autosomal dominant disease, 25.4% (n = 17) had X-linked disease, and 67.2% (n = 45) had autosomal recessive disease. In a further 5.9% of patients (n = 5), a single heterozygous ABCA4 variant was identified; all these participants had a spectrum of clinical features consistent with ABCA4 retinopathy. Most participants (84.7%; n = 72) had undergone EDT and 81.9% (n = 59) of these patients received a probable molecular diagnosis. The genes most frequently mutated in the present cohort were CACNA1F and ABCA4, accounting for 14.9% (n = 10) and 11.9% (n = 8) of diagnoses respectively. Notably, in many cases, genetic testing helped to distinguish stationary from progressive IRD subtypes and to establish a precise diagnosis in a timely fashion. Multigene panel testing pointed to a molecular diagnosis in 84.7% of children with IRD. The diagnostic yield in the study population was significantly higher compared with that in previously reported unselected IRD cohorts. Approaches similar to the one described herein are expected to become a standard component of care in pediatric ophthalmology

  8. A magneto-motive ultrasound platform designed for pre-clinical and clinical applications

    Directory of Open Access Journals (Sweden)

    Diego Ronaldo Thomaz Sampaio

    Full Text Available Abstract Introduction Magneto-motive ultrasound (MMUS combines magnetism and ultrasound (US to detect magnetic nanoparticles in soft tissues. One type of MMUS called shear-wave dispersion magneto-motive ultrasound (SDMMUS analyzes magnetically induced shear waves (SW to quantify the elasticity and viscosity of the medium. The lack of an established presets or protocols for pre-clinical and clinical studies currently limits the use of MMUS techniques in the clinical setting. Methods This paper proposes a platform to acquire, process, and analyze MMUS and SDMMUS data integrated with a clinical ultrasound equipment. For this purpose, we developed an easy-to-use graphical user interface, written in C++/Qt4, to create an MMUS pulse sequence and collect the ultrasonic data. We designed a graphic interface written in MATLAB to process, display, and analyze the MMUS images. To exemplify how useful the platform is, we conducted two experiments, namely (i MMUS imaging to detect magnetic particles in the stomach of a rat, and (ii SDMMUS to estimate the viscoelasticity of a tissue-mimicking phantom containing a spherical target of ferrite. Results The developed software proved to be an easy-to-use platform to automate the acquisition of MMUS/SDMMUS data and image processing. In an in vivo experiment, the MMUS technique detected an area of 6.32 ± 1.32 mm2 where magnetic particles were heterogeneously distributed in the stomach of the rat. The SDMMUS method gave elasticity and viscosity values of 5.05 ± 0.18 kPa and 2.01 ± 0.09 Pa.s, respectively, for a tissue-mimicking phantom. Conclusion Implementation of an MMUS platform with addressed presets and protocols provides a step toward the clinical implementation of MMUS imaging equipment. This platform may help to localize magnetic particles and quantify the elasticity and viscosity of soft tissues, paving a way for its use in pre-clinical and clinical studies.

  9. Pre-employment screening of latent tuberculosis infection among healthcare workers using tuberculin skin test and QuantiFERON-TB Gold test at a tertiary care hospital in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Mohamed El-Helaly

    2014-11-01

    Full Text Available Summary: Objective: To assess the agreement between the tuberculin skin test (TST and the QuantiFERON-TB Gold test (QFT-G as pre-employment screening tests for latent tuberculosis infection (LTBI among healthcare workers. Methods: A retrospective cross-sectional study was conducted among 1412 healthcare workers who were screened for LTBI during the period from August 2009 to May 2011 at a tertiary-care hospital in the Kingdom of Saudi Arabia (KSA. The studied population was screened for LTBI using both TST and QFT-G simultaneously. The agreement between both tests was quantified using the Kappa coefficient (κ. Results: Comparing the results of QFT-G with TST, the tests had a significant overall agreement of 73.7% (1040/1412; κ = 0.33; p < 0.01. Negative concordance comprised 60.1% of the results, and positive concordance comprised 13.5%. However, positive TST but negative QFT comprised 16.3% of the results, and negative TST but positive QFT-G comprised 10.1%. Concordance was significantly associated with young age, female gender, Saudi-born nationals, and early career but not job type (clinical versus non-clinical nor status of Bacillus Calmette–Guerin (BCG vaccination. Conclusions: This study demonstrated 73.7% overall agreement between TST and QFT-G results among healthcare workers during pre-employment screening for LTBI. The results need to be confirmed in future studies before recommending QFT-G as a pre-employment screening test for LTBI. Keywords: Latent tuberculosis infection, Healthcare workers, Tuberculin skin test, QuantiFERON-TB Gold test

  10. Pediatric dentistry clinical education venues evaluation by pre and post-doctoral students.

    Science.gov (United States)

    Bimstein, E; Mayes, A; Mittal, Hc

    2014-01-01

    To evaluate dental students' perspectives about pre- and post-doctoral pediatric dentistry education venues. Surveys with visual analog scales (from 0 to 100) measuring the educational contribution of pediatric dentistry venues were conducted. The pre-doctoral venues included a 3rd year university twilight clinic (UTC), a 3rd year urban community based clinic (CBC) and 4th year mobile clinics (MCs). The post-doctoral venues included treatment of children under general anesthesia, oral sedations, a regular clinic (no sedations), seminars, journal club, case conferences and studding for the American Board of Pediatric Dentistry. Analyses of variance between the scores indicated that the 3rd year CBC score (68.2 ± 4.5) was statistically significant higher (p= .007) than the one for the 3rd year UTC score (44.9 ± 6.1). The 4th year students' MCs score (61.4 ± 4.0) was statistically significant higher than their retrospective scores for the 3rd year CBC (56.4 ± 4.4) or UTC (42.2 ± 4.9) scores (p= .03 and .004 respectively). Among the didactic or clinical post-doctoral venues, the regular clinic and the seminars received the highest scores (84.3 ± 1.7 and 71.6 ± 2.8 respectively). pre-doctoral community-based clinical education and post-doctoral regular university based clinic are considered by students to provide the main contribution to pediatric dental education.

  11. Maximizing the probability of satisfying the clinical goals in radiation therapy treatment planning under setup uncertainty

    International Nuclear Information System (INIS)

    Fredriksson, Albin; Hårdemark, Björn; Forsgren, Anders

    2015-01-01

    Purpose: This paper introduces a method that maximizes the probability of satisfying the clinical goals in intensity-modulated radiation therapy treatments subject to setup uncertainty. Methods: The authors perform robust optimization in which the clinical goals are constrained to be satisfied whenever the setup error falls within an uncertainty set. The shape of the uncertainty set is included as a variable in the optimization. The goal of the optimization is to modify the shape of the uncertainty set in order to maximize the probability that the setup error will fall within the modified set. Because the constraints enforce the clinical goals to be satisfied under all setup errors within the uncertainty set, this is equivalent to maximizing the probability of satisfying the clinical goals. This type of robust optimization is studied with respect to photon and proton therapy applied to a prostate case and compared to robust optimization using an a priori defined uncertainty set. Results: Slight reductions of the uncertainty sets resulted in plans that satisfied a larger number of clinical goals than optimization with respect to a priori defined uncertainty sets, both within the reduced uncertainty sets and within the a priori, nonreduced, uncertainty sets. For the prostate case, the plans taking reduced uncertainty sets into account satisfied 1.4 (photons) and 1.5 (protons) times as many clinical goals over the scenarios as the method taking a priori uncertainty sets into account. Conclusions: Reducing the uncertainty sets enabled the optimization to find better solutions with respect to the errors within the reduced as well as the nonreduced uncertainty sets and thereby achieve higher probability of satisfying the clinical goals. This shows that asking for a little less in the optimization sometimes leads to better overall plan quality

  12. The universe of ANA testing: a case for point-of-care ANA testing.

    Science.gov (United States)

    Konstantinov, Konstantin N; Rubin, Robert L

    2017-12-01

    Testing for total antinuclear antibodies (ANA) is a critical tool for diagnosis and management of autoimmune diseases at both the primary care and subspecialty settings. Repurposing of ANA from a test for lupus to a test for any autoimmune condition has driven the increase in ANA requests. Changes in ANA referral patterns include early or subclinical autoimmune disease detection in patients with low pre-test probability and use of negative ANA results to rule out underlying autoimmune disease. A positive result can lead to further diagnostic considerations. Currently, ANA tests are performed in centralized laboratories; an alternative would be ANA testing at the clinical point-of-care (POC). By virtue of its near real-time data collection capability, low cost, and ease of use, we believe the POC ANA has the potential to enable a new paradigm shift in autoimmune serology testing.

  13. An anaesthetic pre-operative assessment clinic reduces pre-operative inpatient stay in patients requiring major vascular surgery.

    LENUS (Irish Health Repository)

    O'Connor, D B

    2012-02-01

    BACKGROUND: Patients undergoing major vascular surgery (MVS) require extensive anaesthetic assessment. This can require extended pre-operative stays. AIMS: We investigated whether a newly established anaesthetic pre-operative assessment clinic (PAC) would reduce the pre-operative inpatient stay, avoid unnecessary investigations and facilitate day before surgery (DBS) admissions for patients undergoing MVS. PATIENT AND METHODS: One year following and preceding the establishment of the PAC the records of patients undergoing open or endovascular aortic aneurysm repair, carotid endarterectomy and infra-inguinal bypass were reviewed to measure pre-operative length of stay (LoS). RESULTS: Pre-operative LoS was significantly reduced in the study period (1.85 vs. 4.2 days, respectively, P < 0.0001). Only 12 out of 61 patients in 2007 were admitted on the DBS and this increased to 33 out of 63 patients (P = 0.0002). No procedure was cancelled for medical reasons. CONCLUSION: The PAC has facilitated accurate outpatient anaesthetic assessment for patients requiring MVS. The pre-operative in-patient stay has been significantly reduced.

  14. Crop size influences pre-dispersal seed predation in the Brazilian Cerrado

    Directory of Open Access Journals (Sweden)

    Alexander V. Christianini

    2017-11-01

    Full Text Available ABSTRACT Many pre-dispersal seed predators are specialized insects that rely on seeds for larval development. These insects may respond to the amount of seeds produced by a plant (i.e. crop size, increasing the proportion of seeds damaged with increases in seed numbers. Large seeds have more resources and spend more time in plants to complete their development and are probably more prone to be preyed on by those insects than small seeds. Here I tested how crop size and seed mass influence pre-dispersal seed predation in plants from the Cerrado savannas of Brazil. I related plant crop size to pre-dispersal seed predation for Xylopia aromatica and Erythroxylum pelleterianum. A literature review was performed to test if seed mass may explain among-species differences in pre-dispersal seed predation. Pre-dispersal losses increased proportionally to crop size in the two species investigated, but some species show positive or no density-dependent seed predation in literature, indicating that seed losses are not a simple function of crop sizes. Seed mass did not explain pre-dispersal seed loss differences among 14 species with data available. Pre-dispersal losses are often small and probably less important than seed dispersal and establishment limitation for plant recruitment in Cerrado savannas.

  15. Biofluid infrared spectro-diagnostics: pre-analytical considerations for clinical applications.

    Science.gov (United States)

    Lovergne, L; Bouzy, P; Untereiner, V; Garnotel, R; Baker, M J; Thiéfin, G; Sockalingum, G D

    2016-06-23

    Several proof-of-concept studies on the vibrational spectroscopy of biofluids have demonstrated that the methodology has promising potential as a clinical diagnostic tool. However, these studies also show that there is a lack of a standardised protocol in sample handling and preparation prior to spectroscopic analysis. One of the most important sources of analytical errors is the pre-analytical phase. For the technique to be translated into clinics, it is clear that a very strict protocol needs to be established for such biological samples. This study focuses on some of the aspects of the pre-analytical phase in the development of the high-throughput Fourier Transform Infrared (FTIR) spectroscopy of some of the most common biofluids such as serum, plasma and bile. Pre-analytical considerations that can impact either the samples (solvents, anti-coagulants, freeze-thaw cycles…) and/or spectroscopic analysis (sample preparation such as drying, deposit methods, volumes, substrates, operators dependence…) and consequently the quality and the reproducibility of spectral data will be discussed in this report.

  16. Pre-Clinical Medical Students' Exposure to and Attitudes Toward Pharmaceutical Industry Marketing.

    Science.gov (United States)

    Fein, Eric H; Vermillion, Michelle L; Uijtdehaage, Sebastian H J

    2007-12-01

    Background - Recent studies have examined the exposures and attitudes of physicians and third- and fourth-year medical students toward pharmaceutical industry marketing, but fewer studies have addressed these topics among pre-clinical medical students. Thus, the purpose of this study was to assess pre-clinical students' level of exposure to the pharmaceutical industry and their attitudes toward marketing. Method - First and second-year medical students at UCLA completed a 40-item survey based on previous studies. Results - Over three quarters of pre-clinical students (78.5% or 226 of 288) responded to the survey. Exposure to pharmaceutical industry marketing started very early in medical school. Most second-year students (77%) had received gifts including drug samples after three semesters. Most felt that this would not affect their future prescribing behavior. Conclusions - These findings and findings from related studies, coupled with the students' desire to learn more about the issue, suggest that an early educational intervention addressing this topic may be warranted in American medical schools.

  17. Pre-test habituation improves the reliability of a handheld test of mechanical nociceptive threshold in dairy cows

    DEFF Research Database (Denmark)

    Raundal, P. M.; Andersen, P. H.; Toft, Nils

    2015-01-01

    Mechanical nociceptive threshold (MNT) testing has been used to investigate aspects of painful states in bovine claws. We investigated a handheld tool, where the applied stimulation force was monitored continuously relative to a pre-encoded based target force. The effect on MNT of two pre-testing...... habituation procedures was performed in two different experiments comprising a total of 88 sound Holsteins dairy cows kept either inside or outside their home environment. MNT testing was performed using five consecutive mechanical nociceptive stimulations per cow per test at a fixed pre-encoded target rate...... of 2.1 N/s. The habituation procedure performed in dairy cows kept in their home environment led to lowered intra-individual coefficient of variation of MNT (P test...

  18. Online pre-race education improves test scores for volunteers at a marathon.

    Science.gov (United States)

    Maxwell, Shane; Renier, Colleen; Sikka, Robby; Widstrom, Luke; Paulson, William; Christensen, Trent; Olson, David; Nelson, Benjamin

    2017-09-01

    This study examined whether an online course would lead to increased knowledge about the medical issues volunteers encounter during a marathon. Health care professionals who volunteered to provide medical coverage for an annual marathon were eligible for the study. Demographic information about medical volunteers including profession, specialty, education level and number of marathons they had volunteered for was collected. A 15-question test about the most commonly encountered medical issues was created by the authors and administered before and after the volunteers took the online educational course and compared to a pilot study the previous year. Seventy-four subjects completed the pre-test. Those who participated in the pilot study last year (N = 15) had pre-test scores that were an average of 2.4 points higher than those who did not (mean ranks: pilot study = 51.6 vs. non-pilot = 33.9, p = 0.004). Of the 74 subjects who completed the pre-test, 54 also completed the post-test. The overall post-pre mean score difference was 3.8 ± 2.7 (t = 10.5 df = 53 p online education demonstrated a long-term (one-year) increase in test scores. Testing also continued to show short-term improvement in post-course test scores, compared to pre-course test scores. In general, marathon medical volunteers who had no volunteer experience demonstrated greater improvement than those who had prior volunteer experience.

  19. Testing for variation in taxonomic extinction probabilities: a suggested methodology and some results

    Science.gov (United States)

    Conroy, M.J.; Nichols, J.D.

    1984-01-01

    Several important questions in evolutionary biology and paleobiology involve sources of variation in extinction rates. In all cases of which we are aware, extinction rates have been estimated from data in which the probability that an observation (e.g., a fossil taxon) will occur is related both to extinction rates and to what we term encounter probabilities. Any statistical method for analyzing fossil data should at a minimum permit separate inferences on these two components. We develop a method for estimating taxonomic extinction rates from stratigraphic range data and for testing hypotheses about variability in these rates. We use this method to estimate extinction rates and to test the hypothesis of constant extinction rates for several sets of stratigraphic range data. The results of our tests support the hypothesis that extinction rates varied over the geologic time periods examined. We also present a test that can be used to identify periods of high or low extinction probabilities and provide an example using Phanerozoic invertebrate data. Extinction rates should be analyzed using stochastic models, in which it is recognized that stratigraphic samples are random varlates and that sampling is imperfect

  20. 40 CFR 90.408 - Pre-test procedures.

    Science.gov (United States)

    2010-07-01

    ....408 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED... during service accumulation is allowed only in accordance with § 90.118. (b) Engine pre-test preparation... by § 90.324(a). If necessary, allow the heated sample line, filters, and pumps to reach operating...

  1. Pre-clinical heterotopic intrathoracic heart xenotransplantation: a possibly useful clinical technique.

    Science.gov (United States)

    Abicht, Jan-Michael; Mayr, Tanja; Reichart, Bruno; Buchholz, Stefan; Werner, Fabian; Lutzmann, Isabelle; Schmoeckel, Michael; Bauer, Andreas; Thormann, Michael; Langenmayer, Martin; Herbach, Nadja; Pohla, Heike; Herzog, Rudolf; McGregor, Christopher G A; Ayares, David; Wolf, Eckhard; Klymiuk, Nikolai; Baehr, Andrea; Kind, Alexander; Hagl, Christian; Ganswindt, Ute; Belka, Claus; Guethoff, Sonja; Brenner, Paolo

    2015-01-01

    As a step towards clinical cardiac xenotransplantation, our experimental heterotopic intrathoracic xenotransplantation model offers a beating and ejecting donor heart while retaining the recipient's native organ as a backup in case of graft failure. Clinically applicable immunosuppressive regimens (IS) were investigated first, then treatments known to be effective in hypersensitized patients or those with recalcitrant rejection reactions. Consecutive experiments were carried out between 2009 and 2013. Twenty-one genetically modified pigs (GGTA1-knockout/hCD46/± thrombomodulin, in one case HLA-E instead) were used as donors. In all experiments, two cycles of immunoabsorption reduced preformed antibodies. Recipient baboons were divided into two groups according to IS regimen: In group one (n = 10), pre-treatment started either one (anti-CD20) or four weeks (anti-CD20 plus the proteasome inhibitor bortezomib) prior to transplantation. The extended conventional (as for allotransplantation) immunosuppressive maintenance regimen included anti-thymocyte globuline, tacrolimus, mycophenolate mofetil, methylprednisolone and weekly anti-CD20. In group two (n = 11), myeloablative pre-treatment as in multiple myeloma patients (long and short regimens) was added to extended conventional IS; postoperative total thoracic and abdominal lymphoid irradiation (TLI; single dose of 600 cGY) was used to further reduce antibody-producing cells. In the perioperative course, the surgical technique was safely applied: 19 baboons were weaned off extracorporeal circulation and 17 extubated. Nine animals were lost in the early postoperative course due to causes unrelated to surgical technique or IS regimen. Excluding these early failures, median graft survival times of group 1 and 2 were 18.5 (12-50) days and 16 (7-35) days. Necropsy examination of group 1 donor organs revealed hypertrophy of the left ventricular wall in the six longer-lasting grafts; myocardial histology confirmed pre-clinical

  2. The development and psychometric testing of a theory-based instrument to evaluate nurses' perception of clinical reasoning competence.

    Science.gov (United States)

    Liou, Shwu-Ru; Liu, Hsiu-Chen; Tsai, Hsiu-Min; Tsai, Ying-Huang; Lin, Yu-Ching; Chang, Chia-Hao; Cheng, Ching-Yu

    2016-03-01

    The purpose of the study was to develop and psychometrically test the Nurses Clinical Reasoning Scale. Clinical reasoning is an essential skill for providing safe and quality patient care. Identifying pre-graduates' and nurses' needs and designing training courses to improve their clinical reasoning competence becomes a critical task. However, there is no instrument focusing on clinical reasoning in the nursing profession. Cross-sectional design was used. This study included the development of the scale, a pilot study that preliminary tested the readability and reliability of the developed scale and a main study that implemented and tested the psychometric properties of the developed scale. The Nurses Clinical Reasoning Scale was developed based on the Clinical Reasoning Model. The scale includes 15 items using a Likert five-point scale. Data were collected from 2013-2014. Two hundred and fifty-one participants comprising clinical nurses and nursing pre-graduates completed and returned the questionnaires in the main study. The instrument was tested for internal consistency and test-retest reliability. Its validity was tested with content, construct and known-groups validity. One factor emerged from the factor analysis. The known-groups validity was confirmed. The Cronbach's alpha for the entire instrument was 0·9. The reliability and validity of the Nurses Clinical Reasoning Scale were supported. The scale is a useful tool and can be easily administered for the self-assessment of clinical reasoning competence of clinical nurses and future baccalaureate nursing graduates. Study limitations and further recommendations are discussed. © 2015 John Wiley & Sons Ltd.

  3. Internal Medicine residents use heuristics to estimate disease probability.

    Science.gov (United States)

    Phang, Sen Han; Ravani, Pietro; Schaefer, Jeffrey; Wright, Bruce; McLaughlin, Kevin

    2015-01-01

    Training in Bayesian reasoning may have limited impact on accuracy of probability estimates. In this study, our goal was to explore whether residents previously exposed to Bayesian reasoning use heuristics rather than Bayesian reasoning to estimate disease probabilities. We predicted that if residents use heuristics then post-test probability estimates would be increased by non-discriminating clinical features or a high anchor for a target condition. We randomized 55 Internal Medicine residents to different versions of four clinical vignettes and asked them to estimate probabilities of target conditions. We manipulated the clinical data for each vignette to be consistent with either 1) using a representative heuristic, by adding non-discriminating prototypical clinical features of the target condition, or 2) using anchoring with adjustment heuristic, by providing a high or low anchor for the target condition. When presented with additional non-discriminating data the odds of diagnosing the target condition were increased (odds ratio (OR) 2.83, 95% confidence interval [1.30, 6.15], p = 0.009). Similarly, the odds of diagnosing the target condition were increased when a high anchor preceded the vignette (OR 2.04, [1.09, 3.81], p = 0.025). Our findings suggest that despite previous exposure to the use of Bayesian reasoning, residents use heuristics, such as the representative heuristic and anchoring with adjustment, to estimate probabilities. Potential reasons for attribute substitution include the relative cognitive ease of heuristics vs. Bayesian reasoning or perhaps residents in their clinical practice use gist traces rather than precise probability estimates when diagnosing.

  4. High-resolution mutational profiling suggests the genetic validity of glioblastoma patient-derived pre-clinical models.

    Directory of Open Access Journals (Sweden)

    Shawn E Yost

    Full Text Available Recent advances in the ability to efficiently characterize tumor genomes is enabling targeted drug development, which requires rigorous biomarker-based patient selection to increase effectiveness. Consequently, representative DNA biomarkers become equally important in pre-clinical studies. However, it is still unclear how well these markers are maintained between the primary tumor and the patient-derived tumor models. Here, we report the comprehensive identification of somatic coding mutations and copy number aberrations in four glioblastoma (GBM primary tumors and their matched pre-clinical models: serum-free neurospheres, adherent cell cultures, and mouse xenografts. We developed innovative methods to improve the data quality and allow a strict comparison of matched tumor samples. Our analysis identifies known GBM mutations altering PTEN and TP53 genes, and new actionable mutations such as the loss of PIK3R1, and reveals clear patient-to-patient differences. In contrast, for each patient, we do not observe any significant remodeling of the mutational profile between primary to model tumors and the few discrepancies can be attributed to stochastic errors or differences in sample purity. Similarly, we observe ∼96% primary-to-model concordance in copy number calls in the high-cellularity samples. In contrast to previous reports based on gene expression profiles, we do not observe significant differences at the DNA level between in vitro compared to in vivo models. This study suggests, at a remarkable resolution, the genome-wide conservation of a patient's tumor genetics in various pre-clinical models, and therefore supports their use for the development and testing of personalized targeted therapies.

  5. Clinical, neuropsychological, and pre-stimulus dorsomedial thalamic nucleus electrophysiological data in deep brain stimulation patients

    Directory of Open Access Journals (Sweden)

    Catherine M. Sweeney-Reed

    2016-09-01

    Full Text Available The data presented here comprise clinical, neuropsychological, and intrathalamic electrophysiological data from 7 patients with pharmacoresistant focal epilepsy and are related to the article “Pre-stimulus thalamic theta power predicts human memory formation” C.M. Sweeney-Reed, T. Zaehle, J. Voges, F.C. Schmitt, L. Buentjen, K. Kopitzki, et al. (2016 [1]. The patients participated in a memory paradigm after receiving electrodes implanted in the DMTN due to the surgical approach taken in electrode insertion for deep brain stimulation of the anterior thalamic nucleus. Epilepsy duration and pre-operative neuropsychological tests provide an indication of the profile of patients receiving intrathalamic electrode implantation and the memory capabilities in such a patient group. The electrophysiological data were recorded from the right DMTN preceding stimulus presentation during intentional memory encoding. The patients viewed a series of photographic scenes, which they judged as indoors or outdoors. The 900 ms epochs prior to stimulus presentation were labeled as preceding successful or unsuccessful subsequent memory formation according to a subsequent memory test for the items. The difference between theta power preceding successful versus unsuccessful subsequent memory formation is shown against time for each patient individually. Keywords: Memory encoding, Dorsomedial thalamic nucleus, Pre-stimulus theta

  6. 40 CFR 91.408 - Pre-test procedures.

    Science.gov (United States)

    2010-07-01

    ....408 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED... accordance with § 91.117. (b) Engine pre-test preparation. (1) Drain and charge the fuel tank(s) with the..., including the sample probe, using mode 1 from Table 2 in appendix A of this subpart. The emission sampling...

  7. Choreographer Pre-Testing Code Analysis and Operational Testing.

    Energy Technology Data Exchange (ETDEWEB)

    Fritz, David J. [Sandia National Laboratories (SNL-CA), Livermore, CA (United States); Harrison, Christopher B. [Sandia National Laboratories (SNL-CA), Livermore, CA (United States); Perr, C. W. [Sandia National Laboratories (SNL-CA), Livermore, CA (United States); Hurd, Steven A [Sandia National Laboratories (SNL-CA), Livermore, CA (United States)

    2014-07-01

    Choreographer is a "moving target defense system", designed to protect against attacks aimed at IP addresses without corresponding domain name system (DNS) lookups. It coordinates actions between a DNS server and a Network Address Translation (NAT) device to regularly change which publicly available IP addresses' traffic will be routed to the protected device versus routed to a honeypot. More details about how Choreographer operates can be found in Section 2: Introducing Choreographer. Operational considerations for the successful deployment of Choreographer can be found in Section 3. The Testing & Evaluation (T&E) for Choreographer involved 3 phases: Pre-testing, Code Analysis, and Operational Testing. Pre-testing, described in Section 4, involved installing and configuring an instance of Choreographer and verifying it would operate as expected for a simple use case. Our findings were that it was simple and straightforward to prepare a system for a Choreographer installation as well as configure Choreographer to work in a representative environment. Code Analysis, described in Section 5, consisted of running a static code analyzer (HP Fortify) and conducting dynamic analysis tests using the Valgrind instrumentation framework. Choreographer performed well, such that only a few errors that might possibly be problematic in a given operating situation were identified. Operational Testing, described in Section 6, involved operating Choreographer in a representative environment created through EmulyticsTM . Depending upon the amount of server resources dedicated to Choreographer vis-á-vis the amount of client traffic handled, Choreographer had varying degrees of operational success. In an environment with a poorly resourced Choreographer server and as few as 50-100 clients, Choreographer failed to properly route traffic over half the time. Yet, with a well-resourced server, Choreographer handled over 1000 clients without missrouting. Choreographer

  8. Can education improve clinical practice concerning delirium in older hospitalised patients? Results of a pre-test post-test study on an educational intervention for nursing staff.

    Science.gov (United States)

    van Velthuijsen, Eveline L; Zwakhalen, Sandra M G; Warnier, Ron M J; Ambergen, Ton; Mulder, Wubbo J; Verhey, Frans R J; Kempen, Gertrudis I J M

    2018-04-02

    Delirium is a common and serious complication of hospitalisation in older adults. It can lead to prolonged hospital stay, institutionalisation, and even death. However, it often remains unrecognised or is not managed adequately. The aim of this study was to evaluate the effects of an educational intervention for nursing staff on three aspects of clinical practice concerning delirium in older hospitalised patients: the frequency and correctness of screening for delirium using the 13-item Delirium Observation Screening score (DOS), and the frequency of geriatric consultations requested for older patients. The a priori expectations were that there would be an increase in all three of these outcomes. We designed an educational intervention and implemented this on two inpatient hospital units. Before providing the educational session, the nursing staff was asked to fill out two questionnaires about delirium in older hospitalised patients. The educational session was then tailored to each unit based on the results of these questionnaires. Additionally, posters and flyers with information on the screening and management of delirium were provided and participants were shown where to find additional information. Relevant data (outcomes, demographics and background patient data) were collected retrospectively from digital medical files. Data was retrospectively collected for four different time points: three pre-test and one post-test. There was a significant increase in frequency of delirium screening (P = 0.001), and both units showed an increase in the correctness of the screening. No significant effect of the educational intervention was found for the proportion of patients who received a geriatric consultation (P = 0.083). The educational intervention was fairly successful in making positive changes in clinical practice: after the educational session an improvement in the frequency and correctness of screening for delirium was observed. A trend, though not

  9. A well test analysis method accounting for pre-test operations

    International Nuclear Information System (INIS)

    Silin, D.B.; Tsang, C.-F.

    2003-01-01

    We propose to use regular monitoring data from a production or injection well for estimating the formation hydraulic properties in the vicinity of the wellbore without interrupting the operations. In our approach, we select a portion of the pumping data over a certain time interval and then derive our conclusions from analysis of these data. A distinctive feature of the proposed approach differing it form conventional methods is in the introduction of an additional parameter, an effective pre-test pumping rate. The additional parameter is derived based on a rigorous asymptotic analysis of the flow model. Thus, we account for the non-uniform pressure distribution at the beginning of testing time interval caused by pre-test operations at the well. By synthetic and field examples, we demonstrate that deviation of the matching curve from the data that is usually attributed to skin and wellbore storage effects, can also be interpreted through this new parameter. Moreover, with our method, the data curve is matched equally well and the results of the analysis remain stable when the analyzed data interval is perturbed, whereas traditional methods are sensitive to the choice of the data interval. A special efficient minimization procedure has been developed for searching the best fitting parameters. We enhanced our analysis above with a procedure of estimating ambient reservoir pressure and dimensionless wellbore radius. The methods reported here have been implemented in code ODA (Operations Data Analysis). A beta version of the code is available for free testing and evaluation to interested parties

  10. Role of Assessment Tests in the Stability of Intelligence Scoring of Pre-School Children with Uneven/Delayed Cognitive Profile

    Science.gov (United States)

    Yang, P.; Jong, Y-J.; Hsu, H-Y.; Lung, F-W.

    2011-01-01

    Background: As part of an ongoing clinical service programme for pre-school children with developmental delay in an Asian developing country, we analysed the effect of three assessment tests, that is, Bayley Scale of Infant Development-II, Leiter International Performance Scale-Revised and Wechsler Preschool and Primary Scale of…

  11. Statistical tests for whether a given set of independent, identically distributed draws comes from a specified probability density.

    Science.gov (United States)

    Tygert, Mark

    2010-09-21

    We discuss several tests for determining whether a given set of independent and identically distributed (i.i.d.) draws does not come from a specified probability density function. The most commonly used are Kolmogorov-Smirnov tests, particularly Kuiper's variant, which focus on discrepancies between the cumulative distribution function for the specified probability density and the empirical cumulative distribution function for the given set of i.i.d. draws. Unfortunately, variations in the probability density function often get smoothed over in the cumulative distribution function, making it difficult to detect discrepancies in regions where the probability density is small in comparison with its values in surrounding regions. We discuss tests without this deficiency, complementing the classical methods. The tests of the present paper are based on the plain fact that it is unlikely to draw a random number whose probability is small, provided that the draw is taken from the same distribution used in calculating the probability (thus, if we draw a random number whose probability is small, then we can be confident that we did not draw the number from the same distribution used in calculating the probability).

  12. Pre-Clinical Tests of an Integrated CMOS Biomolecular Sensor for Cardiac Diseases Diagnosis.

    Science.gov (United States)

    Lee, Jen-Kuang; Wang, I-Shun; Huang, Chi-Hsien; Chen, Yih-Fan; Huang, Nien-Tsu; Lin, Chih-Ting

    2017-11-26

    Coronary artery disease and its related complications pose great threats to human health. In this work, we aim to clinically evaluate a CMOS field-effect biomolecular sensor for cardiac biomarkers, cardiac-specific troponin-I (cTnI), N -terminal prohormone brain natriuretic peptide (NT-proBNP), and interleukin-6 (IL-6). The CMOS biosensor is implemented via a standard commercialized 0.35 μm CMOS process. To validate the sensing characteristics, in buffer conditions, the developed CMOS biosensor has identified the detection limits of IL-6, cTnI, and NT-proBNP as being 45 pM, 32 pM, and 32 pM, respectively. In clinical serum conditions, furthermore, the developed CMOS biosensor performs a good correlation with an enzyme-linked immuno-sorbent assay (ELISA) obtained from a hospital central laboratory. Based on this work, the CMOS field-effect biosensor poses good potential for accomplishing the needs of a point-of-care testing (POCT) system for heart disease diagnosis.

  13. Review of Pre-Analytical Errors in Oral Glucose Tolerance Testing in a Tertiary Care Hospital.

    Science.gov (United States)

    Nanda, Rachita; Patel, Suprava; Sahoo, Sibashish; Mohapatra, Eli

    2018-03-13

    The pre-pre-analytical and pre-analytical phases form a major chunk of the errors in a laboratory. The process has taken into consideration a very common procedure which is the oral glucose tolerance test to identify the pre-pre-analytical errors. Quality indicators provide evidence of quality, support accountability and help in the decision making of laboratory personnel. The aim of this research is to evaluate pre-analytical performance of the oral glucose tolerance test procedure. An observational study that was conducted overa period of three months, in the phlebotomy and accessioning unit of our laboratory using questionnaire that examined the pre-pre-analytical errors through a scoring system. The pre-analytical phase was analyzed for each sample collected as per seven quality indicators. About 25% of the population gave wrong answer with regard to the question that tested the knowledge of patient preparation. The appropriateness of test result QI-1 had the most error. Although QI-5 for sample collection had a low error rate, it is a very important indicator as any wrongly collected sample can alter the test result. Evaluating the pre-analytical and pre-pre-analytical phase is essential and must be conducted routinely on a yearly basis to identify errors and take corrective action and to facilitate their gradual introduction into routine practice.

  14. A Cryogenic Test Set-Up for the Qualification of Pre-Series Test Cells for the LHC Cryogenic Distribution Line

    CERN Document Server

    Livran, J; Parente, C; Riddone, G; Rybkowski, D; Veillet, N

    2000-01-01

    Three pre-series Test Cells of the LHC Cryogenic Distribution Line (QRL) [1], manufactured by three European industrial companies, will be tested in the year 2000 to qualify the design chosen and verify the thermal and mechanical performances. A dedicated test stand (170 m x 13 m) has been built for extensive testing and performance assessment of the pre-series units in parallel. They will be fed with saturated liquid helium at 4.2 K supplied by a mobile helium dewar. In addition, LN2 cooled helium will be used for cool-down and thermal shielding. For each of the three pre-series units, a set of end boxes has been designed and manufactured at CERN. This paper presents the layout of the cryogenic system for the pre-series units, the calorimetric methods as well as the results of the thermal calculation of the end box test.

  15. Immunotherapy in new pre-clinical models of HPV-associated oral cancers.

    Science.gov (United States)

    Paolini, Francesca; Massa, Silvia; Manni, Isabella; Franconi, Rosella; Venuti, Aldo

    2013-03-01

    Cervical, anal, penile and a sub-set of head and neck (HN) tumors are critical health problems caused by high risk Human Papilloma Viruses (HPVs), like HPV type 16. No specific/effective pharmacological treatments exist. A valid preventive vaccination as well as the immunotherapy of persistent infections, pre-cancerous lesions or early-stage cancers could drive the HPV disease burden down. These treatments might be featured through low-cost platforms like those based on DNA and plant biotechnologies to produce tailored and enhanced formulations taking profit from the use of plants as bio-factories and as a source of immune-stimulators. Finally, and regardless of the formulation type, pre-clinical tests and models are crucial to foresee efficacy of immunotherapy before clinical trials.   In this study, we created an orthotopic mouse model for HPV-related oral tumors, a subset of HN tumors for which no models have been generated before. The model was obtained by inducing the stable expression of the HPV16 E7 protein into the mouse oral squamous cell carcinoma (OSCC) AT-84 (AT-84 E7). The AT-84 E7 cells were injected into the mouth pavement of C3H mice via an extra-oral route to obtain orthotopic tumors. The model turned out to mimic the natural history of the human HPV oral cancer. From AT-84 E7, through engineering to express luciferase, the bioluminescent AT-84 E7-Luc cells were obtained for a fast and easy monitoring by imaging. The AT-84 E7 and the AT-84 E7-Luc tumors were used to test the efficacy of E7-based therapeutic vaccines that we had previously generated and that had been already proven to be active in mice against non-orthotopic E7-expressing tumors (TC-1 cells). In particular, we used genetic and plant-derived formulations based on attenuated HPV16 E7 variants either fused to plant virus genes with immunological activity or produced by tobacco plants. Mice were monitored by imaging allowing to test the size reduction of the mouth implanted

  16. Planning and pre-testing: the key to effective AIDS education materials.

    Science.gov (United States)

    Ostfield, M L; Romocki, L S

    1991-06-01

    The steps in designing and producing effective AIDS prevention educational materials are outlines, using as an example a brochure originated in St. Lucia for clients at STD clinics. The brochure was intended to be read by clients as they waited for their consultation, thus it was targeted to a specific audience delimited by age, sex, language, educational level, religion and associated medical or behavioral characteristics. When researching the audience, it is necessary to learn the medium they best respond to, what they know already, what is their present behavior, how they talk about AIDS, what terms they use, how they perceive the benefits of AIDS prevention behavior, what sources of information they trust. The minimum number of key messages should be selected. Next the most appropriate channel of communication is identified. Mass media are not always best for a target audience, "little media" such as flyers and give-always may be better. The draft is then pre-tested by focus groups and interviews, querying about the text separately, then images, color, format, style. Listen to the way the respondents talk about the draft. Modify the draft and pre-test again. Fine-tune implications of the message for realism in emotional responses, respect, self-esteem, admiration and trust. To achieve wide distribution it is a good idea to involve community leaders to production of the materials, so they will be more likely to take part in the distribution process.

  17. Pre-clinical research in small animals using radiotherapy technology. A bidirectional translational approach

    International Nuclear Information System (INIS)

    Tillner, Falk; Buetof, Rebecca; Krause, Mechthild; Enghardt, Wolfgang; Helmholtz-Zentrum Dresden-Rossendorf, Dresden; Technische Univ. Dresden; Helmholtz-Zentrum Dresden-Rossendorf, Dresden

    2014-01-01

    For translational cancer research, pre-clinical in-vivo studies using small animals have become indispensable in bridging the gap between in-vitro cell experiments and clinical implementation. When setting up such small animal experiments, various biological, technical and methodical aspects have to be considered. In this work we present a comprehensive topical review based on relevant publications on irradiation techniques used for pre-clinical cancer research in mice and rats. Clinical radiotherapy treatment devices for the application of external beam radiotherapy and brachytherapy as well as dedicated research irradiation devices are feasible for small animal irradiation depending on the animal model and the experimental goals. In this work, appropriate solutions for the technological transfer of human radiation oncology to small animal radiation research are summarised. Additionally, important information concerning the experimental design is provided such that reliable and clinically relevant results can be attained.

  18. Tendinopathies and platelet-rich plasma (PRP: from pre-clinical experiments to therapeutic use

    Directory of Open Access Journals (Sweden)

    Kaux JF

    2015-05-01

    Full Text Available Objectives: The restorative properties of platelets, through the local release of growth factors, are used in various medical areas. This article reviews fundamental and clinical research relating to platelet-rich plasma applied to tendinous lesions. Materials and method: Articles in French and English, published between 1 January 2012 and 31 December 2014. dealing with PRP and tendons were searched for using the Medline and Scopus data bases. Results: Forty-seven articles were identified which addressed pre-clinical and clinical studies: 27 relating to in vitro and in vivo animal studies and 20 relating to human studies. Of these, five addressed lateral epicondylitis, two addressed rotator cuff tendinopathies, ten dealt with patellar tendinopathies and three looked at Achilles tendinopathies. Conclusions: The majority of pre-clinical studies show that PRP stimulates the tendon's healing process. However, clinical series remain more controversial and level 1, controlled, randomised studies are still needed.

  19. Pre-clinical research in small animals using radiotherapy technology. A bidirectional translational approach

    Energy Technology Data Exchange (ETDEWEB)

    Tillner, Falk; Buetof, Rebecca [Technische Univ. Dresden (Germany). OncoRay - National Center for Radiation Research in Oncology; Helmholtz-Zentrum Dresden-Rossendorf, Dresden (Germany); Technische Univ. Dresden (Germany). Dept. of Radiation Oncology; Thute, Prasad [Technische Univ. Dresden (Germany). OncoRay - National Center for Radiation Research in Oncology; Helmholtz-Zentrum Dresden-Rossendorf, Dresden (Germany); Krause, Mechthild [Technische Univ. Dresden (Germany). OncoRay - National Center for Radiation Research in Oncology; Helmholtz-Zentrum Dresden-Rossendorf, Dresden (Germany); Technische Univ. Dresden (Germany). Dept. of Radiation Oncology; German Cancer Consortium (DKTK), Dresden (Germany); German Cancer Research Center (DKFZ), Heidelberg (Germany); Enghardt, Wolfgang [Technische Univ. Dresden (Germany). OncoRay - National Center for Radiation Research in Oncology; Helmholtz-Zentrum Dresden-Rossendorf, Dresden (Germany); Technische Univ. Dresden (Germany). Dept. of Radiation Oncology; Helmholtz-Zentrum Dresden-Rossendorf, Dresden (Germany). Inst. of Radiooncology

    2014-07-01

    For translational cancer research, pre-clinical in-vivo studies using small animals have become indispensable in bridging the gap between in-vitro cell experiments and clinical implementation. When setting up such small animal experiments, various biological, technical and methodical aspects have to be considered. In this work we present a comprehensive topical review based on relevant publications on irradiation techniques used for pre-clinical cancer research in mice and rats. Clinical radiotherapy treatment devices for the application of external beam radiotherapy and brachytherapy as well as dedicated research irradiation devices are feasible for small animal irradiation depending on the animal model and the experimental goals. In this work, appropriate solutions for the technological transfer of human radiation oncology to small animal radiation research are summarised. Additionally, important information concerning the experimental design is provided such that reliable and clinically relevant results can be attained.

  20. Prediction of pre-eclampsia: a protocol for systematic reviews of test accuracy

    Directory of Open Access Journals (Sweden)

    Khan Khalid S

    2006-10-01

    Full Text Available Abstract Background Pre-eclampsia, a syndrome of hypertension and proteinuria, is a major cause of maternal and perinatal morbidity and mortality. Accurate prediction of pre-eclampsia is important, since high risk women could benefit from intensive monitoring and preventive treatment. However, decision making is currently hampered due to lack of precise and up to date comprehensive evidence summaries on estimates of risk of developing pre-eclampsia. Methods/Design A series of systematic reviews and meta-analyses will be undertaken to determine, among women in early pregnancy, the accuracy of various tests (history, examinations and investigations for predicting pre-eclampsia. We will search Medline, Embase, Cochrane Library, MEDION, citation lists of review articles and eligible primary articles and will contact experts in the field. Reviewers working independently will select studies, extract data, and assess study validity according to established criteria. Language restrictions will not be applied. Bivariate meta-analysis of sensitivity and specificity will be considered for tests whose studies allow generation of 2 × 2 tables. Discussion The results of the test accuracy reviews will be integrated with results of effectiveness reviews of preventive interventions to assess the impact of test-intervention combinations for prevention of pre-eclampsia.

  1. A comprehensive combined experimental and computational framework for pre-clinical wear simulation of total knee replacements.

    Science.gov (United States)

    Abdelgaied, A; Fisher, J; Jennings, L M

    2018-02-01

    A more robust pre-clinical wear simulation framework is required in order to simulate wider and higher ranges of activities, observed in different patient populations such as younger more active patients. Such a framework will help to understand and address the reported higher failure rates for younger and more active patients (National_Joint_Registry, 2016). The current study has developed and validated a comprehensive combined experimental and computational framework for pre-clinical wear simulation of total knee replacements (TKR). The input mechanical (elastic modulus and Poisson's ratio) and wear parameters of the moderately cross-linked ultra-high molecular weight polyethylene (UHMWPE) bearing material were independently measured from experimental studies under realistic test conditions, similar to the loading conditions found in the total knee replacements. The wear predictions from the computational wear simulation were validated against the direct experimental wear measurements for size 3 Sigma curved total knee replacements (DePuy, UK) in an independent experimental wear simulation study under three different daily activities; walking, deep squat, and stairs ascending kinematic conditions. The measured compressive mechanical properties of the moderately cross-linked UHMWPE material were more than 20% lower than that reported in the literature under tensile test conditions. The pin-on-plate wear coefficient of moderately cross-linked UHMWPE was significantly dependant of the contact stress and the degree of cross-shear at the articulating surfaces. The computational wear predictions for the TKR from the current framework were consistent and in a good agreement with the independent full TKR experimental wear simulation measurements, with 0.94 coefficient of determination of the framework. In addition, the comprehensive combined experimental and computational framework was able to explain the complex experimental wear trends from the three different daily

  2. Pre-clinical research in small animals using radiotherapy technology--a bidirectional translational approach.

    Science.gov (United States)

    Tillner, Falk; Thute, Prasad; Bütof, Rebecca; Krause, Mechthild; Enghardt, Wolfgang

    2014-12-01

    For translational cancer research, pre-clinical in-vivo studies using small animals have become indispensable in bridging the gap between in-vitro cell experiments and clinical implementation. When setting up such small animal experiments, various biological, technical and methodical aspects have to be considered. In this work we present a comprehensive topical review based on relevant publications on irradiation techniques used for pre-clinical cancer research in mice and rats. Clinical radiotherapy treatment devices for the application of external beam radiotherapy and brachytherapy as well as dedicated research irradiation devices are feasible for small animal irradiation depending on the animal model and the experimental goals. In this work, appropriate solutions for the technological transfer of human radiation oncology to small animal radiation research are summarised. Additionally, important information concerning the experimental design is provided such that reliable and clinically relevant results can be attained. Copyright © 2014. Published by Elsevier GmbH.

  3. Comparative analysis of three drug-drug interaction screening systems against probable clinically relevant drug-drug interactions: a prospective cohort study.

    Science.gov (United States)

    Muhič, Neža; Mrhar, Ales; Brvar, Miran

    2017-07-01

    Drug-drug interaction (DDI) screening systems report potential DDIs. This study aimed to find the prevalence of probable DDI-related adverse drug reactions (ADRs) and compare the clinical usefulness of different DDI screening systems to prevent or warn against these ADRs. A prospective cohort study was conducted in patients urgently admitted to medical departments. Potential DDIs were checked using Complete Drug Interaction®, Lexicomp® Online™, and Drug Interaction Checker®. The study team identified the patients with probable clinically relevant DDI-related ADRs on admission, the causality of which was assessed using the Drug Interaction Probability Scale (DIPS). Sensitivity, specificity, and positive and negative predictive values of screening systems to prevent or warn against probable DDI-related ADRs were evaluated. Overall, 50 probable clinically relevant DDI-related ADRs were found in 37 out of 795 included patients taking at least two drugs, most common of them were bleeding, hyperkalemia, digitalis toxicity, and hypotension. Complete Drug Interaction showed the best sensitivity (0.76) for actual DDI-related ADRs, followed by Lexicomp Online (0.50), and Drug Interaction Checker (0.40). Complete Drug Interaction and Drug Interaction Checker had positive predictive values of 0.07; Lexicomp Online had 0.04. We found no difference in specificity and negative predictive values among these systems. DDI screening systems differ significantly in their ability to detect probable clinically relevant DDI-related ADRs in terms of sensitivity and positive predictive value.

  4. Classification-based comparison of pre-processing methods for interpretation of mass spectrometry generated clinical datasets

    Directory of Open Access Journals (Sweden)

    Hoefsloot Huub CJ

    2009-05-01

    Full Text Available Abstract Background Mass spectrometry is increasingly being used to discover proteins or protein profiles associated with disease. Experimental design of mass-spectrometry studies has come under close scrutiny and the importance of strict protocols for sample collection is now understood. However, the question of how best to process the large quantities of data generated is still unanswered. Main challenges for the analysis are the choice of proper pre-processing and classification methods. While these two issues have been investigated in isolation, we propose to use the classification of patient samples as a clinically relevant benchmark for the evaluation of pre-processing methods. Results Two in-house generated clinical SELDI-TOF MS datasets are used in this study as an example of high throughput mass-spectrometry data. We perform a systematic comparison of two commonly used pre-processing methods as implemented in Ciphergen ProteinChip Software and in the Cromwell package. With respect to reproducibility, Ciphergen and Cromwell pre-processing are largely comparable. We find that the overlap between peaks detected by either Ciphergen ProteinChip Software or Cromwell is large. This is especially the case for the more stringent peak detection settings. Moreover, similarity of the estimated intensities between matched peaks is high. We evaluate the pre-processing methods using five different classification methods. Classification is done in a double cross-validation protocol using repeated random sampling to obtain an unbiased estimate of classification accuracy. No pre-processing method significantly outperforms the other for all peak detection settings evaluated. Conclusion We use classification of patient samples as a clinically relevant benchmark for the evaluation of pre-processing methods. Both pre-processing methods lead to similar classification results on an ovarian cancer and a Gaucher disease dataset. However, the settings for pre

  5. Cognitive Laboratory Experiences : On Pre-testing Computerised Questionnaires

    NARCIS (Netherlands)

    Snijkers, G.J.M.E.

    2002-01-01

    In the literature on questionnaire design and survey methodology, pre-testing is mentioned as a way to evaluate questionnaires (i.e. investigate whether they work as intended) and control for measurement errors (i.e. assess data quality). As the American Statistical Association puts it (ASA, 1999,

  6. Targeting as the basis for pre-test market of lithium-ion battery

    Science.gov (United States)

    Yuniaristanto, Zakaria, R.; Saputri, V. H. L.; Sutopo, W.; Kadir, E. A.

    2017-11-01

    This article discusses about market segmentation and targeting as a first step in pre-test market of a new technology. The benefits of targeting towards pre-test market are pre-test market can be conducted to focus on selected target markets so there is no bias during the pre-test market. In determining the target market then do some surveys to identify the state of market in the future, so that the marketing process is not misplaced. Lithium ion battery which is commercialized through start-up companies is the case study. This start-up companies must be able to respond the changes and bring in customers as well as maintain them so that companies can survive and evolve to achieve its objectives. The research aims to determine market segments and target market effectively. Marketing strategy (segmentation and targeting) is used to make questionnaire and cluster analysis in data processing. Respondents were selected by purposive sampling and have obtained data as many as 80 samples. As the results study, there are three segments for lithium ion battery with their own distinguished characteristics and there are two segments that can be used as the target market for the company.

  7. Salmonella testing of pooled pre-enrichment broth cultures for screening multiple food samples.

    Science.gov (United States)

    Price, W R; Olsen, R A; Hunter, J E

    1972-04-01

    A method has been described for testing multiple food samples for Salmonella without loss in sensitivity. The method pools multiple pre-enrichment broth cultures into single enrichment broths. The subsequent stages of the Salmonella analysis are not altered. The method was found applicable to several dry food materials including nonfat dry milk, dried egg albumin, cocoa, cottonseed flour, wheat flour, and shredded coconut. As many as 25 pre-enrichment broth cultures were pooled without apparent loss in the sensitivity of Salmonella detection as compared to individual sample analysis. The procedure offers a simple, yet effective, way to increase sample capacity in the Salmonella testing of foods, particularly where a large proportion of samples ordinarily is negative. It also permits small portions of pre-enrichment broth cultures to be retained for subsequent individual analysis if positive tests are found. Salmonella testing of pooled pre-enrichment broths provides increased consumer protection for a given amount of analytical effort as compared to individual sample analysis.

  8. Providing probability distributions for the causal pathogen of clinical mastitis using naive Bayesian networks

    NARCIS (Netherlands)

    Steeneveld, W.; Gaag, van der L.C.; Barkema, H.W.; Hogeveen, H.

    2009-01-01

    Clinical mastitis (CM) can be caused by a wide variety of pathogens and farmers must start treatment before the actual causal pathogen is known. By providing a probability distribution for the causal pathogen, naive Bayesian networks (NBN) can serve as a management tool for farmers to decide which

  9. Pre- and post-test analyses of a KKL turbine trip test at 109% power using RETRAN-3D

    Energy Technology Data Exchange (ETDEWEB)

    Coddington, P

    2001-03-01

    As part of the PSI/HSK STARS project, pre-test calculations have been performed for a KKL turbine trip test at 109% power using the RETRAN-3D code. In this paper, we first present the results of these calculations, together with a description of the test and a comparison of the results with the measured plant data, and then discuss in more detail the differences between the pre-test results and the plant measurements, including the differences in the initial and boundary conditions, and how these differences influenced the calculated results. Finally, we comment on a series of post-test and sensitivity analyses, which were performed to resolve some of the discrepancies. The results of the pre-test (blind) calculations show good overall agreement with the experimental data, particularly for the maximum in the steam-line mass flow rate following the opening of the turbine bypass valves. This is of critical importance, since the steam-line flow has the least margin to the reactor scram limit. The agreement is especially good since the control rod banks used for the selected rod insertion were changed from those given in the test specification. Following a review of the comparison of the pre-test calculations with the measured data, several deficiencies in the RETRAN-3D model for KKL were identified and corrected as part of the post-test analysis. This allowed for both an improvement in the calculated results, and a deeper understanding of the behaviour of the turbine trip transient. (author)

  10. Pre- and post-test analyses of a KKL turbine trip test at 109% power using RETRAN-3D

    International Nuclear Information System (INIS)

    Coddington, P.

    2001-01-01

    As part of the PSI/HSK STARS project, pre-test calculations have been performed for a KKL turbine trip test at 109% power using the RETRAN-3D code. In this paper, we first present the results of these calculations, together with a description of the test and a comparison of the results with the measured plant data, and then discuss in more detail the differences between the pre-test results and the plant measurements, including the differences in the initial and boundary conditions, and how these differences influenced the calculated results. Finally, we comment on a series of post-test and sensitivity analyses, which were performed to resolve some of the discrepancies. The results of the pre-test (blind) calculations show good overall agreement with the experimental data, particularly for the maximum in the steam-line mass flow rate following the opening of the turbine bypass valves. This is of critical importance, since the steam-line flow has the least margin to the reactor scram limit. The agreement is especially good since the control rod banks used for the selected rod insertion were changed from those given in the test specification. Following a review of the comparison of the pre-test calculations with the measured data, several deficiencies in the RETRAN-3D model for KKL were identified and corrected as part of the post-test analysis. This allowed for both an improvement in the calculated results, and a deeper understanding of the behaviour of the turbine trip transient. (author)

  11. Pre-clinical MR elastography: Principles, techniques, and applications

    Science.gov (United States)

    Bayly, P. V.; Garbow, J. R.

    2018-06-01

    Magnetic resonance elastography (MRE) is a method for measuring the mechanical properties of soft tissue in vivo, non-invasively, by imaging propagating shear waves in the tissue. The speed and attenuation of waves depends on the elastic and dissipative properties of the underlying material. Tissue mechanical properties are essential for biomechanical models and simulations, and may serve as markers of disease, injury, development, or recovery. MRE is already established as a clinical technique for detecting and characterizing liver disease. The potential of MRE for diagnosing or characterizing disease in other organs, including brain, breast, and heart is an active research area. Studies involving MRE in the pre-clinical setting, in phantoms and artificial biomaterials, in the mouse, and in other mammals, are critical to the development of MRE as a robust, reliable, and useful modality.

  12. Decisions under risk in Parkinson's disease: preserved evaluation of probability and magnitude.

    Science.gov (United States)

    Sharp, Madeleine E; Viswanathan, Jayalakshmi; McKeown, Martin J; Appel-Cresswell, Silke; Stoessl, A Jon; Barton, Jason J S

    2013-11-01

    Unmedicated Parkinson's disease patients tend to be risk-averse while dopaminergic treatment causes a tendency to take risks. While dopamine agonists may result in clinically apparent impulse control disorders, treatment with levodopa also causes shift in behaviour associated with an enhanced response to rewards. Two important determinants in decision-making are how subjects perceive the magnitude and probability of outcomes. Our objective was to determine if patients with Parkinson's disease on or off levodopa showed differences in their perception of value when making decisions under risk. The Vancouver Gambling task presents subjects with a choice between one prospect with larger outcome and a second with higher probability. Eighteen age-matched controls and eighteen patients with Parkinson's disease before and after levodopa were tested. In the Gain Phase subjects chose between one prospect with higher probability and another with larger reward to maximize their gains. In the Loss Phase, subjects played to minimize their losses. Patients with Parkinson's disease, on or off levodopa, were similar to controls when evaluating gains. However, in the Loss Phase before levodopa, they were more likely to avoid the prospect with lower probability but larger loss, as indicated by the steeper slope of their group psychometric function (t(24) = 2.21, p = 0.04). Modelling with prospect theory suggested that this was attributable to a 28% overestimation of the magnitude of loss, rather than an altered perception of its probability. While pre-medicated patients with Parkinson's disease show risk-aversion for large losses, patients on levodopa have normal perception of magnitude and probability for both loss and gain. The finding of accurate and normally biased decisions under risk in medicated patients with PD is important because it indicates that, if there is indeed anomalous risk-seeking behaviour in such a cohort, it may derive from abnormalities in components of

  13. Estimation and prediction of maximum daily rainfall at Sagar Island using best fit probability models

    Science.gov (United States)

    Mandal, S.; Choudhury, B. U.

    2015-07-01

    Sagar Island, setting on the continental shelf of Bay of Bengal, is one of the most vulnerable deltas to the occurrence of extreme rainfall-driven climatic hazards. Information on probability of occurrence of maximum daily rainfall will be useful in devising risk management for sustaining rainfed agrarian economy vis-a-vis food and livelihood security. Using six probability distribution models and long-term (1982-2010) daily rainfall data, we studied the probability of occurrence of annual, seasonal and monthly maximum daily rainfall (MDR) in the island. To select the best fit distribution models for annual, seasonal and monthly time series based on maximum rank with minimum value of test statistics, three statistical goodness of fit tests, viz. Kolmogorove-Smirnov test (K-S), Anderson Darling test ( A 2 ) and Chi-Square test ( X 2) were employed. The fourth probability distribution was identified from the highest overall score obtained from the three goodness of fit tests. Results revealed that normal probability distribution was best fitted for annual, post-monsoon and summer seasons MDR, while Lognormal, Weibull and Pearson 5 were best fitted for pre-monsoon, monsoon and winter seasons, respectively. The estimated annual MDR were 50, 69, 86, 106 and 114 mm for return periods of 2, 5, 10, 20 and 25 years, respectively. The probability of getting an annual MDR of >50, >100, >150, >200 and >250 mm were estimated as 99, 85, 40, 12 and 03 % level of exceedance, respectively. The monsoon, summer and winter seasons exhibited comparatively higher probabilities (78 to 85 %) for MDR of >100 mm and moderate probabilities (37 to 46 %) for >150 mm. For different recurrence intervals, the percent probability of MDR varied widely across intra- and inter-annual periods. In the island, rainfall anomaly can pose a climatic threat to the sustainability of agricultural production and thus needs adequate adaptation and mitigation measures.

  14. Dosimetric pre-treatment verification of IMRT using an EPID; clinical experience

    International Nuclear Information System (INIS)

    Zijtveld, Mathilda van; Dirkx, Maarten L.P.; Boer, Hans C.J. de; Heijmen, Ben J.M.

    2006-01-01

    Background and purpose: In our clinic a QA program for IMRT verification, fully based on dosimetric measurements with electronic portal imaging devices (EPID), has been running for over 3 years. The program includes a pre-treatment dosimetric check of all IMRT fields. During a complete treatment simulation at the linac, a portal dose image (PDI) is acquired with the EPID for each patient field and compared with a predicted PDI. In this paper, the results of this pre-treatment procedure are analysed, and intercepted errors are reported. An automated image analysis procedure is proposed to limit the number of fields that need human intervention in PDI comparison. Materials and methods: Most of our analyses are performed using the γ index with 3% local dose difference and 3 mm distance to agreement as reference values. Scalar parameters are derived from the γ values to summarize the agreement between measured and predicted 2D PDIs. Areas with all pixels having γ values larger than one are evaluated, making decisions based on clinically relevant criteria more straightforward. Results: In 270 patients, the pre-treatment checks revealed four clinically relevant errors. Calculation of statistics for a group of 75 patients showed that the patient-averaged mean γ value inside the field was 0.43 ± 0.13 (1 SD) and only 6.1 ± 6.8% of pixels had a γ value larger than one. With the proposed automated image analysis scheme, visual inspection of images can be avoided in 2/3 of the cases. Conclusion: EPIDs may be used for high accuracy and high resolution routine verification of IMRT fields to intercept clinically relevant dosimetric errors prior to the start of treatment. For the majority of fields, PDI comparison can fully rely on an automated procedure, avoiding excessive workload

  15. Targeting NK cells for anti-cancer immunotherapy: clinical and pre-clinical approaches

    Directory of Open Access Journals (Sweden)

    Sebastian eCarotta

    2016-04-01

    Full Text Available The recent success of checkpoint blockade has highlighted the potential of immunotherapy approaches for cancer treatment. While the majority of approved immunotherapy drugs target T cell subsets, it is appreciated that other components of the immune system have important roles in tumor immune-surveillance as well and thus represent promising additional targets for immunotherapy. Natural killer cells are the body’s first line of defense against infected or transformed cells as they kill target cells in an antigen-independent manner. Although several studies have clearly demonstrated the active role of NK cells in cancer-immune surveillance, only few clinically approved therapies currently exist that harness their potential. Our increased understanding of NK cell biology over the past few years has renewed the interest in NK cell based anti-cancer therapies, which has lead to a steady increase of NK cell based clinical and pre-clinical trials. Here, the role of NK cells in cancer immunesurveillance is summarized and several novel approaches to enhance NK cell cytotoxicity against cancer are discussed.

  16. Pre-clinical functional magnetic resonance imaging. Pt. I. The kidney

    Energy Technology Data Exchange (ETDEWEB)

    Zoellner, Frank G.; Kalayciyan, Raffi; Chacon-Caldera, Jorge; Zimmer, Fabian; Schad, Lothar R. [Heidelberg Univ., Mannheim (Germany). Computer Assisted Clinical Medicine

    2014-07-01

    The prevalence of chronic kidney disease (CKD) is increasing worldwide. In Europe alone, at least 8% of the population currently has some degree of CKD. CKD is associated with serious comorbidity, reduced life expectancy, and high economic costs; hence, the early detection and adequate treatment of kidney disease is important. Pre-clinical research can not only give insights into the mechanisms of the various kidney diseases but it also allows for investigating the outcome of new drugs developed to treat kidney disease. Functional magnetic resonance imaging provides non-invasive access to tissue and organ function in animal models. Advantages over classical animal research approaches are numerous: the same animal might be repeatedly imaged to investigate a progress or a treatment of disease over time. This has also a direct impact on animal welfare and the refinement of classical animal experiments as the number of animals in the studies might be reduced. In this paper, we review current state of the art in functional magnetic resonance imaging with a focus on pre-clinical kidney imaging.

  17. Pre-clinical functional magnetic resonance imaging. Pt. I. The kidney

    International Nuclear Information System (INIS)

    Zoellner, Frank G.; Kalayciyan, Raffi; Chacon-Caldera, Jorge; Zimmer, Fabian; Schad, Lothar R.

    2014-01-01

    The prevalence of chronic kidney disease (CKD) is increasing worldwide. In Europe alone, at least 8% of the population currently has some degree of CKD. CKD is associated with serious comorbidity, reduced life expectancy, and high economic costs; hence, the early detection and adequate treatment of kidney disease is important. Pre-clinical research can not only give insights into the mechanisms of the various kidney diseases but it also allows for investigating the outcome of new drugs developed to treat kidney disease. Functional magnetic resonance imaging provides non-invasive access to tissue and organ function in animal models. Advantages over classical animal research approaches are numerous: the same animal might be repeatedly imaged to investigate a progress or a treatment of disease over time. This has also a direct impact on animal welfare and the refinement of classical animal experiments as the number of animals in the studies might be reduced. In this paper, we review current state of the art in functional magnetic resonance imaging with a focus on pre-clinical kidney imaging.

  18. Analysis of Pre-Analytic Factors Affecting the Success of Clinical Next-Generation Sequencing of Solid Organ Malignancies

    International Nuclear Information System (INIS)

    Chen, Hui; Luthra, Rajyalakshmi; Goswami, Rashmi S.; Singh, Rajesh R.; Roy-Chowdhuri, Sinchita

    2015-01-01

    Application of next-generation sequencing (NGS) technology to routine clinical practice has enabled characterization of personalized cancer genomes to identify patients likely to have a response to targeted therapy. The proper selection of tumor sample for downstream NGS based mutational analysis is critical to generate accurate results and to guide therapeutic intervention. However, multiple pre-analytic factors come into play in determining the success of NGS testing. In this review, we discuss pre-analytic requirements for AmpliSeq PCR-based sequencing using Ion Torrent Personal Genome Machine (PGM) (Life Technologies), a NGS sequencing platform that is often used by clinical laboratories for sequencing solid tumors because of its low input DNA requirement from formalin fixed and paraffin embedded tissue. The success of NGS mutational analysis is affected not only by the input DNA quantity but also by several other factors, including the specimen type, the DNA quality, and the tumor cellularity. Here, we review tissue requirements for solid tumor NGS based mutational analysis, including procedure types, tissue types, tumor volume and fraction, decalcification, and treatment effects

  19. Analysis of Pre-Analytic Factors Affecting the Success of Clinical Next-Generation Sequencing of Solid Organ Malignancies

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Hui [Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (United States); Luthra, Rajyalakshmi, E-mail: rluthra@mdanderson.org; Goswami, Rashmi S.; Singh, Rajesh R. [Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (United States); Roy-Chowdhuri, Sinchita [Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (United States)

    2015-08-28

    Application of next-generation sequencing (NGS) technology to routine clinical practice has enabled characterization of personalized cancer genomes to identify patients likely to have a response to targeted therapy. The proper selection of tumor sample for downstream NGS based mutational analysis is critical to generate accurate results and to guide therapeutic intervention. However, multiple pre-analytic factors come into play in determining the success of NGS testing. In this review, we discuss pre-analytic requirements for AmpliSeq PCR-based sequencing using Ion Torrent Personal Genome Machine (PGM) (Life Technologies), a NGS sequencing platform that is often used by clinical laboratories for sequencing solid tumors because of its low input DNA requirement from formalin fixed and paraffin embedded tissue. The success of NGS mutational analysis is affected not only by the input DNA quantity but also by several other factors, including the specimen type, the DNA quality, and the tumor cellularity. Here, we review tissue requirements for solid tumor NGS based mutational analysis, including procedure types, tissue types, tumor volume and fraction, decalcification, and treatment effects.

  20. Analysis of Pre-Analytic Factors Affecting the Success of Clinical Next-Generation Sequencing of Solid Organ Malignancies

    Directory of Open Access Journals (Sweden)

    Hui Chen

    2015-08-01

    Full Text Available Application of next-generation sequencing (NGS technology to routine clinical practice has enabled characterization of personalized cancer genomes to identify patients likely to have a response to targeted therapy. The proper selection of tumor sample for downstream NGS based mutational analysis is critical to generate accurate results and to guide therapeutic intervention. However, multiple pre-analytic factors come into play in determining the success of NGS testing. In this review, we discuss pre-analytic requirements for AmpliSeq PCR-based sequencing using Ion Torrent Personal Genome Machine (PGM (Life Technologies, a NGS sequencing platform that is often used by clinical laboratories for sequencing solid tumors because of its low input DNA requirement from formalin fixed and paraffin embedded tissue. The success of NGS mutational analysis is affected not only by the input DNA quantity but also by several other factors, including the specimen type, the DNA quality, and the tumor cellularity. Here, we review tissue requirements for solid tumor NGS based mutational analysis, including procedure types, tissue types, tumor volume and fraction, decalcification, and treatment effects.

  1. Opportunity to learn: Investigating possible predictors for pre-course Test Of Astronomy STandards TOAST scores

    Science.gov (United States)

    Berryhill, Katie J.

    As astronomy education researchers become more interested in experimentally testing innovative teaching strategies to enhance learning in introductory astronomy survey courses ("ASTRO 101"), scholars are placing increased attention toward better understanding factors impacting student gain scores on the widely used Test Of Astronomy STandards (TOAST). Usually used in a pre-test and post-test research design, one might naturally assume that the pre-course differences observed between high- and low-scoring college students might be due in large part to their pre-existing motivation, interest, experience in science, and attitudes about astronomy. To explore this notion, 11 non-science majoring undergraduates taking ASTRO 101 at west coast community colleges were interviewed in the first few weeks of the course to better understand students' pre-existing affect toward learning astronomy with an eye toward predicting student success. In answering this question, we hope to contribute to our understanding of the incoming knowledge of students taking undergraduate introductory astronomy classes, but also gain insight into how faculty can best meet those students' needs and assist them in achieving success. Perhaps surprisingly, there was only weak correlation between students' motivation toward learning astronomy and their pre-test scores. Instead, the most fruitful predictor of TOAST pre-test scores was the quantity of pre-existing, informal, self-directed astronomy learning experiences.

  2. Functional imaging in pre-motor Parkinson’s disease

    International Nuclear Information System (INIS)

    Arnaldi, D.; Picco, A.; Ferrara, M.; Nobili, F.; Famà, F.; Buschiazzo, A.; Morbelli, S.; De Carli, F.

    2014-01-01

    Several non motor symptoms (NMS) can precede the onset of the classical motor Parkinson’s disease (PD) syndrome. The existence of pre-motor and even pre-clinical PD stages has been proposed but the best target population to be screened to disclose PD patients in a pre-clinical, thus asymptomatic, stage is still matter of debate. The REM sleep behavior disorder (RBD) often affects PD patients at different stages of the disease and could precede the onset of motor symptoms by several years. However, RBD could also precede other synucleinopathies (namely, dementia with Lewy bodies and multisystem atrophy), and less frequently could be related to other neurological conditions or remain idiopathic. Moreover, not all PD patients exhibit RBD. Despite these caveats, RBD probably represents the best feature to disclose pre-motor PD patients given its high-risk of developing a full motor syndrome. Other clinical clues in the premotor stages of PD undergoing active investigation include hyposmia, depression, and autonomic dysfunction. Effective biomarkers are needed in order to improve the diagnostic accuracy in the pre-motor stage of PD, to monitor disease progression and to plan both pharmacological and non-pharmacological intervention. Functional imaging, in particular radionuclide methodologies, has been often used to investigate dopaminergic and non-dopaminergic features as well as cortical functioning in patients with RBD in its idiopathic form (iRBD) and/or associated with PD. Recently, new tracers to image α-synuclein pathologies are under development. Functional imaging in pre-motor PD, and in particular in iRBD, could improve our knowledge about the underlying mechanisms and the neurodegenerative progress of PD

  3. Clinical diagnosis of Graves’ or non-Graves’ hyperthyroidism compared to TSH receptor antibody test

    Directory of Open Access Journals (Sweden)

    Lauren Bell

    2018-04-01

    Full Text Available Background: TSH receptor antibody (TRAb is considered the gold standard diagnostic test for the autoimmunity of Graves’ disease (GD, which is commonly diagnosed clinically. Aim: To evaluate the true positive (sensitivity and true negative (specificity rates of clinical diagnosis of GD or non-GD hyperthyroidism compared to the TRAb test. Setting: University teaching hospital in North West England. Participants: Patients in the Endocrinology service who had a TRAb measurement between December 2009 and October 2015. Methods: Electronic patient records were studied retrospectively for a pre-TRAb clinical diagnosis of GD or non-GD hyperthyroidism. We examined descriptive statistics and binary classification tests; Fisher exact test was used to analyse contingency tables. Results: We identified 316 patients with a mean age of 45 (range, 17–89 years; 247 (78% were women. Compared to the TRAb result, clinical diagnosis had a sensitivity of 88%, specificity 66%, positive predictive value 72%, negative predictive value 84%, false negative rate 12%, false positive rate 34%, positive likelihood ratio 2.6 and negative likelihood ratio 0.2 (P < 0.0001. Conclusions: Clinicians were liable to both over- and under-diagnose GD. The TRAb test can help reduce the number of incorrect or unknown diagnoses in the initial clinical assessment of patients presenting with hyperthyroidism.

  4. 3D Mapping of Language Networks in Clinical and Pre-Clinical Alzheimer's Disease

    Science.gov (United States)

    Apostolova, Liana G.; Lu, Po; Rogers, Steve; Dutton, Rebecca A.; Hayashi, Kiralee M.; Toga, Arthur W.; Cummings, Jeffrey L.; Thompson, Paul M.

    2008-01-01

    We investigated the associations between Boston naming and the animal fluency tests and cortical atrophy in 19 probable AD and 5 multiple domain amnestic mild cognitive impairment patients who later converted to AD. We applied a surface-based computational anatomy technique to MRI scans of the brain and then used linear regression models to detect…

  5. BNL NONLINEAR PRE TEST SEISMIC ANALYSIS FOR THE NUPEC ULTIMATE STRENGTH PIPING TEST PROGRAM

    International Nuclear Information System (INIS)

    DEGRASSI, G.; HOFMAYER, C.; MURPHY, C.; SUZUKI, K.; NAMITA, Y.

    2003-01-01

    The Nuclear Power Engineering Corporation (NUPEC) of Japan has been conducting a multi-year research program to investigate the behavior of nuclear power plant piping systems under large seismic loads. The objectives of the program are: to develop a better understanding of the elasto-plastic response and ultimate strength of nuclear piping; to ascertain the seismic safety margin of current piping design codes; and to assess new piping code allowable stress rules. Under this program, NUPEC has performed a large-scale seismic proving test of a representative nuclear power plant piping system. In support of the proving test, a series of materials tests, static and dynamic piping component tests, and seismic tests of simplified piping systems have also been performed. As part of collaborative efforts between the United States and Japan on seismic issues, the US Nuclear Regulatory Commission (USNRC) and its contractor, the Brookhaven National Laboratory (BNL), are participating in this research program by performing pre-test and post-test analyses, and by evaluating the significance of the program results with regard to safety margins. This paper describes BNL's pre-test analysis to predict the elasto-plastic response for one of NUPEC's simplified piping system seismic tests. The capability to simulate the anticipated ratcheting response of the system was of particular interest. Analyses were performed using classical bilinear and multilinear kinematic hardening models as well as a nonlinear kinematic hardening model. Comparisons of analysis results for each plasticity model against test results for a static cycling elbow component test and for a simplified piping system seismic test are presented in the paper

  6. A Teaching Method on Basic Chemistry for Freshman : Teaching Method with Pre-test and Post-test

    OpenAIRE

    立木, 次郎; 武井, 庚二

    2003-01-01

    This report deals with a teaching method on basic chemistry for freshman. This teaching method contains guidance and instruction to how to understand basic chemistry. Pre-test and post-test have been put into practice each time. Each test was returned to students at class in the following weeks.

  7. Prognostic value of stress echocardiography in women with high (⩾80%) probability of coronary artery disease

    OpenAIRE

    Davar, J; Roberts, E; Coghlan, J; Evans, T; Lipkin, D

    2001-01-01

    OBJECTIVE—To assess the prognostic significance of stress echocardiography in women with a high probability of coronary artery disease (CAD).
SETTING—Secondary and tertiary cardiology unit at a university teaching hospital.
PARTICIPANTS—A total of 135 women (mean (SD) age 63 (9) years) with pre-test probability of CAD ⩾80% were selected from a database of patients investigated by treadmill or dobutamine stress echocardiography between 1995 and 1998.
MAIN OUTCOME MEASURES—Patients were followe...

  8. Prospective Evaluation of Serum β-Glucan Testing in Patients With Probable or Proven Fungal Diseases

    Science.gov (United States)

    Angebault, Cécile; Lanternier, Fanny; Dalle, Frédéric; Schrimpf, Cécile; Roupie, Anne-Laure; Dupuis, Aurélie; Agathine, Aurélie; Scemla, Anne; Paubelle, Etienne; Caillot, Denis; Neven, Bénédicte; Frange, Pierre; Suarez, Felipe; d'Enfert, Christophe; Lortholary, Olivier; Bougnoux, Marie-Elisabeth

    2016-01-01

    Background. Early diagnosis and treatment are crucial in invasive fungal diseases (IFD). Serum (1-3)-β-d-glucan (BG) is believed to be an early IFD marker, but its diagnostic performance has been ambiguous, with insufficient data regarding sensitivity at the time of IFD diagnosis (TOD) and according to outcome. Whether its clinical utility is equivalent for all types of IFD remains unknown. Methods. We included 143 patients with proven or probable IFD (49 invasive candidiasis, 45 invasive aspergillosis [IA], and 49 rare IFD) and analyzed serum BG (Fungitell) at TOD and during treatment. Results. (1-3)-β-d-glucan was undetectable at TOD in 36% and 48% of patients with candidemia and IA, respectively; there was no correlation between negative BG results at TOD and patients' characteristics, localization of infection, or prior antifungal use. Nevertheless, patients with candidemia due to Candida albicans were more likely to test positive for BG at TOD (odds ratio = 25.4, P = .01) than patients infected with other Candida species. In 70% of the patients with a follow-up, BG negativation occurred in >1 month for candidemia and >3 months for IA. A slower BG decrease in patients with candidemia was associated with deep-seated localizations (P = .04). Thirty-nine percent of patients with rare IFD had undetectable BG at TOD; nonetheless, all patients with chronic subcutaneous IFD tested positive at TOD. Conclusions. Undetectable serum BG does not rule out an early IFD, when the clinical suspicion is high. After IFD diagnostic, kinetics of serum BG are difficult to relate to clinical outcome. PMID:27419189

  9. A Web Based Framework for Pre-release Testing of Mobile Applications

    Directory of Open Access Journals (Sweden)

    Hamdy Abeer

    2016-01-01

    Full Text Available Mobile applications are becoming an integral part of daily life and of business’s marketing plan. They are helpful in promoting for the business, attracting and retaining customers. Software testing is vital to ensure the delivery of high quality mobile applications that could be accessed across different platforms and meet business and technical requirements. This paper proposes a web based tool, namely Pons, for the distribution of pre-release mobile applications for the purpose of manual testing. Pons facilities building, running, and manually testing Android applications directly in the browser. It gets the developers and end users engaged in testing the applications in one place, alleviates the tester’s burden of installing and maintaining testing environments, and provides a platform for developers to rapidly iterate on the software and integrate changes over time. Thus, it speeds up the pre-release testing process, reduces its cost and increases customer satisfaction.

  10. Modeling tumor control probability for spatially inhomogeneous risk of failure based on clinical outcome data

    DEFF Research Database (Denmark)

    Lühr, Armin; Löck, Steffen; Jakobi, Annika

    2017-01-01

    PURPOSE: Objectives of this work are (1) to derive a general clinically relevant approach to model tumor control probability (TCP) for spatially variable risk of failure and (2) to demonstrate its applicability by estimating TCP for patients planned for photon and proton irradiation. METHODS AND ...

  11. Feasibility of streamlining an interactive Bayesian-based diagnostic support tool designed for clinical practice

    Science.gov (United States)

    Chen, Po-Hao; Botzolakis, Emmanuel; Mohan, Suyash; Bryan, R. N.; Cook, Tessa

    2016-03-01

    In radiology, diagnostic errors occur either through the failure of detection or incorrect interpretation. Errors are estimated to occur in 30-35% of all exams and contribute to 40-54% of medical malpractice litigations. In this work, we focus on reducing incorrect interpretation of known imaging features. Existing literature categorizes cognitive bias leading a radiologist to an incorrect diagnosis despite having correctly recognized the abnormal imaging features: anchoring bias, framing effect, availability bias, and premature closure. Computational methods make a unique contribution, as they do not exhibit the same cognitive biases as a human. Bayesian networks formalize the diagnostic process. They modify pre-test diagnostic probabilities using clinical and imaging features, arriving at a post-test probability for each possible diagnosis. To translate Bayesian networks to clinical practice, we implemented an entirely web-based open-source software tool. In this tool, the radiologist first selects a network of choice (e.g. basal ganglia). Then, large, clearly labeled buttons displaying salient imaging features are displayed on the screen serving both as a checklist and for input. As the radiologist inputs the value of an extracted imaging feature, the conditional probabilities of each possible diagnosis are updated. The software presents its level of diagnostic discrimination using a Pareto distribution chart, updated with each additional imaging feature. Active collaboration with the clinical radiologist is a feasible approach to software design and leads to design decisions closely coupling the complex mathematics of conditional probability in Bayesian networks with practice.

  12. Verbal versus Numerical Probabilities: Does Format Presentation of Probabilistic Information regarding Breast Cancer Screening Affect Women's Comprehension?

    Science.gov (United States)

    Vahabi, Mandana

    2010-01-01

    Objective: To test whether the format in which women receive probabilistic information about breast cancer and mammography affects their comprehension. Methods: A convenience sample of 180 women received pre-assembled randomized packages containing a breast health information brochure, with probabilities presented in either verbal or numeric…

  13. Test the Overall Significance of p-values by Using Joint Tail Probability of Ordered p-values as Test Statistic

    NARCIS (Netherlands)

    Fang, Yongxiang; Wit, Ernst

    2008-01-01

    Fisher’s combined probability test is the most commonly used method to test the overall significance of a set independent p-values. However, it is very obviously that Fisher’s statistic is more sensitive to smaller p-values than to larger p-value and a small p-value may overrule the other p-values

  14. Pre-transplantation glucose testing for predicting new-onset diabetes mellitus after renal transplantation.

    Science.gov (United States)

    Ramesh Prasad, G V; Huang, M; Bandukwala, F; Nash, M M; Rapi, L; Montada-Atin, T; Meliton, G; Zaltzman, J S

    2009-02-01

    New-onset diabetes after renal transplantation (NODAT) adversely affects graft and patient survival. However, NODAT risk based on pre-transplant blood glucose (BG) levels has not been defined. Our goal was to identify the best pre-transplant testing method and cut-off values. We performed a case-control analysis of non-diabetic recipients who received a live donor allograft with at least 6 months post-transplant survival. Pre-transplant glucose abnormalities were excluded through 75 g oral glucose tolerance testing (OGTT) and random BG (RBG) measurement. NODAT was defined based on 2003 Canadian Diabetes Association criteria. Multivariate logistic and Cox regression analysis was performed to determine independent predictor variables for NODAT. Receiver-operating-characteristic (ROC) curves were constructed to determine threshold BG values for diabetes risk. 151 recipients met initial entry criteria. 12 had pre-transplant impaired fasting glucose and/or impaired glucose tolerance, among who 7 (58%) developed NODAT. In the remaining 139, 24 (17%) developed NODAT. NODAT risk exceeded 25% for those with pre-transplant RBG > 6.0 mmol/l and 50% if > 7.2 mmol/l. Pre-transplant RBG provided the highest AUC (0.69, p = 0.002) by ROC analysis. Increasing age (p = 0.025), acute rejection (p = 0.011), and RBG > 6.0 mmol/l (p = 0.001) were independent predictors of NODAT. Pre-transplant glucose testing is a specific marker for NODAT. Patients can be counseled of their incremental risk even within the normal BG range if the OGTT is normal.

  15. On pre-test sensitisation and peer assessment to enhance learning gain in science education

    NARCIS (Netherlands)

    Bos, Floor/Floris

    2009-01-01

    *The main part of this thesis focuses on designing, optimising, and studying the embedding of two types of interventions: pre-testing and peer assessment, both supported by or combined with ICT-tools. * Pre-test sensitisation is used intentionally to boost the learning gain of the main intervention,

  16. Diagnostic performance of placental alpha-microglobulin-1 test in women with prolonged pre-labour rupture of membranes.

    Science.gov (United States)

    Eleje, George Uchenna; Ezugwu, Euzebus Chinonye; Eke, Ahizechukwu Chigoziem; Eleje, Lydia Ijeoma; Ikechebelu, Joseph Ifeanyichukwu; Afiadigwe, Evaristus Anthony; Ezugwu, Frank O; Udigwe, Gerald Okanandu; Okafor, Charles I; Ezeama, Chukwuemeka Okwudili

    2016-01-01

    To determine diagnostic performance of placental alpha-microglobulin-1 (PAMG-1) test compared to conventional clinical assessment (CCA) in women with prolonged pre-labour rupture of membranes (PROM). A double-blind study of women with symptoms and signs of PROM in Nnamdi Azikiwe University Teaching Hospital, Nnewi and University of Nigeria Teaching Hospital, Enugu, in south-east Nigeria using CCA for PROM and PAMG-1 test was done. Women were included if their symptoms, signs or complaints suggestive of PROM was more than 24 h duration. PROM was diagnosed if two out of three methods from CCA (pooling, positive nitrazine test or ferning) were present. Confirmation of PROM was done after delivery using any two of these clinical criteria: delivery in 48 h to 7 days, evidence of chorioamnionitis, membranes obviously ruptured at delivery and adverse perinatal outcomes strongly correlated with prolonged PROM. Accuracy, specificity and sensitivity value for CCA were 72.5, 36.8 and 86.0% lower than for PAMG-1 test which were 95.7, 94.1 and 96.2%. In equivocal cases, PAMG-1 was significantly more accurate than CCA (92.3% versus 38.5%; p < 0.001). This study in women with prolonged PROM, confirms that PAMG-1 test has high diagnostic accuracy irrespective of the duration of PROM before clinical evaluation.

  17. The detection, diagnosis, therapy, and pre-clinical biology of breast cancer

    International Nuclear Information System (INIS)

    1978-01-01

    The Cancergram covers clinical aspects of cancers of the mammary glands, the fat pads and the supporting tissues. Abstracts included concern certain specific types of neoplasms which occur in the breast, and in ancillary tissues related to the breast (axillary lymph nodes, etc.). Also included are selected studies on receptors and the physiological aspects of lactation, pregnancy, and ontogeny related to cancer of the breast. The topic includes clinically relevant aspects of the prevention, detection, diagnosis, evaluation, and therapy of breast cancer. With certain exceptions, pre-clinical studies of tissue culture systems or animal model studies which are not directly related to primary human disease are excluded

  18. The meaning of diagnostic test results: A spreadsheet for swift data analysis

    International Nuclear Information System (INIS)

    MacEneaney, Peter M.; Malone, Dermot E.

    2000-01-01

    AIMS: To design a spreadsheet program to: (a) analyse rapidly diagnostic test result data produced in local research or reported in the literature; (b) correct reported predictive values for disease prevalence in any population; (c) estimate the post-test probability of disease in individual patients. MATERIALS AND METHODS: Microsoft Excel TM was used. Section A: a contingency (2 x 2) table was incorporated into the spreadsheet. Formulae for standard calculations [sample size, disease prevalence, sensitivity and specificity with 95% confidence intervals, predictive values and likelihood ratios (LRs)] were linked to this table. The results change automatically when the data in the true or false negative and positive cells are changed. Section B: this estimates predictive values in any population, compensating for altered disease prevalence. Sections C-F: Bayes' theorem was incorporated to generate individual post-test probabilities. The spreadsheet generates 95% confidence intervals, LRs and a table and graph of conditional probabilities once the sensitivity and specificity of the test are entered. The latter shows the expected post-test probability of disease for any pre-test probability when a test of known sensitivity and specificity is positive or negative. RESULTS: This spreadsheet can be used on desktop and palmtop computers. The MS Excel TM version can be downloaded via the Internet from the URL ftp://radiography.com/pub/Rad-data99.xls CONCLUSION: A spreadsheet is useful for contingency table data analysis and assessment of the clinical meaning of diagnostic test results. MacEneaney, P.M., Malone, D.E. (2000)

  19. Clinical significance of DVM and its prevalence in pre-gestational diabetes cases versus normal pregnancies

    Directory of Open Access Journals (Sweden)

    Farideh Akhlaghi

    2015-06-01

    Full Text Available Pre-gestational diabetes mellitus affects less than 1% of all pregnancies and is a significant cause of fetal morbidity and mortality. It is hypothesized that impaired placental function, in the form of abnormal placental weight and/or abnormal placental histology, may be responsible for this event in such pregnancies. Delayed villous maturation of placental villi, which is one of the findings associated with pre-gestational diabetes increases the rate of perinatal mortality. There is limited literature regarding the delayed maturation of placental villous. This review included trials (randomized and non-randomized, cohort and case-control studies registered in Medline/PubMed database, from January 2001 to September 2012 that evaluated the clinical significance of delayed villous maturation and its prevalence in pre-gestational diabetic cases compared to normal pregnancies.It emphasizes that further studies with focus on possible clinical or ultrasound markers of placental delayed villous maturation, especially in a high risk-group such as women with pre-gestational diabetes mellitus are highly recommended.

  20. Computing exact bundle compliance control charts via probability generating functions.

    Science.gov (United States)

    Chen, Binchao; Matis, Timothy; Benneyan, James

    2016-06-01

    Compliance to evidenced-base practices, individually and in 'bundles', remains an important focus of healthcare quality improvement for many clinical conditions. The exact probability distribution of composite bundle compliance measures used to develop corresponding control charts and other statistical tests is based on a fairly large convolution whose direct calculation can be computationally prohibitive. Various series expansions and other approximation approaches have been proposed, each with computational and accuracy tradeoffs, especially in the tails. This same probability distribution also arises in other important healthcare applications, such as for risk-adjusted outcomes and bed demand prediction, with the same computational difficulties. As an alternative, we use probability generating functions to rapidly obtain exact results and illustrate the improved accuracy and detection over other methods. Numerical testing across a wide range of applications demonstrates the computational efficiency and accuracy of this approach.

  1. Computational Omics Pre-Awardees | Office of Cancer Clinical Proteomics Research

    Science.gov (United States)

    The National Cancer Institute's Clinical Proteomic Tumor Analysis Consortium (CPTAC) is pleased to announce the pre-awardees of the Computational Omics solicitation. Working with NVIDIA Foundation's Compute the Cure initiative and Leidos Biomedical Research Inc., the NCI, through this solicitation, seeks to leverage computational efforts to provide tools for the mining and interpretation of large-scale publicly available ‘omics’ datasets.

  2. Probability in reasoning: a developmental test on conditionals.

    Science.gov (United States)

    Barrouillet, Pierre; Gauffroy, Caroline

    2015-04-01

    Probabilistic theories have been claimed to constitute a new paradigm for the psychology of reasoning. A key assumption of these theories is captured by what they call the Equation, the hypothesis that the meaning of the conditional is probabilistic in nature and that the probability of If p then q is the conditional probability, in such a way that P(if p then q)=P(q|p). Using the probabilistic truth-table task in which participants are required to evaluate the probability of If p then q sentences, the present study explored the pervasiveness of the Equation through ages (from early adolescence to adulthood), types of conditionals (basic, causal, and inducements) and contents. The results reveal that the Equation is a late developmental achievement only endorsed by a narrow majority of educated adults for certain types of conditionals depending on the content they involve. Age-related changes in evaluating the probability of all the conditionals studied closely mirror the development of truth-value judgements observed in previous studies with traditional truth-table tasks. We argue that our modified mental model theory can account for this development, and hence for the findings related with the probability task, which do not consequently support the probabilistic approach of human reasoning over alternative theories. Copyright © 2014 Elsevier B.V. All rights reserved.

  3. Probability of background to produce a signal-like excess, for all Higgs masses tested.

    CERN Document Server

    ATLAS, collaboration

    2012-01-01

    The probability of background to produce a signal-like excess, for all the Higgs boson masses tested. At almost all masses, the probability (solid curve) is at least a few percent; however, at 126.5 GeV it dips to 3x10-7, or one chance in three million, the '5-sigma' gold-standard normally used for the discovery of a new particle. A Standard Model Higgs boson with that mass would produce a dip to 4.6 sigma.

  4. Fabrication and testing of W7-X pre-series target elements

    International Nuclear Information System (INIS)

    Boscary, J; Boeswirth, B; Greuner, H; Grigull, P; Missirlian, M; Plankensteiner, A; Schedler, B; Friedrich, T; Schlosser, J; Streibl, B; Traxler, H

    2007-01-01

    The assembly of the highly-loaded target plates of the WENDELSTEIN 7-X (W7-X) divertor requires the fabrication of 890 target elements (TEs). The plasma facing material is made of CFC NB31 flat tiles bonded to a CuCrZr copper alloy water-cooled heat sink. The elements are designed to remove a stationary heat flux and power up to 10 MW m -2 and 100 kW, respectively. Before launching the serial fabrication, pre-series activities aimed at qualifying the design, the manufacturing route and the non-destructive examinations (NDEs). High heat flux (HHF) tests performed on full-scale pre-series TEs resulted in an improvement of the design of the bond between tiles and heat sink to reduce the stresses during operation. The consequence is the fabrication of additional pre-series TEs to be tested in the HHF facility GLADIS. NDEs of this bond based on thermography methods are developed to define the acceptance criteria suitable for serial fabrication

  5. Simulation in Pre-departure Training for Residents Planning Clinical Work in a Low-Income Country

    Directory of Open Access Journals (Sweden)

    Kevin R. Schwartz

    2015-12-01

    Full Text Available Introduction: Increasingly, pediatric and emergency medicine (EM residents are pursuing clinical rotations in low-income countries. Optimal pre-departure preparation for such rotations has not yet been established. High-fidelity simulation represents a potentially effective modality for such preparation. This study was designed to assess whether a pre-departure high-fidelity medical simulation curriculum is effective in helping to prepare residents for clinical rotations in a low-income country. Methods: 43 pediatric and EM residents planning clinical rotations in Liberia, West Africa, participated in a simulation-based curriculum focused on severe pediatric malaria and malnutrition and were then assessed by survey at three time points: pre-simulation, post-simulation, and after returning from work abroad. Results: Prior to simulation, 1/43 (2% participants reported they were comfortable with the diagnosis and management of severe malnutrition; this increased to 30/42 (71% after simulation and 24/31 (77% after working abroad. Prior to simulation, 1/43 (2% of residents reported comfort with the diagnosis and management of severe malaria; this increased to 26/42 (62% after simulation and 28/31 (90% after working abroad; 36/42 (86% of residents agreed that a simulation-based global health curriculum is more useful than a didactic curriculum alone, and 41/42 (98% felt a simulator-based curriculum should be offered to all residents planning a clinical trip to a low-income country. Conclusion: High-fidelity simulation is effective in increasing residents’ self-rated comfort in management of pediatric malaria and malnutrition and a majority of participating residents feel it should be included as a component of pre-departure training for all residents rotating clinically to low-income countries.

  6. Clinical feasibility of pre-operative neurodevelopmental assessment of infants undergoing open heart surgery.

    Science.gov (United States)

    Campbell, Miranda; Rabbidge, Bridgette; Ziviani, Jenny; Sakzewski, Leanne

    2017-08-01

    Assessing the neurodevelopmental status of infants with congenital heart disease before surgery provides a means of identifying those at heightened risk of developmental delay. This study aimed to investigate factors impacting clinical feasibility of pre-operative neurodevelopmental assessment of infants undergoing early open heart surgery. Infants who underwent open heart surgery prior to 4 months of age participated in this cross-sectional study. The Test of Infant Motor Performance and Prechtl's Assessment of General Movements were undertaken on infants pre-operatively. When assessments could not be undertaken, reasons were ascribed to either infant or environmental circumstances. Demographic data and Aristotle scores were compared between groups of infants who did or did not undergo assessment. Binary logistic regression was used to explore associations. A total of 60 infants participated in the study. Median gestational age was 38.78 weeks (interquartile range: 36.93-39.72). Of these infants, 37 (62%) were unable to undergo pre-operative assessment. Twenty-four (40%) could not complete assessment due to infant-related factors and 13 (22%) due to environmental-related factors. For every point increase in the Aristotle Patient-Adjusted Complexity score, the infants likelihood of being unable to undergo assessment increased by 35% (odds ratio: 0.35; 95% confidence interval: 1.03-1.77, P = 0.03). Over half of the infants undergoing open heart surgery were unable to complete pre-operative neurodevelopmental assessment. The primary reason for this was infant-related medical instability. Findings suggest further research is warranted to investigate whether the Aristotle Patient-Adjusted Complexity score might serve as an indicator to inform developmental surveillance with this medically fragile cohort. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  7. Evaluation of nuclear power plant component failure probability and core damage probability using simplified PSA model

    International Nuclear Information System (INIS)

    Shimada, Yoshio

    2000-01-01

    It is anticipated that the change of frequency of surveillance tests, preventive maintenance or parts replacement of safety related components may cause the change of component failure probability and result in the change of core damage probability. It is also anticipated that the change is different depending on the initiating event frequency or the component types. This study assessed the change of core damage probability using simplified PSA model capable of calculating core damage probability in a short time period, which is developed by the US NRC to process accident sequence precursors, when various component's failure probability is changed between 0 and 1, or Japanese or American initiating event frequency data are used. As a result of the analysis, (1) It was clarified that frequency of surveillance test, preventive maintenance or parts replacement of motor driven pumps (high pressure injection pumps, residual heat removal pumps, auxiliary feedwater pumps) should be carefully changed, since the core damage probability's change is large, when the base failure probability changes toward increasing direction. (2) Core damage probability change is insensitive to surveillance test frequency change, since the core damage probability change is small, when motor operated valves and turbine driven auxiliary feed water pump failure probability changes around one figure. (3) Core damage probability change is small, when Japanese failure probability data are applied to emergency diesel generator, even if failure probability changes one figure from the base value. On the other hand, when American failure probability data is applied, core damage probability increase is large, even if failure probability changes toward increasing direction. Therefore, when Japanese failure probability data is applied, core damage probability change is insensitive to surveillance tests frequency change etc. (author)

  8. Pre-Gas Drilling Drinking Water Testing--An Educational Opportunity for Extension

    Science.gov (United States)

    Swistock, Brian; Clark, James

    2015-01-01

    The increase in shale gas drilling in Pennsylvania has resulted in thousands of landowners receiving predrilling testing of their drinking water. Landowners often have difficulty understanding test reports resulting in low awareness of pre-existing problems. Extension and several partners developed a program to improve understanding of…

  9. Information theoretic quantification of diagnostic uncertainty.

    Science.gov (United States)

    Westover, M Brandon; Eiseman, Nathaniel A; Cash, Sydney S; Bianchi, Matt T

    2012-01-01

    Diagnostic test interpretation remains a challenge in clinical practice. Most physicians receive training in the use of Bayes' rule, which specifies how the sensitivity and specificity of a test for a given disease combine with the pre-test probability to quantify the change in disease probability incurred by a new test result. However, multiple studies demonstrate physicians' deficiencies in probabilistic reasoning, especially with unexpected test results. Information theory, a branch of probability theory dealing explicitly with the quantification of uncertainty, has been proposed as an alternative framework for diagnostic test interpretation, but is even less familiar to physicians. We have previously addressed one key challenge in the practical application of Bayes theorem: the handling of uncertainty in the critical first step of estimating the pre-test probability of disease. This essay aims to present the essential concepts of information theory to physicians in an accessible manner, and to extend previous work regarding uncertainty in pre-test probability estimation by placing this type of uncertainty within a principled information theoretic framework. We address several obstacles hindering physicians' application of information theoretic concepts to diagnostic test interpretation. These include issues of terminology (mathematical meanings of certain information theoretic terms differ from clinical or common parlance) as well as the underlying mathematical assumptions. Finally, we illustrate how, in information theoretic terms, one can understand the effect on diagnostic uncertainty of considering ranges instead of simple point estimates of pre-test probability.

  10. Case report on babesiosis associated pre-hepatic jaundice in a malabari goat

    Directory of Open Access Journals (Sweden)

    Y. Ajith

    2017-06-01

    Full Text Available Pre-hepatic jaundice associated with babesiosis in a malabari goat and its successful management is described. The animal was presented with muco-purulent nasal discharge, dyspnoea, coughing, icteric sclera and oral mucosa, bloated abdomen, diarrhoea, hematochezia and coffee coloured urine. History of tick infestation was reported by the owner. Clinical examination revealed pyrexia, tachycardia, tachypnea, pre-scapular and pre-femoral lymphadenopathy and respiratory wheezes. Laboratory investigations revealed anaemia, neutrophilia, thrombocytopaenia, hypoproteinemia, hyperbilirubinemia and haemoglobinuria. On microscopic examination, small pyriform Babesia sp. (probably B. ovis could be detected in Giemsa stained peripheral blood smear. The animal had undergone babesicidal therapy using diminazene aceturate (3.5 mg/kg bodyweight deep IM, two doses at 48hr interval and oxytetracycline (10 mg/kg body weight once daily for 5 days, and supportive therapy using NSAIDs, polyionic isotonic fluids, antihistamines, B complex vitamins, stomachic and iron supplements. The animal made an uneventful clinical recovery after two weeks.

  11. Overview of the testing activities on ITER sub-scale pre-compression rings

    Energy Technology Data Exchange (ETDEWEB)

    Rossi, Paolo, E-mail: paolo.rossi@enea.it [Associazione EURATOM-ENEA sulla Fusione, C.R. Frascati, C.P. 65, 00044 Frascati, Rome (Italy); Capobianchi, Mario; Crescenzi, Fabio; Massimi, Alberto; Mugnaini, Giampiero; Pizzuto, Aldo [Associazione EURATOM-ENEA sulla Fusione, C.R. Frascati, C.P. 65, 00044 Frascati, Rome (Italy); Knaster, Juan [ITER Organisation, Route de Vinon sur Verdon, 13115, St. Paul lez Durance (France); Rajainmaki, Hannu [FUSION FOR ENERGY, Josep Pla no. 2, Torres Diagonal Litoral Edificio B3, 08019 Barcelona (Spain)

    2012-08-15

    Highlights: Black-Right-Pointing-Pointer ENEA developed a high strength glass fiber-epoxy composite for ITER pre-compression rings. Black-Right-Pointing-Pointer High UTS values were obtained at RT on linear specimens (2200 MPa) and on scaled ring mock-ups (1550 MPa). Black-Right-Pointing-Pointer Creep tests showed very low creep strain and creep rates. Black-Right-Pointing-Pointer Long term tests showed no significant stress relaxation on the ring mock-ups. - Abstract: After a first R and D and testing activity to develop and characterize by tensile and creep tests a high strength glass fiber-epoxy composite as reference material for the manufacture of ITER pre-compression rings, ENEA designed and manufactured a dedicated testing facility and different sub-scale composite ring mock-ups in order to characterize their mechanical properties. The paper reports the results of the overall testing activities performed during the last years on a total number of eleven sub-scale pre-compression ring mock-ups manufactured by winding S2 glass fibers on a diameter of 1 m (1/5 of the full scale) both by vacuum pressure epoxy impregnation (VPI) and filament wet winding techniques (WW). The first three rings were manufactured by ENEA Frascati thanks to a particular VPI technique; one of them was used as base composite material to manufacture different sets of specimens for shear, compression and non destructive tests (NDT). Then, five other mock-ups were manufactured following ENEA VPI process and three using WW technique by two different industrial companies. The rings were tested in ENEA Frascati in a dedicated hydraulic testing machine consisting of 18 radial actuators working in position control with a total load capability of 1000 tons. The complete testing campaign consisted of six ultimate tensile strength (UTS) tests and four stress relaxation (SR) tests. The tests demonstrated that the composite (S2 glass-epoxy) is a valid and viable solution for the ITER pre

  12. Effects of pathogen-specific clinical mastitis on probability of conception in Holstein dairy cows.

    Science.gov (United States)

    Hertl, J A; Schukken, Y H; Welcome, F L; Tauer, L W; Gröhn, Y T

    2014-11-01

    The objective of this study was to estimate the effects of pathogen-specific clinical mastitis (CM), occurring in different weekly intervals before or after artificial insemination (AI), on the probability of conception in Holstein cows. Clinical mastitis occurring in weekly intervals from 6 wk before until 6 wk after AI was modeled. The first 4 AI in a cow's lactation were included. The following categories of pathogens were studied: Streptococcus spp. (comprising Streptococcus dysgalactiae, Streptococcus uberis, and other Streptococcus spp.); Staphylococcus aureus; coagulase-negative staphylococci (CNS); Escherichia coli; Klebsiella spp.; cases with CM signs but no bacterial growth (above the level that can be detected from our microbiological procedures) observed in the culture sample and cases with contamination (≥ 3 pathogens in the sample); and other pathogens [including Citrobacter, yeasts, Trueperella pyogenes, gram-negative bacilli (i.e., gram-negative organisms other than E. coli, Klebsiella spp., Enterobacter, and Citrobacter), Corynebacterium bovis, Corynebacterium spp., Pasteurella, Enterococcus, Pseudomonas, Mycoplasma, Prototheca, and others]. Other factors included in the model were parity (1, 2, 3, 4 and higher), season of AI (winter, spring, summer, autumn), day in lactation of first AI, farm, and other non-CM diseases (retained placenta, metritis, ketosis, displaced abomasum). Data from 90,271 AI in 39,361 lactations in 20,328 cows collected from 2003/2004 to 2011 from 5 New York State dairy farms were analyzed in a generalized linear mixed model with a Poisson distribution. The largest reductions in probability of conception were associated with CM occurring in the week before AI or in the 2 wk following AI. Escherichia coli and Klebsiella spp. had the greatest adverse effects on probability of conception. The probability of conception for a cow with any combination of characteristics may be calculated based on the parameter estimates. These

  13. The impact of Nursing Rounds on the practice environment and nurse satisfaction in intensive care: pre-test post-test comparative study.

    Science.gov (United States)

    Aitken, Leanne M; Burmeister, Elizabeth; Clayton, Samantha; Dalais, Christine; Gardner, Glenn

    2011-08-01

    Factors previously shown to influence patient care include effective decision making, team work, evidence based practice, staffing and job satisfaction. Clinical rounds have the potential to optimise these factors and impact on patient outcomes, but use of this strategy by intensive care nurses has not been reported. To determine the effect of implementing Nursing Rounds in the intensive care environment on patient care planning and nurses' perceptions of the practice environment and work satisfaction. Pre-test post-test 2 group comparative design. Two intensive care units in tertiary teaching hospitals in Australia. A convenience sample of registered nurses (n=244) working full time or part time in the participating intensive care units. Nurses in participating intensive care units were asked to complete the Practice Environment Scale-Nursing Work Index (PES-NWI) and the Nursing Worklife Satisfaction Scale (NWSS) prior to and after a 12 month period during which regular Nursing Rounds were conducted in the intervention unit. Issues raised during Nursing Rounds were described and categorised. The characteristics of the sample and scale scores were summarised with differences between pre and post scores analysed using t-tests for continuous variables and chi-square tests for categorical variables. Independent predictors of the PES-NWI were determined using multivariate linear regression. Nursing Rounds resulted in 577 changes being initiated for 171 patients reviewed; these changes related to the physical, psychological--individual, psychological--family, or professional practice aspects of care. Total PES-NWI and NWSS scores were similar before and after the study period in both participating units. The NWSS sub-scale of interaction between nurses improved in the intervention unit during the study period (pre--4.85±0.93; post--5.36±0.89, p=0.002) with no significant increase in the control group. Factors independently related to higher PES-NWI included

  14. Pre-registration nursing student's quality of practice learning: Clinical learning environment inventory (actual) questionnaire.

    Science.gov (United States)

    Shivers, Eleanor; Hasson, Felicity; Slater, Paul

    2017-08-01

    Clinical learning is a vital component of nurse education and assessing student's experiences can provide useful insights for development. Whilst most research in this area has focused on the acute setting little attention has been given to all pre-registration nurses' experience across the clinical placements arenas. To examine of pre-registration nursing students (first, second and third year) assessment of their actual experiences of their most recent clinical learning clinical learning experience. A cross sectional survey involving a descriptive online anonymous questionnaire based on the clinical learning environment inventory tool. One higher education institution in the United Kingdom. Nursing students (n=147) enrolled in an undergraduate nursing degree. This questionnaire included demographic questions and the Clinical Learning Environment Inventory (CLEI) a 42 item tool measuring student's satisfaction with clinical placement. SPPS version 22 was employed to analyse data with descriptive and inferential statistics. Overall students were satisfied with their clinical learning experience across all placement areas. This was linked to the 6 constructs of the clinical learning environment inventory; personalization, innovation, individualization, task orientation, involvement, satisfaction. Significant differences in student experience were noted between age groups and student year but there was no difference noted between placement type, age and gender. Nursing students had a positive perception of their clinical learning experience, although there remains room for improvement. Enabling a greater understanding of students' perspective on the quality of clinical education is important for nursing education and future research. Copyright © 2017. Published by Elsevier Ltd.

  15. Effects of Whey Protein Supplementation Pre- or Post-Resistance Training on Muscle Mass, Muscular Strength, and Functional Capacity in Pre-Conditioned Older Women: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Hellen C. G. Nabuco

    2018-05-01

    Full Text Available Aging is associated with sarcopenia and dynapenia, with both processes contributing to functional dependence and mortality in older adults. Resistance training (RT and increased protein intake are strategies that may contribute to health improvements in older adults. Therefore, the aim was to investigate the effects of whey protein (WP supplementation consumed either immediately pre- or post-RT on skeletal muscle mass (SMM, muscular strength, and functional capacity in pre-conditioned older women. Seventy older women participated in this investigation and were randomly assigned to one of three groups: whey protein pre-RT and placebo post-RT (WP-PLA, n = 24, placebo pre-RT and whey protein post-RT (PLA-WP, n = 23, and placebo pre- and post-RT (PLA-PLA, n = 23. Each group ingested 35 g of WP or PLA. The RT program was carried out over 12 weeks (three times per week; 3 × 8–12 repetition maximum. Body composition, muscular strength, functional capacity, and dietary intake were assessed pre- and post-intervention. Two-way analysis of covariance (ANCOVA for repeated measures, with baseline scores as covariates were used for data analysis. A time vs. group interaction (p < 0.05 was observed with WP-PLA and PLA-WP presenting greater increases compared with PLA-PLA for SMM (WP-PLA = 3.4%; PLA-WP = 4.2%; PLA-PLA = 2.0%, strength (WP-PLA = 8.1%; PLA-WP = 8.3%; PLA-PLA = 7.0%, and the 10-m walk test (WP-PLA = −10.8%; PLA-WP = −11.8%; PLA-PLA = −4.3%. Whey protein supplementation was effective in promoting increases in SMM, muscular strength, and functional capacity in pre-conditioned older women, regardless of supplementation timing. This trial was registered at ClinicalTrials.gov: NCT03247192.

  16. Return to work after cancer and pre-cancer job dissatisfaction

    DEFF Research Database (Denmark)

    Heinesen, Eskil; Kolodziejczyk, Christophe; Ladenburg, Jacob

    2017-01-01

    We investigate the association between pre-cancer job dissatisfaction and return-to-work probability 3 years after a cancer diagnosis. We use a Danish data set combining administrative data and a survey to breast and colon cancer survivors. We find that the return-to-work probability has a negative...... correlation with pre-cancer job dissatisfaction with mental demands (where the correlation is driven by the high-educated) and with physical demands and the superior (where the correlation is driven by the low-educated). Educational gradients in the probability of returning to work after cancer...... are not significantly affected by controlling for pre-cancer job dissatisfaction and pre-cancer ability to work....

  17. 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.

  18. Efficiency of the pre-heater against flow rate on primary the beta test loop

    International Nuclear Information System (INIS)

    Edy Sumarno; Kiswanta; Bambang Heru; Ainur R; Joko P

    2013-01-01

    Calculation of efficiency of the pre-heater has been carried out against the flow rate on primary the BETA Test Loop. BETA test loop (UUB) is a facilities of experiments to study the thermal hydraulic phenomenon, especially for thermal hydraulic post-LOCA (Lost of Coolant Accident). Sequences removal on the BETA Test Loop contained a pre-heater that serves as a getter heat from the primary side to the secondary side, determination of efficiency is to compare the incoming heat energy with the energy taken out by a secondary fluid. Characterization is intended to determine the performance of a pre-heater, then used as tool for analysis, and as a reference design experiments. Calculation of efficiency methods performed by operating the pre-heater with fluid flow rate variation on the primary side. Calculation of efficiency on the results obtained that the efficiency change with every change of flow rate, the flow rate is 71.26% on 163.50 ml/s and 60.65% on 850.90 ml/s. Efficiency value can be even greater if the pre-heater tank is wrapped with thermal insulation so there is no heat leakage. (author)

  19. Pre-clinical evaluation of an inverse planning module for segmental MLC based IMRT delivery

    International Nuclear Information System (INIS)

    Georg, Dietmar; Kroupa, Bernhard

    2002-01-01

    Phantom tests are performed for pre-clinical evaluation of a commercial inverse planning system (HELAX TMS, V 6.0) for segmented multileaf collimator (MLC) intensity modulated radiotherapy (IMRT) delivery. The optimization module has available two optimization algorithms: the target primary feasibility and the weighted feasibility algorithm, only the latter allows the user to specify weights for structures. In the first series, single beam tests are performed to evaluate the outcome of inverse planning in terms of plausibility for the following situations: oblique incidence, presence of inhomogeneities, multiple targets at different depths and multiple targets with different desired doses. Additionally, for these tests a manual plan is made for comparison. In the absence of organs at risk, both the optimization algorithms are found to assign the highest priority to low dose constraints for targets. In the second series, tests resembling clinical relevant configurations (simultaneous boost and concave target with critical organ) are performed with multiple beam arrangements in order to determine the impact of the system's configuration on inverse planning. It is found that the definition of certain segment number and segment size limitations does not largely compromise treatment plans when using multiple beams. On the other hand, these limitations are important for delivery efficiency and dosimetry. For the number of iterations and voxels per volume of interest, standard values in the system's configuration are considered to be sufficient. Additionally, it is demonstrated that precautions must be taken to precisely define treatment goals when using computerized treatment optimization. Similar phantom tests could be used for a direct dosimetric verification of all steps from inverse treatment planning to IMRT delivery. (note)

  20. Pre-symptomatic increase in urine-orosomucoid excretion in pre-eclamptic women

    DEFF Research Database (Denmark)

    Kronborg, Camilla Skovhus; Allen, Jim; Vittinghus, Erik

    2007-01-01

    , 32 women developed pre-eclampsia, and 5 controls for every case of pre-eclampsia were found. Blood samples were collected 4 times and urine samples 6 times from the 18/19th week and throughout pregnancy. Orosomucoid and albumin in plasma were analysed by standard methods, and in urine by sandwich...... in orosomucoid. In the plasma samples, orosomucoid was significantly higher late in pre-eclamptic pregnancies (>or=36th week, p=0.0275). CONCLUSIONS: Pre-eclampsia is associated with a pre-symptomatic increase in the urine excretion of orosomucoid, and orosomucoid excretion precedes that of albumin. Orosomucoid...... excretion can probably be used as a prognostic tool in combination with other screening methods, and seems to be a more sensitive marker for evolving pre-eclampsia than albumin. Plasma orosomucoid is significantly increased late in pre-eclampsia. Thus, the increased excretion of orosomucoid must primarily...

  1. Evaluation of the theory-based Quality Improvement in Physical Therapy (QUIP) programme: a one-group, pre-test post-test pilot study.

    Science.gov (United States)

    Rutten, Geert M; Harting, Janneke; Bartholomew, L Kay; Schlief, Angelique; Oostendorp, Rob A B; de Vries, Nanne K

    2013-05-25

    Guideline adherence in physical therapy is far from optimal, which has consequences for the effectiveness and efficiency of physical therapy care. Programmes to enhance guideline adherence have, so far, been relatively ineffective. We systematically developed a theory-based Quality Improvement in Physical Therapy (QUIP) programme aimed at the individual performance level (practicing physiotherapists; PTs) and the practice organization level (practice quality manager; PQM). The aim of the study was to pilot test the multilevel QUIP programme's effectiveness and the fidelity, acceptability and feasibility of its implementation. A one-group, pre-test, post-test pilot study (N = 8 practices; N = 32 PTs, 8 of whom were also PQMs) done between September and December 2009. Guideline adherence was measured using clinical vignettes that addressed 12 quality indicators reflecting the guidelines' main recommendations. Determinants of adherence were measured using quantitative methods (questionnaires). Delivery of the programme and management changes were assessed using qualitative methods (observations, group interviews, and document analyses). Changes in adherence and determinants were tested in the paired samples T-tests and expressed in effect sizes (Cohen's d). Overall adherence did not change (3.1%; p = .138). Adherence to three quality indicators improved (8%, 24%, 43%; .000 ≤ p ≤ .023). Adherence to one quality indicator decreased (-15.7%; p = .004). Scores on various determinants of individual performance improved and favourable changes at practice organizational level were observed. Improvements were associated with the programme's multilevel approach, collective goal setting, and the application of self-regulation; unfavourable findings with programme deficits. The one-group pre-test post-test design limits the internal validity of the study, the self-selected sample its external validity. The QUIP programme has the potential to change physical

  2. ASK Procedure for Instrumented Pre-cracked Charpy-Type Tests

    International Nuclear Information System (INIS)

    Varga, T.; Njo, D.H.; Prantl, G.

    1981-01-01

    The essential technical content of the ASK procedure originated from development work in Switzerland since 1963, and practical experiences gained since 1972. The remainder of the content and the format of the procedure are based on the ASTM E 24.03.03. (Tentative Draft Copy) 'Proposed Method for Pre-cracked Charpy Impact and Slow-Bend Testing of Metallic Materials' by C. E. Harbower, 1973. Two different velocities, 5 m/s and 0.1 m/s were used with a Schnadt-type machine of rigid construction. The stiffness of the machine proved to be very suitable for instrumented testing. The instrumented Schnadt-Type machine was equipped with strain gauges both on the top of the pendulum and on the chisel. A static force calibration was followed by energy calibration, comparing potential energy losses with the area under the force-deflection curve. Deflection was measured using a high frequency eddy current method on the pendulum, and for slow testing by means of an inductive gauge on the chisel. Charpy-Type specimens of 1.0 mm max notch depth and 0.12 mm max notch radius were pre-cracked using a resonant fatigue testing machine, or an eccentric drive machine. Crack propagation rate da/dN was measured using 'Russenberger' measuring gauges. In addition a new technique for the detection of dynamic crack initiation, developed at the Institute of Research and Technology (TVFA) in Vienna is discussed and some results presented

  3. Learning style preferences among pre-clinical medical students

    Directory of Open Access Journals (Sweden)

    Aye Aye Mon

    2014-02-01

    Full Text Available Generally, different students employ different learning styles dur-ing their studies and medical students are exposed to diverse methods of teaching. Therefore, understanding students’ learning style preference is an important consideration for a high quality and effective teaching and learning process.The aim of the study was to study the variation of learning styles among pre-clinical medical students of SEGi University, Malaysia. A cross-sectional study was performed by using VARK (Visual, Audio, Reading and Kinaesthetic questionnaire version 7.2 to assess the learning style preference of 98 (n=98 pre-clinical medical students in SEGi University. The questionnaire consists of 16 items which identify four different learning styles: visual, aural, reading/writing and kin-esthetic. Descriptive statistics were used to identify the learning styles of students. 61 students preferred multimodal as their learning style, out of which 43 (70% of them were female stu-dents and 18 (30% were male students. 37 students preferred unimodal as their learning style out of which 22 (59% of them were female students and 15 (41% were male students. In addi-tion, female students had more diverse preferences than male students by having 10 out of the other 11 possible combinations in multimodal learning style of preference, whereas the male stu-dents only had 5 out of the 11 combinations. In this study, there was no significant gender difference in the percentages of males and female students who preferred unimodal and multimodal styles of information presentation (P= 0.263; α=0.05. To con-clude, the majority of students of both genders had chosen quad-modal as their learning style preference. The results of this study can provide useful information for improving the quality of the teaching and learning experiences of students.

  4. Pre-test analyses for the NESC1 spinning cylinder experiment

    International Nuclear Information System (INIS)

    Fokkens, J.H.

    1995-10-01

    The spinning cylinder experiment organised by the Network for the Evaluation of Steel Components (NESC) is designed to investigate the cleavage initiation behaviour of both surface breaking and subclad defects in simulated end of life RPV material, exposed to a pressurised thermal shock transient. Pre-test structural integrity assessments are performed by the NESC Structural Analysis Task Group (TG3). The results of these structural integrity assessments are used to determine the design of the experiment and especially the sizes of the introduced defects. In this report the results of the pre-test analyses performed by the group Applied Mechanics at ECN - Nuclear Energy are described. Elastic as well as elasto-plastic structural analyses are performed for a surface breaking and a subclad defect in a forged cylinder with a 4 mm cladding. The semi elliptical defects have a depth of 40 mm and an aspect ratio of 1:3. (orig.)

  5. Challenges of Pre- and Post-Test Counseling for Orthodox Jewish Individuals in the Premarital Phase.

    Science.gov (United States)

    Rose, E; Schreiber-Agus, N; Bajaj, K; Klugman, S; Goldwaser, T

    2016-02-01

    The Jewish community has traditionally taken ownership of its health, and has taken great strides to raise awareness about genetic issues that affect the community, such as Tay-Sachs disease and Hereditary Breast and Ovarian Cancer syndrome. Thanks in part to these heightened awareness efforts, many Orthodox Jewish individuals are now using genetics services as they begin to plan their families. Due to unique cultural and religious beliefs and perceptions, the Orthodox Jewish patients who seek genetic counseling face many barriers to a successful counseling session, and often seek the guidance of programs such as the Program for Jewish Genetic Health (PJGH). In this article, we present clinical vignettes from the PJGH's clinical affiliate, the Reproductive Genetics practice at the Montefiore Medical Center. These cases highlight unique features of contemporary premarital counseling and screening within the Orthodox Jewish Community, including concerns surrounding stigma, disclosure, "marriageability," the use of reproductive technologies, and the desire to include a third party in decision making. Our vignettes demonstrate the importance of culturally-sensitive counseling. We provide strategies and points to consider when addressing the challenges of pre- and post-test counseling as it relates to genetic testing in this population.

  6. Depression, Fatigue, and Pre-Sleep Arousal: A Mediation Model

    Science.gov (United States)

    Karlson, Cynthia W.; Stevens, Natalie R.; Olson, Christy A.; Hamilton, Nancy A.

    2010-01-01

    Fatigue is a common and debilitating symptom of clinical depression; however, the causes are not well understood. The present study was designed to test the hypotheses that subjective sleep, objective sleep, and arousal in the pre-sleep state would mediate the relationship between depression status and fatigue. Sleep, pre-sleep arousal, and…

  7. Clinical leadership as an integral curriculum thread in pre-registration nursing programmes.

    Science.gov (United States)

    Brown, Angela; Dewing, Jan; Crookes, Patrick

    2016-03-01

    In recent years there has been a growth in leadership development frameworks in health for the existing workforce. There has also been a related abundance of leadership programmes developed specifically for qualified nurses. There is a groundswell of opinion that clinical leadership preparation needs to extend to preparatory programmes leading to registration as a nurse. To this end a doctoral research study has been completed that focused specifically on the identification and verification of the antecedents of clinical leadership (leadership and management) so they can shape the curriculum content and the best way to deliver the curriculum content as a curriculum thread. To conceptualise how the curriculum content, identified and verified empirically, can be structured within a curriculum thread and to contribute to the discussion on effective pedagogical approaches and educational strategies for learning and teaching of clinical leadership. A multi-method design was utilised in the research in Australia. Drawing on core principles in critical social theory, an integral curriculum thread is proposed for pre-registration nursing programmes that identifies the antecedents of clinical leadership; the core concepts, together with the continuum of enlightenment, empowerment, and emancipation. The curriculum content, the effective pedagogical approaches and the educational strategies are supported theoretically and we believe this offers a design template for action and a way of thinking about this important aspect of preparatory nursing education. Moreover, we hope to have created a process contributing to a heighten sense of awareness in the nursing student (and other key stakeholders) of the what, how and when of clinical leadership for a novice registered nurse. The next stage is to further test through research the proposed integral curriculum thread. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Evaluation of the effect of high-dose folic acid on endothelial dysfunction in pre-eclamptic patients: A randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Mohammad Hashemi

    2016-01-01

    Full Text Available Background: Pre-eclampsia as a hypertensive disorder of pregnancy complicates up to 5–10% of pregnancies worldwide. Endothelial dysfunction plays an important role in the pathogenesis of pre-eclampsia. In this study, we aim to evaluate the effect of high-dose folic acid on endothelial dysfunction in pre-eclamptic patients. Materials and Methods: In this triple-blinded randomized clinical trial, the enrolled patients were divided randomly into two groups. Folic acid 5.0 mg or placebo was taken daily by oral administration from the initiation of diagnosis until 2 months after delivery by the participants. Every patient's flow-mediated dilation (FMD was evaluated at the beginning of the study and 2 months after delivery with the same experienced operator at the same period of time (3–5 p.m. by high-resolution B-mode ultrasonography. Potential confounding variables were included in the independent samples t-test. t-test or Mann–Whitney U-test was used in the comparison of means between the intervention and placebo groups. To compare FMD in each group, before and after the intervention, paired t-test was used. Results: Mean value of FMD in intervention (9.64 ± 5.57 and control group (9.30 ± 4.25 has no significant difference before the consumption of drugs (P < 0.05. FMD in intervention group (13.72 ± 7.89 significantly increases after daily consumption of 5 mg folic acid in comparison with control group (10.02 ± 4.81 after daily consumption of placebo (P = 0.002. Conclusion: Increased mean of FMD in intervention group shows that this supplement can improve endothelial function and can be significantly affected by maternal blood pressure during pregnancy and some endothelium-dependent disease such as pre-eclampsia and its associated adverse outcomes.

  9. Clinical leadership development in a pre-registration nursing curriculum: What the profession has to say about it.

    Science.gov (United States)

    Brown, Angela; Crookes, Patrick; Dewing, Jan

    2016-01-01

    In the last decade literature, inquiries and reports into the short comings in health services have highlighted the vital role of leadership in clinical practice and the impact on patient care and effective workplace culture. Whilst there is an abundance of literature on leadership and the registered nursing workforce, an international literature review revealed there is very little known on leadership development in pre-registration nursing programmes. To identify what the profession's views are on proposed indicative curriculum content suggested for clinical leadership development in a pre-registration nursing degree in Australia. This is a multi-method research study. This paper presents the development and results of one aspect of the study, a national online survey. Nurses: clinicians, managers and academics. In the absence of a strong evidence base in the literature review, additional pre-requisite curriculum content was augmented from the work of two published frameworks of leadership and management. From this a 67-item survey was designed to ask the profession whether the aggregated content is a reasonable view of what should be included in a pre-registration programme to develop clinical leadership. The survey sought the views of nurses on whether the proposed content was relevant (yes/no) and their opinion on whether it is significant via a 5-point Likert scale. Descriptive and chi-square analyses were performed in SPSS v.19. A total of 418 nurses completed the survey; there was consensus amongst the profession on what is considered relevant and important in a pre-registration nursing programme. The content identified could be considered indicative and pre-requisite to include in a pre-registration nursing programme. Members of the nursing profession in Australia have clear views about this. The next step is to design and evaluate a purposeful pedagogical approach and curriculum, leading to the development of clinical leadership knowledge, skills and

  10. Probability of Transmission of Malaria from Mosquito to Human Is Regulated by Mosquito Parasite Density in Naïve and Vaccinated Hosts.

    Directory of Open Access Journals (Sweden)

    Thomas S Churcher

    2017-01-01

    Full Text Available Over a century since Ronald Ross discovered that malaria is caused by the bite of an infectious mosquito it is still unclear how the number of parasites injected influences disease transmission. Currently it is assumed that all mosquitoes with salivary gland sporozoites are equally infectious irrespective of the number of parasites they harbour, though this has never been rigorously tested. Here we analyse >1000 experimental infections of humans and mice and demonstrate a dose-dependency for probability of infection and the length of the host pre-patent period. Mosquitoes with a higher numbers of sporozoites in their salivary glands following blood-feeding are more likely to have caused infection (and have done so quicker than mosquitoes with fewer parasites. A similar dose response for the probability of infection was seen for humans given a pre-erythrocytic vaccine candidate targeting circumsporozoite protein (CSP, and in mice with and without transfusion of anti-CSP antibodies. These interventions prevented infection more efficiently from bites made by mosquitoes with fewer parasites. The importance of parasite number has widespread implications across malariology, ranging from our basic understanding of the parasite, how vaccines are evaluated and the way in which transmission should be measured in the field. It also provides direct evidence for why the only registered malaria vaccine RTS,S was partially effective in recent clinical trials.

  11. Bayes factor and posterior probability: Complementary statistical evidence to p-value.

    Science.gov (United States)

    Lin, Ruitao; Yin, Guosheng

    2015-09-01

    As a convention, a p-value is often computed in hypothesis testing and compared with the nominal level of 0.05 to determine whether to reject the null hypothesis. Although the smaller the p-value, the more significant the statistical test, it is difficult to perceive the p-value in a probability scale and quantify it as the strength of the data against the null hypothesis. In contrast, the Bayesian posterior probability of the null hypothesis has an explicit interpretation of how strong the data support the null. We make a comparison of the p-value and the posterior probability by considering a recent clinical trial. The results show that even when we reject the null hypothesis, there is still a substantial probability (around 20%) that the null is true. Not only should we examine whether the data would have rarely occurred under the null hypothesis, but we also need to know whether the data would be rare under the alternative. As a result, the p-value only provides one side of the information, for which the Bayes factor and posterior probability may offer complementary evidence. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. A Teaching Method on Basic Chemistry for Freshman (II) : Teaching Method with Pre-test and Post-test

    OpenAIRE

    立木, 次郎; 武井, 庚二

    2004-01-01

    This report deals with review of a teaching method on basic chemistry for freshman in this first semester. We tried to review this teaching method with pre-test and post-test by means of the official and private questionnaires. Several hints and thoughts on teaching skills are obtained from this analysis.

  13. Thermal and mechanical quantitative sensory testing in Chinese patients with burning mouth syndrome--a probable neuropathic pain condition?

    Science.gov (United States)

    Mo, Xueyin; Zhang, Jinglu; Fan, Yuan; Svensson, Peter; Wang, Kelun

    2015-01-01

    To explore the hypothesis that burning mouth syndrome (BMS) probably is a neuropathic pain condition, thermal and mechanical sensory and pain thresholds were tested and compared with age- and gender-matched control participants using a standardized battery of psychophysical techniques. Twenty-five BMS patients (men: 8, women: 17, age: 49.5 ± 11.4 years) and 19 age- and gender-matched healthy control participants were included. The cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT), heat pain threshold (HPT), mechanical detection threshold (MDT) and mechanical pain threshold (MPT), in accordance with the German Network of Neuropathic Pain guidelines, were measured at the following four sites: the dorsum of the left hand (hand), the skin at the mental foramen (chin), on the tip of the tongue (tongue), and the mucosa of the lower lip (lip). Statistical analysis was performed using ANOVA with repeated measures to compare the means within and between groups. Furthermore, Z-score profiles were generated, and exploratory correlation analyses between QST and clinical variables were performed. Two-tailed tests with a significance level of 5 % were used throughout. CDTs (P < 0.02) were significantly lower (less sensitivity) and HPTs (P < 0.001) were significantly higher (less sensitivity) at the tongue and lip in BMS patients compared to control participants. WDT (P = 0.007) was also significantly higher at the tongue in BMS patients compared to control subjects . There were no significant differences in MDT and MPT between the BMS patients and healthy subjects at any of the four test sites. Z-scores showed that significant loss of function can be identified for CDT (Z-scores = -0.9±1.1) and HPT (Z-scores = 1.5±0.4). There were no significant correlations between QST and clinical variables (pain intensity, duration, depressions scores). BMS patients had a significant loss of thermal function but not

  14. Achievement of course outcome in vector calculus pre-test questions ...

    African Journals Online (AJOL)

    No Abstract. Keywords: pre-test; course outcome; bloom taxanomy; Rasch measurement model; vector calculus. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians ...

  15. Receiver-operating characteristic curves and likelihood ratios: improvements over traditional methods for the evaluation and application of veterinary clinical pathology tests

    DEFF Research Database (Denmark)

    Gardner, Ian A.; Greiner, Matthias

    2006-01-01

    Receiver-operating characteristic (ROC) curves provide a cutoff-independent method for the evaluation of continuous or ordinal tests used in clinical pathology laboratories. The area under the curve is a useful overall measure of test accuracy and can be used to compare different tests (or...... different equipment) used by the same tester, as well as the accuracy of different diagnosticians that use the same test material. To date, ROC analysis has not been widely used in veterinary clinical pathology studies, although it should be considered a useful complement to estimates of sensitivity...... and specificity in test evaluation studies. In addition, calculation of likelihood ratios can potentially improve the clinical utility of such studies because likelihood ratios provide an indication of how the post-test probability changes as a function of the magnitude of the test results. For ordinal test...

  16. Empirical Investigation of Job Applicants' Reactions to Taking a Pre-Employment Honesty Test.

    Science.gov (United States)

    Jones, John W.; Joy, Dennis

    Employee theft is widespread and difficult to detect. Many companies have attempted to control the employee theft problem through pre-employment screening. The use of paper-and-pencil honesty tests in this process has become increasingly common. These two studies empirically investigated job applicants' (N=450) reactions to taking a pre-employment…

  17. Curriculum content and assessment of pre-clinical dental skills: A survey of undergraduate dental education in Europe.

    Science.gov (United States)

    Field, J; Stone, S; Orsini, C; Hussain, A; Vital, S; Crothers, A; Walmsley, D

    2018-05-01

    Since 1981, the qualifications for various healthcare professionals across the European Union have enjoyed mutual recognition in accordance with the EU Directive 81/1057/EEC. Whilst the directive includes dental practitioners, it is recognised that significant variation exists in curriculum structure, content and scope of practice across institutions. This article aimed to explore pan-European practice in relation to curriculum content, teaching and learning strategies and assessment of pre-clinical dental skills. A request to complete an online questionnaire, in English, was sent electronically to skills leads at all Association of Dental Education in Europe member schools. The questionnaire collected information in relation to institution and country, regulatory requirements to demonstrate safety, details of specific pre-clinical skills courses, learning materials and teaching staff. Forty-eight institutions, from 25 European countries responded. Seven countries (n=7, 28%) reported no requirement to demonstrate student operative safety prior to patient treatment. Several core and operative clinical skills are common to the majority of institutions. The most commonly taught core skills related directly to the clinical environment such as cross-infection control and hand washing. The least common were skills that indirectly related to patient care, such as communication skills and working as a team. There are clear differences within European pre-clinical dental education, and greater efforts are needed to demonstrate that all European students are fit to practice before they start treating patients. Learning outcomes, teaching activities and assessment activities of pre-clinical skills should be shared collaboratively to further standardise curricula. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Assessment of Oral Fluid HIV Test Performance in an HIV Pre-Exposure Prophylaxis Trial in Bangkok, Thailand.

    Directory of Open Access Journals (Sweden)

    Pravan Suntharasamai

    Full Text Available Rapid easy-to-use HIV tests offer opportunities to increase HIV testing among populations at risk of infection. We used the OraQuick Rapid HIV-1/2 antibody test (OraQuick in the Bangkok Tenofovir Study, an HIV pre-exposure prophylaxis trial among people who inject drugs.The Bangkok Tenofovir Study was a randomized, double-blind, placebo-controlled trial. We tested participants' oral fluid for HIV using OraQuick monthly and blood using a nucleic-acid amplification test (NAAT every 3 months. We used Kaplan-Meier methods to estimate the duration from a positive HIV NAAT until the mid-point between the last non-reactive and first reactive oral fluid test and proportional hazards to examine factors associated with the time until the test was reactive.We screened 3678 people for HIV using OraQuick. Among 447 with reactive results, 436 (97.5% were confirmed HIV-infected, 10 (2.2% HIV-uninfected, and one (0.2% had indeterminate results. Two participants with non-reactive OraQuick results were, in fact, HIV-infected at screening yielding 99.5% sensitivity, 99.7% specificity, a 97.8% positive predictive value, and a 99.9% negative predictive value. Participants receiving tenofovir took longer to develop a reactive OraQuick (191.8 days than participants receiving placebo (16.8 days (p = 0.02 and participants infected with HIV CRF01_AE developed a reactive OraQuick earlier than participants infected with other subtypes (p = 0.04.The oral fluid HIV test performed well at screening, suggesting it can be used when rapid results and non-invasive tools are preferred. However, participants receiving tenofovir took longer to develop a reactive oral fluid test result than those receiving placebo. Thus, among people using pre-exposure prophylaxis, a blood-based HIV test may be an appropriate choice.ClinicalTrials.gov NCT00119106.

  19. Approximation of Measurement Results of “Emergency” Signal Reception Probability

    Directory of Open Access Journals (Sweden)

    Gajda Stanisław

    2017-08-01

    Full Text Available The intended aim of this article is to present approximation results of the exemplary measurements of EMERGENCY signal reception probability. The probability is under-stood as a distance function between the aircraft and a ground-based system under established conditions. The measurements were approximated using the properties of logistic functions. This probability, as a distance function, enables to determine the range of the EMERGENCY signal for a pre-set confidence level.

  20. A Functional Neuroimaging Analysis of the Trail Making Test-B: Implications for Clinical Application

    Directory of Open Access Journals (Sweden)

    Mark D. Allen

    2011-01-01

    Full Text Available Recent progress has been made using fMRI as a clinical assessment tool, often employing analogues of traditional “paper and pencil” tests. The Trail Making Test (TMT, popular for years as a neuropsychological exam, has been largely ignored in the realm of neuroimaging, most likely because its physical format and administration does not lend itself to straightforward adaptation as an fMRI paradigm. Likewise, there is relatively more ambiguity about the neural systems associated with this test than many other tests of comparable clinical use. In this study, we describe an fMRI version of Trail Making Test-B (TMTB that maintains the core functionality of the TMT while optimizing its use for both research and clinical settings. Subjects (N = 32 were administered the Functional Trail Making Test-B (f-TMTB. Brain region activations elicited by the f-TMTB were consistent with expectations given by prior TMT neurophysiological studies, including significant activations in the ventral and dorsal visual pathways and the medial pre-supplementary motor area. The f-TMTB was further evaluated for concurrent validity with the traditional TMTB using an additional sample of control subjects (N = 100. Together, these results support the f-TMTB as a viable neuroimaging adaptation of the TMT that is optimized to evoke maximally robust fMRI activation with minimal time and equipment requirements.

  1. Initial clinical test of a breast-PET scanner

    International Nuclear Information System (INIS)

    Raylman, Raymond R.; Koren, Courtney; Schreiman, Judith S.; Majewski, Stan; Marano, Gary D.; Abraham, Jame; Kurian, Sobha; Hazard, Hannah; Filburn, Shannon

    2011-01-01

    The goal of this initial clinical study was to test a new positron emission/tomography imager and biopsy system (PEM/PET) in a small group of selected subjects to assess its clinical imaging capabilities. Specifically, the main task of this study is to determine whether the new system can successfully be used to produce images of known breast cancer and compare them to those acquired by standard techniques. The PEM/PET system consists of two pairs of rotating radiation detectors located beneath a patient table. The scanner has a spatial resolution of ∼2 mm in all three dimensions. The subjects consisted of five patients diagnosed with locally advanced breast cancer ranging in age from 40 to 55 years old scheduled for pre-treatment, conventional whole body PET imaging with F-18 Fluorodeoxyglucose (FDG). The primary lesions were at least 2 cm in diameter. The images from the PEM/PET system demonstrated that this system is capable of identifying some lesions not visible in standard mammograms. Furthermore, while the relatively large lesions imaged in this study where all visualised by a standard whole body PET/CT scanner, some of the morphology of the tumours (ductal infiltration, for example) was better defined with the PEM/PET system. Significantly, these images were obtained immediately following a standard whole body PET scan. The initial testing of the new PEM/PET system demonstrated that the new system is capable of producing good quality breast-PET images compared standard methods.

  2. Predictive validity of pre-admission assessments on medical student performance.

    Science.gov (United States)

    Dabaliz, Al-Awwab; Kaadan, Samy; Dabbagh, M Marwan; Barakat, Abdulaziz; Shareef, Mohammad Abrar; Al-Tannir, Mohamad; Obeidat, Akef; Mohamed, Ayman

    2017-11-24

    To examine the predictive validity of pre-admission variables on students' performance in a medical school in Saudi Arabia. In this retrospective study, we collected admission and college performance data for 737 students in preclinical and clinical years. Data included high school scores and other standardized test scores, such as those of the National Achievement Test and the General Aptitude Test. Additionally, we included the scores of the Test of English as a Foreign Language (TOEFL) and the International English Language Testing System (IELTS) exams. Those datasets were then compared with college performance indicators, namely the cumulative Grade Point Average (cGPA) and progress test, using multivariate linear regression analysis. In preclinical years, both the National Achievement Test (p=0.04, B=0.08) and TOEFL (p=0.017, B=0.01) scores were positive predictors of cGPA, whereas the General Aptitude Test (p=0.048, B=-0.05) negatively predicted cGPA. Moreover, none of the pre-admission variables were predictive of progress test performance in the same group. On the other hand, none of the pre-admission variables were predictive of cGPA in clinical years. Overall, cGPA strongly predict-ed students' progress test performance (p<0.001 and B=19.02). Only the National Achievement Test and TOEFL significantly predicted performance in preclinical years. However, these variables do not predict progress test performance, meaning that they do not predict the functional knowledge reflected in the progress test. We report various strengths and deficiencies in the current medical college admission criteria, and call for employing more sensitive and valid ones that predict student performance and functional knowledge, especially in the clinical years.

  3. Development, validation, and application of ELISA for detection of anti-HD105 antibodies in pre-clinical safety evaluation using monkeys.

    Science.gov (United States)

    Choi, Woo Hyuck; Jo, Hye Ryun; Jeon, Eun-Jeong; Youm, So-Young; Jeon, Jang Su; Son, Yong-Gyu; You, Weon-Kyoo; Koh, Woo Suk; Lee, Sang Hoon; Kim, Sang Kyum

    2016-11-30

    Unwanted immunogenicity of protein therapeutics can result in severe side effects and should be assessed in animals before applying the treatment to humans. Monkeys are the most relevant choice for pre-clinical toxicity testing of antibody-based therapeutics. To assess the immunogenicity of HD105, a novel antibody therapeutic that targets both vascular endothelial growth factor and Delta-like-ligand 4, a bridging enzyme-linked immunosorbent assay was developed as an anti-drug antibody (ADA) assay and validated for use in pre-clinical studies using non-human primates. This method was found to have suitable assay sensitivity, intra- and inter-assay precision, confirmation, drug tolerance, recovery, and sample stability for measuring ADA in monkey serum samples. The results showed that ADA elevation occurred following repeated doses of HD105, and that ADA production was negatively associated with serum HD105 concentration. These results suggest that intravenous administration of HD105 induces production of ADA in monkeys and that the detection of ADA may be negatively influenced by free HD105 in serum. Copyright © 2016 Elsevier B.V. All rights reserved.

  4. Finite-element pre-analysis for pressurized thermoshock tests

    International Nuclear Information System (INIS)

    Keinaenen, H.; Talja, H.; Lehtonen, M.; Rintamaa, R.; Bljumin, A.; Timofeev, B.

    1992-05-01

    The behaviour of a model pressure vessel is studied in a pressurized thermal shock loading. The tests were performed at the Prometey Institute in St. Petersburg. The calculations were performed at the Technical Research Centre of Finland. The report describes the preliminary finite-element analyses for the fourth, fifth and sixth thermoshock tests with the first model pressure vessel. Seven pressurized thermoshock tests were made with the same model using five different flaw geometries. In the first three tests the flaw was actually a blunt notch. In the two following tests (tests 4 and 5) a sharp pre-crack was produced before the test. In the last two test (tests 6 and 7) the old crack was used. According to the measurements and post-test ultrasonic examination of the crack front, the sixth test led to significant crack extension. Both temperatures and stresses were calculated using the finite-element method. The calculations were made using the idealized initial flaw geometry and preliminary material data. Both two-and three-dimensional models were used in the calculations. J-integral values were calculated from the elastic-plastic finite-element results. The stress intensity factor values were evaluated on the basis of the calculated J-integrals and compared with the preliminary material fracture toughness data obtained from the Prometey Institute

  5. FUMEX cases 1, 2, and 3 calculated pre-test and post-test results

    Energy Technology Data Exchange (ETDEWEB)

    Stefanova, S; Vitkova, M; Passage, G; Manolova, M; Simeonova, V [Bylgarska Akademiya na Naukite, Sofia (Bulgaria). Inst. za Yadrena Izsledvaniya i Yadrena Energetika; Scheglov, A; Proselkov, V [Russian Research Centre Kurchatov Inst., Moscow (Russian Federation); Kharalampieva, Ts [Kombinat Atomna Energetika, Kozloduj (Bulgaria)

    1994-12-31

    Two versions (modified pre-test and modified post-test) of PIN-micro code were used to analyse the fuel rod behaviour of three FUMEX experiments. The experience of applying PIN-micro code with its simple structure and old conception of the steady-state operation shows significant difficulties in treating the complex processes like those in FUMEX experiments. These difficulties were partially overcame through different model modifications and corrections based on special engineering estimations and the results obtained as a whole do not seem unreasonable. The calculations have been performed by a group from two Bulgarian institutions in collaboration with specialists from the Kurchatov Research Center. 1 tab., 14 figs., 8 refs.

  6. Probability and Statistics The Science of Uncertainty (Revised Edition)

    CERN Document Server

    Tabak, John

    2011-01-01

    Probability and Statistics, Revised Edition deals with the history of probability, describing the modern concept of randomness and examining "pre-probabilistic" ideas of what most people today would characterize as randomness. This revised book documents some historically important early uses of probability to illustrate some very important probabilistic questions. It goes on to explore statistics and the generations of mathematicians and non-mathematicians who began to address problems in statistical analysis, including the statistical structure of data sets as well as the theory of

  7. Event-related brain potentials, bilateral electrodermal activity and Mangina-Test performance in learning disabled/ADHD pre-adolescents with severe behavioral disorders as compared to age-matched normal controls.

    Science.gov (United States)

    Mangina, C A; Beuzeron-Mangina, J H; Grizenko, N

    2000-07-01

    The most frequently encountered developmental problems of learning disabilities/ADHD often co-exist with severe behavioral disorders. As a direct consequence, this condition opens the way to delinquency, school drop-out, depression, suicide, substance abuse, work absenteeism, and other psycho-social complications. In this paper, we are presenting a selective overview of our previous research and its clinical applications in this field as it relates to our present research data pertaining to the effects of our original Memory Workload Paradigm on the event-related brain potentials in differentiating normal and pathological pre-adolescents (learning disabled/ADHD with concomitant severe behavioral disorders such as oppositional and conduct). In addition, it provides data on the bilateral electrodermal activity during cognitive workload and Mangina-Test performance of pathological and normal pre-adolescents conducted in separate sessions. The results of our present research indicate that a significant memory load effect for the P450 latency (F(3,27)=4.98, PWorkload Paradigm in pre-frontal and frontal regions clearly differentiated normal from pathological pre-adolescents (F(1, 18)=12.21, Presearch findings provide an original and valuable demonstration of an integrative and effective clinical psychophysiological application of central (ERPs), autonomic (bilateral electrodermal activity) and neuro-psychometric aspects (Mangina-Test) which characterize normal and pathological pre-adolescents and underpin the neurophysiological basis of learning disabled/ADHD with severe behavioral disorders as opposed to normal subjects.

  8. Evaluation of test-strategies for estimating probability of low prevalence of paratuberculosis in Danish dairy herds

    DEFF Research Database (Denmark)

    Sergeant, E.S.G.; Nielsen, Søren S.; Toft, Nils

    2008-01-01

    of this study was to develop a method to estimate the probability of low within-herd prevalence of paratuberculosis for Danish dairy herds. A stochastic simulation model was developed using the R(R) programming environment. Features of this model included: use of age-specific estimates of test......-sensitivity and specificity; use of a distribution of observed values (rather than a fixed, low value) for design prevalence; and estimates of the probability of low prevalence (Pr-Low) based on a specific number of test-positive animals, rather than for a result less than or equal to a specified cut-point number of reactors....... Using this model, five herd-testing strategies were evaluated: (1) milk-ELISA on all lactating cows; (2) milk-ELISA on lactating cows 4 years old; (4) faecal culture on all lactating cows; and (5) milk-ELISA plus faecal culture in series on all lactating cows. The five testing strategies were evaluated...

  9. Behavior of pre-irradiated fuel under a simulated RIA condition. Results of NSRR Test JM-5

    International Nuclear Information System (INIS)

    Fuketa, Toyoshi; Sasajima, Hideo; Mori, Yukihide; Tanzawa, Sadamitsu; Ishijima, Kiyomi; Kobayashi, Shinsho; Kamata, Hiroshi; Homma, Kozo; Sakai, Haruyuki.

    1995-11-01

    This report presents results from the power burst experiment with pre-irradiated fuel rod, Test JM-5, conducted in the Nuclear Safety Research Reactor (NSRR). The data concerning test method, pre-irradiation, pre-pulse fuel examination, pulse irradiation, transient records and post-pulse fuel examination are described, and interpretations and discussions of the results are presented. Preceding to the pulse irradiation in the NSRR, test fuel rod was irradiated in the Japan Materials Testing Reactor (JMTR) up to a fuel burnup of 25.7 MWd/kgU with average linear heat rate of 33.4 kW/m. The fuel rod was subjected to the pulse irradiation resulting in a desposited energy of 223 ± 7 cal/g·fuel (0.93 ± 0.03 kJ/g·fuel) and a peak fuel enthalpy of 167 ± 5 cal/g·fuel (0.70 ± 0.02 kJ/g·fuel) under stagnant water cooling condition at atmospheric pressure and ambient temperature. Test fuel rod behavior was assessed from pre- and post-pulse fuel examinations and transient records during the pulse. The Test JM-5 resulted in cladding failure. More than twenty small cracks were found in the post-test cladding, and most of the defects located in pre-existing locally hydrided region. The result indicates an occurrence of fuel failure by PCMI (pellet/cladding mechanical interaction) in combination with decreased integrity of hydrided cladding. (author)

  10. Frailty Testing Pilot Study: Pros and Pitfalls.

    Science.gov (United States)

    Adlam, Taylor; Ulrich, Elizabeth; Kent, Missy; Malinzak, Lauren

    2018-02-01

    Frailty can be defined as an inflammatory state with a loss of physiologic reserve in multiple systems that manifests as a decreased ability to respond to stressors that ultimately leads to an increased risk of adverse outcomes. The aim of this study was to determine the ease of frailty testing in a pre-kidney transplant clinic and the resources required to do so. A secondary goal was to better understand the utility of frailty testing when evaluating potential kidney transplant recipients. Frailty testing was conducted at a pre-kidney transplant clinic in three phases using Fried's frailty phenotype (shrinking, exhaustion, low physical activity, slowness, and grip strength). A total of 132 frailty tests were completed on 128 patients. Frail patients had significantly higher rates of shrinking (26% vs. 8.5%, P testing was most complete when an examiner dedicated to frailty testing performed the testing. Frailty testing is feasible to complete in a pre-transplant clinic with an appropriate investment in personnel and resources.

  11. 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.

  12. Foundations of probability

    International Nuclear Information System (INIS)

    Fraassen, B.C. van

    1979-01-01

    The interpretation of probabilities in physical theories are considered, whether quantum or classical. The following points are discussed 1) the functions P(μ, Q) in terms of which states and propositions can be represented, are classical (Kolmogoroff) probabilities, formally speaking, 2) these probabilities are generally interpreted as themselves conditional, and the conditions are mutually incompatible where the observables are maximal and 3) testing of the theory typically takes the form of confronting the expectation values of observable Q calculated with probability measures P(μ, Q) for states μ; hence, of comparing the probabilities P(μ, Q)(E) with the frequencies of occurrence of the corresponding events. It seems that even the interpretation of quantum mechanics, in so far as it concerns what the theory says about the empirical (i.e. actual, observable) phenomena, deals with the confrontation of classical probability measures with observable frequencies. This confrontation is studied. (Auth./C.F.)

  13. Computational challenges and human factors influencing the design and use of clinical research participant eligibility pre-screening tools

    Directory of Open Access Journals (Sweden)

    Pressler Taylor R

    2012-05-01

    Full Text Available Abstract Background Clinical trials are the primary mechanism for advancing clinical care and evidenced-based practice, yet challenges with the recruitment of participants for such trials are widely recognized as a major barrier to these types of studies. Data warehouses (DW store large amounts of heterogenous clinical data that can be used to enhance recruitment practices, but multiple challenges exist when using a data warehouse for such activities, due to the manner of collection, management, integration, analysis, and dissemination of the data. A critical step in leveraging the DW for recruitment purposes is being able to match trial eligibility criteria to discrete and semi-structured data types in the data warehouse, though trial eligibility criteria tend to be written without concern for their computability. We present the multi-modal evaluation of a web-based tool that can be used for pre-screening patients for clinical trial eligibility and assess the ability of this tool to be practically used for clinical research pre-screening and recruitment. Methods The study used a validation study, usability testing, and a heuristic evaluation to evaluate and characterize the operational characteristics of the software as well as human factors affecting its use. Results Clinical trials from the Division of Cardiology and the Department of Family Medicine were used for this multi-modal evaluation, which included a validation study, usability study, and a heuristic evaluation. From the results of the validation study, the software demonstrated a positive predictive value (PPV of 54.12% and 0.7%, respectively, and a negative predictive value (NPV of 73.3% and 87.5%, respectively, for two types of clinical trials. Heuristic principles concerning error prevention and documentation were characterized as the major usability issues during the heuristic evaluation. Conclusions This software is intended to provide an initial list of eligible patients to a

  14. Pre-maxillary complex morphology in bilateral cleft and hypothesis on laterality of deviated pre-maxilla

    Directory of Open Access Journals (Sweden)

    Jyotsna Murthy

    2016-01-01

    Full Text Available Introduction: Pre-maxillary complex (pre-maxilla [PMX] + vomer morphology in bilateral complete cleft of primary and secondary palate (BCLCP is very complex and less reviewed in literature. Materials and Methods: In this retrospective cross-sectional study, 200 consecutive BCLCP patients were selected. Their pre-operative clinical photographs and dental casts were evaluated by a single investigator at two different points of time, to study the morphology of PMX and vomer with special emphasis on deviation of vomer and rotation of PMX. Results: It is found that in above 70% of patients, PMX and vomer both displaced or deviated towards left side in horizontal plane and PMX rotated anticlockwise at PMX vomerine suture (PVS. In 10% of cases, both PMX and vomer are displaced towards the right side, PMX rotated clockwise at PVS. In 11% of cases, vomer is displaced towards the left side, but PMX rotated clockwise at PVS. In 5% of cases, vomer is displaced towards the right side, but PMX rotated anticlockwise at PVS. Both PMX and vomer are in midline in 4% of cases. Conclusion: Specific morphological deviation of vomer and PMX has been studied. We put forward the probable hypothesis to explain the deviation and rotation of PMX.

  15. The potential of shark bone powder in breast cancer inhibition (pre-clinical study in DMBA-Induced Sprague Dawly Rats)

    Science.gov (United States)

    Bintari, S. H.; Parman, S.; Dafip, M.

    2018-03-01

    Breast cancer is a malignant disease, which lead to second cause of that after cervical cancer in women. To date, lots of drugs and supplement have been developed and consumed by patients. Shark bone is one of the supplements that might inhibit the proliferation of cancer cells. The application of shark bone powder for supplementation in breast cancer cases still becomes controversy; but until now people are still many who consume as a supplement. This study aimed to prove the potency of shark bone powder in the inhibition of breast cancer proliferation and to propose the possibility of its biological mechanism. The pre-clinical experimental study used a controlled posttest controlled design with 25 white rats strains of DML-induced Sprague-Dawley strains. The cancer markers observed were p53, AgNORs, VEGF, Bcl-2, and Cas-3. The test subjects were divided into 3 groups: control group and 2 treatment groups fed modified with 60% and 90% respectively. A pre-clinical trial of shark bone powder showed that there was significant inhibition for the DMBA-induced anti proliferation and breast cell cancer (p breast cancer proliferation lies in concentration 30mg/BB/day.

  16. Prediction of later clinical course by a specific glucose metabolic pattern in non-demented patients with probable REM sleep behavior disorder admitted to a memory clinic: A case study.

    Science.gov (United States)

    Ota, Kazumi; Fujishiro, Hiroshige; Kasanuki, Koji; Kondo, Daizo; Chiba, Yuhei; Murayama, Norio; Arai, Heii; Sato, Kiyoshi; Iseki, Eizo

    2016-02-28

    The present study is a follow-up study of 11 non-demented patients with probable rapid eye movement (REM) sleep behavior disorder (RBD) at our memory clinic. During the follow-up period (mean±SD of 46.7±6.4 months), all 11 patients exhibited cognitive decline: four (Group A) exhibited core clinical features of dementia with Lewy bodies (DLB), along with severe cognitive decline, and were subsequently diagnosed as having probable DLB; four (Group B) did not exhibit core clinical features of DLB; and the remaining three (Group C) were diagnosed as having Parkinson's disease with dementia (PDD). Positron emission tomography with fluorodeoxyglucose-F18 at baseline revealed that Groups A and B exhibited glucose hypometabolism in the occipital lobe, especially in the primary visual cortex, and Group A tended to present hypometabolism in the parieto-temporal area as well. Group C tended to present hypometabolism in the medial prefrontal area and anterior cingulate gyrus. Neuropsychological examinations indicated poor performance in verbal memory and visuoperception in all groups. This case study suggests that patterns of hypometabolism and neuropsychological examinations at baseline may be indicators of the later clinical course of probable RBD patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  17. Gratitude influences sleep through the mechanism of pre-sleep cognitions.

    Science.gov (United States)

    Wood, Alex M; Joseph, Stephen; Lloyd, Joanna; Atkins, Samuel

    2009-01-01

    To test whether individual differences in gratitude are related to sleep after controlling for neuroticism and other traits. To test whether pre-sleep cognitions are the mechanism underlying this relationship. A cross-sectional questionnaire study was conducted with a large (186 males, 215 females) community sample (ages=18-68 years, mean=24.89, S.D.=9.02), including 161 people (40%) scoring above 5 on the Pittsburgh Sleep Quality Index, indicating clinically impaired sleep. Measures included gratitude, the Pittsburgh Sleep Quality Index (PSQI), self-statement test of pre-sleep cognitions, the Mini-IPIP scales of Big Five personality traits, and the Social Desirability Scale. Gratitude predicted greater subjective sleep quality and sleep duration, and less sleep latency and daytime dysfunction. The relationship between gratitude and each of the sleep variables was mediated by more positive pre-sleep cognitions and less negative pre-sleep cognitions. All of the results were independent of the effect of the Big Five personality traits (including neuroticism) and social desirability. This is the first study to show that a positive trait is related to good sleep quality above the effect of other personality traits, and to test whether pre-sleep cognitions are the mechanism underlying the relationship between any personality trait and sleep. The study is also the first to show that trait gratitude is related to sleep and to explain why this occurs, suggesting future directions for research, and novel clinical implications.

  18. Anesthesiologists' and surgeons' perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians' decisions to order pre-operative tests.

    Science.gov (United States)

    Patey, Andrea M; Islam, Rafat; Francis, Jill J; Bryson, Gregory L; Grimshaw, Jeremy M

    2012-06-09

    Routine pre-operative tests for anesthesia management are often ordered by both anesthesiologists and surgeons for healthy patients undergoing low-risk surgery. The Theoretical Domains Framework (TDF) was developed to investigate determinants of behaviour and identify potential behaviour change interventions. In this study, the TDF is used to explore anaesthesiologists' and surgeons' perceptions of ordering routine tests for healthy patients undergoing low-risk surgery. Sixteen clinicians (eleven anesthesiologists and five surgeons) throughout Ontario were recruited. An interview guide based on the TDF was developed to identify beliefs about pre-operative testing practices. Content analysis of physicians' statements into the relevant theoretical domains was performed. Specific beliefs were identified by grouping similar utterances of the interview participants. Relevant domains were identified by noting the frequencies of the beliefs reported, presence of conflicting beliefs, and perceived influence on the performance of the behaviour under investigation. Seven of the twelve domains were identified as likely relevant to changing clinicians' behaviour about pre-operative test ordering for anesthesia management. Key beliefs were identified within these domains including: conflicting comments about who was responsible for the test-ordering (Social/professional role and identity); inability to cancel tests ordered by fellow physicians (Beliefs about capabilities and social influences); and the problem with tests being completed before the anesthesiologists see the patient (Beliefs about capabilities and Environmental context and resources). Often, tests were ordered by an anesthesiologist based on who may be the attending anesthesiologist on the day of surgery while surgeons ordered tests they thought anesthesiologists may need (Social influences). There were also conflicting comments about the potential consequences associated with reducing testing, from negative

  19. Effects of Brief Psychoeducational Program on Stigma in Malaysian Pre-clinical Medical Students: A Randomized Controlled Trial.

    Science.gov (United States)

    Fernandez, Aaron; Tan, Kit-Aun; Knaak, Stephanie; Chew, Boon How; Ghazali, Sazlina Shariff

    2016-12-01

    If presented with serious mental illness (SMI), individuals' low help-seeking behaviors and poor adherence to treatment are associated with negative stereotypes and attitudes of healthcare providers. In this study, we examined the effects of a brief psychoeducational program on reducing stigma in pre-clinical medical students. One hundred and two pre-clinical medical students (20-23 years old) were randomly assigned to face-to-face contact + educational lecture (n = 51) condition or video-based contact + educational lecture (n = 51) condition. Measures of pre-clinical medical students' mental illness-related stigma using the Opening Minds Stigma Scale for Health Care Providers (OMS-HC) were administered at pre-, post-treatment, and 1-month follow-up. A 2 (condition: face-to-face contact + educational lecture, video-based contact + educational lecture) by 3 (time: pre-treatment, post-treatment, and 1-month follow-up) mixed model MANOVA was conducted on the Attitudes, Disclosure and Help-Seeking, and Social Distance OMS-HC subscales. Participants' scores on all subscales changed significantly across time, regardless of conditions. To determine how participants' scores changed significantly over time on each subscale, Bonferroni follow-up comparisons were performed to access pairwise differences for the main effect of time. Specifically, pairwise comparisons produced a significant reduction in Social Distance subscale between pre-treatment and post-treatment and between pre-treatment and 1-month follow-up, and a significant increase between post-treatment and 1-month follow-up, regardless of conditions. With respect to the Attitudes and Disclosure and Help-Seeking subscales, pairwise comparisons produced a significant reduction in scores between pre-treatment and post-treatment and a significant increase between post-treatment and 1-month follow-up. Our findings provide additional evidence that educational lecture on mental illness, coupled

  20. Experimental data report for Test TS-2 reactivity initiated accident test in NSRR with pre-irradiated BWR fuel rod

    International Nuclear Information System (INIS)

    Nakamura, Takehiko; Yoshinaga, Makio; Sobajima, Makoto; Fujishiro, Toshio; Kobayashi, Shinsho; Yamahara, Takeshi; Sukegawa, Tomohide; Kikuchi, Teruo

    1993-02-01

    This report presents experimental data for Test TS-2 which was the second test in a series of Reactivity Initiated Accident (RIA) condition test using pre-irradiated BWR fuel rods, performed at the Nuclear Safety Research Reactor (NSRR) in February, 1990. Test fuel rod used in the Test TS-2 was a short sized BWR (7x7) type rod which was fabricated from a commercial rod irradiated at Tsuruga Unit 1 power reactor. The fuel had an initial enrichment of 2.79% and a burnup of 21.3Gwd/tU (bundle average). A pulse irradiation of the test fuel rod was performed under a cooling condition of stagnant water at atmospheric pressure and at ambient temperature which simulated a BWR's cold start-up RIA event. The energy deposition of the fuel rod in this test was evaluated to be 72±5cal/g·fuel (66±5cal/g·fuel in peak fuel enthalpy) and no fuel failure was observed. Descriptions on test conditions, test procedures, transient behavior of the test rod during the pulse irradiation, and, results of pre and post pulse irradiation examinations are described in this report. (author)

  1. Pre-analytical and analytical aspects affecting clinical reliability of plasma glucose results.

    Science.gov (United States)

    Pasqualetti, Sara; Braga, Federica; Panteghini, Mauro

    2017-07-01

    The measurement of plasma glucose (PG) plays a central role in recognizing disturbances in carbohydrate metabolism, with established decision limits that are globally accepted. This requires that PG results are reliable and unequivocally valid no matter where they are obtained. To control the pre-analytical variability of PG and prevent in vitro glycolysis, the use of citrate as rapidly effective glycolysis inhibitor has been proposed. However, the commercial availability of several tubes with studies showing different performance has created confusion among users. Moreover, and more importantly, studies have shown that tubes promptly inhibiting glycolysis give PG results that are significantly higher than tubes containing sodium fluoride only, used in the majority of studies generating the current PG cut-points, with a different clinical classification of subjects. From the analytical point of view, to be equivalent among different measuring systems, PG results should be traceable to a recognized higher-order reference via the implementation of an unbroken metrological hierarchy. In doing this, it is important that manufacturers of measuring systems consider the uncertainty accumulated through the different steps of the selected traceability chain. In particular, PG results should fulfil analytical performance specifications defined to fit the intended clinical application. Since PG has tight homeostatic control, its biological variability may be used to define these limits. Alternatively, given the central diagnostic role of the analyte, an outcome model showing the impact of analytical performance of test on clinical classifications of subjects can be used. Using these specifications, performance assessment studies employing commutable control materials with values assigned by reference procedure have shown that the quality of PG measurements is often far from desirable and that problems are exacerbated using point-of-care devices. Copyright © 2017 The Canadian

  2. Binomial Test Method for Determining Probability of Detection Capability for Fracture Critical Applications

    Science.gov (United States)

    Generazio, Edward R.

    2011-01-01

    The capability of an inspection system is established by applications of various methodologies to determine the probability of detection (POD). One accepted metric of an adequate inspection system is that for a minimum flaw size and all greater flaw sizes, there is 0.90 probability of detection with 95% confidence (90/95 POD). Directed design of experiments for probability of detection (DOEPOD) has been developed to provide an efficient and accurate methodology that yields estimates of POD and confidence bounds for both Hit-Miss or signal amplitude testing, where signal amplitudes are reduced to Hit-Miss by using a signal threshold Directed DOEPOD uses a nonparametric approach for the analysis or inspection data that does require any assumptions about the particular functional form of a POD function. The DOEPOD procedure identifies, for a given sample set whether or not the minimum requirement of 0.90 probability of detection with 95% confidence is demonstrated for a minimum flaw size and for all greater flaw sizes (90/95 POD). The DOEPOD procedures are sequentially executed in order to minimize the number of samples needed to demonstrate that there is a 90/95 POD lower confidence bound at a given flaw size and that the POD is monotonic for flaw sizes exceeding that 90/95 POD flaw size. The conservativeness of the DOEPOD methodology results is discussed. Validated guidelines for binomial estimation of POD for fracture critical inspection are established.

  3. Nephron segment specific microRNA biomarkers of pre-clinical drug-induced renal toxicity: Opportunities and challenges

    Energy Technology Data Exchange (ETDEWEB)

    Nassirpour, Rounak, E-mail: Rounak.nassirpour@pfizer.com [Drug Safety, Pfizer Worldwide Research and Development, 1 Burtt Rd, Andover, MA 01810 (United States); Ramaiah, Shashi K. [Drug Safety, Pfizer Worldwide Research and Development, 610 Main Street, Cambridge, MA 02139 (United States); Whiteley, Laurence O. [Drug Safety, Pfizer Worldwide Research and Development, 1 Burtt Rd, Andover, MA 01810 (United States)

    2016-12-01

    Drug-induced nephrotoxicity is a common drug development complication for pharmaceutical companies. Sensitive, specific, translatable and non-invasive biomarkers of renal toxicity are urgently needed to diagnose nephron segment specific injury. The currently available gold standard biomarkers for nephrotoxicity are not kidney-specific, lack sensitivity for early detection, and are not suitable for renal damage localization (glomerular vs tubulointerstitial injury). MicroRNAs (miRNAs) are increasingly gaining momentum as promising biomarkers of various organ toxicities, including drug induced renal injury. This is mostly due to their stability in easily accessible biofluids, ease of developing nucleic acids detection compared to protein detection assays, as well as their interspecies translatability. Increasing concordance of miRNA findings by standardizing methodology most suitable for their detection and quantitation, as well as characterization of their expression pattern in a cell type specific manner, will accelerate progress toward validation of these miRNAs as biomarkers in pre-clinical, and clinical settings. This review aims to highlight the current pre-clinical findings surrounding miRNAs as biomarkers in two important segments of the nephron, the glomerulus and tubules. - Highlights: • miRNAs are promising biomarkers of drug-induced kidney injury. • Summarized pre-clinical miRNA biomarkers of drug-induced nephrotoxicity. • Described the strengths and challenges associated with miRNAs as biomarkers.

  4. Data for a pre-performance test of self-developed electronic tongue sensors

    Directory of Open Access Journals (Sweden)

    Laura Isabell Immohr

    2016-12-01

    Full Text Available This article presents data, which can be applied for a pre-performance test of self-developed electronic tongue sensors. Contained data is related to the research article “Impact of Sodium Lauryl Sulfate in oral liquids on E-Tongue Measurements” (http://dx.doi.org/10.1016/j.ijpharm.2016.10.045; (L.I. Immohr, R. Turner, M. Pein-Hackelbusch, 2016 [1]. Sensor responses were obtained from 10 subsequent measurements and four different concentrations of quinine hydrochloride by electronic tongue (TS-5000Z, Insent Inc., Atsugi-Shi, Japan measurements. Based on the data for the pre-performance testing, which were calculated based on the fluctuation range of the sensor responses around the median, stability criteria and required preconditions cycles were defined.

  5. Effects of direct-to-consumer advertising and clinical guidelines on appropriate use of human papillomavirus DNA tests.

    Science.gov (United States)

    Price, Rebecca Anhang; Frank, Richard G; Cleary, Paul D; Goldie, Sue J

    2011-02-01

    Both clinical guidelines and direct-to-consumer (DTC) advertising influence the use of new health care technologies, but little is known about their relative effects. The introduction of a cervical cancer screening test in 2000 offered a unique opportunity to assess the 2 strategies. To evaluate the effects of clinical guidelines and a targeted DTC advertising campaign on overall and appropriate use of human papillomavirus (HPV) DNA tests. Quasi-experimental study using difference-in-differences analysis. Data were MarketScan private insurance claims for 500,000 women aged 21 to 64 enrolled at least 12 consecutive months from January 2001 through December 2005. Both clinical guidelines and DTC advertising were associated with increases in overall HPV DNA test use. DTC advertising was associated with a statistically significant increase in HPV DNA test use in 2 groups of DTC cities (+5.57%, P advertising was associated with comparable increases in the probability of appropriate and inappropriate use of the HPV DNA test in primary screening. Clinical guideline releases from the American College of Obstetricians and Gynecologists, and by a cosponsored panel, were associated with greater increases in HPV DNA tests for appropriate primary screening than for inappropriate primary screening (β = 0.3347, P advertising was associated with increased overall use of a cervical cancer screening test, whereas clinical guidelines were differentially associated with increased appropriate use. These findings suggest distinct influences of consumer marketing and professional guidelines on the use of health care products and services.

  6. Impact of pre-hospital antibiotic use on community-acquired pneumonia.

    Science.gov (United States)

    Simonetti, A F; Viasus, D; Garcia-Vidal, C; Grillo, S; Molero, L; Dorca, J; Carratalà, J

    2014-09-01

    Information on the influence of pre-hospital antibiotic treatment on the causative organisms, clinical features and outcomes of patients with community-acquired pneumonia (CAP) remains scarce. We performed an observational study of a prospective cohort of non-immunosuppressed adults hospitalized with CAP between 2003 and 2012. Patients were divided into two groups: those who had received pre-hospital antibiotic treatment for the same episode of CAP and those who had not. A propensity score was used to match patients. Of 2179 consecutive episodes of CAP, 376 (17.3%) occurred in patients who had received pre-hospital antibiotic treatment. After propensity score matching, Legionella pneumophila was more frequently identified in patients with pre-hospital antibiotic treatment, while Streptococcus pneumoniae was less common (p sensitivity and specificity of the pneumococcal urinary antigen test for diagnosing pneumococcal pneumonia were similar in the two groups. Patients with pre-hospital antibiotic treatment were less likely to present fever (p 0.02) or leucocytosis (p 0.001). Conversely, chest X-ray cavitation was more frequent in these patients (p 0.04). No significant differences were found in the frequency of patients classified into high-risk Pneumonia Severity Index classes, in intensive care unit admission, or in 30-day mortality between the groups. In conclusion, L. pneumophila occurrence was nearly three times higher in patients who received pre-hospital antibiotics. After a propensity-adjusted analysis, no significant differences were found in prognosis between study groups. Pre-hospital antibiotic use should be considered when choosing aetiological diagnostic tests and empirical antibiotic therapy in patients with CAP. © 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.

  7. Allergic contact dermatitis from ophthalmic products: can pre-treatment with sodium lauryl sulfate increase patch test sensitivity?

    Science.gov (United States)

    Corazza, Monica; Virgili, Annarosa

    2005-05-01

    In patients suspected of allergic contact dermatitis because of topical ophthalmic medicaments, patch tests performed with patients' own products are often negative. The irritant anionic surfactant sodium lauryl sulfate (SLS) may alter the stratum corneum and increase antigen penetration. Pre-treatment of the skin with SLS 0.5% for 24 h was performed in the sites of patch tests with patients' own products in 15 selected patients. In patients previously negative to their own products tested with conventional patch tests, SLS pre-treatment showed 6 new relevant positive reactions and induced a stronger positive reaction in 1 patient. SLS pre-treatment could be proposed as an alternative promising method, which may increase sensitivity of patch tests with patients' own products.

  8. Heterologous Prime-Boost HIV-1 Vaccination Regimens in Pre-Clinical and Clinical Trials

    Directory of Open Access Journals (Sweden)

    Julia L. Hurwitz

    2010-02-01

    Full Text Available Currently, there are more than 30 million people infected with HIV-1 and thousands more are infected each day. Vaccination is the single most effective mechanism for prevention of viral disease, and after more than 25 years of research, one vaccine has shown somewhat encouraging results in an advanced clinical efficacy trial. A modified intent-to-treat analysis of trial results showed that infection was approximately 30% lower in the vaccine group compared to the placebo group. The vaccine was administered using a heterologous prime-boost regimen in which both target antigens and delivery vehicles were changed during the course of inoculations. Here we examine the complexity of heterologous prime-boost immunizations. We show that the use of different delivery vehicles in prime and boost inoculations can help to avert the inhibitory effects caused by vector-specific immune responses. We also show that the introduction of new antigens into boost inoculations can be advantageous, demonstrating that the effect of ‘original antigenic sin’ is not absolute. Pre-clinical and clinical studies are reviewed, including our own work with a three-vector vaccination regimen using recombinant DNA, virus (Sendai virus or vaccinia virus and protein. Promising preliminary results suggest that the heterologous prime-boost strategy may possibly provide a foundation for the future prevention of HIV-1 infections in humans.

  9. Effects of video-feedback on the communication, clinical competence and motivational interviewing skills of practice nurses: a pre-test posttest control group study.

    Science.gov (United States)

    Noordman, Janneke; van der Weijden, Trudy; van Dulmen, Sandra

    2014-10-01

    To examine the effects of individual video-feedback on the generic communication skills, clinical competence (i.e. adherence to practice guidelines) and motivational interviewing skills of experienced practice nurses working in primary care. Continuing professional education may be necessary to refresh and reflect on the communication and motivational interviewing skills of experienced primary care practice nurses. A video-feedback method was designed to improve these skills. Pre-test/posttest control group design. Seventeen Dutch practice nurses and 325 patients participated between June 2010-June 2011. Nurse-patient consultations were videotaped at two moments (T0 and T1), with an interval of 3-6 months. The videotaped consultations were rated using two protocols: the Maastrichtse Anamnese en Advies Scorelijst met globale items (MAAS-global) and the Behaviour Change Counselling Index. Before the recordings, nurses were allocated to a control or video-feedback group. Nurses allocated to the video-feedback group received video-feedback between T0 and T1. Data were analysed using multilevel linear or logistic regression. Nurses who received video-feedback appeared to pay significantly more attention to patients' request for help, their physical examination and gave significantly more understandable information. With respect to motivational interviewing, nurses who received video-feedback appeared to pay more attention to 'agenda setting and permission seeking' during their consultations. Video-feedback is a potentially effective method to improve practice nurses' generic communication skills. Although a single video-feedback session does not seem sufficient to increase all motivational interviewing skills, significant improvement in some specific skills was found. Nurses' clinical competences were not altered after feedback due to already high standards. © 2014 John Wiley & Sons Ltd.

  10. Branchial cleft anomalies: accuracy of pre-operative diagnosis, clinical presentation and management.

    Science.gov (United States)

    Guldfred, L-A; Philipsen, B B; Siim, C

    2012-06-01

    To examine the accuracy of the pre-operative diagnosis of branchial cleft anomalies, and also to describe their occurrence, clinical presentation and management. Retrospective review of the records of patients diagnosed with a branchial cleft anomaly between 1997 and 2006. One hundred and twenty-six patients were included. Pre-operative diagnosis had a positive predictive value of 0.856 (95 per cent confidence interval, 0.771-0.918) and a sensitivity of 0.944 (95 per cent confidence interval, 0.869-0.979). These patients' demographic data, investigations, findings and management are presented, along with a possible strategy for dealing with solitary cystic masses in the neck. As pre-operative diagnosis has a positive predictive value of 86 per cent, cystic lesions in the neck should be presumed to be carcinomatous until proven otherwise. Branchial fistulae and sinuses seem to be a disease of childhood, while branchial cysts occur mainly in adults. Branchial cleft anomalies are equally frequent in men and women, and equally distributed on the left and right side of the neck.

  11. 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

  12. Prevalence of Pre-Analytical Errors in Clinical Chemistry Diagnostic Labs in Sulaimani City of Iraqi Kurdistan

    OpenAIRE

    Najat, Dereen

    2017-01-01

    Background Laboratory testing is roughly divided into three phases: a pre-analytical phase, an analytical phase and a post-analytical phase. Most analytical errors have been attributed to the analytical phase. However, recent studies have shown that up to 70% of analytical errors reflect the pre-analytical phase. The pre-analytical phase comprises all processes from the time a laboratory request is made by a physician until the specimen is analyzed at the lab. Generally, the pre-analytical ph...

  13. The Flipped Classroom for pre-clinical dental skills teaching - a reflective commentary.

    Science.gov (United States)

    Crothers, A J; Bagg, J; McKerlie, R

    2017-05-12

    A Flipped Classroom method for teaching of adult practical pre-clinical dental skills was introduced to the BDS curriculum in Glasgow during the 2015/2016 academic session. This report provides a commentary of the first year of employing this method - from the identification of the need to optimise teaching resources, through the planning, implementation and development of the method, with an early indication of performance.

  14. Normal probability plots with confidence.

    Science.gov (United States)

    Chantarangsi, Wanpen; Liu, Wei; Bretz, Frank; Kiatsupaibul, Seksan; Hayter, Anthony J; Wan, Fang

    2015-01-01

    Normal probability plots are widely used as a statistical tool for assessing whether an observed simple random sample is drawn from a normally distributed population. The users, however, have to judge subjectively, if no objective rule is provided, whether the plotted points fall close to a straight line. In this paper, we focus on how a normal probability plot can be augmented by intervals for all the points so that, if the population distribution is normal, then all the points should fall into the corresponding intervals simultaneously with probability 1-α. These simultaneous 1-α probability intervals provide therefore an objective mean to judge whether the plotted points fall close to the straight line: the plotted points fall close to the straight line if and only if all the points fall into the corresponding intervals. The powers of several normal probability plot based (graphical) tests and the most popular nongraphical Anderson-Darling and Shapiro-Wilk tests are compared by simulation. Based on this comparison, recommendations are given in Section 3 on which graphical tests should be used in what circumstances. An example is provided to illustrate the methods. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  15. Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF to identify factors that influence physicians’ decisions to order pre-operative tests

    Directory of Open Access Journals (Sweden)

    Patey Andrea M

    2012-06-01

    Full Text Available Abstract Background Routine pre-operative tests for anesthesia management are often ordered by both anesthesiologists and surgeons for healthy patients undergoing low-risk surgery. The Theoretical Domains Framework (TDF was developed to investigate determinants of behaviour and identify potential behaviour change interventions. In this study, the TDF is used to explore anaesthesiologists’ and surgeons’ perceptions of ordering routine tests for healthy patients undergoing low-risk surgery. Methods Sixteen clinicians (eleven anesthesiologists and five surgeons throughout Ontario were recruited. An interview guide based on the TDF was developed to identify beliefs about pre-operative testing practices. Content analysis of physicians’ statements into the relevant theoretical domains was performed. Specific beliefs were identified by grouping similar utterances of the interview participants. Relevant domains were identified by noting the frequencies of the beliefs reported, presence of conflicting beliefs, and perceived influence on the performance of the behaviour under investigation. Results Seven of the twelve domains were identified as likely relevant to changing clinicians’ behaviour about pre-operative test ordering for anesthesia management. Key beliefs were identified within these domains including: conflicting comments about who was responsible for the test-ordering (Social/professional role and identity; inability to cancel tests ordered by fellow physicians (Beliefs about capabilities and social influences; and the problem with tests being completed before the anesthesiologists see the patient (Beliefs about capabilities and Environmental context and resources. Often, tests were ordered by an anesthesiologist based on who may be the attending anesthesiologist on the day of surgery while surgeons ordered tests they thought anesthesiologists may need (Social influences. There were also conflicting comments about the potential

  16. Gait analysis and weight bearing in pre-clinical joint pain research.

    Science.gov (United States)

    Ängeby Möller, Kristina; Svärd, Heta; Suominen, Anni; Immonen, Jarmo; Holappa, Johanna; Stenfors, Carina

    2018-04-15

    There is a need for better joint pain treatment, but development of new medication has not been successful. Pre-clinical models with readouts that better reflect the clinical situation are needed. In patients with joint pain, pain at rest and pain at walking are two major complaints. We describe a new way of calculating results from gait analysis using the CatWalk™ setup. Rats with monoarthritis induced by injection of Complete Freund's Adjuvant (CFA) intra-articularly into the ankle joint of one hind limb were used to assess gait and dynamic weight bearing. The results show that dynamic weight bearing was markedly reduced for the injected paw. Gait parameters such as amount of normal step sequences, walking speed and duration of step placement were also affected. Treatment with naproxen (an NSAID commonly used for inflammatory pain) attenuated the CFA-induced effects. Pregabalin, which is used for neuropathic pain, had no effect. Reduced dynamic weight bearing during locomotion, assessed and calculated in the way we present here, showed a dose-dependent and lasting normalization after naproxen treatment. In contrast, static weight bearing while standing (Incapacitance tester) showed a significant effect for a limited time only. Mechanical sensitivity (von Frey Optihairs) was completely normalized by naproxen, and the window for testing pharmacological effect disappeared. Objective and reproducible effects, with an endpoint showing face validity compared to pain while walking in patients with joint pain, are achieved by a new way of calculating dynamic weight bearing in monoarthritic rats. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Use of a National Continuing Medical Education Meeting to Provide Simulation-Based Training in Temporary Hemodialysis Catheter Insertion Skills: A Pre-Test Post-Test Study

    Directory of Open Access Journals (Sweden)

    Edward G Clark

    2014-10-01

    , prior experience or procedural self-confidence with pre-test performance. Limitations: Small sample-size and self-selection of participants. Costs could limit the long-term feasibility of providing this type of training at a CME conference. Conclusions: Despite most participants reporting having previously inserted NTHCs in clinical practice, none met the MPS at baseline; this suggests their prior training may have been inadequate.

  18. Use of a national continuing medical education meeting to provide simulation-based training in temporary hemodialysis catheter insertion skills: a pre-test post-test study.

    Science.gov (United States)

    Clark, Edward G; Paparello, James J; Wayne, Diane B; Edwards, Cedric; Hoar, Stephanie; McQuillan, Rory; Schachter, Michael E; Barsuk, Jeffrey H

    2014-01-01

    Simulation-based-mastery-learning (SBML) is an effective method to train nephrology fellows to competently insert temporary, non-tunneled hemodialysis catheters (NTHCs). Previous studies of SBML for NTHC-insertion have been conducted at a local level. Determine if SBML for NTHC-insertion can be effective when provided at a national continuing medical education (CME) meeting. Describe the correlation of demographic factors, prior experience with NTHC-insertion and procedural self-confidence with simulated performance of the procedure. Pre-test - post-test study. 2014 Canadian Society of Nephrology annual meeting. Nephrology fellows, internal medicine residents and medical students. Participants were surveyed regarding demographics, prior NTHC-insertion experience, procedural self-confidence and attitudes regarding the training they received. NTHC-insertion skills were assessed using a 28-item checklist. Participants underwent a pre-test of their NTHC-insertion skills at the internal jugular site using a realistic patient simulator and ultrasound machine. Participants then had a training session that included a didactic presentation and 2 hours of deliberate practice using the simulator. On the following day, trainees completed a post-test of their NTHC-insertion skills. All participants were required to meet or exceed a minimum passing score (MPS) previously set at 79%. Trainees who did not reach the MPS were required to perform more deliberate practice until the MPS was achieved. Twenty-two individuals participated in SBML training. None met or exceeded the MPS at baseline with a median checklist score of 20 (IQR, 7.25 to 21). Seventeen of 22 participants (77%) completed post-testing and improved their scores to a median of 27 (IQR, 26 to 28; p < 0.001). All met or exceeded the MPS on their first attempt. There were no significant correlations between demographics, prior experience or procedural self-confidence with pre-test performance. Small sample-size and

  19. Clinical role of electrocardiography and of 201Tl scintigraphy exercise tests in diagnosis of ischemic heart disease

    International Nuclear Information System (INIS)

    Jelok, I.; Hatala, R.; Mistrik, A.; Borovicova, F.

    1988-01-01

    The diagnostic potential of ECG and scintigraphy exercise tests is assessed in the light of the experience gained by the authors in the detection of ischemic heart disease, and the complementary character of the two methods is emphasized. The rational and differentiated use of the two noninvasive examination methods requires an optimal clinical assessment of the patient's condition with regard to the probable incidence of the disease. Optimal diagnostic benefit (as compared with the ECG exercise test up to 32%) is shown of scintigraphy, especially in persons with multiple risk factors and atypical chest pain. With regard to the unavailability of perfusion scintigraphy of the myocardium in the authors' clinical practice, they recommend that this examination should mainly be indicated for patients who have a negative or uniterpretable ECG exercise test. (author). 1 tab., 13 refs

  20. Statistical validation of normal tissue complication probability models.

    Science.gov (United States)

    Xu, Cheng-Jian; van der Schaaf, Arjen; Van't Veld, Aart A; Langendijk, Johannes A; Schilstra, Cornelis

    2012-09-01

    To investigate the applicability and value of double cross-validation and permutation tests as established statistical approaches in the validation of normal tissue complication probability (NTCP) models. A penalized regression method, LASSO (least absolute shrinkage and selection operator), was used to build NTCP models for xerostomia after radiation therapy treatment of head-and-neck cancer. Model assessment was based on the likelihood function and the area under the receiver operating characteristic curve. Repeated double cross-validation showed the uncertainty and instability of the NTCP models and indicated that the statistical significance of model performance can be obtained by permutation testing. Repeated double cross-validation and permutation tests are recommended to validate NTCP models before clinical use. Copyright © 2012 Elsevier Inc. All rights reserved.

  1. Statistical Validation of Normal Tissue Complication Probability Models

    Energy Technology Data Exchange (ETDEWEB)

    Xu Chengjian, E-mail: c.j.xu@umcg.nl [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Schaaf, Arjen van der; Veld, Aart A. van' t; Langendijk, Johannes A. [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Schilstra, Cornelis [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Radiotherapy Institute Friesland, Leeuwarden (Netherlands)

    2012-09-01

    Purpose: To investigate the applicability and value of double cross-validation and permutation tests as established statistical approaches in the validation of normal tissue complication probability (NTCP) models. Methods and Materials: A penalized regression method, LASSO (least absolute shrinkage and selection operator), was used to build NTCP models for xerostomia after radiation therapy treatment of head-and-neck cancer. Model assessment was based on the likelihood function and the area under the receiver operating characteristic curve. Results: Repeated double cross-validation showed the uncertainty and instability of the NTCP models and indicated that the statistical significance of model performance can be obtained by permutation testing. Conclusion: Repeated double cross-validation and permutation tests are recommended to validate NTCP models before clinical use.

  2. Reduced benefit from mnemonic strategies in early-stage Alzheimer's disease: a brief testing-the-limits paradigm for clinical practice.

    Science.gov (United States)

    Uttner, Ingo; Schurig, Niklas; von Arnim, Christine A F; Lange-Asschenfeldt, Christian; Tumani, Hayrettin; Riepe, Matthias W

    2010-10-01

    Discriminating incipient Alzheimer's disease (AD) from major depression (MD) and age related memory decline is a challenge in clinical practice. Since AD is characterized by an early loss of neuronal and functional plasticity, a dynamic test strategy, such as the testing-the-limits (TtL) approach, that measures learning capacity can be a helpful diagnostic tool. To evaluate this, a short recognition paradigm consisting of a pre-test (baseline) and two post-test conditions with an interposed encoding instruction was developed and administered to individuals with incipient AD (n = 19; Mini Mental Status Examination (MMSE) 26.5), patients with depressive disorders (n = 11; MMSE 30), and healthy controls (n = 11; MMSE 30). In addition, participants completed a set of traditional neuropsychological tests that focused on the subjects' cognitive baseline performance. Intergroup comparisons (Kruskal-Wallis, U test) revealed significantly higher post-test failure rates in AD patients. Pre-test performance of MD and AD patients did not differ. Intra-group comparisons (Friedman, Wilcoxon test) showed that all three subject samples benefit from intervention in post-test 1. In contrast to MD and healthy individuals, who revealed significantly lower failure rates in post-test 2 compared to the pre-test, AD patients did not improve. Out of the 15 traditional test scores obtained, only two discriminated simultaneously between AD and each of the other groups. Our data confirm the finding of an impaired cognitive plasticity already present in very early stages of AD and illustrate the efficiency of a dynamic test approach in identifying incipient dementia.

  3. Pre-irradiation tests on U-Si alloys

    International Nuclear Information System (INIS)

    Howe, L.M.; Bell, L.G.

    1958-05-01

    Pre-irradiation tests of hardness, density, electrical resistivity, and corrosion resistance as well as metallographic and X-ray examinations were undertaken on U-Si core material, which had been co-extruded in Zr--2, in order that the effect of irradiation on alloys in the epsilon range could be assessed. In addition, a study of the epsilonization of arc-melted material was undertaken in order to rain familiarity with the epsilonization process and to obtain information on the corrosion behaviour of epsilonized material. Sheathed U-Si samples in the epsilonized and de-epsilonized conditions have been irradiated in the X-2 loop, with a water temperature of 275 o C. The samples have been examined after 250 MWD/Tonne and show no dimensional change. (author)

  4. Problem-Solving Test: Nucleocytoplasmic Shuttling of Pre-mRNA Binding Proteins

    Science.gov (United States)

    Szeberenyi, Jozsef

    2012-01-01

    Terms to be familiar with before you start to solve the test: transcription, pre-mRNA, RNA processing, RNA transport, RNA polymerase II, direct and indirect immunofluorescence staining, cell fractionation by centrifugation, oligo(dT)-cellulose chromatography, washing and elution of the column, ribonuclease, SDS-polyacrylamide gel electrophoresis,…

  5. High heat flux tests of the WENDELSTEIN 7-X pre-series target elements

    International Nuclear Information System (INIS)

    Greuner, H.; Boeswirth, B.; Boscary, J.; Plankensteiner, A.; Schedler, B.

    2007-01-01

    The high heat flux (HHF) testing of WENDELSTEIN 7-X pre-series target elements is an indispensable step in the qualification of the manufacturing process. A set of 20 full scale pre-series elements was manufactured by PLANSEE SE to validate the materials and manufacturing technologies prior to the start of the series production. The HHF tests were performed in the ion beam test facility GLADIS. All actively water-cooled elements were tested for about 100 cycles at 10 MW/m 2 (10-15 s pulse duration). Several elements were loaded with even higher cycle numbers (up to 1000) and heat loads up to 24 MW/m 2 . Hot spots were, observed at the edges of several tiles during the HHF tests indicating local bonding problems of the CFC. The thermo-mechanical behaviour under HHF loading has been evaluated and compared to the FEM predictions. The measured temperatures and strains confirm the chosen FEM approach. This allows a component optimisation to achieve a successful series production of the W7-X divertor target elements

  6. Effects of Direct-to-Consumer Advertising and Clinical Guidelines on Appropriate Use of Human Papillomavirus DNA Tests

    Science.gov (United States)

    2011-01-01

    Background Both clinical guidelines and direct-to-consumer (DTC) advertising influence use of new health care technologies, but little is known about their relative effects. The introduction of a cervical cancer screening test in 2000 offered a unique opportunity to assess the two strategies. Objective To evaluate the effects of clinical guidelines and a targeted DTC advertising campaign on overall and appropriate use of human papillomavirus (HPV) DNA tests. Research Design Quasi-experimental study using difference-in-differences analysis. Data were MarketScan private insurance claims for 500,000 women ages 21 to 64 enrolled at least 12 consecutive months from January 2001 through December 2005. Results Both clinical guidelines and DTC advertising were associated with increases in overall HPV DNA test use. DTC advertising was associated with a statistically significant increase in HPV DNA test use in two groups of DTC cities (+5.57 percent, padvertising was associated with comparable increases in the probability of appropriate and inappropriate use of the HPV DNA test in primary screening. Clinical guideline releases from the American College of Obstetricians and Gynecologists, and by a co-sponsored panel, were associated with greater increases in HPV DNA tests for appropriate primary screening than for inappropriate primary screening (β=0.3347, padvertising was associated with increased overall use of a cervical cancer screening test, while clinical guidelines were differentially associated with increased appropriate use. These findings suggest distinct influences of consumer marketing and professional guidelines on the use of health care products and services. PMID:21150798

  7. Anti-inflammatory and neuroprotective effects of an orally active apocynin derivative in pre-clinical models of Parkinson’s disease

    Directory of Open Access Journals (Sweden)

    Ghosh Anamitra

    2012-10-01

    Full Text Available Abstract Background Parkinson’s disease (PD is a devastating neurodegenerative disorder characterized by progressive motor debilitation, which affects several million people worldwide. Recent evidence suggests that glial cell activation and its inflammatory response may contribute to the progressive degeneration of dopaminergic neurons in PD. Currently, there are no neuroprotective agents available that can effectively slow the disease progression. Herein, we evaluated the anti-inflammatory and antioxidant efficacy of diapocynin, an oxidative metabolite of the naturally occurring agent apocynin, in a pre-clinical 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP mouse model of PD. Methods Both pre-treatment and post-treatment of diapocynin were tested in the MPTP mouse model of PD. Diapocynin was administered via oral gavage to MPTP-treated mice. Following the treatment, behavioral, neurochemical and immunohistological studies were performed. Neuroinflammatory markers, such as ionized calcium binding adaptor molecule 1 (Iba-1, glial fibrillary acidic protein (GFAP, gp91phox and inducible nitric oxide synthase (iNOS, were measured in the nigrostriatal system. Nigral tyrosine hydroxylase (TH-positive neurons as well as oxidative markers 3-nitrotyrosine (3-NT, 4-hydroxynonenal (4-HNE and striatal dopamine levels were quantified for assessment of the neuroprotective efficacy of diapocynin. Results Oral administration of diapocynin significantly attenuated MPTP-induced microglial and astroglial cell activation in the substantia nigra (SN. MPTP-induced expression of gp91phox and iNOS activation in the glial cells of SN was also completely blocked by diapocynin. Notably, diapocynin markedly inhibited MPTP-induced oxidative markers including 3-NT and 4-HNE levels in the SN. Treatment with diapocynin also significantly improved locomotor activity, restored dopamine and its metabolites, and protected dopaminergic neurons and their nerve terminals in

  8. Palifermin for the protection and regeneration of epithelial tissues following injury: new findings in basic research and pre-clinical models.

    Science.gov (United States)

    Finch, Paul W; Mark Cross, Lawrence J; McAuley, Daniel F; Farrell, Catherine L

    2013-09-01

    Keratinocyte growth factor (KGF) is a paracrine-acting epithelial mitogen produced by cells of mesenchymal origin, that plays an important role in protecting and repairing epithelial tissues. Pre-clinical data initially demonstrated that a recombinant truncated KGF (palifermin) could reduce gastrointestinal injury and mortality resulting from a variety of toxic exposures. Furthermore, the use of palifermin in patients with hematological malignancies reduced the incidence and duration of severe oral mucositis experienced after intensive chemoradiotherapy. Based upon these findings, as well as the observation that KGF receptors are expressed in many, if not all, epithelial tissues, pre-clinical studies have been conducted to determine the efficacy of palifermin in protecting different epithelial tissues from toxic injury in an attempt to model various clinical situations in which it might prove to be of benefit in limiting tissue damage. In this article, we review these studies to provide the pre-clinical background for clinical trials that are described in the accompanying article and the rationale for additional clinical applications of palifermin. © 2013 The Authors. Journal of Cellular and Molecular Medicine Published by Foundation for Cellular and Molecular Medicine/Blackwell Publishing Ltd.

  9. Extensively and Pre-Extensively Drug Resistant Tuberculosis in Clinical Isolates of Multi-Drug Resistant Tuberculosis Using Classical Second Line Drugs (Levofloxacin and Amikacin)

    International Nuclear Information System (INIS)

    Mirza, I. A.; Khan, F. A.; Khan, K. A.; Satti, L.; Ghafoor, T.; Fayyaz, M.

    2015-01-01

    Objective:To find out the frequency of Extensively Drug Resistant (XDR) and pre-XDR tuberculosis in clinical isolates of Multi-Drug Resistant (MDR) Tuberculosis (TB) by determining the susceptibilities against Levofloxacin and Amikacin (classical second line antituberculosis drugs). Study Design: A descriptive cross-sectional study. Place and Duration of Study: Microbiology Department, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from September 2011 to August 2013. Methodology: Amikacin (AK) and Levofloxacin (LEVO) were obtained in chemically pure form from Sigma (Taufkirchen, Germany). The breakpoint concentration used for AK was 1.0 micro g/ml and for LEVO 2.0 micro g/ml. Mycobacterial Growth Indicator Tube (MGIT) 960 system was used to carry out drug susceptibility testing as per recommended protocol. Results: A total of 3 MDR-TB isolates (3 percentage) turned out to be XDR-TB based upon simultaneous resistance to injectable second line antituberculosis drug AK and one of the fluoro-quinolones (LEVO). A total of 24 MDR-TB isolates (24 percentage) were found to be pre-XDR based upon resistance to LEVO alone. Treatment status record of patients with XDR and pre-XDRTB isolates revealed that majority of patients had received fluoroquinolones (FQs) during the course of treatment. Conclusion: XDR-TB has started to emerge in MDR-TB isolates in our set up. The worrying sign is the high frequency of pre-XDR tuberculosis. Urgent steps need to be taken to stem the tide of pre-XDR-TB in our population. It is thus recommended to develop facilities to carry out drug susceptibility testing to monitor the status of pre-XDR and XDR-TB in our population. (author)

  10. Survey of clinical infant lung function testing practices.

    Science.gov (United States)

    Peterson-Carmichael, Stacey L; Rosenfeld, Margaret; Ascher, Simon B; Hornik, Christoph P; Arets, H G M; Davis, Stephanie D; Hall, Graham L

    2014-02-01

    Data supporting the clinical use of infant lung function (ILF) tests are limited making the interpretation of clinical ILF measures difficult. To evaluate current ILF testing practices and to survey users regarding the indications, limitations and perceived clinical benefits of ILF testing. We created a 26-item survey hosted on the European Respiratory Society (ERS) website between January and May 2010. Notifications were sent to members of the ERS, American Thoracic Society and the Asian Pacific Society of Respirology. Responses were sought from ILF laboratory directors and pediatric respirologists. The survey assessed the clinical indications, patient populations, equipment and reference data used, and perceived limitations of ILF testing. We received 148 responses with 98 respondents having ILF equipment and performing testing in a clinical capacity. Centers in North America were less likely to perform ≥50 studies/year than centers in Europe or other continents (13% vs. 41%). Most respondents used ILF data to either "start a new therapy" (78%) or "help decide about initiation of further diagnostic workup such as bronchoscopy, chest CT or serological testing" (69%). Factors reported as limiting clinical ILF testing were need for sedation, uncertainty regarding clinical impact of study results and time intensive nature of the study. Clinical practices associated with ILF testing vary significantly; centers that perform more studies are more likely to use the results for clinical purposes and decision making. The future of ILF testing is uncertain in the face of the limitations perceived by the survey respondents. © 2013 Wiley Periodicals, Inc.

  11. Comparison of patient comprehension of rapid HIV pre-test fundamentals by information delivery format in an emergency department setting

    Directory of Open Access Journals (Sweden)

    Clark Melissa A

    2007-09-01

    Full Text Available Abstract Background Two trials were conducted to compare emergency department patient comprehension of rapid HIV pre-test information using different methods to deliver this information. Methods Patients were enrolled for these two trials at a US emergency department between February 2005 and January 2006. In Trial One, patients were randomized to a no pre-test information or an in-person discussion arm. In Trial Two, a separate group of patients were randomized to an in-person discussion arm or a Tablet PC-based video arm. The video, "Do you know about rapid HIV testing?", and the in-person discussion contained identical Centers for Disease Control and Prevention-suggested pre-test information components as well as information on rapid HIV testing with OraQuick®. Participants were compared by information arm on their comprehension of the pre-test information by their score on a 26-item questionnaire using the Wilcoxon rank-sum test. Results In Trial One, 38 patients completed the no-information arm and 31 completed the in-person discussion arm. Of these 69 patients, 63.8% had twelve years or fewer of formal education and 66.7% had previously been tested for HIV. The mean score on the questionnaire for the in-person discussion arm was higher than for the no information arm (18.7 vs. 13.3, p ≤ 0.0001. In Trial Two, 59 patients completed the in-person discussion and 55 completed the video arms. Of these 114 patients, 50.9% had twelve years or fewer of formal education and 68.4% had previously been tested for HIV. The mean score on the questionnaire for the video arm was similar to the in-person discussion arm (20.0 vs. 19.2; p ≤ 0.33. Conclusion The video "Do you know about rapid HIV testing?" appears to be an acceptable substitute for an in-person pre-test discussion on rapid HIV testing with OraQuick®. In terms of adequately informing ED patients about rapid HIV testing, either form of pre-test information is preferable than for patients

  12. The value of integrating pre-clinical data to predict nausea and vomiting risk in humans as illustrated by AZD3514, a novel androgen receptor modulator

    Energy Technology Data Exchange (ETDEWEB)

    Grant, Claire, E-mail: claire.grant@astrazeneca.com [Drug Safety and Metabolism, AstraZeneca, Alderley Park, Macclesfield SK10 4TG (United Kingdom); Ewart, Lorna [Drug Safety and Metabolism, AstraZeneca, Da Vinci Building, Melbourn Science Park, Cambridge Road, Melbourn, Royston SG8 6HB (United Kingdom); Muthas, Daniel [Respiratory, Inflammation and Autoimmunity iMED, AstraZeneca, Pepparedsleden 1, 431 83 Mölndal (Sweden); Deavall, Damian [Drug Safety and Metabolism, AstraZeneca, Alderley Park, Macclesfield SK10 4TG (United Kingdom); Smith, Simon A. [Oncology Translational Medicine Unit, Early Clinical Development, AstraZeneca, Da Vinci Building, Melbourn Science Park, Melbourn, Royston SG8 6HB (United Kingdom); Clack, Glen [Translational Medicine Unit, Early Clinical Development, AstraZeneca, Alderley Park, Macclesfield SK10 4TG (United Kingdom); Newham, Pete [Drug Safety and Metabolism, AstraZeneca, Darwin Building, Cambridge Science Park, Milton Road, Cambridge CB4 0WG (United Kingdom)

    2016-04-01

    Nausea and vomiting are components of a complex mechanism that signals food avoidance and protection of the body against the absorption of ingested toxins. This response can also be triggered by pharmaceuticals. Predicting clinical nausea and vomiting liability for pharmaceutical agents based on pre-clinical data can be problematic as no single animal model is a universal predictor. Moreover, efforts to improve models are hampered by the lack of translational animal and human data in the public domain. AZD3514 is a novel, orally-administered compound that inhibits androgen receptor signaling and down-regulates androgen receptor expression. Here we have explored the utility of integrating data from several pre-clinical models to predict nausea and vomiting in the clinic. Single and repeat doses of AZD3514 resulted in emesis, salivation and gastrointestinal disturbances in the dog, and inhibited gastric emptying in rats after a single dose. AZD3514, at clinically relevant exposures, induced dose-responsive “pica” behaviour in rats after single and multiple daily doses, and induced retching and vomiting behaviour in ferrets after a single dose. We compare these data with the clinical manifestation of nausea and vomiting encountered in patients with castration-resistant prostate cancer receiving AZD3514. Our data reveal a striking relationship between the pre-clinical observations described and the experience of nausea and vomiting in the clinic. In conclusion, the emetic nature of AZD3514 was predicted across a range of pre-clinical models, and the approach presented provides a valuable framework for predicition of clinical nausea and vomiting. - Highlights: • Integrated pre-clinical data can be used to predict clinical nausea and vomiting. • Data integrated from standard toxicology studies is sufficient to make a prediction. • The use of the nausea algorithm developed by Parkinson (2012) aids the prediction. • Additional pre-clinical studies can be used

  13. Experimental data report for test TS-3 Reactivity Initiated Accident test in the NSRR with pre-irradiated BWR fuel rod

    International Nuclear Information System (INIS)

    Nakamura, Takehiko; Yoshinaga, Makio; Fujishiro, Toshio; Kobayashi, Shinsho; Yamahara, Takeshi; Sukegawa, Tomohide; Kikuchi, Teruo; Sobajima, Makoto.

    1993-09-01

    This report presents experimental data for Test TS-3 which was the third test in a series of Reactivity Initiated Accident (RIA) tests using pre-irradiated BWR fuel rods, performed in the Nuclear Safety Research Reactor (NSRR) in September, 1990. Test fuel rod used in the Test TS-3 was a short-sized BWR (7 x 7) type rod which was re-fabricated from a commercial rod irradiated in the Tsuruga Unit 1 power reactor of Japan Atomic Power Co. The fuel had an initial enrichment of 2.79 % and a burnup of 26 Gwd/tU. A pulse irradiation of the test fuel rod was performed under a cooling condition of stagnant water at atmospheric pressure and at ambient temperature which simulated a BWR's cold start-up RIA event. The energy deposition of the fuel rod in this test was evaluated to be 94 ± 4 cal/g · fuel (88 ± 4 cal/g · fuel in peak fuel enthalpy) and no fuel failure was observed. Descriptions on test conditions, test procedures, transient behavior of the test rod during the pulse irradiation, and results of pre-pulse and post-pulse irradiation examinations are described in this report. (author)

  14. TH-AB-206-02: Nuclear Medicine Theronostics: Wave of the Future; Pre-Clinical and Clinical Opportunities

    International Nuclear Information System (INIS)

    Delpassand, E.

    2016-01-01

    In the past few decades, the field of nuclear medicine has made long strides with the continued advancement of related sciences and engineering and the availability of diagnostic and therapeutic radionuclides. Leveraging these advancements while combining the advantages of therapeutic and diagnostic radionuclides into one radiopharmaceutical has also created a new subfield “theranostics” in nuclear medicine that has the potential to further propel the field into the future. This session is composed of two talks; one focused on the physics principles of theranostics from properties of beta and alpha emitting radionuclides to dosimetric models and quantification; while the second describes preclinical and clinical applications of theranostics and discusses the challenges and opportunities of bringing them to the clinic. At the end of the session the listener should be able to identify: The different properties of beta and alpha emitting radionuclides Which radionuclides are selected for which nuclear medicine therapies and why How PET can be used to accurately quantify the uptake of tumor targeting molecules How individualized dosimetry can be performed from the management of thyroid cancer to novel radiolabeled antibody therapies Promising pre-clinical radiopharmaceutical pairs in prostate cancer and melanoma. Promising clinical Theranostics in neuroendocrine cancers. Challenges of bringing Theranostics to the clinic. E. Delpassand, RITA Foundation -Houston; SBIR Grant; CEO and share holder of RadioMedix.

  15. TH-AB-206-02: Nuclear Medicine Theronostics: Wave of the Future; Pre-Clinical and Clinical Opportunities

    Energy Technology Data Exchange (ETDEWEB)

    Delpassand, E. [Excel Diagnostic & Nuclear Oncology Center, Houston, TX (United States)

    2016-06-15

    In the past few decades, the field of nuclear medicine has made long strides with the continued advancement of related sciences and engineering and the availability of diagnostic and therapeutic radionuclides. Leveraging these advancements while combining the advantages of therapeutic and diagnostic radionuclides into one radiopharmaceutical has also created a new subfield “theranostics” in nuclear medicine that has the potential to further propel the field into the future. This session is composed of two talks; one focused on the physics principles of theranostics from properties of beta and alpha emitting radionuclides to dosimetric models and quantification; while the second describes preclinical and clinical applications of theranostics and discusses the challenges and opportunities of bringing them to the clinic. At the end of the session the listener should be able to identify: The different properties of beta and alpha emitting radionuclides Which radionuclides are selected for which nuclear medicine therapies and why How PET can be used to accurately quantify the uptake of tumor targeting molecules How individualized dosimetry can be performed from the management of thyroid cancer to novel radiolabeled antibody therapies Promising pre-clinical radiopharmaceutical pairs in prostate cancer and melanoma. Promising clinical Theranostics in neuroendocrine cancers. Challenges of bringing Theranostics to the clinic. E. Delpassand, RITA Foundation -Houston; SBIR Grant; CEO and share holder of RadioMedix.

  16. [Overview of the Ebola vaccines in pre-clinical and clinical development].

    Science.gov (United States)

    Buchy, P

    2016-10-01

    The Ebola epidemic that occurred in West Africa between 2013-2016 significantly accelerated the research and development of Ebola vaccines. Few dozens of clinical trials have been recently conducted leading to opportunities to test several new vaccine candidates. Other vaccines are still in early development phases (table 1). This paper provides an overview of the new developments in that area.

  17. ATTITUDE AND PERCEPTION OF FACULTIES TOWARDS TEACHING EVIDENCE BASED MEDICINE TO PRE - CLINICAL & PARA - CLINICAL MEDICAL STUDENTS

    Directory of Open Access Journals (Sweden)

    Bhavita Patel

    2015-02-01

    Full Text Available NTRODUCTION: Evidence - based medicine (EBM is defined as the „conscientious, explicit, and judicious use of current best evidence‟. It i s an important tool for lifelong learning in medicine, and medical students can develop the skills necessary to understand and use EBM. The teaching of EBM in Sumandeep Vidyapeeth is as part of Evidence Based Education System (EBES. The university has imp lemented the 16 hours of teaching with project work on Evidence Based Medicine in 1st MBBS and 2nd MBBS curriculum in addition to MBBS syllabus. AIMS & OBJECTIVES: This study was planned to take feedback from all the faculties those who are involved in Evi dence based Medicine teaching to evaluate their attitude and perception towards this innovative teaching method and to recommend improvements. MATERIAL & METHODS: A Descriptive, self - structured , pilot pretested questionnaire based cross sectional study was conducted in the year 2013 - 2014 among 40 faculties from 7 Departments like Anatomy, Physiology, Biochemistry, Microbiology, Pharmacology, Pathology and Forensic Medicine teaching Evidence Base d Medicine to students at S.B.K.S MI & RC, Sumandeep Vidyapeeth. Data was expressed as percentage. RESULTS: The response rate for the study was 75%. Almost 87% of faculties agreed that teaching EBM is a welcoming development during pre and para clinical ye ars. About 80% faculties agreed that it will help them in future clinical learning. 87% faculties agreed that literature and research searching improves their day to day teaching. About 77% of faculties have attended workshop and training held in Universit y and 83% of faculties agreed that they are interested in more learning and improving skills necessary to incorporate Evidence based medicine into their discipline. Barriers included shortage of time and need for training in teaching EBM. CONCLUSION: Facul ties of this University teaching Pre - clinical and Para - clinical medical students recognized

  18. Students' Understanding of Conditional Probability on Entering University

    Science.gov (United States)

    Reaburn, Robyn

    2013-01-01

    An understanding of conditional probability is essential for students of inferential statistics as it is used in Null Hypothesis Tests. Conditional probability is also used in Bayes' theorem, in the interpretation of medical screening tests and in quality control procedures. This study examines the understanding of conditional probability of…

  19. VARK Learning Preferences and Mobile Anatomy Software Application Use in Pre-Clinical Chiropractic Students

    Science.gov (United States)

    Meyer, Amanda J.; Stomski, Norman J.; Innes, Stanley I.; Armson, Anthony J.

    2016-01-01

    Ubiquitous smartphone ownership and reduced face-to-face teaching time may lead to students making greater use of mobile technologies in their learning. This is the first study to report on the prevalence of mobile gross anatomy software applications (apps) usage in pre-clinical chiropractic students and to ascertain if a relationship exists…

  20. Pre-travel advice seeking from GPs by travellers with chronic illness seen at a travel clinic.

    Science.gov (United States)

    Gagneux-Brunon, Amandine; Andrillat, Carole; Fouilloux, Pascale; Daoud, Fatiha; Defontaine, Christiane; Charles, Rodolphe; Lucht, Frédéric; Botelho-Nevers, Elisabeth

    2016-03-01

    Travellers are ageing and frequently report chronic illness. Pre-travel health advice is crucial, particularly in this subgroup, and general practitioners (GPs) are first in line for treatment adjustment before departure. Our aim is to evaluate pre-travel health advice seeking from GPs by travellers with chronic illness seen at a travel clinic. A cross-sectional observational survey using a questionnaire was conducted between August 2013 and July 2014 in travellers attending the travel medicine clinic of a tertiary university hospital in France. During the study, 2019 travellers were included. Mean age was 39.4 years (±18.8). Three hundred and ninety-one (19.4%) travellers reported a history of a chronic illness. Arterial hypertension and diabetes mellitus were the most frequently reported illnesses, affecting, respectively, 168 (8.3%) travellers and 102 (5.1%). Hajj pilgrims were more likely to report a history of chronic illness than other travellers. Only 810 (40.1%) travellers sought pre-travel advice from their GP. Six hundred and fifty-two (40.1%) healthy travellers and 158 (40.5%) travellers reporting chronic illness sought pre-travel advice from their GP (P = 0.96). Travellers with a history of chronic illness do not seek pre-travel health advice from their GP more frequently than healthy travellers. Travel health specialists are generally not the best practitioners to manage the care of underlying medical conditions presenting risks during travel. However, GPs offer continuity and disease management expertise to improve the specificity of pre-travel planning. Thus, ongoing collaboration between the traveller, GP and travel health specialist is likely to yield the best outcomes. © International Society of Travel Medicine, 2016. All rights reserved. Published by Oxford University Press. For permissions, please e-mail: journals.permissions@oup.com.

  1. An analysis of pre-service family planning teaching in clinical and nursing education in Tanzania.

    Science.gov (United States)

    Muganyizi, Projestine S; Ishengoma, Joyce; Kanama, Joseph; Kikumbih, Nassoro; Mwanga, Feddy; Killian, Richard; McGinn, Erin

    2014-07-12

    Promoting family planning (FP) is a key strategy for health, economic and population growth. Sub-Saharan Africa, with one of the lowest contraceptive prevalence and highest fertility rates globally, contributes half of the global maternal deaths. Improving the quality of FP services, including enhancing pre-service FP teaching, has the potential to improve contraceptive prevalence. In efforts to improve the quality of FP services in Tanzania, including provider skills, this study sought to identify gaps in pre-service FP teaching and suggest opportunities for strengthening the training. Data were collected from all medical schools and a representative sample of pre-service nursing, Assistant Medical Officer (AMO), Clinical Officer (CO) and assistant CO schools in mainland Tanzania. Teachers responsible for FP teaching at the schools were interviewed using a semi-structured questionnaire. Observations on availability of teaching resources and other evidence of FP teaching and evaluation were documented. Relevant approved teaching documents were assessed for their suitability as competency-based FP teaching tools against predefined criteria. Quantitative data were analyzed using EPI Info 6 and qualitative data were manually analyzed using content analysis. A total of 35 pre-service schools were evaluated for FP teaching including 30 technical education and five degree offering schools. Of the assessed 11 pre-service curricula, only one met the criteria for suitability of FP teaching. FP teaching was typically theoretical with only 22.9% of all the schools having systems in place to produce graduates who could skillfully provide FP methods. Across schools, the target skills were the same level of competence and skewed toward short acting methods of contraception. Only 23.3% (n = 7) of schools had skills laboratories, 76% (n = 22) were either physically connected or linked to FP clinics. None of the degree providing schools practiced FP at its own teaching hospital

  2. Trends in CD4 Count Testing, Retention in Pre-ART Care, and ART Initiation Rates over the First Decade of Expansion of HIV Services in Haiti.

    Directory of Open Access Journals (Sweden)

    Serena P Koenig

    Full Text Available High attrition during the period from HIV testing to antiretroviral therapy (ART initiation is widely reported. Though treatment guidelines have changed to broaden ART eligibility and services have been widely expanded over the past decade, data on the temporal trends in pre-ART outcomes are limited; such data would be useful to guide future policy decisions.We evaluated temporal trends and predictors of retention for each step from HIV testing to ART initiation over the past decade at the GHESKIO clinic in Port-au-Prince Haiti. The 24,925 patients >17 years of age who received a positive HIV test at GHESKIO from March 1, 2003 to February 28, 2013 were included. Patients were followed until they remained in pre-ART care for one year or initiated ART.24,925 patients (61% female, median age 35 years were included, and 15,008 (60% had blood drawn for CD4 count within 12 months of HIV testing; the trend increased over time from 36% in Year 1 to 78% in Year 10 (p500 cells/mm3, respectively. The trend increased over time for each CD4 strata, and in Year 10, 94%, 95%, 79%, and 74% were retained in pre-ART care or initiated ART for each CD4 strata. Predictors of pre-ART attrition included male gender, low income, and low educational status. Older age and tuberculosis (TB at HIV testing were associated with retention in care.The proportion of patients completing assessments for ART eligibility, remaining in pre-ART care, and initiating ART have increased over the last decade across all CD4 count strata, particularly among patients with CD4 count ≤350 cells/mm3. However, additional retention efforts are needed for patients with higher CD4 counts.

  3. Use of operational data for the assessment of pre-existing software

    International Nuclear Information System (INIS)

    Helminen, Atte; Gran, Bjoern Axel; Kristiansen, Monica; Winther, Rune

    2004-01-01

    To build sufficient confidence on the reliability of the safety systems of nuclear power plants all available sources of information should be used. One important data source is the operational experience collected for the system. The operational experience is particularly applicable for systems of pre-existing software. Even though systems and devices involving pre-existing software are not considered for the functions of highest safety levels of nuclear power plants, they will most probably be introduced to functions of lower safety levels and to none-safety related applications. In the paper we shortly discuss the use of operational experience data for the reliability assessment of pre-existing software in general, and the role of pre-existing software in relation to safety applications. Then we discuss the modelling of operational profiles, the application of expert judgement on operational profiles and the need of a realistic test case. Finally, we discuss the application of operational experience data in Bayesian statistics. (Author)

  4. Adaptive clinical trial designs with pre-specified rules for modifying the sample size: understanding efficient types of adaptation.

    Science.gov (United States)

    Levin, Gregory P; Emerson, Sarah C; Emerson, Scott S

    2013-04-15

    Adaptive clinical trial design has been proposed as a promising new approach that may improve the drug discovery process. Proponents of adaptive sample size re-estimation promote its ability to avoid 'up-front' commitment of resources, better address the complicated decisions faced by data monitoring committees, and minimize accrual to studies having delayed ascertainment of outcomes. We investigate aspects of adaptation rules, such as timing of the adaptation analysis and magnitude of sample size adjustment, that lead to greater or lesser statistical efficiency. Owing in part to the recent Food and Drug Administration guidance that promotes the use of pre-specified sampling plans, we evaluate alternative approaches in the context of well-defined, pre-specified adaptation. We quantify the relative costs and benefits of fixed sample, group sequential, and pre-specified adaptive designs with respect to standard operating characteristics such as type I error, maximal sample size, power, and expected sample size under a range of alternatives. Our results build on others' prior research by demonstrating in realistic settings that simple and easily implemented pre-specified adaptive designs provide only very small efficiency gains over group sequential designs with the same number of analyses. In addition, we describe optimal rules for modifying the sample size, providing efficient adaptation boundaries on a variety of scales for the interim test statistic for adaptation analyses occurring at several different stages of the trial. We thus provide insight into what are good and bad choices of adaptive sampling plans when the added flexibility of adaptive designs is desired. Copyright © 2012 John Wiley & Sons, Ltd.

  5. Nitric oxide nanoparticles: Pre-clinical utility as a therapeutic for intramuscular abscesses

    OpenAIRE

    Schairer, David O.; Martinez, Luis R.; Blecher, Karin; Chouake, Jason S.; Nacharaju, Parimala; Gialanella, Philip; Friedman, Joel M.; Nosanchuk, Joshua D.; Friedman, Adam J.

    2012-01-01

    Nitric oxide (NO) is a critical component of host defense against invading pathogens; however, its therapeutic utility is limited due to a lack of practical delivery systems. Recently, a NO-releasing nanoparticulate platform (NO-np) was shown to have in vitro broad-spectrum antimicrobial activity and in vivo pre-clinical efficacy in a dermal abscess model. To extend these findings, both topical (TP) and intralesional (IL) NO-np administration was evaluated in a MRSA intramuscular murine absce...

  6. Learning style preferences: A study of pre-clinical medical students in Barbados

    OpenAIRE

    OJEH, NKEMCHO; SOBERS-GRANNUM, NATASHA; GAUR, UMA; UDUPA, ALAYA; MAJUMDER, MD.ANWARUL AZIM

    2017-01-01

    Introduction: Educators need to be aware of different learning styles to effectively tailor instructional strategies and methods to cater to the students’ learning needs and support a conductive learning environment. The VARK [an acronym for visual (V), aural (A), read/write (R) and kinesthetic (K)] instrument is a useful model to assess learning styles. The aim of this study was to use the VARK questionnaire to determine the learning styles of pre-clinical medical students in order to compar...

  7. Including ethical considerations in models for first-trimester screening for pre-eclampsia

    DEFF Research Database (Denmark)

    Jørgensen, Jennifer Maureen; Hedley, Paula L.; Gjerris, Mickey

    2014-01-01

    Recent efforts to develop reliable and efficient early pregnancy screening programmes for pre-eclampsia have focused on com-bining clinical, biochemical and biophysical markers. The same model has been used for first-trimester screening for fetal aneuploidies i.e. prenatal diagnosis (PD), which...... is routinely offered to all pregnant women in many developed countries. Some studies suggest combining PD and pre-eclampsia screening, so women can be offered testing for a number of conditions at the same clinical visit. A combination of these tests may be practical in terms of saving time and resources......; however, the combination raises ethical issues. First-trimester PD and pre-eclampsia screening entail qualitative differences which alter the requirements for disclosure, non-directedness and consent with regard to the informed consent process. This article explores the differences related to the ethical...

  8. Robust estimation of the expected survival probabilities from high-dimensional Cox models with biomarker-by-treatment interactions in randomized clinical trials

    Directory of Open Access Journals (Sweden)

    Nils Ternès

    2017-05-01

    Full Text Available Abstract Background Thanks to the advances in genomics and targeted treatments, more and more prediction models based on biomarkers are being developed to predict potential benefit from treatments in a randomized clinical trial. Despite the methodological framework for the development and validation of prediction models in a high-dimensional setting is getting more and more established, no clear guidance exists yet on how to estimate expected survival probabilities in a penalized model with biomarker-by-treatment interactions. Methods Based on a parsimonious biomarker selection in a penalized high-dimensional Cox model (lasso or adaptive lasso, we propose a unified framework to: estimate internally the predictive accuracy metrics of the developed model (using double cross-validation; estimate the individual survival probabilities at a given timepoint; construct confidence intervals thereof (analytical or bootstrap; and visualize them graphically (pointwise or smoothed with spline. We compared these strategies through a simulation study covering scenarios with or without biomarker effects. We applied the strategies to a large randomized phase III clinical trial that evaluated the effect of adding trastuzumab to chemotherapy in 1574 early breast cancer patients, for which the expression of 462 genes was measured. Results In our simulations, penalized regression models using the adaptive lasso estimated the survival probability of new patients with low bias and standard error; bootstrapped confidence intervals had empirical coverage probability close to the nominal level across very different scenarios. The double cross-validation performed on the training data set closely mimicked the predictive accuracy of the selected models in external validation data. We also propose a useful visual representation of the expected survival probabilities using splines. In the breast cancer trial, the adaptive lasso penalty selected a prediction model with 4

  9. Use of the radiometric method at creation cell test-systems for pre-screening of anticancer preparations

    International Nuclear Information System (INIS)

    Kuznetsova, N.N.; Khashimova, Z.S.; Sadikov, A.A.

    2004-01-01

    Full text: Development of cancer chemotherapy is tightly bound with investigation of biological activity of different compounds on in vitro test systems. Our research has been directed on definition of sensitivity of the cell line KML removed by us from passed of mice melanoma B-16. We had been investigated action of 18 clinical antineoplastic preparations of different classes: alkylating - sarcolysinum, thiophosphamide, dopan, fhthordopan; antimetabolites - cytararibinum, methotrexatum, 6-mercaptopurinum, 5-fhthorouracilum, fhthorafur; antineoplastic antibiotics- adriamycinum, neomycinum, rubomycinum, bruneomycinum, carminomycinum, olivomycinum; plant substances - vinblastinum, colchaminum (component of ointment which used at treatment of skin cancer) and other - carboplatin. Cytotoxic effect of preparations estimated two methods - radiometric on inclusion of 3H - timidine in cells and spectrophotometric by definition of total amount nucleic acids and protein. For this purpose KML cells passed in quantity of 120 thousand in 3 ml of nutrient medium RPMI 1640, 10 % calf embryo serum in bottles and after 24 hours entered substances in dozes from 0,01 up to 100 μg/ml. Contact of substances to cells was 24 hours, then 10 μ Ci 3 H - timidine was injected on bottles at 1 hour. Cells transferred on GFC-filters, washed from not connected label. Filters transferred in scintillation liquid and a level of a radio-activity determined on β-counter. All tested clinical preparations appeared active within the criteria of activity, thus the radiometric method was more sensitive, than spectrophotometric. Thus, testing results of model have shown that stable cell line KML was sensitive to action of 18 clinical preparations with various mechanisms of action by different estimations of damaging action. This model can be used for biological activity of new potential cancerolytics pre-screening. This work was supported by the Center of Science and Technology of the Republic of

  10. [Clinical Tests Testing New Therapies for Stargardt Disease].

    Science.gov (United States)

    Kousal, B; Ďuďáková, Ľ; Hlavatá, L; Lišková, P

    2016-02-01

    To provide information on currently ongoing clinical trials for Stargardt disease. We have searched the clinical trial register (www.clinicaltrials.gov) for the keyword "Stargardt" and list active ongoing studies. There are currently eight registered clinical trials enrolling patients with Stargardt disease; all in phase I or II aiming at four mechanisms of action: inhibition of the production of vitamin A toxic dimers, gene therapy restoring wild type transcription of the ABCA4 gene, neuroprotection preventing retinal cells from oxidative damage, and replacement of the damaged retinal pigment epithelium using stem cell therapy. The basic prerequisite for enrolment in the vast majority of clinical trials is confirmation of the clinical diagnosis by mutational analysis. The wide variety of therapies that are registered as clinical trials for Stargardt disease significantly raises the possibility that effective treatments will be available in the near future for this currently incurable condition and that molecular genetic testing should be increasingly considered. Stargardt disease, clinical trial, ABCA4, mutation.

  11. Reduction in Unnecessary Clinical Laboratory Testing Through Utilization Management at a US Government Veterans Affairs Hospital.

    Science.gov (United States)

    Konger, Raymond L; Ndekwe, Paul; Jones, Genea; Schmidt, Ronald P; Trey, Marty; Baty, Eric J; Wilhite, Denise; Munshi, Imtiaz A; Sutter, Bradley M; Rao, Maddamsetti; Bashir, Chowdry M

    2016-03-01

    To implement an electronic laboratory utilization management system (laboratory expert system [LES]) to provide safe and effective reductions in unnecessary clinical laboratory testing. The LES is a set of frequency filter subroutines within the Veterans Affairs hospital and laboratory information system that was formulated by an interdisciplinary medical team. Since implementing the LES, total test volume has decreased by a mean of 11.18% per year compared with our pre-LES test volume. This change was not attributable to fluctuations in outpatient visits or inpatient days of care. Laboratory cost savings were estimated at $151,184 and $163,751 for 2012 and 2013, respectively. A significant portion of these cost savings was attributable to reductions in high-volume, large panel testing. No adverse effects on patient care were reported, and mean length of stay for patients remained unchanged. Electronic laboratory utilization systems can effectively reduce unnecessary laboratory testing without compromising patient care. Published by Oxford University Press on behalf of the American Society for Clinical Pathology, 2016. This work is written by US Government employees and is in the public domain in the US.

  12. Thrombophilia testing has limited usefulness in clinical decision-making and should be used selectively.

    Science.gov (United States)

    Masuda, Elna M; Lee, Raymond W; Okazaki, Ian J; Benyamini, Pouya; Kistner, Robert L

    2015-04-01

    Management of venous thromboembolism (VTE) includes evaluation for hypercoagulable state, especially if the VTE occurs in young patients, is recurrent, or is associated with a positive family history. These laboratory tests are costly, and surprisingly, there is little evidence showing that testing leads to improved clinical outcomes. Evidence based on observational prospective studies suggests that optimal duration of anticoagulation should be based on clinical risks resulting in VTE, such as transient, permanent, and idiopathic or unprovoked risks, and less on abnormal thrombophilia values. Thrombophilia screening is important in a subgroup of clinical scenarios, such as when there is clinical suspicion of antiphospholipid antibody syndrome, heparin resistance, or warfarin necrosis; with thrombosis occurring in unusual sites (such as mesenteric or cerebral deep venous thrombosis); and for pregnant women or those seeking pregnancy or considering estrogen-based agents. Thrombophilia screening is not likely to be helpful in most cases of first-time unprovoked VTE in the setting of transient risks, active malignant disease, deep venous thrombosis of upper extremity veins or from central lines, two or more VTEs, or arterial thrombosis with pre-existing atherosclerotic risk factors. The desire by both patient and physician for a scientific explanation of the clotting event may alone lead to testing, and if so, it should be with the understanding that an abnormal test result will likely not change management, and normal results do not accurately exclude a thrombophilic defect because there are likely factors yet to be discovered. Such false assumptions may lead to shorter durations of treatment than are optimal. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  13. Pre-anaesthetic screening of geriatric dogs

    Directory of Open Access Journals (Sweden)

    K.E. Joubert

    2007-05-01

    Full Text Available Pre-anaesthetic screening has been advocated as a valuable tool for improving anaesthetic safety and determining anaesthetic risk. This study was done determine whether pre-anaesthetic screening result in cancellation of anaesthesia and the diagnosis of new clinical conditions in geriatric dogs. One hundred and one dogs older than 7 years of age provided informed owner consent were included in the study. Each dog was weighed, and its temperature, pulse and respiration recorded. An abdominal palpation, examination of the mouth, including capillary refill time and mucous membranes, auscultation, body condition and habitus was performed and assessed. A cephalic catheter was placed and blood drawn for pre-anaesthetic testing. A micro-haematocrit tube was filled and the packed cell volume determined. The blood placed was in a test tube, centrifuged and then analysed on an in-house blood analyser. Alkaline phosphatase, alanine transferase, urea, creatinine, glucose and total protein were determined. A urine sample was then obtained by cystocentesis, catheterisation or free-flow for analysis. The urine specific gravity was determined with a refractometer. A small quantity of urine was then placed on a dip stick. Any new diagnoses made during the pre-anaesthetic screening were recorded. The average age of the dogs was 10.99+2.44 years and the weight was 19.64+15.78 kg. There were 13 dogs with pre-existing medical conditions. A total of 30 new diagnoses were made on the basis of the pre-anaesthetic screening. The most common conditions were neoplasia, chronic kidney disease and Cushing's disease. Of the 30 patients with a new diagnosis, 13 did not undergo anaesthesia as result of the new diagnosis. From this study it can be concluded that screening of geriatric patients is important and that sub-clinical disease could be present in nearly 30 % of these patients. The value of screening before anaesthesia is perhaps more questionable in terms of

  14. Pre-Test Analysis Predictions for the Shell Buckling Knockdown Factor Checkout Tests - TA01 and TA02

    Science.gov (United States)

    Thornburgh, Robert P.; Hilburger, Mark W.

    2011-01-01

    This report summarizes the pre-test analysis predictions for the SBKF-P2-CYL-TA01 and SBKF-P2-CYL-TA02 shell buckling tests conducted at the Marshall Space Flight Center (MSFC) in support of the Shell Buckling Knockdown Factor (SBKF) Project, NASA Engineering and Safety Center (NESC) Assessment. The test article (TA) is an 8-foot-diameter aluminum-lithium (Al-Li) orthogrid cylindrical shell with similar design features as that of the proposed Ares-I and Ares-V barrel structures. In support of the testing effort, detailed structural analyses were conducted and the results were used to monitor the behavior of the TA during the testing. A summary of predicted results for each of the five load sequences is presented herein.

  15. Frequency formats, probability formats, or problem structure? A test of the nested-sets hypothesis in an extensional reasoning task

    Directory of Open Access Journals (Sweden)

    William P. Neace

    2008-02-01

    Full Text Available Five experiments addressed a controversy in the probability judgment literature that centers on the efficacy of framing probabilities as frequencies. The natural frequency view predicts that frequency formats attenuate errors, while the nested-sets view predicts that highlighting the set-subset structure of the problem reduces error, regardless of problem format. This study tested these predictions using a conjunction task. Previous studies reporting that frequency formats reduced conjunction errors confounded reference class with problem format. After controlling this confound, the present study's findings show that conjunction errors can be reduced using either a probability or a frequency format, that frequency effects depend upon the presence of a reference class, and that frequency formats do not promote better statistical reasoning than probability formats.

  16. HIV pre-test information, discussion or counselling? A review of guidance relevant to the WHO European Region.

    Science.gov (United States)

    Bell, Stephen A; Delpech, Valerie; Raben, Dorthe; Casabona, Jordi; Tsereteli, Nino; de Wit, John

    2016-02-01

    In the context of a shift from exceptionalism to normalisation, this study examines recommendations/evidence in current pan-European/global guidelines regarding pre-test HIV testing and counselling practices in health care settings. It also reviews new research not yet included in guidelines. There is consensus that verbal informed consent must be gained prior to testing, individually, in private, confidentially, in the presence of a health care provider. All guidelines recommend pre-test information/discussion delivered verbally or via other methods (information sheet). There is agreement about a minimum standard of information to be provided before a test, but guidelines differ regarding discussion about issues encouraging patients to think about implications of the result. There is heavy reliance on expert consultation in guideline development. Referenced scientific evidence is often more than ten years old and based on US/UK research. Eight new papers are reviewed. Current HIV testing and counselling guidelines have inconsistencies regarding the extent and type of information that is recommended during pre-test discussions. The lack of new research underscores a need for new evidence from a range of European settings to support the process of expert consultation in guideline development. © The Author(s) 2015.

  17. Oligonucleotide-based pharmaceuticals: Non-clinical and clinical safety signals and non-clinical testing strategies.

    Science.gov (United States)

    Mustonen, Enni-Kaisa; Palomäki, Tiina; Pasanen, Markku

    2017-11-01

    Antisense oligonucleotides, short interfering RNAs (siRNAs) and aptamers are oligonucleotide-based pharmaceuticals with a promising role in targeted therapies. Currently, five oligonucleotide-based pharmaceuticals have achieved marketing authorization in Europe or USA and many more are undergoing clinical testing. However, several safety concerns have been raised in non-clinical and clinical studies. Oligonucleotides share properties with both chemical and biological pharmaceuticals and therefore they pose challenges also from the regulatory point of view. We have analyzed the safety data of oligonucleotides and evaluated the applicability of current non-clinical toxicological guidelines for assessing the safety of oligonucleotide-based pharmaceuticals. Oligonucleotide-based pharmaceuticals display a similar toxicological profile, exerting adverse effects on liver and kidney, evoking hematological alterations, as well as causing immunostimulation and prolonging the coagulation time. It is possible to extrapolate some of these effects from non-clinical studies to humans. However, evaluation strategies for genotoxicity testing of "non-natural" oligonucleotides should be revised. Additionally, the selective use of surrogates and prediction of clinical endpoints for non-clinically observed immunostimulation is complicated by its multiple potential manifestations, demanding improvements in the testing strategies. Utilizing more relevant and mechanistic-based approaches and taking better account of species differences, could possibly improve the prediction of relevant immunological/proinflammatory effects in humans. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Development and Validation of a Calculator for Estimating the Probability of Urinary Tract Infection in Young Febrile Children.

    Science.gov (United States)

    Shaikh, Nader; Hoberman, Alejandro; Hum, Stephanie W; Alberty, Anastasia; Muniz, Gysella; Kurs-Lasky, Marcia; Landsittel, Douglas; Shope, Timothy

    2018-06-01

    Accurately estimating the probability of urinary tract infection (UTI) in febrile preverbal children is necessary to appropriately target testing and treatment. To develop and test a calculator (UTICalc) that can first estimate the probability of UTI based on clinical variables and then update that probability based on laboratory results. Review of electronic medical records of febrile children aged 2 to 23 months who were brought to the emergency department of Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania. An independent training database comprising 1686 patients brought to the emergency department between January 1, 2007, and April 30, 2013, and a validation database of 384 patients were created. Five multivariable logistic regression models for predicting risk of UTI were trained and tested. The clinical model included only clinical variables; the remaining models incorporated laboratory results. Data analysis was performed between June 18, 2013, and January 12, 2018. Documented temperature of 38°C or higher in children aged 2 months to less than 2 years. With the use of culture-confirmed UTI as the main outcome, cutoffs for high and low UTI risk were identified for each model. The resultant models were incorporated into a calculation tool, UTICalc, which was used to evaluate medical records. A total of 2070 children were included in the study. The training database comprised 1686 children, of whom 1216 (72.1%) were female and 1167 (69.2%) white. The validation database comprised 384 children, of whom 291 (75.8%) were female and 200 (52.1%) white. Compared with the American Academy of Pediatrics algorithm, the clinical model in UTICalc reduced testing by 8.1% (95% CI, 4.2%-12.0%) and decreased the number of UTIs that were missed from 3 cases to none. Compared with empirically treating all children with a leukocyte esterase test result of 1+ or higher, the dipstick model in UTICalc would have reduced the number of treatment delays by 10.6% (95% CI

  19. Development and psychometric testing of a Clinical Reasoning Evaluation Simulation Tool (CREST) for assessing nursing students' abilities to recognize and respond to clinical deterioration.

    Science.gov (United States)

    Liaw, Sok Ying; Rashasegaran, Ahtherai; Wong, Lai Fun; Deneen, Christopher Charles; Cooper, Simon; Levett-Jones, Tracy; Goh, Hongli Sam; Ignacio, Jeanette

    2018-03-01

    The development of clinical reasoning skills in recognising and responding to clinical deterioration is essential in pre-registration nursing education. Simulation has been increasingly used by educators to develop this skill. To develop and evaluate the psychometric properties of a Clinical Reasoning Evaluation Simulation Tool (CREST) for measuring clinical reasoning skills in recognising and responding to clinical deterioration in a simulated environment. A scale development with psychometric testing and mixed methods study. Nursing students and academic staff were recruited at a university. A three-phase prospective study was conducted. Phase 1 involved the development and content validation of the CREST; Phase 2 included the psychometric testing of the tool with 15 second-year and 15 third-year nursing students who undertook the simulation-based assessment; Phase 3 involved the usability testing of the tool with nine academic staff through a survey questionnaire and focus group discussion. A 10-item CREST was developed based on a model of clinical reasoning. A content validity of 0.93 was obtained from the validation of 15 international experts. The construct validity was supported as the third-year students demonstrated significantly higher (preasoning scores than the second-year students. The concurrent validity was also supported with significant positive correlations between global rating scores and almost all subscale scores, and the total scores. The predictive validity was supported with an existing tool. The internal consistency was high with a Cronbach's alpha of 0.92. A high inter-rater reliability was demonstrated with an intraclass correlation coefficient of 0.88. The usability of the tool was rated positively by the nurse educators but the need to ease the scoring process was highlighted. A valid and reliable tool was developed to measure the effectiveness of simulation in developing clinical reasoning skills for recognising and responding to

  20. Pre- and Post-Test Results of KEEP Class 2: 1973-74. Technical Report #40.

    Science.gov (United States)

    Fox, Candy

    This report presents the pre-and posttest results for the kindergarten year of the Kamehameha Early Education Program (KEEP) Class 2, 1973-1974. Results are presented for the Wechsler Preschool and Primary Scale of Intelligence (WPPSI), the Metropolitan Readiness Test (MRT), and the Standard English Repetition Test (SERT). Comparisons are made…

  1. Performance of Male and Female C57BL/6J Mice on Motor and Cognitive Tasks Commonly Used in Pre-Clinical Traumatic Brain Injury Research

    Science.gov (United States)

    Tucker, Laura B.; Fu, Amanda H.

    2016-01-01

    Abstract To date, clinical trials have failed to find an effective therapy for victims of traumatic brain injury (TBI) who live with motor, cognitive, and psychiatric complaints. Pre-clinical investigators are now encouraged to include male and female subjects in all translational research, which is of particular interest in the field of neurotrauma given that circulating female hormones (progesterone and estrogen) have been demonstrated to exert neuroprotective effects. To determine whether behavior of male and female C57BL6/J mice is differentially impaired by TBI, male and cycling female mice were injured by controlled cortical impact and tested for several weeks with functional assessments commonly employed in pre-clinical research. We found that cognitive and motor impairments post-TBI, as measured by the Morris water maze (MWM) and rotarod, respectively, were largely equivalent in male and female animals. However, spatial working memory, assessed by the y-maze, was poorer in female mice. Female mice were generally more active, as evidenced by greater distance traveled in the first exposure to the open field, greater distance in the y-maze, and faster swimming speeds in the MWM. Statistical analysis showed that variability in all behavioral data was no greater in cycling female mice than it was in male mice. These data all suggest that with careful selection of tests, procedures, and measurements, both sexes can be included in translational TBI research without concern for effect of hormones on functional impairments or behavioral variability. PMID:25951234

  2. Barley Seed Germination/Root Elongation Toxicity Test For Evaluation Of Sludge Pre-Treatment

    DEFF Research Database (Denmark)

    Eriksson, Eva; Kusk, Kresten Ole; Barrett Sørensen, Mie

    Application of sludge from wastewater treatment plants (WWTPs) on agricultural land is an approach for nutrient recycling that rise challenges due to recalcitrant and harmful pollutants. In this study we assessed the feasibility of a seed germination test to evaluate sludge ecotoxicity and compared...... germination responses from two test parameters, root elongation and seed germination (sprouts elongation) of the barley (Hordeum vulgare). 2nd objective was to evaluate sewage sludge pre-treatments at batch-scale of sludge samples from two WWTPs using anaerobic digestion, and thermal and ozonation pre......-treatments. Glyphosate and eco-labelled soil were used as references. Inhibition of germination of seeds exposed to the glyphosate and sludge was registered and thus germination was successfully applied for sludge ecotoxicity assessment, and using the root elongation as the end-point was both faster and more precise...

  3. A clinical evaluation of placental growth factor in routine practice in high-risk women presenting with suspected pre-eclampsia and/or fetal growth restriction.

    Science.gov (United States)

    Ormesher, L; Johnstone, E D; Shawkat, E; Dempsey, A; Chmiel, C; Ingram, E; Higgins, L E; Myers, J E

    2018-03-13

    To evaluate the use of plasma Placental Growth Factor (PlGF), recommended by the recent NICE guidance, in women with suspected pre-eclampsia (PE) and/or fetal growth restriction (FGR). Non-randomised prospective clinical evaluation study in high-risk antenatal clinics in a tertiary maternity unit. PlGF testing was performed in addition to routine clinical assessment in 260 women >20 weeks' gestation with chronic disease (hypertension, renal disease ± diabetes) with a change in maternal condition or in women with suspected FGR to determine the impact on clinical management. Results were revealed and standardised care pathways followed. Outcome of pregnancies with a low PlGF (women had an adverse outcome (PE/birthweight women with PlGF 14 days. The PlGF result altered clinical management (surveillance or timing of birth) in 196/260 (75.4%) cases. Alternative PlGF thresholds did not significantly improve diagnostic performance. Our evaluation confirms the value of PlGF as a diagnostic tool for placental dysfunction. However, low PlGF in isolation should not trigger iatrogenic delivery. Further research linking placental pathology, maternal disease and maternal PlGF levels is urgently needed before this test can be implemented in routine clinical practice. Copyright © 2018. Published by Elsevier B.V.

  4. Responsiveness of clinical tests for people with neck pain

    DEFF Research Database (Denmark)

    Jørgensen, René; Ris, Inge; Juhl, Carsten

    2017-01-01

    of four clinical tests which are low cost and easy to perform in a clinical setting, including the craniocervical flexion test, cervical active range of movement, test for the cervical extensors and pressure pain threshold testing. METHODS: This study is a secondary analysis of data collected......BACKGROUND: Responsiveness of a clinical test is highly relevant in order to evaluate the effect of a given intervention. However, the responsiveness of clinical tests for people with neck pain has not been adequately evaluated. The objective of the present study was to examine the responsiveness...... in a previously published randomised controlled trial. Participants were randomized to either physical training, exercises and pain education combined or pain education only. Participants were tested on the clinical tests at baseline and at 4-month follow-up. An anchor-based approach using Receiver Operator...

  5. Design and Effectiveness of a Required Pre-Clinical Simulation-based Curriculum for Fundamental Clinical Skills and Procedures

    Directory of Open Access Journals (Sweden)

    Daryl P. Lofaso

    2011-12-01

    Full Text Available For more than 20 years, medical literature has increasingly documented the need for students to learn, practice and demonstrate competence in basic clinical knowledge and skills. In 2001, the Louisiana State University Health Science Centers (LSUHSC School of Medicine – New Orleans replaced its traditional Introduction in to Clinical Medicine (ICM course with the Science and Practice of Medicine (SPM course. The main component within the SPM course is the Clinical Skills Lab (CSL. The CSL teaches 30 plus skills to all pre-clinical medical students (Years 1 and 2. Since 2002, an annual longitudinal evaluation questionnaire was distributed to all medical students targeting the skills taught in the CSL. Students were asked to rate their self- confidence (Dreyfus and Likert-type and estimate the number of times each clinical skill was performed (clinically/non-clinically. Of the 30 plus skills taught, 8 were selected for further evaluation. An analysis was performed on the eight skills selected to determine the effectiveness of the CSL. All students that participated in the CSL reported a significant improvement in self-confidence and in number performed in the clinically/non-clinically setting when compared to students that did not experience the CSL. For example, without CSL training, the percentage of students reported at the end of their second year self-perceived expertise as “novice” ranged from 21.4% (CPR to 84.7% (GU catheterization. Students who completed the two-years CSL, only 7.8% rated their self-perceived expertise at the end of the second year as “novice” and 18.8% for GU catheterization. The CSL design is not to replace real clinical patient experiences. It's to provide early exposure, medial knowledge, professionalism and opportunity to practice skills in a patient free environment.

  6. Predictive potential of pre-operative functional neuroimaging in patients treated with subthalamic stimulation

    International Nuclear Information System (INIS)

    Sestini, Stelvio; Castagnoli, Antonio; Pupi, Alberto; Sciagra, Roberto; Ammannati, Franco; Ramat, Silvia; Sorbi, Sandro; Mansi, Luigi

    2010-01-01

    The aim of this study was to investigate the predictive potential of pre-operative regional cerebral blood flow (rCBF) in the pre-supplementary motor area (pre-SMA) and clinical factors in Parkinson's disease (PD) patients treated with subthalamic nucleus (STN) stimulation. Ten patients underwent rCBF SPECT and motor Unified Parkinson's Disease Rating Scale (UPDRS) pre- and post-operatively during stimulation at 5 and 42 months. Statistical parametric mapping (SPM) was used to extract rCBF values in the pre-SMA because it is related with motor improvement. Post-operative outcomes included motor response to stimulation and percent improvement in UPDRS. Pre-operative predictors were explored by correlation test, linear regression and multivariate analyses. Higher pre-operative rCBF in the pre-SMA and younger age were associated with favourable outcomes at 5 and 42 months. Pre-operative rCBF results were significantly associated with baseline clinical factors. This study shows that PD patients with younger age have higher rCBF values in the pre-SMA and better outcome, thus giving the rationale to the hypothesis that STN stimulation could be considered early in the course of disease. (orig.)

  7. Predictive potential of pre-operative functional neuroimaging in patients treated with subthalamic stimulation

    Energy Technology Data Exchange (ETDEWEB)

    Sestini, Stelvio; Castagnoli, Antonio [Ospedale Misericordia e Dolce, Department of Diagnostic Imaging, Nuclear Medicine Unit, Prato (Italy); Pupi, Alberto; Sciagra, Roberto [University of Florence, Department of Clinical Physiopathology, Nuclear Medicine Unit, Florence (Italy); Ammannati, Franco; Ramat, Silvia; Sorbi, Sandro [University of Florence, Department of Neurological and Psychiatric Sciences, Florence (Italy); Mansi, Luigi [University II Naples, Department of Diagnostic Imaging, Nuclear Medicine Unit, Naples (Italy)

    2010-01-15

    The aim of this study was to investigate the predictive potential of pre-operative regional cerebral blood flow (rCBF) in the pre-supplementary motor area (pre-SMA) and clinical factors in Parkinson's disease (PD) patients treated with subthalamic nucleus (STN) stimulation. Ten patients underwent rCBF SPECT and motor Unified Parkinson's Disease Rating Scale (UPDRS) pre- and post-operatively during stimulation at 5 and 42 months. Statistical parametric mapping (SPM) was used to extract rCBF values in the pre-SMA because it is related with motor improvement. Post-operative outcomes included motor response to stimulation and percent improvement in UPDRS. Pre-operative predictors were explored by correlation test, linear regression and multivariate analyses. Higher pre-operative rCBF in the pre-SMA and younger age were associated with favourable outcomes at 5 and 42 months. Pre-operative rCBF results were significantly associated with baseline clinical factors. This study shows that PD patients with younger age have higher rCBF values in the pre-SMA and better outcome, thus giving the rationale to the hypothesis that STN stimulation could be considered early in the course of disease. (orig.)

  8. Return to work after cancer and pre-cancer job dissatisfaction

    OpenAIRE

    Heinesen, Eskil; Kolodziejczyk, Christophe; Ladenburg, Jacob; Andersen, Ingelise; Thielen, Karsten

    2017-01-01

    We investigate the association between pre-cancer job dissatisfaction and return-to-work probability 3 years after a cancer diagnosis. We use a Danish data set combining administrative data and a survey to breast and colon cancer survivors. We find that the return-to-work probability has a negative correlation with pre-cancer job dissatisfaction with mental demands (where the correlation is driven by the high-educated) and with physical demands and the superior (where the correlation is drive...

  9. Bayesian Probability Theory

    Science.gov (United States)

    von der Linden, Wolfgang; Dose, Volker; von Toussaint, Udo

    2014-06-01

    Preface; Part I. Introduction: 1. The meaning of probability; 2. Basic definitions; 3. Bayesian inference; 4. Combinatrics; 5. Random walks; 6. Limit theorems; 7. Continuous distributions; 8. The central limit theorem; 9. Poisson processes and waiting times; Part II. Assigning Probabilities: 10. Transformation invariance; 11. Maximum entropy; 12. Qualified maximum entropy; 13. Global smoothness; Part III. Parameter Estimation: 14. Bayesian parameter estimation; 15. Frequentist parameter estimation; 16. The Cramer-Rao inequality; Part IV. Testing Hypotheses: 17. The Bayesian way; 18. The frequentist way; 19. Sampling distributions; 20. Bayesian vs frequentist hypothesis tests; Part V. Real World Applications: 21. Regression; 22. Inconsistent data; 23. Unrecognized signal contributions; 24. Change point problems; 25. Function estimation; 26. Integral equations; 27. Model selection; 28. Bayesian experimental design; Part VI. Probabilistic Numerical Techniques: 29. Numerical integration; 30. Monte Carlo methods; 31. Nested sampling; Appendixes; References; Index.

  10. A Cryogenic Test Station for the Pre-series 2400 W @ 1.8 K Refrigeration Units for the LHC

    CERN Document Server

    Claudet, S; Gully, P; Jäger, B; Millet, F; Roussel, P; Tavian, L

    2002-01-01

    The cooling capacity below 2 K for the superconducting magnets in the Large Hadron Collider (LHC), at CERN, will be provided by eight refrigeration units at 1.8 K, each of them coupled to a 4.5 K refrigerator. The supply of the series units is linked to successful testing and acceptance of the pre-series delivered by the two selected vendors. To properly assess the performance of specific components such as cold compressors and some process specificities a dedicated test station is necessary. The test station is able to process up to 130 g/s between 4.5 & 20 K and aims at simulating the steady and transient operational modes foreseen for the LHC. After recalling the basic characteristics of the 1.8 K refrigeration units and the content of the acceptance tests of the pre-series, the principle of the test cryostat is detailed. The components of the test station and corresponding layout are described. The first testing experience is presented as well as preliminary results of the pre-series units.

  11. Impact of a rapid molecular test for positive blood cultures from neonatal intensive care patients on clinical management: a retrospective audit.

    Science.gov (United States)

    Koh, L L; O'Rourke, S; Brennan, M; Clooney, L; Cafferkey, M; McCallion, N; Drew, R J

    2018-05-01

    Both Staphylococcus aureus and coagulase negative Staphylococci are common causes of late-onset neonatal sepsis in the neonatal intensive care unit (NICU), usually relating to intravascular access device infections. This project aimed to review the impact on antimicrobial treatment and clinical outcome in the NICU setting, of the introduction of the Xpert MRSA/SA BC test (Cepheid, USA) for the identification of staphylococci in blood cultures. A retrospective audit was carried out of the pre- and post-intervention periods; the intervention was the introduction of the Xpert MRSA/SA BC test. In total, 88 neonates had positive blood cultures with Staphylococcus spp., comprising 42 neonates in the pre-intervention and 46 in the post-intervention groups. The pre-intervention group had a higher birth weight (1.541 kg vs. 1.219 kg, p = 0.05) and higher platelet count (288 vs. 224 × 10 9 /L, p = 0.05). There was a trend towards a shorter duration of antimicrobial therapy in term infants and in the length of admission; however, this was not statistically significant (p = 0.2). All of the nine infants post-intervention with significant bacteraemia (S. aureus =3, CoNS =6) were changed to the optimal antimicrobial at the time the result was available. This study shows that the introduction of the Xpert MRSA/SA BC test can lead to a reduction in the length of admission and duration of antimicrobials in term infants; however, the difference was not statistically significant. All nine infants with clinically significant bacteraemia were treated with the appropriate antimicrobial when the Xpert MRSA/SA BC test result was available.

  12. PHARMACOLOGICAL IN VITRO MODELS IN PRE-CLINICAL DRUG TESTING - EXAMPLE OF hSERT TRANSFECTED HUMAN EMBRYONIC KIDNEY CELLS

    Directory of Open Access Journals (Sweden)

    Mihajlo Jakovljević

    2012-06-01

    Full Text Available Preclinical drug testing should be considered an important stage during examinations of its efficiency and safety in any likely indication observed. Purpose of the process is acquisition of substantial amount of particular drug-related data before approaching clinical trials in humans. Historical preclinical testing relied on available testing in microbe cultures and animal models. During recent decades laboratory techniques of human cell lines cultivation have been developed and improved. These provide unique possibility of drug acting mechanism testing in a simplified environment lacking basic homeostatic mechanisms. Some examples of these are measuring drug impact to biochemical transport, signaling or anabolic processes. Humane cell lines of embrional kidney 293 are an example of easy-to-grow and disseminate and quite endurable cell line. This methodological article notices some of the details of HEK293 cells cultivation and breading. We took transfection as an example of in vitro model creation for drug testing. Transfection refers to gene introduction into HEK293 cellular genome in order to achieve membrane expression of coded protein. In our case it would be human serotonin transporter. Article contains description of one particular methodological approach in measuring human serotonin transporter expression. The role and importance of serotonin pump in affective disorders genesis was already widely recognized. Aim of the paper was to emphasize feasibility of cell cultivation and its advantages in comparison with alternative traditional methods.

  13. Clinical Presentation and Treatment Outcome of Sleeping Sickness in Sudanese Pre-School Children.

    OpenAIRE

    Eperon, G; Schmid, C; Loutan, L; Chappuis, F

    2007-01-01

    BACKGROUND: Existing data on human African trypanosomiasis (HAT) due to Trypanosoma brucei gambiense among children are limited. Here, we described the demographic, clinical, diagnostic, treatment and outcome characteristics of HAT in pre-school children from Kajo-Keji County, South Sudan in comparison with older patients. METHODS: We did a retrospective analysis of HAT patients treated at the Kiri Sleeping Sickness Treatment Centre (SSTC), Kajo-Keji County, from June 2000 to December 2002. R...

  14. A structured framework improves clinical patient assessment and nontechnical skills of early career emergency nurses: a pre-post study using full immersion simulation.

    Science.gov (United States)

    Munroe, Belinda; Curtis, Kate; Murphy, Margaret; Strachan, Luke; Considine, Julie; Hardy, Jennifer; Wilson, Mark; Ruperto, Kate; Fethney, Judith; Buckley, Thomas

    2016-08-01

    The aim of this study was to evaluate the effect of the new evidence-informed nursing assessment framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, reassessment and communication) on the quality of patient assessment and fundamental nontechnical skills including communication, decision making, task management and situational awareness. Assessment is a core component of nursing practice and underpins clinical decisions and the safe delivery of patient care. Yet there is no universal or validated system used to teach emergency nurses how to comprehensively assess and care for patients. A pre-post design was used. The performance of thirty eight emergency nurses from five Australian hospitals was evaluated before and after undertaking education in the application of the HIRAID assessment framework. Video recordings of participant performance in immersive simulations of common presentations to the emergency department were evaluated, as well as participant documentation during the simulations. Paired parametric and nonparametric tests were used to compare changes from pre to postintervention. From pre to postintervention, participant performance increases were observed in the percentage of patient history elements collected, critical indicators of urgency collected and reported to medical officers, and patient reassessments performed. Participants also demonstrated improvement in each of the four nontechnical skills categories: communication, decision making, task management and situational awareness. The HIRAID assessment framework improves clinical patient assessments performed by emergency nurses and has the potential to enhance patient care. HIRAID should be considered for integration into clinical practice to provide nurses with a systematic approach to patient assessment and potentially improve the delivery of safe patient care. © 2016 John Wiley & Sons Ltd.

  15. Probability of spent fuel transportation accidents

    International Nuclear Information System (INIS)

    McClure, J.D.

    1981-07-01

    The transported volume of spent fuel, incident/accident experience and accident environment probabilities were reviewed in order to provide an estimate of spent fuel accident probabilities. In particular, the accident review assessed the accident experience for large casks of the type that could transport spent (irradiated) nuclear fuel. This review determined that since 1971, the beginning of official US Department of Transportation record keeping for accidents/incidents, there has been one spent fuel transportation accident. This information, coupled with estimated annual shipping volumes for spent fuel, indicated an estimated annual probability of a spent fuel transport accident of 5 x 10 -7 spent fuel accidents per mile. This is consistent with ordinary truck accident rates. A comparison of accident environments and regulatory test environments suggests that the probability of truck accidents exceeding regulatory test for impact is approximately 10 -9 /mile

  16. Advanced Pre-clinical Research Approaches and Models to Studying Pediatric Anesthetic Neurotoxicity

    Directory of Open Access Journals (Sweden)

    Cheng eWang

    2012-10-01

    Full Text Available Advances in pediatric and obstetric surgery have resulted in an increase in the duration and complexity of anesthetic procedures. A great deal of concern has recently arisen regarding the safety of anesthesia in infants and children. Because of obvious limitations, it is not possible to thoroughly explore the effects of anesthetic agents on neurons in vivo in human infants or children. However, the availability of some advanced pre-clinical research approaches and models, such as imaging technology both in vitro and in vivo, stem cell and nonhuman primate experimental models, have provided potentially invaluable tools for examining the developmental effects of anesthetic agents. This review discusses the potential application of some sophisticaled research approaches, e.g., calcium imaging, in stem cell-derived in vitro models, especially human embryonic neural stem cells, along with their capacity for proliferation and their potential for differentiation, to dissect relevant mechanisms underlying the etiology of the neurotoxicity associated with developmental exposures to anesthetic agents. Also, this review attempts to discuss several advantages for using the developing rhesus monkey models (in vivo, when combined with dynamic molecular imaging approaches, in addressing critical issues related to the topic of pediatric sedation/anesthesia. These include the relationships between anesthetic-induced neurotoxicity, dose response, time-course and developmental stage at time of exposure (in vivo studies, serving to provide the most expeditious platform toward decreasing the uncertainty in extrapolating pre-clinical data to the human condition.

  17. Potency probability following conformal megavoltage radiotherapy using conventional doses for localized prostate cancer

    International Nuclear Information System (INIS)

    Mantz, C.A.; Song, P.; Farhangi, E.; Nautiyal, J.; Awan, A.; Ignacio, L.; Weichselbaum, R.; Vijayakumar, S.

    1997-01-01

    test, p = 0.741) between ages 50 and 65. Finally, potency probability after follow-up of 1 year or more in EBRT-treated patients was stratified by age and substratified by clinical stage and then compared to similarly stratified potencies for patients treated with NSRP. The prostatectomy data were derived from the pooled data of six large (total n, 952), independent series conducted at academic centers. For patients older than 70 years, 79.1% of EBRT patients and 32.9% of NSRP patients remained potent after treatment. For patients with stage B2 disease, 75.0% of EBRT patients and 49.3% of NSRP patients remained potent after treatment. Overall EBRT patient potency was 76.1% vs. 66.2% for NSRP patients. Conclusions: 1) By 36 months after completion of EBRT for localized prostate cancer, fully one-third of all patients becomes impotent; however, for patients younger than 70 years, the probability of impotence does not depart significantly from that for normal males. 2) In the EBRT-treated population, pre-EBRT partial potency, vascular disease, and diabetes are the most significant predispositions to the development of impotence. Patients with these predispositions, though, do not become impotent significantly earlier than other patients. 3) When comparing age and stage-stratified potency rates for EBRT and NSRP patients, potency is roughly equal for both modalities for most age and stage groups; however, for patients older than 70 years or with stage B2 disease, EBRT offers notably higher posttreatment potency rates than NSRP. Thus, for the treatment of localized prostate cancer, EBRT may not affect the normal age trend of impotence in younger patients and may induce impotence less frequently than NSRP in older patients or in patients with later stage disease

  18. Validation of the Preverbal Visual Assessment (PreViAs) questionnaire.

    Science.gov (United States)

    García-Ormaechea, Inés; González, Inmaculada; Duplá, María; Andres, Eva; Pueyo, Victoria

    2014-10-01

    Visual cognitive integrative functions need to be evaluated by a behavioral assessment, which requires an experienced evaluator. The Preverbal Visual Assessment (PreViAs) questionnaire was designed to evaluate these functions, both in general pediatric population or in children with high risk of visual cognitive problems, through primary caregivers' answers. We aimed to validate the PreViAs questionnaire by comparing caregiver reports with results from a comprehensive clinical protocol. A total of 220 infants (visual development, as determined by the clinical protocol. Their primary caregivers completed the PreViAs questionnaire, which consists of 30 questions related to one or more visual domains: visual attention, visual communication, visual-motor coordination, and visual processing. Questionnaire answers were compared with results of behavioral assessments performed by three pediatric ophthalmologists. Results of the clinical protocol classified 128 infants as having normal visual maturation, and 92 as having abnormal visual maturation. The specificity of PreViAs questionnaire was >80%, and sensitivity was 64%-79%. More than 80% of the infants were correctly classified, and test-retest reliability exceeded 0.9 for all domains. The PreViAs questionnaire is useful to detect abnormal visual maturation in infants from birth to 24months of age. It improves the anamnesis process in infants at risk of visual dysfunctions. Copyright © 2014. Published by Elsevier Ireland Ltd.

  19. Mineralogic and petrologic investigation of pre-test core samples from the spent fuel test-climax

    International Nuclear Information System (INIS)

    Ryerson, F.J.; Qualheim, B.J.

    1983-12-01

    Pre-test samples obtained from just inside the perimeter of the canister emplacement holes of the Spent Fuel Test-Climax have been characterized by petrographic and microanalytical techniques. The primary quartz monzonite has undergone various degrees of hydrothermal alteration as a result of natural processes. Alteration is most apparent on primary plagioclase and biotite. The most common secondary phases on plagioclase are muscovite and calcite, while the most common secondary phases on biotite are epidote and chlorite. The major alteration zones encountered are localized along filled fractures, i.e. veins. The thickness and mineralogy of the alteration zones can be correlated with the vein mineralogy, becoming wider and more complex mineralogically when the veins contain calcite. 7 references, 10 figures, 4 tables

  20. Qualitative pre-test of Energy Star advertising : final report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2003-01-01

    Natural Resources Canada launched a print advertising campaign and one 30-second television commercial to promote the Energy Star symbol and to acquaint the public with the program that identifies energy efficient products that reduce energy use, save money and reduce greenhouse gas emissions that contribute to climate change. The Communications Branch of Natural Resources Canada wanted to pre-test the television and print ads. Each print ad focused on a particular product category, including home comfort, appliances, electronics and office equipment. The qualitative research methodology was used in the pre-testing because it is the best learning tool for understanding the range and depth of reactions toward a subject at any given time. The findings were not quantifiable because they are not representative of the population at large. Ten focus groups were surveyed in January 2003 in 5 Canadian centres with a total of 83 participants aged 18 to 54. The target groups included people who were informed about climate change issues as well as those who were note. Participants were questioned about the Energy Star Product. Findings were consistent across all 5 locations. There was some general awareness of EnerGuide on appliances in all groups, but generally a low awareness of the Energy Star symbol. Most people did not place energy efficiency as a high priority when purchasing appliances. This report presented the main findings of attitudes towards climate change, Kyoto and energy efficiency. The reaction to the television and print ads was also included along with opinions regarding their main weaknesses and strengths. Some recommendations for improvement were also included. Samples of the print advertisements were included in both English and French. tabs., figs.

  1. Introducing evidence based medicine to the journal club, using a structured pre and post test: a cohort study

    Directory of Open Access Journals (Sweden)

    Mahoney Martin C

    2001-11-01

    Full Text Available Abstract Background Journal Club at a University-based residency program was restructured to introduce, reinforce and evaluate residents understanding of the concepts of Evidence Based Medicine. Methods Over the course of a year structured pre and post-tests were developed for use during each Journal Club. Questions were derived from the articles being reviewed. Performance with the key concepts of Evidence Based Medicine was assessed. Study subjects were 35 PGY2 and PGY3 residents in a University based Family Practice Program. Results Performance on the pre-test demonstrated a significant improvement from a median of 54.5 % to 78.9 % over the course of the year (F 89.17, p Conclusions Following organizational revision, the introduction of a pre-test/post-test instrument supported achievement of the learning objectives with a better understanding and utilization of the concepts of Evidence Based Medicine.

  2. Understanding Pre-Quantitative Risk in Projects

    Science.gov (United States)

    Cooper, Lynne P.

    2011-01-01

    Standard approaches to risk management in projects depend on the ability of teams to identify risks and quantify the probabilities and consequences of these risks (e.g., the 5 x 5 risk matrix). However, long before quantification does - or even can - occur, and long after, teams make decisions based on their pre-quantitative understanding of risk. These decisions can have long-lasting impacts on the project. While significant research has looked at the process of how to quantify risk, our understanding of how teams conceive of and manage pre-quantitative risk is lacking. This paper introduces the concept of pre-quantitative risk and discusses the implications of addressing pre-quantitative risk in projects.

  3. IEEE guide for planning of pre-operational testing programs for class 1E power systems for nuclear-power generating stations

    International Nuclear Information System (INIS)

    Anon.

    1976-01-01

    The Institute of Electrical and Electronics Engineers (IEEE) guide for pre-operational testing of Class 1E power systems for nuclear-power generating stations is presented. The guidelines apply to power systems both ac and dc supplies but not to the equipment which utilizes the ac and dc power. The pre-operational tests are performed after appropriate construction tests

  4. Software for illustrative presentation of basic clinical characteristics of laboratory tests--GraphROC for Windows.

    Science.gov (United States)

    Kairisto, V; Poola, A

    1995-01-01

    GraphROC for Windows is a program for clinical test evaluation. It was designed for the handling of large datasets obtained from clinical laboratory databases. In the user interface, graphical and numerical presentations are combined. For simplicity, numerical data is not shown unless requested. Relevant numbers can be "picked up" from the graph by simple mouse operations. Reference distributions can be displayed by using automatically optimized bin widths. Any percentile of the distribution with corresponding confidence limits can be chosen for display. In sensitivity-specificity analysis, both illness- and health-related distributions are shown in the same graph. The following data for any cutoff limit can be shown in a separate click window: clinical sensitivity and specificity with corresponding confidence limits, positive and negative likelihood ratios, positive and negative predictive values and efficiency. Predictive values and clinical efficiency of the cutoff limit can be updated for any prior probability of disease. Receiver Operating Characteristics (ROC) curves can be generated and combined into the same graph for comparison of several different tests. The area under the curve with corresponding confidence interval is calculated for each ROC curve. Numerical results of analyses and graphs can be printed or exported to other Microsoft Windows programs. GraphROC for Windows also employs a new method, developed by us, for the indirect estimation of health-related limits and change limits from mixed distributions of clinical laboratory data.

  5. Awareness of Pre-diabetes or Diabetes and Associated Factors in People With Psychosis

    Science.gov (United States)

    Foley, Debra L.; Mackinnon, Andrew; Morgan, Vera A.; Watts, Gerald F.; Castle, David J.; Waterreus, Anna; Galletly, Cherrie A.

    2016-01-01

    Objective: To estimate awareness of pre-diabetes or type 2 diabetes and associated factors in people with psychosis, a known high-risk group. Methods: Cross sectional analysis of a national sample with psychosis who were aged 18–64 years, gave a fasting blood sample (n = 1155), had pre-diabetes or diabetes based on testing (n = 359) and reported if they knew they had high blood sugar or diabetes at survey (n = 356). Logistic regression was used to identify factors associated with awareness of pre-diabetes or diabetes prior to testing. Results: The prevalence of pre-diabetes (19.0% 219/1153) or type 2 diabetes (12.1%, 140/1153) was 31.1% (359/1153); 45% (160/356) were known prior to testing. Factors associated with detection were higher fasting blood glucose, older age, a perception of poor health, severe obesity, dyslipidaemia or treatment with a lipid regulating drug, a family history of diabetes, Aboriginal or Torres Strait Islander descent, decreased cognitive functioning, regional economic disadvantage, treatment with an antihypertensive drug, and an elevated 5-year risk for cardiovascular disease. The prevalence of undiagnosed pre-diabetes/diabetes was highest in those aged 25–34 years at 34.2%. Conclusions: Clinical detection of pre-diabetes or diabetes in people with psychosis was strongly dependent on established risk factors for type 2 diabetes in the population but not on current antipsychotic drug treatment or psychiatric case management which should ensure regular screening. Screening must become a clinical priority and should not wait until age 40. PMID:27150636

  6. Pre-HEAT: submillimeter site testing and astronomical spectra from Dome A, Antarctica

    Science.gov (United States)

    Kulesa, C. A.; Walker, C. K.; Schein, M.; Golish, D.; Tothill, N.; Siegel, P.; Weinreb, S.; Jones, G.; Bardin, J.; Jacobs, K.; Martin, C. L.; Storey, J.; Ashley, M.; Lawrence, J.; Luong-Van, D.; Everett, J.; Wang, L.; Feng, L.; Zhu, Z.; Yan, J.; Yang, J.; Zhang, X.-G.; Cui, X.; Yuan, X.; Hu, J.; Xu, Z.; Jiang, Z.; Yang, H.; Li, Y.; Sun, B.; Qin, W.; Shang, Z.

    2008-07-01

    Pre-HEAT is a 20 cm aperture submillimeter-wave telescope with a 660 GHz (450 micron) Schottky diode heterodyne receiver and digital FFT spectrometer for the Plateau Observatory (PLATO) developed by the University of New South Wales. In January 2008 it was deployed to Dome A, the summit of the Antarctic plateau, as part of a scientific traverse led by the Polar Research Institute of China and the Chinese Academy of Sciences. Dome A may be one of the best sites in the world for ground based Terahertz astronomy, based on the exceptionally cold, dry and stable conditions which prevail there. Pre-HEAT is measuring the 450 micron sky opacity at Dome A and mapping the Galactic Plane in the 13CO J=6-5 line, constituting the first submillimeter measurements from Dome A. It is field-testing many of the key technologies for its namesake -- a successor mission called HEAT: the High Elevation Antarctic Terahertz telescope. Exciting prospects for submillimeter astronomy from Dome A and the status of Pre-HEAT will be presented.

  7. Developing and pre-testing a decision board to facilitate informed choice about delivery approach in uncomplicated pregnancy

    Directory of Open Access Journals (Sweden)

    Wood Stephen

    2009-10-01

    Full Text Available Abstract Background The rate of caesarean sections is increasing worldwide, yet medical literature informing women with uncomplicated pregnancies about relative risks and benefits of elective caesarean section (CS compared with vaginal delivery (VD remains scarce. A decision board may address this gap, providing systematic evidence-based information so that patients can more fully understand their treatment options. The objective of our study was to design and pre-test a decision board to guide clinical discussions and enhance informed decision-making related to delivery approach (CS or VD in uncomplicated pregnancy. Methods Development of the decision board involved two preliminary studies to determine women's preferred mode of risk presentation and a systematic literature review for the most comprehensive presentation of medical risks at the time (VD and CS. Forty women were recruited to pre-test the tool. Eligible subjects were of childbearing age (18-40 years but were not pregnant in order to avoid raising the expectation among pregnant women that CS was a universally available birth option. Women selected their preferred delivery approach and completed the Decisional Conflict Scale to measure decisional uncertainty before and after reviewing the decision board. They also answered open-ended questions reflecting what they had learned, whether or not the information had helped them to choose between birth methods, and additional information that should be included. Descriptive statistics were used to analyse sample characteristics and women's choice of delivery approach pre/post decision board. Change in decisional conflict was measured using Wilcoxon's sign rank test for each of the three subscales. Results The majority of women reported that they had learned something new (n = 37, 92% and that the tool had helped them make a hypothetical choice between delivery approaches (n = 34, 85%. Women wanted more information about neonatal risks and

  8. Probability density fittings of corrosion test-data: Implications on ...

    Indian Academy of Sciences (India)

    Steel-reinforced concrete; probability distribution functions; corrosion ... to be present in the corrosive system at a suitable concentration (Holoway et al 2004; Söylev & ..... voltage, equivalent to voltage drop, across a resistor divided by the ...

  9. Validity of subjective assessment as screening tool for dry eye disease and its association with clinical tests

    Directory of Open Access Journals (Sweden)

    Kavita R Bhatnagar

    2015-02-01

    Full Text Available AIM: To determine the role of subjective assessment using McMonnies dry eye questionnaire in diagnosing dry eye disease and its association with clinical tests. METHODS: There were 500 patients screened for dry eye using McMonnies dry eye questionnaire between May to October 2013 at the outpatient Department of Ophthalmology of a medical college hospital. All 500 patients were subjected to clinical tests. Dry eye was defined as having one or more symptoms often or all the time. Positive signs were if one or both eyes revealed tear film breakup time (TBUT of ≤10s, a Schirmer test score of ≤10 mm, a Rose Bengal staining score of ≥1, a Lissamine green staining score of ≥1 or existence of meibomian gland disease (≥grade 1. Statistical analysis was performed to describe the distribution of symptoms and signs, to assess the correlations between McMonnies score (MS and variable clinical signs of dry eye, and to explore the association between dry eye symptoms and variable clinical signs. Analysis was performed using software package Epi info. A Probability (P value using Chi-square test of RESULTS: Dry eye prevalence with symptoms (questionnaire, Schirmer test, TBUT, Rose Bengal staining and Lissamine green staining was 25.6%, 15.20%, 20.80%, 23.60%, and 22.60% respectively. Among those with severe symptoms (MS>20, 75.86% had a low TBUT (CONCLUSION: Subjective assessment plays an important role in diagnosing dry eye disease. There is strong correlation between MS and Schirmer test, TBUT, Rose Bengal staining and Lissamine green staining in normal as well as marginal and pathological dry eye.

  10. The nutritional impact of the Pre-School Health Programme at three clinics in Central Province, Kenya

    NARCIS (Netherlands)

    Hoorweg, J.C.; Niemeijer, R.

    1980-01-01

    Abr. sum.: Contains an account of a study of the effects of the Pre-School Health Programme at three clinics in different ecological zones in Central Province, Kenya. Two groups of mothers were selected for interviewing: recent entrants and longtime participants. The study concentrates on the

  11. Sensitivity and bias in decision-making under risk: evaluating the perception of reward, its probability and value.

    Directory of Open Access Journals (Sweden)

    Madeleine E Sharp

    Full Text Available BACKGROUND: There are few clinical tools that assess decision-making under risk. Tests that characterize sensitivity and bias in decisions between prospects varying in magnitude and probability of gain may provide insights in conditions with anomalous reward-related behaviour. OBJECTIVE: We designed a simple test of how subjects integrate information about the magnitude and the probability of reward, which can determine discriminative thresholds and choice bias in decisions under risk. DESIGN/METHODS: Twenty subjects were required to choose between two explicitly described prospects, one with higher probability but lower magnitude of reward than the other, with the difference in expected value between the two prospects varying from 3 to 23%. RESULTS: Subjects showed a mean threshold sensitivity of 43% difference in expected value. Regarding choice bias, there was a 'risk premium' of 38%, indicating a tendency to choose higher probability over higher reward. An analysis using prospect theory showed that this risk premium is the predicted outcome of hypothesized non-linearities in the subjective perception of reward value and probability. CONCLUSIONS: This simple test provides a robust measure of discriminative value thresholds and biases in decisions under risk. Prospect theory can also make predictions about decisions when subjective perception of reward or probability is anomalous, as may occur in populations with dopaminergic or striatal dysfunction, such as Parkinson's disease and schizophrenia.

  12. Sensitivity and Bias in Decision-Making under Risk: Evaluating the Perception of Reward, Its Probability and Value

    Science.gov (United States)

    Sharp, Madeleine E.; Viswanathan, Jayalakshmi; Lanyon, Linda J.; Barton, Jason J. S.

    2012-01-01

    Background There are few clinical tools that assess decision-making under risk. Tests that characterize sensitivity and bias in decisions between prospects varying in magnitude and probability of gain may provide insights in conditions with anomalous reward-related behaviour. Objective We designed a simple test of how subjects integrate information about the magnitude and the probability of reward, which can determine discriminative thresholds and choice bias in decisions under risk. Design/Methods Twenty subjects were required to choose between two explicitly described prospects, one with higher probability but lower magnitude of reward than the other, with the difference in expected value between the two prospects varying from 3 to 23%. Results Subjects showed a mean threshold sensitivity of 43% difference in expected value. Regarding choice bias, there was a ‘risk premium’ of 38%, indicating a tendency to choose higher probability over higher reward. An analysis using prospect theory showed that this risk premium is the predicted outcome of hypothesized non-linearities in the subjective perception of reward value and probability. Conclusions This simple test provides a robust measure of discriminative value thresholds and biases in decisions under risk. Prospect theory can also make predictions about decisions when subjective perception of reward or probability is anomalous, as may occur in populations with dopaminergic or striatal dysfunction, such as Parkinson's disease and schizophrenia. PMID:22493669

  13. Dangerous "spin": the probability myth of evidence-based prescribing - a Merleau-Pontyian approach.

    Science.gov (United States)

    Morstyn, Ron

    2011-08-01

    The aim of this study was to examine logical positivist statistical probability statements used to support and justify "evidence-based" prescribing rules in psychiatry when viewed from the major philosophical theories of probability, and to propose "phenomenological probability" based on Maurice Merleau-Ponty's philosophy of "phenomenological positivism" as a better clinical and ethical basis for psychiatric prescribing. The logical positivist statistical probability statements which are currently used to support "evidence-based" prescribing rules in psychiatry have little clinical or ethical justification when subjected to critical analysis from any of the major theories of probability and represent dangerous "spin" because they necessarily exclude the individual , intersubjective and ambiguous meaning of mental illness. A concept of "phenomenological probability" founded on Merleau-Ponty's philosophy of "phenomenological positivism" overcomes the clinically destructive "objectivist" and "subjectivist" consequences of logical positivist statistical probability and allows psychopharmacological treatments to be appropriately integrated into psychiatric treatment.

  14. Errors in the Total Testing Process in the Clinical Chemistry ...

    African Journals Online (AJOL)

    2018-03-01

    Mar 1, 2018 ... Analytical errors related to internal and external quality control exceeding the target range, (14.4%) ... indicators to assess errors in the total testing process. The. University ... Evidence showed that the risk of .... Data management and quality control: Pre-test ..... indicators and specifications for key processes.

  15. The Sequential Probability Ratio Test: An efficient alternative to exact binomial testing for Clean Water Act 303(d) evaluation.

    Science.gov (United States)

    Chen, Connie; Gribble, Matthew O; Bartroff, Jay; Bay, Steven M; Goldstein, Larry

    2017-05-01

    The United States's Clean Water Act stipulates in section 303(d) that states must identify impaired water bodies for which total maximum daily loads (TMDLs) of pollution inputs into water bodies are developed. Decision-making procedures about how to list, or delist, water bodies as impaired, or not, per Clean Water Act 303(d) differ across states. In states such as California, whether or not a particular monitoring sample suggests that water quality is impaired can be regarded as a binary outcome variable, and California's current regulatory framework invokes a version of the exact binomial test to consolidate evidence across samples and assess whether the overall water body complies with the Clean Water Act. Here, we contrast the performance of California's exact binomial test with one potential alternative, the Sequential Probability Ratio Test (SPRT). The SPRT uses a sequential testing framework, testing samples as they become available and evaluating evidence as it emerges, rather than measuring all the samples and calculating a test statistic at the end of the data collection process. Through simulations and theoretical derivations, we demonstrate that the SPRT on average requires fewer samples to be measured to have comparable Type I and Type II error rates as the current fixed-sample binomial test. Policymakers might consider efficient alternatives such as SPRT to current procedure. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. Pre-operational proof and leakage rate testing requirements for concrete containment structures for CANDU nuclear power plants

    International Nuclear Information System (INIS)

    1994-02-01

    This Standard provides the requirements for pre-operational proof tests and leakage rate tests of concrete containment structures of a containment system designed as Class Containment components. 1 fig

  17. Validation of pre-coated ELISA tests to detect antibodies against T. congolense and T. vivax

    International Nuclear Information System (INIS)

    Shumba, W.

    2000-01-01

    The anti-trypanosomal antibody detecting enzyme linked immunosorbent assay (ELISA) was first described in 1977 and was further developed for use in large scale surveys in Zimbabwe. More recently, the IAEA initiated a programme to improve the robustness and standardisation of the assay. The IAEA supplied plates pre-coated with either a crude T. congolense or T. vivax antigen and the reagents necessary for analysing samples. Parasitologically positive and negative sera were used to validate and determine the cut-off values of the two tests. The samples were tested and results analysed using a variety of cut-off values. The tests provided similar information although the T. congolense pre-coated plates gave significantly higher optical density values than the plates coated with T. vivax. Sensitivity and specificity values were calculated using the different cut-off points. Results indicate that the test using T. congolense antigen had the highest specificity and sensitivity for a given cut-off value. Although the test could distinguish positive from negative sera, it was quite difficult to provide a suitable cut-off value, but the value should be dictated by the use of the test. (author)

  18. ENDF/B Pre-Processing Codes: Implementing and testing on a Personal Computer

    International Nuclear Information System (INIS)

    McLaughlin, P.K.

    1987-05-01

    This document describes the contents of the diskettes containing the ENDF/B Pre-Processing codes by D.E. Cullen, and example data for use in implementing and testing these codes on a Personal Computer of the type IBM-PC/AT. Upon request the codes are available from the IAEA Nuclear Data Section, free of charge, on a series of 7 diskettes. (author)

  19. Pre-registration interprofessional clinical education in the workplace: a realist review.

    Science.gov (United States)

    Kent, Fiona; Hayes, Jacinta; Glass, Sharon; Rees, Charlotte E

    2017-09-01

    The inclusion of interprofessional education opportunities in clinical placements for pre-registration learners has recently been proposed as a strategy to enhance graduates' skills in collaborative practice. A realist review was undertaken to ascertain the contexts, mechanisms and outcomes of formal interprofessional clinical workplace learning. Initial scoping was carried out, after which Ovid MEDLINE, CINAHL and EMBASE were searched from 2005 to April 2016 to identify formal interprofessional workplace educational interventions involving pre-registration learners. Papers reporting studies conducted in dedicated training wards were excluded, leaving a total of 30 papers to be included in the review. Several educational formats that combined students from medicine, nursing, pharmacy and allied health professions were identified. These included: the use of engagement by student teams with a real patient through interview as the basis for discussion and reflection; the use of case studies through which student teams work to promote discussion; structured workshops; ward rounds, and shadowing. Meaningful interprofessional student discussion and reflection comprised the mechanism by which the outcome of learners acquiring knowledge of the roles of other professions and teamwork skills was achieved. The mechanism of dialogue during an interaction with a real patient allowed the patient to provide his or her perspective and contributed to an awareness of the patient's perspective in health care practice. Medication- or safety-focused interprofessional tasks contributed to improved safety awareness. In the absence of trained facilitators or in the context of negative role-modelling, programmes were less successful. In the design of workplace education initiatives, curriculum decisions should take into consideration the contexts of the initiatives and the mechanisms for achieving the education-related outcomes of interest. © 2017 John Wiley & Sons Ltd and The Association

  20. Pre-clinical and Clinical Development of Low Dose Methamphetamine for the Treatment of Traumatic Brain Injury

    Science.gov (United States)

    2014-12-01

    Aim 3: Secure FDA approval of a phase I/II clinical trial plan and obtain an amended IND in preparation for initiating human clinical testing in TBI...Neurology 6:193–201. Raineri M, Gonzalez B, Goitia B, Garcia-Rill E, Krasnova IN, Cadet JL, Urbano FJ, Bisagno V. 2012. Modafinil abrogates

  1. Education in radiopharmacy at pre and post-graduate level : in it valuable for clinical practice

    International Nuclear Information System (INIS)

    Savio, E.O.; Rey, A.M.; Teran, M.A.; Fornaro, L.R.; Leon, A.S.

    2004-01-01

    Radiopharmacy deals with the design preparation, quality control and dispensation of medicinal radioactive products used in Nuclear Medicine. In the context of the Hospital Radiopharmacy Unit the Radio pharmacist responsibilities also include radiation protection of personnel and patients, monitoring and advice in case of adverse effects after administration, involvement in clinical protocols and training of other members of the staff. In order to develop all these functions, knowledge in a variety of fields including radiation physics and biology, chemistry of radiopharmaceuticals, GMP, radiopharmacology, etc. is required. However, Radio pharmacists have traditionally got their expertise by a combination of informal training and self-education. Possibilities of formal education in Radiopharmacy are still very limited. Consequently, the Faculty of Chemistry and Pharmacy of Uruguay has started a pre graduate optional course of Radiopharmacy for advanced Pharmacy students and a post-graduate course for Hospital Pharmacy Specialization. Both subjects include theoretical and practical classes on handling and detection of radioactive substance, radioprotection, preparation of radiopharmaceuticals and clinical applications, together with seminars for discussion of relevant matters. At pre graduate level, the subject provides a basic training for a future professionals working in this field. For Hospital Pharmacists the pos graduate course supports the interpretation of clinical histories of patients that have undergone Nuclear Medicine procedures, and provides the necessary background to give suitable advice to patients, their family and health staff about radiation protection

  2. Delusional patterns and its pre-morbid personality linkages in ...

    African Journals Online (AJOL)

    DSM IVTR, psychological tests: MMPI, SCL-90R and clinical observations were used for the diagnosis of the patients according to the centre policy. Two recording scales designed by the researchers were used to assign the participants to different types of delusions and pre-morbid personalities. The study design was a ...

  3. Advantages and limitations of anticipating laboratory test results from regression- and tree-based rules derived from electronic health-record data.

    Directory of Open Access Journals (Sweden)

    Fahim Mohammad

    Full Text Available Laboratory testing is the single highest-volume medical activity, making it useful to ask how well one can anticipate whether a given test result will be high, low, or within the reference interval ("normal". We analyzed 10 years of electronic health records--a total of 69.4 million blood tests--to see how well standard rule-mining techniques can anticipate test results based on patient age and gender, recent diagnoses, and recent laboratory test results. We evaluated rules according to their positive and negative predictive value (PPV and NPV and area under the receiver-operator characteristic curve (ROC AUCs. Using a stringent cutoff of PPV and/or NPV≥0.95, standard techniques yield few rules for sendout tests but several for in-house tests, mostly for repeat laboratory tests that are part of the complete blood count and basic metabolic panel. Most rules were clinically and pathophysiologically plausible, and several seemed clinically useful for informing pre-test probability of a given result. But overall, rules were unlikely to be able to function as a general substitute for actually ordering a test. Improving laboratory utilization will likely require different input data and/or alternative methods.

  4. Advantages and limitations of anticipating laboratory test results from regression- and tree-based rules derived from electronic health-record data.

    Science.gov (United States)

    Mohammad, Fahim; Theisen-Toupal, Jesse C; Arnaout, Ramy

    2014-01-01

    Laboratory testing is the single highest-volume medical activity, making it useful to ask how well one can anticipate whether a given test result will be high, low, or within the reference interval ("normal"). We analyzed 10 years of electronic health records--a total of 69.4 million blood tests--to see how well standard rule-mining techniques can anticipate test results based on patient age and gender, recent diagnoses, and recent laboratory test results. We evaluated rules according to their positive and negative predictive value (PPV and NPV) and area under the receiver-operator characteristic curve (ROC AUCs). Using a stringent cutoff of PPV and/or NPV≥0.95, standard techniques yield few rules for sendout tests but several for in-house tests, mostly for repeat laboratory tests that are part of the complete blood count and basic metabolic panel. Most rules were clinically and pathophysiologically plausible, and several seemed clinically useful for informing pre-test probability of a given result. But overall, rules were unlikely to be able to function as a general substitute for actually ordering a test. Improving laboratory utilization will likely require different input data and/or alternative methods.

  5. Safety and effectiveness considerations for clinical studies of visual prosthetic devices

    Science.gov (United States)

    Cohen, Ethan D.

    2007-03-01

    With the advent of new designs of visual prostheses for the blind, FDA is faced with developing guidance for evaluating their engineering, safety and patient performance. Visual prostheses are considered significant risk medical devices, and their use in human clinical trials must be approved by FDA under an investigation device exemption (IDE). This paper contains a series of test topics and design issues that sponsors should consider in order to assess the safety and efficacy of their device. The IDE application includes a series of pre-clinical and clinical data sections. The pre-clinical section documents laboratory, animal and bench top performance tests of visual prostheses safety and reliability to support a human clinical trial. The materials used in constructing the implant should be biocompatible, sterile, corrosion resistant, and able to withstand any forces exerted on it during normal patient use. The clinical data section is composed of items related to patient-related evaluation of device performance. This section documents the implantation procedure, trial design, statistical analysis and how visual performance is assessed. Similar to cochlear implants, a visual prosthesis is expected to last in the body for many years, and good pre-clinical and clinical testing will help ensure its safety, durability and effectiveness.

  6. Converting dose distributions into tumour control probability

    International Nuclear Information System (INIS)

    Nahum, A.E.

    1996-01-01

    The endpoints in radiotherapy that are truly of relevance are not dose distributions but the probability of local control, sometimes known as the Tumour Control Probability (TCP) and the Probability of Normal Tissue Complications (NTCP). A model for the estimation of TCP based on simple radiobiological considerations is described. It is shown that incorporation of inter-patient heterogeneity into the radiosensitivity parameter a through s a can result in a clinically realistic slope for the dose-response curve. The model is applied to inhomogeneous target dose distributions in order to demonstrate the relationship between dose uniformity and s a . The consequences of varying clonogenic density are also explored. Finally the model is applied to the target-volume DVHs for patients in a clinical trial of conformal pelvic radiotherapy; the effect of dose inhomogeneities on distributions of TCP are shown as well as the potential benefits of customizing the target dose according to normal-tissue DVHs. (author). 37 refs, 9 figs

  7. Converting dose distributions into tumour control probability

    Energy Technology Data Exchange (ETDEWEB)

    Nahum, A E [The Royal Marsden Hospital, London (United Kingdom). Joint Dept. of Physics

    1996-08-01

    The endpoints in radiotherapy that are truly of relevance are not dose distributions but the probability of local control, sometimes known as the Tumour Control Probability (TCP) and the Probability of Normal Tissue Complications (NTCP). A model for the estimation of TCP based on simple radiobiological considerations is described. It is shown that incorporation of inter-patient heterogeneity into the radiosensitivity parameter a through s{sub a} can result in a clinically realistic slope for the dose-response curve. The model is applied to inhomogeneous target dose distributions in order to demonstrate the relationship between dose uniformity and s{sub a}. The consequences of varying clonogenic density are also explored. Finally the model is applied to the target-volume DVHs for patients in a clinical trial of conformal pelvic radiotherapy; the effect of dose inhomogeneities on distributions of TCP are shown as well as the potential benefits of customizing the target dose according to normal-tissue DVHs. (author). 37 refs, 9 figs.

  8. Lentivector Iterations and Pre-Clinical Scale-Up/Toxicity Testing: Targeting Mobilized CD34+ Cells for Correction of Fabry Disease

    Directory of Open Access Journals (Sweden)

    Ju Huang

    2017-06-01

    Full Text Available Fabry disease is a rare lysosomal storage disorder (LSD. We designed multiple recombinant lentivirus vectors (LVs and tested their ability to engineer expression of human α-galactosidase A (α-gal A in transduced Fabry patient CD34+ hematopoietic cells. We further investigated the safety and efficacy of a clinically directed vector, LV/AGA, in both ex vivo cell culture studies and animal models. Fabry mice transplanted with LV/AGA-transduced hematopoietic cells demonstrated α-gal A activity increases and lipid reductions in multiple tissues at 6 months after transplantation. Next we found that LV/AGA-transduced Fabry patient CD34+ hematopoietic cells produced even higher levels of α-gal A activity than normal CD34+ hematopoietic cells. We successfully transduced Fabry patient CD34+ hematopoietic cells with “near-clinical grade” LV/AGA in small-scale cultures and then validated a clinically directed scale-up transduction process in a GMP-compliant cell processing facility. LV-transduced Fabry patient CD34+ hematopoietic cells were subsequently infused into NOD/SCID/Fabry (NSF mice; α-gal A activity corrections and lipid reductions were observed in several tissues 12 weeks after the xenotransplantation. Additional toxicology studies employing NSF mice xenotransplanted with the therapeutic cell product demonstrated minimal untoward effects. These data supported our successful clinical trial application (CTA to Health Canada and opening of a “first-in-the-world” gene therapy trial for Fabry disease.

  9. Erythema-index of clinical patch test reactions

    DEFF Research Database (Denmark)

    Jemec, G B; Johansen, J D

    1995-01-01

    that the method could be used for the grading of eczematous reactions in a clinical setting as well. OBJECTIVE: To assess the usefulness of the erythema index for the quantification of eczematous reactions using the Derma-Spectrometer (Cortex technology, Hadsund, Denmark) in a clinical setting. METHOD......: The erythema index of 56 patch test reactions ranging from +? to +++, was compared to regional controls and negative patch tests (189). The effects of intrumental application pressure was studied in 5 volunteers. Statistical analysis was carried out using Mann-Whitney and Jonckheere-Terpstra tests. RESULTS......: The erythema-index was significantly higher in all degrees of patch test reactions than in uninvolved regional skin or negative patch tests. It also showed a significant positive trend for higher values in +, ++ and +++ reactions (P

  10. Pre-Analytical Conditions in Non-Invasive Prenatal Testing of Cell-Free Fetal RHD

    DEFF Research Database (Denmark)

    Clausen, Frederik Banch; Jakobsen, Tanja Roien; Rieneck, Klaus

    2013-01-01

    D positive fetus. Prophylaxis reduces the risk of immunization that may lead to hemolytic disease of the fetus and the newborn. The reliability of predicting the fetal RhD type depends on pre-analytical factors and assay sensitivity. We evaluated the testing setup in the Capital Region of Denmark, based...

  11. Online learning versus blended learning of clinical supervisee skills with pre-registration nursing students: A randomised controlled trial.

    Science.gov (United States)

    McCutcheon, Karen; O'Halloran, Peter; Lohan, Maria

    2018-06-01

    The World Health Organisation amongst others recognises the need for the introduction of clinical supervision education in health professional education as a central strategy for improving patient safety and patient care. Online and blended learning methods are growing exponentially in use in higher education and the systematic evaluation of these methods will aid understanding of how best to teach clinical supervision. The purpose of this study was to test whether undergraduate nursing students who received clinical supervisee skills training via a blended learning approach would score higher in terms of motivation and attitudes towards clinical supervision, knowledge of clinical supervision and satisfaction of learning method, when compared to those students who received an online only teaching approach. A post-test-only randomised controlled trial. Participants were a total of 122 pre-registration nurses enrolled at one United Kingdom university, randomly assigned to the online learning control group (n = 60) or the blended learning intervention group (n = 62). The blended learning intervention group participated in a face-to-face tutorial and the online clinical supervisee skills training app. The online learning control group participated in an online discussion forum and the same online clinical supervisee skills training app. The outcome measures were motivation and attitudes using the modified Manchester Clinical Supervision Scale, knowledge using a 10 point Multiple Choice Questionnaire and satisfaction using a university training evaluation tool. Statistical analysis was performed using independent t-tests to compare the differences between the means of the control group and the intervention group. Thematic analysis was used to analyse responses to open-ended questions. All three of our study hypotheses were confirmed. Participants who received clinical supervisee skills training via a blended learning approach scored higher in terms of motivation

  12. Evaluation of clinical skills for first-year surgical residents using orientation programme and objective structured clinical evaluation as a tool of assessment

    Directory of Open Access Journals (Sweden)

    Pandya J

    2010-01-01

    Full Text Available Background: Postgraduate specialities require a combination of knowledge and clinical skills. The internship year is less structured. Clinical and practical skills that are picked up during training are not well regulated and the impact is not assessed. In this study, we assessed knowledge and skills using objective structured clinical examination (OSCE. Aim: To evaluate the clinical skills of new first-year surgical residents using orientation programme and OSCE as a tool for assessment. Settings and Design: Observational study. Materials and Methods: Twenty new first-year surgical residents (10 each in 2008 and 2009 participated in a detailed structured orientation programme conducted over a period of 7 days. Clinically important topics and skills expected at this level (e.g., suturing, wound care etc. were covered. The programme was preceded by an OSCE to test pre-programme knowledge (the "pre-test". The questions were validated by senior department staff. A post-programme OSCE (the "post-test" helped to evaluate the change in clinical skill level brought about by the orientation programme. Statistical Analysis: Wilcoxson matched-pairs signed-ranks test. Results: Passing performance was achieved by all participants in both pre- and post-tests. Following the orientation programme, significant improvement was seen in tasks testing the psychomotor and cognitive domains. (P = 0.0001 and P = 0.0401, respectively. Overall reliability of the OSCE was found to be 0.7026 (Cronbach′s coefficient alpha. Conclusions: This study highlighted the lacunae in current internship training, especially for skill-based tasks. There is a need for universal inclusion of structured orientation programmes in the training of first-year residents. OSCE is a reliable, valid and effective method for the assessment of clinical skills.

  13. A Novel Approach to Simulation-Based Education for Veterinary Medical Communication Training Over Eight Consecutive Pre-Clinical Quarters.

    Science.gov (United States)

    Englar, Ryane E

    Experiential learning through the use of standardized patients (SPs) is the primary way by which human medical schools teach clinical communication. The profession of veterinary medicine has followed suit in response to new graduates' and their employers' concerns that veterinary interpersonal skills are weak and unsatisfactory. As a result, standardized clients (SCs) are increasingly relied upon as invaluable teaching tools within veterinary curricula to advance relationship-centered care in the context of a clinical scenario. However, there is little to no uniformity in the approach that various colleges of veterinary medicine take when designing simulation-based education (SBE). A further complication is that programs with pre-conceived curricula must now make room for training in clinical communication. Curricular time constraints challenge veterinary colleges to individually decide how best to utilize SCs in what time is available. Because it is a new program, Midwestern University College of Veterinary Medicine (MWU CVM) has had the flexibility and the freedom to prioritize an innovative approach to SBE. The author discusses the SBE that is currently underway at MWU CVM, which incorporates 27 standardized client encounters over eight consecutive pre-clinical quarters. Prior to entering clinical rotations, MWU CVM students are exposed to a variety of simulation formats, species, clients, settings, presenting complaints, and communication tasks. These represent key learning opportunities for students to practice clinical communication, develop self-awareness, and strategize their approach to future clinical experiences.

  14. Puzzle test: A tool for non-analytical clinical reasoning assessment.

    Science.gov (United States)

    Monajemi, Alireza; Yaghmaei, Minoo

    2016-01-01

    Most contemporary clinical reasoning tests typically assess non-automatic thinking. Therefore, a test is needed to measure automatic reasoning or pattern recognition, which has been largely neglected in clinical reasoning tests. The Puzzle Test (PT) is dedicated to assess automatic clinical reasoning in routine situations. This test has been introduced first in 2009 by Monajemi et al in the Olympiad for Medical Sciences Students.PT is an item format that has gained acceptance in medical education, but no detailed guidelines exist for this test's format, construction and scoring. In this article, a format is described and the steps to prepare and administer valid and reliable PTs are presented. PT examines a specific clinical reasoning task: Pattern recognition. PT does not replace other clinical reasoning assessment tools. However, it complements them in strategies for assessing comprehensive clinical reasoning.

  15. A test-based method for the assessment of pre-crash warning and braking systems.

    Science.gov (United States)

    Bálint, András; Fagerlind, Helen; Kullgren, Anders

    2013-10-01

    In this paper, a test-based assessment method for pre-crash warning and braking systems is presented where the effectiveness of a system is measured by its ability to reduce the number of injuries of a given type or severity in car-to-car rear-end collisions. Injuries with whiplash symptoms lasting longer than 1 month and MAIS2+ injuries in both vehicles involved in the crash are considered in the assessment. The injury reduction resulting from the impact speed reduction due to a pre-crash system is estimated using a method which has its roots in the dose-response model. Human-machine interaction is also taken into account in the assessment. The results reflect the self-protection as well as the partner-protection performance of a pre-crash system in the striking vehicle in rear-end collisions and enable a comparison between two or more systems. It is also shown how the method may be used to assess the importance of warning as part of a pre-crash system. Copyright © 2013 Elsevier Ltd. All rights reserved.

  16. Clinical Application Of Serological Tests For Syphilis

    OpenAIRE

    Lawee, David

    1980-01-01

    This article differentiates and describes the serological tests for syphilis— antitreponemal antibody tests (TPI, FTA-ABS, TPHA), non-treponemal antigen test (VDRL)—their clinical and serological correlation, the responses to therapy and the biologically false positive syndrome.

  17. Detection of cervical lymph node metastasis in head and neck cancer patients with clinically N0 neck—a meta-analysis comparing different imaging modalities

    International Nuclear Information System (INIS)

    Liao, Li-Jen; Lo, Wu-Chia; Hsu, Wan-Lun; Wang, Chi-Te; Lai, Mei-Shu

    2012-01-01

    How to properly manage clinically negative neck of head and neck cancer patients is a controversial topic. Research is now directed toward finding a method sensitive enough to bring the risk of occult metastases below 20%. The aim of this review was to compare the diagnostic accuracy of different imaging modalities, including CT, MRI, PET and US, in clinically N0 head and neck cancer patients. For this systematic review and meta-analysis, PubMed and the Cochrane Database were searched for relevant original articles published up to May 2011. Inclusion criteria were as follows: articles were reported in English; CT, MRI, PET or US were performed to identify cervical metastases in clinically N0 head and neck squamous cell carcinoma; and data were sufficient for the calculation of true-positive or false-negative values. A bivariate random effect model was used to obtain pooled sensitivity and specificity. The positive and negative test probability of neck metastasis was generated based on Bayesian theory and collected data for different pre-test possibilities. Of the 168 identified relevant articles, 7 studies fulfilled all inclusion criteria for CT, 6 studies for MRI, 11 studies for PET and 8 studies for US. There was no difference in sensitivity and specificity among these imaging modalities, except CT was superior to US in specificity. The pooled estimates for sensitivity were 52% (95% confidence interval [CI], 39% ~ 65%), 65% (34 ~ 87%) 66% (47 ~ 80%), and 66% (45 ~ 77%), on a per-neck basis for CT, MRI, PET and US, respectively. The pooled estimates for specificity were 93% (87% ~ 97%), 81% (64 ~ 91%), 87% (77 ~ 93%), and 78% (71 ~ 83%) for CT, MRI, PET and US, respectively. With pre-examination nodal metastasis probabilities set at 10%, 20% and 30%, the post-exam probabilities of positive nodal metastasis rates were 47%, 66% and 77% for CT; 27%, 46% and 59% for MRI; 36%, 56% and 69% for PET; and 25%, 42% and 56% for US, respectively. Negative nodal metastasis

  18. 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.)

  19. Assurance of Learning, "Closing the Loop": Utilizing a Pre and Post Test for Principles of Finance

    Science.gov (United States)

    Flanegin, Frank; Letterman, Denise; Racic, Stanko; Schimmel, Kurt

    2010-01-01

    Since there is no standard national Pre and Post Test for Principles of Finance, akin to the one for Economics, by authors created one by selecting questions from previously administered examinations. The Cronbach's Alpha of 0.851, exceeding the minimum of 0.70 for reliable pen and paper test, indicates that our Test can detect differences in…

  20. Generalized Probability-Probability Plots

    NARCIS (Netherlands)

    Mushkudiani, N.A.; Einmahl, J.H.J.

    2004-01-01

    We introduce generalized Probability-Probability (P-P) plots in order to study the one-sample goodness-of-fit problem and the two-sample problem, for real valued data.These plots, that are constructed by indexing with the class of closed intervals, globally preserve the properties of classical P-P

  1. Quantum Probabilities as Behavioral Probabilities

    Directory of Open Access Journals (Sweden)

    Vyacheslav I. Yukalov

    2017-03-01

    Full Text Available We demonstrate that behavioral probabilities of human decision makers share many common features with quantum probabilities. This does not imply that humans are some quantum objects, but just shows that the mathematics of quantum theory is applicable to the description of human decision making. The applicability of quantum rules for describing decision making is connected with the nontrivial process of making decisions in the case of composite prospects under uncertainty. Such a process involves deliberations of a decision maker when making a choice. In addition to the evaluation of the utilities of considered prospects, real decision makers also appreciate their respective attractiveness. Therefore, human choice is not based solely on the utility of prospects, but includes the necessity of resolving the utility-attraction duality. In order to justify that human consciousness really functions similarly to the rules of quantum theory, we develop an approach defining human behavioral probabilities as the probabilities determined by quantum rules. We show that quantum behavioral probabilities of humans do not merely explain qualitatively how human decisions are made, but they predict quantitative values of the behavioral probabilities. Analyzing a large set of empirical data, we find good quantitative agreement between theoretical predictions and observed experimental data.

  2. Nitric oxide nanoparticles: pre-clinical utility as a therapeutic for intramuscular abscesses.

    Science.gov (United States)

    Schairer, David; Martinez, Luis R; Blecher, Karin; Chouake, Jason; Nacharaju, Parimala; Gialanella, Philip; Friedman, Joel M; Nosanchuk, Joshua D; Friedman, Adam

    2012-01-01

    Nitric oxide (NO) is a critical component of host defense against invading pathogens; however, its therapeutic utility is limited due to a lack of practical delivery systems. Recently, a NO-releasing nanoparticulate platform (NO-np) was shown to have in vitro broad-spectrum antimicrobial activity and in vivo pre-clinical efficacy in a dermal abscess model. To extend these findings, both topical (TP) and intralesional (IL) NO-np administration was evaluated in a MRSA intramuscular murine abscess model and compared with vancomycin. All treatment arms accelerated abscess clearance clinically, histologically, and by microbiological assays on both days 4 and 7 following infection. However, abscesses treated with NO-np via either route demonstrated a more substantial, statistically significant decrease in bacterial survival based on colony forming unit assays and histologically revealed less inflammatory cell infiltration and preserved muscular architecture. These data suggest that the NO-np may be an effective addition to our armament for deep soft tissue infections.

  3. Pre- and post-bronchodilator airway obstruction are associated with similar clinical characteristics but different prognosis – report from a population-based study

    Directory of Open Access Journals (Sweden)

    Sawalha S

    2017-04-01

    Full Text Available Sami Sawalha,1 Linnea Hedman,2 Eva Rönmark,2 Bo Lundbäck,3 Anne Lindberg1 1Department of Public Health and Clinical Medicine, Division of Medicine, 2Department of Public Health and Clinical Medicine, The OLIN Unit, Division of Occupational and Environmental Medicine, Umeå University, Umeå, 3Krefting Research Center, Institution of Medicine, University of Gothenburg, Gothenburg, Sweden Introduction: According to guidelines, the diagnosis of COPD should be confirmed by post-bronchodilator (post-BD airway obstruction on spirometry; however, in clinical practice, this is not always performed. The aim of this population-based study was to compare clinical characteristics and prognosis, assessed as mortality, between subjects with airway obstruction divided into pre- but not post-BD obstruction, post-BD airway obstruction (COPD, and subjects without airway obstruction.Materials and methods: In 2002–2004, four adult population-based cohorts were reexamined with spirometry and structured interview. Subjects with airway obstruction, with a ratio of forced expiratory volume in 1 s to (forced vital capacity <0.70 (n=993, were identified together with sex- and age-matched referents (n=993. These subjects were further divided into subjects with pre- but not post-BD airway obstruction (pre- not post-BD obstruction and subjects with post-BD airway obstruction (COPD. Mortality data were collected until December 31, 2014.Results: Out of 993 subjects with airway obstruction, 736 (74% had COPD and 257 (26% pre- not post-BD obstruction. Any respiratory symptoms, allergic rhinitis, asthma, exacerbations, and comorbidities were equally common among subjects with COPD and pre- not post-BD obstruction, but less common among nonobstructive subjects. Mortality was highest among subjects with COPD and higher in men than in women. In both sexes, COPD, but not pre- not post-BD obstruction, was associated with an increased risk for death compared to those without

  4. Asymptomatic Ventricular Pre-excitation: Between Sudden Cardiac Death and Catheter Ablation.

    Science.gov (United States)

    Brugada, Josep; Keegan, Roberto

    2018-03-01

    Debate about the best clinical approach to the management of asymptomatic patients with ventricular pre-excitation and advice on whether or not to invasively stratify and ablate is on-going. Weak evidence about the real risk of sudden cardiac death and the potential benefit of catheter ablation has probably prevented the clarification of action in this not infrequent and sometimes conflicting clinical situation. After analysing all available data, real evidence-based medicine could be the alternative strategy for managing this group of patients. According to recent surveys, most electrophysiologists invasively stratify. Based on all accepted risk factors - younger age, male, associated structural heart disease, posteroseptal localisation, ability of the accessory pathway to conduct anterogradely at short intervals of ≤250 milliseconds and inducibility of sustained atrioventricular re-entrant tachycardia and/or atrial fibrillation - a shared decisionmaking process on catheter ablation is proposed.

  5. Probability Aggregates in Probability Answer Set Programming

    OpenAIRE

    Saad, Emad

    2013-01-01

    Probability answer set programming is a declarative programming that has been shown effective for representing and reasoning about a variety of probability reasoning tasks. However, the lack of probability aggregates, e.g. {\\em expected values}, in the language of disjunctive hybrid probability logic programs (DHPP) disallows the natural and concise representation of many interesting problems. In this paper, we extend DHPP to allow arbitrary probability aggregates. We introduce two types of p...

  6. Tests of Cumulative Prospect Theory with graphical displays of probability

    Directory of Open Access Journals (Sweden)

    Michael H. Birnbaum

    2008-10-01

    Full Text Available Recent research reported evidence that contradicts cumulative prospect theory and the priority heuristic. The same body of research also violates two editing principles of original prospect theory: cancellation (the principle that people delete any attribute that is the same in both alternatives before deciding between them and combination (the principle that people combine branches leading to the same consequence by adding their probabilities. This study was designed to replicate previous results and to test whether the violations of cumulative prospect theory might be eliminated or reduced by using formats for presentation of risky gambles in which cancellation and combination could be facilitated visually. Contrary to the idea that decision behavior contradicting cumulative prospect theory and the priority heuristic would be altered by use of these formats, however, data with two new graphical formats as well as fresh replication data continued to show the patterns of evidence that violate cumulative prospect theory, the priority heuristic, and the editing principles of combination and cancellation. Systematic violations of restricted branch independence also contradicted predictions of ``stripped'' prospect theory (subjectively weighted additive utility without the editing rules.

  7. Clinical applications of preimplantation genetic testing.

    Science.gov (United States)

    Brezina, Paul R; Kutteh, William H

    2015-02-19

    Genetic diagnostic technologies are rapidly changing the way medicine is practiced. Preimplantation genetic testing is a well established application of genetic testing within the context of in vitro fertilization cycles. It involves obtaining a cell(s) from a developing embryo in culture, which is then subjected to genetic diagnostic analysis; the resulting information is used to guide which embryos are transferred into the uterus. The potential applications and use of this technology have increased in recent years. Experts agree that preimplantation genetic diagnosis is clinically appropriate for many known genetic disorders. However, some applications of such testing, such as preimplantation genetic screening for aneuploidy, remain controversial. Clinical data suggest that preimplantation genetic screening may be useful, but further studies are needed to quantify the size of the effect and who would benefit most. © BMJ Publishing Group Ltd 2015.

  8. Pre- and post- test calculation for the parameter-SF1 experiment with ATHLET-CD

    Energy Technology Data Exchange (ETDEWEB)

    Erdmann, W.; Trambauer, K.; Stuckert, J. [Gesellschaft fuer Anlagen- und Reaktorsicherheit mbH (GRS), Koln (Germany)

    2006-07-01

    The main objective of the PARAMETER-SF1 experiment in the frame of the ISTC project 3194 is the experimental and analytical investigation of the Russian VVER-1000 fuel rod assemblies behavior under simulated conditions of a severe accident. The special feature is to study the effect of flooding a superheated test bundle from the top (top quenching) which has not yet been investigated at all. - Simulation of the PARAMETER test facility To calculate the special effects of the top quenching, some aspects are important: detailed simulation of the bundle top, top and bottom quench front, heat losses at top/bottom of bundle, electrical heater power. - Main initial and boundary conditions The proposed initial and boundary conditions for the double-blind pre-test calculation were quite different from the actual experimental data during the test e.g.: electric power, mass flow (water, steam, argon), temperature. - Conclusions: first experiment with top flooding proposed initial condition given in the specification could not be performed during the experiment, bundle parameters deviated from anticipated values, thus, the pre-calculations not comparable with the experiment, post-calculations with ATHLET-CD showed good agreement with experiment data, top flooding is well predicted, calculational results sensitive with respect to: boundary conditions, nodalization. (authors)

  9. Conditional non-independence of radiographic image features and the derivation of post-test probabilities – A mammography BI-RADS example

    International Nuclear Information System (INIS)

    Benndorf, Matthias

    2012-01-01

    Bayes' theorem has proven to be one of the cornerstones in medical decision making. It allows for the derivation of post-test probabilities, which in case of a positive test result become positive predictive values. If several test results are observed successively Bayes' theorem may be used with assumed conditional independence of test results or with incorporated conditional dependencies. Herein it is examined whether radiographic image features should be considered conditionally independent diagnostic tests when post-test probabilities are to be derived. For this purpose the mammographic mass dataset from the UCI (University of California, Irvine) machine learning repository is analysed. It comprises the description of 961 (516 benign, 445 malignant) mammographic mass lesions according to the BI-RADS (Breast Imaging: Reporting and Data System) lexicon. Firstly, an exhaustive correlation matrix is presented for mammography BI-RADS features among benign and malignant lesions separately; correlation can be regarded as measure for conditional dependence. Secondly, it is shown that the derived positive predictive values for the conjunction of the two features “irregular shape” and “spiculated margin” differ significantly depending on whether conditional dependencies are incorporated into the decision process or not. It is concluded that radiographic image features should not generally be regarded as conditionally independent diagnostic tests.

  10. Clinical, social and ethical issues associated with non-invasive prenatal testing for aneuploidy.

    Science.gov (United States)

    Griffin, Blanche; Edwards, Samantha; Chitty, Lyn S; Lewis, Celine

    2018-03-01

    Non-invasive prenatal testing (NIPT), based on analysis of cell-free foetal DNA, is rapidly becoming a preferred method to screen for chromosomal aneuploidy with the technology now available in over 90 countries. This review provides an up-to-date discussion of the key clinical, social and ethical implications associated with this revolutionary technology. Stakeholders are positive about a test that is highly accurate, safe, can be perfomed early in pregnancy, identifies affected pregnancies that might otherwise have been missed and reduces the need for invasive testing. Nevertheless, professional societies currently recommend it as an advanced screening test due to the low false positive rate (FPR). Despite the practical and psychological benefits, a number of concerns have been raised which warrant attention. These include the potential for routinisation of testing and subsequent impact on informed decision-making, an "easy" blood test inadvertently contributing to women feeling pressured to take the test, fears NIPT will lead to less tolerance and support for those living with Down syndrome and the heightened expectation of having "perfect babies". These issues can be addressed to some extent through clinician education, patient information and establishing national and international consensus in the development of comprehensive and regularly updated guidelines. As the number of conditions we are able to test for non-invasively expands it will be increasingly important to ensure pre-test counselling can be delivered effectively supported by knowledgeable healthcare professionals.

  11. Couples’ Educational Needs Referred to Ershad and Fazel Health Centers of Tehran for Pre-marriage Tests in 2014

    Directory of Open Access Journals (Sweden)

    ّFarima Mohammadi

    2016-12-01

    Full Text Available Background and Objective: Premarital education is the foundation for the development of couples’ communications, sexual relationships, health and fertility. Therefore, this study was done with the purpose of determining couples’ educational needs referred to Ershad and Fazel health centers of Tehran for pre-marriage tests.Materials and Methods: A Cross Sectional study was conducted among couples who referred to health centers. The sample size was 1672 and the sampling method was convenience.. Demographic data was collected through interview with women based on questionnaires. Then the couples responded to the self-administered educational needs questionnaire. The collected data were entered into SPSS-21 statistical software and analyzed using Chi-Square test.Results: 883 women and 789 men completed the educational needs questionnaire. The mean (SD age of women and men were 27.1 (4.5 and 30.2 (5.3 years respectively. Of all female participants 483 (54.7% and 369 (41.8% of male participants had a bachelor's degree. 97.5% of men and 57.1% of women were employed. The ethnicity of about 72% of participants was Far. Most of the pre-marriage educational needs of men and women were marital health, importance of pre-marriage tests, unintended pregnancy prevention methods, correct marital relationship and prenatal care. 313 (64.6% women and 238 (42.8% men reported the pre-marriage educational class to be very helpful. The educational needs of couples were not different based on education, ethnicity and place of residence.Conclusion: Results of the currents study shows the need for pre-marriage education in all evaluated aspects and the importance of paying attention to it for prospering the pre-marital classes.

  12. Pre-exposure to food temptation reduces subsequent consumption: A test of the procedure with a South-African sample.

    Science.gov (United States)

    Duh, Helen Inseng; Grubliauskiene, Aiste; Dewitte, Siegfried

    2016-01-01

    It has been suggested that the consumption of unhealthy Westernized diet in a context of poverty and resultant food insecurity may have contributed to South-Africa's status of the third fattest country in the World. Considering that a number of South-Africans are reported to have experienced, or are still experiencing food insecurity, procedures which have been shown to reduce the consumption of unhealthy food in higher income countries may be ineffective in South-Africa. We thus tested the robustness of the so called pre-exposure procedure in South-Africa. We also tested the moderating role of childhood poverty in the pre-exposure procedure. With the pre-exposure procedure, a respondent is exposed to a tempting unhealthy food (e.g. candy) in a context that is designed such that eating the food interferes with a task goal. The typical result is that this procedure spills over and reduces consumption of similar tempting food later on. An experimental study conducted in a South-African laboratory showed that the pre-exposure effect is robust even with a sample, where food insecurity prevails. Childhood poverty did not moderate the effect. This study proves that behavioral procedures aimed at reducing the consumption of unhealthy food would be valuable in less rich non-Western countries. Further testing of the robustness of the pre-exposure effect is however recommended in other poorer food insecure countries. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Transition probabilities for atoms

    International Nuclear Information System (INIS)

    Kim, Y.K.

    1980-01-01

    Current status of advanced theoretical methods for transition probabilities for atoms and ions is discussed. An experiment on the f values of the resonance transitions of the Kr and Xe isoelectronic sequences is suggested as a test for the theoretical methods

  14. Effects of concurrent caffeine and mobile phone exposure on local target probability processing in the human brain.

    Science.gov (United States)

    Trunk, Attila; Stefanics, Gábor; Zentai, Norbert; Bacskay, Ivett; Felinger, Attila; Thuróczy, György; Hernádi, István

    2015-09-23

    Millions of people use mobile phones (MP) while drinking coffee or other caffeine containing beverages. Little is known about the potential combined effects of MP irradiation and caffeine on cognitive functions. Here we investigated whether caffeine intake and concurrent exposure to Universal Mobile Telecommunications System (UMTS) MP-like irradiation may interactively influence neuro-cognitive function in an active visual oddball paradigm. In a full factorial experimental design, 25 participants performed a simple visual target detection task while reaction time (RT) and electroencephalogram (EEG) was recorded. Target trials were divided into Low and High probability sets based on target-to-target distance. We analyzed single trial RT and alpha-band power (amplitude) in the pre-target interval. We found that RT was shorter in High vs. Low local probability trials, and caffeine further shortened RT in High probability trials relative to the baseline condition suggesting that caffeine improves the efficiency of implicit short-term memory. Caffeine also decreased pre-target alpha amplitude resulting in higher arousal level. Furthermore, pre-target gamma power positively correlated with RT, which may have facilitated target detection. However, in the present pharmacologically validated study UMTS exposure either alone or in combination with caffeine did not alter RT or pre-stimulus oscillatory brain activity.

  15. Mid-level healthcare personnel training: an evaluation of the revised, nationally-standardized, pre-service curriculum for clinical officers in Mozambique.

    Directory of Open Access Journals (Sweden)

    Caryl Feldacker

    Full Text Available Mozambique suffers from a critical shortage of healthcare workers. Mid-level healthcare workers, (Tecnicos de Medicina Geral (TMG, in Mozambique require less money and time to train than physicians. From 2009-2010, the Mozambique Ministry of Health (MoH and the International Training and Education Center for Health (I-TECH, University of Washington, Seattle, revised the TMG curriculum. To evaluate the effect of the curriculum revision, we used mixed methods to determine: 1 if TMGs meet the MoH's basic standards of clinical competency; and 2 do scores on measurements of clinical knowledge, physical exam, and clinical case scenarios differ by curriculum?T-tests of differences in means examined differences in continuous score variables between curriculum groups. Univariate and multivariate linear regression models assess curriculum-related and demographic factors associated with assessment scores on each of the three evaluation methods at the p<0.05 level. Qualitative interviews and focus groups inform interpretation.We found no significant differences in sex, marital status and age between the 112 and 189 TMGs in initial and revised curriculum, respectively. Mean scores at graduation of initial curriculum TMGs were 56.7%, 63.5%, and 49.1% on the clinical cases, knowledge test, and physical exam, respectively. Scores did not differ significantly from TMGs in the revised curriculum. Results from linear regression models find that training institute was the most significant predictor of TMG scores on both the clinical cases and physical exam.TMGs trained in either curriculum may be inadequately prepared to provide quality care. Curriculum changes are a necessary, but insufficient, part of improving TMG knowledge and skills overall. A more comprehensive, multi-level approach to improving TMG training that includes post-graduation mentoring, strengthening the pre-service internship training, and greater resources for training institute faculty may

  16. High throughput nonparametric probability density estimation.

    Science.gov (United States)

    Farmer, Jenny; Jacobs, Donald

    2018-01-01

    In high throughput applications, such as those found in bioinformatics and finance, it is important to determine accurate probability distribution functions despite only minimal information about data characteristics, and without using human subjectivity. Such an automated process for univariate data is implemented to achieve this goal by merging the maximum entropy method with single order statistics and maximum likelihood. The only required properties of the random variables are that they are continuous and that they are, or can be approximated as, independent and identically distributed. A quasi-log-likelihood function based on single order statistics for sampled uniform random data is used to empirically construct a sample size invariant universal scoring function. Then a probability density estimate is determined by iteratively improving trial cumulative distribution functions, where better estimates are quantified by the scoring function that identifies atypical fluctuations. This criterion resists under and over fitting data as an alternative to employing the Bayesian or Akaike information criterion. Multiple estimates for the probability density reflect uncertainties due to statistical fluctuations in random samples. Scaled quantile residual plots are also introduced as an effective diagnostic to visualize the quality of the estimated probability densities. Benchmark tests show that estimates for the probability density function (PDF) converge to the true PDF as sample size increases on particularly difficult test probability densities that include cases with discontinuities, multi-resolution scales, heavy tails, and singularities. These results indicate the method has general applicability for high throughput statistical inference.

  17. Distance learning training in genetics and genomics testing for Italian health professionals: results of a pre and post-test evaluation

    Directory of Open Access Journals (Sweden)

    Maria Benedetta Michelazzo

    2015-09-01

    Full Text Available BackgroundProgressive advances in technologies for DNA sequencing and decreasing costs are allowing an easier diffusion of genetic and genomic tests. Physicians’ knowledge and confidence on the topic is often low and not suitable for manage this challenge. Tailored educational programs are required to reach a more and more appropriate use of genetic technologies.MethodsA distance learning course has been created by experts from different Italian medical associations with the support of the Italian Ministry of Health. The course was directed to professional figures involved in prescription and interpretation of genetic tests. A pretest-post-test study design was used to assess knowledge improvement. We analyzed the proportion of correct answers for each question pre and post-test, as well as the mean score difference stratified by gender, age, professional status and medical specialty.ResultsWe reported an improvement in the proportion of correct answers for 12 over 15 questions of the test. The overall mean score to the questions significantly increased in the post-test, from 9.44 to 12.49 (p-value < 0.0001. In the stratified analysis we reported an improvement in the knowledge of all the groups except for geneticists; the pre-course mean score of this group was already very high and did not improve significantly.ConclusionDistance learning is effective in improving the level of genetic knowledge. In the future, it will be useful to analyze which specialists have more advantage from genetic education, in order to plan more tailored education for medical professionals.

  18. Pre-clinical therapeutic development of a series of metalloporphyrins for Parkinson's disease

    International Nuclear Information System (INIS)

    Liang, Li-Ping; Huang, Jie; Fulton, Ruth; Pearson-Smith, Jennifer N.; Day, Brian J.; Patel, Manisha

    2017-01-01

    Reactive oxygen species are a well-defined therapeutic target for Parkinson's disease (PD) and pharmacological agents that catalytically scavenge reactive species are promising neuroprotective strategies for treatment. Metalloporphyrins are synthetic catalytic antioxidants that mimic the body's own antioxidant enzymes i.e. superoxide dismutases and catalase. The goal of this study was to determine if newly designed metalloporphyrins have enhanced pharmacodynamics including oral bioavailability, longer plasma elimination half-lives, penetrate the blood brain barrier, and show promise for PD treatment. Three metalloporphyrins (AEOL 11216, AEOL 11203 and AEOL 11114) were identified in this study as potential candidates for further pre-clinical development. Each of these compounds demonstrated blood brain barrier permeability by the i.p. route and two of three compounds (AEOL 11203 and AEOL 11114) were orally bioavailable. All of these compounds protected against 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced neurotoxicity, including dopamine depletion in the striatum, dopaminergic neuronal loss in the substantial nigra, and increased oxidative/nitrative stress indices (glutathione disulfide and 3-nitrotyrosine) in the ventral midbrain of the mice without inhibiting MPTP metabolism. Daily therapeutic dosing of these metalloporphyrins were well tolerated without accumulation of brain manganese levels or behavioral alterations assessed by open field and rotarod tests. The study identified two orally active metalloporphyrins and one injectable metalloporphyrin as clinical candidates for further development in PD. - Highlights: • A series of metalloporphyrins were optimized in a mouse model of parkinsonism. • Two novel orally active, brain permeable antioxidant metalloporphyrins were identified. • The identified metalloporphyrins were well tolerated.

  19. Pre-clinical therapeutic development of a series of metalloporphyrins for Parkinson's disease

    Energy Technology Data Exchange (ETDEWEB)

    Liang, Li-Ping [Department of Pharmaceutical Sciences, University of Colorado Denver, Aurora, CO (United States); Huang, Jie [Department of Medicine, National Jewish Health, Denver, CO (United States); Fulton, Ruth; Pearson-Smith, Jennifer N. [Department of Pharmaceutical Sciences, University of Colorado Denver, Aurora, CO (United States); Day, Brian J. [Department of Pharmaceutical Sciences, University of Colorado Denver, Aurora, CO (United States); Department of Medicine, National Jewish Health, Denver, CO (United States); Patel, Manisha, E-mail: manisha.patel@ucdenver.edu [Department of Pharmaceutical Sciences, University of Colorado Denver, Aurora, CO (United States)

    2017-07-01

    Reactive oxygen species are a well-defined therapeutic target for Parkinson's disease (PD) and pharmacological agents that catalytically scavenge reactive species are promising neuroprotective strategies for treatment. Metalloporphyrins are synthetic catalytic antioxidants that mimic the body's own antioxidant enzymes i.e. superoxide dismutases and catalase. The goal of this study was to determine if newly designed metalloporphyrins have enhanced pharmacodynamics including oral bioavailability, longer plasma elimination half-lives, penetrate the blood brain barrier, and show promise for PD treatment. Three metalloporphyrins (AEOL 11216, AEOL 11203 and AEOL 11114) were identified in this study as potential candidates for further pre-clinical development. Each of these compounds demonstrated blood brain barrier permeability by the i.p. route and two of three compounds (AEOL 11203 and AEOL 11114) were orally bioavailable. All of these compounds protected against 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced neurotoxicity, including dopamine depletion in the striatum, dopaminergic neuronal loss in the substantial nigra, and increased oxidative/nitrative stress indices (glutathione disulfide and 3-nitrotyrosine) in the ventral midbrain of the mice without inhibiting MPTP metabolism. Daily therapeutic dosing of these metalloporphyrins were well tolerated without accumulation of brain manganese levels or behavioral alterations assessed by open field and rotarod tests. The study identified two orally active metalloporphyrins and one injectable metalloporphyrin as clinical candidates for further development in PD. - Highlights: • A series of metalloporphyrins were optimized in a mouse model of parkinsonism. • Two novel orally active, brain permeable antioxidant metalloporphyrins were identified. • The identified metalloporphyrins were well tolerated.

  20. Pre-test genetic counseling services for hereditary breast and ovarian cancer delivered by non-genetics professionals in the state of Florida.

    Science.gov (United States)

    Vadaparampil, S T; Scherr, C L; Cragun, D; Malo, T L; Pal, T

    2015-05-01

    Genetic counseling and testing for hereditary breast and ovarian cancer now includes practitioners from multiple healthcare professions, specialties, and settings. This study examined whether non-genetics professionals (NGPs) perform guideline-based patient intake and informed consent before genetic testing. NGPs offering BRCA testing services in Florida (n = 386) were surveyed about clinical practices. Among 81 respondents (response rate = 22%), approximately half reported: sometimes scheduling a separate session for pre-test counseling lasting 11-30 min prior to testing, discussing familial implications of testing, benefits and limitations of risk management options, and discussing the potential psychological impact and insurance-related issues. Few constructed a three-generation pedigree, discussed alternative hereditary cancer syndromes, or the meaning of a variant result. This lack of adherence to guideline-based practice may result in direct harm to patients and their family members. NGPs who are unable to deliver guideline adherent cancer genetics services should focus on identification and referral of at-risk patients to in person or telephone services provided by genetics professionals. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  1. Pre-Test pan Work Plan sebagai Strategi Pembelajaran Efektif pada Praktikum Bahan Teknik Lanjut Jurusan Pendidikan Teknik Mesin FT UNY

    Directory of Open Access Journals (Sweden)

    Nurdjito Nurdjito

    2013-09-01

    Full Text Available To find the most effective learning strategy for the practicum in the laboratory of materials of the department of Mechanical Engineering Education, Faculty of Engineering, Yogyakarta State University (YSU, a study that aims to determine the effect of applying pre-test and work plan on the learning activities and the achievement of students in the laboratory was conducted. This action research used the purposive random sampling technique. Pre-test and work plan were conducted as the treatment. The data of study was collected through a test to analyse the students’ achievement scores, then they were analyzed using t-test with SPSS. The results of this study indicated that the application of pre-test and work plan in addition to the standard module was proven to be more effective than the  normative learning using the module with t = 3.055 p = 0.003 <0.05. The implementation of the pre-test and work plan in addition to the use of standard modules is able to  improve the students’ motivation, independence and readiness to learn as well as the cooperation among the students, therefore the achievement is also improved. The mastery of competencies increased significantly proved by the increasing values of mode 66 to 85 (the experiment, and mean 73.12 into 79.32 (experiment.

  2. On-line ethics education for occupational therapy clinician-educators: a single-group pre-/post-test study.

    Science.gov (United States)

    VanderKaay, Sandra; Letts, Lori; Jung, Bonny; Moll, Sandra E

    2018-05-20

    Ethics education is a critical component of training rehabilitation practitioners. There is a need for capacity-building among ethics educators regarding facilitating ethical decision-making among students. The purpose of this study was to evaluate the utility of an on-line ethics education module for occupational therapy clinician-educators (problem-based learning tutors/clinical placement preceptors/evidence-based practice facilitators). The Knowledge-to-Action Process informed development and evaluation of the module. Clinician-educators (n = 33) viewed the module and reported on its impact on knowledge and facilitation practices via pre, post, and follow-up questionnaires. Pre- and post-test data indicated improvement in self-reported ethics knowledge (t = 8.275, p ethics education module for clinician-educators. Future recommendations include broader consideration of context, adding supplemental knowledge translation components, and further research exploring outcomes with larger samples, longer follow-up and randomized trial methodology. Implications for Rehabilitation The on-line ethics module has potential to improve rehabilitation practice by addressing the noted gap in knowledge among clinician-educators. Viewing an on-line module regarding approaches to ethics education may not be sufficient to change clinician-educators' teaching practices. More time and opportunities to discuss ethics with student occupational therapists may be required to effect practice change among clinician-educators. Developing ethics education tools for clinician-educators requires ongoing and iterative input from knowledge users to optimize translation of ideas to practice.

  3. Enhancing clinical effectiveness of pre-radiotherapy workflow by using multidisciplinary-cooperating e-control and e-alerts: A SQUIRE-compliant quality-improving study.

    Science.gov (United States)

    Lin, Yung-Hsiang; Hung, Shih-Kai; Lee, Moon-Sing; Chiou, Wen-Yen; Lai, Chun-Liang; Shih, Yi-Ting; Yeh, Pei-Han; Lin, Yi-An; Tsai, Wei-Ta; Hsieh, Hui-Ling; Chen, Liang-Cheng; Huang, Li-Wen; Lin, Po-Hao; Liu, Dai-Wei; Hsu, Feng-Chun; Tsai, Shiang-Jiun; Liu, Jia-Chi; Chung, En-Seu; Lin, Hon-Yi

    2017-06-01

    Radiotherapy (RT) is useful in managing cancer diseases. In clinical practice, early initiation of RT is crucial for enhancing tumor control. But, delivering precise RT requires a series of pre-RT working processes in a tight staff-cooperation manner. In this regard, using information system to conduct e-control and e-alerts has been suggested to improve practice effectiveness; however, this effect is not well defined in a real-world RT setting.We designed an information system to perform e-control and e-alerts for the whole process of pre-RT workflow to shorten processing time, to improve overall staff satisfaction, and to enhance working confidence.A quality-improving study conducted in a large RT center.Externally validated data were retrospectively analyzed for comparison before (from Sep. 2012 to Dec. 2012, n = 223) and after (from Sep. 2013 to Dec. 2013, n = 240) implementation of pre-RT e-control and e-alerts.Applying the e-control with delay-working e-alerts in pre-RT workflow was the main intervention.Nine workstations were identified in pre-RT workflow. The primary outcome measure was the processing time in each pre-RT workstations before and after implementing the e-control and e-alerts. Secondary measures were staff-working confidence and near-missing cases during the process of pre-RT workflow.After implementing e-control, overall processing time of pre-RT workflow was shortened from 12.2 days to 8.9 days (P workflow. Clinical effectiveness, staff satisfaction, and working confidence are able to be enhanced obviously.

  4. Sensitivity and Specificity of Clinical and Laboratory Otolith Function Tests.

    Science.gov (United States)

    Kumar, Lokesh; Thakar, Alok; Thakur, Bhaskar; Sikka, Kapil

    2017-10-01

    To evaluate clinic based and laboratory tests of otolith function for their sensitivity and specificity in demarcating unilateral compensated complete vestibular deficit from normal. Prospective cross-sectional study. Tertiary care hospital vestibular physiology laboratory. Control group-30 healthy adults, 20-45 years age; Case group-15 subjects post vestibular shwannoma excision or post-labyrinthectomy with compensated unilateral complete audio-vestibular loss. Otolith function evaluation by precise clinical testing (head tilt test-HTT; subjective visual vertical-SVV) and laboratory testing (headroll-eye counterroll-HR-ECR; vesibular evoked myogenic potentials-cVEMP). Sensitivity and specificity of clinical and laboratory tests in differentiating case and control subjects. Measurable test results were universally obtained with clinical otolith tests (SVV; HTT) but not with laboratory tests. The HR-ECR test did not indicate any definitive wave forms in 10% controls and 26% cases. cVEMP responses were absent in 10% controls.HTT test with normative cutoff at 2 degrees deviations from vertical noted as 93.33% sensitive and 100% specific. SVV test with normative cutoff at 1.3 degrees noted as 100% sensitive and 100% specific. Laboratory tests demonstrated poorer specificities owing primarily to significant unresponsiveness in normal controls. Clinical otolith function tests, if conducted with precision, demonstrate greater ability than laboratory testing in discriminating normal controls from cases with unilateral complete compensated vestibular dysfunction.

  5. Test de Evaluacion de Conocimientos Medicos-CIIPME (Test of Evaluation of Medical Knowledge-CIIPME). Publication No. 42.

    Science.gov (United States)

    Alfici, C.; And Others

    The purpose of this research is to build a test for the evaluation of the knowledge needed by medical students before entering clinical courses in medical school. The criterion for this was provided by teachers in both the pre-clinical and clinical subjects. The Pilot instrument consisted of 335 items that covered 8 sections. Each one of these…

  6. The Use of Conditional Probability Integral Transformation Method for Testing Accelerated Failure Time Models

    Directory of Open Access Journals (Sweden)

    Abdalla Ahmed Abdel-Ghaly

    2016-06-01

    Full Text Available This paper suggests the use of the conditional probability integral transformation (CPIT method as a goodness of fit (GOF technique in the field of accelerated life testing (ALT, specifically for validating the underlying distributional assumption in accelerated failure time (AFT model. The method is based on transforming the data into independent and identically distributed (i.i.d Uniform (0, 1 random variables and then applying the modified Watson statistic to test the uniformity of the transformed random variables. This technique is used to validate each of the exponential, Weibull and lognormal distributions' assumptions in AFT model under constant stress and complete sampling. The performance of the CPIT method is investigated via a simulation study. It is concluded that this method performs well in case of exponential and lognormal distributions. Finally, a real life example is provided to illustrate the application of the proposed procedure.

  7. How to conduct External Quality Assessment Schemes for the pre-analytical phase?

    Science.gov (United States)

    Kristensen, Gunn B B; Aakre, Kristin Moberg; Kristoffersen, Ann Helen; Sandberg, Sverre

    2014-01-01

    In laboratory medicine, several studies have described the most frequent errors in the different phases of the total testing process, and a large proportion of these errors occur in the pre-analytical phase. Schemes for registration of errors and subsequent feedback to the participants have been conducted for decades concerning the analytical phase by External Quality Assessment (EQA) organizations operating in most countries. The aim of the paper is to present an overview of different types of EQA schemes for the pre-analytical phase, and give examples of some existing schemes. So far, very few EQA organizations have focused on the pre-analytical phase, and most EQA organizations do not offer pre-analytical EQA schemes (EQAS). It is more difficult to perform and standardize pre-analytical EQAS and also, accreditation bodies do not ask the laboratories for results from such schemes. However, some ongoing EQA programs for the pre-analytical phase do exist, and some examples are given in this paper. The methods used can be divided into three different types; collecting information about pre-analytical laboratory procedures, circulating real samples to collect information about interferences that might affect the measurement procedure, or register actual laboratory errors and relate these to quality indicators. These three types have different focus and different challenges regarding implementation, and a combination of the three is probably necessary to be able to detect and monitor the wide range of errors occurring in the pre-analytical phase.

  8. Improving information extraction using a probability-based approach

    DEFF Research Database (Denmark)

    Kim, S.; Ahmed, Saeema; Wallace, K.

    2007-01-01

    Information plays a crucial role during the entire life-cycle of a product. It has been shown that engineers frequently consult colleagues to obtain the information they require to solve problems. However, the industrial world is now more transient and key personnel move to other companies...... or retire. It is becoming essential to retrieve vital information from archived product documents, if it is available. There is, therefore, great interest in ways of extracting relevant and sharable information from documents. A keyword-based search is commonly used, but studies have shown...... the recall, while maintaining the high precision, a learning approach that makes identification decisions based on a probability model, rather than simply looking up the presence of the pre-defined variations, looks promising. This paper presents the results of developing such a probability-based entity...

  9. Study of oxide film formed in a pre cracked CT specimen of AISI 304L during a rising displacement test in 288 C water

    International Nuclear Information System (INIS)

    Diaz S, A.; Castano M, V.

    2007-01-01

    A study of oxide film formed inside pre cracked CT specimens during a rising displacement test in high temperature water (288 C) was performed in this study, The environmental conditions used during the experiments were similar to these found in Boiling Water Reactors (BWR): Normal Water Condition (NWC - 200 ppb O 2 ) and Hydrogen Water Chemistry (HWC - 125 ppb H2). The oxide films formed were analyzed by scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS) and X-ray diffraction (XRD). In both cases the oxide film consisted of two layers identified as magnetite. In the case of HWC the results agree with previous reports that mention magnetite as a stable phase in reducing conditions. However the stable phase in oxidant conditions is hematite and this work shows the presence of magnetite crystals in the narrow crack of CT specimens in spite of the oxidant environmental condition. This situation confirms that inside the pre-cracked CT specimens the environmental conditions were different from the oxidant bulk, and probably a poor oxygen access and stagnant conditions within the narrow crack promoted a localized reducing environment that permitted the magnetite formation. Is evident that the crack growth studies should consider the conditions inside crack because they are significantly different. (Author)

  10. SPORT AND EXERCISE PHYSIOLOGY TESTING Volume one: Sport Testing Volume two: Exercise and Clinical Testing

    Directory of Open Access Journals (Sweden)

    Edward M. Winter

    2007-03-01

    Full Text Available DESCRIPTION The objective of the book is to discuss the theoretical and practical aspects of physiological testing in exercise and sports which is essential to evaluate and monitor developing exercise performance for athletes and public health, and improving quality of life for patients.A board of leading sport and exercise physiologists and scientists are gathered to discuss physiological assessments that have proven validity and reliability, both in sport and health relevant issues. Incidentally, it updates the reader about the current subjects of physiological exertion testing in both research and clinical procedures. Both volumes individually cover the increasing number of available research and review publications, and theoretical explanations are supported by practical examples. A step-by-step and/or checklist method is used in appropriate sections which make the guides more user-friendly than most. PURPOSE The first volume is designed to help readers develop an understanding of the essential concepts of sport specific testing whereas the second volume aims at making the exercise and clinical specific testing comprehensible, dealing with both technical terms and the theories underlying the importance of these tests. AUDIENCE As Guidelines books of the British Association of Sport and Exercise Sciences, it will be of interest to a wide range of students, researchers and practitioners in the sport and exercise disciplines whether they work in the laboratory or in the field. FEATURES The first volume features immediate practical requirements particularly in sport testing. It is composed of five parts with detailed sub-sections in all of them. The topics of the parts are: i general principles, ii methodological issues, iii general procedures, iv sport specific procedures, v special populations.The second volume is also presented in five parts, again with sub-sections in all of them, but considering the requirements in clinical and exercise

  11. Safety, effectiveness and acceptability of the PrePex device for adult male circumcision in Kenya.

    Directory of Open Access Journals (Sweden)

    Paul J Feldblum

    Full Text Available To assess the safety, effectiveness and acceptability of the PrePex device for adult medical male circumcision (MMC in routine service delivery in Kenya.We enrolled 427 men ages 18-49 at one fixed and two outreach clinics. Procedures were performed by trained clinical officers and nurses. The first 50 enrollees were scheduled for six follow-up visits, and remaining men were followed at Days 7 and 42. We recorded adverse events (AEs and time to complete healing, and interviewed men about acceptability and pain.Placement and removal procedures each averaged between 3 and 4 minutes. Self-reported pain was minimal during placement but was fleetingly intense during removal. The rate of moderate/severe AEs was 5.9% overall (95% confidence interval [CI] 3.8%-8.5%, all of which resolved without sequelae. AEs included 5 device displacements, 2 spontaneous foreskin detachments, and 9 cases of insufficient foreskin removal. Surgical completion of MMC was required for 9 men (2.1%. Among the closely monitored first 50 participants, the probability of complete healing by Day 42 was 0.44 (95% CI 0.30-0.58, and 0.90 by Day 56. A large majority of men was favorable about their MMC procedure and would recommend PrePex to friends and family.The PrePex device was effective for MMC in Kenya, and well-accepted. The AE rate was higher than reported for surgical procedures there, or in previous PrePex studies. Healing time is longer than following surgical circumcision. Provider experience and clearer counseling on post-placement and post-removal care should lead to lower AE rates.ClinicalTrials.gov NCT01711411.

  12. External quality assurance of malaria nucleic acid testing for clinical trials and eradication surveillance.

    Science.gov (United States)

    Murphy, Sean C; Hermsen, Cornelus C; Douglas, Alexander D; Edwards, Nick J; Petersen, Ines; Fahle, Gary A; Adams, Matthew; Berry, Andrea A; Billman, Zachary P; Gilbert, Sarah C; Laurens, Matthew B; Leroy, Odile; Lyke, Kristen E; Plowe, Christopher V; Seilie, Annette M; Strauss, Kathleen A; Teelen, Karina; Hill, Adrian V S; Sauerwein, Robert W

    2014-01-01

    Nucleic acid testing (NAT) for malaria parasites is an increasingly recommended diagnostic endpoint in clinical trials of vaccine and drug candidates and is also important in surveillance of malaria control and elimination efforts. A variety of reported NAT assays have been described, yet no formal external quality assurance (EQA) program provides validation for the assays in use. Here, we report results of an EQA exercise for malaria NAT assays. Among five centers conducting controlled human malaria infection trials, all centers achieved 100% specificity and demonstrated limits of detection consistent with each laboratory's pre-stated expectations. Quantitative bias of reported results compared to expected results was generally Quality Assessment program that fulfills the need for EQA of malaria NAT assays worldwide.

  13. High probability of disease in angina pectoris patients

    DEFF Research Database (Denmark)

    Høilund-Carlsen, Poul F.; Johansen, Allan; Vach, Werner

    2007-01-01

    BACKGROUND: According to most current guidelines, stable angina pectoris patients with a high probability of having coronary artery disease can be reliably identified clinically. OBJECTIVES: To examine the reliability of clinical evaluation with or without an at-rest electrocardiogram (ECG......) in patients with a high probability of coronary artery disease. PATIENTS AND METHODS: A prospective series of 357 patients referred for coronary angiography (CA) for suspected stable angina pectoris were examined by a trained physician who judged their type of pain and Canadian Cardiovascular Society grade...... on CA. Of the patients who had also an abnormal at-rest ECG, 14% to 21% of men and 42% to 57% of women had normal MPS. Sex-related differences were statistically significant. CONCLUSIONS: Clinical prediction appears to be unreliable. Addition of at-rest ECG data results in some improvement, particularly...

  14. Negative probability in the framework of combined probability

    OpenAIRE

    Burgin, Mark

    2013-01-01

    Negative probability has found diverse applications in theoretical physics. Thus, construction of sound and rigorous mathematical foundations for negative probability is important for physics. There are different axiomatizations of conventional probability. So, it is natural that negative probability also has different axiomatic frameworks. In the previous publications (Burgin, 2009; 2010), negative probability was mathematically formalized and rigorously interpreted in the context of extende...

  15. Serodiagnosis of dengue infection using rapid immunochromatography test in patients with probable dengue infection.

    Science.gov (United States)

    Kidwai, Aneela Altaf; Jamal, Qaiser; Saher; Mehrunnisa; Farooqi, Faiz-ur-rehman; Saleem-Ullah

    2010-11-01

    To determine the frequency of seropositive dengue infection using rapid immunochromatographic assay in patients with probable dengue infection as per WHO criteria. A cross-sectional observational study was conducted at Abbasi Shaheed Hospital, Karachi from July 2008 to January 2009. Patients presenting with acute febrile illness, rashes, bleeding tendencies, leucopenia and or thrombocytopenia were evaluated according to WHO criteria for probable dengue infection. Acute phase sera were collected after 5 days of the onset of fever as per WHO criteria. Serology was performed using rapid immunochromatographic (ICT) assay with differential detection of IgM and IgG. A primary dengue infection was defined by a positive IgM band and a negative IgG band whereas secondary infection was defined by a positive IgG band with or without positive IgM band. Among 599 patients who met the WHO criteria for dengue infection, 251(41.9%) were found to be ICT reactive among whom 42 (16.73%) had primary infection. Secondary infection was reported in 209 (83.26%). Acute phase sera of 348 (58.09%) were ICT non reactive. Four patients died because of dengue shock syndrome among which three had secondary infection. Early identification of secondary infection in acute phase sera using rapid ICT is valuable in terms of disease progression and mortality. However in highly suspected cases of dengue infection clinical management should not rely on negative serological results.

  16. Clinical Laboratory Tests in Some Acute Exogenous Poisonings.

    Science.gov (United States)

    Tufkova, Stoilka G; Yankov, Ivan V; Paskaleva, Diana A

    2017-09-01

    There is no specific toxicological screening of clinical laboratory parameters in clinical toxicology when it comes to acute exogenous poisoning. To determine routine clinical laboratory parameters and indicators for assessment of vital functions in patients with acute intoxications. One hundred and fifty-three patients were included in the present study. They were hospitalized in the Department of Clinical Toxicology at St. George University Hospital, Plovdiv for cerebral toxicity inducing medication (n = 45), alcohol (n = 40), heroin abuse (n = 33). The controls were 35. The laboratory tests were conducted in compliance with the standards of the clinical laboratory. We used the following statistical analyses: analysis of variance (the ucriterion of normal distribution, the Student's t-test, dispersion analysis based on ANOVA) and non-parametric analysis. Based on the routine hematological parameters with statistically significant changes in three groups of poisoning are: red blood cells, hematocrit, hemoglobin (except alcohol intoxication) and leukocytes. We found statistically significant changes in serum total protein, sodium and bilirubin. The highest statistical significance is the increased activity of AST and ALT. We present a model for selection of clinical laboratory tests for severe acute poisoning with modern equipment under standardized conditions. The results of the study suggest that the clinical laboratory constellation we used can be used as a mandatory element in the diagnosis of moderate and severe intoxication with the mentioned toxic substances.

  17. Asymptomatic Ventricular Pre-excitation: Between Sudden Cardiac Death and Catheter Ablation

    Science.gov (United States)

    Brugada, Josep

    2018-01-01

    Debate about the best clinical approach to the management of asymptomatic patients with ventricular pre-excitation and advice on whether or not to invasively stratify and ablate is on-going. Weak evidence about the real risk of sudden cardiac death and the potential benefit of catheter ablation has probably prevented the clarification of action in this not infrequent and sometimes conflicting clinical situation. After analysing all available data, real evidence-based medicine could be the alternative strategy for managing this group of patients. According to recent surveys, most electrophysiologists invasively stratify. Based on all accepted risk factors – younger age, male, associated structural heart disease, posteroseptal localisation, ability of the accessory pathway to conduct anterogradely at short intervals of ≤250 milliseconds and inducibility of sustained atrioventricular re-entrant tachycardia and/or atrial fibrillation – a shared decisionmaking process on catheter ablation is proposed. PMID:29636970

  18. Extending the theoretical framework for curriculum integration in pre-clinical medical education

    DEFF Research Database (Denmark)

    Vergel, John; Stentoft, Diana; Montoya, Juny

    2017-01-01

    students' knowledge integration. Therefore, we aimed to uncover how curriculum integration is manifested through context. METHODS: We collected data from the official curriculum and interviewed ten participants (including curriculum designers, facilitators, and students) in the bachelor's medical program......INTRODUCTION: Curriculum integration is widely discussed in medical education but remains ill defined. Although there is plenty of information on logistical aspects of curriculum integration, little attention has been paid to the contextual issues that emerge from its practice and may complicate...... at Aalborg University. We observed various learning activities focused on pre-clinical education. Inspired by grounded theory, we analyzed the information we gathered. RESULTS: The following theoretical constructs emerged after the inductive analysis: 1) curriculum integration complexity is embedded...

  19. Detecting pre-diabetes and the role of the pharmacist

    Directory of Open Access Journals (Sweden)

    Simoens S

    2011-06-01

    Full Text Available Objective: This study aims to use a pharmacoepidemiological approach to study the drug use of patients during the year prior to diabetes diagnosis (i.e. pre-diabetic patients and control patients. Drug use might reveal cardiovascular, metabolic and/or endocrinological changes and help to identify indicators for active monitoring of Type 2 diabetes mellitus.Methods: A retrospective case-control study compared drug use of patients with a future diagnosis of diabetes (experimental patients with patients without a diabetes diagnosis (control patients based on community pharmacy records. An experimental patient had used oral hypoglycaemic drugs during 2005 or 2006. Experimental and control patients were matched in terms of age, gender and quarter of index date. Drugs were selected based on possible co-morbidities of diabetes. Drug use was expressed as a binary variable, indicating whether or not a patient took specific drugs. Drug use was compared between experimental patients during the year prior to diagnosis and control patients using the chi-squared test.Results: Our dataset covered 5,064 patients (1,688 experimental and 3,376 control patients. A higher probability of taking cardiovascular drugs was observed for specific subgroups of patients with pre-diabetes as compared to control patients: this trend was observed for men as well as for women, for various cardiovascular drug classes, and for different age groups (p<0.05, although it was not always statistically significant for the 29-38 age group. For each selected age and gender group, patients with pre-diabetes had a higher probability of taking a combination of a lipid-modifying agent and an antihypertensive drug than control patients (p<0.005.Conclusions: Using community pharmacy data, this study demonstrated that age and a characteristic drug use pattern could contribute to detecting pre-diabetes. There is a potential role for community pharmacists to follow up drug indicators of patients

  20. Mid-level healthcare personnel training: an evaluation of the revised, nationally-standardized, pre-service curriculum for clinical officers in Mozambique.

    Science.gov (United States)

    Feldacker, Caryl; Chicumbe, Sergio; Dgedge, Martinho; Augusto, Gerito; Cesar, Freide; Robertson, Molly; Mbofana, Francisco; O'Malley, Gabrielle

    2014-01-01

    Mozambique suffers from a critical shortage of healthcare workers. Mid-level healthcare workers, (Tecnicos de Medicina Geral (TMG)), in Mozambique require less money and time to train than physicians. From 2009-2010, the Mozambique Ministry of Health (MoH) and the International Training and Education Center for Health (I-TECH), University of Washington, Seattle, revised the TMG curriculum. To evaluate the effect of the curriculum revision, we used mixed methods to determine: 1) if TMGs meet the MoH's basic standards of clinical competency; and 2) do scores on measurements of clinical knowledge, physical exam, and clinical case scenarios differ by curriculum? T-tests of differences in means examined differences in continuous score variables between curriculum groups. Univariate and multivariate linear regression models assess curriculum-related and demographic factors associated with assessment scores on each of the three evaluation methods at the pTMG scores on both the clinical cases and physical exam. TMGs trained in either curriculum may be inadequately prepared to provide quality care. Curriculum changes are a necessary, but insufficient, part of improving TMG knowledge and skills overall. A more comprehensive, multi-level approach to improving TMG training that includes post-graduation mentoring, strengthening the pre-service internship training, and greater resources for training institute faculty may result in improvements in TMG capacity and patient care over time.

  1. Trends in clinical characteristics and outcomes of Pre-ART care at a large HIV clinic in Nairobi, Kenya: a retrospective cohort study.

    Science.gov (United States)

    Mecha, Jared O; Kubo, Elizabeth N; Nganga, Lucy W; Muiruri, Peter N; Njagi, Lilian N; Mutisya, Immaculate N; Odionyi, Justine J; Ilovi, Syokau C; Wambui, Mary; Githu, Christopher; Ngethe, Richard; Obimbo, Elizabeth M; Ngumi, Zipporah W

    2016-01-01

    The success of antiretroviral therapy in resource-scarce settings is an illustration that complex healthcare interventions can be successfully delivered even in fragile health systems. Documenting the success factors in the scale-up of HIV care and treatment in resource constrained settings will enable health systems to prepare for changing population health needs. This study describes changing demographic and clinical characteristics of adult pre-ART cohorts, and identifies predictors of pre-ART attrition at a large urban HIV clinic in Nairobi, Kenya. We conducted a retrospective cohort analysis of data on HIV infected adults (≥15 years) enrolling in pre-ART care between January 2004 and September 2015. Attrition (loss to program) was defined as those who died or were lost to follow-up (having no contact with the facility for at least 6 months). We used Kaplan-Meier survival analysis to determine time to event for the different modes of transition, and Cox proportional hazards models to determine predictors of pre-ART attrition. Over the 12 years of observation, there were increases in the proportions of young people (age 15 to 24 years); and patients presenting with early disease (by WHO clinical stage and higher median CD4 cell counts), p = 0.0001 for trend. Independent predictors of attrition included: aHR (95% CI): male gender 1.98 (1.69-2.33), p = 0.0001; age 20-24 years 1.80 (1.37-2.37), p = 0.0001), or 25-34 years 1.22 (1.01-1.47), p = 0.0364; marital status single 1.55 (1.29-1.86), p = 0.0001) or divorced 1.41(1.02-1.95), p = 0.0370; urban residency 1.83 (1.40-2.38), p = 0.0001; CD4 count of 0-100 cells/µl 1.63 (1.003-2.658), p = 0.0486 or CD4 count >500 cells/µl 2.14(1.46-3.14), p = 0.0001. In order to optimize the impact of HIV prevention, care and treatment in resource scarce settings, there is an urgent need to implement prevention and treatment interventions targeting young people and patients entering care with severe

  2. Interference by pralidoxime (PAM) salts in clinical laboratory tests.

    Science.gov (United States)

    Nagase, Sumika; Kohguchi, Katsunori; Tohyama, Kaoru; Watanabe, Mikio; Iwatani, Yoshinori

    2013-02-01

    Drugs sometimes alter the results of clinical laboratory tests. We examined the effects of pralidoxime (PAM) salts, a medicine used to treat organophosphorus poisoning, on clinical laboratory test results for the first time. The effects of PAM salts on glucose (GLU) measurements were examined using a point-of-care testing (POCT) meter, four self-monitoring of blood glucose (SMBG) meters, and two biochemical autoanalyzers. The effects of PAM salts on other clinical tests were also evaluated. The addition of PAM iodide or potassium iodide, but not of PAM chloride or potassium chloride, to blood samples increased the GLU values measured by one POCT meter and 4 SMBG meters using the enzyme electrode (hydrogen peroxidase or oxygen electrode) method. On the other hand, PAM iodide or PAM chloride, but not KI or KCl, affected the values measured at 340 nm by an autoanalyzer using absorption spectrophotometry in 8 of 14 clinical laboratory tests. The absorption spectrum of PAM changed from 294 to 338 nm due to the reaction between PAM and the alkaline buffer, a component of the measuring reagents. PAM iodide increases the GLU values measured by the enzyme electrode method, and PAM salts affected the values measured at 340 nm by absorption spectrophotometry in many other clinical test items. Copyright © 2012 Elsevier B.V. All rights reserved.

  3. Pre-clinical testing of a phased array ultrasound system for MRI-guided noninvasive surgery of the brain--a primate study.

    Science.gov (United States)

    Hynynen, Kullervo; McDannold, Nathan; Clement, Greg; Jolesz, Ferenc A; Zadicario, Eyal; Killiany, Ron; Moore, Tara; Rosen, Douglas

    2006-08-01

    MRI-guided and monitored focused ultrasound thermal surgery of brain through intact skull was tested in three rhesus monkeys. The aim of this study was to determine the amount of skull heating in an animal model with a head shape similar to that of a human. The ultrasound beam was generated by a 512 channel phased array system (Exablate 3000, InSightec, Haifa, Israel) that was integrated within a 1.5-T MR-scanner. The skin was pre-cooled by degassed temperature controlled water circulating between the array surface and the skin. Skull surface temperature was measured with invasive thermocouple probes. The results showed that by applying surface cooling the skin and skull surface can be protected, and that the brain surface temperature becomes the limiting factor. The MRI thermometry was shown to be useful in detecting the tissue temperature distribution next to the bone, and it should be used to monitor the brain surface temperature. The acoustic intensity values during the 20 s sonications were adequate for thermal ablation in the human brain provided that surface cooling is used.

  4. Crash probability estimation via quantifying driver hazard perception.

    Science.gov (United States)

    Li, Yang; Zheng, Yang; Wang, Jianqiang; Kodaka, Kenji; Li, Keqiang

    2018-07-01

    Crash probability estimation is an important method to predict the potential reduction of crash probability contributed by forward collision avoidance technologies (FCATs). In this study, we propose a practical approach to estimate crash probability, which combines a field operational test and numerical simulations of a typical rear-end crash model. To consider driver hazard perception characteristics, we define a novel hazard perception measure, called as driver risk response time, by considering both time-to-collision (TTC) and driver braking response to impending collision risk in a near-crash scenario. Also, we establish a driving database under mixed Chinese traffic conditions based on a CMBS (Collision Mitigation Braking Systems)-equipped vehicle. Applying the crash probability estimation in this database, we estimate the potential decrease in crash probability owing to use of CMBS. A comparison of the results with CMBS on and off shows a 13.7% reduction of crash probability in a typical rear-end near-crash scenario with a one-second delay of driver's braking response. These results indicate that CMBS is positive in collision prevention, especially in the case of inattentive drivers or ole drivers. The proposed crash probability estimation offers a practical way for evaluating the safety benefits in the design and testing of FCATs. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Growth/differentiation factor-5: a candidate therapeutic agent for periodontal regeneration? A review of pre-clinical data.

    Science.gov (United States)

    Moore, Yolanda R; Dickinson, Douglas P; Wikesjö, Ulf M E

    2010-03-01

    Therapeutic concepts involving the application of matrix, growth and differentiation factors have been advocated in support of periodontal wound healing/regeneration. Growth/differentiation factor-5 (GDF-5), a member of the bone morphogenetic protein family, represents one such factor. The purpose of this review is to provide a background of the therapeutic effects of GDF-5 expressed in various musculoskeletal settings using small and large animal platforms. A comprehensive literature search was conducted to identify all reports in the English language evaluating GDF-5 using the PubMed and Google search engines, and a manual search of the reference lists from the electronically retrieved reports. Two reviewers independently screened the titles and abstracts from a total of 69 reports, 22 of which were identified as pre-clinical (in vivo) evaluations of GDF-5. The full-length article of the 22 pre-clinical reports was then reviewed. Various applications including cranial and craniofacial bone formation, spine fusion, long bone fracture healing, cartilage, and tendon/ligament repair using a variety of small and large animal platforms evaluating GDF-5 as a therapeutic agent were identified. A majority of studies, using biomechanical, radiographic, and histological analysis, demonstrated significant dose-dependent effects of GDF-5. These include increased/enhanced local bone formation, fracture healing/repair, and cartilage and tendon/ligament formation. GDF-5 frequently was shown to accelerate wound maturation. Several studies demonstrated GDF-5 to be a realistic alternative to autograft bone. Studies using pre-clinical models and human histology suggest GDF-5 may also increase/enhance periodontal wound healing/regeneration. GDF-5 appears a promising therapeutic agent for periodontal wound healing/regeneration as GDF-5 supports/accelerates bone and tendon/ligament formation in several musculoskeletal settings including periodontal tissues.

  6. Usability testing of Avoiding Diabetes Thru Action Plan Targeting (ADAPT) decision support for integrating care-based counseling of pre-diabetes in an electronic health record.

    Science.gov (United States)

    Chrimes, Dillon; Kitos, Nicole R; Kushniruk, Andre; Mann, Devin M

    2014-09-01

    Usability testing can be used to evaluate human-computer interaction (HCI) and communication in shared decision making (SDM) for patient-provider behavioral change and behavioral contracting. Traditional evaluations of usability using scripted or mock patient scenarios with think-aloud protocol analysis provide a way to identify HCI issues. In this paper we describe the application of these methods in the evaluation of the Avoiding Diabetes Thru Action Plan Targeting (ADAPT) tool, and test the usability of the tool to support the ADAPT framework for integrated care counseling of pre-diabetes. The think-aloud protocol analysis typically does not provide an assessment of how patient-provider interactions are effected in "live" clinical workflow or whether a tool is successful. Therefore, "Near-live" clinical simulations involving applied simulation methods were used to compliment the think-aloud results. This complementary usability technique was used to test the end-user HCI and tool performance by more closely mimicking the clinical workflow and capturing interaction sequences along with assessing the functionality of computer module prototypes on clinician workflow. We expected this method to further complement and provide different usability findings as compared to think-aloud analysis. Together, this mixed method evaluation provided comprehensive and realistic feedback for iterative refinement of the ADAPT system prior to implementation. The study employed two phases of testing of a new interactive ADAPT tool that embedded an evidence-based shared goal setting component into primary care workflow for dealing with pre-diabetes counseling within a commercial physician office electronic health record (EHR). Phase I applied usability testing that involved "think-aloud" protocol analysis of eight primary care providers interacting with several scripted clinical scenarios. Phase II used "near-live" clinical simulations of five providers interacting with standardized

  7. Optimal selection for BRCA1 and BRCA2 mutation testing using a combination of ' easy to apply ' probability models

    NARCIS (Netherlands)

    Bodmer, D.; Ligtenberg, M. J. L.; van der Hout, A. H.; Gloudemans, S.; Ansink, K.; Oosterwijk, J. C.; Hoogerbrugge, N.

    2006-01-01

    To establish an efficient, reliable and easy to apply risk assessment tool to select families with breast and/or ovarian cancer patients for BRCA mutation testing, using available probability models. In a retrospective study of 263 families with breast and/or ovarian cancer patients, the utility of

  8. Posterior Probability Matching and Human Perceptual Decision Making.

    Directory of Open Access Journals (Sweden)

    Richard F Murray

    2015-06-01

    Full Text Available Probability matching is a classic theory of decision making that was first developed in models of cognition. Posterior probability matching, a variant in which observers match their response probabilities to the posterior probability of each response being correct, is being used increasingly often in models of perception. However, little is known about whether posterior probability matching is consistent with the vast literature on vision and hearing that has developed within signal detection theory. Here we test posterior probability matching models using two tools from detection theory. First, we examine the models' performance in a two-pass experiment, where each block of trials is presented twice, and we measure the proportion of times that the model gives the same response twice to repeated stimuli. We show that at low performance levels, posterior probability matching models give highly inconsistent responses across repeated presentations of identical trials. We find that practised human observers are more consistent across repeated trials than these models predict, and we find some evidence that less practised observers more consistent as well. Second, we compare the performance of posterior probability matching models on a discrimination task to the performance of a theoretical ideal observer that achieves the best possible performance. We find that posterior probability matching is very inefficient at low-to-moderate performance levels, and that human observers can be more efficient than is ever possible according to posterior probability matching models. These findings support classic signal detection models, and rule out a broad class of posterior probability matching models for expert performance on perceptual tasks that range in complexity from contrast discrimination to symmetry detection. However, our findings leave open the possibility that inexperienced observers may show posterior probability matching behaviour, and our methods

  9. How the detector resolution affects the clinical significance of SBRT pre-treatment quality assurance results.

    Science.gov (United States)

    Bruschi, A; Esposito, M; Pini, S; Ghirelli, A; Zatelli, G; Russo, S

    2017-12-01

    Aim of this work was to study how the detector resolution can affect the clinical significance of SBRT pre-treatment volumetric modulated arc therapy (VMAT) verification results. Three detectors (PTW OCTAVIUS 4D 729, 1500 and 100 SRS) used in five configurations with different resolution were compared: 729, 729 merged, 1500, 1500 merged and 1000 SRS. Absolute local gamma passing rates of 3D pre-treatment quality assurance (QA) were evaluated for 150 dose distributions in 30 plans. Five different kinds of error were introduced in order to establish the detection sensitivity of the three devices. Percentage dosimetric differences were evaluated between planned dosevolume histogram (DVH) and patients' predicted DVH calculated by PTW DVH 4D® software. The mean gamma passing rates and the standard deviations were 92.4% ± 3.7%, 94.6% ± 1.8%, 95.3% ± 4.2%, 97.4% ± 2.5% and 97.6% ± 1.4 respectively for 729, 729 merged, 1500, 1500 merged and 1000 SRS with 2% local dose/2mm criterion. The same trend was found on the sensitivity analysis: using a tight gamma analysis criterion (2%L/1mm) only the 1000 SRS detected every kind of error, while 729 and 1500 merged detected three and four kinds of error respectively. Regarding dose metrics extracted from DVH curves, D50% was within the tolerance level in more than 90% of cases only for the 1000 SRS. The detector resolution can significantly affect the clinical significance of SBRT pre-treatment verification results. The choice of a detector with resolution suitable to the investigated field size is of main importance to avoid getting false positive. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  10. Pre-test analysis of ATLAS SBO with RCP seal leakage scenario using MARS code

    Energy Technology Data Exchange (ETDEWEB)

    Pham, Quang Huy; Lee, Sang Young; Oh, Seung Jong [KEPCO International Nuclear Graduate School, Ulsan (Korea, Republic of)

    2015-10-15

    This study presents a pre-test calculation for the Advanced Thermal-hydraulic Test Loop for Accident Simulation (ATLAS) SBO experiment with RCP seal leakage scenario. Initially, turbine-driven auxfeed water pumps are used. Then, outside cooling water injection method is used for long term cooling. The analysis results would be useful for conducting the experiment to verify the APR 1400 extended SBO optimum mitigation strategy using outside cooling water injection in future. The pre-test calculation for ATLAS extended SBO with RCP seal leakage and outside cooling water injection scenario is performed. After Fukushima nuclear accident, the capability of coping with the extended station blackout (SBO) becomes important. Many NPPs are applying FLEX approach as main coping strategies for extended SBO scenarios. In FLEX strategies, outside cooling water injection to reactor cooling system (RCS) and steam generators (SGs) is considered as an effective method to remove residual heat and maintain the inventory of the systems during the accident. It is worthwhile to examine the soundness of outside cooling water injection method for extended SBO mitigation by both calculation and experimental demonstration. From the calculation results, outside cooling water injection into RCS and SGs is verified as an effective method during extended SBO when RCS and SGs depressurization is sufficiently performed.

  11. Sequential Probability Ratio Test for Collision Avoidance Maneuver Decisions Based on a Bank of Norm-Inequality-Constrained Epoch-State Filters

    Science.gov (United States)

    Carpenter, J. R.; Markley, F. L.; Alfriend, K. T.; Wright, C.; Arcido, J.

    2011-01-01

    Sequential probability ratio tests explicitly allow decision makers to incorporate false alarm and missed detection risks, and are potentially less sensitive to modeling errors than a procedure that relies solely on a probability of collision threshold. Recent work on constrained Kalman filtering has suggested an approach to formulating such a test for collision avoidance maneuver decisions: a filter bank with two norm-inequality-constrained epoch-state extended Kalman filters. One filter models 1he null hypothesis 1ha1 the miss distance is inside the combined hard body radius at the predicted time of closest approach, and one filter models the alternative hypothesis. The epoch-state filter developed for this method explicitly accounts for any process noise present in the system. The method appears to work well using a realistic example based on an upcoming highly-elliptical orbit formation flying mission.

  12. CT abnormality in multiple sclerosis analysis based on 28 probable cases and correlation with clinical manifestations

    International Nuclear Information System (INIS)

    Kakigi, Ryusuke; Shibasaki, Hiroshi; Tabira, Takeshi; Kuroiwa, Yoshigoro; Numaguchi, Yuji.

    1981-01-01

    In order to investigate the occurrence and nature of CT abnormality and its correlation with clinical manifestations in multiple sclerosis, 34 CT records obtained from 28 consecutive patients with probable multiple sclerosis were reviewed. Forty-six percent of all cases showed abnormal CT. Dilatation of cortical sulci was found in 39%; dilatation of the lateral ventricle in 36%; dilatation of prepontine or cerebello-pontine cistern and the fourth ventricle, suggesting brainstem atrophy, in 18%; dilatation of cerebellar sulci, superior cerebellar cistern and cisterna magna, suggesting cerebellar atrophy, in 11%. Low density area was found in the cerebral hemisphere in 11% of cases. Contrast enhancement, performed on 25 CT records, did not show any change. There was no correlation between CT abnormality and duration of the illness. Although abnormal CT tended to occur more frequently during exacerbations and chronic stable state than during remissions, the difference was not statistically significant. CT abnormalities suggesting brainstem atrophy, cerebellar atrophy or plaques were found exclusively during exacerbations and chronic stable state. The occurrence of CT abnormalities was not significantly different among various clinical forms which were classified based on clinically estimated sites of lesion, except that abnormal CT tended to occur less frequently in cases classified as the optic-spinal form. It is noteworthy that cerebral cortical atrophy and/or dilatation of the lateral ventricle were found in 31% of cases who did not show any clinical sign of cerebral involvement. There was a statistically significant correlation between CT abnormalities and levels of clinical disability. Eighty percent of the bedridden or severely disabled patients showed abnormal CT, in contrast with only 29% of those with moderate, slight or no disability. (author)

  13. CT abnormality in multiple sclerosis analysis based on 28 probable cases and correlation with clinical manifestations

    Energy Technology Data Exchange (ETDEWEB)

    Kakigi, R.; Shibasaki, H.; Tabira, T.; Kuroiwa, Y. (Kyushu Univ., Fukuoka (Japan). Faculty of Medicine); Numaguchi, Y.

    1981-10-01

    In order to investigate the occurrence and nature of CT abnormality and its correlation with clinical manifestations in multiple sclerosis, 34 CT records obtained from 28 consecutive patients with probable multiple sclerosis were reviewed. Forty-six percent of all cases showed abnormal CT. Dilatation of cortical sulci was found in 39%; dilatation of the lateral ventricle in 36%; dilatation of prepontine or cerebello-pontine cistern and the fourth ventricle, suggesting brainstem atrophy, in 18%; dilatation of cerebellar sulci, superior cerebellar cistern and cisterna magna, suggesting cerebellar atrophy, in 11%. Low density area was found in the cerebral hemisphere in 11% of cases. Contrast enhancement, performed on 25 CT records, did not show any change. There was no correlation between CT abnormality and duration of the illness. Although abnormal CT tended to occur more frequently during exacerbations and chronic stable state than during remissions, the difference was not statistically significant. CT abnormalities suggesting brainstem atrophy, cerebellar atrophy or plaques were found exclusively during exacerbations and chronic stable state. The occurrence of CT abnormalities was not significantly different among various clinical forms which were classified based on clinically estimated sites of lesion, except that abnormal CT tended to occur less frequently in cases classified as the optic-spinal form. It is noteworthy that cerebral cortical atrophy and/or dilatation of the lateral ventricle were found in 31% of cases who did not show any clinical sign of cerebral involvement. There was a statistically significant correlation between CT abnormalities and levels of clinical disability. Eighty percent of the bedridden or severely disabled patients showed abnormal CT, in contrast with only 29% of those with moderate, slight or no disability.

  14. Experimental data report for Test TS-1 Reactivity Initiated Accident Test in NSRR with pre-irradiated BWR fuel rod

    International Nuclear Information System (INIS)

    Nakamura, Takehiko; Yoshinaga, Makio; Sobajima, Makoto; Fujishiro, Toshio; Horiki, Ohichiro; Yamahara, Takeshi; Ichihashi, Yoshinori; Kikuchi, Teruo

    1992-01-01

    This report presents experimental data for Test TS-1 which was the first in a series of tests, simulating Reactivity Initiated Accident (RIA) conditions using pre-irradiated BWR fuel rods, performed in the Nuclear Safety Research Reactor (NSRR) in October, 1989. Test fuel rod used in the Test TS-1 was a short-sized BWR (7 x 7) type rod which was fabricated from a commercial rod provided from Tsuruga Unit 1 power reactor. The fuel had an initial enrichment of 2.79 % and burnup of 21.3 GWd/t (bundle average). Pulse irradiation was performed at a condition of stagnant water cooling, atmospheric pressure and ambient temperature using a newly developed double container-type capsule. Energy deposition of the rod in this test was evaluated to be about 61 cal/g·fuel (55 cal/g·fuel in peak fuel enthalpy) and no fuel failure was observed. Descriptions on test conditions, test procedures, fuel burnup measurements, transient behavior of the test rod during pulse irradiation and results of post pulse irradiation examinations are contained in this report. (author)

  15. Pre-Analytical Components of Risk in Four Branches of Clinical Laboratory in Romania--Prospective Study.

    Science.gov (United States)

    David, Remona E; Dobreanu, Minodora

    2016-01-01

    Development of quality measurement principles is a strategic point for each clinical laboratory. Preexamination process is the most critical and the most difficult to be managed. The aim of this study is to identify, quantify, and monitor the nonconformities of the pre-analytical process using quality indicators that can affect the patient's health safety in four different locations of a Romanian private clinical laboratory. The study group consisted of all the analysis requests received by the departments of biochemistry, hematology, and coagulation from January through March 2015. In order to collect the pre-analytical nonconformities, we created a "Risk Budget", using the entries from the "Evidence notebook--non-conform samples" from the above mentioned departments. The laboratory established the quality indicators by means of the risk management technique in order to identify and control the sources of errors, FMEA (Failure Modes and Effects Analyses), which had been implemented and monitored for its purposes and special needs. For the assessment of the control level over the processes, the results were transformed on the Six Sigma scale, using the Westgard calculation method and being obtained in this way the frequency with which an error may occur. (https://www.westgard. com/six-sigma-calculators.htm). The obtained results prove that the quantification and monitoring of the indicators can be a control instrument for the pre-analytic activities. The calculation of the Six Sigma value adds extra information to the study because it allows the detection of the processes which need improvement (Sigma value higher than 4 represents a well controlled process). The highest rates were observed for the hemolyzed and the lipemic samples, in the department of biochemistry and hemolyzed, insufficient sample volume, or clotted samples for the department of hematology and coagulation. Significant statistical differences between laboratories participating in the study have

  16. Exclusion and diagnosis of pulmonary embolism by a rapid ELISA D-dimer test and noninvasive imaging techniques within the context of a clinical model.

    Science.gov (United States)

    Michiels, J J; Pattynama, P M

    2000-01-01

    A negative rapid ELISA D-dimer test alone in out-patients with a low to moderate clinical probability (CP) on pulmonary embolism (PE) is predicted to safely exclude pulmonary embolism. The combination of a negative rapid ELISA D-dimer test and a low to moderate CP on PE followed by compression ultrasonography (CUS) for the detection of deep vein thrombosis (DVT) is safe and cost-effective as it reduces the need for noninvasive imaging techniques to about 50% to 60% of outpatients with suspected PE. A high probability ventilation-perfusion (VP) scan or a positive spiral CT consistent with PE and the detection of DVT by CUS are currently considered to be clear indications for anticoagulant treatment. Subsequent pulmonary angiography (PA) is the gold standard diagnostic strategy to exclude or diagnose PE in suspected outpatients with a negative CUS, a positive rapid ELISA D-dimer test, and a nondiagnostic VP scan or negative spiral CT to prevent overtreatment with anticoagulants. However, the willingness of clinicians and the availability of resources to perform PA is restricted, a fact that has provided an impetus for clinical investigators to search for alternative noninvasive strategies to exclude or detect venous thromboembolism (VTE). Serial CUS testing for the detection of DVT in patients with a low to moderate CP on PE and a nondiagnostic VP scan or negative spiral CT is predicted to be safe and will reduce the need for PA to less than 10% or even less than 5%. This noninvasive serial CUS strategy restricts the need for invasive PA to a minor group of patients (spiral CT and a high CP on PE. Prospective evaluations are warranted to implement and to validate the advantages and the disadvantages of the various combinations of noninvasive strategies and to compare serial CUS testing versus PA in randomized clinical management studies of outpatients with suspected pulmonary embolism.

  17. Managed ventricular pacing vs. conventional dual-chamber pacing for elective replacements: the PreFER MVP study: clinical background, rationale, and design.

    Science.gov (United States)

    Quesada, Aurelio; Botto, Gianluca; Erdogan, Ali; Kozak, Milan; Lercher, Peter; Nielsen, Jens Cosedis; Piot, Olivier; Ricci, Renato; Weiss, Christian; Becker, Daniel; Wetzels, Gwenn; De Roy, Luc

    2008-03-01

    Several clinical studies have shown that, in patients with intact atrioventricular (AV) conduction, unnecessary chronic right ventricular (RV) pacing can be detrimental. The managed ventricular pacing (MVP) algorithm is designed to give preference to spontaneous AV conduction, thus minimizing RV pacing. The clinical outcomes of MVP are being studied in several ongoing trials in patients undergoing a first device implantation, but it is unknown to what extent MVP is beneficial in patients with a history of ventricular pacing. The purpose of the Prefer for Elective Replacement MVP (PreFER MVP) study is to assess the superiority of the MVP algorithm to conventional pacemaker and implantable cardioverter-defibrillator programming in terms of freedom from hospitalization for cardiovascular causes in a population of patients exposed to long periods of ventricular pacing. PreFER MVP is a prospective, 1:1 parallel, randomized (MVP ON/MVP OFF), single-blinded multi-centre trial. The study population consists of patients with more than 40% ventricular pacing documented with their previous device. Approximately, 600 patients will be randomized and followed for at least 24 months. The primary endpoint comprises cardiovascular hospitalization. The PreFER MVP trial is the first large prospective randomized clinical trial evaluating the effect of MVP in patients with a history of RV pacing.

  18. Comparing the IRT Pre-equating and Section Pre-equating: A Simulation Study.

    Science.gov (United States)

    Hwang, Chi-en; Cleary, T. Anne

    The results obtained from two basic types of pre-equatings of tests were compared: the item response theory (IRT) pre-equating and section pre-equating (SPE). The simulated data were generated from a modified three-parameter logistic model with a constant guessing parameter. Responses of two replication samples of 3000 examinees on two 72-item…

  19. Pre-employment physical capacity testing as a predictor for musculoskeletal injury in paramedics: A review of the literature.

    Science.gov (United States)

    Jenkins, Natasha; Smith, Gavin; Stewart, Scott; Kamphuis, Catherine

    2016-11-22

    Workplace injuries place a significant physical, social and financial burden on organisations globally. Paramedics provide emergency management of workplace injuries, and are subjected to heightened injury risk as a direct consequence of providing such care. This review aims to identify the current evidence reporting workplace musculoskeletal injury generally, and to relate this to pre-employment physical capacity testing within the paramedic industry specifically. A search of the electronic databases (Ovid Medline, Cochrane Database of Systematic Reviews, NIOSHTIC-2, RILOSH, CISDOC and HSELINE) was completed using the keywords musculoskeletal, workplace, injury, industrial, accident, pre-employment physical capacity testing, paramedic, emergency service employee, firefighter, and police. Articles were excluded if they did not describe pre-employment physical capacity testing, musculoskeletal injuries, or were not available in English. The electronic literature search identified 765 articles, following application of exclusion criteria: based on title/abstract of article (669); no relevance (62) or unavailable in English (4), 30 articles were included in this review.The review identified that physical fitness, gender, age, equipment and demographic variables were key factors in the current high rate of paramedic workplace injury. However, there is little evidence available to quantify the relationship between pre-employment physical capacity testing and subsequent injury amongst the paramedic cohort. Despite evidence suggesting that pre-employment physical capacity testing scores may be predictive of subsequent musculoskeletal injury in paramedics, there are currently no studies in this area. Quantifying the potential association between factors affecting the conduct of paramedic work and the type of injuries that result requires examination through future research.

  20. Subsequent investigation and management of patients with intermediate-category and - probability ventilation - perfusion scintigraphy

    International Nuclear Information System (INIS)

    Walsh, G.; Jones, D.N.

    2000-01-01

    The authors wished to determine the proportion of patients with intermediate-category and intermediate-probability ventilation-perfusion scintigraphy (IVQS) who proceed to further imaging for investigation of thromboembolism, to identify the defining clinical parameters and to determine the proportion of patients who have a definite imaging diagnosis of thromboembolism prior to discharge from hospital on anticoagulation therapy. One hundred and twelve VQS studies performed at the Flinders Medical Centre over a 9-month period were reported as having intermediate category and probability for pulmonary embolism. Medical case notes were available for review in 99 of these patients and from these the pretest clinical probability, subsequent patient progress and treatment were recorded. Eight cases were excluded because they were already receiving anticoagulation therapy. In the remaining 91 patients the pretest clinical probability was considered to be low in 25; intermediate in 30; and high in 36 cases. In total, 51.6% (n = 47) of these patients (8% (n = 2) with low, 66% (n = 20) with intermediate, and 69.4% (n = 25) with high pretest probability) proceeded to CT pulmonary angiography (CTPA) and/or lower limb duplex Doppler ultrasound (DUS) evaluation. Of the patients with IVQS results, 30.7% (n 28) were evaluated with CTPA. No patient with a low, all patients with a high and 46% of patients with an intermediate pretest probability initially received anticoagulation therapy. This was discontinued in three patients with high and in 12 patients with intermediate clinical probability prior to discharge from hospital. Overall, 40% of patients discharged on anticoagulation therapy (including 39% of those with a high pretest probability) had a positive imaging diagnosis of thromboembolism The results suggest that, although the majority of patients with intermediate-to-high pretest probability and IVQS proceed to further imaging investigation, CTPA is relatively underused in

  1. The Influence of Pre-University Students' Mathematics Test Anxiety and Numerical Anxiety on Mathematics Achievement

    Science.gov (United States)

    Seng, Ernest Lim Kok

    2015-01-01

    This study examines the relationship between mathematics test anxiety and numerical anxiety on students' mathematics achievement. 140 pre-university students who studied at one of the institutes of higher learning were being investigated. Gender issue pertaining to mathematics anxieties was being addressed besides investigating the magnitude of…

  2. Knowledge of thromboprophylaxis guidelines pre- and post-didactic lectures during a venous thromboembolism awareness day at a tertiary-care hospital.

    Science.gov (United States)

    Al-Dorzi, Hasan M; Cherfan, Antoine; Al-Harbi, Shmylan; Al-Askar, Ahmad; Al-Azzam, Saleh; Hroub, Ahmad; Olivier, Joan; Al-Hameed, Fahad; Al-Moamary, Mohamed; Abdelaal, Mohamed; Poff, Gregory A; Arabi, Yaseen M

    2013-07-01

    Didactic lectures are frequently used to improve compliance with practice guidelines. This study assessed the knowledge of health-care providers (HCPs) at a tertiary-care hospital of its evidence-based thromboprophylaxis guidelines and the impact of didactic lectures on their knowledge. The hospital launched a multifaceted approach to improve thromboprophylaxis practices, which included posters, a pocket-size guidelines summary and didactic lectures during the annual thromboprophylaxis awareness days. A self-administered questionnaire was distributed to HCPs before and after lectures on thromboprophylaxis guidelines (June 2010). The questionnaire, formulated and validated by two physicians, two nurses and a clinical pharmacist, covered various subjects such as risk stratification, anticoagulant dosing and the choice of anticoagulants in specific clinical situations. Seventy-two and 63 HCPs submitted the pre- and post-test, respectively (62% physicians, 28% nurses, from different clinical disciplines). The mean scores were 7.8 ± 2.1 (median = 8.0, range = 2-12, maximum possible score = 15) for the pre-test and 8.4 ± 1.8 for the post-test, P = 0.053. There was no significant difference in the pre-test scores of nurses and physicians (7.9 ± 1.7 and 8.2 ± 2.4, respectively, P = 0.67). For the 35 HCPs who completed the pre- and post-tests, their scores were 7.7 ± 1.7 and 8.8 ± 1.6, respectively, P = 0.003. Knowledge of appropriate anticoagulant administration in specific clinical situations was frequently inadequate, with approximately two-thirds of participants failing to adjust low-molecular-weight heparin doses in patients with renal failure. Education via didactic lectures resulted in a modest improvement of HCPs' knowledge of thromboprophylaxis guidelines. This supports the need for a multifaceted approach to improve the awareness and implementation of thromboprophylaxis guidelines.

  3. Effects of different centrifugation conditions on clinical chemistry and Immunology test results.

    Science.gov (United States)

    Minder, Elisabeth I; Schibli, Adrian; Mahrer, Dagmar; Nesic, Predrag; Plüer, Kathrin

    2011-05-10

    The effect of centrifugation time of heparinized blood samples on clinical chemistry and immunology results has rarely been studied. WHO guideline proposed a 15 min centrifugation time without citing any scientific publications. The centrifugation time has a considerable impact on the turn-around-time. We investigated 74 parameters in samples from 44 patients on a Roche Cobas 6000 system, to see whether there was a statistical significant difference in the test results among specimens centrifuged at 2180 g for 15 min, at 2180 g for 10 min or at 1870 g for 7 min, respectively. Two tubes with different plasma separators (both Greiner Bio-One) were used for each centrifugation condition. Statistical comparisons were made by Deming fit. Tubes with different separators showed identical results in all parameters. Likewise, excellent correlations were found among tubes to which different centrifugation conditions were applied. Fifty percent of the slopes lay between 0.99 and 1.01. Only 3.6 percent of the statistical tests results fell outside the significance level of p < 0.05, which was less than the expected 5%. This suggests that the outliers are the result of random variation and the large number of statistical tests performed. Further, we found that our data are sufficient not to miss a biased test (beta error) with a probability of 0.10 to 0.05 in most parameters. A centrifugation time of either 7 or 10 min provided identical test results compared to the time of 15 min as proposed by WHO under the conditions used in our study.

  4. Internal Medicine residents use heuristics to estimate disease probability

    Directory of Open Access Journals (Sweden)

    Sen Phang

    2015-12-01

    Conclusions: Our findings suggest that despite previous exposure to the use of Bayesian reasoning, residents use heuristics, such as the representative heuristic and anchoring with adjustment, to estimate probabilities. Potential reasons for attribute substitution include the relative cognitive ease of heuristics vs. Bayesian reasoning or perhaps residents in their clinical practice use gist traces rather than precise probability estimates when diagnosing.

  5. A global, incremental development method for a web-based prostate cancer treatment decision aid and usability testing in a Dutch clinical setting.

    Science.gov (United States)

    Cuypers, Maarten; Lamers, Romy Ed; Kil, Paul Jm; The, Regina; Karssen, Klemens; van de Poll-Franse, Lonneke V; de Vries, Marieke

    2017-07-01

    Many new decision aids are developed while aspects of existing decision aids could also be useful, leading to a sub-optimal use of resources. To support treatment decision-making in prostate cancer patients, a pre-existing evidence-based Canadian decision aid was adjusted to Dutch clinical setting. After analyses of the original decision aid and routines in Dutch prostate cancer care, adjustments to the decision aid structure and content were made. Subsequent usability testing (N = 11) resulted in 212 comments. Care providers mainly provided feedback on medical content, and patients commented most on usability and summary layout. All participants reported that the decision aid was comprehensible and well-structured and would recommend decision aid use. After usability testing, final adjustments to the decision aid were made. The presented methods could be useful for cultural adaptation of pre-existing tools into other languages and settings, ensuring optimal usage of previous scientific and practical efforts and allowing for a global, incremental decision aid development process.

  6. Probability

    CERN Document Server

    Shiryaev, A N

    1996-01-01

    This book contains a systematic treatment of probability from the ground up, starting with intuitive ideas and gradually developing more sophisticated subjects, such as random walks, martingales, Markov chains, ergodic theory, weak convergence of probability measures, stationary stochastic processes, and the Kalman-Bucy filter Many examples are discussed in detail, and there are a large number of exercises The book is accessible to advanced undergraduates and can be used as a text for self-study This new edition contains substantial revisions and updated references The reader will find a deeper study of topics such as the distance between probability measures, metrization of weak convergence, and contiguity of probability measures Proofs for a number of some important results which were merely stated in the first edition have been added The author included new material on the probability of large deviations, and on the central limit theorem for sums of dependent random variables

  7. Importance of clinical toxicology teaching and its impact in improving knowledge: sharing experience from a workshop

    International Nuclear Information System (INIS)

    Khan, N.U.; Fayyaz, J.; Khan, U.R.; Feroze, A.

    2013-01-01

    Objective: To assess the impact of a one-day clinical toxicology workshop in improving knowledge. Methods: A one-day clinical toxicology workshop was conducted as a pre-conference workshop of the Annual Emergency Medicine Conference at the Aga Khan University Hospital, Karachi, in April 2012. The course was composed of poisoning-related common clinical scenarios. The pre-test and post-test understanding was used to assess the impact of the course in improving knowledge. The participants also evaluated the workshop as a whole thorough written evaluation forms. SPSS 19 was used for statistical analysis of the data. Result: There were 22 participants in the course. The pre-test mean score was 31.6+-15.1% (95% CI; 24-40; n=19) compared to the post-test the mean score of 56.0+-10.8% (95% CI; 47- 61; n=17). The positive difference was also statistically significant (p<0.001). The overall workshop was evaluated as excellent by 08 (47.46%) and very good by 10 (52.63%) participants. Conclusion: Short training in clinical toxicology improved knowledge of the participants. (author)

  8. Prevalence and Clinical Characteristics of Probable REM Behavior Disorder in Thai Parkinson’s Disease Patients

    Directory of Open Access Journals (Sweden)

    Patama Gomutbutra

    2018-01-01

    Full Text Available Background. Previous studies have shown that Parkinson’s disease (PD patients who have REM behavior disorder (PD with RBD might be a PD subtype since they have different symptom clusters and disease trajectories from PD without RBD. Objective. To study the prevalence of PD with pRBD and to compare the clinical characteristics with PD without pRBD. The feasibility of clinical interview of items adopted from the Mayo Sleep Questionnaire was also to be determined. Methods. A total of 140 Parkinson's patients visiting neurological clinics during January to December 2016 were enrolled in this study. “Probable RBD (pRBD” was defined as present when the patient answered “yes” to a question adapted from the first Mayo Sleep Questionnaire (MSQ. The demographic data, motor symptoms, and nonmotor symptoms were obtained. Results. The prevalence of pRBD among this study’s PD patients was 48.5% (68 out of the total of 140. The median onset of RBD before PD diagnosis was 5 years (range: 0–11 years. By comparison of PD with pRBD and PD without pRBD, this study showed significant difference in the levodopa equivalent dose (742 mg/day versus 566 mg/day; p<0.01, prevalence of symptomatic orthostatic hypotension (35.3% versus 8.3%; p<0.01. The multivariable analysis found that pRBD is independently associated with orthostatic hypotension (OR = 5.02, p<0.01. Conclusion. The findings regarding prevalence and main clinical features of PD with pRBD in this study were similar to those of a previous study of PD with polysomnogram- (PSG- proven RBD. This study hypothesized that interviewing by adopted MSQ may be a cost-effective tool for screening RBD. Further studies with direct comparison are needed.

  9. Pre-test calculations for FAL-19 and FAL-20 using the ITHACA code

    International Nuclear Information System (INIS)

    Bradley, S.J.; Ketchell, N.

    1992-08-01

    Falcon is a small scale experimental apparatus, designed to simulate the transport of fission products through the primary circuit and containment of a nuclear power reactor under severe accident conditions. Information gained from the experiments in Falcon will be used to guide and assist in understanding the much larger Phebus-FP experiments. This report presents the results of pre-test calculations performed using ITHACA for the two tests: FAL-19 and FAL-20. Initial calculations were concerned solely with the thermal-hydraulic conditions in the containment while later ones briefly investigated the effect of the injection of an insoluble aerosol into the containment with the same thermal-hydraulic conditions. (author)

  10. NESC-1 spinning cylinder experiment. Pre-test fracture analysis evaluation

    International Nuclear Information System (INIS)

    Moinereau, D.; Pitard-Bouet, J.M.

    1996-10-01

    A pre-test structural analysis evaluation has been conducted by Electricite de France (EDF) including several three dimensional elastic and elastic-plastic computations. Two cylinder geometries have been studied. Higher values of the stress intensity factor are obtained in both geometries in the elastic-plastic computations due to the yielding of the cladding during the thermal transient. The comparisons between the stress intensity factors and the expected base metal toughness show that cleavage initiation must occur preferably in base metal near the interface with cladding. The comparison between both geometries show also that the thicker vessel with a deeper semi-elliptical sub-clad flaw (70 mm deep) is more favourable to cleavage initiation near the base metal - cladding interface. (K.A.)

  11. Use of a web portal by adult patients with pre-diabetes and type 2 diabetes mellitus seen in a family medicine outpatient clinic.

    Science.gov (United States)

    Coughlin, Steven S; Heboyan, Vahé; Young, Lufei; De Leo, Gianluca; Wilkins, Thad

    2018-05-01

    There has been increasing interest in the use of web portals by patients with type 2 diabetes mellitus (T2DM). Studies of web portal use by patients with pre-diabetes have not been reported. To plan studies of web portal use by adult clinic patients seen for pre-diabetes and T2DM at an academic medical center, we examined characteristics of those who had or had not registered for a web portal. Electronic records were reviewed to identify web portal registration by patients treated for pre-diabetes or T2DM by age, sex, race and ethnicity. A total of 866 patients with pre-diabetes and 2,376 patients with T2DM were seen in a family medicine outpatient clinic. About 41.5% of patients with pre-diabetes and 34.7% of those with T2DM had registered for the web portal. In logistic regression analysis, web portal registration among patients with T2DM was significantly associated with age 41-45 years, and with Hispanic ethnicity. Similar results were obtained for pre-diabetes except that the positive association with age 41-45 years and inverse association with Hispanic ethnicity were not statistically significant. Among patients with pre-diabetes or T2DM, Black men and Black women were less likely to have registered than their white counterparts. Patients who were aged 18-25 and >65 years were less likely to have registered for the web portal than those 26-65 years. Additional research is needed to identify portal design features that improve health outcomes for patients with pre-diabetes and T2DM and interventions that will increase use of patient portals by pre-diabetic and diabetic patients, especially among Black patients and older patients.

  12. Pre-Clinical Testing of New Hydroxybutyrate Analogues

    Science.gov (United States)

    2012-07-01

    will be assessed. Mac- 1 and GFAP immunostaining will be done to gauge inflammation as it relates to HDAC activity. Tyrosine hydroxylase and Nissl ... stained neurons will be counted and complex II histochemistry will be performed. Part II, we will prepare a new set of implanted mice treated with

  13. Test-retest reliability of the Middlesex Assessment of Mental State (MEAMS): a preliminary investigation in people with probable dementia.

    Science.gov (United States)

    Powell, T; Brooker, D J; Papadopolous, A

    1993-05-01

    Relative and absolute test-retest reliability of the MEAMS was examined in 12 subjects with probable dementia and 12 matched controls. Relative reliability was good. Measures of absolute reliability showed scores changing by up to 3 points over an interval of a week. A version effect was found to be in evidence.

  14. Using mobile clinics to deliver HIV testing and other basic health services in rural Malawi.

    Science.gov (United States)

    Lindgren, T G; Deutsch, K; Schell, E; Bvumbwe, A; Hart, K B; Laviwa, J; Rankin, S H

    2011-01-01

    The majority of Malawians are impoverished and primarily dependant on subsistence farming, with 85% of the population living in a rural area. The country is highly affected by HIV and under-resourced rural health centers struggle to meet the government's goal of expanding HIV testing, antiretroviral treatment, and other basic services. This report describes the work of two four-wheel drive mobile clinics launched in 2008 to fill an identified service gap in the remote areas of Mulanje District, Malawi. The program was developed by an international non-governmental organization, Global AIDS Interfaith Alliance (GAIA), and the Mulanje District Health Office, with funding from the Elizabeth Taylor HIV/AIDS Foundation. The clinics provide: (1) rapid HIV testing and treatment referral; (2) diagnosis and treatment of malaria; (3) sputum collection for TB screening; (4) diagnosis and treatment of sexually transmitted and opportunistic infections; and (5) pre-natal care. The clinic vehicles provide medical supplies and personnel (a clinical officer, nurse, and nurse aide) to set up clinics in community buildings such as churches or schools. In such a project, the implementation process and schedule can be affected by medication, supply chain and infrastructural issues, as well as governmental and non-governmental requirements. Timelines should be sufficiently flexible to accommodate unexpected delays. Once established, service scheduling should be flexible and responsive; for instance, malaria treatment rather than HIV testing was most urgently needed in the season when these services were launched. Assessing the impact of healthcare delivery in Malawi is challenging. Although mobile clinic and the government Health Management Information System (HMIS) data were matched, inconsistent variables and gaps in data made direct comparisons difficult. Data collection was compromised by the competing demand of high patient volume; however, rather than reducing the burden on

  15. Information, motivation, and behavioral skills for early pre-ART engagement in HIV care among patients entering clinical care in KwaZulu-Natal, South Africa.

    Science.gov (United States)

    Smith, Laramie R; Amico, K Rivet; Shuper, Paul A; Christie, Sarah; Fisher, William A; Cornman, Deborah H; Doshi, Monika; MacDonald, Susan; Pillay, Sandy; Fisher, Jeffrey D

    2013-01-01

    Little is known regarding factors implicated in early engagement and retention in HIV care among individuals not yet eligible for antiretroviral therapy (pre-ART) in sub-Saharan Africa. Identifying such factors is critical for supporting retention in pre-ART clinical care to ensure timely ART initiation and optimize long-term health outcomes. We assessed patients' pre-ART HIV care-related information, motivation, and behavioral skills among newly diagnosed ART-ineligible patients, initiating care in KwaZulu-Natal, South Africa. The survey was interviewer-administered to eligible patients, who were aged 18 years or older, newly entering care (diagnosed within the last six-months), and ineligible for ART (CD4 count > 200 cells/mm(3)) in one of four primary care clinical sites. Self-reported information, motivation, and behavioral skills specific to retention in pre-ART HIV-care were characterized by categorizing responses into those reflecting potential strengths and those reflective of potential deficits. Information, motivation, and behavioral skills deficits sufficiently prevalent in the overall sample (i.e.,≥30% prevalent) were identified as areas in need of specific attention through intervention efforts adapted to the clinic level. Gender-based differences were also evaluated. A total of 288 patients (75% female) completed structured interviews. Across the sample, eight information, eight motivation, and eight behavioral skills deficit areas were identified as sufficiently prevalent to warrant specific targeted attention. Gender differences did not emerge. The deficits in pre-ART HIV care-related information, motivation, and behavioral skills that were identified suggest that efforts to improve accurate information on immune function and HIV disease are needed, as is accurate information regarding HIV treatment and transmission risk prior to ART initiation. Additional efforts to facilitate the development of social support, including positive interactions

  16. [Static posturography versus clinical tests in elderly people with vestibular pathology].

    Science.gov (United States)

    Ortuño-Cortés, Miguel A; Martín-Sanz, Eduardo; Barona-de Guzmán, Rafael

    2008-01-01

    Balance can be quantified by clinical tests and through instrumental studies. The objective of this paper is to determine the correlation between static posturography and 4 clinical tests of balance in elderly people with vestibular disorders and to identify its capability to discriminate the groups studied. 60 patients with vestibular disorders and 60 healthy subjects performed 4 clinical tests (one leg standing with opened eyes, Timed Up and Go, Tinetti and Berg tests) and a static posturography analysis (NedSVE/IBV system) under 4 conditions: Romberg Test, Eyes Open (REO), Romberg Test, Eyes Closed (REC), Romberg Test on Foam with Eyes Open (RFEO), and Romberg Test on Foam with Eyes Closed (RFEC). RFEO correlated best with the clinical tests and RFEC was the worst. RFEO distinguished between healthy individuals and decompensated patients. RFEO gave the best information about postural balance in the elderly. RFEC was not useful. Static posturography can be useful to distinguish vestibular compensation status.

  17. Influence of Pre-question and genre-based instructional strategies on reading

    Directory of Open Access Journals (Sweden)

    Titi J. Fola-Adebayo

    2014-12-01

    Full Text Available This study investigated the influence of Pre-question and genre-based instructional strategies on science undergraduates’ achievement in, and attitude to, reading. Using purposive sampling,two specialised universities in Nigeria were selected and stratified sampling was employed in assigning students to research groups based on gender and performance in a verbal ability test. Two hundred and eighty-five students participated in the study. Pre-post randomised block experimental design was used with three experimental groups and one control group. The experimental procedure involving Pre-question, genre-based instruction and a combination of Pre-question and genre-based instructional strategies were used for the experimental groups for four weeks whilst the control group received normal teacher input. Data were collected through a Reading Comprehension Achievement Test and Students’ Attitude Questionnaire. Qualitative data, obtained from videotapes of classroom interactions, were subjected to conversation and interaction analyses and quantitative data were analysed with Analysis of Covariance (ANCOVA. The results indicate that although there was no significant main effect of instructional strategy on students’ achievement in reading comprehension, there was significant main effect of instructional strategy on students’ attitude to reading (F(3,231 = 30.9;p <.05. Findings from the qualitative enquiry revealed that female students were more voluble and assertive in their responses probably because of the need to resist male domination whilst male students used discourse strategies to affirm their authority. The study indicated that the combination of pre-question and genre-based approach was the most effective in enhancing the students’ attitude to reading. Reading is one of the most useful of the Language Arts skills which learners need for academic reasons and for lifelong learning. The globalised world demands that the second language

  18. Imprecise Probability Methods for Weapons UQ

    Energy Technology Data Exchange (ETDEWEB)

    Picard, Richard Roy [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Vander Wiel, Scott Alan [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-05-13

    Building on recent work in uncertainty quanti cation, we examine the use of imprecise probability methods to better characterize expert knowledge and to improve on misleading aspects of Bayesian analysis with informative prior distributions. Quantitative approaches to incorporate uncertainties in weapons certi cation are subject to rigorous external peer review, and in this regard, certain imprecise probability methods are well established in the literature and attractive. These methods are illustrated using experimental data from LANL detonator impact testing.

  19. Early pre-eclampsia unmasks underlying IgA nephropathy

    Directory of Open Access Journals (Sweden)

    Mona Singh

    2010-12-01

    Full Text Available Mona Singh, Akhenaton Pappoe, Burl R DonDivision of Nephrology, University of California Davis Medical Center, Sacramento, CA, USAAbstract: Pre-eclampsia is the most ominous complication of pregnancy, and primary glomerular diseases can mimic pre-eclampsia in presentation. A patient presented at 21 weeks gestation with signs and symptoms of both pre-eclampsia and primary glomerular nephropathy. A critical clinical decision whether to continue or terminate the pregnancy was dependent on results of a renal biopsy. The biopsy noted the presence of both pre-eclampsia and immunoglobulin A (IgA nephropathy. Thus, the onset of pre-eclampsia unmasked the presence of unrecognized IgA nephropathy, and the IgA nephropathy was a risk factor for this patient developing pre-eclampsia. The results of a renal biopsy are key in distinguishing pre-eclampsia from other kidney diseases and instituting appropriate clinical management.Keywords: proteinuria, IgA nephropathy, renal biopsy, pre-eclampsia

  20. The Stice model of overeating: Tests in clinical and non-clinical samples

    NARCIS (Netherlands)

    Strien, T. van; Engels, R.C.M.E.; Leeuwe, J.F.J. van; Snoek, H.M.

    2005-01-01

    The present study tested the dual pathway model of Stice [Stice, E (1994). A review of the evidence for a sociocultural model of bulimia nervosa and an exploration of the mechanisms of action. Clinical Psychology Review, 14, 633-661 and Stice, E. (2001). A prospective test of the dual-pathway model

  1. Dynamic Toughness Testing of Pre-Cracked Charpy V-Notch Specimens. Convention ELECTRABEL - SCK-CEN

    Energy Technology Data Exchange (ETDEWEB)

    Lucon, E

    1999-04-01

    This document describes the experimental and analytical procedures which have been adopted at the laboratories of the Belgian Nuclear Research Centre SCK-CEN for performing dynamic toughness tests on pre-cracked Charpy-V specimens. Such procedures were chosen on the basis of the existing literature on the subject, with several updates in the data analysis stages which reflect more recent developments in fracture toughness testing. Qualification tests have been carried out on PCCv specimens of JRQ steel, in order to assess the reliability of the results obtained; straightforward comparisons with reference data have been performed, as well as more advanced analyses using the Master Curve approach. Aspects related to machine compliance and dynamic tup calibration have also been addressed.

  2. Effectiveness of a computer-aided neuroanatomy program for entry-level physical therapy students: anatomy and clinical examination of the dorsal column-medial lemniscal system.

    Science.gov (United States)

    McKeough, D Michael; Mattern-Baxter, Katrin; Barakatt, Edward

    2010-01-01

    The purpose of this study was to determine if a computer-aided instruction learning module improves students' knowledge of the neuroanatomy/physiology and clinical examination of the dorsal column-medial lemniscal (DCML) system. Sixty-one physical therapy students enrolled in a clinical neurology course in entry-level PT educational programs at two universities participated in the study. Students from University-1 (U1;) had not had a previous neuroanatomy course, while students from University-2 (U2;) had taken a neuroanatomy course in the previous semester. Before and after working with the learning module, students took a paper-and-pencil test on the neuroanatomy/physiology and clinical examination of the DCML system. Kruskal-Wallis one-way ANOVA and Mann-Whitney tests were used to determine if differences existed between neuroanatomy/physiology examination scores and clinical examination scores before and after taking the learning module, and between student groups based on university attended. For students from U1, neuroanatomy/physiology post-test scores improved significantly over pre-test scores (p Neuroanatomy/physiology pre-test scores from U2 were significantly better than those from U1 (p < 0.001); there was no significant difference in post-test scores (p = 0.062). Clinical examination pre-test and post-test scores from U2 were significantly better than those from U1 (p < 0.001). Clinical examination post-test scores improved significantly from the pre-test scores for both U1 (p < 0.001) and U2 (p < 0.001).

  3. Bioluminescent imaging: a critical tool in pre-clinical oncology research.

    LENUS (Irish Health Repository)

    O'Neill, Karen

    2010-02-01

    Bioluminescent imaging (BLI) is a non-invasive imaging modality widely used in the field of pre-clinical oncology research. Imaging of small animal tumour models using BLI involves the generation of light by luciferase-expressing cells in the animal following administration of substrate. This light may be imaged using an external detector. The technique allows a variety of tumour-associated properties to be visualized dynamically in living models. The increasing use of BLI as a small-animal imaging modality has led to advances in the development of xenogeneic, orthotopic, and genetically engineered animal models expressing luciferase genes. This review aims to provide insight into the principles of BLI and its applications in cancer research. Many studies to assess tumour growth and development, as well as efficacy of candidate therapeutics, have been performed using BLI. More recently, advances have also been made using bioluminescent imaging in studies of protein-protein interactions, genetic screening, cell-cycle regulators, and spontaneous cancer development. Such novel studies highlight the versatility and potential of bioluminescent imaging in future oncological research.

  4. Prevalence and risk factors of pre-hypertension in Congolese pre ...

    African Journals Online (AJOL)

    viduals with pre-hypertension are at high risk of develop- ing clinical hypertension .... blood pressure (BP) was measured on the left arm from each subject with the ... In contrast, no statistically significant differences were found between the ...

  5. Learning style preferences: A study of pre-clinical medical students in Barbados

    Science.gov (United States)

    OJEH, NKEMCHO; SOBERS-GRANNUM, NATASHA; GAUR, UMA; UDUPA, ALAYA; MAJUMDER, MD.ANWARUL AZIM

    2017-01-01

    Introduction: Educators need to be aware of different learning styles to effectively tailor instructional strategies and methods to cater to the students’ learning needs and support a conductive learning environment. The VARK [an acronym for visual (V), aural (A), read/write (R) and kinesthetic (K)] instrument is a useful model to assess learning styles. The aim of this study was to use the VARK questionnaire to determine the learning styles of pre-clinical medical students in order to compare the perceived and assessed learning style preferences, assess gender differences in learning style preferences, and determine whether any relationships exists between awareness of learning styles and academic grades, age, gender and learning modality. Methods: The VARK questionnaire was administered to pre-clinical students taking a variety of courses in the first three years of the undergraduate MB BS degree programme at the Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados in 2014. Results: The majority of the students were multimodal learners with no differences observed between males (59.5%) and females (60.0%), with tetramodal being the most common. Read/write (33.8%) followed by kinesthetic (32.5%) were the most common learning style preferences. The sensory modality preference for females was read/write (34.2%) and for males it was kinesthetic (40.5%). Significant differences were observed between the perceived and assessed learning style preferences with a majority of visual and read/write learners correctly matching their perceived to their actual learning styles. Awareness of learning styles was associated with learning modality but not with academic performance, age or gender. Overall, 60.7% of high achievers used multimodal learning compared to 56.9% low achievers. Conclusion: The findings from this study indicated that the VARK tool was useful in gathering information about different learning styles, and might assist

  6. Learning style preferences: A study of pre-clinical medical students in Barbados.

    Science.gov (United States)

    Ojeh, Nkemcho; Sobers-Grannum, Natasha; Gaur, Uma; Udupa, Alaya; Majumder, Md Anwarul Azim

    2017-10-01

    Educators need to be aware of different learning styles to effectively tailor instructional strategies and methods to cater to the students' learning needs and support a conductive learning environment. The VARK [an acronym for visual (V), aural (A), read/write (R) and kinesthetic (K)] instrument is a useful model to assess learning styles. The aim of this study was to use the VARK questionnaire to determine the learning styles of pre-clinical medical students in order to compare the perceived and assessed learning style preferences, assess gender differences in learning style preferences, and determine whether any relationships exists between awareness of learning styles and academic grades, age, gender and learning modality. The VARK questionnaire was administered to pre-clinical students taking a variety of courses in the first three years of the undergraduate MB BS degree programme at the Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados in 2014. The majority of the students were multimodal learners with no differences observed between males (59.5%) and females (60.0%), with tetramodal being the most common. Read/write (33.8%) followed by kinesthetic (32.5%) were the most common learning style preferences. The sensory modality preference for females was read/write (34.2%) and for males it was kinesthetic (40.5%). Significant differences were observed between the perceived and assessed learning style preferences with a majority of visual and read/write learners correctly matching their perceived to their actual learning styles. Awareness of learning styles was associated with learning modality but not with academic performance, age or gender. Overall, 60.7% of high achievers used multimodal learning compared to 56.9% low achievers. The findings from this study indicated that the VARK tool was useful in gathering information about different learning styles, and might assist educators in designing blended teaching

  7. DECOFF Probabilities of Failed Operations

    DEFF Research Database (Denmark)

    Gintautas, Tomas

    2015-01-01

    A statistical procedure of estimation of Probabilities of Failed Operations is described and exemplified using ECMWF weather forecasts and SIMO output from Rotor Lift test case models. Also safety factor influence is investigated. DECOFF statistical method is benchmarked against standard Alpha-factor...

  8. Serodiagnosis of dengue infection using rapid immuno chromatography test in patients with probable dengue infection

    International Nuclear Information System (INIS)

    Kidwai, A.A.; Jamal, Q.; Mehrunnisa, S.; Farooqi, F.R.

    2010-01-01

    Objective: To determine the frequency of seropositive dengue infection using rapid immuno chromatographic assay in patients with probable dengue infection as per WHO criteria. Method: A cross-sectional observational study was conducted at Abbasi Shaheed Hospital, Karachi from July 2008 to January 2009. Patients presenting with acute febrile illness, rashes, bleeding tendencies, leucopenia and or thrombocytopenia were evaluated according to WHO criteria for probable dengue infection. Acute phase sera were collected after 5 days of the onset of fever as per WHO criteria. Serology was performed using rapid immuno chromatographic (ICT) assay with differential detection of IgM and IgG. A primary dengue infection was defined by a positive IgM band and a negative IgG band whereas secondary infection was defined by a positive IgG band with or without positive IgM band. Result: Among 599 patients who met the WHO criteria for dengue infection, 251(41.9%) were found to be ICT reactive among whom 42 (16.73%) had primary infection. Secondary infection was reported in 209 (83.26%). Acute phase sera of 348 (58.09%) were ICT non reactive. Four patients died because of dengue shock syndrome among which three had secondary infection. Conclusion: Early identification of secondary infection in acute phase sera using rapid ICT is valuable in terms of disease progression and mortality. However in highly suspected cases of dengue infection clinical management should not rely on negative serological results. (author)

  9. Pre-operative evaluation for thorax surgery

    International Nuclear Information System (INIS)

    Silva Luis, Saenz; Morales, Oscar Alberto

    2002-01-01

    A pre-operative analysis of the function of the breathing system is made in the patient that will be taken to thorax surgery. The paper includes risk factors, pre-operative clinical evaluation and of breathing and cardiovascular system

  10. Perceived Benefits of Pre-Clinical Simulation-based Training on Clinical Learning Outcomes among Omani Undergraduate Nursing Students

    Directory of Open Access Journals (Sweden)

    Girija Madhavanprabhakaran

    2015-01-01

    Full Text Available Objectives: This study aimed to explore the benefits perceived by Omani undergraduate maternity nursing students regarding the effect of pre-clinical simulation-based training (PSBT on clinical learning outcomes. Methods: This non-experimental quantitative survey was conducted between August and December 2012 among third-year baccalaureate nursing students at Sultan Qaboos University in Muscat, Oman. Voluntary participants were exposed to faculty-guided PSBT sessions using low- and medium-fidelity manikins, standardised scenarios and skill checklists on antenatal, intranatal, postnatal and newborn care and assessment. Participants answered a purposely designed self-administered questionnaire on the benefits of PSBT in enhancing learning outcomes. Items were categorised into six subscales: knowledge, skills, patient safety, academic safety, confidence and satisfaction. Scores were rated on a four-point Likert scale. Results: Of the 57 participants, the majority (95.2% agreed that PSBT enhanced their knowledge. Most students (94.3% felt that their patient safety practices improved and 86.5% rated PSBT as beneficial for enhancing skill competencies. All male students and 97% of the female students agreed that PSBT enhanced their confidence in the safe holding of newborns. Moreover, 93% of participants were satisfied with PSBT. Conclusion: Omani undergraduate nursing students perceived that PSBT enhanced their knowledge, skills, patient safety practices and confidence levels in providing maternity care. These findings support the use of simulation training as a strategy to facilitate clinical learning outcomes in future nursing courses in Oman, although further research is needed to explore the objective impact of PSBT on learning outcomes.

  11. Prognostic significance of electrophysiological tests for facial nerve outcome in vestibular schwannoma surgery.

    Science.gov (United States)

    van Dinther, J J S; Van Rompaey, V; Somers, T; Zarowski, A; Offeciers, F E

    2011-01-01

    To assess the prognostic significance of pre-operative electrophysiological tests for facial nerve outcome in vestibular schwannoma surgery. Retrospective study design in a tertiary referral neurology unit. We studied a total of 123 patients with unilateral vestibular schwannoma who underwent microsurgical removal of the lesion. Nine patients were excluded because they had clinically abnormal pre-operative facial function. Pre-operative electrophysiological facial nerve function testing (EPhT) was performed. Short-term (1 month) and long-term (1 year) post-operative clinical facial nerve function were assessed. When pre-operative facial nerve function, evaluated by EPhT, was normal, the outcome from clinical follow-up at 1-month post-operatively was excellent in 78% (i.e. HB I-II) of patients, moderate in 11% (i.e. HB III-IV), and bad in 11% (i.e. HB V-VI). After 1 year, 86% had excellent outcomes, 13% had moderate outcomes, and 1% had bad outcomes. Of all patients with normal clinical facial nerve function, 22% had an abnormal EPhT result and 78% had a normal result. No statistically significant differences could be observed in short-term and long-term post-operative facial function between the groups. In this study, electrophysiological tests were not able to predict facial nerve outcome after vestibular schwannoma surgery. Tumour size remains the best pre-operative prognostic indicator of facial nerve function outcome, i.e. a better outcome in smaller lesions.

  12. [The Amsterdam Dementia Screening Test in cognitively healthy and clinical samples. An update of normative data].

    Science.gov (United States)

    van Toutert, Meta; Diesfeldt, Han; Hoek, Dirk

    2016-10-01

    The six tests in the Amsterdam Dementia Screening Test (ADST) examine the cognitive domains of episodic memory (delayed picture recognition, word learning), orientation, category fluency (animals and occupations), constructional ability (figure copying) and executive function (alternating sequences). New normative data were collected in a sample of 102 elderly volunteers (aged 65-94), including subjects with medical or other health conditions, except dementia or frank cognitive impairment (MMSE > 24). Included subjects were independent in complex instrumental activities of daily living.Fluency, not the other tests, needed adjustment for age and education. A deficit score (0-1) was computed for each test. Summation (range 0-6) proved useful in differentiating patients with dementia (N = 741) from normal elderly (N = 102).Positive and negative predictive power across a range of summed deficit scores and base rates are displayed in Bayesian probability tables.In the normal elderly, delayed recall for eight words was tested and adjusted for initial recall. A recognition test mixed the target words with eight distractors. Delayed recognition was adjusted for immediate and delayed recall.The ADST and the normative data in this paper help the clinical neuropsychologist to make decisions concerning the presence or absence of neurocognitive disorder in individual elderly examinees.

  13. 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.

  14. Probability and statistics with integrated software routines

    CERN Document Server

    Deep, Ronald

    2005-01-01

    Probability & Statistics with Integrated Software Routines is a calculus-based treatment of probability concurrent with and integrated with statistics through interactive, tailored software applications designed to enhance the phenomena of probability and statistics. The software programs make the book unique.The book comes with a CD containing the interactive software leading to the Statistical Genie. The student can issue commands repeatedly while making parameter changes to observe the effects. Computer programming is an excellent skill for problem solvers, involving design, prototyping, data gathering, testing, redesign, validating, etc, all wrapped up in the scientific method.See also: CD to accompany Probability and Stats with Integrated Software Routines (0123694698)* Incorporates more than 1,000 engaging problems with answers* Includes more than 300 solved examples* Uses varied problem solving methods

  15. Scaling Qualitative Probability

    OpenAIRE

    Burgin, Mark

    2017-01-01

    There are different approaches to qualitative probability, which includes subjective probability. We developed a representation of qualitative probability based on relational systems, which allows modeling uncertainty by probability structures and is more coherent than existing approaches. This setting makes it possible proving that any comparative probability is induced by some probability structure (Theorem 2.1), that classical probability is a probability structure (Theorem 2.2) and that i...

  16. Unemployment in Iraqi Refugees: The Interaction of Pre and Post-Displacement Trauma

    Science.gov (United States)

    Wright, A. Michelle; Dhalimi, Abir; Lumley, Mark A.; Jamil, Hikmet; Pole, Nnamdi; Arnetz, Judith E.; Arnetz, Bengt B.

    2016-01-01

    Previous refugee research has been unable to link pre-displacement trauma with unemployment in the host country. The current study assessed the role of pre-displacement trauma, post-displacement trauma, and the interaction of both trauma types to prospectively examine unemployment in a random sample of newly-arrived Iraqi refugees. Participants (N=286) were interviewed three times over the first two years post-arrival. Refugees were assessed for pre-displacement trauma exposure, post-displacement trauma exposure, a history of unemployment in the country of origin and host country, and symptoms of posttraumatic stress disorder (PTSD) and depression. Analyses found that neither pre-displacement nor post-displacement trauma independently predicted unemployment 2 years post-arrival; however, the interaction of pre and post-displacement trauma predicted 2-year unemployment. Refugees with high levels of both pre and post-displacement trauma had a 91% predicted probability of unemployment, whereas those with low levels of both traumas had a 20% predicted probability. This interaction remained significant after controlling for sociodemographic variables and mental health upon arrival to the U.S. Resettlement agencies and community organizations should consider the interactive effect of encountering additional trauma after escaping the hardships of the refugee's country of origin. PMID:27535348

  17. Effect of clinic experience on pre-service professionals perceptions of applied special needs services. DOI: 10.5007/1980-0037.2011v13n2p145

    Directory of Open Access Journals (Sweden)

    Chris Carpenter

    2011-02-01

    Full Text Available With the understanding that the attitudes and expectations a teacher carries into the classroom directly affect student achievement, this study was administered to evaluate the cognitive affect that clinical experience incorporating individuals with disabilities had on pre-service exercise science professionals. University Students with and without experience in an adapted clinical environment were given surveys covering attitudes and perceptions towards classroom atmosphere, teachers’ instructional techniques, inclusion, and self-efficacy. Data were analyzed and used to determine pedagogical implications. Findings suggest that pre-service educators tend to feel unprepared and ill-equipped to work in an inclusive educational environment. Therefore, pre-service teacher programs should ideally include coursework in adaptive education and experiential components such as practicum, field experience, and clinical experience. In addition, a school-university collaborative relationship can facilitate beneficial outcomes to future educators as well as special needs populations.

  18. Effect of clinic experience on pre-service professionals perceptions of applied special needs services. DOI: 10.5007/1980-0037.2011v13n2p145

    Directory of Open Access Journals (Sweden)

    Chris Carpenter

    2011-03-01

    Full Text Available With the understanding that the attitudes and expectations a teacher carries into the classroom directly affect student achievement, this study was administered to evaluate the cognitive affect that clinical experience incorporating individuals with disabilities had on pre-service exercise science professionals. University Students with and without experience in an adapted clinical environment were given surveys covering attitudes and perceptions towards classroom atmosphere, teachers’ instructional techniques, inclusion, and self-efficacy. Data were analyzed and used to determine pedagogical implications. Findings suggest that pre-service educators tend to feel unprepared and ill-equipped to work in an inclusive educational environment. Therefore, pre-service teacher programs should ideally include coursework in adaptive education and experiential components such as practicum, field experience, and clinical experience. In addition, a school-university collaborative relationship can facilitate beneficial outcomes to future educators as well as special needs populations.

  19. Potential clinical impact of normal-tissue intrinsic radiosensitivity testing

    International Nuclear Information System (INIS)

    Bentzen, Soeren M.

    1997-01-01

    A critical appraisal is given of the possible benefit from a reliable pre-treatment knowledge of individual normal-tissue sensitivity to radiotherapy. The considerations are in part, but not exclusively, based on the recent experience with in vitro colony-forming assays of the surviving fraction at 2 Gy, the SF 2 . Three strategies are reviewed: (1) to screen for rare cases with extreme radiosensitivity, so-called over-reactors, and treat these with reduced total dose, (2) to identify the sensitive tail of the distribution of 'normal' radiosensitivities, refer these patients to other treatment, and to escalate the dose to the remaining patients, or (3) to individualize dose prescriptions based on individual radiosensitivity, i.e. treating to isoeffect rather than to a specific dose-fractionation schedule. It is shown that these strategies will have a small, if any, impact on routine radiotherapy. Screening for over-reactors is hampered by the low prevalence of these among otherwise un-selected patients that leads to a low positive predictive value of in vitro radiosensitivity assays. It is argued, that this problem may persist even if the noise on current assays could be reduced to (the unrealistic value of) zero, simply because of the large biological variation in SF 2 . Removing the sensitive tail of the patient population, will only have a minor effect on the dose that could be delivered to the remaining patients, because of the sigmoid shape of empirical dose-response relationships. Finally, individualizing dose prescriptions based exclusively on information from a normal-tissue radiosensitivity assay, leads to a nearly symmetrical distribution of dose-changes that would produce a very small gain, or even a loss, of tumor control probability if implemented in the clinic. From a theoretical point of view, other strategies could be devised and some of these are considered in this review. Right now the most promising clinical use of in vitro radiosensitivity

  20. A new framework for the interpretation of IgE sensitization tests

    DEFF Research Database (Denmark)

    Roberts, G; Ollert, M; Aalberse, R.

    2016-01-01

    tests to make a definitive diagnosis; these are often expensive and potentially associated with severe reactions. The likelihood of clinical allergy can be semi-quantified from an IgE sensitization test results. This relationship varies though according to the patients' age, ethnicity, nature...... of the putative allergic reaction and coexisting clinical diseases such as eczema. The likelihood of clinical allergy can be more precisely estimated from an IgE sensitization test result, by taking into account the patient's presenting features (pretest probability). The presence of each of these patient...... pretest probabilities for diverse setting, regions and allergens. Also, cofactors, such as exercise, may be necessary for exposure to an allergen to result in an allergic reaction in specific IgE-positive patients. The diagnosis of IgE-mediated allergy is now being aided by the introduction of allergen...

  1. Association of obesity and overweight with the prevalence of insulin resistance, pre-diabetes and clinical-biochemical characteristics among infertile Mexican women with polycystic ovary syndrome: a cross-sectional study.

    Science.gov (United States)

    Reyes-Muñoz, Enrique; Ortega-González, Carlos; Martínez-Cruz, Nayeli; Arce-Sánchez, Lidia; Estrada-Gutierrez, Guadalupe; Moran, Carlos; Sánchez-Serrano, Ana Paola; Higareda-Sánchez, Rodolfo; de la Jara-Díaz, Julio Francisco

    2016-07-22

    To study the association of obesity and overweight with the prevalence of insulin resistance (IR), pre-diabetes and clinical-biochemical characteristics among infertile Mexican women with polycystic ovary syndrome (PCOS). Retrospective cross-sectional study. Level-three medical institution, an infertility clinic in Mexico City. We included infertile Mexican women with diagnosis of PCOS according to the Rotterdam criteria: group 1 (n=83), normal weight (body mass index (BMI) 18.5-24.9 kg/m(2)); group 2 (n=217), overweight (BMI 25-29.9 kg/m(2)); and group 3 (n=238), obese (BMI≥30 kg/m(2)). IR was determined by homeostatic model assessment (HOMA) >2.5 and pre-diabetes by fasting glucose between 5.6 and 6.9 mmol/L and/or glucose value between 7.8 and 11 mmol/L at 2 hours during an oral glucose tolerance test. We compared clinical-biochemical characteristics among groups. Prevalence of IR for groups 1, 2 and 3 was 19.3%, 56.2% and 78.2%; overweight and obesity increase the IR OR (CI 95%) to 5.3 (2.9 to 9.8) and 14.9 (8.0 to 28), respectively. Prevalence of pre-diabetes for groups 1, 2 and 3 was 7.2%, 17.5% and 31.5%; overweight and obesity increase the pre-diabetes OR (CI 95%) to 2.7 (1.1 to 6.7) and 5.9 (2.4 to 14), respectively. Acanthosis nigricans was more frequent in group 3 than group 1. Free Androgen Index (FAI) and thyroid-stimulating hormone (TSH) levels were lower in group 1 than in groups 2 and 3. Progesterone and sex hormone-binding globulin (SHBG) levels were higher in group 1 than in groups 2 and 3. Dehydroepiandrosterone sulfate (DHEA-S) was higher in group 1 than group 3. Obese and overweight infertile Mexican women with PCOS, attending to an infertility clinic, have a higher prevalence of IR and pre-diabetes compared with normal-weight women with PCOS. Therapeutic interventions should include those that improved metabolic functioning prior to attempting pregnancy in these groups of women. Published by the BMJ Publishing Group Limited. For

  2. Silane pre-treatments on copper and aluminium

    International Nuclear Information System (INIS)

    Deflorian, F.; Rossi, S.; Fedrizzi, L.

    2006-01-01

    A large part of aluminium products are coated with an organic layer in order to improve the corrosion resistance. Copper surfaces are also sometimes protected with an organic coating to improve the durability or the aesthetic properties. Examples of industrial applications are household appliances and heat exchanger components. For these applications it is not rare to have the industrial need to treat at the same time components made of aluminium and copper. In order to extend the service life of the organic coated copper a specific surface pre-treatment is often required. Nevertheless, probably because of the limited market of this application, no specific pre-treatments for copper are industrially developed, with the exception of cleaning procedures, but simply extensions of existing pre-treatments optimised for other metals (aluminium, zinc) are used. The application of silane pre-treatments as adhesion promoters for organic coated metals is remarkably increasing in the last decade, because silanes offer very good performance together with high environmental compatibility. The idea is therefore to try to develop a specific silane based pre-treatment for copper. The starting point is the existing silane products for aluminium, optimising the composition and the application conditions (concentration, temperature, pH of the bath, etc.) in order to develop a high performance copper alloy pre-treatment increasing the protective properties and the adhesion of a successively applied organic coating. Moreover these pre-treatments could be used for aluminium alloys too and therefore could be suggested for multi-metals components. The deposits were analysed using FTIR spectroscopy and optical and electron microscopic observations. A careful electrochemical characterisation, mainly by electrochemical impedance spectroscopy measurements (EIS) was carried out to highlight the presence of silane and to evaluate the performance of the different deposits. In order to study an

  3. Learners’ perspective: where and when pre-residency trainees learn more to achieve their core clinical competencies

    Directory of Open Access Journals (Sweden)

    Eusang Ahn

    2016-12-01

    Full Text Available Purpose While it is known that effective clinical education requires active involvement of its participants, regular feedback, communication skills and interprofessional training, limited studies have been conducted in Korea that demonstrate how pre-residency trainees acquire their core clinical skills. This is a cross-sectional study of interns and students across a third-tier university hospital in Korea to examine where and when they acquire core clinical skills. Methods A total of 74 students and 91 interns were asked to participate in a closed-ended questionnaire, and 50 participants (20 students and 30 interns were involved in semistructured individual interviews. The questionnaire was based on the Accreditation Council for Graduate Medical Education core competencies. Results The majority of core clinical skills were acquired during their rotations in emergency medicine, general surgery, and cardiothoracic surgery. The semistructured interviews revealed that these departments required their trainees to be highly involved and analytical, and participate in clinical discourse. Conclusion The common factor among the three departments is an environment in which trainees are highly involved in clinical duties, and are expected to make first-contact patient encounters, participate in clinical discourse, interpret investigative results and arrive at their own conclusions. Work-based learning appear to be key to the trends observed, and further study is warranted to determine whether these findings are indicative of true acquisition of clinical competence.

  4. Learners' perspective: where and when pre-residency trainees learn more to achieve their core clinical competencies.

    Science.gov (United States)

    Ahn, Eusang; Ahn, Ducksun; Lee, Young-Mee

    2016-12-01

    While it is known that effective clinical education requires active involvement of its participants, regular feedback, communication skills and interprofessional training, limited studies have been conducted in Korea that demonstrate how pre-residency trainees acquire their core clinical skills. This is a cross-sectional study of interns and students across a third-tier university hospital in Korea to examine where and when they acquire core clinical skills. A total of 74 students and 91 interns were asked to participate in a closed-ended questionnaire, and 50 participants (20 students and 30 interns) were involved in semistructured individual interviews. The questionnaire was based on the Accreditation Council for Graduate Medical Education core competencies. The majority of core clinical skills were acquired during their rotations in emergency medicine, general surgery, and cardiothoracic surgery. The semistructured interviews revealed that these departments required their trainees to be highly involved and analytical, and participate in clinical discourse. The common factor among the three departments is an environment in which trainees are highly involved in clinical duties, and are expected to make first-contact patient encounters, participate in clinical discourse, interpret investigative results and arrive at their own conclusions. Work-based learning appear to be key to the trends observed, and further study is warranted to determine whether these findings are indicative of true acquisition of clinical competence.

  5. Risk factors associated with short-term post-treatment outcomes of clinical mastitis.

    Science.gov (United States)

    Pinzón-Sánchez, C; Ruegg, P L

    2011-07-01

    The objectives of this study were to characterize 60-d outcomes after treatment of mild (abnormal milk) and moderate (abnormal milk and abnormal udder) cases of clinical mastitis (CM) occurring in a single quarter of cows on Wisconsin farms (n=4) and to determine risk factors associated with those outcomes. Duplicate milk samples were collected from the affected quarter of each cow for microbiological analysis at the onset of CM (PRE) and 21 d later (POST). Cows were treated only in the affected quarter using an intramammary product containing 125 mg of ceftiofur. Bacteriological cure was defined as absence of pathogens in the POST sample obtained from the enrolled quarter. Recurrence was defined for the cow when CM occurred after the milk-withholding period for the enrolled case of CM. Retention in the herd was defined when a cow was retained within the herd for the 60-d follow-up period. Somatic cell count reduction (SCCR) was defined at the cow level as somatic cell count (SCC) below 200,000 cells/mL at the Dairy Herd Improvement Association test day occurring between 21 to 55 d post-treatment. The effects of farm, days in milk, parity, severity, microbiological diagnosis at PRE, previous milk yield, previous SCC, previous occurrence of CM and treatment duration on selected post-treatment outcomes were assessed using Chi-squared analysis and logistic regression. Microbiological results at PRE were distributed as: Escherichia coli (n=14), Klebsiella spp. (n=11), Enterobacter spp. (n=8), Serratia spp. (n=7), other gram-negative species (n=3), Streptococcus spp. (n=25), coagulase-negative staphylococci (n=4); Staphylococcus aureus (n=1); Streptococcus agalactiae (n=1), other gram-positive species (n=9), and culture negative (n=60). Treated quarters were more likely to experience bacteriological cure when the cow experienced CM for the first time in the lactation and when no pathogen was recovered from PRE milk samples obtained from the enrolled quarter. Parity and

  6. Pre-operative irradiation with rectal carcinoma - clinical practices and results

    International Nuclear Information System (INIS)

    Rendl, H.

    1986-01-01

    The goal of this work is to portray the effect of a high-dosed short-timed pre-irradiation on intra- and post-operative therapy of rectal carcinoma and the appearance of recidivistic tumors, respectively distant metastasis. This intermediate balance should help make the decision easier as to whether to continue to use this combined treatment form. The subjects consisted of 65 rectal carcinoma patients - pre-irradiated and operated - and 95 only operated patients. The irradiation was completed using a 8 MeV linear accelerator with ultra hard x-radiation. Dosing - (more than 80%) as short-timed irradiation with 16 Gy (4 x 4 Gy in 2 days) - 25 Gy (10 x 2,5 Gy in 12 days); average field size 150 mm x 150 mm. There were no significant differences with regard to intra- and post-operative complications, late complications or distant metastasis, but there was with tumor recidivision reduced with pre-irradiated. Regarding the survival rate, there was a slight tendency in favor of the pre-irradiated. (orig./MG) [de

  7. Pre-service proof pressure and leak rate tests for the Qinshan CANDU project reactor buildings

    International Nuclear Information System (INIS)

    Petrunik, K.J.; Khan, A.; Ricciuti, R.; Ivanov, A.; Chen, S.

    2003-01-01

    The Qinshan CANDU Project Reactor Buildings (Units 1 and 2) have been successfully tested for the Pre-Service Proof Pressure and Integrated Leak Rate Tests. The Unit 1 tests took place from May 3 to May 9, 2002 and from May 22 to May 25, 2002, and the Unit 2 tests took place from January 21 to January 27, 2003. This paper discusses the significant steps taken at minimum cost on the Qinshan CANDU Project, which has resulted in a) very good leak rate (0.21%) for Unit 1 and excellent leak rate (0.130%) for Unit 2; b) continuous monitoring of the structural behaviour during the Proof Pressure Test, thus eliminating any repeat of the structural test due to lack of data; and c) significant schedule reduction achieved for these tests in Unit 2. (author)

  8. Influence of dose distribution homogeneity on the tumor control probability in heavy-ion radiotherapy

    International Nuclear Information System (INIS)

    Wen Xiaoqiong; Li Qiang; Zhou Guangming; Li Wenjian; Wei Zengquan

    2001-01-01

    In order to estimate the influence of the un-uniform dose distribution on the clinical treatment result, the Influence of dose distribution homogeneity on the tumor control probability was investigated. Basing on the formula deduced previously for survival fraction of cells irradiated by the un-uniform heavy-ion irradiation field and the theory of tumor control probability, the tumor control probability was calculated for a tumor mode exposed to different dose distribution homogeneity. The results show that the tumor control probability responding to the same total dose will decrease if the dose distribution homogeneity gets worse. In clinical treatment, the dose distribution homogeneity should be better than 95%

  9. Most probable mixing state of aerosols in Delhi NCR, northern India

    Science.gov (United States)

    Srivastava, Parul; Dey, Sagnik; Srivastava, Atul Kumar; Singh, Sachchidanand; Tiwari, Suresh

    2018-02-01

    Unknown mixing state is one of the major sources of uncertainty in estimating aerosol direct radiative forcing (DRF). Aerosol DRF in India is usually reported for external mixing and any deviation from this would lead to high bias and error. Limited information on aerosol composition hinders in resolving this issue in India. Here we use two years of aerosol chemical composition data measured at megacity Delhi to examine the most probable aerosol mixing state by comparing the simulated clear-sky downward surface flux with the measured flux. We consider external, internal, and four combinations of core-shell (black carbon, BC over dust; water-soluble, WS over dust; WS over water-insoluble, WINS and BC over WINS) mixing. Our analysis reveals that choice of external mixing (usually considered in satellite retrievals and climate models) seems reasonable in Delhi only in the pre-monsoon (Mar-Jun) season. During the winter (Dec-Feb) and monsoon (Jul-Sep) seasons, 'WS coating over dust' externally mixed with BC and WINS appears to be the most probable mixing state; while 'WS coating over WINS' externally mixed with BC and dust seems to be the most probable mixing state in the post-monsoon (Oct-Nov) season. Mean seasonal TOA (surface) aerosol DRF for the most probable mixing states are 4.4 ± 3.9 (- 25.9 ± 3.9), - 16.3 ± 5.7 (- 42.4 ± 10.5), 13.6 ± 11.4 (- 76.6 ± 16.6) and - 5.4 ± 7.7 (- 80.0 ± 7.2) W m- 2 respectively in the pre-monsoon, monsoon, post-monsoon and winter seasons. Our results highlight the importance of realistic mixing state treatment in estimating aerosol DRF to aid in policy making to combat climate change.

  10. A tool for simulating collision probabilities of animals with marine renewable energy devices.

    Directory of Open Access Journals (Sweden)

    Pál Schmitt

    Full Text Available The mathematical problem of establishing a collision probability distribution is often not trivial. The shape and motion of the animal as well as of the the device must be evaluated in a four-dimensional space (3D motion over time. Earlier work on wind and tidal turbines was limited to a simplified two-dimensional representation, which cannot be applied to many new structures. We present a numerical algorithm to obtain such probability distributions using transient, three-dimensional numerical simulations. The method is demonstrated using a sub-surface tidal kite as an example. Necessary pre- and post-processing of the data created by the model is explained, numerical details and potential issues and limitations in the application of resulting probability distributions are highlighted.

  11. A tool for simulating collision probabilities of animals with marine renewable energy devices.

    Science.gov (United States)

    Schmitt, Pál; Culloch, Ross; Lieber, Lilian; Molander, Sverker; Hammar, Linus; Kregting, Louise

    2017-01-01

    The mathematical problem of establishing a collision probability distribution is often not trivial. The shape and motion of the animal as well as of the the device must be evaluated in a four-dimensional space (3D motion over time). Earlier work on wind and tidal turbines was limited to a simplified two-dimensional representation, which cannot be applied to many new structures. We present a numerical algorithm to obtain such probability distributions using transient, three-dimensional numerical simulations. The method is demonstrated using a sub-surface tidal kite as an example. Necessary pre- and post-processing of the data created by the model is explained, numerical details and potential issues and limitations in the application of resulting probability distributions are highlighted.

  12. Free Fall Misconceptions: Results of a Graph Based Pre-Test of Sophomore Civil Engineering Students

    Science.gov (United States)

    Montecinos, Alicia M.

    2014-01-01

    A partially unusual behaviour was found among 14 sophomore students of civil engineering who took a pre test for a free fall laboratory session, in the context of a general mechanics course. An analysis contemplating mathematics models and physics models consistency was made. In all cases, the students presented evidence favoring a correct free…

  13. Self-Perception of HIV Risk and Candidacy for Pre-Exposure Prophylaxis Among Men Who Have Sex with Men Testing for HIV at Commercial Sex Venues in New York City.

    Science.gov (United States)

    Gallagher, Timothy; Link, Lauren; Ramos, Michael; Bottger, Edward; Aberg, Judith; Daskalakis, Demetre

    2014-09-01

    The purpose of this study was to evaluate the ability of men who have sex with men (MSM) testing for HIV at commercial sex venues to assess the following: their candidacy for pre-exposure chemoprophylaxis (PrEP) as defined by meeting entry criteria for the iPrEx (Iniciativa Profilaxis Pre-Exposición) phase III clinical trial of PrEP, and their perception of their own HIV risk and candidacy for PrEP. Interviewers surveyed 629 MSM at three NYC commercial sex venues from June 2011 through June 2012. Questions focused on demographics, sexual activity, and drug use in the three months prior to testing, as well as perceived risk of HIV acquisition and perceived candidacy for PrEP use. Data were analyzed by Chi square and Fisher's exact test. Results show that a majority of clients (80.3%) met entry criteria for the iPrEX. Most of these men (78.0%), however, did not perceive their risk to be significant enough to warrant PrEP use (P=.000). Factors were identified which associated with a risk perception that correlated with eligibility for iPrEX.

  14. Contingency bias in probability judgement may arise from ambiguity regarding additional causes.

    Science.gov (United States)

    Mitchell, Chris J; Griffiths, Oren; More, Pranjal; Lovibond, Peter F

    2013-09-01

    In laboratory contingency learning tasks, people usually give accurate estimates of the degree of contingency between a cue and an outcome. However, if they are asked to estimate the probability of the outcome in the presence of the cue, they tend to be biased by the probability of the outcome in the absence of the cue. This bias is often attributed to an automatic contingency detection mechanism, which is said to act via an excitatory associative link to activate the outcome representation at the time of testing. We conducted 3 experiments to test alternative accounts of contingency bias. Participants were exposed to the same outcome probability in the presence of the cue, but different outcome probabilities in the absence of the cue. Phrasing the test question in terms of frequency rather than probability and clarifying the test instructions reduced but did not eliminate contingency bias. However, removal of ambiguity regarding the presence of additional causes during the test phase did eliminate contingency bias. We conclude that contingency bias may be due to ambiguity in the test question, and therefore it does not require postulation of a separate associative link-based mechanism.

  15. Failure probability analysis on mercury target vessel

    International Nuclear Information System (INIS)

    Ishikura, Syuichi; Futakawa, Masatoshi; Kogawa, Hiroyuki; Sato, Hiroshi; Haga, Katsuhiro; Ikeda, Yujiro

    2005-03-01

    Failure probability analysis was carried out to estimate the lifetime of the mercury target which will be installed into the JSNS (Japan spallation neutron source) in J-PARC (Japan Proton Accelerator Research Complex). The lifetime was estimated as taking loading condition and materials degradation into account. Considered loads imposed on the target vessel were the static stresses due to thermal expansion and static pre-pressure on He-gas and mercury and the dynamic stresses due to the thermally shocked pressure waves generated repeatedly at 25 Hz. Materials used in target vessel will be degraded by the fatigue, neutron and proton irradiation, mercury immersion and pitting damages, etc. The imposed stresses were evaluated through static and dynamic structural analyses. The material-degradations were deduced based on published experimental data. As a result, it was quantitatively confirmed that the failure probability for the lifetime expected in the design is very much lower, 10 -11 in the safety hull, meaning that it will be hardly failed during the design lifetime. On the other hand, the beam window of mercury vessel suffered with high-pressure waves exhibits the failure probability of 12%. It was concluded, therefore, that the leaked mercury from the failed area at the beam window is adequately kept in the space between the safety hull and the mercury vessel by using mercury-leakage sensors. (author)

  16. Beyond the 2×2 -contingency table: a primer on entropies and mutual information in various scenarios involving m diagnostic categories and n categories of diagnostic tests.

    Science.gov (United States)

    Reibnegger, Gilbert

    2013-10-21

    Usual evaluation tools for diagnostic tests such as, sensitivity/specificity and ROC analyses, are designed for the discrimination between two diagnostic categories, using dichotomous test results. Information theoretical quantities such as mutual information allow in depth-analysis of more complex discrimination problems, including continuous test results, but are rarely used in clinical chemistry. This paper provides a primer on useful information theoretical concepts with a strong focus on typical diagnostic scenarios. Information theoretical concepts are shortly explained. Mathematica CDF documents are provided which compute entropies and mutual information as function of pretest probabilities and the distribution of test results among the categories, and allow interactive exploration of the behavior of these quantities in comparison with more conventional diagnostic measures. Using data from a previously published study, the application of information theory to practical diagnostic problems involving up to 4×4 -contingency tables is demonstrated. Information theoretical concepts are particularly useful for diagnostic problems requiring more than the usual binary classification. Quantitative test results can be properly analyzed, and in contrast to popular concepts such as ROC analysis, the effects of variations of pre-test probabilities of the diagnostic categories can be explicitly taken into account. © 2013 Elsevier B.V. All rights reserved.

  17. Correlations and Non-Linear Probability Models

    DEFF Research Database (Denmark)

    Breen, Richard; Holm, Anders; Karlson, Kristian Bernt

    2014-01-01

    the dependent variable of the latent variable model and its predictor variables. We show how this correlation can be derived from the parameters of non-linear probability models, develop tests for the statistical significance of the derived correlation, and illustrate its usefulness in two applications. Under......Although the parameters of logit and probit and other non-linear probability models are often explained and interpreted in relation to the regression coefficients of an underlying linear latent variable model, we argue that they may also be usefully interpreted in terms of the correlations between...... certain circumstances, which we explain, the derived correlation provides a way of overcoming the problems inherent in cross-sample comparisons of the parameters of non-linear probability models....

  18. On the probability of cure for heavy-ion radiotherapy

    International Nuclear Information System (INIS)

    Hanin, Leonid; Zaider, Marco

    2014-01-01

    The probability of a cure in radiation therapy (RT)—viewed as the probability of eventual extinction of all cancer cells—is unobservable, and the only way to compute it is through modeling the dynamics of cancer cell population during and post-treatment. The conundrum at the heart of biophysical models aimed at such prospective calculations is the absence of information on the initial size of the subpopulation of clonogenic cancer cells (also called stem-like cancer cells), that largely determines the outcome of RT, both in an individual and population settings. Other relevant parameters (e.g. potential doubling time, cell loss factor and survival probability as a function of dose) are, at least in principle, amenable to empirical determination. In this article we demonstrate that, for heavy-ion RT, microdosimetric considerations (justifiably ignored in conventional RT) combined with an expression for the clone extinction probability obtained from a mechanistic model of radiation cell survival lead to useful upper bounds on the size of the pre-treatment population of clonogenic cancer cells as well as upper and lower bounds on the cure probability. The main practical impact of these limiting values is the ability to make predictions about the probability of a cure for a given population of patients treated to newer, still unexplored treatment modalities from the empirically determined probability of a cure for the same or similar population resulting from conventional low linear energy transfer (typically photon/electron) RT. We also propose that the current trend to deliver a lower total dose in a smaller number of fractions with larger-than-conventional doses per fraction has physical limits that must be understood before embarking on a particular treatment schedule. (paper)

  19. Platelet function testing: methods of assessment and clinical utility.

    LENUS (Irish Health Repository)

    Mylotte, Darren

    2012-02-01

    Platelets play a central role in the regulation of both thrombosis and haemostasis yet tests of platelet function have, until recently, been exclusively used in the diagnosis and management of bleeding disorders. Recent advances have demonstrated the clinical utility of platelet function testing in patients with cardiovascular disease. The ex vivo measurement of response to antiplatelet therapies (aspirin and clopidogrel), by an ever-increasing array of platelet function tests, is with some assays, predictive of adverse clinical events and thus, represents an emerging area of interest for both the clinician and basic scientist. This review article will describe the advantages and disadvantages of the currently available methods of measuring platelet function and discuss both the limitations and emerging data supporting the role of platelet function studies in clinical practice.

  20. Platelet function testing: methods of assessment and clinical utility.

    LENUS (Irish Health Repository)

    Mylotte, Darren

    2011-01-01

    Platelets play a central role in the regulation of both thrombosis and haemostasis yet tests of platelet function have, until recently, been exclusively used in the diagnosis and management of bleeding disorders. Recent advances have demonstrated the clinical utility of platelet function testing in patients with cardiovascular disease. The ex vivo measurement of response to antiplatelet therapies (aspirin and clopidogrel), by an ever-increasing array of platelet function tests, is with some assays, predictive of adverse clinical events and thus, represents an emerging area of interest for both the clinician and basic scientist. This review article will describe the advantages and disadvantages of the currently available methods of measuring platelet function and discuss both the limitations and emerging data supporting the role of platelet function studies in clinical practice.