Sample records for clinically important phenomenon

  1. Immunosuppression by hypoxic cell radiosensitizers: a phenomenon of potential clinical importance

    International Nuclear Information System (INIS)

    Rockwell, S.; Kapp, D.S.


    The nitroimidazoles metronidazole, misonidazol, and desmethyl misonidazole are currently undergoing clinical trials as possible adjuncts to radiotherapy. Ongoing clinical trials are evaluating the effectiveness of these agents and also documenting the pharmacokinetics and toxicities of radiosensitizing doses of these drugs in man. A variety of toxic effects have been noted in man, including anorexia, nausea and vomiting, peripheral neuropathy, central nervous system symptoms, ototoxicity, allergy, and fear. Laboratory studies have also suggested that these agents have potential to be mutagenic, carcinogenic, and teratogenic. In the editorial presented, the author attempts to draw attention to an additional toxic effect of nitroimidazoles - the inhibition of cell-mediated immune responses

  2. Cell Competition: Roles and Importance as a Central Phenomenon. (United States)

    Patel, Manish; Antala, Bhavesh; Shrivastava, Neeta


    Cell competition is a type of short-range cell-cell interaction first observed in Drosophila melanogaster. In two heterogeneous cell populations, cells that have a higher fitness level would have a competitive advantage and grow at the cost of neighbor cells that have comparatively lower fitness. This interaction is due to differences in expression levels of a specific protein in the two cell populations, and it is known as cell competition. In this review, we have studied recent findings of cell competition in different biological processes in Drosophila as well as mammalian systems. The purpose of this review is to collate important studies of competitive cell interactions, and to understand its roles and importance as a central phenomenon. This review provides evidence of the relevance of cell competition in various physiological and pathological conditions, such as size control in organ development, stem cell maintenance, tissue repair, organ regeneration, aging, formation of memory, and cancer.

  3. Freezing of gait: moving forward on a mysterious clinical phenomenon

    NARCIS (Netherlands)

    Nutt, J.G.; Bloem, B.R.; Giladi, N.; Hallett, M.; Horak, F.B.; Nieuwboer, A.


    Freezing of gait (FoG) is a unique and disabling clinical phenomenon characterised by brief episodes of inability to step or by extremely short steps that typically occur on initiating gait or on turning while walking. Patients with FoG, which is a feature of parkinsonian syndromes, show variability

  4. The clinical and neurophysiological characteristics of the deja vu phenomenon in epilepsy

    Directory of Open Access Journals (Sweden)

    P. N. Vlasov


    Full Text Available Objective: to study the clinical and neurophysiological characteristics of the deja vu phenomenon in epilepsy. Patients and methods. The manifestations of the dВjЕ vu phenomenon were compared in 154 examinees in two groups: 1 139 healthy individuals and 2 25 patients with epilepsy (mean age 25.17±9.19 years; women, 63.2% The characteristics of the phenomenon were determined, by questioning the examinees; 12—16-hour ambulatory electroencephalogram (EEG monitoring was made. Results. The deja vu phenomenon occurred with cryptogenic and symptomatic focal epilepsy with equal frequency; however, the phenomenon was also seen in the idiopathic generalized form of the latter and could be concurrent virtually with any types of seizures and observed as an individual seizure and in the structure of a partial and secondarily generalized seizure. In epileptic patients, the main clinical characteristics of the deja vu vu phenomenon are its frequency, fear before its onset, and emotional coloring. The most important criterion is a change in the characteristics of deja vu vu: prolongation, more frequencies, and the emergence of negative emotions. On EEG, the phenomenon was characterized by the onset of polyspike activity in the right temporal leads and, in some cases, ended with slow-wave, theta-delta activity in the right hemisphere.

  5. The clinical and neurophysiological characteristics of the deja vu phenomenon in epilepsy


    P. N. Vlasov; A. V. Chervyakov; G. R. Drozhzhina; М. V. Antonyuk; N. V. Orekhova; V. V. Gnezditsky; T. Yu. Noskova; P. A. Fedin


    Objective: to study the clinical and neurophysiological characteristics of the deja vu phenomenon in epilepsy. Patients and methods. The manifestations of the dВjЕ vu phenomenon were compared in 154 examinees in two groups: 1) 139 healthy individuals and 2) 25 patients with epilepsy (mean age 25.17±9.19 years; women, 63.2%) The characteristics of the phenomenon were determined, by questioning the examinees; 12—16-hour ambulatory electroencephalogram (EEG) monitoring was made. Results. The dej...

  6. The importance of early diagnosis and treatment of kaposiform hemangioendothelioma complicated by Kasabach-Merritt phenomenon. (United States)

    Vivas-Colmenares, Grecia V; Ramirez-Villar, Gema L; Bernabeu-Wittel, Jose; Matute de Cardenas, Jose A; Fernandez-Pineda, Israel


    Kaposiform hemangioendothelioma (KHE) is a locally aggressive vascular tumor that may be complicated by Kasabach-Merritt phenomenon (KMP), a profound thrombocytopenia resulting from platelet trapping within a vascular tumor, either KHE or tufted angioma (TA). Typical features also include low fibrinogen and elevated D-dimers. It is well known that KMP is not caused by infantile hemangiomas. Management of vascular tumors complicated by KMP is challenging, and it is common for referral centers to receive patients in critical medical condition after multimodality treatment failure of vascular anomalies. Our aim is to communicate the importance of early diagnosis and treatment of KHE associated with KMP. A full-term male newborn with KHE complicated by KMP is reported. Treatment with vincristine, aspirin and ticlopidine normalized the coagulation parameters within one week, requiring a total of six doses of vincristine, seven months of ticlopidine and 17 months of aspirin. Early diagnosis and treatment of KHE complicated by KMP may allow the administration of fewer doses of vincristine and avoid the use of corticosteroids.

  7. Clinical importance of electromagnetic fields

    International Nuclear Information System (INIS)

    Ruppe, I.


    The clinical importance of most of the electromagnetic fields is not highly. Mostly they only have thermal effects, produced by energy-absorption. About 1 C increase of whole-body-temperature is valid for tolerable limit. For measuring is used the SAR-Value (Specific Absorption Rate) in W/kg body mass. SAR = 0,8W/kg for the whole body is valid to be safety. For the evaluation of possible other effects of electromagnetic fields the scientific knowledges are till now not sufficient to allow a final statement. That could be impacts of electromagnetic fields to conduction or switch processes in the nerves or brains, in the framwork of cellular regulations, in the genetic reactions are occurig is little, but if is necessary to find it out in scinentific investigations. (orig.) [de

  8. The importance of Clinical Research

    Directory of Open Access Journals (Sweden)

    Frank Lizaraso Caparó


    Full Text Available Objetives: to describe the clinical and epidemiological characteristics, evolution and to identify mortality factors associated in patients with snp.Material and methods: descriptive study of a serie of cases of the intensive care unit (icu of a general hospital. medical records of patients which received medical attention and who meet the selection criteria were reviewed. Results: forty-one clinical records were evaluated. the average age was 69 old, predominantly male (68,3%. snp was the reason of admission in 60.9% and 95.1% required mechanical ventilation. hospital stay prior to diagnosis was 10 days, 65% of patients had some risk factor for multi resistence organisms, cpis of entry was 9.3, cultures were positive in 39% of the cases and of these, 48.8% received proper antibiotic according to culture results. the days of stay in icu were 20.6 days and 20 of the 41 medical records were for death patients. the clinical and epidemiological characteristics were similar between death and alive patients. an analysis of factors that could be associated with mortality snp was made and it was found that for an age ≥ 70 years, the presence of any risk factor for multidrug resistence organism and control cpis ≥ 6 were associated with higher mortality; while acquisition of the icu was associated to lower mortality. Conclusions: the clinical, epidemiological characteristics and evolution of patients with snp in our icu were similar to those describe in the literature. three factors associated with mortality in the icu were identified.


    Directory of Open Access Journals (Sweden)

    Pavel Nikolaevich Vlasov


    This investigation was undertaken to study the implication of the DV phenomenon in the clinical picture of glial brain tumors (GBT. One hundred and sixty-one subjects (mean age 29,2±6,4 years; males 47%, including 129 healthy individuals and 32 patients with GBT, were examined. In the clinical picture of GBT with seizures, DV is a common symptom that is encountered in the involvement of predominantly the right temporal lobe and accompanied by generalized convulsive attacks and olfactory hallucinations. DV in GBT occurs more than once daily; its duration is a few (as many as 5 minutes; DV is characterized by a negative emotional tinge and attended by fear

  10. Listeriosis in Mexico: Clinical and epidemiological importance

    Directory of Open Access Journals (Sweden)

    Gloria Castañeda-Ruelas


    Full Text Available Listeriosis is caused by Listeria monocytogenes, an important food-borne disease due to its clinical forms, high mortality rate, and the economic impact in both clinical and food production industries. In Mexico, the lack of epidemiological surveillance systems leads to the need of accurate data on the incidence of listeriosis and its association with food-borne disease. In this paper, we present data about the presence of this bacterium in food, reports related to clinical cases of listeriosis, and information of diseases in which L. monocytogenes may be involved. However, in most of these cases the etiology was not established. Given this, there´s a need to inform and warn the appropriate entities, to define strategies for the mandatory search of L. monocytogenes through the whole food production chain and clinical suspects, for the epidemiological importance and control of listeriosis in Mexico.

  11. Responsiveness and minimal clinically important change

    DEFF Research Database (Denmark)

    Christiansen, David Høyrup; Frost, Poul; Falla, Deborah


    Study Design A prospective cohort study nested in a randomized controlled trial. Objectives To determine and compare responsiveness and minimal clinically important change of the modified Constant score (CS) and the Oxford Shoulder Score (OSS). Background The OSS and the CS are commonly used...... to assess shoulder outcomes. However, few studies have evaluated the measurement properties of the OSS and CS in terms of responsiveness and minimal clinically important change. Methods The study included 126 patients who reported having difficulty returning to usual activities 8 to 12 weeks after...... were observed for the CS and the OSS. Minimal clinically important change ROC values were 6 points for the OSS and 11 points for the CS, with upper 95% cutoff limits of 12 and 22 points, respectively. Conclusion The CS and the OSS were both suitable for assessing improvement after decompression surgery....

  12. Quantifying the lumbar flexion-relaxation phenomenon: theory, normative data, and clinical applications. (United States)

    Neblett, Randy; Mayer, Tom G; Gatchel, Robert J; Keeley, Janice; Proctor, Tim; Anagnostis, Christopher


    A two-part investigation was conducted: 1) a prospective study of asymptomatic subjects quantitatively comparing trunk mobility to surface electromyographic (sEMG) signals from the erector spinae during trunk flexion; and 2) a prospective repeated-measures cohort study of patients with chronic disabled work-related spinal disorder tested for the flexion-relaxation (FR) phenomenon while measured simultaneously for lumbar spine inclinometric range of motion (ROM). To describe a theoretical model for the potential use of FR unloaded in assessing patients with chronic low back pain patients before and after rehabilitation, and to establish a normative database (Part 1) for subsequent use in comparison to patients with chronic low back pain (Part 2). The second part of the study assessed the clinical utility of combined sEMG and ROM measurements for assessing the FR phenomenon as a test to assist potentially in planning rehabilitation programs, guiding patients' individual rehabilitation progress, and identifying early posttreatment outcome failures. The FR phenomenon has been recognized since 1951, and it can be reproducibly assessed in normal subjects with FR unloaded. It can be found intermittently in patients with chronic low back pain. Recent studies have moved toward deriving formulas to identify FR, but only a few have examined a potential relation between inclinometric lumbar motion measures and the sEMG signal. No previous studies have developed normative data potentially useful for objectively assessing nonoperative treatment progress, effort, or the validity of permanent impairment rating measures. In Part 1, 12 asymptomatic subjects were evaluated in an intra- and interrater repeated-measures protocol to examine reliability of sEMG signal readings in FR, as well as ROM measures at FR and maximum voluntary flexion. The mean sEMG signal averaging right-left electrode recordings, as well as the gross, true, and sacral lumbar ROM measurements, were recorded as

  13. Nutcracker or left renal vein compression phenomenon: multidetector computed tomography findings and clinical significance

    International Nuclear Information System (INIS)

    Cuellar i Calabria, Hug; Quiroga Gomez, Sergi; Sebastia Cerqueda, Carmen; Boye de la Presa, Rosa; Miranda, Americo; Alvarez-Castells, Agusti


    The use of multidetector computed tomography (MDCT) in routine abdominal explorations has increased the detection of the nutcracker phenomenon, defined as left renal vein (LRV) compression by adjacent anatomic structures. The embryology and anatomy of the nutcracker phenomenon are relevant as a background for the nutcracker syndrome, a rare cause of hematuria as well as other symptoms. MDCT examples of collateral renal vein circulation (gonadal, ureteric, azygous, lumbar, capsular) and aortomesenteric (anterior) and retroaortic (posterior) nutcracker phenomena in patients with no urologic complaint are shown as well as studies performed on patients with gross hematuria of uncertain origin. Incidental observation of collateral veins draining the LRV in abdominal MDCT explorations of asymptomatic patients may be a sign of a compensating nutcracker phenomenon. Imbalance between LRV compression and development of collateral circulation may lead to symptomatic nutcracker syndrome. (orig.)

  14. Nutcracker or left renal vein compression phenomenon: multidetector computed tomography findings and clinical significance

    Energy Technology Data Exchange (ETDEWEB)

    Cuellar i Calabria, Hug; Quiroga Gomez, Sergi; Sebastia Cerqueda, Carmen; Boye de la Presa, Rosa; Miranda, Americo; Alvarez-Castells, Agusti [Hospitals Universitaris Vall D' Hebron, Institut de Diagnostic Per La Imatge, Servei De Radiodiagnostic, Barcelona (Spain)


    The use of multidetector computed tomography (MDCT) in routine abdominal explorations has increased the detection of the nutcracker phenomenon, defined as left renal vein (LRV) compression by adjacent anatomic structures. The embryology and anatomy of the nutcracker phenomenon are relevant as a background for the nutcracker syndrome, a rare cause of hematuria as well as other symptoms. MDCT examples of collateral renal vein circulation (gonadal, ureteric, azygous, lumbar, capsular) and aortomesenteric (anterior) and retroaortic (posterior) nutcracker phenomena in patients with no urologic complaint are shown as well as studies performed on patients with gross hematuria of uncertain origin. Incidental observation of collateral veins draining the LRV in abdominal MDCT explorations of asymptomatic patients may be a sign of a compensating nutcracker phenomenon. Imbalance between LRV compression and development of collateral circulation may lead to symptomatic nutcracker syndrome. (orig.)

  15. Giant U waves: an important clinical clue

    Directory of Open Access Journals (Sweden)

    Verma N


    Full Text Available Nitin Verma, Vincent M Figueredo, Allan M Greenspan, Gregg S PressmanAlbert Einstein Medical Center, Philadelphia, PA, USAAbstract: Electrocardiographic U waves are a common clinical finding, and yet are poorly understood by many physicians. They can be seen in many clinical conditions, most importantly hypokalemia and ischemic heart disease. Over the years, many theories have been put forth to explain their origin. While still not completely understood, it now appears that mechanoelectrical interactions are responsible for normal U waves. Pathologic U waves may be seen in ischemic heart disease where they sometimes point to acute ischemic events. The large U waves of hypokalemia are most likely not true U waves but rather the terminal deflection in a bifid T wave.Keywords: U waves, hypokalemia, myocardial ischemia, electrocardiogram

  16. [Organic and functional limitations due to milking phenomenon: a clinical case report]. (United States)

    Gómez-Henry, Juan Carlos; Rodríguez-Pérez, Francisco Antonio


    The incidence of milking phenomenon is between 0.6 and 4 % in angiographic series; however, autopsy studies raise the incidence of myocardial bridges up to 85 %. This malformation goes unnoticed in most cases but can have a big impact on personal and professional level. The objective was to present an example of milking phenomenon with disability and professional consequences. Male, 44 years old, bricklayer and farmhand laborer. He referred tonsillectomy and osteoarthritis and being a smoker of 10 cigarettes per day, drinking 2-3 cups of coffee daily and 2-3 glasses of wine at the weekends. The primary care physician referred him to cardiologist with suspicion of arrhythmia. The cardiology service report mentioned electrocardiogram at sinusal rhythm, 90 beats per minute and incomplete right bundle-branch block. At ergonomics test, in the first stage of Bruce protocol, the patient's development of hypertensive crisis suggested a milking phenomenon. Finally, the diagnosis was established by angiographic studies with left common branch, circumflex coronary artery, right coronary artery and anterior descendent artery, without evidence of pathology but it was seen systolic compression on the medial segment. The case was concluded by the disability assessment team, recognizing a total permanent disability with limitations for activities requiring moderate physical efforts. The milking phenomenon diagnosis that could be related with ischemic heart disease is by angiography. Finally, the patient ended with total permanent disability.

  17. Artifactual Hypoglycaemia in Systemic Sclerosis and Raynaud’s Phenomenon: A Clinical Case Report and Short Review

    Directory of Open Access Journals (Sweden)

    RH Bishay


    Full Text Available Background. Artifactual hypoglycaemia, defined as a discrepancy between glucometer (capillary and plasma glucose levels, may lead to overtreatment and costly investigations. It is not infrequently observed in patients with Raynaud’s phenomenon due to vascular capillary distortion, yet this is clinically underappreciated. Case Report. We report a 76-year-old woman with systemic sclerosis and Raynaud’s phenomenon, who presented with upper gastrointestinal bleeding and found to have concomitant persistent hypoglycaemia (1.0–2.7mmol/L on a point-of-care glucometer in the absence hypoglycaemic symptoms. She underwent a 2-week hospital admission, repeated glucose monitoring, hydrocortisone replacement and dextrose infusions, with consequent hyperglycaemia on plasma measurements. Clinically, she did not satisfy Whipple’s triad and radiological investigations failed to identify pituitary or pancreatic pathology. A 72-hour fast was negative for hyperinsulinaemia or exogenous insulin use and her sulphonylurea metabolite urinary screen was negative. Discussion. Treatment of low capillary blood glucose is usually met with clinical impetus to treat, even when hypoglycaemic symptoms are lacking. The correct diagnosis may have been achieved had there been an observation of her cold hands, scleroderma facies, and consideration of the likely distorted peripheral microvasculature. Early identification of this presumably rare clinical scenario may have prevented overtreatment, altered methods of monitoring, and avoided unnecessary investigations.

  18. Clinical applicability of quantitative nailfold capillaroscopy in differential diagnosis of connective tissue diseases with Raynaud's phenomenon. (United States)

    Wu, Po-Chang; Huang, Min-Nung; Kuo, Yu-Min; Hsieh, Song-Chou; Yu, Chia-Li


    Nailfold capillaroscopy is a useful tool to distinguish primary from secondary Raynaud's phenomenon (RP) by examining the morphology of nailfold capillaries but its role in disease diagnosis is not clearly established. The purpose of this study was to evaluate the roles of quantitative nailfold capillaroscopy in differential diagnosis of connective tissue diseases (CTDs) with RP. The data between the year 2005 and 2009 were retrieved from the nailfold capillaroscopic database of National Taiwan University Hospital (NTUH). Only the data from the patients with RP were analyzed. The criteria for interpretation of capillaroscopic findings were predefined. The final diagnoses of the patients were based on the American College of Rheumatology classification criteria for individual diseases, independent of nailfold capillaroscopic findings. The sensitivity and the specificity of each capillaroscopic pattern to the diseases were determined. The data from a total of 67 patients were qualified for the current study. We found the sensitivity and specificity of scleroderma pattern for systemic sclerosis (SSc) were 89.47% and 80%, and the specificity of the early, active, and late scleroderma patterns for SSc reached 87.5%, 97.5%, and 95%, respectively. The sensitivity/specificity of systemic lupus erythematosus (SLE) pattern for SLE and polymyositis/dermatomyositis (PM/DM) pattern for PM/DM were 33.33%/95.45% and 60%/96.3%, respectively. The sensitivity/specificity of mixed connective tissue disease (MCTD) pattern for MCTD were 20%/100%. The nailfold capillaroscopic (NC) patterns may be useful in the differential diagnosis of CTDs with RP. The NC patterns for SSc and PM/DM are both sensitive and specific to the diseases, while the SLE and MCTD patterns exhibit high specificity but relatively low sensitivity. Copyright © 2012. Published by Elsevier B.V.

  19. The importance of clinical and management scripts. (United States)

    Levin, Roger P


    Simply having excellent clinical skills is not enough to enable you to achieve practice goals. In the end, people will validate the quality of the practice based on the way you and your team communicate. It is amazing to realize how much impact we have on other individuals, based purely on what we say. A well-groomed dentist and staff possessing very attractive features and beautiful teeth almost invariably will work in the practice's favor. However, these traits, powerful as they may be, are incomplete without the ability to say the right thing at the right time. In the practice, the easiest way to ensure consistently excellent communication is to use clinical and management scripts. Nothing you do in your practice will equal the impact of what you say because it affects patient perceptions of quality and overall customer service experiences. Your goal is to have all routine communications in the practice turned into written scripts within 6 months.

  20. Clinical importance of caffeine dependence and abuse. (United States)

    Ogawa, Naoshi; Ueki, Hirofumi


    Caffeine is the most widely consumed psychoactive substance and is a legal stimulant that is readily available to children. Caffeine has occasionally been considered a drug of abuse and the potential for dependence on caffeine has been debated. Presently, due to a paucity of clinical evidence on caffeine dependence or abuse, no such diagnosis is included in the Diagnostic and Statistical Manual of Mental Disorder-fourth edition. The authors present two cases of abuse or dependence on the caffeine contained in 'eutrophic' (energy/nutritional) beverages or caffeine preparations, followed by a review of clinical studies demonstrating evidence that some people can manifest a clinical syndrome of caffeine dependence or abuse. The cases suggest that caffeine can produce a clinical dependence syndrome similar to those produced by other psychoactive substances and has a potential for abuse. In a recent study using a structured interview and the Diagnostic and Statistical Manual of Mental Disorder-fourth edition criteria for substance dependence and abuse, a subset of the general population was found to demonstrate caffeine dependence or caffeine abuse. Therefore, the authors propose that companies or businesses manufacturing or marketing caffeine or products containing caffeine must meet the following guidelines: (i) clearly indicate the caffeine content of products containing comparatively higher quantities of caffeine; (ii) warn that such products should be avoided by infants and children wherever possible, and inform adult consumers about the precise quantity of caffeine that is considered safe for consumption; and (iii) clearly state that consuming large quantities of caffeine and the long-term use of caffeine carry health risks.

  1. The flare-up phenomenon in endodontics: a clinical perspective and review. (United States)

    Matusow, R J


    The acute endodontic cellulitis exacerbation, which can be potentially fatal, is a definitive entity in endodontic flare-ups. Aerobic microbes, particularly streptococci, are the predominant causative microbes isolated. There was a noticeable absence of obligate anaerobes. This is significant for the selection of an antibiotic for therapy. Treatment parameters were presented. An endodontic cellulitis exacerbation is most unlikely with obligate anaerobes. An endodontic flare-up perspective was attempted with some clinical parameters. The proponents of routine one-visit endodontic treatment with prophylactic drugs to prevent cellulitis exacerbations do not appear to offer any advantage to the more traditional approaches to endodontic treatment of the patient, which may be more beneficial.

  2. [Clinical microbiology laboratory and imported parasitic diseases]. (United States)

    Martín-Rabadán, Pablo; Martínez-Ruiz, Rocío; Cuadros, Juan; Cañavate, Carmen


    Imported parasitosis represents an increasingly frequent diagnostic challenge for microbiology laboratories. A surge in immigration and international travel has led to a rise in the number of imported cases of parasitosis, and this trend is expected to continue in the future. The present article addresses this challenge by reviewing recommended diagnostic approaches and tests. Currently, microscopy is always recommended when analysing blood samples for parasites. If malaria is suspected, rapid antigen testing (including at least HRP2 antigen) should also be performed. The work-up for suspected leishmaniasis should include serology, culture, and in selected cases detection of antigen in urine. In suspected Chagas disease, two different serological tests should be performed. PCR for blood protozoa is highly sensitive, although it cannot be used to rule out Chagas disease, since this condition may be present without parasitemia. Accurate diagnosis of intestinal amebiasis usually requires PCR or antigen detection tests. In helminthiasis, traditional microscopy may need to be complemented with other tests, such as agar plate culture for strongyloidiasis, Og4C3 antigen detection for bancroftian filariasis, and antibody detection test for filariasis and schistosomiasis. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  3. Raynaud's phenomenon

    DEFF Research Database (Denmark)

    Nielsen, S L; Christensen, N J; Olsen, N


    . The forearm venous concentration of noradrenaline was lower and adrenaline concentration higher in the sympathectomized patients than in the other groups (p less than 0,05). Noradrenaline showed a significant increase during body cooling in normals and primary Raynaud's (p less than 0......The reaction to body and finger cooling was recorded in seven patients with relapse of primary Raynaud's phenomenon after sufficiently performed bilateral upper thoracic sympathectomy and for comparison in eight young women with primary Raynaud's phenomenon as well as in seven normal women......,05). There was no significant correlation between the vasoconstrictor response to cooling of a finger and the noradrenaline concentration probably due to the fact that skin vasoconstriction impeded release of noradrenaline from the skin. The relapse of Raynaud's phenomenon after surgically sufficient sympathectomy could...

  4. Preliminary clinical evaluation of semi-automated nailfold capillaroscopy in the assessment of patients with Raynaud's phenomenon. (United States)

    Murray, Andrea K; Feng, Kaiyan; Moore, Tonia L; Allen, Phillip D; Taylor, Christopher J; Herrick, Ariane L


      Nailfold capillaroscopy is well established in screening patients with Raynaud's phenomenon for underlying SSc-spectrum disorders, by identifying abnormal capillaries. Our aim was to compare semi-automatic feature measurement from newly developed software with manual measurements, and determine the degree to which semi-automated data allows disease group classification.   Images from 46 healthy controls, 21 patients with PRP and 49 with SSc were preprocessed, and semi-automated measurements of intercapillary distance and capillary width, tortuosity, and derangement were performed. These were compared with manual measurements. Features were used to classify images into the three subject groups.   Comparison of automatic and manual measures for distance, width, tortuosity, and derangement had correlations of r=0.583, 0.624, 0.495 (p<0.001), and 0.195 (p=0.040). For automatic measures, correlations were found between width and intercapillary distance, r=0.374, and width and tortuosity, r=0.573 (p<0.001). Significant differences between subject groups were found for all features (p<0.002). Overall, 75% of images correctly matched clinical classification using semi-automated features, compared with 71% for manual measurements.   Semi-automatic and manual measurements of distance, width, and tortuosity showed moderate (but statistically significant) correlations. Correlation for derangement was weaker. Semi-automatic measurements are faster than manual measurements. Semi-automatic parameters identify differences between groups, and are as good as manual measurements for between-group classification. © 2011 John Wiley & Sons Ltd.

  5. Clinical and diagnostic importance of proteinuria: A review | Oni ...

    African Journals Online (AJOL)

    Clinical and diagnostic importance of proteinuria: A review. ... shown that diabetis mellitus, cardiovascular disease and hypertension could provoke secondary ... Proteinuria is also significant in some non-pathological cases such as pregnancy

  6. The Second Victim Phenomenon After a Clinical Error: The Design and Evaluation of a Website to Reduce Caregivers' Emotional Responses After a Clinical Error. (United States)

    Mira, José Joaquín; Carrillo, Irene; Guilabert, Mercedes; Lorenzo, Susana; Pérez-Pérez, Pastora; Silvestre, Carmen; Ferrús, Lena


    Adverse events (incidents that harm a patient) can also produce emotional hardship for the professionals involved (second victims). Although a few international pioneering programs exist that aim to facilitate the recovery of the second victim, there are no known initiatives that aim to raise awareness in the professional community about this issue and prevent the situation from worsening. The aim of this study was to design and evaluate an online program directed at frontline hospital and primary care health professionals that raises awareness and provides information about the second victim phenomenon. The design of the Mitigating Impact in Second Victims (MISE) online program was based on a literature review, and its contents were selected by a group of 15 experts on patient safety with experience in both clinical and academic settings. The website hosting MISE was subjected to an accreditation process by an external quality agency that specializes in evaluating health websites. The MISE structure and content were evaluated by 26 patient safety managers at hospitals and within primary care in addition to 266 frontline health care professionals who followed the program, taking into account its comprehension, usefulness of the information, and general adequacy. Finally, the amount of knowledge gained from the program was assessed with three objective measures (pre- and posttest design). The website earned Advanced Accreditation for health websites after fulfilling required standards. The comprehension and practical value of the MISE content were positively assessed by 88% (23/26) and 92% (24/26) of patient safety managers, respectively. MISE was positively evaluated by health care professionals, who awarded it 8.8 points out of a maximum 10. Users who finished MISE improved their knowledge on patient safety terminology, prevalence and impact of adverse events and clinical errors, second victim support models, and recommended actions following a severe adverse

  7. The importance of dialogue in student nurses' clinical education. (United States)

    Haugan, Grethe; Sørensen, Ann-Hallfrid; Hanssen, Ingrid


    Develop in-hospital tutorials where the hospital unit's nurse preceptor, the college teacher and student nurses discuss clinical experiences and together acquire knowledge. Literary research combined with examples from a clinical tutorial/discussion group project with B.A. student nurses, clinical nurses and college teacher. Clinical reflection groups may be an important step towards accomplishing stability in a collaborative effort between hospital and college to help students become knowledgeable, perceptive, reflecting, caring and effective nurses. The teacher's role in clinical practice is changing. The learning method described in this text, however resource-demanding, furthers close collaboration between hospital and college, and success depends on the educator's and clinician's collective competency. Our experience is that all parties concerned found that they gained a more holistic view of nurse education through participating in a forum focused on students' experiences through patient histories. Copyright © 2011 Elsevier Ltd. All rights reserved.

  8. Students' Assessment and Self-assessment of Nursing Clinical Faculty Competencies: Important Feedback in Clinical Education? (United States)

    Lovrić, Robert; Prlić, Nada; Zec, Davor; Pušeljić, Silvija; Žvanut, Boštjan


    The students' assessment of clinical faculty competencies and the faculty members' self-assessment can provide important information about nursing clinical education. The aim of this study was to identify the differences between the students' assessment of the clinical faculty member's competencies and the faculty member's self-assessment. These differences can reveal interesting insights relevant for improving clinical practice.

  9. Importance of Pharmaceutical Training and Clinical Research at Medical Facilities. (United States)

    Myotoku, Michiaki


    To respond to advancements in medical techniques, and to address the separation of medical and dispensary practices, clinical professors are required to educate human resource staff to become highly-skilled pharmacists. For this purpose, it is extremely important for these professors to learn about cutting-edge practical skills and knowledge, as well as to advance their expertise. In addition, they need to conduct clinical research in cooperation with relevant facilities. As our university does not have its own hospital or pharmacy, it is important to provide training for clinical professors in clinical facilities. Such training mainly involves medical teams' in-hospital rounds and participation in conferences (nutrition support team; NST), operation of the pharmacy department, and intervention targeting improvement in the department's duties. We have conducted collaborative studies, provided research instructions, implemented studies aimed at improving the department's work (pharmacists appointed on wards at all times to ensure medical safety) as well as studies regarding team medical care (nutritional evaluation during outpatient chemotherapy), and resolved issues regarding this work (drug solution mixability in a hand-held constant infusion pump, and a safe pump-filling methods). Thus, it has become possible to keep track of the current state of a pharmacists' work within team medical care, to access information about novel drugs, to view clinical and prescription-claim data, to cooperate with other professionals (e.g., doctors and nurses), to promote pharmacists' self-awareness of their roles in cooperative medical practice, and to effectively maintain the hospital's clinical settings.

  10. Public health importance of lassa fever epidemiology, clinical ...

    African Journals Online (AJOL)

    The public health importance of Lassa fever can not be over emphasized if one considers the high infectivity and mortality rates associated with the disease. This study dealt extensively on the epidemiology, clinical features and current management of Lassa fever through literature review. The aim of this study is to sensitise ...

  11. Reversible left ventricular dysfunction - important clinical problem of contemporary cardiology

    International Nuclear Information System (INIS)

    Witkowski, A.


    An important clinical issue there is determination whether left ventricular damages are reversible or not single photon emission computed tomography and positron computed tomography techniques are shown to provide valuable data in this problem. Article describes basic syndromes connected with left ventricular dysfunction, namely: hibernating myocardium, stunned myocardium and ischemic myocardium preconditioning. (author). 18 refs

  12. The importance of intuition in the occupational medicine clinical consultation. (United States)

    Philipp, R; Philipp, E; Thorne, P


    Clinical consultation involves unspoken elements which flow between doctor and patient. They are vital ingredients of successful patient management but are not easily measured, objective or evidence-based. These elements include empathy and intuition for what the patient is experiencing and trying to express, or indeed suppressing. Time is needed to explore the instinctive feeling for what is important, particularly in present day society which increasingly recognizes the worth of psychosocial factors. This time should be available in the occupational health consultation. In this paper the importance of intuition and its essential value in the clinical interview are traced through history. Differences between intuition and empathy are explored and the use of intuition as a clinical tool is examined.

  13. Graduate admissions in clinical neuropsychology: the importance of undergraduate training. (United States)

    Karazsia, Bryan T; Stavnezer, Amy Jo; Reeves, Jonathan W


    Discussions of and recommendations for the training of clinical neuropsychologists exist at the doctoral, internship, and post-doctoral level. With few exceptions, the literature on undergraduate preparations in clinical neuropsychology is sparse and lacks empirical evidence. In the present study, graduate-level faculty and current trainees completed surveys about graduate school preparations. Faculty expectations of minimum and ideal undergraduate training were highest for research methods, statistics, and assessment. Preferences for "goodness of fit" also emerged as important admissions factors. These results offer evidence for desirable undergraduate preparations for advanced study in clinical neuropsychology. Although undergraduate training in psychology is intentionally broad, results from this study suggest that students who desire advanced study in clinical neuropsychology need to tailor their experiences to be competitive in the application process. The findings have implications for prospective graduate students, faculty who train and mentor undergraduates, and faculty who serve on admissions committees.

  14. The mollusks in zootherapy: traditional medicine and clinical-pharmacological importance

    Directory of Open Access Journals (Sweden)

    Eraldo Medeiros Costa Neto


    Full Text Available The use of animals as sources of medicines is a cross-cultural phenomenon that is historically ancient and geographically widespread. This article reviews the use of mollusks in traditional medicine and discusses the clinical and pharmacological importance of these invertebrates. The roles that mollusks play in folk practices related to the healing and/or prevention of illnesses have been recorded in different social-cultural contexts worldwide. The clinical and therapeutic use of compounds coming from different species of mollusks is recorded in the literature. The chemistry of natural products provided by oysters, mussels, clams, sluggards, and snails has been substantially investigated, but the majority of these studies have focused on the subclasses Opistobranchia and Prosobranchia. Research into the knowledge and practices of folk medicine makes possible a better understanding of the interaction between human beings and the environment, in addition to allowing the elaboration of suitable strategies for the conservation of natural resources.

  15. Minimal clinically important difference in the fibromyalgia impact questionnaire. (United States)

    Bennett, Robert M; Bushmakin, Andrew G; Cappelleri, Joseph C; Zlateva, Gergana; Sadosky, Alesia B


    The Fibromyalgia Impact Questionnaire (FIQ) is a disease-specific composite instrument that measures the effect of problems experienced by patients with fibromyalgia (FM). Utilization of the FIQ in measuring changes due to interventions in FM requires derivation of a clinically meaningful change for that instrument. Analyses were conducted to estimate the minimal clinically important difference (MCID), and to propose FIQ severity categories. Data from 3 similarly designed, 3-month placebo-controlled, clinical treatment trials of pregabalin 300, 450, and 600 mg/day in patients with FM were modeled to estimate the change in the mean FIQ total and stiffness items corresponding to each category on the Patient Global Impression of Change. FIQ severity categories were modeled and determined using established pain severity cutpoints as an anchor. A total of 2228 patients, mean age 49 years, 93% women, with a mean baseline FIQ total score of 62 were treated in the 3 studies. Estimated MCID on a given measure were similar across the studies. In a pooled analysis the estimated MCID (95% confidence interval) was 14% (13; 15) and for FIQ stiffness it was 13% (12; 14). In the severity analysis a FIQ total score from 0 to or= 39 to or=59 to 100 a severe effect. The analysis indicates that a 14% change in the FIQ total score is clinically relevant, and results of these analyses should enhance the clinical utility of the FIQ in research and practice.

  16. Optimizer convergence and local minima errors and their clinical importance

    International Nuclear Information System (INIS)

    Jeraj, Robert; Wu, Chuan; Mackie, Thomas R


    Two of the errors common in the inverse treatment planning optimization have been investigated. The first error is the optimizer convergence error, which appears because of non-perfect convergence to the global or local solution, usually caused by a non-zero stopping criterion. The second error is the local minima error, which occurs when the objective function is not convex and/or the feasible solution space is not convex. The magnitude of the errors, their relative importance in comparison to other errors as well as their clinical significance in terms of tumour control probability (TCP) and normal tissue complication probability (NTCP) were investigated. Two inherently different optimizers, a stochastic simulated annealing and deterministic gradient method were compared on a clinical example. It was found that for typical optimization the optimizer convergence errors are rather small, especially compared to other convergence errors, e.g., convergence errors due to inaccuracy of the current dose calculation algorithms. This indicates that stopping criteria could often be relaxed leading into optimization speed-ups. The local minima errors were also found to be relatively small and typically in the range of the dose calculation convergence errors. Even for the cases where significantly higher objective function scores were obtained the local minima errors were not significantly higher. Clinical evaluation of the optimizer convergence error showed good correlation between the convergence of the clinical TCP or NTCP measures and convergence of the physical dose distribution. On the other hand, the local minima errors resulted in significantly different TCP or NTCP values (up to a factor of 2) indicating clinical importance of the local minima produced by physical optimization

  17. Vitamin D binding protein: a multifunctional protein of clinical importance. (United States)

    Speeckaert, Marijn M; Speeckaert, Reinhart; van Geel, Nanja; Delanghe, Joris R


    Since the discovery of group-specific component and its polymorphism by Hirschfeld in 1959, research has put spotlight on this multifunctional transport protein (vitamin D binding protein, DBP). Besides the transport of vitamin D metabolites, DBP is a plasma glycoprotein with many important functions, including sequestration of actin, modulation of immune and inflammatory responses, binding of fatty acids, and control of bone development. A considerable DBP polymorphism has been described with a specific allele distribution in different geographic area. Multiple studies have shed light on the interesting relationship between polymorphisms of the DBP gene and the susceptibility to diseases. In this review, we give an overview of the multifunctional character of DBP and describe the clinical importance of DBP and its polymorphisms. Finally, we discuss the possibilities to use DBP as a novel therapeutic agent.

  18. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations

    DEFF Research Database (Denmark)

    Dworkin, R.H.; Turk, D.C.; Wyrwich, K.W.


    of 40 participants from universities, governmental agencies, a patient self-help organization, and the pharmaceutical industry considered methodologic issues and research results relevant to determining the clinical importance of changes in the specific outcome measures previously recommended by IMMPACT...


    Directory of Open Access Journals (Sweden)

    I. G. Mikhaylyuk


    Full Text Available The communication between the median and ulnar nerves on the forearm, known as the Martin–Gruber anastomosis, is widespread in the general population. Despite the fact that this connection is described by anatomists in XVIII century, its importance has only recently been appreciated because of the widespread of the electrophysiological techniques in clinical practies. However, in the Russian literature aspects of its practical value described so far is not enough. This article deals with the prevalence of the anastomosis, its anatomical and electrophysiological classification, options innervation of muscles of the hand, is carried out through him, described electrophysiological methods and criteria for its diagnosis, including the collision technique, in healthy subjects and patients with lesions of the median and ulnar nerves, given its practical value. Such a course of nerve fibers through this anastomosis can have a significant impact on the clinical manifestations in patients with lesions of the median and ulnar nerves, as well as the results of an electrophysiological study. Martin–Gruber anastomosis provides variability innervation muscles of the hand, which can make it difficult topic diagnostic damage to the median and ulnar nerves, in addition, because of the connection between the nerves of the clinical presentation may not reflect the extent of their defeat: the hand muscles function can be preserved with full nerve damage or, conversely, significantly disrupted with minimal nerve lesions. Moreover, different electrophysiological findings on patients with pathology of the median or ulnar nerves in the conditions of functioning anastomosis may also complicate the interpretation of the clinical data. Thus, knowledge of the anatomy and physiology of the Martin–Gruber communication as necessary for the electrophysiologist for correct interpretation of the finding and the clinician to accurately diagnose the pathology of the median

  20. Cervical spondylotic myelopathy: the clinical phenomenon and the current pathobiology of an increasingly prevalent and devastating disorder. (United States)

    Kalsi-Ryan, Sukhvinder; Karadimas, Spyridon K; Fehlings, Michael G


    Cervical spondylotic myelopathy (CSM) is a common disorder involving chronic progressive compression of the cervical spinal cord due to degenerative disc disease, spondylosis, or other degenerative pathology. CSM is the most common form of spinal cord impairment and causes functional decline leading to reduced independence and quality of life. Despite a sound understanding of the disease process, clinical presentation and management, a universal definition of CSM and a standardized index of severity are not currently used universally. Work is required to develop a definition and establish clinical predictors of progression to improve management of CSM. Despite advances in decompressive and reconstructive surgery, patients are often left with residual disability. Gaps in knowledge of the pathobiology of CSM have limited therapeutic advances to complement surgery. Although the histopathologic and pathophysiologic similarities between CSM and traumatic spinal cord injury have long been acknowledged, the unique pathomechanisms of CSM remain unexplored. Increased efforts to elucidate CSM pathobiology could lead to the discovery of novel therapeutic targets for human CSM and other spinal cord diseases. Here, the natural history of CSM, epidemiology, clinical presentation, and current methods of clinical management are reported, along with the current state of basic scientific research in the field.

  1. Health status measurement in COPD : the minimal clinically important difference of the clinical COPD questionnaire

    NARCIS (Netherlands)

    Kocks, J. W. H.; Tuinenga, M. G.; Uil, S. M.; van den Berg, J. W. K.; Stahl, E.; van der Molen, T.


    Background: Patient-reported outcomes ( PRO) questionnaires are being increasingly used in COPD clinical studies. The challenge facing investigators is to determine what change is significant, ie what is the minimal clinically important difference (MCID). This study aimed to identify the MCID for

  2. Clinically important drug interactions with zopiclone, zolpidem and zaleplon. (United States)

    Hesse, Leah M; von Moltke, Lisa L; Greenblatt, David J


    Insomnia, an inability to initiate or maintain sleep, affects approximately one-third of the American population. Conventional benzodiazepines, such as triazolam and midazolam, were the treatment of choice for short-term insomnia for many years but are associated with adverse effects such as rebound insomnia, withdrawal and dependency. The newer hypnosedatives include zolpidem, zaleplon and zopiclone. These agents may be preferred over conventional benzodiazepines to treat short-term insomnia because they may be less likely to cause significant rebound insomnia or tolerance and are as efficacious as the conventional benzodiazepines. This review aims to summarise the published clinical drug interaction studies involving zolpidem, zaleplon and zopiclone. The pharmacokinetic and pharmacodynamic interactions that may be clinically important are highlighted. Clinical trials have studied potential interactions of zaleplon, zolpidem and zopiclone with the following types of drugs: cytochrome P450 (CYP) inducers (rifampicin), CYP inhibitors (azoles, ritonavir and erythromycin), histamine H(2) receptor antagonists (cimetidine and ranitidine), antidepressants, antipsychotics, antagonists of benzodiazepines and drugs causing sedation. Rifampicin significantly induced the metabolism of the newer hypnosedatives and decreased their sedative effects, indicating that a dose increase of these agents may be necessary when they are administered with rifampicin. Ketoconazole, erythromycin and cimetidine inhibited the metabolism of the newer hypnosedatives and enhanced their sedative effects, suggesting that a dose reduction may be required. Addition of ethanol to treatment with the newer hypnosedatives resulted in additive sedative effects without altering the pharmacokinetic parameters of the drugs. Compared with some of the conventional benzodiazepines, fewer clinically important interactions appear to have been reported in the literature with zaleplon, zolpidem and zopiclone. The

  3. Raynaud’s phenomenon

    Directory of Open Access Journals (Sweden)

    F. Ingegnoli


    Full Text Available Raynaud’s phenomenon (RP is a vasospastic disorder characterized by episodic color changes of blanching, cyanosis, and hyperemia in response to cold and/or emotional stress. Although most typically noted in the fingers, the circulation of the toes, ears, nose and tongue is also frequently affected. Population studies have shown that RP in adults is more common in women than men, with prevalence estimates ranging from 4% to 30%. Geographic variations in the prevalence reflect differences in climate. RP may be a primary or a secondary process. LeRoy and Medsger suggested criteria for primary RP: symmetric attacks, the absence of tissue necrosis, ulceration or gangrene, the absence of a secondary cause, negative antinuclear antibodies, normal nailfold capillaroscopy and a normal erythrocyte sedimentation rate. Secondary RP is characterized by an age of onset of more than 30 years, painful and asymmetric attacks, ischemic skin lesions, positive autoautoantibodies, capillaroscopic abnormalities and/or clinical features suggestive of connective tissue diseases (CTDs. Among the CTDs, systemic sclerosis has the highest frequency of RP. Finding a cause for RP requires a knowledge of the patient’s occupational, smoking, drug history, physical examination, nailfold capillaroscopy, routine laboratory tests and autoantibodies. Furthermore, RP should be distinguished from acrocyanosis, a condition characterized by continuous cyanosis of the hands or feet that is aggravated by cold temperature. The most important instruction to the patient is abstinence from any smoking, offending drugs should be discontinued, and abrupt changes in temperature. If these measures are inadequate, calcium-channel blockers are the most widely used (nifedipine 30 mg up to 90 mg daily. Alternatively, sympatholytic agent (prazosin, angiotensin II -receptor type I antagonist (losartan, selective sertonin-reuptake inhibitor (fluoxetine may be useful. In the severe cases the role of

  4. Clinical importance of voluntary and induced Bennett movement. (United States)

    Tupac, R G


    A total of 136 dentulous patients were divided into three groups for purposes of quantitative pantographic comparison of voluntary and induced Bennett movement. The effects of patient age and operator experience on recording the Bennett movement were also studied. The results indicates that for patients studied with Bennett movement iduced in the manner described: 1. Experienced operators can obtain more induced Bennett movement that inexperienced operators. 2. Inducing Bennett movement has a greater effect on the immediate side shift component than it has on the progressive side shift component. 3. For older individuals the amount and direction of induced immediate side shift is greater than for younger patients, statistically highly significant, and therefore clinically important. In conclusion, if the objective of a pantographic survey is to record the complete capacity of the joint to move, *lateral jaw movements must be induced.

  5. The importance of clinical case reports in research

    Directory of Open Access Journals (Sweden)

    Ricardo Pineda-Leguízamo


    Full Text Available Clinical case reports correspond to articles that have the lowest level of evidence within different research trials. However, not only are they common and significant in the medical field, but they have often been the basis the generation of research. The purpose of their publication can be scientific or educational. In general terms, the discovery of new diseases, the presentation of rare diseases, unusual forms of common diseases, the complications of a common treatment, or the effect (beneficial or adverse of a treatment, among other things, are narrated in these documents. Clinical case reports continue to be one of the most important sources of knowledge. The advent of a standardized guideline for the creation of this type of reports allows homogenizing the form and content of the cases intended to be described in the near future and, furthermore, will enable authors to have a reference when preparing this type of publications. Case reports are valuable resources of new and unusual information that can encourage and serve to conduct future research studies with a higher level of evidence.

  6. Bactericidal effects of bioactive glasses on clinically important aerobic bacteria. (United States)

    Munukka, Eveliina; Leppäranta, Outi; Korkeamäki, Mika; Vaahtio, Minna; Peltola, Timo; Zhang, Di; Hupa, Leena; Ylänen, Heimo; Salonen, Jukka I; Viljanen, Matti K; Eerola, Erkki


    Bioactive glasses (BAGs) have been studied for decades for clinical use, and they have found many dental and orthopedic applications. BAGs have also been shown to have an antibacterial effect e.g., on some oral microorganisms. In this extensive work we show that six powdered BAGs and two sol-gel derived materials have a clear antibacterial effect on 29 clinically important bacterial species. We also incorporated a rapid and accurate flow cytometric (FCM) method to calculate and standardize the numbers of viable bacteria inoculated in the suspensions used in the tests for antibacterial activity. In all materials tested growth inhibition could be demonstrated, although the concentration and time needed for the effect varied depending on the BAG. The most effective glass was S53P4, which had a clear growth-inhibitory effect on all pathogens tested. The sol-gel derived materials CaPSiO and CaPSiO II also showed a strong antibacterial effect. In summary, BAGs were found to clearly inhibit the growth of a wide selection of bacterial species causing e.g., infections on the surfaces of prostheses in the body after implantation.

  7. Variations in Transverse Foramina of Cervical Vertebrae: Morphology & Clinical Importance

    Directory of Open Access Journals (Sweden)

    Vaishakhi Gonsai


    Full Text Available Background: The purpose of this study is to investigate variations in transverse foramina in the cervical vertebrae and its morphological and clinical importance. Materials and Method : The variations in the number and size of transverse foramina was studied in total 200 human dried cervical vertebrae, which were taken from the Department of Anatomy, B.J.Medical College, Ahmedabad. All the vertebrae were observed for variation in number and size of transverse foramina. Results: Out of 200 cervical vertebrae, complete double transverse foramina were observed in 40 vertebrae (20%, among them unilateral double foramina were found in 31 vertebrae (15.5% and the bilateral double foramina were found in 9 vertebrae (4.5%. Incomplete double transverse foramina were observed in 22 vertebrae (11%, among them unilateral double foramina were found in 16 vertebrae (8% and bilateral double foramina were observed in 6 vertebrae (3%. Conclusion: Complete unilateral double transverse foramina of cervical vertebrae were more common than bilateral. Also unilateral small size transverse foramina of cervical vertebrae were also common. This variation is important for the neurosurgeon during cervical surgery. Under such condition the course of the vertebral artery may be distorted. It is also useful for Radiologist during CT and MRI scan.

  8. Importance of training on clinical thinking and clinical competence to interventional radiologists

    International Nuclear Information System (INIS)

    Xu Ke; Zhong Hongshan


    Although the history of Interventional Radiology is no longer than 50 years, interventional techniques have been dramatically developed. Interventional radiologists have been responsible for much of the medical innovations and development of the minimally invasive procedures that are commonplace today to treat many complicated diseases as physicians. But the education backgrounds of interventional radiologist in China are different. Therefore, we should be aware that the job of an interventional radiologist is totally different from that of a diagnostic radiologist. It is very important to train interventional radiologists for improving their clinical thinking and clinical competence. Herein, we propose our suggestions on how to improve the clinical thinking and clinical competence of interventional radiologists. In this paper we also systemically introduce the accurate and proper treatment procedures which should be strictly followed in clinical work and,meanwhile, the perioperative patients care is emphasized. (authors)

  9. PET: the importance of physicists for the clinical arena

    CERN Multimedia


    David Townsend giving a seminar at CERN on 9 February. The past few years have seen significant advances in the development of instrumentation for Positron Emission Tomography (PET). The recent appearance of combined PET and Computed Tomography (CT) scanners that can simultaneously image both anatomy and function is of particular importance. This was the main subject of "Advances in PET imaging: from physics to physician", a seminar presented at CERN by David Townsend on Wednesday 9 February  and organized by the TT and PH groups. David Townsend, who started his career at CERN in the 1970s, is now Professor at the Department of Medicine, University of Tennessee Medical Center (Knoxville, TN). Recipient of the 2004 Clinical Scientist of the Year Award, he is an internationally renowned researcher and PET physicist, with over 25 years of experience in the field. His 1999 image of the year, an award from the Society of Nuclear Medicine in the US, was produced using a combined state-of-the art PET and a true d...

  10. Is statistical significance clinically important?--A guide to judge the clinical relevance of study findings

    NARCIS (Netherlands)

    Sierevelt, Inger N.; van Oldenrijk, Jakob; Poolman, Rudolf W.


    In this paper we describe several issues that influence the reporting of statistical significance in relation to clinical importance, since misinterpretation of p values is a common issue in orthopaedic literature. Orthopaedic research is tormented by the risks of false-positive (type I error) and


    Directory of Open Access Journals (Sweden)

    Marius Ezer


    Full Text Available Moral harassment at the workplace has become in the last period a very often met phenomenon that severely affects the work relations and represents a significant health and safety danger. This problem has become in the last period an important issue for the European Union which has initiated a series of studie for analyzing the consequences of this pehenomenon on the normal process of the work relations, that has lead, in its turn to an awareness of this new dimenion of harassment between the employees at the internal level.

  12. Copy number variation plays an important role in clinical epilepsy (United States)

    Olson, Heather; Shen, Yiping; Avallone, Jennifer; Sheidley, Beth R.; Pinsky, Rebecca; Bergin, Ann M.; Berry, Gerard T.; Duffy, Frank H.; Eksioglu, Yaman; Harris, David J.; Hisama, Fuki M.; Ho, Eugenia; Irons, Mira; Jacobsen, Christina M.; James, Philip; Kothare, Sanjeev; Khwaja, Omar; Lipton, Jonathan; Loddenkemper, Tobias; Markowitz, Jennifer; Maski, Kiran; Megerian, J. Thomas; Neilan, Edward; Raffalli, Peter C.; Robbins, Michael; Roberts, Amy; Roe, Eugene; Rollins, Caitlin; Sahin, Mustafa; Sarco, Dean; Schonwald, Alison; Smith, Sharon E.; Soul, Janet; Stoler, Joan M.; Takeoka, Masanori; Tan, Wen-Han; Torres, Alcy R.; Tsai, Peter; Urion, David K.; Weissman, Laura; Wolff, Robert; Wu, Bai-Lin; Miller, David T.; Poduri, Annapurna


    Objective To evaluate the role of copy number abnormalities detectable by chromosomal microarray (CMA) testing in patients with epilepsy at a tertiary care center. Methods We identified patients with ICD-9 codes for epilepsy or seizures and clinical CMA testing performed between October 2006 and February 2011 at Boston Children’s Hospital. We reviewed medical records and included patients meeting criteria for epilepsy. We phenotypically characterized patients with epilepsy-associated abnormalities on CMA. Results Of 973 patients who had CMA and ICD-9 codes for epilepsy or seizures, 805 patients satisfied criteria for epilepsy. We observed 437 copy number variants (CNVs) in 323 patients (1–4 per patient), including 185 (42%) deletions and 252 (58%) duplications. Forty (9%) were confirmed de novo, 186 (43%) were inherited, and parental data were unavailable for 211 (48%). Excluding full chromosome trisomies, CNV size ranged from 18 kb to 142 Mb, and 34% were over 500 kb. In at least 40 cases (5%), the epilepsy phenotype was explained by a CNV, including 29 patients with epilepsy-associated syndromes and 11 with likely disease-associated CNVs involving epilepsy genes or “hotspots.” We observed numerous recurrent CNVs including 10 involving loss or gain of Xp22.31, a region described in patients with and without epilepsy. Interpretation Copy number abnormalities play an important role in patients with epilepsy. Given that the diagnostic yield of CMA for epilepsy patients is similar to the yield in autism spectrum disorders and in prenatal diagnosis, for which published guidelines recommend testing with CMA, we recommend the implementation of CMA in the evaluation of unexplained epilepsy. PMID:24811917

  13. Clinical importance of cross-reactivity in food allergy

    NARCIS (Netherlands)

    van Ree, Ronald


    PURPOSE OF REVIEW: Review of recent developments in the field of cross-reactivity in food allergy and the clinical relevance of these developments. RECENT FINDINGS: New foods have been added to the list of Bet v 1 and profilin-related food allergies. Clinical relevance of cross-reactions based on

  14. Is the Hegemonic Position of American Culture Able to Subjugate Local Cultures of Importing Countries? A Constructive Analysis on the Phenomenon of Cultural Localization (United States)

    Chiang, Tien-Hui


    It has been argued that globalization assists the USA to gain a hegemonic position, allowing it to export its culture. Because this exportation leads to the domination by American culture of the local cultures of importing countries, which are the key element in sustaining their citizens' national identity, citizens of these countries are…

  15. Clinical and Business Intelligence: Why It's Important to Your Pharmacy. (United States)

    Pinto, Brian; Fox, Brent I


    According to the Healthcare Information Management and Systems Society, "Clinical & Business Intelligence (C&BI) is the use and analysis of data captured in the healthcare setting to directly inform decision-making" ( Some say that it is the right information given to the right person at the right time in the right way. No matter how you define it, the fact remains that timely access, synthesis, and visualization of clinical data have become key to how health professionals make patient care decisions and improve care delivery.

  16. Importance of clinical microbiologists for U.S. healthcare infrastructure. (United States)

    Carvalho, John


    Clinical microbiologists are highly skilled scientists within national hospitals and reference laboratories who diagnose patients with infections by emerging pathogens. Most advanced training for clinical microbiologists occurs at universities, where an individual can receive certification as a "Medical Laboratory Scientist" (MLS). Unfortunately, many MLS programs have closed in the United States and this has caused a shortage of clinical microbiologists at U.S. hospitals and reference laboratories. This paper explores the present crisis in MLS training and its ramifications for the emergence of antibiotic-resistant bacteria, the economics of hospitals, and the overall health of the nation, and provides resolutions for better public health policy with respect to MLS education.

  17. Clinical Significance of Reverse Redistribution Phenomenon on Delayed Tc-99m Tetrofosmin Myocardial Perfusion Imaging in Patients with Acute Myocardial Infarction

    International Nuclear Information System (INIS)

    Park, Soon Ah; Kim, Dae Weung; Kim, Chang Guhn; Jeong, Jin Won; Kim, Nam Ho; Yun, Kyeong Ho


    This study was performed to investigate the clinical significance of reverse redistribution (RR) phenomenon detected on delayed Tc-99m tetrofosmin myocardial single photon emission computed tomography (SPECT) in patients with acute myocardial infarction after revascularization. A Tc-99m tetrofrosmin myocardial SPECT was performed in 67 consecutive patients after revascularization for acute myocardial infarction. Myocardial SPECT imaging was performed for early imaging at 40 min and for delayed imaging at 180 min after reinjection at myocardial stress. Regional myocardial uptakes were scored by 4-point scoring in the left ventricular wall divided into 17 segments. Reverse redistribution was defined as an increase of more than 2 point in the activity score on the delayed image. Follow-up myocardial SPECT and coronary angiography (CAG) were performed 9 months later. On myocardial SPECT performed following revascularization, RR was observed in 100 of all 319 segments (31%) and in 43 patients (64%). The abnormalities of perfusion and regional wall motion were more severe in the patients with RR compared to those without RR (p<0.05). On follow-up myocardial SPECT, the myocardial perfusion, regional wall motion, and myocardial thickness were significantly improved in the patients with RR (p<0.05) however, these changes were not significant in those without RR. There was no significant difference between the patients with RR and those without RR in the occurrence of restenosis on CAG. In patients with acute myocardial infarction, the regions showing the RR phenomenon on delayed Tc-99m tetrofosmin SPECT may reflect viable myocardium and indicate recovery of salvaged myocardium

  18. Participation in HIV research: the importance of clinic contact factors. (United States)

    Worthington, Catherine A; Gill, M John


    Recruiting minority populations living with HIV to many types of clinic-based HIV research is a concern. This study examined an expanded range of predictors of HIV research participation (clinic contact, clinical, and personal characteristics) to investigate observed ethnocultural differences in HIV research participation. Research participation was defined as participation in any of diagnostic, pathogenesis, drug trial or survey research. Logistic regression modeling was used to predict research participation of 657 eligible patients (93% of the patient population) who began care between January 1997 and the end of September 2003 at a regional outpatient HIV care program in Calgary, Canada. Approximately one third (32%) were non-white, including 18% Aboriginal, 9% black, 4% Asian, and 1% Hispanic individuals. Twenty-nine percent (187/657) of the patients participated in at least one study of any kind. Multivariate analysis indicated that the strongest predictors of any research participation (including diagnostic, pathogenesis, drug trial, or survey studies) are clinical (including nadir CD4 count [odds ratio {OR} = 0.132, p percentage of appointments kept [OR = 1.022, p service use shown by these groups that may influence research participation. To attract under researched populations, attention should shift from the "who" of research participation to the "how" of clinical interactions.

  19. 3D molecular descriptors important for clinical success. (United States)

    Kombo, David C; Tallapragada, Kartik; Jain, Rachit; Chewning, Joseph; Mazurov, Anatoly A; Speake, Jason D; Hauser, Terry A; Toler, Steve


    The pharmacokinetic and safety profiles of clinical drug candidates are greatly influenced by their requisite physicochemical properties. In particular, it has been shown that 2D molecular descriptors such as fraction of Sp3 carbon atoms (Fsp3) and number of stereo centers correlate with clinical success. Using the proteomic off-target hit rate of nicotinic ligands, we found that shape-based 3D descriptors such as the radius of gyration and shadow indices discriminate off-target promiscuity better than do Fsp3 and the number of stereo centers. We have deduced the relevant descriptor values required for a ligand to be nonpromiscuous. Investigating the MDL Drug Data Report (MDDR) database as compounds move from the preclinical stage toward the market, we have found that these shape-based 3D descriptors predict clinical success of compounds at preclinical and phase1 stages vs compounds withdrawn from the market better than do Fsp3 and LogD. Further, these computed 3D molecular descriptors correlate well with experimentally observed solubility, which is among well-known physicochemical properties that drive clinical success. We also found that about 84% of launched drugs satisfy either Shadow index or Fsp3 criteria, whereas withdrawn and discontinued compounds fail to meet the same criteria. Our studies suggest that spherical compounds (rather than their elongated counterparts) with a minimal number of aromatic rings may exhibit a high propensity to advance from clinical trials to market.

  20. Secondary Hemophagocytic Syndrome: The Importance of Clinical Suspicion

    Directory of Open Access Journals (Sweden)

    Cristina Oliveira


    Full Text Available Hemophagocytic syndrome is a rare and potentially fatal disorder characterized by pathological immune activation associated with a primary familial disorder, genetic mutations, or occurring as a sporadic condition. The latter can be secondary to infections, malignancies, or autoimmune diseases. Clinically, patients present signs of severe inflammation, with unremitting fever, cytopenias, spleen enlargement, phagocytosis of bone marrow elements, hypertriglyceridemia, and hypofibrinogenemia. Increased suspicion is determinant to timely initiate treatment in an attempt to alter the natural history. The authors present three clinical cases of this syndrome, with a brief review of the diagnostic criteria and treatment.

  1. Sleep syncope: Important clinical associations with phobia and vagotonia

    NARCIS (Netherlands)

    Busweiler, L.; Jardine, D. L.; Frampton, C. M.; Wieling, W.


    Objectives: To compare demographic and clinical data from patients with sleep syncope to those of patients with "classical" vasovagal syncope [VVS] collected over the last 8 years. Design: Retrospective case-controlled study. Setting: Syncope unit. Patients and methods: Fifty-four patients with a

  2. Importance of placebo effect in cough clinical trials. (United States)

    Eccles, Ron


    Cough is a unique symptom because, unlike sneeze and other symptoms, it can be under voluntary control and this complicates clinical trials on cough medicines. All over-the-counter cough medicines (OTC) are very effective treatments because of their placebo effect. The placebo effect is enhanced by expectancy related to advertising, brand, packaging, and formulation. This placebo effect creates a problem for the conduct of clinical trials on OTC cough medicines that attempt to demonstrate the efficacy of a pharmacological agent above that of any placebo effect. Up to 85% of the efficacy of some cough medicines can be attributed to a placebo effect. The placebo effect apparent in clinical trials consists of several components: natural recovery, regression of cough response toward mean, demulcent effect, effect of sweetness, voluntary control, and effects related to expectancy and meaning of the treatment. The placebo effect has been studied most in the pain model, and placebo analgesia is reported to depend on the activation of endogenous opioid systems in the brain; this model may be applicable to cough. A balanced placebo design may help to control for the placebo effect, but this trial design may not be acceptable due to deception of patients. The placebo effect in clinical trials may be controlled by use of a crossover design, where feasible, and the changes in the magnitude of the placebo effect in this study design are discussed.

  3. [Recurrent clinical mastitis in dairy cattle - importance and causes]. (United States)

    Grieger, A-S; Zoche-Golob, V; Paduch, J-H; Hoedemaker, M; Krömker, V


    Clinical mastitis as a frequently recurrent event can cause substantive economic loss on dairy farms. The reason for recurrent mastitis can be either a persistent infection of the bovine mammary gland by a mastitis pathogen or a reinfection of a quarter or udder after bacteriological cure. The virulence properties of a mastitis pathogen and the cure odds of an individual cow determine the development of persistent infections. Clinical episodes may alternate with periods without symptoms in the course of persistent infections. Strategies to reduce cases of recurrent mastitis have to include improved treatment concepts and measures to decrease new infection rates. The present literature review summarises the knowledge of definitions, frequencies, causes and effects of recurrent mastitis.

  4. Financial disclosure and clinical research: what is important to participants? (United States)

    Hutchinson, Anastasia; Rubinfeld, Abe R


    To assess what participants in company-sponsored clinical trials wish to know about financial aspects of the study. Cross-sectional questionnaire administered to 324 participants in six clinical trials conducted at the Royal Melbourne Hospital in 1999-2000 and 2006 for non-acute conditions (asthma, chronic obstructive pulmonary disease, osteoporosis, rheumatoid arthritis, diabetes and influenza vaccine efficacy). Participants' desire for information on study funding, investigators' conflicts of interest, and use of accrued funds. 259 participants (80%) completed the survey. Participants wanted to be informed about the identity of the project sponsor (148 participants; 57%), whether the investigators owned shares in the company (105; 41%) or received travel grants (83; 32%), how much funding was accrued at study completion (88; 34%), how accrued funds were used (98; 38%), and who approved their use (91; 35%). After adjusting for year of survey and level of education, younger subjects (aged informed more often than older participants of who sponsored the project (odds ratio [OR], 2.35 [95% CI, 1.21-4.55]; P=0.012), whether the investigators owned shares in the company (OR, 2.41 [95% CI, 1.27-4.60]; P=0.007) and how much funding was available for other uses (OR, 1.79 [95% CI, 0.94-3.41]; P=0.078). While most participants indicated that they would take part in clinical research again regardless of whether they received financial information, providing information on the sponsor, the investigators' financial interest in the company, whether accrual of funds is expected, and how these funds will be spent should satisfy the interests of participants in company-sponsored clinical trials.

  5. Health status measurement in COPD: the minimal clinically important difference of the clinical COPD questionnaire

    Directory of Open Access Journals (Sweden)

    van den Berg JWK


    Full Text Available Abstract Background Patient-reported outcomes (PRO questionnaires are being increasingly used in COPD clinical studies. The challenge facing investigators is to determine what change is significant, ie what is the minimal clinically important difference (MCID. This study aimed to identify the MCID for the clinical COPD questionnaire (CCQ in terms of patient referencing, criterion referencing, and by the standard error of measurement (SEM. Methods Patients were ≥40 years of age, diagnosed with COPD, had a smoking history of >10 pack-years, and were participating in a randomized, controlled clinical trial comparing intravenous and oral prednisolone in patients admitted with an acute exacerbation of COPD. The CCQ was completed on Days 1–7 and 42. A Global Rating of Change (GRC assessment was taken to establish the MCID by patient referencing. For criterion referencing, health events during a period of 1 year after Day 42 were included in this analysis. Results 210 patients were recruited, 168 completed the CCQ questionnaire on Day42. The MCID of the CCQ total score, as indicated by patient referencing in terms of the GRC, was 0.44. The MCID of the CCQ in terms of criterion referencing for the major outcomes was 0.39, and calculation of the SEM resulted in a value of 0.21. Conclusion This investigation, which is the first to determine the MCID of a PRO questionnaire via more than one approach, indicates that the MCID of the CCQ total score is 0.4.

  6. Taxonomy and antifungal susceptibility of clinically important Rasamsonia species

    DEFF Research Database (Denmark)

    Houbraken, J.; Giraud, S.; Meijer, M.


    In recent years, Geosmithia argillacea has been increasingly reported in humans and animals and can be considered an emerging pathogen. The taxonomy of Geosmithia was recently studied, and Geosmithia argillacea and related species were transferred to the new genus Rasamsonia. The diversity among...... reported clinical isolates from animal or human patients. Susceptibility tests showed that the antifungal susceptibility profiles of the four members of the R. argillacea complex are similar, and caspofungin showed significant activity in vitro, followed by amphotericin B and posaconazole. Voriconazole...


    Directory of Open Access Journals (Sweden)

    T A Nevskaya


    Full Text Available The aim of the study was to investigate whether serum levels of interleukin-4 ( IL-4 reflects the clinical disease status and laboratory features of systemic sclerosis (SSc. IL-4 was measured by ELISA in forty patients wilh SSc. We revealed IL-4 (Ю-lOOOpg/ml in sera from 12 of 40 pts (30%. These pts had significantly less duration of disease, the progression of skin and visceral involvement by the time of investigation and a trend lo the greater frequency of lung fibrosis. There was no correlation of IL-4 level with type of SSc. The pts with increased scrum levels of IL-4 had higher levels of circulated immune complexes, y-globulins, but the levels of acute phase reactants (CRP, fibrinogen were lower compared with the of others. We suggest that serum IL-4 may serve a biologic marker for the progression of skin and lung fibrosis, but the results require confirmation in longitudinal study.

  8. What is clinical leadership…and why is it important? (United States)

    Swanwick, Tim; McKimm, Judy


    The 'invitation' for clinicians to participate in leadership practices, previously considered the province of the professional health service manager, is driven by a number of international policy and professional agendas. This article, the first in a short series, considers definitions and theories of clinical leadership and management, and explores leadership roles and responsibilities of the clinician in terms of levels of engagement. Recent developments in the UK's National Health Service (NHS), the largest health care organisation in the world, are used as illustrations of how theory has informed clinical leadership development. Narrative review and discussion. The tensions arising from the situation of health care professionals within managed health care are described. Leadership is defined alongside its relationship to management. Key theories of leadership are considered and applications of theory to practice explored. The role and usefulness of the 'competency framework' in leadership development is debated. Health care is delivered by complex systems often involving large numbers of individuals and organisations. The effective clinician needs to understand these pathways and systems of care if they are to be able to function effectively, and must be comfortable working both within, and with, these systems for the benefit of their patients. Engaging in leading and managing systems of health care, on whatever scale - team, department, unit, hospital or health authority - is therefore a professional obligation of all clinicians. Just as leadership is argued to be necessary 'at all levels', so 'leadership development', assessment and feedback must be provided throughout the education and training of health professionals. © Blackwell Publishing Ltd 2011.

  9. Biometrics of Pyramidalis Muscle and its Clinical Importance. (United States)

    Das, Sushant Swaroop; Saluja, Sandeep; Vasudeva, Neelam


    Pyramidalis is classified as a vestigial muscle which is frequently present. It is muscle of the anterior abdominal wall. It is thought to tense the linea alba. It has been used as a surgical landmark, source of muscle stem cells and in various surgical procedures. The aim of this study was to describe the morphometry and morphology of pyramidalis muscle in an adult Indian population and its correlation with the clinical significance. A cadaveric study on 25 formalin fixed cadavers (males-17, females-8) was conducted in context with prevalence, morphology and morphometry of pyramidalis muscle. Statistical analysis was done using the Chi-Square test and student's t-test using SPSS version 23. The pyramidalis muscle was present in 92% cases, usually bilaterally (72%) than unilaterally (20%) and more frequently in males (94.11%) than in females (87.5%). This study was conducted in Department of Anatomy, Maulana Azad Medical College, New Delhi, India from August 2014 to August 2016. Bilateral asymmetry was reported. The mean length of the muscle in males and females was 52.21±14.32 and 50.13±13.62mm on the right and 53.97±15.11 and 51.22±13.78mm on the left side. No significant gender predominance existed on the right and left-sided pyramidalis lengths. The mean width of the right-sided pyramidalis in males and females was 18.35±5.15 and 17.05±4.99mm and the left-sided was 17.8±4.80 and 16.21±4.23mm without gender dimorphism. The mean thickness of the right-sided pyramidalis in males and females was 4.91±1.33 and 4.53±1.29mm and the left-sided 4.33±1.28 and 4.38±1.27mm without gender differences. The mean pyramidalis-puboumbilical index was 35.15±4.38%, 36.01±4.97% in males and females respectively. No anatomical variations with regard to origin and insertion were seen. This study provides valuable information on pyramidalis muscle which may help in appropriate understanding of anatomy, functions and clinical significance of the muscle.

  10. Bone biology in the elderly: clinical importance for fracture treatment

    Directory of Open Access Journals (Sweden)

    Rolvien Tim


    Full Text Available Age-related bone impairment often leads to fragility fractures in the elderly. Although excellent surgical care is widely provided, diagnosis and treatment of the underlying bone disorder are often not kept in mind. The interplay of the three major bone cells – osteoblasts, osteoclasts, and osteocytes – is normally well regulated via the secretion of messengers to control bone remodeling. Possible imbalances that might occur in the elderly are partly due to age, genetic risk factors, and adverse lifestyle factors but importantly also due to imbalances in calcium homeostasis (mostly due to vitamin D deficiency or hypochlorhydria, which have to be eliminated. Therefore, the cooperation between the trauma surgeon and the osteologist is of major importance to diagnose and treat the respective patients at risk. We propose that any patient suffering from fragility fractures is rigorously screened for osteoporosis and metabolic bone diseases. This includes bone density measurement by dual-energy X-ray absorptiometry, laboratory tests for calcium, phosphate, vitamin D, and bone turnover markers, as well as additional diagnostic modalities if needed. Thereby, most risk factors, including vitamin D deficiency, can be identified and treated while patients who meet the criteria for a specific therapy (i.e. antiresorptive and osteoanabolic receive such. If local health systems succeed to manage this process of secondary fracture prevention, morbidity and mortality of fragility fractures will decline to a minimum level.

  11. Polymorphism of human haptoglobin and its clinical importance

    Directory of Open Access Journals (Sweden)

    Vânia Peretti de Albuquerque Wobeto


    Full Text Available Haptoglobin (Hp is a plasma glycoprotein, the main biological function of which is to bind free hemoglobin (Hb and prevent the loss of iron and subsequent kidney damage following intravascular hemolysis. Haptoglobin is also a positive acute-phase protein with immunomodulatory properties. In humans, the HP locus is polymorphic, with two codominant alleles (HP1 and HP2 that yield three distinct genotypes/phenotypes (Hp1-1, Hp2-1 and Hp2-2. The corresponding proteins have structural and functional differences that may influence the susceptibility and/or outcome in several diseases. This article summarizes the available data on the structure and functions of Hp and the possible effects of Hp polymorphism in a number of important human disorders.

  12. The clinical importance of radiological determination of the heart volume

    International Nuclear Information System (INIS)

    Jaedicke, W.; Ong, T.S.; Barmeyer, J.


    The size of the heart is an autonomous, important parameter of its functional state, i.e. in the radiologic heart diagnostics, the measurement of the heart volume is of equal value as the shape analysis. A size determination which must be exact enough for course controls and differentiation from the normal picture makes sense only if the measurement is carriet out in 3 dimensions and not in only one as is done when determining the heart-lung-quotient. The heart volume measurement carried out in lying or sitting position is considerably more reliable than in standing position as too many extracardiac factors influence the heart volume when the patient is standing. The echo cardiogram is a nearly ideal supplement but no competitor of radiological heart volume measurement and can be of the same value as or superior to heart volume measurement for functional diagnostics only in diseases limited to nearly exclusively to the left ventricle as in coronary diseases. (orig.) [de

  13. Antibiotic resistance plasmids of Staphylococcus aureus and their clinical importance

    International Nuclear Information System (INIS)

    Lacey, R.W.


    A variety of plasmids were isolated physically, and most antibiotic resistance is thought to be plasmid mediated. A number of characters (e.g., resistance to erythromycin or methicillin, and production of pigment) are determined by genes that do not give clear indications of either plasmid or chromosomal location. Although the formation of a particular plasmid is probably, even in bacterial terms, a very rare event, once formed such an element can spread rapidly among the bacterial population. The spectacular increase in the incidence of penicillinase-producing hospital strains in the late 1940's could have been due in part to this process. Evidence is stronger, however, for the intercell transfer of recently isolated plasmids coding for resistance to fusidic acid (and penicillinase production), or for neomycin, or for tetracycline resistance. Study of bacterial plasmids can resolve fundamental biochemical problems, and give some insight into the life of the cell at the molecular level. But the immediate application of the study of staphylococcal plasmids may be directed towards improving the effectiveness of antibiotic therapy. The most important aspect of future anti-staphylococcal chemotherapy should thus be the limitation of the use of antibiotics, particularly for application to the skin and nose. (U.S.)

  14. The human coronary collateral circulation: development and clinical importance. (United States)

    Seiler, Christian; Stoller, Michael; Pitt, Bertram; Meier, Pascal


    Coronary collaterals are an alternative source of blood supply to myocardium jeopardized by ischaemia. In comparison with other species, the human coronary collateral circulation is very well developed. Among individuals without coronary artery disease (CAD), there are preformed collateral arteries preventing myocardial ischaemia during a brief vascular occlusion in 20-25%. Determinants of such anastomoses are low heart rate and the absence of systemic arterial hypertension. In patients with CAD, collateral arteries preventing myocardial ischaemia during a brief occlusion are present in every third individual. Collateral flow sufficient to prevent myocardial ischaemia during coronary occlusion amounts to one-fifth to one-fourth the normal flow through the open vessel. Myocardial infarct size, the most important prognostic determinant after such an event, is the product of coronary artery occlusion time, area at risk for infarction, and the inverse of collateral supply. Well-developed coronary collateral arteries in patients with CAD mitigate myocardial infarcts and improve survival. Approximately one-fifth of patients with CAD cannot be revascularized by percutaneous coronary intervention or coronary artery bypass grafting. Therapeutic promotion of collateral growth is a valuable treatment strategy in those patients. It should aim at growth of large conductive collateral arteries (arteriogenesis). Potential arteriogenic approaches include the treatment with granulocyte colony-stimulating factor, physical exercise training, and external counterpulsation.

  15. The impostor phenomenon

    DEFF Research Database (Denmark)

    Ringby, Betina; Østergaard, Gert Værge; Bønnelykke, Helle

    Persons suffering from the impostor phenomenon often fail to thrive and might be in danger of dropping out of studies. The impostor-phenomenon relates to people who are both skillful and capable, but sees themselves as frauds and as someone who is not worthy of good grades, appraisal for their work...

  16. Interfacial phenomenon theory

    International Nuclear Information System (INIS)

    Kim, Jong Deuk


    This book is composed of 8 chapters. It tells what interfacial phenomenon is by showing interfacial energy, characteristic of interface and system of interface from chapter 1. It also introduces interfacial energy and structure theory, molecular structure and orientation theory, and interfacial electricity phenomenon theory in the following 3 chapters. It still goes on by introducing super molecule cluster, disequilibrium dispersion, and surface and film through 3 chapters. And the last chapter is about colloid and application of interface.

  17. Rescuing--a universal phenomenon. (United States)

    Little, John


    Rescuing, where the person is delivered from the immediacy of their conundrum by another, complicates management. The object of this paper is to understand the difficulty in relinquishing the rescuing role. Rescuing is a universal phenomenon in parenting, teaching and therapy that has developed over time through a variety of interwoven social, economic, psychological and clinical variables. © The Royal Australian and New Zealand College of Psychiatrists 2014.

  18. The Diagnostic Value of the Vacuum Phenomenon during Hip Arthroscopy (United States)

    Rath, Ehud; Gortzak, Yair; Schwarzkopf, Ran; Benkovich, Vadim; Cohen, Eugene; Atar, Dan


    The diagnostic value of the vacuum phenomenon between the femoral head and the acetabulum, and time frame of its occurrence after application of traction is an important clinical question. The resulting arthrogram may outline the shape, location, and extent of cartilage lesions prior to arthroscopy of the hip joint. The presence, duration, and diagnostic information of the vacuum phenomenon were evaluated in 24 hips that underwent arthroscopy. The operative diagnosis was compared to the results of imaging studies and to findings obtained during a traction trial prior to arthroscopy. Indications for arthroscopy included avascular necrosis, labral tears, loose bodies, osteoarthrosis, and intractable hip pain. In 22 hips the vacuum phenomenon developed within 30 seconds after application of traction. The most important data obtained from the vacuum phenomenon was the location and extent of femoral head articular cartilage detachment and the presence of nonossified loose bodies. The vacuum phenomenon did not reveal labral or acetabular cartilage pathology in any of these patients. The vacuum phenomenon obtained during the trial of traction can add valuable information prior to hip arthroscopy. Femoral head articular cartilage detachment was best documented by this method. The hip arthroscopist should utilize this diagnostic window routinely prior to hip arthroscopy. PMID:24977068

  19. [Rhytidectomy and Raynaud's phenomenon: about two cases]. (United States)

    Nicolas, J; Labbé, D


    Raynaud's phenomenon is a currently vascular syndrome (8 to 10% of women and 3 to 5% of men). It was defined as episodic ischaemia of the fingers, toes, nose, ears and nipples, which presents clinically as pallor, cyanosis, and often rubor of the skins, in response to cold, emotional stimuli and vasoconstriction agents. The phenomenon is caused by a vasoconstriction of arterials skin. In severe forms of the phenomenon, we can see ulcerations and necrosis. We report here two cases of rhytidectomy flap necrosis in Raynaud's Phenomenon. After review of literature, we explain the elements of physiopathology whose can explain these complications and we try to establish recommendations to these complications.


    Directory of Open Access Journals (Sweden)

    Omid Hashemifard


    due to proximal vessel obstruction or extensive intragraft pathology. The injection of contrast in the distal vasculature will show a patent distal artery. The treatment is correction of the proximal obstructive lesion. b. If there is no pressure gradient and no single large embolus to explain the reduction of the flow, and the contrast wash out remains poor in distal bed , then the patient has no reflow. This diagnosis of distal microvascular spasm and obstruction is a diagnosis of exclusion. c.  If there is no gradient, however, the pullback angiography could show a distal severe lesion that was not seen by conventional antegrade angiography through the guide because the contrast could not reach the distal segment. Correction of the lesion should resolve the apparent no reflow phenomenon and the symptoms of the patient      Table 3. The characteristics of No Reflow phenomenon and its differential diagnoses Diagnosis Proximal Lesion No- reflow Distal lesion Pressure gradient (+ (- (- Distal flow Patent No flow Slow flow due to distal Lesion   Management Supportive measures Treatment of the no reflow phenomenon involves basic supportive measures for the patient, including fluid resuscitation, attention to oxygenation airway management, and blood pressure maintenance with pressors or inotropes (Table 4. Maintenance of blood pressure is especially important, because distal perfusion pressure is necessary for recovery from no reflow and also for delivery of pharmacologic therapy to the distal vascular bed. When no reflow occurs in the right coronary artery or inferior distribution, atropine therapy may be necessary to treat the reflex hypotension and bradycardia that may occur. Intra aortic balloon pump therapy for blood pressure support is another mainstay of treatment in refractory cases.7,8   Table 4. Initial evaluation and treatment of No Reflow phenomenon Excludedissection, thrombus, spasm at lesion site (IVUS, distalcontrast injection, or translesion pressure

  1. Broadening conceptions of medical student mistreatment during clinical teaching: message from a study of “toxic” phenomenon during bedside teaching

    Directory of Open Access Journals (Sweden)

    Olasoji HO


    Full Text Available Hector Oladapo Olasoji Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, College of Medical Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria Purpose: Part of the local hidden curriculum during clinical training of students in the University of Maiduguri medical college in Nigeria, metaphorically referred to as “toxic” practice by students, are situations where a teacher belittles and/or humiliates a student who has fallen short of expected performance, with the belief that such humiliation as part of feedback will lead to improvement in future performance. Through a framework of sociocultural perspective, this study gathered data to define the breadth and magnitude of this practice and identify risk and protective factors with the aim of assessing effectiveness of current intervention strategies. Materials and methods: Using a mixed method research approach, quantitative data were collected from fourth-year medical students in a Nigerian medical college through a survey questionnaire, and qualitative data were obtained through a face-to-face, individual, semi-structured interview of students attending the same institution.Results: Findings indicate that many students continue to experience “toxic” practice, with only very few reporting the incidents to relevant authorities, raising important questions about the appropriateness of current intervention efforts.Conclusion: Current intervention strategies grossly underestimate the influence of institutional forces that can lead to or promote this behavior. Acknowledgment of this has implications for an appropriate intervention strategy. Keywords: clinical teaching, verbal interactions, belittling, socio-cultural perspective, intervention 

  2. 77 FR 75670 - Importer of Controlled Substances; Notice of Registration; Fisher Clinical Services,Inc. (United States)


    ... Registration; Fisher Clinical Services,Inc. By Notice dated September 20, 2012, and published in the Federal Register on October 2, 2012, 77 FR 60143, Fisher Clinical Services, Inc., 7554 Schantz Road, Allentown... that the registration of Fisher Clinical Services, Inc., to import the basic class of controlled...

  3. 78 FR 23958 - Importer of Controlled Substances: Notice of Registration; Fisher Clinical Services, Inc. (United States)


    ... Registration; Fisher Clinical Services, Inc. By Notice dated November 27, 2012, and published in the Federal Register on December 5, 2012, 77 FR 72409, Fisher Clinical Services, Inc., 7554 Schantz Road, Allentown... the registration of Fisher Clinical Services, Inc., to import the basic class of controlled substance...

  4. 78 FR 5497 - Importer of Controlled Substances; Notice of Registration; Fisher Clinical Services, Inc. (United States)


    ... Registration; Fisher Clinical Services, Inc. By Notice dated November 1, 2012, and published in the Federal Register on November 9, 2012, 77 FR 67396, Fisher Clinical Services, Inc., 7554 Schantz Road, Allentown... the registration of Fisher Clinical Services, Inc., to import the basic class of controlled substance...

  5. 78 FR 46371 - Importer of Controlled Substances; Notice of Registration; Almac Clinical Services, Inc. (United States)


    ... Register on April 19, 2013, 78 FR 23594, Almac Clinical Services, Inc., (ACSI), 25 Fretz Road, Souderton... registration of Almac Clinical Services, Inc., (ACSI) to import the basic classes of controlled substances is..., conventions, or protocols in effect on May 1, 1971. DEA has investigated Almac Clinical Services, Inc., (ACSI...

  6. What constitutes a clinically important pain reduction in patients after third molar surgery?

    NARCIS (Netherlands)

    Martin, W.J.J.M.; Ashton-James, C.E.; Skorpil, N.E.; Heymans, M.W.; Forouzanfar, T.


    BACKGROUND: For patients with surgical third molar removal, it is unknown what constitutes a clinically important change in patients’ visual analogue scale (VAS) reports of pain intensity. OBJECTIVES: To determine what constitutes a clinically important change in pain intensity on a VAS following

  7. 77 FR 66848 - Minimum Clinically Important Difference: An Outcome Metric in Orthopaedic Device Science and... (United States)


    ...] Minimum Clinically Important Difference: An Outcome Metric in Orthopaedic Device Science and Regulation... Clinically Important Difference: An Outcome Metric in Orthopaedic Device Science and Regulation.'' FDA is co... (MCID) for patient-reported outcome (PRO) instruments used in orthopaedic extremity device-related...

  8. Phenomenon detection device

    International Nuclear Information System (INIS)

    Suzuki, Yasuo.


    Detection signals for a specific phenomenon outputted from any of detectors are distributed by way of half mirrors and inputted to a logic discrimination circuit by way of a photoelectric convertor. The photoelectric convertor detects the quantity of light corresponding to the optical signals from more than two detectors which detected the phenomenon, and outputs detection signals to the logic discrimination circuit. If the phenomenon is detected, since both inputs turn ON in the logic discrimination circuit in accordance with the predetermined logical sum, the occurrence of a specific phenomenon is detected. Thus, an optical system substantially comprises half mirrors, reflection mirrors and photoelectric convertor in combination provides a logic circuit. Since the circuit which transmits signals of the detectors is constituted with an optical system using the half mirrors, the number of parts constituting the logic circuit can greatly be saved. In addition, since the optical system comprises mirrors or half mirrors which have been used so far, they can be used, once assembled, quasipermanently, and the reliability can be enhanced greatly. (N.H.)

  9. Mask Phenomenon in Communication

    Institute of Scientific and Technical Information of China (English)



    People sometimes wear masks. Abusive expression may be used to convey love while polite words can be exchanged among enemies. This essay describes and discusses this special phenomenon in communication and analyzes the elements that con-tribute to the success of a mask communication.

  10. What Constitutes a Clinically Important Pain Reduction in Patients after Third Molar Surgery?

    Directory of Open Access Journals (Sweden)

    Wilhelmus JJM Martin


    Full Text Available BACKGROUND: For patients with surgical third molar removal, it is unknown what constitutes a clinically important change in patients’ visual analogue scale (VAS reports of pain intensity.

  11. 77 FR 67396 - Importer of Controlled Substances; Notice of Application, Fisher Clinical Services, Inc. (United States)


    ... DEPARTMENT OF JUSTICE Drug Enforcement Administration Importer of Controlled Substances; Notice of Application, Fisher Clinical Services, Inc. Pursuant to Title 21 Code of Federal Regulations 1301.34(a), this is notice that on August 20, 2012, Fisher Clinical Services, Inc., 7554 Schantz Road, [[Page 67397...

  12. 77 FR 60143 - Importer of Controlled Substances; Notice of Application; Fisher Clinical Services, Inc. (United States)


    ... DEPARTMENT OF JUSTICE Drug Enforcement Administration Importer of Controlled Substances; Notice of Application; Fisher Clinical Services, Inc. Pursuant to Title 21 Code of Federal Regulations 1301.34(a), this is notice that on July 18, 2012, Fisher Clinical Services, Inc., 7554 Schantz Road, Allentown...

  13. 77 FR 72409 - Importer of Controlled Substances; Notice of Application; Fisher Clinical Services, Inc. (United States)


    ... DEPARTMENT OF JUSTICE Drug Enforcement Administration Importer of Controlled Substances; Notice of Application; Fisher Clinical Services, Inc. Pursuant to Title 21 Code of Federal Regulations 1301.34 (a), this is notice that on October 16, 2012, Fisher Clinical Services, Inc., 7554 Schantz Road, Allentown...

  14. 78 FR 59064 - Importer of Controlled Substances; Notice of Application; Fisher Clinical Services, Inc. (United States)


    ... DEPARTMENT OF JUSTICE Drug Enforcement Administration Importer of Controlled Substances; Notice of Application; Fisher Clinical Services, Inc. Pursuant to Title 21 Code of Federal Regulations (CFR) 1301.34 (a), this is notice that on June 21, 2013, Fisher Clinical Services, Inc., 7554 Schantz Road, Allentown...

  15. 77 FR 24985 - Importer of Controlled Substances; Notice of Application; Almac Clinical Services, Inc., (ACSI) (United States)


    ... DEPARTMENT OF JUSTICE Drug Enforcement Administration Importer of Controlled Substances; Notice of Application; Almac Clinical Services, Inc., (ACSI) Pursuant to 21 U.S.C. 958(i), the Attorney General shall... on March 5, 2012, Almac Clinical Services, Inc., (ACSI), 25 Fretz Road, Souderton, Pennsylvania 18964...

  16. 77 FR 50162 - Importer of Controlled Substances; Notice of Registration; Almac Clinical Services, Inc. (United States)


    ... Register on April 26, 2012, 77 FR 24985, Almac Clinical Services, Inc., (ACSI), 25 Fretz Road, Souderton... that the registration of Almac Clinical Services, Inc. (ACSI) to import the basic classes of controlled..., Inc. (ACSI) to ensure that the company's registration is consistent with the public interest. The...

  17. 78 FR 23594 - Importer of Controlled Substances, Notice of Application, Almac Clinical Services, Inc., (ACSI) (United States)


    ... DEPARTMENT OF JUSTICE Drug Enforcement Administration Importer of Controlled Substances, Notice of Application, Almac Clinical Services, Inc., (ACSI) Pursuant to Title 21 Code of Federal Regulations 1301.34(a), this is notice that on March 5, 2013, Almac Clinical Services, Inc., (ACSI), 25 Fretz Road, Souderton...

  18. Coronary artery anomalies and clinically important anatomy in patients with congenital heart disease: multislice CT findings

    International Nuclear Information System (INIS)

    Goo, Hyun Woo; Seo, Dong-Man; Yun, Tae-Jin; Park, Jeong-Jun; Park, In-Sook; Ko, Jae Kon; Kim, Young Hwee


    In patients with congenital heart disease, coronary artery anomalies are common and have different clinical importance from individuals with structurally normal hearts. Visibility of the coronary arteries by CT has markedly improved due to high temporal resolution and ECG-synchronized data acquisition. In this article we describe current multislice CT techniques for coronary artery imaging and illustrate coronary artery anomalies and clinically important coronary artery anatomy from the point of view of congenital heart disease. (orig.)

  19. Coronary artery anomalies and clinically important anatomy in patients with congenital heart disease: multislice CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Hyun Woo [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea); Seo, Dong-Man; Yun, Tae-Jin; Park, Jeong-Jun [University of Ulsan College of Medicine, Department of Pediatric Cardiac Surgery, Asan Medical Center, Seoul (Korea); Park, In-Sook; Ko, Jae Kon; Kim, Young Hwee [University of Ulsan College of Medicine, Department of Pediatric Cardiology, Asan Medical Center, Seoul (Korea)


    In patients with congenital heart disease, coronary artery anomalies are common and have different clinical importance from individuals with structurally normal hearts. Visibility of the coronary arteries by CT has markedly improved due to high temporal resolution and ECG-synchronized data acquisition. In this article we describe current multislice CT techniques for coronary artery imaging and illustrate coronary artery anomalies and clinically important coronary artery anatomy from the point of view of congenital heart disease. (orig.)

  20. Pattern of Clinical Medication Seeking for Import Malaria by Migrant Workers

    Directory of Open Access Journals (Sweden)

    Muhammad Mahmudi


    Full Text Available Number of malaria cases in Kabupaten Trenggalek in 2014 is 89 cases, and 83 cases are import malaria from migrant workers. Import malaria is transmitted across two areas and affects the clinical medication seeking. This research wants to describe the pattern of clinical medication seeking for import malaria by migrant workers in Puskesmas Pandean working area. This was cross sectional study with descriptive quantitative approach. Research’s sample is 26 import malaria sufferers in 2013–2015 who has chosen purposively with inclusion criteria. Interview had used to get information about characteristics, place felt the symptom, first clinical medication seeking (place and time, clinical diagnosis, medication follow up, and recovery status. The result of the research shows 100% respondent is man and the age about 20-30 years old (53,8 who is working as agricultural laborers outside Java. Mostly of respondent feel the malaria symptoms in their working place (53,8%. The day seeks clinical medication at day three after symptom (34, 6%. Respondents that feel the symptom in Puskesmas Pandean working area chose Puskesmas as clinical medication place (42,3%, and hospital (19,2% for them whose experience the malaria symptom in their working area. Puskesmas is chosen as clinical diagnosis place (69% and only 11,5% respondent got medication follow up. Puskesmas is chosen as intermediate clinical medication place (60% for 19,2% respondent that is not recovered well, although 20% go to Dukun. All of respondent chose the clinical medication as their prime medication. Need to make medication follow up visitation well complete. Keyword: pattern, clinical medication, import malaria, migrant worker

  1. Important considerations for designing and reporting epidemiologic and clinical studies in dental traumatology. (United States)

    Andersson, Lars; Andreasen, Jens O


    The purpose of this article is to suggest important considerations for epidemiologic and clinical studies in the field of dental traumatology. The article is based on the authors' experiences from research in this field and editorial board work for the scientific journal Dental Traumatology. Examples are given of issues where development is important. The importance of planning ahead of the study and consulting with experts in other fields is emphasized. © 2011 John Wiley & Sons A/S.

  2. Important considerations for designing and reporting epidemiologic and clinical studies in dental traumatology

    DEFF Research Database (Denmark)

    Andersson, Lars; Andreasen, Jens O


    The purpose of this article is to suggest important considerations for epidemiologic and clinical studies in the field of dental traumatology. The article is based on the authors' experiences from research in this field and editorial board work for the scientific journal Dental Traumatology....... Examples are given of issues where development is important. The importance of planning ahead of the study and consulting with experts in other fields is emphasized....

  3. Clinical skill center: a review of present situation and importance in medical education curriculum

    Directory of Open Access Journals (Sweden)

    Haleh Talaei


    Full Text Available Clinical skill centers were designed in 1960, offers innovative, more effective clinical health care and treatment curriculum. Clinical skill center (CSC can provide a special facility for clinical and communication skills practice in a setting outside hospital wards in order to train students with enough confidence of confronting real patients. Learning clinical skills in these centers are not patient-dependent and by practicing on manikins and simulated models errors in real patients can be prevented. Moreover, possible feedback of this method can be used for evaluation and can improve quality and quantity of the education. This review intends to determine the purpose, undertaking, and structure of CSC. The study emphasizes the importance of integrating the clinical skill centers into the teaching curriculum of medical universities. Apparently, organizing clinical skill centers can play an important role for improving the quality and quantity of the educational system and consequently post-graduate performance. The authors recommend this program can be a solution for having both the knowledge and skill of diagnosis and treatment seasonal and rare diseases. Key words clinical skill center, medical education, curriculum

  4. The statistical stability phenomenon

    CERN Document Server

    Gorban, Igor I


    This monograph investigates violations of statistical stability of physical events, variables, and processes and develops a new physical-mathematical theory taking into consideration such violations – the theory of hyper-random phenomena. There are five parts. The first describes the phenomenon of statistical stability and its features, and develops methods for detecting violations of statistical stability, in particular when data is limited. The second part presents several examples of real processes of different physical nature and demonstrates the violation of statistical stability over broad observation intervals. The third part outlines the mathematical foundations of the theory of hyper-random phenomena, while the fourth develops the foundations of the mathematical analysis of divergent and many-valued functions. The fifth part contains theoretical and experimental studies of statistical laws where there is violation of statistical stability. The monograph should be of particular interest to engineers...

  5. Determining Minimal Clinically Important Differences in Japanese Cedar/Cypress Pollinosis Patients


    Takaya Higaki; Mitsuhiro Okano; Shin Kariya; Tazuko Fujiwara; Takenori Haruna; Haruka Hirai; Aya Murai; Minoru Gotoh; Kimihiro Okubo; Shuji Yonekura; Yoshitaka Okamoto; Kazunori Nishizaki


    Background: Statistically significant results of medical intervention trials are not always clinically meaningful. We sought to estimate the minimal clinically important difference (MCID) (the smallest change in a given endpoint that is meaningful to a patient) during seasonal alteration of Japanese cedar/cypress pollinosis (JCCP). Methods: Results of a double-blinded, placebo-controlled trial of JCCP patients conducted between 2008 and 2010 were analyzed using an anchor-based method in wh...

  6. Open source innovation phenomenon, participant behaviour, impact

    CERN Document Server

    Herstatt, Cornelius


    Open Source Innovation (OSI) has gained considerable momentum within the last years. Academic and management practice interest grows as more and more end-users consider and even participate in Open Source product development like Linux, Android, or Wikipedia. Open Source Innovation: Phenomenon, Participant Behaviour, Impact brings together rigorous academic research and business importance in scrutinizing OCI from three perspectives: The Phenomenon, Participants' Behavior, and Business Implications. The first section introduces OCI artefacts, including who is participating and why, and provide

  7. A review of CCFL phenomenon

    International Nuclear Information System (INIS)

    Al Issa, S.; Macian, R.


    Highlights: → CCFL mechanisms, correlations, parameters and related variables were reviewed extensively. → Consideration of geometrical effects is crucial for meaningful comparison and review. → Differentiation between 'onset of CCFL' and 'deflooding/partial delivery' data is required. → Following 2+3, new correlations for onset of CCFL according to liquid velocity ranges were suggested. → Large number of correlations was compared against large data bank that considers points 2+3. - Abstract: Counter current flow limitation CCFL is an important phenomenon for numerous engineering applications and safety of light water reactors. In particular, the possible occurrence of CCFL in the hot-leg of a PWR during SBLOCA or LOCA accidents is of special interest for nuclear safety research. A review of the related literature has made in order to present the most important studies about the phenomenon and to reach common general understanding of the different factors that govern CCFL. Eventually this will allow explaining contradictions among different explanations provided by different authors. Most important factors were geometrical characteristics, liquid superficial velocity, and physical properties. The review shows that despite numerous experimental works, many scaling and geometrical effects are still not fully understood. For Instance there exist no consistent explanation of the channel diameter and inclined riser length effect upon results. The same can be stated-though to a minimum extent - for the inclination angle while channel length (or channel to diameter ratio) effect was clear and consistent. Since most experimental work was done in down-scaled hot-leg simulators, it becomes interesting to build a coherent knowledge about these effects and to explain arising contradictions in order to safely extrapolate results to full-scale hot-leg. The review has shown that many differences were simply due to geometrical effects, this leads to the need to

  8. The crossed phrenic phenomenon. (United States)

    Ghali, Michael George Zaki


    The cervical spine is the most common site of traumatic vertebral column injuries. Respiratory insufficiency constitutes a significant proportion of the morbidity burden and is the most common cause of mortality in these patients. In seeking to enhance our capacity to treat specifically the respiratory dysfunction following spinal cord injury, investigators have studied the "crossed phrenic phenomenon", wherein contraction of a hemidiaphragm paralyzed by a complete hemisection of the ipsilateral cervical spinal cord above the phrenic nucleus can be induced by respiratory stressors and recovers spontaneously over time. Strengthening of latent contralateral projections to the phrenic nucleus and sprouting of new descending axons have been proposed as mechanisms contributing to the observed recovery. We have recently demonstrated recovery of spontaneous crossed phrenic activity occurring over minutes to hours in C 1 -hemisected unanesthetized decerebrate rats. The specific neurochemical and molecular pathways underlying crossed phrenic activity following injury require further clarification. A thorough understanding of these is necessary in order to develop targeted therapies for respiratory neurorehabilitation following spinal trauma. Animal studies provide preliminary evidence for the utility of neuropharmacological manipulation of serotonergic and adenosinergic pathways, nerve grafts, olfactory ensheathing cells, intraspinal microstimulation and a possible role for dorsal rhizotomy in recovering phrenic activity following spinal cord injury.

  9. Capilaroscopia periungueal: importância para a investigação do fenômeno de Raynaud e doenças do espectro da esclerose sistêmica Importance of the nailfold capillaroscopy in the investigation of Raynaud's phenomenon and scleroderma-spectrum syndromes

    Directory of Open Access Journals (Sweden)

    Cristiane Kayser


    Full Text Available A capilaroscopia periungueal é um exame não invasivo e extremamente útil para avaliação do componente morfológico da microcirculação. Permite o diagnóstico diferencial precoce entre indivíduos com fenômeno de Raynaud (FRy primário e secundário. Na esclerose sistêmica e síndromes correlatas ocorrem alterações capilaroscópicas facilmente distinguíveis do padrão encontrado em indivíduos normais, sendo caracterizadas pela presença de ectasia capilar e áreas de deleção vascular, além de diminuição difusa da quantidade de alças. Em razão de sua relevância diagnóstica, a familiarização do médico clínico e do reumatologista com a CPU é de fundamental importância.Nailfold capillaroscopy is a noninvasive method useful for the evaluation of microcirculation morphologic component. It allows an early differential diagnosis between subjects with primary Raynaud's phenomenon and patients with secondary Raynaud's phenomenon. In systemic sclerosis and sclerodermaspectrum syndromes there are capillaroscopic findings easily distinguished from the pattern of healthy controls, and characterized by the presence of enlarged loops, avascular areas and diffuse loss of capillaries. Because of their diagnostic relevance, the acquaintance of internists and rheumatologists with nailfold capillaroscopy is of utmost importance.

  10. Avoiding misdiagnosis of imported malaria: screening of emergency department samples with thrombocytopenia detects clinically unsuspected cases

    NARCIS (Netherlands)

    Hänscheid, Thomas; Melo-Cristino, José; Grobusch, Martin P.; Pinto, Bernardino G.


    BACKGROUND: Misdiagnosis of imported malaria is not uncommon and even abnormal routine laboratory tests may not trigger malaria smears. However, blind screening of all thrombocytopenic samples might be a possible way to detect clinically unsuspected malaria cases in the accident and emergency

  11. Statistical significance versus clinical importance: trials on exercise therapy for chronic low back pain as example.

    NARCIS (Netherlands)

    van Tulder, M.W.; Malmivaara, A.; Hayden, J.; Koes, B.


    STUDY DESIGN. Critical appraisal of the literature. OBJECIVES. The objective of this study was to assess if results of back pain trials are statistically significant and clinically important. SUMMARY OF BACKGROUND DATA. There seems to be a discrepancy between conclusions reported by authors and

  12. An Update on the Epidemiology of Schizophrenia with a Special Reference to Clinically Important Risk Factors (United States)

    El-Missiry, Ahmed; Aboraya, Ahmed Sayed; Manseur, Hader; Manchester, Johnna; France, Cheryl; Border, Katherine


    Schizophrenia is a chronic mental illness which poses a tremendous burden on the families, caregivers and the society. The purpose of this paper is to provide an updated review of the epidemiology of schizophrenia with a special attention to the clinically important risk factors such as drug abuse, hormonal factors and the new advances in genetic…

  13. Approaches for estimating minimal clinically important differences in systemic lupus erythematosus. (United States)

    Rai, Sharan K; Yazdany, Jinoos; Fortin, Paul R; Aviña-Zubieta, J Antonio


    A minimal clinically important difference (MCID) is an important concept used to determine whether a medical intervention improves perceived outcomes in patients. Prior to the introduction of the concept in 1989, studies focused primarily on statistical significance. As most recent clinical trials in systemic lupus erythematosus (SLE) have failed to show significant effects, determining a clinically relevant threshold for outcome scores (that is, the MCID) of existing instruments may be critical for conducting and interpreting meaningful clinical trials as well as for facilitating the establishment of treatment recommendations for patients. To that effect, methods to determine the MCID can be divided into two well-defined categories: distribution-based and anchor-based approaches. Distribution-based approaches are based on statistical characteristics of the obtained samples. There are various methods within the distribution-based approach, including the standard error of measurement, the standard deviation, the effect size, the minimal detectable change, the reliable change index, and the standardized response mean. Anchor-based approaches compare the change in a patient-reported outcome to a second, external measure of change (that is, one that is more clearly understood, such as a global assessment), which serves as the anchor. Finally, the Delphi technique can be applied as an adjunct to defining a clinically important difference. Despite an abundance of methods reported in the literature, little work in MCID estimation has been done in the context of SLE. As the MCID can help determine the effect of a given therapy on a patient and add meaning to statistical inferences made in clinical research, we believe there ought to be renewed focus on this area. Here, we provide an update on the use of MCIDs in clinical research, review some of the work done in this area in SLE, and propose an agenda for future research.

  14. Incidental extracerebral findings on brain nonenhanced magnetic resonance imaging: frequency, nondetection rate, and clinical importance

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Ming-Liang; Wei, Xiao-Er [School of Medicine, Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, Shanghai (China); Lu, Li-Yan [Nanjing Medical University, Department of Radiology, Nanjing First Hospital, Nanjing (China); Li, Wen-Bin [School of Medicine, Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, Shanghai (China); Kashgar Prefecture Second People' s Hospital, Imaging Center, Kashgar (China)


    This study aims to elucidate the frequency, nondetection rate, and clinical importance of incidental extracerebral findings (IECFs) on brain nonenhanced magnetic resonance imaging (MRI). A total of 8284 brain MRIs performed between January 1, 2015 and December 31, 2015 were evaluated for the presence of IECFs and the distribution of IECFs was analyzed. IECFs were categorized as E1 (clinically unimportant, e.g., sinus mucosal thickening); E2 (likely unimportant, e.g., pharyngeal mucosal symmetrical thickening); and E3 (potentially important, e.g., pharyngeal mucosal asymmetrical thickening). The nondetection rate was determined by comparing the results of the structured approach with the initial MRI reports. The medical records were examined for patients with E3 IECFs to assess clinical importance and outcome of these lesions. A total of 5992 IECFs were found in 4469 of the 8284 patients (54.0%). E1 findings constituted 82.2% (4924/5992) of all IECFs; E2 constituted 16.6% (995/5992) and E3 constituted 1.2% (73/5992). Overall IECFs and E1 findings were significantly more common in male patients (P < 0.05). Statistically significant difference was also seen between the different age groups (P < 0.001). The nondetection rate was 56.9% (3409/5992) for overall IECFs and 32.9% (24/73) for E3 IECFs. Of the 73 patients with E3 IECFs, 34 (46.6%) received final diagnosis and appropriate treatment during the study period. IECFs are prevalent in clinical patients on brain MR images with a nondetection rate of 32.9% for potentially important (E3) findings. The reporting of IECFs according to clinical importance is helpful for patients' management. (orig.)

  15. The Minimal Clinically Important Difference for the Mayo-Portland Adaptability Inventory. (United States)

    Malec, James F; Kean, Jacob; Monahan, Patrick O

    To determine the Minimal Clinically Important Difference (MCID) and Robust Clinically Important Difference (RCID) of the Mayo-Portland Adaptability Inventory-4 (MPAI-4) as measures of response to intervention. Retrospective analysis of existing data. Both distribution- and anchor-based methods were used to triangulate on the MCID and to identify a moderate, that is, more robust, level of change (RCID) for the MPAI-4. These were further evaluated with respect to clinical provider ratings. Data for individuals with acquired brain injury in rehabilitation programs throughout the United States in the OutcomeInfo Database (n = 3087) with 2 MPAI-4 ratings. MPAI-4, Supervision Rating Scale, Clinician Rating of Global Clinical Improvement. Initial analyses suggested 5 T-score points (5T) as the MCID and 9T as the RCID. Eighty-one percent to 87% of clinical raters considered a 5T change and 99% considered a 9T change to indicate meaningful improvement. 5T represents the MCID for the MPAI-4 and 9T, the RCID. Both values are notably less than the Reliable Change Index (RCI). While the RCI indicates change with a high level of statistical confidence, it may be insensitive to change that is considered meaningful by providers and participants as indicated by the MCID.

  16. Minimal clinically important difference on the Motor Examination part of MDS-UPDRS. (United States)

    Horváth, Krisztina; Aschermann, Zsuzsanna; Ács, Péter; Deli, Gabriella; Janszky, József; Komoly, Sámuel; Balázs, Éva; Takács, Katalin; Karádi, Kázmér; Kovács, Norbert


    Recent studies increasingly utilize the Movement Disorders Society Sponsored Unified Parkinson's Disease Rating Scale (MDS-UPDRS). However, the minimal clinically important difference (MCID) has not been fully established for MDS-UPDRS yet. To assess the MCID thresholds for MDS-UPDRS Motor Examination (Part III). 728 paired investigations of 260 patients were included. At each visit both MDS-UPDRS and Clinician-reported Global Impression-Improvement (CGI-I) scales were assessed. MDS-UPDRS Motor Examination (ME) score changes associated with CGI-I score 4 (no change) were compared with MDS-UPDRS ME score changes associated with CGI-I score 3 (minimal improvement) and CGI-I score 5 (minimal worsening). Both anchor- and distribution-based techniques were utilized to determine the magnitude of MCID. The MCID estimates for MDS-UPDRS ME were asymmetric: -3.25 points for detecting minimal, but clinically pertinent, improvement and 4.63 points for observing minimal, but clinically pertinent, worsening. MCID is the smallest change of scores that are clinically meaningful to patients. These MCID estimates may allow the judgement of a numeric change in MDS-UPDRS ME on its clinical importance. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. The attitudes of medical students in Europe toward the clinical importance of histology. (United States)

    Moxham, Bernard John; Emmanouil-Nikoloussi, Elpida; Brenner, Erich; Plaisant, Odile; Brichova, Hana; Kucera, Tomas; Pais, Diogo; Stabile, Isobel; Borg, Jordy; Scholz, Michael; Paulsen, Friedrich; Luis Bueno-López, José; Alfonso Arraez Aybar, Luis; De Caro, Raffaele; Arsic, Stojanka; Lignier, Baptiste; Chirculescu, Andy


    Many studies have been undertaken to assess the attitudes of medical students to the clinical importance of gross anatomy. However, much less is known about their attitudes toward the clinical importance of histology. Using Thurstone and Chave methods to assess attitudes, over 2,000 early stage medical students across Europe provided responses to a survey that tested the hypothesis that the students have a high regard for histology's clinical relevance. Regardless of the university and country surveyed, and of the teaching methods employed for histology, our findings were not consistent with our hypotheses, students providing a more moderate assessment of histology's importance compared to gross anatomy but more positive than their attitudes toward embryology. Histology should play a significant role in medical education in terms of appreciating not just normal structure and function but also pathology. We conclude that teachers of histology should pay special attention to informing newly-recruited medical students of the significant role played by histology in attaining clinical competence and in underpinning their status as being learned members of a healthcare profession. This work was conducted under the auspices of the Trans-European Pedagogic Research Group (TEPARG). Clin. Anat. 30:635-643, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  18. New Phenomenon of Commercial Corruption

    Directory of Open Access Journals (Sweden)

    Krzysztof Nowakowski


    Full Text Available This article is about increase corruption in private sector as commercial corruption. This establishes a wide understanding of that phenomenon in social science and law. Corruption and bribery are types of fraud and are linked with the private sector too. Although certain types of corruption will decline as the private sector grows and consolidates, other new types involving private sector firms may increase. The commercial corruption can be described as relation inside of an organization and as relation between firms. Corruption in private sector in Poland is connected with social distrust and specific organizational culture, too. Commercial corruption is a familiar feature of their societies and has been the focus of law enforcement and institutional reform. Many others problems do not change the fact that such corruption is a new important problem and causes lost of competitiveness and creates a substitute for fair market and competition in Polish economy and abroad.

  19. Emerging souvenirs-clinical presentation of the returning traveller with imported arbovirus infections in Europe. (United States)

    Eckerle, I; Briciu, V T; Ergönül, Ö; Lupşe, M; Papa, A; Radulescu, A; Tsiodras, S; Tsitou, C; Drosten, C; Nussenblatt, V R; Reusken, C B; Sigfrid, L A; Beeching, N J


    Arboviruses are an emerging group of viruses that are causing increasing health concerns globally, including in Europe. Clinical presentation usually consists of a nonspecific febrile illness that may be accompanied by rash, arthralgia and arthritis, with or without neurological or haemorrhagic syndromes. The range of differential diagnoses of other infectious and noninfectious aetiologies is broad, presenting a challenge for physicians. While knowledge of the geographical distribution of pathogens and the current epidemiological situation, incubation periods, exposure risk factors and vaccination history can help guide the diagnostic approach, the nonspecific and variable clinical presentation can delay final diagnosis. This narrative review aims to summarize the main clinical and laboratory-based findings of the three most common imported arboviruses in Europe. Evidence is extracted from published literature and clinical expertise of European arbovirus experts. We present three cases that highlight similarities and differences between some of the most common travel-related arboviruses imported to Europe. These include a patient with chikungunya virus infection presenting in Greece, a case of dengue fever in Turkey and a travel-related case of Zika virus infection in Romania. Early diagnosis of travel-imported cases is important to reduce the risk of localized outbreaks of tropical arboviruses such as dengue and chikungunya and the risk of local transmission from body fluids or vertical transmission. Given the global relevance of arboviruses and the continuous risk of (re)emerging arbovirus events, clinicians should be aware of the clinical syndromes of arbovirus fevers and the potential pitfalls in diagnosis. Copyright © 2018. Published by Elsevier Ltd.

  20. The tsunami phenomenon (United States)

    Röbke, B. R.; Vött, A.


    With human activity increasingly concentrating on coasts, tsunamis (from Japanese tsu = harbour, nami = wave) are a major natural hazard to today's society. Stimulated by disastrous tsunami impacts in recent years, for instance in south-east Asia (2004) or in Japan (2011), tsunami science has significantly flourished, which has brought great advances in hazard assessment and mitigation plans. Based on tsunami research of the last decades, this paper provides a thorough treatise on the tsunami phenomenon from a geoscientific point of view. Starting with the wave features, tsunamis are introduced as long shallow water waves or wave trains crossing entire oceans without major energy loss. At the coast, tsunamis typically show wave shoaling, funnelling and resonance effects as well as a significant run-up and backflow. Tsunami waves are caused by a sudden displacement of the water column due to a number of various trigger mechanisms. Such are earthquakes as the main trigger, submarine and subaerial mass wastings, volcanic activity, atmospheric disturbances (meteotsunamis) and cosmic impacts, as is demonstrated by giving corresponding examples from the past. Tsunamis are known to have a significant sedimentary and geomorphological off- and onshore response. So-called tsunamites form allochthonous high-energy deposits that are left at the coast during tsunami landfall. Tsunami deposits show typical sedimentary features, as basal erosional unconformities, fining-upward and -landward, a high content of marine fossils, rip-up clasts from underlying units and mud caps, all reflecting the hydrodynamic processes during inundation. The on- and offshore behaviour of tsunamis and related sedimentary processes can be simulated using hydro- and morphodynamic numerical models. The paper provides an overview of the basic tsunami modelling techniques, including discretisation, guidelines for appropriate temporal and spatial resolution as well as the nesting method. Furthermore, the

  1. [Clinical analysis of two cases of imported children Zika virus infection in China]. (United States)

    Zheng, C G; Xu, Y; Jiang, H Q; Yin, Y X; Zhang, J H; Zhu, W J; Liang, X J; Chen, M X; Ye, J W; Tan, L M; Luo, D; Gong, S T


    To analyze the clinical characteristics, outcome and diagnosis of two cases of imported children Zika virus infection in China. A retrospective analysis was performed on clinical characteristics, treatment and outcome of two cases of imported children with Zika virus infection in February 2016 in Enping People's Hospital of Guangdong. Two cases of children with imported Zika virus infection resided in an affected area of Venezuela, 8-year-old girl and her 6 year-old brother. The main findings on physical examination included the following manifestations: fever, rash, and conjunctivitis. The rash was first limited to the abdomen, but extended to the torso, neck and face, and faded after 3-4 d. The total number of white blood cells was not high and liver function was normal. The diagnosis of two cases of Zika virus infection was confirmed by the expert group of Guangdong Provincial Center for Disease Control and Prevention, according to the epidemiological history, clinical manifestations and Zika virus nucleic acid detection results.Treatment of Zika virus infection involves supportive care. Two Zika virus infection children had a relatively benign outcome. At present, Zika virus infection in children is an imported disease in China. No specific therapy is available for this disease. Information on long-term outcomes among infants and children with Zika virus disease is limited, routine pediatric care is advised for these infants and children.

  2. CT and MR imaging of the liver. Clinical importance of nutritional status

    International Nuclear Information System (INIS)

    Leander, P.; Sjoeberg, S.; Hoeglund, P.


    Purpose: In an experimental study in rats a correlation between nutritional status and hepatic attenuation in CT and signal intensities in MR imaging was shown. Is physiological nutritional status of importance in clinical CT and MR imaging? Material and methods: In a cross-over study including 12 healthy volunteers (6 women and 6 men, mean age 34 years), CT and MR imaging of the liver were performed with nutritional status at three different levels, i.e., normal, fasting and after glycogen-rich meals. CT and MR were performed on clinical imaging systems and hepatic attenuation and signal intensity, respectively, were assessed. In MR, T1-weighted, proton density-weighted and T2-weighted pulse-sequences were used. Results: In CT there were significantly (p<0.01) higher liver attenuations in normal nutritional status and after glycogen rich-meals compared to the fasting condition. The difference between fasting and glycogen-rich meals were 10.5 HU for men, 7.4 for women and mean 8.8 HU for all 12 volunteers. In MR imaging the differences were small and non-significant. The results of this study are in accordance with an earlier experimental study in rats. Conclusion: In CT it may be of importance not to have patients in a fasting condition as it lowers the attenuation in normal liver tissue. The findings are important for planning of clinical studies where hepatic attenuation will be assessed and may be of some importance in clinical CT. In MR imaging the results indicate that the nutritional status is of less importance

  3. Vascular diagnostics for Raynaud's phenomenon

    Directory of Open Access Journals (Sweden)

    Dinsdale G


    Full Text Available Graham Dinsdale, Ariane L Herrick Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK Abstract: Raynaud's phenomenon (RP is common, and in most patients is primary (idiopathic when due to reversible vasospasm and does not progress to irreversible tissue injury. However, in those patients for whom RP is secondary to an underlying disease (eg, systemic sclerosis or atherosclerosis, progression to digital ulceration or critical ischemia can occur. Therefore, the key question for the clinician is “Why does this patient have RP?” Vascular diagnostics play a key role in answering this. In this review, we firstly discuss the different vascular investigations relevant to clinical practice: nail fold capillaroscopy (including the different methodologies for examining the nail fold capillaries, and the role of capillaroscopy in helping to differentiate between primary and systemic sclerosis-related RP, thermography (available in specialist centers, and evaluation of large vessel disease (for example, due to atherosclerosis. We then discuss research tools, mainly laser Doppler methods, including laser Doppler imaging and laser speckle contrast imaging. These are commercially available as complete imaging systems and are (relatively easy to use. The main current goal in vascular imaging research is to validate these novel state-of-the-art techniques as outcome measures of digital vascular disease, and then apply them in early and later phase studies of new treatment approaches, thus facilitating drug development programs. Keywords: Raynaud's phenomenon, systemic sclerosis, nail fold capillaroscopy, thermography, laser Doppler, angiography

  4. Association between clinically important depressive symptoms and academic achivement among students in Cartagena, Colombia

    Directory of Open Access Journals (Sweden)

    Zuleima Cogollo


    Full Text Available Background: Some studies show a strongassociation between depressive symptoms andacademic achievement in the adolescent population.However, there are few Colombian publicationsabout this topic.Objective: To establish the association betweenclinically important depressive symptoms and academic achievement among low socioeconomicstatus adolescent students.Method: A group of 13 to 17 year-aged adolescentswas studied. Meaningful clinically depressivesymptoms were measured with Zung’self-rating depression scale (40/80. Academicachievement was evaluated according to Colombianqualitative model.Results: A total of 43.5% of students reportedclinically important depressive symptoms and30.7% accomplished a poor academic achievement,according to teacher report. The academicachievement was independent of meaningfulclinically depressive symptoms, after controllingother variables.Conclusion: Meaningful clinically depressivesymptoms are frequent in low socioeconomic statusadolescent students. But, meaningful clinicallydepressive symptoms are not associatedwith academic performance. Further investigationsare needed.

  5. Specific determination of clinical and toxicological important substances in biological samples by LC-MS

    International Nuclear Information System (INIS)

    Mitulovic, G.


    This thesis of this dissertation is the specific determination of clinical and toxicological important substances in biological samples by LC-MS. Nicotine was determined in serum after application of nicotine plaster and nicotine nasal spray with HPLC-ESI-MS. Cotinine was determined direct in urine with HPLC-ESI-MS. Short time anesthetics were determined in blood and cytostatics were determined in liquor with HPLC-ESI-MS. (botek)

  6. Radioactivity: A Natural Phenomenon. (United States)

    Ronneau, C.


    Discussed is misinformation people have on the subject of radiation. The importance of comparing artificial source levels of radiation to natural levels is emphasized. Measurements of radioactivity, its consequences, and comparisons between the risks induced by radiation in the environment and from artificial sources are included. (KR)


    Directory of Open Access Journals (Sweden)



    Full Text Available The proposed scientific theme is going to approach and study the hooliganism phenomenon as a contemporary social matter, in terms of conceptual and etiological. The present work has four main purposes: (1- that of explaining the meaning of hooliganism social phenomenon; (2- that of discovering the origins of hooliganism; (3- that of knowing which are the causes that encourages the occurence of the hooliganism; (4- that of knowing how to control and minimize this phenomenon.

  8. The comparative importance of books: clinical psychology in the health sciences library. (United States)

    Wehmeyer, J M; Wehmeyer, S


    Clinical psychology has received little attention as a subject in health sciences library collections. This study seeks to demonstrate the relative importance of the monographic literature to clinical psychology through the examination of citations in graduate student theses and dissertations at the Fordham Health Sciences Library, Wright State University. Dissertations and theses were sampled randomly; citations were classified by format, counted, and subjected to statistical analysis. Books and book chapters together account for 35% of the citations in clinical psychology dissertations, 25% in nursing theses, and 8% in biomedical sciences theses and dissertations. Analysis of variance indicates that the citations in dissertations and theses in the three areas differ significantly (F = 162.2 with 2 and 253 degrees of freedom, P = 0.0001). Dissertations and theses in biomedical sciences and nursing theses both cite significantly more journals per book than the dissertations in clinical psychology. These results support the hypothesis that users of clinical psychology literature rely more heavily on books than many other users of a health sciences library. Problems with using citation analyses in a single subject to determine a serials to monographs ratio for a health sciences library are pointed out. PMID:10219478

  9. Which factors are important for the successful development and implementation of clinical pathways? A qualitative study. (United States)

    De Allegri, Manuela; Schwarzbach, Matthias; Loerbroks, Adrian; Ronellenfitsch, Ulrich


    Clinical pathways (CPs) are detailed longitudinal care plans delineating measures to be conducted during a patient's treatment. Although positive effects on resource consumption and quality of care have been shown, CPs are still underutilised in many clinical settings because their development and implementation are difficult. Evidence underpinning successful development and implementation is sparse. The authors conducted semistructured face-to-face interviews with key staff members involved in the design and implementation of CPs in a large surgery department. Interviewees were asked to provide opinions on various issues, which were previously identified as potentially important in CP development and implementation. The transcribed text was read and coded independently by two researchers. Respondents highlighted the importance of a multidisciplinary participatory approach for CP design and implementation. There was a strong initial fear of losing individual freedom of treatment, which subsided after people worked with CPs in clinical everyday life. It was appreciated that the project originated from people at different levels of the department's hierarchy. Likewise, it was felt that CP implementation granted more autonomy to lower-level staff. The structured qualitative approach of this study provides information on what issues are considered important by staff members for CP design and implementation. Whereas some concepts such as the importance of a multidisciplinary approach or continuous feedback of results are known from theories, others such as strengthening the authority especially of lower-level health professionals through CPs have not been described so far. Many of the findings point towards strong interactions between factors important for CP implementation and a department's organisational structure.

  10. Determination of minimal clinically important change in early and advanced Parkinson's disease. (United States)

    Hauser, Robert A; Auinger, Peggy


    Two common primary efficacy outcome measures in Parkinson's disease (PD) are change in Unified Parkinson's Disease Rating Scale (UPDRS) scores in early PD and change in "off" time in patients with motor fluctuations. Defining the minimal clinically important change (MCIC) in these outcome measures is important to interpret the clinical relevance of changes observed in clinical trials and other situations. We analyzed data from 2 multicenter, placebo-controlled, randomized clinical trials of rasagiline; TEMPO studied 404 early PD subjects, and PRESTO studied 472 levodopa-treated subjects with motor fluctuations. An anchor-based approach using clinical global impression of improvement (CGI-I) was used to determine MCIC for UPDRS scores and daily "off" time. MCIC was defined as mean change in actively treated subjects rated minimally improved on CGI-I. Receiver operating characteristic (ROC) curves defined optimal cutoffs discriminating between changed and unchanged subjects. MCIC for improvement in total UPDRS score (parts I-III) in early PD was determined to be -3.5 points based on mean scores and -3.0 points based on ROC curves. In addition, we found an MCIC for reduction in "off" time of 1.0 hours as defined by mean reduction in "off" time in active treated subjects self-rated as minimally improved on CGI-I minus mean reduction in "off" time in placebo-treated subjects self-rated as unchanged (1.9-0.9 hours). We hypothesize that many methodological factors can influence determination of the MCIC, and a range of values is likely to emerge from multiple studies. Copyright © 2011 Movement Disorder Society.

  11. [Anaesthetists learn--do institutions also learn? Importance of institutional learning and corporate culture in clinics]. (United States)

    Schüpfer, G; Gfrörer, R; Schleppers, A


    In only a few contexts is the need for substantial learning more pronounced than in health care. For a health care provider, the ability to learn is essential in a changing environment. Although individual humans are programmed to learn naturally, organisations are not. Learning that is limited to individual professions and traditional approaches to continuing medical education is not sufficient to bring about substantial changes in the learning capacity of an institution. Also, organisational learning is an important issue for anaesthesia departments. Future success of an organisation often depends on new capabilities and competencies. Organisational learning is the capacity or processes within an organisation to maintain or improve performance based on experience. Learning is seen as a system-level phenomenon as it stays in the organisation regardless of the players involved. Experience from other industries shows that learning strategies tend to focus on single loop learning, with relatively little double loop learning and virtually no meta-learning or non-learning. The emphasis on team delivery of health care reinforces the need for team learning. Learning organisations make learning an intrinsic part of their organisations and are a place where people continually learn how to learn together. Organisational learning practice can help to improve existing skills and competencies and to change outdated assumptions, procedures and structures. So far, learning theory has been ignored in medicine, due to a wide variety of complex political, economic, social, organisational culture and medical factors that prevent innovation and resist change. The organisational culture is central to every stage of the learning process. Learning organisations move beyond simple employee training into organisational problem solving, innovation and learning. Therefore, teamwork and leadership are necessary. Successful organisations change the competencies of individuals, the systems


    Directory of Open Access Journals (Sweden)

    R Khajotia


    Full Text Available Mediastinal shift (upper and lower is a clinical and radiologicalmarker of significant importance, which at times helps todetermine the aetiological cause of the underlying pathology.Tracheal shift is an indicator of upper mediastinal shift, whilea shift in the position of the heart indicates a lower mediastinalshift. Since the pleural cavity is confined by the rib cage, incase of a moderately large pleural effusion, the structures inthe thoracic cavity normally get ‘pushed’ to the opposite sideresulting in a shift of the upper and lower mediastinum. Thisis clinically and radiologically detected by a shift in the tracheaand heart to the side opposite to the pleural effusion. This iscommonly seen in pleural effusions resulting from tuberculosisor other infections. However, in some cases even a largepleural effusion fails to shift the mediastinum to the oppositeside. In fact, in some cases, the trachea and heart areobserved to be central or even shifted to the same side asthe effusion. This finding is of immense importance as it is aclinical indicator of a more serious condition which needsprompt diagnosis and urgent management. We report here,one such case of a middle-aged man who presented to theemergency department with complaints of increasingbreathlessness and whose clinical and radiological examinationrevealed a moderately large right-sided pleural effusion withthe trachea and heart also shifted to the right side.

  13. Pragmatic characteristics of patient-reported outcome measures are important for use in clinical practice. (United States)

    Kroenke, Kurt; Monahan, Patrick O; Kean, Jacob


    Measures for assessing patient-reported outcomes (PROs) that may have initially been developed for research are increasingly being recommended for use in clinical practice as well. Although psychometric rigor is essential, this article focuses on pragmatic characteristics of PROs that may enhance uptake into clinical practice. Three sources were drawn on in identifying pragmatic criteria for PROs: (1) selected literature review including recommendations by other expert groups; (2) key features of several model public domain PROs; and (3) the authors' experience in developing practical PROs. Eight characteristics of a practical PRO include: (1) actionability (i.e., scores guide diagnostic or therapeutic actions/decision making); (2) appropriateness for the relevant clinical setting; (3) universality (i.e., for screening, severity assessment, and monitoring across multiple conditions); (4) self-administration; (5) item features (number of items and bundling issues); (6) response options (option number and dimensions, uniform vs. varying options, time frame, intervals between options); (7) scoring (simplicity and interpretability); and (8) accessibility (nonproprietary, downloadable, available in different languages and for vulnerable groups, and incorporated into electronic health records). Balancing psychometric and pragmatic factors in the development of PROs is important for accelerating the incorporation of PROs into clinical practice. Published by Elsevier Inc.

  14. Determining the Minimal Clinically Important Difference for Six-Minute Walk Distance in Fibromyalgia (United States)

    Kaleth, Anthony S.; Slaven, James E.; Ang, Dennis C.


    Objective To estimate the minimal clinically important difference (MCID) for 6-minute walk distance (6MWD) in patients with fibromyalgia (FM). Design Data from a recently completed trial that included 187 patients who completed the 6-minute walk test, Fibromyalgia Impact Questionnaire (FIQ), and Short-Form 36 (SF36) at 12 and 36 weeks were used to examine longitudinal changes in 6MWD. An anchor-based approach that used linear regression analyses was used to determine the MCID for 6MWD, using the total FIQ score (FIQ-Total) and SF36-physical function domain (SF36-PF) as clinical anchors. Results The mean (SD) change in 6MWD from baseline to week 36 was 34.4 (65.2) m (pFIQ and SF36-PF, respectively. These MCID’s correspond with clinically meaningful improvements in FIQ (14% reduction) and SF36-PF (10 point increase). Conclusion The MCID for 6MWD in patients with FM was 156 to 167 m. These findings provide the first evidence of the change in 6MWD that is perceived by patients to be clinically meaningful. Further research using other MCID calculation methods is needed to refine estimates of the MCID for 6MWD in patients with FM. PMID:27003201

  15. Determining the Minimal Clinically Important Difference for 6-Minute Walk Distance in Fibromyalgia. (United States)

    Kaleth, Anthony S; Slaven, James E; Ang, Dennis C


    The aim of this study was to estimate the minimal clinically important difference (MCID) for 6-min walk distance (6MWD) in patients with fibromyalgia. Data from a recently completed trial that included 187 patients who completed the 6-min walk test, Fibromyalgia Impact Questionnaire (FIQ), and Short-Form 36 (SF36) at 12 and 36 wks were used to examine longitudinal changes in 6MWD. An anchor-based approach that used linear regression analyses was used to determine the MCID for 6MWD, using the total FIQ score (FIQ-Total) and SF36-physical function domain as clinical anchors. The mean (SD) change in 6MWD from baseline to week 36 was 34.4 (65.2) m (P FIQ and SF36-physical function domain, respectively. These MCIDs correspond with clinically meaningful improvements in FIQ (14% reduction) and SF36-physical function domain (10-point increase). The MCID for 6MWD in patients with fibromyalgia was 156 to 167 m. These findings provide the first evidence of the change in 6MWD that is perceived by patients to be clinically meaningful. Further research using other MCID calculation methods is needed to refine estimates of the MCID for 6MWD in patients with fibromyalgia.

  16. Antibacterial effect of bioactive glasses on clinically important anaerobic bacteria in vitro. (United States)

    Leppäranta, Outi; Vaahtio, Minna; Peltola, Timo; Zhang, Di; Hupa, Leena; Hupa, Mikko; Ylänen, Heimo; Salonen, Jukka I; Viljanen, Matti K; Eerola, Erkki


    Bioactive glasses (BAGs) of different compositions have been studied for decades for clinical use and they have found many dental and orthopaedic applications. Particulate BAGs have also been shown to have antibacterial properties. This large-scale study shows that two bioactive glass powders (S53P4 and 13-93) and a sol-gel derived material (CaPSiO II) have an antibacterial effect on 17 clinically important anaerobic bacterial species. All the materials tested demonstrated growth inhibition, although the concentration and time needed for the effect varied depending on the BAG. Glass S53P4 had a strong growth-inhibitory effect on all pathogens tested. Glass 13-93 and sol-gel derived material CaPSiO II showed moderate antibacterial properties.

  17. Do clinical diagnoses correlate with pathological diagnoses in cardiac transplant patients? The importance of endomyocardial biopsy

    DEFF Research Database (Denmark)

    Luk, Adriana; Metawee, Mohammed; Ahn, Eric


    . Patient records were reviewed for preoperative clinical diagnoses and other relevant data, including pretransplant endomyocardial biopsy (EMB) results, information regarding left ventricular assist devices and, finally, evidence of disease recurrence in the grafted heart. RESULTS: A shift...... diagnose patients with diseases such as sarcoidosis, amyloidosis and particular types of myocarditis because these can readily recur in the grafted heart. The risk for recurrence must be known to practitioners and, most importantly, to the patient. We strongly recommend the use of EMB if a nonischemic...

  18. The importance of genotype-phenotype correlation in the clinical management of Marfan syndrome. (United States)

    Becerra-Muñoz, Víctor Manuel; Gómez-Doblas, Juan José; Porras-Martín, Carlos; Such-Martínez, Miguel; Crespo-Leiro, María Generosa; Barriales-Villa, Roberto; de Teresa-Galván, Eduardo; Jiménez-Navarro, Manuel; Cabrera-Bueno, Fernando


    Marfan syndrome (MFS) is a disorder of autosomal dominant inheritance, in which aortic root dilation is the main cause of morbidity and mortality. Fibrillin-1 (FBN-1) gene mutations are found in more than 90% of MFS cases. The aim of our study was to summarise variants in FBN-1 and establish the genotype-phenotype correlation, with particular interest in the onset of aortic events, in a broad population of patients with an initial clinical suspicion of MFS. This single centre prospective cohort study included all patients presenting variants in the FBN-1 gene who visited a Hereditary Aortopathy clinic between September 2010 and October 2016. The study included 90 patients with FBN-1 variants corresponding to 58 non-interrelated families. Of the 57 FBN-1 variants found, 25 (43.9%) had previously been described, 23 of which had been identified as associated with MFS, while the the remainder are described for the first time. For 84 patients (93.3%), it was possible to give a definite diagnosis of Marfan syndrome in accordance with Ghent criteria. 44 of them had missense mutations, 6 of whom had suffered an aortic event (with either prophylactic surgery for aneurysm or dissection), whereas 20 of the 35 patients with truncating mutations had suffered an event (13.6% vs. 57.1%, p importance not only in the diagnosis, but also in risk stratification and clinical management of patients with suspected MFS.

  19. Late radiation-induced heart disease after radiotherapy. Clinical importance, radiobiological mechanisms and strategies of prevention

    International Nuclear Information System (INIS)

    Andratschke, Nicolaus; Maurer, Jean; Molls, Michael; Trott, Klaus-Ruediger


    The clinical importance of radiation-induced heart disease, in particular in post-operative radiotherapy of breast cancer patients, has been recognised only recently. There is general agreement, that a co-ordinated research effort would be needed to explore all the potential strategies of how to reduce the late risk of radiation-induced heart disease in radiotherapy. This approach would be based, on one hand, on a comprehensive understanding of the radiobiological mechanisms of radiation-induced heart disease after radiotherapy which would require large-scale long-term animal experiments with high precision local heart irradiation. On the other hand - in close co-operation with mechanistic in vivo research studies - clinical studies in patients need to determine the influence of dose distribution in the heart on the risk of radiation-induced heart disease. The aim of these clinical studies would be to identify the critical structures within the organ which need to be spared and their radiation sensitivity as well as a potential volume and dose effect. The results of the mechanistic studies might also provide concepts of how to modify the gradual progression of radiation damage in the heart by drugs or biological molecules. The results of the studies in patients would need to also incorporate detailed dosimetric and imaging studies in order to develop early indicators of impending radiation-induced heart disease which would be a pre-condition to develop sound criteria for treatment plan optimisation.

  20. The keloid phenomenon: progress toward a solution. (United States)

    Louw, Louise


    For centuries, keloids have been an enigma and despite considerable research to unravel this phenomenon no universally accepted treatment protocol currently exists. Historically, the etiology of keloids has been hypothesized by multiple different theories; however, a more contemporary view postulates a multifactoral basis for this disorder involving nutritional, biochemical, immunological, and genetic factors that play a role in this abnormal wound healing. Critical to the process of preventing or managing keloids is the need to locally control fibroblasts and their activities at the wound site. In recent years, considerable evidence has accumulated demonstrating the importance of fatty acids and bioactive lipids in health and disease, especially those involving inflammatory disorders or immune dysfunction. If hypertrophic scarring and keloid formation can be argued to have significant inflammatory histories, then it is possible to postulate a role for lipids in their etiology and potentially in their treatment. This report briefly visits past views and theories on keloid formation and treatment, and offers a theoretical rationale for considering adjuvant fatty acid therapy for keloid management. Sufficient scientific evidence in support of fatty acid strategies for the prevention and treatment of keloids currently exists, which offer opportunities to bridge the gap between the laboratory and the clinic. The intent of this paper is to serve as a basic guideline for researchers, nutritionists, and clinicians interested in keloids and to propose new directions for keloid management.

  1. Quality of Life After Cardiac Surgery Based on the Minimal Clinically Important Difference Concept. (United States)

    Grand, Nathalie; Bouchet, Jean Baptiste; Zufferey, Paul; Beraud, Anne Marie; Awad, Sahar; Sandri, Fabricio; Campisi, Salvator; Fuzellier, Jean François; Molliex, Serge; Vola, Marco; Morel, Jerome


    Health-related quality of life (HRQOL) is an increasingly important issue in assessing the consequences of any surgical or medical intervention. Our study aimed to evaluate change in HRQOL 6 months after elective cardiac surgery and to identify specific predictors of poor HRQOL. In this prospective, single-center study, HRQOL was evaluated before and 6 months after surgery using the SF-36 questionnaire and its two components: the physical component summary (PCS) and the mental component summary (MCS). We distinguished patients with worsening of HRQOL according to the minimal clinically important difference. All consecutive adult patients undergoing cardiac surgery were included. 326 patients completed the preoperative and postoperative SF-36 questionnaires and 24 patients died before completing follow-up questionnaires. Based on the definition used, clinically significant deterioration of HRQOL was observed in 93 patients (26.6%) for PCS and 99 patients (28.2%) for MCS. Renal replacement for acute renal failure and mechanical ventilation for longer than 48 hours were independent risk factors for PCS and MCS worsening or death. Although our study showed overall improvement of QOL after cardiac surgery, over a quarter of the patients manifested deterioration of HRQOL at 6 months post-surgery. The findings from this study should help clinicians to inform patients about their likely postoperative functional status and quality of life. Copyright © 2018. Published by Elsevier Inc.

  2. What is clinical leadership and why might it be important in dentistry? (United States)

    Brocklehurst, P; Ferguson, J; Taylor, N; Tickle, M


    The concept of leadership means different things to different people. At present there is no single definition of leadership nor an established theoretical approach. Despite this, leadership in the clinical environment is becoming increasingly cited as an important component in the transition of the National Health Service (NHS) and in the development of clinician led services. In medicine, clinical commissioning groups (CCGs) will soon be operational and the Department of Health (DH) seeks to establish a similar approach in dentistry, where local clinicians drive forward a quality agenda with a focus on patient outcomes. To facilitate this, the NHS Commissioning Board (NHSCB) are in the process of developing Local Professional Networks (LPNs) for dentistry. Given this shift towards localism and clinician led services it would appear that leadership will have a significant role in both medicine and dentistry. This paper explores what leadership is, before determining why it might be important in providing a clinician-led, patient-based and outcomes-focused service.


    Directory of Open Access Journals (Sweden)

    Cristian Raluca


    Full Text Available In our contemporary democratic society the migration phenomenon meets unknown valences in any previous societies. Free will and right to self-determination, much exploited by the XX century society., raised the possibility of interpretation of migration

  4. Is daily routine important for sleep? An investigation of social rhythms in a clinical insomnia population. (United States)

    Moss, Taryn G; Carney, Colleen E; Haynes, Patricia; Harris, Andrea L


    Social rhythms, also known as daily routines (e.g. exercise, of school or work, recreation, social activities), have been identified as potential time cues to help to regulate the biological clock. Past research has shown links between regularity and healthy sleep. This study examined the regularity and frequency of daytime activities in a clinical insomnia population and a good sleeper comparison group. Participants (N = 69) prospectively monitored their sleep and daily activities for a 2-week period. Although participants with insomnia and good sleepers had similar levels of activity, relative to good sleepers, those with insomnia were less regular in their activities. Findings from this study add to the growing number of studies that highlight the relative importance of the regularity of daytime activities on sleep. Accordingly, future research should test treatment components that focus on regulating daytime activities, which would likely improve treatment outcomes.

  5. [Antibacterial and antifungal activity of Salvia apiana against clinically important microorganisms]. (United States)

    Córdova-Guerrero, Iván; Aragon-Martinez, Othoniel H; Díaz-Rubio, Laura; Franco-Cabrera, Santiago; Serafín-Higuera, Nicolas A; Pozos-Guillén, Amaury; Soto-Castro, Tely A; Martinez-Morales, Flavio; Isiordia-Espinoza, Mario

    Due to the great global concern regarding bacterial resistance to antibiotics, an ongoing search for new molecules having antibacterial activity is necessary. This study evaluated the antibacterial and anticandidal effects of a hexane extract from the root of Salvia apiana. Salvia extracts at concentrations of 27, 13.5, 6.8 and 3.4mg/ml caused growth inhibition of Staphylococcus aureus, Streptococcus pyogenes, Enterococcus faecalis and Candida albicans. However, no significant effect was observed on Escherichia coli and Candida tropicalis in comparison to vehicle. It was here demonstrated for the first time that Salvia apiana has an important antimicrobial effect on human pathogens of great clinical value, thus opening the field to continue the evaluation of this lamiaceous plant for its future use as a therapeutic agent. Copyright © 2016 Asociación Argentina de Microbiología. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Shared decision making in mental health: the importance for current clinical practice. (United States)

    Alguera-Lara, Victoria; Dowsey, Michelle M; Ride, Jemimah; Kinder, Skye; Castle, David


    We reviewed the literature on shared decision making (regarding treatments in psychiatry), with a view to informing our understanding of the decision making process and the barriers that exist in clinical practice. Narrative review of published English-language articles. After culling, 18 relevant articles were included. Themes identified included models of psychiatric care, benefits for patients, and barriers. There is a paucity of published studies specifically related to antipsychotic medications. Shared decision making is a central part of the recovery paradigm and is of increasing importance in mental health service delivery. The field needs to better understand the basis on which decisions are reached regarding psychiatric treatments. Discrete choice experiments might be useful to inform the development of tools to assist shared decision making in psychiatry.

  7. Importance/performance analysis: a tool for service quality control by clinical laboratories. (United States)

    Scammon, D L; Weiss, R


    A study of customer satisfaction with clinical laboratory service is used as the basis for identifying potential improvements in service and more effectively targeting marketing activities to enhance customer satisfaction. Data on customer satisfaction are used to determine the aspects of service most critical to customers, how well the organization is doing in delivery of service, and how consistent service delivery is. Importance-performance analysis is used to highlight areas for future resource reallocation and strategic emphasis. Suggestions include the establishment of performance guidelines for customer contact personnel, the enhancement of timely delivery of reports via electronic transmission (computer and fax), and the development of standardized graphics for request and report forms to facilitate identification of appropriate request forms and guide clients to key items of information on reports.

  8. Differential Diagnoses of Overgrowth Syndromes: The Most Important Clinical and Radiological Disease Manifestations

    International Nuclear Information System (INIS)

    Lacerda, L.S.; Alves, U.D.; Zanier, J.F.C.; Machado, D.C.; Camilo, G.B.; Machado, D.C.; Camilo, G.B.; Lopes, A.J.


    Overgrowth syndromes comprise a heterogeneous group of diseases that are characterized by excessive tissue development. Some of these syndromes may be associated with dysfunction in the receptor tyrosine kinase (RTK)/PI3K/AKT pathway, which results in an increased expression of the insulin receptor. In the current review, four overgrowth syndromes were characterized (Proteus syndrome, Klippel-Trenaunay-Weber syndrome, Made lung’s disease, and neurofibromatosis type I) and illustrated using cases from our institution. Because these syndromes have overlapping clinical manifestations and have no established genetic tests for their diagnosis, radiological methods are important contributors to the diagnosis of many of these syndromes. The correlation of genetic discoveries and molecular pathways that may contribute to the phenotypic expression is also of interest, as this may lead to potential therapeutic interventions

  9. ABC gene expression profiles have clinical importance and possibly form a new hallmark of cancer. (United States)

    Dvorak, Pavel; Pesta, Martin; Soucek, Pavel


    Adenosine triphosphate-binding cassette proteins constitute a large family of active transporters through extracellular and intracellular membranes. Increased drug efflux based on adenosine triphosphate-binding cassette protein activity is related to the development of cancer cell chemoresistance. Several articles have focused on adenosine triphosphate-binding cassette gene expression profiles (signatures), based on the expression of all 49 human adenosine triphosphate-binding cassette genes, in individual tumor types and reported connections to established clinicopathological features. The aim of this study was to test our theory about the existence of adenosine triphosphate-binding cassette gene expression profiles common to multiple types of tumors, which may modify tumor progression and provide clinically relevant information. Such general adenosine triphosphate-binding cassette profiles could constitute a new attribute of carcinogenesis. Our combined cohort consisted of tissues from 151 cancer patients-breast, colorectal, and pancreatic carcinomas. Standard protocols for RNA isolation and quantitative real-time polymerase chain reaction were followed. Gene expression data from individual tumor types as well as a merged tumor dataset were analyzed by bioinformatics tools. Several general adenosine triphosphate-binding cassette profiles, with differences in gene functions, were established and shown to have significant relations to clinicopathological features such as tumor size, histological grade, or clinical stage. Genes ABCC7, A3, A8, A12, and C8 prevailed among the most upregulated or downregulated ones. In conclusion, the results supported our theory about general adenosine triphosphate-binding cassette gene expression profiles and their importance for cancer on clinical as well as research levels. The presence of ABCC7 (official symbol CFTR) among the genes with key roles in the profiles supports the emerging evidence about its crucial role in various

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

    Directory of Open Access Journals (Sweden)

    Alan J. McMichael BSc


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

  11. [Imported malaria and HIV infection in Madrid. Clinical and epidemiological features]. (United States)

    Ramírez-Olivencia, G; Herrero, M D; Subirats, M; de Juanes, J R; Peña, J M; Puente, S


    Few data are available in Spain data on human immunodeficiency virus (HIV) patients coinfected with malaria. This study has aimed to determine the epidemiological and clinical characteristics of imported malaria in patients coinfected with HIV. A case-series retrospective study was performed using the patient's medical records. The study population consisted on patients diagnosed with malaria attended in our center from january 1, 2002 to december 31, 2007. A total of 484 episodes of malaria, 398 of which were included in this study, were identified. Co-infection with HIV was described in 32 cases. All of them occurred in individuals presumably with some degree of semi-immunity. In the coinfected group, there were 13 cases (40.6%) asymptomatic, whereas this event occurred in 99 cases of patients not coinfected (37.2%) (P=0.707). The greater presence of anemia in co-infected patients (62.5% vs 32.3% in non-coinfected [P=0.001]) stands out. In present study, the clinical presentation forms were similar, regardless of the presence or absence of HIV infection. Although the study population does not reflect all possible scenarios of malaria and HIV coinfection, our results indicate the reality of patients attended in the Autonomous Community of Madrid. Copyright © 2011 Elsevier España, S.L. All rights reserved.

  12. Clinical importance of pharmacogenetics in the treatment of hepatitis C virus infection. (United States)

    Kamal, Adina Maria; MitruŢ, Paul; Kamal, Kamal Constantin; Tica, Oana Sorina; Niculescu, Mihaela; Alexandru, Dragoş Ovidiu; Tica, Andrei Adrian


    Globally, over 4% of the world population is affected by hepatitis C virus (HCV) infection. The current standard of care for hepatitis C infection is combination therapy with pegylated interferon and ribavirin for 48 weeks, which yield a sustained virological response in only a little over half of the patients with genotype 1 HCV. We investigated the clinical importance of pharmacogenetics in treatment efficacy and prediction of hematotoxicity. A total of 148 patients infected with HCV were enrolled. All patients were treated for a period of 48 weeks or less with pegylated interferon and ribavirin. Four genotypes were investigated: inosine triphosphatase (ITPA) rs1127354, C20orf194 rs6051702, interferon lambda (IFNL)3 rs8099917, IFNL3÷4 rs12979860 in the population from southwestern Romania. Genetic variants for rs129798660 and rs6051702 proved once more to represent an indisputable clinical tool for predicting sustained virological response (SVR) (69.23%, chi-square p=0.007846, ppharmacogenetics should play a constant role in treatment decisions for patients infected with hepatitis C virus.

  13. The importance, impact and influence of group clinical supervision for graduate entry nursing students. (United States)

    Sheppard, Fiona; Stacey, Gemma; Aubeeluck, Aimee


    This paper will report on an evaluation of group clinical supervision (CS) facilitated for graduate entry nursing (GEN) students whilst on clinical placement. The literature suggests educational forums which enable GEN students to engage in critical dialogue, promote reflective practice and ongoing support are an essential element of GEN curricula. The model of supervision employed was informed by Proctor's three function interactive CS model and Inskipp and Proctor's Supervision Alliance. Both emphasise the normative, formative and restorative functions of CS as task areas within an overarching humanistic supervisory approach. The three-function model informed the design of a questionnaire which intended to measure their importance, impact and influence through both structured and open-ended questions. Findings suggest the restorative function of supervision is most valued and is facilitated in an environment where humanistic principles of non-judgement, empathy and trust are clearly present. Also the opportunity to learn from others, consider alternative perspectives and question personal assumptions regarding capability and confidence are a priority for this student group. It is suggested that the restorative function of CS should be prioritised within future developments and models which view this function as a key purpose of CS should be explored. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Importance of patient-centred signage and navigation guide in an orthopaedic and plastics clinic. (United States)

    Maqbool, Talha; Raju, Sneha; In, Eunji


    Gulshan & Nanji Orthopaedic and Plastics Center at the North York General Hospital is the second busiest site after the emergency department serving more than 26,000 patients annually. Increase in patient flow, overworked staff, and recent renovations to the hospital have resulted in patients experiencing long wait times, and thusly patient dissatisfaction and stress. Several factors contribute to patient dissatisfaction and stress: i) poor and unfriendly signage; ii) inconsistent utilization of the numbering system; and iii) difficulty navigating to and from the imaging center. A multidisciplinary QI team was assembled to improve the patient experience. We developed a questionnaire to assess patient stress levels at the baseline. Overall, more than half of the patients (54.8%) strongly agreed or agreed to having a stressful waiting experience. Subsequently, based on patient feedback and staff perspectives, we implemented two PDSA cycles. For PDSA 1, we placed a floor graphic (i.e. black tape) to assist patients in navigating from the clinic to the imaging centre and back. For PDSA 2, we involved creating a single 21"×32" patient-friendly sign at the entrance to welcome patients, with clear instructions outlining registration procedures. Surveys were re-administered to assess patient stress levels. A combination of both interventions caused a statistically significant reduction in patient stress levels based on the Kruskal-Wallis and Mann-Whitney U Tests. The present project highlighted the importance of involving stakeholders as well as frontline staff when undertaking quality improvement projects as a way to identify bottlenecks as well as establish sustainable solutions. Additionally, the team recognized the importance of incorporating empirical based solutions and involving experts in the field to optimize results. The present project successfully implemented strategies to improve patient satisfaction and reduce stress in a high flow community clinic. These

  15. The importance of histopathological and clinical variables in predicting the evolution of colon cancer. (United States)

    Diculescu, Mircea; Iacob, Răzvan; Iacob, Speranţa; Croitoru, Adina; Becheanu, Gabriel; Popeneciu, Valentin


    It has been a consensus that prognostic factors should always be taken into account before planning treatment in colorectal cancer. A 5 year prospective study was conducted, in order to assess the importance of several histopathological and clinical prognostic variables in the prediction of evolution in colon cancer. Some of the factors included in the analysis are still subject to dispute by different authors. 46 of 53 screened patients qualified to enter the study and underwent a potentially curative resection of the tumor, followed, when necessary, by adjuvant chemotherapy. Univariate and multivariate analyses were carried out in order to identify independent prognostic indicators. The endpoint of the study was considered the recurrence of the tumor or the detection of metastases. 65.2% of the patients had a good evolution during the follow up period. Multivariate survival analysis performed by Cox proportional hazard model identified 3 independent prognostic factors: Dukes stage (p = 0.00002), the grade of differentiation (p = 0.0009) and the weight loss index, representing the weight loss of the patient divided by the number of months when it was actually lost (p = 0.02). Age under 40 years, sex, microscopic aspect of the tumor, tumor location, anemia degree were not identified by our analysis as having prognostic importance. Histopathological factors continue to be the most valuable source of information regarding the possible evolution of patients with colorectal cancer. Individual clinical symptoms or biological parameters such as erytrocyte sedimentation rate or hemoglobin level are of little or no prognostic value. More research is required relating to the impact of a performance status index (which could include also weight loss index) as another reliable prognostic variable.

  16. Phenomenon of isomorphic provoking responses in cases of limited scleroderma

    Directory of Open Access Journals (Sweden)

    Talnikova Е.Е.


    Full Text Available The article presents the historical origin of the term "Koebner phenomenon". The literature data reflect the etiology, pathogenesis and epidemiology of isomorphic mechanisms provoking responses in lichen planus, psoriasis, scleroder-ma, syphilis. Variants of the Koebner phenomenon's classifications are given. The clinical cases of limited scleroderma after mechanical injury are described.

  17. The Clinical Importance of Perforator Preservation in Intracranial Aneurysm Surgery: An Overview with a Review of the Literature. (United States)

    Joo, Sung-Pil; Kim, Tae-Sun


    Clipping for intracranial aneurysms is done to achieve complete occlusion of the aneurysm without a remnant sac. Despite modern advancements of neurosurgical techniques, morbidity related to the clipping of intracranial aneurysms still exists. Clip occlusion of a parent artery or small hidden perforators commonly leads to permanent neurological deficits, and is a serious and unwanted complication. Thus, preserving blood flow in the branches and perforators of a parent artery is very important for successful surgery without postoperative morbidity and mortality. The aim of this review article is to discuss the consequences of perforator injury and how to avoid this phenomenon in aneurysm surgeries using intraoperative monitoring devices.

  18. Clinical importance of the anterior choroidal artery: a review of the literature. (United States)

    Yu, Jing; Xu, Ning; Zhao, Ying; Yu, Jinlu


    The anterior choroidal artery (AChA) is a critical artery in brain physiology and function. The AChA is involved in many diseases, including aneurysm, brain infarct, Moyamoya disease (MMD), brain tumor, arteriovenous malformation (AVM), etc. The AChA is vulnerable to damage during the treatment of these diseases and is thus a very important vessel. However, a comprehensive systematic review of the importance of the AChA is currently lacking. In this study, we used the PUBMED database to perform a literature review of the AChA to increase our understanding of its role in neurophysiology. Although the AChA is a small thin artery, it supplies an extremely important region of the brain. The AChA consists of cisternal and plexal segments, and the point of entry into the choroidal plexus is known as the plexal point. During treatment for aneurysms, tumors, AVM or AVF, the AChA cisternal segments should be preserved as a pathway to prevent the infarction of the AChA target region in the brain. In MMD, a dilated AChA provides collateral flow for posterior circulation. In brain infarcts, rapid treatment is necessary to prevent brain damage. In Parkinson disease (PD), the role of the AChA is unclear. In trauma, the AChA can tear and result in intracranial hematoma. In addition, both chronic and non-chronic branch vessel occlusions in the AChA are clinically silent and should not deter aneurysm treatment with flow diversion. Based on the data available, the AChA is a highly essential vessel.

  19. Koebner Phenomenon and Mycosis Fungoides

    Directory of Open Access Journals (Sweden)

    Eve Lebas


    Full Text Available Mycosis fungoides (MF is the most frequent type of primary cutaneous T-cell/NK-cell lymphoma. The Koebner phenomenon is defined as the appearance of cutaneous lesions on previously noninvolved skin following trauma and is observed in a series of cutaneous diseases including psoriasis, lichen planus, viral warts, molluscum contagiosum, etc. In this case report, 3 patients with longstanding MF are presented, the 1st with the appearance of a circumscribed early-stage type MF lesion rapidly following a surgical excision of an infundibular cyst, the 2nd with the appearance of a unique unilateral palmar tumoral MF lesion at the pressure site of a crutch, and the 3rd presented localized MF early stage lesions at the friction site of a belt. This report suggests that some MF patients may experience Koebner phenomenon-induced MF lesions and that MF should be added to the long list of skin diseases potentially exhibiting the Koebner phenomenon.

  20. The importance of exercise self-efficacy for clinical outcomes in pulmonary rehabilitation. (United States)

    Selzler, Anne-Marie; Rodgers, Wendy M; Berry, Tanya R; Stickland, Michael K


    Pulmonary rehabilitation (PR) improves functional exercise capacity and health status in people with chronic obstructive pulmonary disease (COPD), although these outcomes are often not maintained following PR. Self-efficacy is a precursor to outcomes achievement, yet few studies have examined the importance of self-efficacy to outcome improvement during PR, or how it develops over time. Further, the contribution of exercise-specific self-efficacy to outcomes in PR is unknown. The aims of this study were to determine (a) whether baseline exercise self-efficacy predicts PR attendance and change in functional exercise capacity and health status over PR, and (b) if exercise self-efficacy changes with PR. Fifty-eight out of 64 patients with COPD completed PR and assessments of exercise self-efficacy (task, coping, scheduling), the 6-minute walk test (6MWT), and St. George's Respiratory Questionnaire (SGRQ) at the beginning and end of PR. Analyses were conducted to predict attendance, and change in 6MWT and SGRQ, while controlling for baseline demographic and clinical indicators. Change in 6MWT, SGRQ, and self-efficacy with PR was also examined. Clinically significant increases in the 6MWT and SGRQ were achieved with PR. Stronger task self-efficacy predicted better attendance, while stronger coping self-efficacy predicted greater 6MWT improvement. No variables predicted SGRQ change. Scheduling self-efficacy significantly improved with PR, whereas task and coping self-efficacy did not. Baseline exercise self-efficacy appears to be a determinant of rehabilitation attendance and functional exercise improvement with PR. Clinicians should evaluate and target exercise self-efficacy to maximize adherence and health outcome improvement with PR. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  1. Hip Arthroscopy Outcomes With Respect to Patient Acceptable Symptomatic State and Minimal Clinically Important Difference. (United States)

    Levy, David M; Kuhns, Benjamin D; Chahal, Jaskarndip; Philippon, Marc J; Kelly, Bryan T; Nho, Shane J


    To determine whether the hip arthroscopy literature to date has shown outcomes consistent with published patient acceptable symptomatic state (PASS) and minimal clinically important difference (MCID) estimates. All clinical investigations of hip arthroscopy using modified Harris Hip Score (mHHS) and/or Hip Outcome Score (HOS) outcomes with at least 1 year of follow-up were reviewed. Ninety-one studies (9,746 hips) were included for review. Eighty-one studies (9,317 hips) contained only primary hip arthroscopies and were the primary focus of this review. The remaining studies (429 hips) did not exclude patients with prior surgical history and were thus considered separately. Mean mHHS, HOS-ADL (Activities of Daily Living) and HOS-SS (Sports-Specific) scores were compared with previously published PASS and MCID values. After 31 ± 20 months, 5.8% of study populations required revision arthroscopy and 5.5% total hip arthroplasty. A total of 88%, 25%, and 30% of study populations met PASS for mHHS, HOS-ADL, and HOS-SS, respectively, and 97%, 90%, and 93% met MCID. On bivariate analysis, increasing age was associated with significantly worse postoperative mHHS (P arthroscopy, we have found that more than 90% of study populations meet MCID standards for the most commonly used patient-reported outcomes measures in hip arthroscopy literature, mHHS and HOS. Eighty-eight percent meet PASS standards for the mHHS, but PASS standards are far more difficult to achieve for HOS-ADL (25%) and HOS-SS (30%) subscales. Differences in psychometric properties of the mHHS and HOS likely account for the discrepancies in PASS. Level IV, systematic review of Level I to IV studies. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  2. Evaluating clinically meaningful change on the ITP-PAQ: preliminary estimates of minimal important differences. (United States)

    Mathias, Susan D; Gao, Sue K; Rutstein, Mark; Snyder, Claire F; Wu, Albert W; Cella, David


    Interpretation of data from health-related quality of life (HRQoL) questionnaires can be enhanced with the availability of minimally important difference (MID) estimates. This information will aid clinicians in interpreting HRQoL differences within patients over time and between treatment groups. The Immune Thrombocytopenic Purpura (ITP)-Patient Assessment Questionnaire (PAQ) is the only comprehensive HRQoL questionnaire available for adults with ITP. Forty centers from within the US and Europe enrolled ITP patients into one of two multicenter, randomized, placebo-controlled, double-blind, 6-month, phase III clinical trials of romiplostim. Patients enrolled in these studies self-administered the ITP-PAQ and two items assessing global change (anchors) at baseline and weeks 4, 12, and 24. Using data from the ITP-PAQ and these two anchors, an anchor-based estimate was computed and combined with the standard error of measurement and standard deviation to compute a distribution-based estimate in order to provide an MID range for each of the 11 scales of the ITP-PAQ. A total of 125 patients participated in these clinical trials and provided data for use in these analyses. Combining results from anchor- and distribution-based approaches, MID values were computed for 9 of the 11 scales. MIDs ranged from 8 to 12 points for Symptoms, Bother, Psychological, Overall QOL, Social Activity, Menstrual Symptoms, and Fertility, while the range was 10 to 15 points for the Fatigue and Activity scales of the ITP-PAQ. These estimates, while slightly higher than other published MID estimates, were consistent with moderate effect sizes. These MID estimates will serve as a useful tool to researchers and clinicians using the ITP-PAQ, providing guidance for interpretation of baseline scores as well as changes in ITP-PAQ scores over time. Additional work should be done to finalize these initial estimates using more appropriate anchors that correlate more highly with the ITP-PAQ scales.

  3. Clinical Trials With Large Numbers of Variables: Important Advantages of Canonical Analysis. (United States)

    Cleophas, Ton J


    Canonical analysis assesses the combined effects of a set of predictor variables on a set of outcome variables, but it is little used in clinical trials despite the omnipresence of multiple variables. The aim of this study was to assess the performance of canonical analysis as compared with traditional multivariate methods using multivariate analysis of covariance (MANCOVA). As an example, a simulated data file with 12 gene expression levels and 4 drug efficacy scores was used. The correlation coefficient between the 12 predictor and 4 outcome variables was 0.87 (P = 0.0001) meaning that 76% of the variability in the outcome variables was explained by the 12 covariates. Repeated testing after the removal of 5 unimportant predictor and 1 outcome variable produced virtually the same overall result. The MANCOVA identified identical unimportant variables, but it was unable to provide overall statistics. (1) Canonical analysis is remarkable, because it can handle many more variables than traditional multivariate methods such as MANCOVA can. (2) At the same time, it accounts for the relative importance of the separate variables, their interactions and differences in units. (3) Canonical analysis provides overall statistics of the effects of sets of variables, whereas traditional multivariate methods only provide the statistics of the separate variables. (4) Unlike other methods for combining the effects of multiple variables such as factor analysis/partial least squares, canonical analysis is scientifically entirely rigorous. (5) Limitations include that it is less flexible than factor analysis/partial least squares, because only 2 sets of variables are used and because multiple solutions instead of one is offered. We do hope that this article will stimulate clinical investigators to start using this remarkable method.

  4. Establishing the minimal clinically important difference for the Questionnaire of Olfactory Disorders. (United States)

    Mattos, Jose L; Schlosser, Rodney J; Mace, Jess C; Smith, Timothy L; Soler, Zachary M


    Olfactory-specific quality of life (QOL) can be measured using the Questionnaire of Olfactory Disorders Negative Statements (QOD-NS). Changes in the QOD-NS after treatment can be difficult to interpret since there is no standardized definition of clinically meaningful improvement. Patients with chronic rhinosinusitis (CRS) completed the QOD-NS. Four distribution-based methods were used to calculate the minimal clinically important difference (MCID): (1) one-half standard deviation (SD); (2) standard error of the mean (SEM); (3) Cohen's effect size (d) of the smallest unit of change; and (4) minimal detectable change (MDC). We also averaged all 4 of the scores together. Finally, the likelihood of achieving a MCID after sinus surgery using these methods, as well as average QOD-NS scores, was stratified by normal vs abnormal baseline QOD-NS scores. Outcomes were examined on 128 patients. The mean ± SD improvement in QOD-NS score after surgery was 4.3 ± 11.0 for the entire cohort and 9.6 ± 12.9 for those with abnormal baseline scores (p < 0.001). The MCID values using the different techniques were: (1) SD = 6.5; (2) SEM = 3.1; (3) d = 2.6; and (4) MDC = 8.6. The MCID score was 5.2 on average. For the total cohort analysis, the likelihood of reporting a MCID ranged from 26% to 51%, and 49% to 70% for patients reporting preoperative abnormal olfaction. Distribution-based MCID values of the QOD-NS range between 2.6 and 8.6 points, with an average of 5.2. When stratified by preoperative QOD-NS scores the majority of patients reporting abnormal preoperative QOD-NS scores achieved a MCID. © 2018 ARS-AAOA, LLC.

  5. The Importance of Prolonged Provocation in Drug Allergy - Results From a Danish Allergy Clinic. (United States)

    Fransson, Sara; Mosbech, Holger; Kappel, Mogens; Hjortlund, Janni; Poulsen, Lars K; Kvisselgaard, Ask D; Garvey, Lene H

    Drug provocation is the "Gold Standard" in drug allergy investigation. Recent studies suggest that a negative drug provocation on first dose should be followed by a prolonged provocation over several days. To evaluate drug allergy investigations on the basis of drug provocation, including prolonged provocation. Data from adult patients investigated for drug allergy in a Danish Allergy Clinic during the period 2010 to 2014 were entered into a database. Data included clinical details and results of provocations with suspected culprit drug (for penicillins performed only in specific IgE-negative patients). If provocation was negative on first dose, treatment was continued for 3 to 10 days. A total of 1,913 provocations were done in 1,659 patients, median age 46 years, of whom 1,237 (74.6%) were females. Drugs investigated were antibiotics, 1,776 (92.8%), of which 1,590 (89.5%) were penicillins; analgesics, 59 (3.1%); local anesthetics, 33 (1.7%); and other drugs, 45 (2.4%). In total, 211 of 1,913 (11.0%) provocations were positive. Causes were antibiotics, 198 (93.8%), of which 167 (84.3%) were penicillins; analgesics, 7 (3.3%); local anesthetics, 0; and other drugs, 6 (2.8%). Only 43 (20.4%) provocations were positive on first dose, whereas 95 (45.0%) turned positive more than 3 days later. Only 11.0% of the provocations were positive. Importantly, only 1 of 5 patients tested positive on the first dose, indicating that prolonged exposure should always be considered when drug provocation is included in allergy investigations. Most provocations were with penicillins, reflecting the pattern of antibiotic use in Denmark, which differs from that in other countries, especially outside Northern Europe. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  6. Positive clinical interventions : Why are they important and how do they work?

    NARCIS (Netherlands)

    Bohlmeijer, E. T.; Bolier, L.; Lamers, S. M.A.; Westerhof, G. J.


    In this paper we discuss positive clinical psychology as an emerging field within clinical psychology. Positive clinical psychology is based on research demonstrating that mental health is more than the absence of mental illness, on research showing that well-being has buffering effects on the

  7. Inhibitory effect of Allium sativum and Zingiber officinale extracts on clinically important drug resistant pathogenic bacteria

    Directory of Open Access Journals (Sweden)

    Gull Iram


    Full Text Available Abstract Background Herbs and spices are very important and useful as therapeutic agent against many pathological infections. Increasing multidrug resistance of pathogens forces to find alternative compounds for treatment of infectious diseases. Methods In the present study the antimicrobial potency of garlic and ginger has been investigated against eight local clinical bacterial isolates. Three types of extracts of each garlic and ginger including aqueous extract, methanol extract and ethanol extract had been assayed separately against drug resistant Escherichia coli, Pseudomonas aeruginosa, Bacillus subtilis, Staphylococcus aureus, Klebsiella pneumoniae, Shigella sonnei, Staphylococcusepidermidis and Salmonella typhi. The antibacterial activity was determined by disc diffusion method. Results All tested bacterial strains were most susceptible to the garlic aqueous extract and showed poor susceptibility to the ginger aqueous extract. The (minimum inhibitory concentration MIC of different bacterial species varied from 0.05 mg/ml to 1.0 mg/ml. Conclusion In the light of several socioeconomic factors of Pakistan mainly poverty and poor hygienic condition, present study encourages the use of spices as alternative or supplementary medicine to reduce the burden of high cost, side effects and progressively increasing drug resistance of pathogens.

  8. Cardiac Alpha1-Adrenergic Receptors: Novel Aspects of Expression, Signaling Mechanisms, Physiologic Function, and Clinical Importance (United States)

    O’Connell, Timothy D.; Jensen, Brian C.; Baker, Anthony J.


    Adrenergic receptors (AR) are G-protein-coupled receptors (GPCRs) that have a crucial role in cardiac physiology in health and disease. Alpha1-ARs signal through Gαq, and signaling through Gq, for example, by endothelin and angiotensin receptors, is thought to be detrimental to the heart. In contrast, cardiac alpha1-ARs mediate important protective and adaptive functions in the heart, although alpha1-ARs are only a minor fraction of total cardiac ARs. Cardiac alpha1-ARs activate pleiotropic downstream signaling to prevent pathologic remodeling in heart failure. Mechanisms defined in animal and cell models include activation of adaptive hypertrophy, prevention of cardiac myocyte death, augmentation of contractility, and induction of ischemic preconditioning. Surprisingly, at the molecular level, alpha1-ARs localize to and signal at the nucleus in cardiac myocytes, and, unlike most GPCRs, activate “inside-out” signaling to cause cardioprotection. Contrary to past opinion, human cardiac alpha1-AR expression is similar to that in the mouse, where alpha1-AR effects are seen most convincingly in knockout models. Human clinical studies show that alpha1-blockade worsens heart failure in hypertension and does not improve outcomes in heart failure, implying a cardioprotective role for human alpha1-ARs. In summary, these findings identify novel functional and mechanistic aspects of cardiac alpha1-AR function and suggest that activation of cardiac alpha1-AR might be a viable therapeutic strategy in heart failure. PMID:24368739

  9. Importance of public health nurses precepting students in clinical practice: a qualitative study. (United States)

    Hjälmhult, Esther; Haaland, Gerd Unstad; Litland, Astrid Synnøve


    Preceptors' working environment, support and competence affect how they perform the preceptor role, are therefore important for developing students and can influence students' roles as students and future professionals. Previous research has focused on precepting student nurses and not so much on public health nurses or other postgraduate students. Knowledge in this field is therefore lacking. The article aims to present a grounded theory of the role of public health nurses as student preceptors in Norway. We conducted 20 interviews with public health nurses in addition to a focus group with four participants. We used classical grounded theory method to gather and analyze data. The preceptors were strongly concerned about invisibility and lack of recognition of the preceptor role. This main concern was resolved by the strategy of being obligated and included three patterns: optimistic, ambivalent and reluctant performance, all with differing motivation for being obligated. All stakeholders involved in clinical practice seem to contribute to making the preceptors' role invisible and thereby contribute to the lack of recognition, support and reward, which again seem to self-reinforce invisibility. The study highlights the obligation of public health nurses in precepting students and increases the understanding of the challenges of this role. Ensuring education of a high academic standard requires paying more attention to developing effective support for the people involved. Copyright © 2012 Elsevier Ltd. All rights reserved.

  10. Adhesive systems: important aspects related to their composition and clinical use

    Directory of Open Access Journals (Sweden)

    Mario Honorato Silva e Souza Junior


    Full Text Available This literature review article addresses the types and the main components of different etch-and-rinse and self-etch adhesive systems available in the market, and relates them to their function, possible chemical interactions and infuence of handling characteristics. Scanning electron microscopy (SEM images are presented to characterize the interface between adhesives and dentin. Adhesive systems have been recently classifed according to their adhesion approaches in etch-and-rinse, self-etch and glass ionomer. The etch-and-rinse systems require a specifc acid-etch procedure and may be performed in two or three steps. Self-etch systems employ acidic monomers that demineralize and impregnate dental substrates almost at the same time. These systems are separated in one or two steps. Some advantages and defciencies were noted for etch-and-rinse and self-etch approaches, mainly for the simplifed ones due to some chemical associations and interactions. The SEM micrographs illustrate different relationships between adhesive systems and dental structures, particularly dentin. The knowledge of composition, characteristics and mechanisms of adhesion of each adhesive system is of fundamental importance to permit the adoption of ideal bonding strategies under clinical conditions.

  11. Clinical importance of median mandibular flexure in oral rehabilitation: a review. (United States)

    Sivaraman, K; Chopra, A; Venkatesh, S B


    The mandible has a property to flex inwards around the mandibular symphysis with change in shape and decrease in mandibular arch width during opening and protrusion of the mandible. The mandibular deformation may range from a few micrometres to more than 1 mm. The movement occurs because of the contraction of lateral pterygoid muscles that pulls mandibular condyles medially and causes a sagittal movement of the posterior segments. This movement of mandible can have a profound influence on prognosis and treatment outcome for various restorative, endodontics, fixed, removable and implant-related prosthesis. The review unfolds the causes, importance and clinical implications of median mandibular flexure in oral rehabilitation. This review also highlights the appropriate preventive measures and techniques that should be adopted by clinicians to minimise the effect of flexural movement of the jaw during oral rehabilitation. This would not only help clinicians to achieve a good prosthesis with accurate fit and longevity but also maintain the health of the surrounding periodontal or periimplant gingival tissues and bone. © 2015 John Wiley & Sons Ltd.

  12. Clinical leadership in mental health nursing: the importance of a calm and confident approach. (United States)

    Ennis, Gary; Happell, Brenda; Reid-Searl, Kerry


    Explore the perceptions of nurses working in mental health of effective clinical leadership. In-depth interviews were conducted with registered nurses employed in a mental health setting. Qualitative research using grounded theory. Remaining calm and confident in times of crisis and uncertainty was identified as one attribute of clinical leadership. Participants noted clinical leaders' demeanor during stressful or crisis situations, and their ability to manage unpredictable or unexpected clinical situations as contributing positively to clinical practice. Understanding these characteristics and how they can influence positive outcomes for clients is crucial in addressing the recruitment and retention challenges for the nursing workforce. © 2014 Wiley Periodicals, Inc.

  13. [Radiation-induced bystander effect: the important part of ionizing radiation response. Potential clinical implications]. (United States)

    Wideł, Maria; Przybyszewski, Waldemar; Rzeszowska-Wolny, Joanna


    It has long been a central radiobiological dogma that the damaging effects of ionizing radiation, such as cell death, cytogenetic changes, apoptosis, mutagenesis, and carcinogenesis, are the results of the direct ionization of cell structures, particularly DNA, or indirect damage via water radiolysis products. However, several years ago attention turned to a third mechanism of radiation, termed the "bystander effect" or "radiation-induced bystander effect" (RIBE). This is induced by agents and signals emitted by directly irradiated cells and manifests as a lowering of survival, cytogenetic damage, apoptosis enhancement, and biochemical changes in neighboring non-irradiated cells. The bystander effect is mainly observed in in vitro experiments using very low doses of alpha particles (range; mGy, cGy), but also after conventional irradiation (X-rays, gamma rays) at low as well as conventional doses. The mechanisms responsible for the bystander effect are complex and still poorly understood. It is believed that molecular signals released from irradiated cells induce different signaling ways in non-irradiated neighboring cells, leading to the observed events. The molecular signals may be transmitted through gap junction intercellular communication and through a medium transfer mechanism. The nature of these transmitted factors are diverse, and still not definitely established. It seems that RIBE may have important clinical implications for health risk associated with radiation exposure. Potentially, this effect may have important implications in the creation of whole-body or localized side effects in tissues beyond the irradiation field and also in low-dose radiological and radioisotope diagnostics. Factors emitted by irradiated cells may result in the risk of genetic instability, mutations, and second primary cancer induction. They might also have their own part in inducing and extending post-radiation side effects in normal tissue. The bystander effect may be a

  14. Radiation-induced bystander effect: The important part of ionizing radiation response. Potential clinical implications

    Directory of Open Access Journals (Sweden)

    Maria Wideł


    Full Text Available It has long been a central radiobiological dogma that the damaging effects of ionizing radiation, such as cell death, cytogenetic changes, apoptosis, mutagenesis, and carcinogenesis, are the results of the direct ionization of cell structures, particularly DNA, or indirect damage via water radiolysis products. However, several years ago attention turned to a third mechanism of radiation, termed the “bystander effect” or “radiation-induced bystander effect” (RIBE. This is induced by agents and signals emitted by directly irradiated cells and manifests as a lowering of survival, cytogenetic damage, apoptosis enhancement, and biochemical changes in neighboring non-irradiated cells. The bystander effect is mainly observed in in vitro experiments using very low doses of alpha particles (range; mGy, cGy, but also after conventional irradiation (X-rays, gamma rays at low as well as conventional doses. The mechanisms responsible for the bystander effect are complex and still poorly understood. It is believed that molecular signals released from irradiated cells induce different signaling ways in non-irradiated neighboring cells, leading to the observed events. The molecular signals may be transmitted through gap junction intercellular communication and through a medium transfer mechanism. The nature of these transmitted factors are diverse, and still not defi nitely established. It seems that RIBE may have important clinical implications for health risk associated with radiation exposure. Potentially, this effectmay have important implications in the creation of whole-body or localized side effects in tissues beyond the irradiation fi eld and also in low-dose radiological and radioisotope diagnostics. Factors emitted by irradiated cells may result in the risk of genetic instability, mutations, and second primary cancer induction. They might also have their own part in inducing and extending post-radiation side effects in normal tissue. The

  15. The phenomenon of retarded potentials

    International Nuclear Information System (INIS)

    Noskov, N.K.


    The logic simulation of process of time delay of potential on a moved body - recipient resulted in the deduction about cyclic irregularity of time delay, that means, that the moved body makes longitudinal vibrations. A conclusion is drawn that length of longitudinal vibrations depending from three variable: the law of interaction, spacing interval between bodies of interaction and phase velocity looks like: λ=Hv ph /R·F(R) (1), where λ- length of oscillations; H- factor of proportionality; v ph - phase velocity of a body; R - distance between test and central bodies R(t); F(R) - law of interaction. So far as λ=v ph /v, and R·F(R)=∫ ∞ R F(R)dR=E move , then formula (1) will be transformed into: E move =Hv pv /λ=Hv. Thus, the energy of radiating having the similar law is only reflex of motion of a matter. The energy of oscillating motion can be expressed through linear maximal velocity. It is established, that different expressions of the same energy, result in the law of a view of a proportion for lengths of de Broglie's waves: It shows that de Broglie's waves - the actual oscillating motions of bodies, as demonstrate interference and diffraction pictures at a dissipation of the accelerated particles on crystalline gratings. This deduction has far-reaching consequences for finding - out of the cause bases of the laws of a nature. So, the quantum mechanics becomes partition of mechanics of solids and is comprises all interactions. The nuclear energy is not 'defect of mass', but is 'defect' of energy of oscillating motion: ΔE=H v1 -H v2 . Definition of real cause of nuclear energy is very important for construction of model of nuclei and for development of physics as the whole. The interconnection of the phenomenon of longitudinal vibrations of moved bodies, as result of irregularity of time delay of potential, with many other natural phenomena is looked through. By such, as: motion of planets and electrons on elliptical orbits, oscillating of dipping drips

  16. Phenomenon of displacement in Arabic language

    Directory of Open Access Journals (Sweden)


    Full Text Available Displacement is one of the characteristics of language and common phenomena in the Arabic language. Not only is this phenomenon limited to Arabic poetry and prose, but it is also broadened, so we can see examples of this in the Qur'an. Because of this phenomenon extensively in Arabic literature and also because of its essence that leads to the transmission of the elements for the first visibility to the other visibility in the sentence and sometimes had to change the grammatical role of the words, its identify helps us in a better understanding of text and the correct translation of it and protects the reader from mistakes. This paper in the descriptive analytical approach tries studying of the phenomenon of the displacement in the Arabic language and bringing its instances in Arabic poetry and prose as well as verses contained in the Holy Quran, to show that through the types and characteristics in the Arabic language and to response to several questions, including: how important is the displacement and what is its types in rhetoric, and the reasons of the displacement, and etc... Of the most important results of this study may refer to the undeniable role of the displacement as a rhetorical method to better understanding of the texts including: one of the most important reasons of the displacement in the use of language is to improve speech verbally and morally, and violation of the standard language and create a poetic atmosphere, and the recognition of the occurrence of the phenomenon of displacement in the Arabic language that uphold different interpretations remote and estimates when faced with the displacement in the text and help us to understand it and etc...

  17. Minimal Clinically Important Differences for American Orthopaedic Foot & Ankle Society Score in Hallux Valgus Surgery. (United States)

    Chan, Hiok Yang; Chen, Jerry Yongqiang; Zainul-Abidin, Suraya; Ying, Hao; Koo, Kevin; Rikhraj, Inderjeet Singh


    The American Orthopaedic Foot & Ankle Society (AOFAS) score is one of the most common and adapted outcome scales in hallux valgus surgery. However, AOFAS is predominantly physician based and not patient based. Although it may be straightforward to derive statistical significance, it may not equate to the true subjective benefit of the patient's experience. There is a paucity of literature defining MCID for AOFAS in hallux valgus surgery although it could have a great impact on the accuracy of analyzing surgical outcomes. Hence, the primary aim of this study was to define the Minimal Clinically Important Difference (MCID) for the AOFAS score in these patients, and the secondary aim was to correlate patients' demographics to the MCID. We conducted a retrospective cross-sectional study. A total of 446 patients were reviewed preoperatively and followed up for 2 years. An anchor question was asked 2 years postoperation: "How would you rate the overall results of your treatment for your foot and ankle condition?" (excellent, very good, good, fair, poor, terrible). The MCID was derived using 4 methods, 3 from an anchor-based approach and 1 from a distribution-based approach. Anchor-based approaches were (1) mean difference in 2-year AOFAS scores of patients who answered "good" versus "fair" based on the anchor question; (2) mean change of AOFAS score preoperatively and at 2-year follow-up in patients who answered good; (3) receiver operating characteristic (ROC) curves method, where the area under the curve (AUC) represented the likelihood that the scoring system would accurately discriminate these 2 groups of patients. The distribution-based approach used to calculate MCID was the effect size method. There were 405 (90.8%) females and 41 (9.2%) males. Mean age was 51.2 (standard deviation [SD] = 13) years, mean preoperative BMI was 24.2 (SD = 4.1). Mean preoperative AOFAS score was 55.6 (SD = 16.8), with significant improvement to 85.7 (SD = 14.4) in 2 years ( P value

  18. Aloantígenos de granulocitos: Importancia clínica The granulocyte alloantigens. Clinical importance

    Directory of Open Access Journals (Sweden)

    María del Rosario López De Roux


    Full Text Available Los aloantígenos de granulocitos se agrupan en 2 grandes categorías: antígenos específicos de granulocitos y antígenos cuya distribución es más amplia y comprende otras líneas celulares. En 1998 se acordó establecer una nueva nomenclatura de los aloantígenos de granulocitos, basada en la localización glucoproteica de estos antígenos. La molécula FcgRIIIb es un miembro de la superfamilia de inmunoglobulinas (CD 16 en la cual se asientan varios de los aloantígenos específicos de granulocitos. Existen otros aloantígenos cuya función y localización se desconocen. Estas moléculas son de gran importancia clínica, pues se ven envueltas en una serie de enfermedades como la neutropenia neonatal aloinmune, cuyo carácter clínico moderado hace que pase inadvertida, la reacción febril no hemolítica, el daño pulmonar agudo relacionado con la transfusión, la neutropenia inmune asociada con el trasplante de médula ósea y la neutropenia autoinmune. Aunque se han producido avances en la caracterización de los aloantígenos de granulocitos, muchos puntos quedan sin aclarar, entre ellos, la significación clínica de muchos antígenos. El desarrollo creciente de técnicas moleculares, bioquímicas y serológicas para el estudio de los antígenos de células sanguíneas, nos permitirá aclarar los puntos que aún permanecen oscuros en este campo de la investigaciónThe granulocyte alloantigens are grouped into 2 big categories: specific granulocyte antigens and antigens, whose distribution is wider and comprises other cellular lines. In 1998, it was agreed to establish a new nomenclature of granulocyte alloantigens based on the glycoprotein localization of these antigens. The FcgRIIIb molecule is a member of the superfamily of immunoglobulins (CD 16, in which many of the specific granulocyte alloantigens are found. There are other alloantigens with an unknown function and localization. These molecules have a great clinical importance

  19. Prevention of clinically important deteriorations in COPD with umeclidinium/vilanterol

    Directory of Open Access Journals (Sweden)

    Singh D


    Full Text Available Dave Singh,1 M Reza Maleki-Yazdi,2 Lee Tombs,3 Ahmar Iqbal,4 William A Fahy,5 Ian Naya5 1Medicines Evaluation Unit, University of Manchester, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK; 2Division of Respiratory Medicine, Women’s College Hospital, University of Toronto, ON, Canada; 3Precise Approach LTD, London UK; 4Respiratory Medical Franchise, GSK, Research Triangle Park, NC, USA; 5Respiratory Medicines Development Centre, GSK, Stockley Park, Middlesex, UK Background: Minimizing the risk of disease progression and exacerbations is the key goal of COPD management, as these are well-established indicators of poor COPD prognosis. We developed a novel composite end point assessing three important aspects (lung function, health status, and exacerbations of worsening in COPD. The objective was to determine whether dual bronchodilation with umeclidinium/vilanterol (UMEC/VI reduces clinically important deteriorations (CIDs in COPD versus placebo or bronchodilator monotherapy.  Methods: This study is a post hoc analysis of two 24-week trials comparing UMEC/VI 62.5/25 µg with UMEC 62.5 µg, VI 25 µg, or placebo (Study A; NCT01313650, or UMEC/VI 62.5/25 µg with tiotropium (TIO 18 µg (Study B; NCT01777334 in patients with symptomatic COPD, without a history of frequent exacerbations. Deterioration was assessed as the time to a first CID, a composite measure defined as a decrease of ≥100 mL in trough forced expiratory volume in 1 second or ≥4-unit increase in St George’s Respiratory Questionnaire total score or an on-treatment moderate-to-severe COPD exacerbation.  Results: In Study A, fewer patients experienced a first CID with UMEC/VI (44% versus UMEC (50%, VI (56%, and placebo (75%. The risk of a first CID was reduced with UMEC/VI (hazard ratio [HR]: 0.37 [95% confidence interval, CI: 0.30, 0.45], UMEC (HR: 0.46 [95% CI: 0.38, 0.56], and VI (HR: 0.55 [95% CI: 0.45, 0.66]; all P<0.001 versus placebo

  20. Fix my child: The importance of including siblings in clinical assessments. (United States)

    Farnfield, Steve


    This study examined concordance in the attachment strategies of school-aged siblings with reference to environmental risk in terms of poverty and maltreatment. It also investigated the effect of child maltreatment and maternal mental illness on children's psychosocial functioning in terms of the Dynamic-Maturational Model of Attachment and Adaptation (DMM) including unresolved trauma and the DMM Depressed modifier. The attachment strategies of 30 sibling pairs, aged 5-14 years, were assessed using the School-age Assessment of Attachment (SAA). Unlike most previous studies, this study included siblings from large families of two to six children. The main finding was that as environmental risk increases, the diversity of sibling attachment strategies decreases with greater recourse to the DMM Type A3-6 and A/C strategies. Unlike previous studies, the highest level of concordance was found in sibling pairs with the opposite gender. Boys whose mothers had a history of mental illness were significantly more likely than girls to be assessed with the DMM-depression modifier. As danger increases, children in the same family experience more of the same childhood. Further research should focus on single case, intra-familial studies to build a systemic model of the shared environment. Research should also evaluate the effects of environmental risk compared with size of the sibling group on children's attachment strategies. The clinical implications point to the importance of assessing all children in the family using a model built around functional formulation rather than diagnosing the symptoms of a particular child.

  1. Clinical Importance of Angiogenic Cytokines, Fibrinolytic Activity and Effusion Size in Parapneumonic Effusions (United States)

    Chung, Chi-Li; Hsiao, Shih-Hsin; Hsiao, George; Sheu, Joen-Rong; Chen, Wei-Lin; Chang, Shi-Chuan


    Objective To investigate the relationship among angiogenic cytokines, fibrinolytic activity and effusion size in parapneumonic effusion (PPE) and their clinical importance. Methods From January 2008 through December 2010, 26 uncomplicated (UPPE) and 38 complicated (CPPE) PPE were studied. Based on chest ultrasonography, there were non-loculated in 30, uni-loculated in 12, and multi-loculated effusions in 22 patients. The effusion size radiological scores, and effusion vascular endothelial growth factor (VEGF), interleukin (IL)-8, plasminogen activator inhibitor type-1 (PAI-1) and tissue type plasminogen activator (tPA) were measured on admission. Treatment outcome and pleural fibrosis, defined as radiological residual pleural thickening (RPT), were assessed at 6-month follow-up. Results The effusion size and effusion VEGF, IL-8 and PAI-1/tPA ratio were significantly higher in CPPE than in UPPE, and significantly higher in multi-loculated PPE than in non-locualted and uni-loculated PPE, respectively. VEGF (cutoff value 1975 pg/ml) and IL-8 (cutoff value 1937 pg/ml) seemed best to discriminate between UPPE and CPPE. VEGF, IL-8 and effusion size correlated positively with PAI-1/tPA ratio in both UPPE and CPPE. Moreover, the level of VEGF, but not IL-8, correlated positively with effusion size in all patients (r = 0.79, peffusion were prone to have medical treatment failure (n = 10; VEGF, odds ratio 1.01, p = 0.02; effusion size, odds ratio 1.26, p = 0.01). Additionally, ten patients with RPT had larger effusion size and higher levels of VEGF and PAI-1/tPA ratio than did those without. Conclusions In PPE, VEGF and IL-8 levels are valuable to identify CPPE, and higher VEGF level or larger effusion is associated with decreased fibrinolytic activity, development of pleural loculation and fibrosis, and higher risk of medical treatment failure. PMID:23308155

  2. The Importance of Medicinal Chemistry Knowledge in the Clinical Pharmacist's Education. (United States)

    Fernandes, João Paulo S


    Objective. To show why medicinal chemistry must be a key component of the education of pharmacy students, as well as in the pharmacist's practice. Findings. Five case reports were selected by their clinically relevant elements of medicinal chemistry and were explained using structure-activity relationship data of the drugs involved in the case easily obtained from primary literature and in medicinal chemistry textbooks. Summary. This paper demonstrates how critical clinical decisions can be addressed using medicinal chemistry knowledge. While such knowledge may not explain all clinical decisions, medicinal chemistry concepts are essential for the education of pharmacy students to explain drug action in general and clinical decisions.

  3. Combining clinical practice and academic work in nursing: a qualitative study about perceived importance, facilitators and barriers regarding clinical academic careers for nurses in university hospitals.

    NARCIS (Netherlands)

    Oostveen, C.J. van; Goedhart, N.S.; Francke, A.L.; Vermeulen, H.


    Aims and objectives: To obtain in-depth insight into the perceptions of nurse aca- demics and other stakeholders regarding the importance, facilitators and barriers for nurses combining clinical and academic work in university hospitals. Background: Combining clinical practice and academic work

  4. The Clinical Importance of Assessing Tumor Hypoxia: Relationship of Tumor Hypoxia to Prognosis and Therapeutic Opportunities (United States)

    Walsh, Joseph C.; Lebedev, Artem; Aten, Edward; Madsen, Kathleen; Marciano, Liane


    I. Introduction II. The Clinical Importance of Tumor Hypoxia A. Pathophysiology of hypoxia B. Hypoxia's negative impact on the effectiveness of curative treatment 1. Hypoxic tumors accumulate and propagate cancer stem cells 2. Hypoxia reduces the effectiveness of radiotherapy 3. Hypoxia increases metastasis risk and reduces the effectiveness of surgery 4. Hypoxic tumors are resistant to the effects of chemotherapy and chemoradiation C. Hypoxia is prognostic for poor patient outcomes III. Diagnosis of Tumor Hypoxia A. Direct methods 1. Oxygen electrode—direct pO2 measurement most used in cancer research 2. Phosphorescence quenching—alternative direct pO2 measurement 3. Electron paramagnetic resonance 4. 19F-magnetic resonance spectroscopy 5. Overhauser-enhanced MRI B. Endogenous markers of hypoxia 1. Hypoxia-inducible factor-1α 2. Carbonic anhydrase IX 3. Glucose transporter 1 4. Osteopontin 5. A combined IHC panel of protein markers for hypoxia 6. Comet assay C. Physiologic methods 1. Near-infrared spectroscopy/tomography—widely used for pulse oximetry 2. Photoacoustic tomography 3. Contrast-enhanced color duplex sonography 4. MRI-based measurements 5. Blood oxygen level-dependent MRI 6. Pimonidazole 7. EF5 (pentafluorinated etanidazole) 8. Hypoxia PET imaging—physiologic hypoxia measurement providing tomographic information a. 18F-fluoromisonidazole b. 18F-fluoroazomycinarabinofuranoside c. 18F-EF5 (pentafluorinated etanidazole) d. 18F-flortanidazole e. Copper (II) (diacetyl-bis (N4-methylthiosemicarbazone)) f. 18F-FDG imaging of hypoxia IV. Modifying Hypoxia to Improve Therapeutic Outcomes A. Use of hypoxia information in radiation therapy planning B. Use of hypoxia assessment for selection of patients responsive to nimorazole C. Use of hypoxia assessment for selection of patients responsive to tirapazamine D. Use of hypoxia assessment for selection of patients

  5. Clinical importance of angiogenic cytokines, fibrinolytic activity and effusion size in parapneumonic effusions.

    Directory of Open Access Journals (Sweden)

    Chi-Li Chung

    Full Text Available OBJECTIVE: To investigate the relationship among angiogenic cytokines, fibrinolytic activity and effusion size in parapneumonic effusion (PPE and their clinical importance. METHODS: From January 2008 through December 2010, 26 uncomplicated (UPPE and 38 complicated (CPPE PPE were studied. Based on chest ultrasonography, there were non-loculated in 30, uni-loculated in 12, and multi-loculated effusions in 22 patients. The effusion size radiological scores, and effusion vascular endothelial growth factor (VEGF, interleukin (IL-8, plasminogen activator inhibitor type-1 (PAI-1 and tissue type plasminogen activator (tPA were measured on admission. Treatment outcome and pleural fibrosis, defined as radiological residual pleural thickening (RPT, were assessed at 6-month follow-up. RESULTS: The effusion size and effusion VEGF, IL-8 and PAI-1/tPA ratio were significantly higher in CPPE than in UPPE, and significantly higher in multi-loculated PPE than in non-locualted and uni-loculated PPE, respectively. VEGF (cutoff value 1975 pg/ml and IL-8 (cutoff value 1937 pg/ml seemed best to discriminate between UPPE and CPPE. VEGF, IL-8 and effusion size correlated positively with PAI-1/tPA ratio in both UPPE and CPPE. Moreover, the level of VEGF, but not IL-8, correlated positively with effusion size in all patients (r = 0.79, p<0.001 and in UPPE (r = 0.64, p<0.001 and CPPE (r = 0.71, p<0.001 groups. The patients with higher VEGF or greater effusion were prone to have medical treatment failure (n = 10; VEGF, odds ratio 1.01, p = 0.02; effusion size, odds ratio 1.26, p = 0.01. Additionally, ten patients with RPT had larger effusion size and higher levels of VEGF and PAI-1/tPA ratio than did those without. CONCLUSIONS: In PPE, VEGF and IL-8 levels are valuable to identify CPPE, and higher VEGF level or larger effusion is associated with decreased fibrinolytic activity, development of pleural loculation and fibrosis, and higher risk of medical treatment failure.

  6. Automated realtime data import for the i2b2 clinical data warehouse: introducing the HL7 ETL cell. (United States)

    Majeed, Raphael W; Röhrig, Rainer


    Clinical data warehouses are used to consolidate all available clinical data from one or multiple organizations. They represent an important source for clinical research, quality management and controlling. Since its introduction, the data warehouse i2b2 gathered a large user base in the research community. Yet, little work has been done on the process of importing clinical data into data warehouses using existing standards. In this article, we present a novel approach of utilizing the clinical integration server as data source, commonly available in most hospitals. As information is transmitted through the integration server, the standardized HL7 message is immediately parsed and inserted into the data warehouse. Evaluation of import speeds suggest feasibility of the provided solution for real-time processing of HL7 messages. By using the presented approach of standardized data import, i2b2 can be used as a plug and play data warehouse, without the hurdle of customized import for every clinical information system or electronic medical record. The provided solution is available for download at

  7. Clinical importance of neutralising antibodies against interferon beta in patients with relapsing-remitting multiple sclerosis

    DEFF Research Database (Denmark)

    Sorensen, Per Soelberg; Ross, Christian; Clemmesen, Katja Maria


    Interferon beta is the first-line treatment for relapsing-remitting multiple sclerosis, but the drug can induce neutralising antibodies against itself, which might reduce effectiveness. We aimed to assess the clinical effect of neutralising antibodies....


    Directory of Open Access Journals (Sweden)

    E.T. Bohlmeijer


    Full Text Available In this paper we discuss positive clinical psychology as an emerging field within clinical psychology. Positive clinical psychology is based on research demonstrating that mental health is more than the absence of mental illness, on research showing that wellbeing has buffering effects on the incidence of psychopathology and mental illnesses and on studies demonstrating that positive characteristics, such as positive emotions and gratitude, can predict pathology beyond the predictive power of negative characteristics. In this paper we present three distinct forms of well-being: emotional, psychological and social. In addition we review three types of positive clinical interventions: well-being therapy, positive psychotherapy and acceptance and commitment therapy. The paper ends with a call for a transformation of mental health care in which illness oriented treatments are complemented with well-being oriented treatments.

  9. In vitro susceptibility patterns of clinically important Trichophyton and Epidermophyton species against nine antifungal drugs

    NARCIS (Netherlands)

    Badali, Hamid; Mohammadi, Rasoul; Mashedi, Olga; de Hoog, G Sybren; Meis, Jacques F

    Despite the common, worldwide, occurrence of dermatophytes, little information is available regarding susceptibility profiles against currently available and novel antifungal agents. A collection of sixty-eight clinical Trichophyton species and Epidermophyton floccosum were previously identified and

  10. Important clinical descriptors to include in the examination and assessment of patients with femoroacetabular impingement syndrome

    DEFF Research Database (Denmark)

    Reiman, M P; Thorborg, K; Covington, K


    PURPOSE: Determine which examination findings are key clinical descriptors of femoroacetabular impingement syndrome (FAIS) through use of an international, multi-disciplinary expert panel. METHODS: A three-round Delphi survey utilizing an international, multi-disciplinary expert panel operationally...

  11. The clinical importance of expanded subarachnoid spaces detected by CT in early infancy

    International Nuclear Information System (INIS)

    Krusche, S.


    It depends on the clinical course and on follow-jup CT findings whether expansions of the subarachnoid space should be considered as pathological changes or as normal. There is no direct correlation between the degree of severity of the clinical symptoms on the one hand and the CT changes on the other. The clinical course and the follow-up CT images are found to be uncorrelated, too. CT findings alone are insufficient in predicting children's development. Especially in the case of unspecific changes, e.g. slight expansions of the subarachnoid space, cranial CT can only provide further proof of a suspected clinical diagnosis. The ventricular indices frequently used for CT interpretation can rarely be used as decision aids or as factors providing new information. (orig./MG) [de


    Directory of Open Access Journals (Sweden)

    Carmen BOGHEAN


    Full Text Available Migration is not a new phenomenon, neither for Europe, nor for the entire world and it exists since the beginning of mankind. Over time, this kind of international mobility generated many opportunities, but many challenges as well. Being an extremely important and complex phenomenon, both in economic terms and mostly from the social perspective, mass emigration has never been more intense as nowadays. Together with this particular complexity, the intensity of the migration phenomenon reveals each individual’s profound freedom desire, but also the acute need to ensure a better future for himself and especially for his family. Currently, an ever increasing number of individuals migrate in search of a better place, changing regions, countries or even continents. Witnessing the events that transcend the people all around the world, we consider that migration generates economic, social and cultural, but also political profound changes. These major changes require the involvement of the political actors, namely the governments, in creating a favorable and reliable framework so as the society and decision makers to understand that immigrants represent an opportunity for the emerging economies and not a phenomenon that should be criticized. In this paper we aim to follow the theories regarding the migration process, as well as the changes it generates, taking into consideration that of the 507 million current inhabitants of the EU, approximately 20 million are from countries outside the EU. We consider this research to be underlain, taking into consideration that regardless of the form it takes, in Europe immigration is and will remain a difficult to manage reality.

  13. Rational use of intensity-modulated radiation therapy: the importance of clinical outcome. (United States)

    De Neve, Wilfried; De Gersem, Werner; Madani, Indira


    During the last 2 decades, intensity-modulated radiation therapy (IMRT) became a standard technique despite its drawbacks of volume delineation, planning, robustness of delivery, challenging quality assurance, and cost as compared with non-IMRT. The theoretic advantages of IMRT dose distributions are generally accepted, but the clinical advantages remain debatable because of the lack of clinical assessment of the effort that is required to overshadow the disadvantages. Rational IMRT use requires a positive advantage/drawback balance. Only 5 randomized clinical trials (RCTs), 3 in the breast and 2 in the head and neck, which compare IMRT with non-IMRT (2-dimensional technique in four fifths of the trials), have been published (as of March 2011), and all had toxicity as the primary endpoint. More than 50 clinical trials compared results of IMRT-treated patients with a non-IMRT group, mostly historical controls. RCTs systematically showed a lower toxicity in IMRT-treated patients, and the non-RCTs confirmed these findings. Toxicity reduction, counterbalancing the drawbacks of IMRT, was convincing for breast and head and neck IMRT. For other tumor sites, the arguments favoring IMRT are weaker because of the inability to control bias outside the randomized setting. For anticancer efficacy endpoints, like survival, disease-specific survival, or locoregional control, the balance between advantages and drawbacks is fraught with uncertainties because of the absence of robust clinical data. Copyright © 2012 Elsevier Inc. All rights reserved.

  14. Resonance phenomenon in classical cepheids

    International Nuclear Information System (INIS)

    Takeuti, Mine; Aikawa, Toshiki


    To investigate resonance phenomenon in classical cepheids, the non-linear radial oscillation of stars is studied based on the assumption that the non-adiabatic perturbation is expressed in terms of van der Pol's type damping. Two- and three-wave resonance in this system is applied to classical cepheids to describe their bump and double-mode behavior. The phase of bump and the depression of amplitude are explained for bump cepheids. The double-periodicity is shown by the enhancement of the third overtone in three-wave resonance. Non-linear effect on resonant period is also discussed briefly. (author)

  15. Clinical Outcome of Degenerative Mitral Regurgitation: Critical Importance of Echocardiographic Quantitative Assessment in Routine Practice. (United States)

    Antoine, Clemence; Benfari, Giovanni; Michelena, Hector I; Malouf, Joseph F; Nkomo, Vuyisile T; Thapa, Prabin; Enriquez-Sarano, Maurice


    Background -Echocardiographic quantitation of degenerative mitral regurgitation (DMR) is recommended whenever possible in clinical guidelines but is criticized and its scalability to routine clinical practice doubted. We hypothesized that echocardiographic DMR quantitation, performed in routine clinical practice by multiple practitioners predicts independently long-term survival, and thus is essential to DMR management. Methods -We included patients diagnosed with isolated mitral-valve-prolapse 2003-2011 and any degree of MR quantified by any physician/sonographer in routine clinical practice. Clinical/echocardiographic data acquired at diagnosis were retrieved electronically. Endpoint was mortality under medical treatment analyzed by Kaplan-Meir method and Proportional-Hazard models. Results -The cohort included 3914 patients (55% male) aged 62±17 years, with left ventricular ejection fraction (LVEF) 63±8% and routinely measured effective regurgitant orifice area (EROA) 19[0-40] mm 2 During follow-up (6.7±3.1 years) 696 patients died under medical management and 1263 underwent mitral surgery. In multivariate analysis, routinely measured EROA was associated with mortality (adjusted-hazard-ratio 1.19[1.13-1.24] p 40 mm 2 threshold. Conclusions -Echocardiographic DMR quantitation is scalable to routine practice and is independently associated with clinical outcome. Routinely measured EROA is strongly associated with long-term survival under medical treatment. Excess mortality vs. the general population appears in the "moderate" DMR range and steadily increases with higher EROA. Hence, individual EROA values should be integrated into therapeutic considerations, additionally to categorical DMR grading.

  16. The Diagnostic importance of clinical and radiologic features of the Multiple Cemento-osseous dysplasia

    International Nuclear Information System (INIS)

    Han, M. R.; Kim, Y. H.; Kang, B. C.


    This case was diagnosed as multiple cementoosseous dysplasia on the basis of clinical and radiological features but was diagnosed as ossifying fibroma on the basis of histopathological feature. The histopathologic features of the multiple cementoosseous dysplasia and cementoossifying fibroma have common features of cementum, fibrous network and bone. Multiple cementoosseous dysplasia is reactive lesion and shows restricted lesion size, occurred on anterior and posterior tooth of the mandible and needs no treatment except periodic follow up. But Cementoossifying fibroma is the true neoplasm and grows continuously and needs surgical removal. The final diagnosis of the multiple cementoosseous dysplasia requires good correlation of the clinical histopathological, and radiological features.

  17. Why quality of life measurement is important in dermatology clinical practice

    DEFF Research Database (Denmark)

    Finlay, A Y; Salek, M S; Abeni, D


    The aim of this study was to describe the many ways in which quality of life (QoL) measurement may potentially be advantageous in routine clinical dermatology practice. Thirteen members of the EADV Task Force on Quality of Life, eight dermatologists, three health psychologists, one epidemiologist...

  18. Are estimates of meaningful decline in mobility performance consistent among clinically important subgroups? (Health ABC Study).

    NARCIS (Netherlands)

    Perera, S.; Studenski, S.; Newman, A.; Simonsick, E.; Harris, T.; Schwartz, A.; Visser, M.


    Background: Meaningful change criteria help determine if function has improved or declined, but their magnitudes may vary across clinically relevant subgroups. We estimate meaningful decline in four common measures of physical performance in subgroups of older adults based on initial performance,

  19. Determining Minimal Clinically Important Differences in Japanese Cedar/Cypress Pollinosis Patients

    Directory of Open Access Journals (Sweden)

    Takaya Higaki


    Conclusions: For T5SS in the diary, T6SS and QOL in JRQLQ, unit differences of 1.5 (0.3 per item, 3.6 (0.6 and 8.2 (0.5, respectively, were considered clinically meaningful by JCCP patients. The MCID for symptoms recorded in the diary was stable irrespective of the dispersed pollen level.

  20. 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.


    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)

  1. The Importance of Clinical Phenotype in Understanding and Preventing Spontaneous Preterm Birth. (United States)

    Esplin, M Sean


    Spontaneous preterm birth (SPTB) is a well-known cause of maternal and neonatal morbidity. The search for the underlying pathways, documentation of the genetic causes, and identification of markers of spontaneous PTB have been marginally successful due to the fact that it is highly complex, with numerous processes that lead to a final common pathway. There is a great need for a comprehensive, consistent, and uniform classification system, which will be useful in identifying mechanisms, assigning prognosis, aiding in clinical management, and can identify areas of interest for intervention and future study. Effective classification systems must overcome obstacles including the lack of widely accepted definitions and uncertainty about inclusion of classifying features (e.g., presentation at delivery and multiple gestations) and levels of detail of these features. The optimal classification system should be based on the clinical phenotype, including characteristics of the mother, fetus, placenta, and the presentation for delivery. We present a proposed phenotyping system for spontaneous PTB. Future classification systems must establish a universally accepted set of definitions and a standardized clinical workup for all PTBs including the minimum clinical data to be collected and the laboratory and pathologic evaluation that should be completed. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  2. Clinical and diagnostic importance of changes of colon at chronic prostatitis

    Directory of Open Access Journals (Sweden)

    V.M. Popkov


    Full Text Available The aim of researches was studying clinical, microbiological and morphological characteristic of colon at patients at chronic prostatitis, definition of method of pathogenetic therapy on the basis of the received results. Material and methods of investigation. 50 patients at chronic bacterial prostatitis, 50 patients at asymptomatic inflammatory prostatitis and 30 practically healthy males were inspected. Microflora of prostata's secret and colon, morphology and structure of components of diffuse neuroendocrine system of colon were studied. Clinical, microbiological, иммуногистохимические methods and morphometrical analysis were applied. Results. It is defined, that at 74% patients with asymptomatic inflammatory prostatitis irritable bowel syndrome and at 26% - chronic nonulcerative colitis were diagnosed. At all patients at chronic bacterial prostatitis chronic nonulcerative colitis were detected. These variants were correlleted with different types of intestinal dysbiosis and degree of microbe producing of prostate. Use probiotic Bactistatin® at patients with a chronic prostatitis raises clinical efficiency of antibacterial therapy, promotes reduction of inflammatory changes, restoration of its microbic landscape and neuroendocrine homeostasis of colon. inclusion. At chronic prostatitis structural and functional pathology of colon are often registered, they are connected with clinical variant of prostatitis and can mask of prostata's pathology. Using Bactistatin® at patients with a chronic prostatitis is proved and effective

  3. Important options available - from start to finish -for translating proteomics results to clinical chemistry

    DEFF Research Database (Denmark)

    Heegaard, Niels H H; Ostergaard, Ole; Bahl, Justyna M C


    assay development downstream. Putative new assay candidates generated by proteomics discovery projects compete with well-established assays with known indications, well-described performance, and of known value in specific clinical settings. Careful attention to the many options available in the design...

  4. PCR diagnosis and characterization of Leishmania in local and imported clinical samples

    NARCIS (Netherlands)

    Schönian, Gabriele; Nasereddin, Abedelmajeed; Dinse, Nicole; Schweynoch, Carola; Schallig, Henk D. F. H.; Presber, Wolfgang; Jaffe, Charles L.


    Leishmaniasis diagnosis in regions where multiple species exist should identify each species directly in the clinical sample without parasite culturing. The sensitivity of two PCR approaches which amplify part of the ssu rRNA gene and the ribosomal internal transcribed spacer (ITS), respectively,

  5. Importance of comprehensive molecular profiling for clinical outcome in children with recurrent cancer

    DEFF Research Database (Denmark)

    Østrup, Olga; Nysom, Karsten; Scheie, David


    treatment. Results: Of the 48 patients, 33 had actionable findings. The most efficient method for the identification of actionable findings was WES (39%), followed by SNP array (37%). Of note, gene fusions were identified by RNAseq in 21% of the samples. Eleven findings led to clinical intervention, i...

  6. Predictors, Prognosis, and Management of New Clinically Important Atrial Fibrillation After Noncardiac Surgery: A Prospective Cohort Study. (United States)

    Alonso-Coello, Pablo; Cook, Deborah; Xu, Shou Chun; Sigamani, Alben; Berwanger, Otavio; Sivakumaran, Soori; Yang, Homer; Xavier, Denis; Martinez, Luz Ximena; Ibarra, Pedro; Rao-Melacini, Purnima; Pogue, Janice; Zarnke, Kelly; Paniagua, Pilar; Ostrander, Jack; Yusuf, Salim; Devereaux, P J


    Despite the frequency of new clinically important atrial fibrillation (AF) after noncardiac surgery and its increased association with the risk of stroke at 30 days, there are limited data informing their prediction, association with outcomes, and management. We used the data from the PeriOperative ISchemic Evaluation trial to determine, in patients undergoing noncardiac surgery, the association of new clinically important AF with 30-day outcomes, and to assess management of these patients. We also aimed to derive a clinical prediction rule for new clinically important AF in this population. We defined new clinically important AF as new AF that resulted in symptoms or required treatment. We recorded an electrocardiogram 6 to 12 hours postoperatively and on the 1st, 2nd, and 30th days after surgery. A total of 211 (2.5% [8351 patients]; 95% confidence interval, 2.2%-2.9%) patients developed new clinically important AF within 30 days of randomization (8140 did not develop new AF). AF was independently associated with an increased length of hospital stay by 6.0 days (95% confidence interval, 3.5-8.5 days) and vascular complications (eg, stroke or congestive heart failure). The usage of an oral anticoagulant at the time of hospital discharge among patients with new AF and a CHADS2 score of 0, 1, 2, 3, and ≥4 was 6.9%, 10.2%, 23.0%, 9.4%, and 33.3%, respectively. Two independent predictors of patients developing new clinically important AF were identified (ie, age and surgery). The prediction rule included the following factors and assigned weights: age ≥85 years (4 points), age 75 to 84 years (3 points), age 65 to 74 years (2 points), intrathoracic surgery (3 points), major vascular surgery (2 points), and intra-abdominal surgery (1 point). The incidence of new AF based on scores of 0 to 1, 2, 3 to 4, and 5 to 6 was 0.5%, 1.0%, 3.1%, and 5.3%, respectively. Age and surgery are independent predictors of new clinically important AF in the perioperative setting. A

  7. Earnings Management: Obvious Phenomenon in Albanian Market

    Directory of Open Access Journals (Sweden)

    Teuta Llukani


    This paper is focused on reviewing the existing literature with regard to the Earnings Management in response to the growing pressure of investors, policy makers, and companies’ governance reform mechanisms to curb opportunistic behavior of the managers of these companies. It also examines the existence of this phenomenon in Albanian context as well as tests the importance of Modified Jones Model as an efficient tool for detection of abnormal accruals, used as a proxy for earnings management. The results show that firms in the Albanian market are engaged in earnings management initiatives.

  8. Evolving Identification of Blood Cells Associated with Clinically Isolated Syndrome: Importance of Time since Clinical Presentation and Diagnostic MRI. (United States)

    Trend, Stephanie; Jones, Anderson P; Geldenhuys, Sian; Byrne, Scott N; Fabis-Pedrini, Marzena J; Nolan, David; Booth, David R; Carroll, William M; Lucas, Robyn M; Kermode, Allan G; Hart, Prue H


    It is not clear how the profile of immune cells in peripheral blood differs between patients with clinically isolated syndrome (CIS) and healthy controls (HC). This study aimed to identify a CIS peripheral blood signature that may provide clues for potential immunomodulatory approaches early in disease. Peripheral blood mononuclear cells (PBMCs) were collected from 18 people with CIS, 19 HC and 13 individuals with other demyelinating conditions (ODC) including multiple sclerosis (MS). Individuals with CIS separated into two groups, namely those with early (≤14 days post-diagnostic magnetic resonance imaging (MRI); n = 6) and late (≥27 days; n = 12) blood sampling. Transitional B cells were increased in the blood of CIS patients independently of when blood was taken. However, there were two time-dependent effects found in the late CIS group relative to HC, including decreased CD56bright NK cells, which correlated significantly with time since MRI, and increased CD141+ myeloid dendritic cell (mDC2) frequencies. Higher CD1c+ B cells and lower non-classical monocyte frequencies were characteristic of more recent demyelinating disease activity (ODC and early CIS). Analysing cell populations by time since symptoms (subjective) and diagnostic MRI (objective) may contribute to understanding CIS.

  9. Methodological considerations related to nurse researchers using their own experience of a phenomenon within phenomenology. (United States)

    Johnston, Colleen M; Wallis, Marianne; Oprescu, Florin I; Gray, Marion


    This paper summarizes phenomenology and discusses how nurses can use their own experiences as data and maintain rigour within the method. It explores how data from researchers experiencing the phenomenon of interest could be used to explicate assumptions and pre-understandings and may also be used as data. While the ethnographic concept of insider research has gained popularity, the notion of researcher as participant in phenomenology is relatively new. The lived experience of a phenomenon is unique to each person and utilization of the nurse researcher's experiences of the phenomenon should be considered for inclusion as data. Discussion paper. Articles from 2001 - 2015 in the CINAHL and PubMed databases were identified using keywords such as 'insider research', 'phenomenology', 'bracketing' and 'qualitative research'. In addition, reference lists from articles used were examined to identify additional literature. Phenomenology is a valuable research method. Usability, credibility, trustworthiness and auditability of data collected must be considered to ensure rigour and maintain orientation to the phenomenon under investigation. Nurse researchers may be interviewed as participants if these four principles are considered and methods used are made explicit. Utilizing appropriate research methods are as important as getting clinical practice correct to advance knowledge and benefit those under our care. We recommend using the researchers' experience as a data source to gain a complete picture of the phenomenon under investigation. Using the approach proposed here, nurses can ensure they are incorporating all data sources available while maintaining research rigour. © 2016 John Wiley & Sons Ltd.

  10. Dopamine transporter imaging in clinically unclear cases of parkinsonism and the importance of Scans Without Evidence of Dopaminergic Deficit (SWEDDs

    Directory of Open Access Journals (Sweden)

    Marco A. T. Utiumi


    Full Text Available The clinical diagnosis of Parkinson's disease (PD is susceptible to misdiagnosis, especially in the earlier stages of the disease. Recently, in vivo imaging techniques assessing the presynaptic dopamine transporter (DAT have emerged as a useful tool in PD diagnosis, improving its accuracy. OBJECTIVE: It was to illustrate the clinical usefulness of a brain single-photon emission computed tomography (SPECT DAT ligand, and highlight relevant aspects of scans without evidence of dopaminergic deficit (SWEDDs in this context. CASES: We described four representative patients with clinically unclear parkinsonian syndromes who underwent [99mTc]-TRODAT-1 SPECT and reviewed the clinical implications. CONCLUSION: DAT-SPECT is an important, cost-effective, technique for the differential diagnosis of parkinsonian syndromes. Additionally, SWEDD cases present clinical and paraclinical peculiarities that may retrospectively identify them as essential/dystonic tremor. The lack of histopathological data limits further conclusions.

  11. Combining clinical practice and academic work in nursing: A qualitative study about perceived importance, facilitators and barriers regarding clinical academic careers for nurses in university hospitals. (United States)

    van Oostveen, Catharina J; Goedhart, Nicole S; Francke, Anneke L; Vermeulen, Hester


    To obtain in-depth insight into the perceptions of nurse academics and other stakeholders regarding the importance, facilitators and barriers for nurses combining clinical and academic work in university hospitals. Combining clinical practice and academic work facilitates the use of research findings for high-quality patient care. However, nurse academics move away from the bedside because clinical academic careers for nurses have not yet been established in the Netherlands. This qualitative study was conducted in two Dutch university hospitals and their affiliated medical faculties and universities of applied sciences. Data were collected between May 2015 and August 2016. We used purposive sampling for 24 interviews. We asked 14 participants in two focus groups for their perceptions of importance, facilitators and barriers in nurses' combined clinical and academic work in education and research. We audiotaped, transcribed and thematically analysed the interviews and focus groups. Three themes related to perceived importance, facilitators and barriers: culture, leadership and infrastructure. These themes represent deficiencies in facilitating clinical academic careers for nurses. The current nursing culture emphasises direct patient care, which is perceived as an academic misfit. Leadership is lacking at all levels, resulting in the underuse of nurse academics and the absence of supporting structures for nurses who combine clinical and academic work. The present nursing culture appears to be the root cause of the dearth of academic positions and established clinical academic posts. A culture change would require a show of leadership that would promote and enable combined research, teaching and clinical practice and that would introduce clinical academic career pathways for nurses. Meanwhile, nurse academics should collaborate with established medical academics for whom combined roles are mainstream, and they should take advantage of their established infrastructure

  12. Nontuberculous mycobacteria in Denmark, incidence and clinical importance during the last quarter-century

    DEFF Research Database (Denmark)

    Hermansen, Thomas S; Ravn, Pernille; Svensson, Erik


    and trends in annual incidence rates. 524,119 clinical specimens were cultured for mycobacteria from 1991 through 2015 at the International Reference Laboratory of Mycobacteriology in Denmark. Among these, 8,227 NTM strains were identified from 3,462 patients and distributed according to microbiological...... disease criteria. We observed no increase in NTM disease incidence or proportion of patients with positive NTM cultures during the study period (Quasi-Poisson regression, p = 0.275 and 0.352 respectively). Annual incidence rates were 1.20/105 for definite NTM disease, 0.49/105 for possible NTM disease...... and 0.88/105 for NTM colonization. The incidence rate of NTM disease was highest in children aged 0-4 years (5.36/105/year), predominantly with cervical Mycobacterium avium complex (MAC) adenitis. Surprisingly, based on more than half a million clinical specimens cultured for mycobacteria in Denmark...

  13. Nontuberculous mycobacteria in Denmark, incidence and clinical importance during the last quarter-century

    DEFF Research Database (Denmark)

    Hermansen, Thomas S; Ravn, Pernille; Svensson, Erik


    and trends in annual incidence rates. 524,119 clinical specimens were cultured for mycobacteria from 1991 through 2015 at the International Reference Laboratory of Mycobacteriology in Denmark. Among these, 8,227 NTM strains were identified from 3,462 patients and distributed according to microbiological...... disease criteria. We observed no increase in NTM disease incidence or proportion of patients with positive NTM cultures during the study period (Quasi-Poisson regression, p = 0.275 and 0.352 respectively). Annual incidence rates were 1.20/10(5) for definite NTM disease, 0.49/10(5) for possible NTM disease...... and 0.88/10(5) for NTM colonization. The incidence rate of NTM disease was highest in children aged 0-4 years (5.36/10(5)/year), predominantly with cervical Mycobacterium avium complex (MAC) adenitis. Surprisingly, based on more than half a million clinical specimens cultured for mycobacteria in Denmark...

  14. [The Classification of Headache: Important Aspects of Patient's History and Clinical Diagnostic]. (United States)

    Kamm, Katharina; Ruscheweyh, Ruth; Eren, Ozan; Straube, Andreas


    Headache disorders are the most occuring symptoms in human population. Basis for a successful therapy of headaches is a definite diagnosis, which needs in turn valid criteria for the graduation of headaches. Corresponding to the classification of the International Headache Society (IHS) especially relevant questions about patient's history and clinical examination lead to a diagnosis. © Georg Thieme Verlag KG Stuttgart · New York.

  15. Characterization and susceptibility patterns of clinically important Enterococcus species in eastern Nepal. (United States)

    Acharya, A; Khanal, A; Kanungo, R; Mohapatra, T


    Life threatening infections caused by enterococcus species with multidrug resistance has emerged as a threat to medical care in the present era. This study was conducted to characterize enterococcus species isolated from different clinical samples and to detect the pattern of susceptibility to some of the commonly used antibiotics in B.P Koirala Institute of Health Sciences (BPKIHS), a tertiary care hospital in eastern Nepal. Clinical samples submitted to the microbiology unit of Central Laboratory Service (CLS) for culture and sensitivity during March 2002 - February 2003 was analyzed. Enterococcus species were identified by colony characteristics, gram staining and relevant biochemical tests. Antibiotic susceptibility test was done by the Kirby Bauer disc diffusion technique. Of 50 Enterococcus species isolated, E. faecalis was the predominant isolate (48.0%) followed by E. faecium (32.0%) and E. avium (20.0%). Eighty-eight percent of E. faecalis showed sensitivity to cephotaxime and 87.0% to vancomycin. Multiple drug resistance was observed most commonly in E. faecium. Seventeen percent of E. faecium were resistant to vancomycin and 63.0% to ciprofloxacin and 44.0% to ampicillin. On the contrary E. avium rarely showed resistance to the antimicrobials tested including vancomycin. Enterococcal infections are common nowadays specially in hospitalized patients. Inappropriate use of antibiotics in clinical practice and poultry should be discouraged to prevent the emergence of multidrug resistant species.

  16. Clinical Findings in Patients with Splenic Injuries: Are Injuries to the Left Lower Chest Important?

    Directory of Open Access Journals (Sweden)

    Schneir, Aaron


    Full Text Available The purpose of this study was to describe the clinical findings in patients with splenic injury and to determine if isolated left lower chest injury may be the single clinical indicator of splenic injury. The medical records of all adult blunt trauma patients with splenic injury over a 14 month period were reviewed. Significant left lower chest injury was considered present if the patient had left sided pleuritic chest pain with tenderness to ribs 7-12 or if these ribs were visualized as fractured on any imaging study. Patients were considered to have clinical findings suggestive of splenic injury if they had pre-hospital or emergency department hypotension, abdominal pain or tenderness, a Glasgow coma scale < 15, or gross hematuria. Ninety patients had splenic injury. Thirty-nine (43%. 95% CI 33, 54% patients had significant left lower chest injury. In five (6%. 95% CI 2, 12% patients, injury to this portion of the chest was the single indicator of splenic injury. Nearly half the patients with splenic injury will have significant injury to the left lower chest and this finding may be the only indicator of splenic injury.

  17. Clinical importance of achieving biochemical control with medical therapy in adult patients with acromegaly (United States)

    Christofides, Elena A


    In acromegaly, achieving biochemical control (growth hormone [GH] level acromegaly is challenging because it is rooted in observing subtle clinical manifestations, and it is typical for acromegaly to evolve for up to 10 years before it is recognized. This results in chronic exposure to elevated levels of GH and IGF-1 and delay in patients receiving appropriate treatment, which consequently increases mortality risk. In this review, the clinical impact of elevated GH and IGF-1 levels, the effectiveness of current therapies, and the potential role of novel treatments for acromegaly will be discussed. Clinical burden of acromegaly and benefits associated with management of GH and IGF-1 levels will be reviewed. Major treatment paradigms in acromegaly include surgery, medical therapy, and radiotherapy. With medical therapies, such as somatostatin analogs, dopamine agonists, and GH receptor antagonists, a substantial proportion of patients achieve reduced GH and normalized IGF-1 levels. In addition, signs and symptoms, quality of life, and comorbidities have also been reported to improve to varying degrees in patients who achieve biochemical control. Currently, there are several innovative therapies in development to improve patient outcomes, patient use, and access. Timely biochemical control of acromegaly ensures that the patient can ultimately improve morbidity and mortality from this disease and its extensive consequences. PMID:27471378

  18. The Phenomenon of Dental Fear

    DEFF Research Database (Denmark)

    Moore, Rod

    Odontophobia is a rather unique phobia with special psychosomatic components that impact on the dental health of odontophobic persons. It also has psychosocial components largely as a result of destruction of the teeth and subsequent embarrassment that can affect a person and cause a vicious cycle...... of dental fear (see fig. 1). The phenomenon is facilitated by misunderstandings and myths generated by both patients and dentists (see table 1 for examples). The most common reasons given in the literature for such strong fears of dental treatment are: 1) bad experiences in childhood for 85% of cases, 2......) feeling of powerlessness and lack of control over personal emotional reactions and over the social situation in the dental chair, 3) social learning processes in which the image of the dentist is cast in a negative light by the mass media or by the person's relatives or friends and 4) that the person has...

  19. Authorship issues in multi-centre clinical trials: the importance of making an authorship contract. (United States)

    Rosenberg, Jacob; Burcharth, Jakob; Pommergaard, Hans-Christian; Vinther, Siri


    Discussions about authorship often arise in multi-centre clinical trials. Such trials may involve up to hundreds of contributors of whom some will eventually co-author the final publication. It is, however, often impossible to involve all contributors in the manuscript process sufficiently for them to qualify for authorship as defined by the International Committee of Medical Journal Editors. Therefore, rules for authorship in multi-centre trials are strongly recommended. We propose two contracts to prevent conflicts regarding authorship; both are freely available for use without pay but with reference to the original source.

  20. Zika virus and the risk of imported infection in returned travelers: Implications for clinical care

    NARCIS (Netherlands)

    Goorhuis, Abraham; Von Eije, Karin J.; Douma, Renée A.; Rijnberg, Noor; van Vugt, Michele; Stijnis, Cornelis; Grobusch, Martin P.


    Since late 2015, an unprecedented outbreak of Zika virus is spreading quickly across Southern America. The large size of the current outbreak in The Americas will also result in an increase in Zika virus infections among travelers returning from endemic areas. We report five cases of imported Zika

  1. Clinical importance of the middle meningeal artery: A review of the literature (United States)

    Yu, Jinlu; Guo, Yunbao; Xu, Baofeng; Xu, Kan


    The middle meningeal artery (MMA) is a very important artery in neurosurgery. Many diseases, including dural arteriovenous fistula (DAVF), pseudoaneurysm, true aneurysm, traumatic arteriovenous fistula (AVF), moyamoya disease (MMD), recurrent chronic subdural hematoma (CSDH), migraine and meningioma, can involve the MMA. In these diseases, the lesions occur in either the MMA itself and treatment is necessary, or the MMA is used as the pathway to treat the lesions; therefore, the MMA is very important to the development and treatment of a variety of neurosurgical diseases. However, no systematic review describing the importance of MMA has been published. In this study, we used the PUBMED database to perform a review of the literature on the MMA to increase our understanding of its role in neurosurgery. After performing this review, we found that the MMA was commonly used to access DAVFs and meningiomas. Pseudoaneurysms and true aneurysms in the MMA can be effectively treated via endovascular or surgical removal. In MMD, the MMA plays a very important role in the development of collateral circulation and indirect revascularization. For recurrent CDSHs, after burr hole irrigation and drainage have failed, MMA embolization may be attempted. The MMA can also contribute to the occurrence and treatment of migraines. Because the ophthalmic artery can ectopically originate from the MMA, caution must be taken to avoid causing damage to the MMA during operations. PMID:27766029

  2. Name Changes in Medically Important Fungi and Their Implications for Clinical Practice

    DEFF Research Database (Denmark)

    de Hoog, G. Sybren; Chaturvedi, Vishnu; Denning, David W.


    Recent changes in the Fungal Code of Nomenclature and developments in molecular phylogeny are about to lead to dramatic changes in the naming of medically important molds and yeasts. In this article, we present a widely supported and simple proposal to prevent unnecessary nomenclatural instability....

  3. Clinical importance of the middle meningeal artery: A review of the literature. (United States)

    Yu, Jinlu; Guo, Yunbao; Xu, Baofeng; Xu, Kan


    The middle meningeal artery (MMA) is a very important artery in neurosurgery. Many diseases, including dural arteriovenous fistula (DAVF), pseudoaneurysm, true aneurysm, traumatic arteriovenous fistula (AVF), moyamoya disease (MMD), recurrent chronic subdural hematoma (CSDH), migraine and meningioma, can involve the MMA. In these diseases, the lesions occur in either the MMA itself and treatment is necessary, or the MMA is used as the pathway to treat the lesions; therefore, the MMA is very important to the development and treatment of a variety of neurosurgical diseases. However, no systematic review describing the importance of MMA has been published. In this study, we used the PUBMED database to perform a review of the literature on the MMA to increase our understanding of its role in neurosurgery. After performing this review, we found that the MMA was commonly used to access DAVFs and meningiomas. Pseudoaneurysms and true aneurysms in the MMA can be effectively treated via endovascular or surgical removal. In MMD, the MMA plays a very important role in the development of collateral circulation and indirect revascularization. For recurrent CDSHs, after burr hole irrigation and drainage have failed, MMA embolization may be attempted. The MMA can also contribute to the occurrence and treatment of migraines. Because the ophthalmic artery can ectopically originate from the MMA, caution must be taken to avoid causing damage to the MMA during operations.

  4. Name changes in medically important fungi and their implications for clinical practice

    NARCIS (Netherlands)

    de Hoog, G Sybren; Chaturvedi, Vishnu; Denning, David W; Dyer, Paul S; Frisvad, Jens Christian; Geiser, David; Gräser, Yvonne; Guarro, Josep; Haase, Gerhard; Kwon-Chung, Kyung-Joo; Meis, Jacques F; Meyer, Wieland; Pitt, John I; Samson, Robert A; Taylor, John W; Tintelnot, Kathrin; Vitale, Roxana G; Walsh, Thomas J; Lackner, Michaela


    Recent changes in the Fungal Code of Nomenclature and developments in molecular phylogeny are about to lead to dramatic changes in the naming of medically important moulds and yeasts. In this article, we present a widely supported and simple proposal to prevent unnecessary nomenclatural instability.

  5. The importance of hydration in wound healing: reinvigorating the clinical perspective. (United States)

    Ousey, K; Cutting, K F; Rogers, A A; Rippon, M G


    Balancing skin hydration levels is important as any disruption in skin integrity will result in disturbance of the dermal water balance. The discovery that a moist environment actively supports the healing response when compared with a dry environment highlights the importance of water and good hydration levels for optimal healing. The benefits of 'wet' or 'hyper-hydrated' wound healing appear similar to those offered by moist over a dry environment. This suggests that the presence of free water may not be detrimental to healing, but any adverse effects of wound fluid on tissues is more likely related to the biological components contained within chronic wound exudate, for example elevated protease levels. Appropriate dressings applied to wounds must not only be able to absorb the exudate, but also retain this excess fluid together with its protease solutes, while concurrently preventing desiccation. This is particularly important in the case of chronic wounds where peri-wound skin barrier properties are compromised and there is increased permeation across the injured skin. This review discusses the importance of appropriate levels of hydration in skin, with a particular focus on the need for optimal hydration levels for effective healing. Declaration of interest: This paper was supported by Paul Hartmann Ltd. The authors have provided consultative services to Paul Hartmann Ltd.

  6. Epidermotropic presentation by splenic B-cell lymphoma: The importance of clinical-pathologic correlation. (United States)

    Hedayat, Amin A; Carter, Joi B; Lansigan, Frederick; LeBlanc, Robert E


    There are exceedingly rare reports of patients with epidermotropic B-cell lymphomas. A subset presented with intermittent, variably pruritic papular eruptions and involvement of their spleens, peripheral blood and bone marrow at the time of diagnosis. Furthermore, some experienced an indolent course despite dissemination of their lymphomas. We report a 66-year-old woman with a 12-year history of intermittent eruptions of non-pruritic, salmon-colored papules on her torso and proximal extremities that occurred in winter and resolved with outdoor activity in spring. Skin biopsy revealed an epidermotropic B-cell lymphoma with a non-specific B-cell phenotype and heavy chain class switching with IgG expression. On workup, our patient exhibited mild splenomegaly and low-level involvement of her peripheral blood and bone marrow by a kappa-restricted B-cell population. A splenic B-cell lymphoma was diagnosed. Considering her longstanding history and absences of cytopenias, our patient has been followed without splenectomy or systemic therapy. Furthermore, the papules have responded dramatically to narrowband UVB. Our case and a review of similar rare reports aim to raise awareness among dermatopathologists and dermatologists of a clinically distinct and indolent subset of epidermotropic splenic lymphomas with characteristic clinical and histologic findings. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. The importance of clinical information in patients with gastroenteropancreatic neuroendocrine tumor. (United States)

    Kudo, Atsushi; Akashi, Takumi; Kumagai, Jiro; Ban, Daisuke; Inokuchi, Mikito; Kojima, Kazuyuki; Kawano, Tatsuyuki; Tanaka, Shinji; Arii, Shigeki


    The WHO 2010 grading system for gastroenteropancreatic neuroendocrine tumors(GEP-NETs) is used to evaluate the malignant potential without clinicopathological information. This study was conducted to examine whether the new index is superior to the previous WHO 2004 classification, e.g.for well-differentiated endocrine carcinoma (WEC),involving clinical information. Between 2000 and 2011, 77 patients with sporadic GEP-NETs were treated at our institution and statistically estimated risk factors for overall survival (OS) were evaluated. Cox proportional hazards regression analyses were performed to estimate risk factors for OS. Overall 1-, 3- and 5-year survival rates were 92.8%, 78.4% and 76.0%, respectively. Median OS was 551 days in WEC-patients (odds ratio (OR)for OS=13.1, 95% confidence interval (CI)=2.90-59.5;p=0.001). The median OS was 813 days in G3-patients as compared with 1885 days in G1/G2-patients(OR for OS= 2.64, p=0.002). Multivariate analyses according to baseline characteristics revealed WEC as independent risk factor (OR=9.06, p=0.01). WEC was the only predictor of prognosis with an area under the receiver operating characteristic curves of 0.78(p=0.001). Clinical information was the best predictor for the prognosis of NETs.

  8. QUALITY OF LIFE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: importance of clinical, demographic and psychosocial factors

    Directory of Open Access Journals (Sweden)



    Full Text Available Context Inflammatory bowel disease causes physical and psychosocial consequences that can affect the health related quality of life. Objectives To analyze the relationship between clinical and sociodemographic factors and quality of life in inflammatory bowel disease patients. Methods Ninety two patients with Crohn’s disease and 58 with ulcerative colitis, filled in the inflammatory bowel disease questionnaire (IBDQ-32 and a questionnaire to collect sociodemographic and clinical data. The association between categorical variables and IBDQ-32 scores was determined using Student t test. Factors statistically significant in the univariate analysis were included in a multivariate regression model. Results IBDQ-32 scores were significantly lower in female patients (P<0.001, patients with an individual perception of a lower co-workers support (P<0.001 and career fulfillment (P<0.001, patients requiring psychological support (P = 0.010 and pharmacological treatment for anxiety or depression (P = 0.002. A multivariate regression analysis identified as predictors of impaired HRQOL the female gender (P<0.001 and the perception of a lower co-workers support (P = 0.025 and career fulfillment (P = 0.001. Conclusions The decrease in HRQQL was significantly related with female gender and personal perception of disease impact in success and social relations. These factors deserve a special attention, so timely measures can be implemented to improve the quality of life of patients.

  9. A rare variant of the ulnar artery with important clinical implications: a case report

    Directory of Open Access Journals (Sweden)

    Casal Diogo


    Full Text Available Abstract Background Variations in the major arteries of the upper limb are estimated to be present in up to one fifth of people, and may have significant clinical implications. Case presentation During routine cadaveric dissection of a 69-year-old fresh female cadaver, a superficial brachioulnar artery with an aberrant path was found bilaterally. The superficial brachioulnar artery originated at midarm level from the brachial artery, pierced the brachial fascia immediately proximal to the elbow, crossed superficial to the muscles that originated from the medial epicondyle, and ran over the pronator teres muscle in a doubling of the antebrachial fascia. It then dipped into the forearm fascia, in the gap between the flexor carpi radialis and the palmaris longus. Subsequently, it ran deep to the palmaris longus muscle belly, and superficially to the flexor digitorum superficialis muscle, reaching the gap between the latter and the flexor carpi ulnaris muscle, where it assumed is usual position lateral to the ulnar nerve. Conclusion As far as the authors could determine, this variant of the superficial brachioulnar artery has only been described twice before in the literature. The existence of such a variant is of particular clinical significance, as these arteries are more susceptible to trauma, and can be easily confused with superficial veins during medical and surgical procedures, potentially leading to iatrogenic distal limb ischemia.

  10. The importance of communication for clinical leaders in mental health nursing: the perspective of nurses working in mental health. (United States)

    Ennis, Gary; Happell, Brenda; Broadbent, Marc; Reid-Searl, Kerry


    Communication has been identified as an important attribute of clinical leadership in nursing. However, there is a paucity of research on its relevance in mental health nursing. This article presents the findings of a grounded theory informed study exploring the attributes and characteristics required for effective clinical leadership in mental health nursing, specifically the views of nurses working in mental health about the importance of effective communication in day to day clinical leadership. In-depth interviews were conducted to gain insight into the participants' experiences and views on clinical leadership in mental health nursing. The data that emerged from these interviews were constantly compared and reviewed, ensuring that any themes that emerged were based on the participants' own experiences and views. Participants recognized that effective communication was one of the attributes of effective clinical leadership and they considered communication as essential for successful working relationships and improved learning experiences for junior staff and students in mental health nursing. Four main themes emerged: choice of language; relationships; nonverbal communication, and listening and relevance. Participants identified that clinical leadership in mental health nursing requires effective communication skills, which enables the development of effective working relationships with others that allows them to contribute to the retention of staff, improved outcomes for clients, and the development of the profession.

  11. Child-rearing practices toward children with hemophilia: The relative importance of clinical characteristics and parental emotional reactions

    NARCIS (Netherlands)

    Banis, Hendrika; Suurmeijer, Th.P.B.M.; van Peer, D.R.

    This study addresses the relative importance of clinical characteristics of the child and parental emotional reactions, to child-rearing practices towards children who suffer from hemophilia. The variables were assessed in a Dutch sample of 108 zero-to-twelve-year-old boys with hemophilia and their

  12. An Unusual Course of Segmental Renal Artery Displays a Rare Case of Hilar Nutcracker Phenomenon

    Directory of Open Access Journals (Sweden)

    Devendra A. Sawant


    Full Text Available Nutcracker phenomenon or renal vein entrapment is classically seen as a compression of renal vein in between abdominal aorta and superior mesenteric artery with patients being asymptomatic or clinically manifested in the form of nutcracker syndrome as proteinuria, hematuria, flank pain, pelvic congestion in women, and varicocele in men. In this report, we are presenting a case of rare variant of nutcracker phenomenon along with brief review of anatomy, pathophysiology, public health, and clinical significance of nutcracker syndrome. On a routine dissection of an adult male cadaver, we noticed an unusual arrangement of the structures at the hilum of the left kidney showing entrapment of renal vein between left anterior inferior and posterior segmental renal arteries. The variation in the course of left anterior inferior segmental renal artery leads to compression of left renal vein at renal hilum. Therefore, we have named this rare abnormal anatomical entity as hilar nutcracker phenomenon. The structures in the right renal hilum are normal. The objective of this paper is to report an unusual but important variant of nutcracker phenomenon and also give collective knowledge of such anatomical variations in renal vasculature that will help in diagnosing and treating such rare renal disorder.

  13. The clinical importance of the anatomic variations in the paranasal sinuses

    International Nuclear Information System (INIS)

    Teixeira Junior, Francisco Ribeiro; Bretas, Elisa Almeida Sathler; Madeira, Ivana Andrade; Diniz, Renata Furletti; Ribeiro, Marcelo Almeida; Motta, Emilia Guerra Pinto Coelho; Moreira, Wanderval


    The anatomic variations of the paranasal sinuses are common findings. The importance of such variations predisposing disease through the obstruction of the drainage pathway has been discussed by several authors, although it is not yet a matter of agreement. The literature was reviewed and a iconographic assay was prepared aiming the discussion of the importance of the main anatomic variations of the paranasal sinuses. The prevalence of anatomic variations of the paranasal sinuses varies largely amongst studies and its role in sinus disease is controversial. In this article, it is described the different variations associated to paranasal disease and how they relate to pathologic conditions. Most studies confirm the concept that anatomic variations of the paranasal sinuses are related to disease when they obstruct the drainage pathways. The knowledge of such alterations and its relations to pathologic conditions is expected from the general radiologist. (author)

  14. Importance of carbon dioxide in the critical patient: Implications at the cellular and clinical levels. (United States)

    Morales Quinteros, Luis; Bringué Roque, Josep; Kaufman, David; Artigas Raventós, Antonio


    Important recent insights have emerged regarding the cellular and molecular role of carbon dioxide (CO 2 ) and the effects of hypercapnia. The latter may have beneficial effects in patients with acute lung injury, affording reductions in pulmonary inflammation, lessened oxidative alveolar damage, and the regulation of innate immunity and host defenses by inhibiting the expression of inflammatory cytokines. However, other studies suggest that CO 2 can have deleterious effects upon the lung, reducing alveolar wound repair in lung injury, decreasing the rate of reabsorption of alveolar fluid, and inhibiting alveolar cell proliferation. Clearly, hypercapnia has both beneficial and harmful consequences, and it is important to determine the net effect under specific conditions. The purpose of this review is to describe the immunological and physiological effects of carbon dioxide, considering their potential consequences in patients with acute respiratory failure. Copyright © 2018 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  15. State-of-the-art measurements in human body composition: A moving frontier of clinical importance (United States)

    Gallagher, D.; Shaheen, I.; Zafar, K.


    The measurement of human body composition allows for the estimation of body tissues, organs, and their distributions in living persons without inflicting harm. From a nutritional perspective, the interest in body composition has increased multi-fold with the global increase in the prevalence of obesity and its complications. The latter has driven in part the need for improved measurement methods with greater sensitivity and precision. There is no single gold standard for body-composition measurements in-vivo. All methods incorporate assumptions that do not apply in all individuals and the more accurate models are derived by using a combination of measurements, thereby reducing the importance of each assumption. This review will discuss why the measurement of body composition or human phenotyping is important; discuss new areas where the measurement of body composition (human phenotyping) is recognized as having important application; and will summarize recent advances made in new methodology. Reference will also be made to areas we cannot yet measure due to the lack of appropriate measurement methodologies, most especially measurements methods that provide information on kinetic states (not just static state) and metabolic function. PMID:21234275

  16. Comparison of medication reconciliation and medication review: errors and clinical importance

    DEFF Research Database (Denmark)

    Bjeldbak-Olesen, Mette; Danielsen, Anja Gadsbølle; Tomsen, Dorthe Vilstrup


    in the patient record and the EMS. 15% of the discrepancies were potentially serious or fatal, 62% were potentially significant and 23% were potentially non-significant. A total of 129 DRPs were identified by medication review, 1.7 per patient. The most frequent DRPs were sub therapeutic dosage, inappropriate......Introduction: The objective of this study was to compare medication reconciliation and medication review based on number, type and severity of discrepancies and drug-re­lated problems (DRPs), denoted errors. Material and methods: This was a retrospective study conducted at the Department...... of Cardiology, Hillerød Hos­pital. Medication reconciliation compared the prescriptions in patient records, an electronic medication system (EMS) and in discharge summaries (DS). The medication review was based on the EMS. The two methods were performed on the same data material. To assess the clinical...

  17. The symmetrical calcification of the basal cerebral ganglia (SCBG): its clinical importance

    International Nuclear Information System (INIS)

    Stellamor, V.; Summer, K.; Stellamor, K.


    Since CT is has been possible to detect subtle SCBG. Usually they are without any symptoms. Massive calcification is visible in conventional radiogram; it can form the patho-anatomical substrate for neuro-psychiatric defects. Fahr's triad consists of SCBG, typical neuro-psychiatric symptoms, and decreased activity of the parathyroid symptoms, and decreased activity of the parathyroid glands leading to a pathologic calcium-metabolism. In our opinion SCBG is of clinical relevance in each stage. Calcium-metabolism, intoxications and sclerosis of cerebral vessels have to be looked for. The combination of hypoparathyroidism and sclerosis of the cerebral vessels turned out to be fatal with one of our patients. In a case of SCBG the neuro-psychiatric symptoms were progressive. Interventions in the calcium-metabolism e.g. in strumectomy should depend on the status of the cerebral vessels. (Author)

  18. Follicular neoplasms of the thyroid: importance of clinical and cytological correlation. (United States)

    Granados-García, Martín; Cortés-Flores, Ana Olivia; del Carmen González-Ramírez, Imelda; Cano-Valdez, Ana María; Flores-Hernández, Lorena; Aguilar-Ponce, José Luis


    Thyroid cancer presents as nodules. Thyroid nodules are frequent, but only 5-30% are malignant. Fine needle aspiration biopsy (FNAB) is useful for initial evaluation; nevertheless, malignancy is uncertain when follicular neoplasm is reported. Some factors can be associated with malignancy. Therefore, we analyzed our follicular neoplasms in order to identify those factors associated with a higher risk of malignancy. We analyzed the clinical files of consecutive patients with cytological diagnoses of follicular neoplasm. From 1,005 cases of thyroid nodules, 121 were follicular neoplasms according to cytology. Of these, 75 were surgically treated. Definitive report showed 45 benign (60%) and 30 malignant (40%) cases. Benign cases included 29 goiters, 11 follicular adenomas, and 5 cases of thyroiditis. Malignant cases were comprised of 12 papillary carcinomas, 4 follicular carcinomas, 3 papillary carcinomas-follicular variant, 1 lymphoma, 1 teratoma, 5 medullary carcinomas, 2 insular carcinomas, 1 anaplastic carcinoma and 1 metastatic breast carcinoma. Tumor size of benign lesions was 3.43 ± 2.04 cm, and 4.67 ± 2.78 (p = 0.049) for malignant lesions. Age was 46.95 ± 15.39 years for benign lesions and 48.67 ± 17.28 for malignant lesions (p = 0.66). Fifty percent of males showed malignancy vs. 37.7% of females (p < 0.005). Our results suggest that size and gender, but not age, are associated with cytological pattern. Ultrasonographic characteristics may be useful discriminating patients with a higher risk of malignancy. FNAB is a useful tool for initial evaluation of thyroid nodules, but clinical evaluation can enhance predictive value.

  19. Abnormal muscle and hematopoietic gene expression may be important for clinical morbidity in primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Reppe, Sjur; Stilgren, Lis; Abrahamsen, Bo


    out in biopsies obtained before and 1 yr after parathyroidectomy in seven patients discovered by routine blood [Ca(2+)] screening. The tissue distribution of PTH receptor (PTHR1 and PTHR2) mRNAs were quantitated using real-time RT-PCR in unrelated persons to define PTH target tissues. Of about 10......, muscle, and hematopoietic cells have to be considered as one independent, important cause of molecular disease in PHPT leading to profound alterations in gene expression that may help explain symptoms like muscle fatigue, cardiovascular pathology, and precipitation of psychiatric illness....

  20. Importance of repeated CT scan in Fournier gangrene treatment: clinical case

    International Nuclear Information System (INIS)

    Ignatenco, Sergiu


    A patient of 53 years presented fever, swelling and erythema in the perineal region. After computed tomography (CT) was diagnosed Fournier gangrene. After aggressive surgical debridement postoperative evolution was unfavorable. Repeated CT scan trace spread of infection to new areas that led to new surgical debridement on time. Use of CT scan in the postoperative period allows assessment of the effectiveness of surgical debridement and spread of infection. This article presents CT scan images and the most important periods of intraoperative surgical intervention. (authors)

  1. Difficulty in the Clinical Diagnosis of Tularemia: Highlighting the Importance of a Physical Exam

    Directory of Open Access Journals (Sweden)

    Rupin Kumar


    Full Text Available We report an 18-month-old male who presented with fever and nonspecific symptoms. He was evaluated for multiple differential diagnoses including Kawasaki disease and JIA and received treatment for them. After he was readmitted, tularemia was considered based on the physical exam finding of an ulcer on the scalp and enlarged lymph nodes. Tularemia titers were positive, and the patient was given the appropriate antibiotic and was discharged home. Follow-up of the patient showed complete resolution of symptoms. This is a case that demonstrates the importance of physical exam in identifying rare diseases presenting with common signs and symptoms.

  2. The Overshoot Phenomenon in Geodynamics Codes (United States)

    Kommu, R. K.; Heien, E. M.; Kellogg, L. H.; Bangerth, W.; Heister, T.; Studley, E. H.


    The overshoot phenomenon is a common occurrence in numerical software when a continuous function on a finite dimensional discretized space is used to approximate a discontinuous jump, in temperature and material concentration, for example. The resulting solution overshoots, and undershoots, the discontinuous jump. Numerical simulations play an extremely important role in mantle convection research. This is both due to the strong temperature and stress dependence of viscosity and also due to the inaccessibility of deep earth. Under these circumstances, it is essential that mantle convection simulations be extremely accurate and reliable. CitcomS and ASPECT are two finite element based mantle convection simulations developed and maintained by the Computational Infrastructure for Geodynamics. CitcomS is a finite element based mantle convection code that is designed to run on multiple high-performance computing platforms. ASPECT, an adaptive mesh refinement (AMR) code built on the Deal.II library, is also a finite element based mantle convection code that scales well on various HPC platforms. CitcomS and ASPECT both exhibit the overshoot phenomenon. One attempt at controlling the overshoot uses the Entropy Viscosity method, which introduces an artificial diffusion term in the energy equation of mantle convection. This artificial diffusion term is small where the temperature field is smooth. We present results from CitcomS and ASPECT that quantify the effect of the Entropy Viscosity method in reducing the overshoot phenomenon. In the discontinuous Galerkin (DG) finite element method, the test functions used in the method are continuous within each element but are discontinuous across inter-element boundaries. The solution space in the DG method is discontinuous. FEniCS is a collection of free software tools that automate the solution of differential equations using finite element methods. In this work we also present results from a finite element mantle convection

  3. Hypersensitivity pneumonitis associated with mushroom worker's lung: an update on the clinical significance of the importation of exotic mushroom varieties. (United States)

    Moore, John E; Convery, Rory P; Millar, B Cherie; Rao, Juluri R; Elborn, J Stuart


    Hypersensitivity pneumonitis remains an important industrial disease in mushroom workers. It has a significant morbidity, and early diagnosis and removal from exposure to the antigen are critically important in its management. Recently, several new allergens have been described, particularly those from mushroom species originating in the Far East, which are of clinical significance to workers occupationally exposed to such allergens in cultivation, picking, and packing of commercial mushroom crops. Importing of exotic mushrooms including Shiitake is common in EU countries, and some of the exotic species of mushrooms are cultivated for local markets. This practice may contribute to an increase in clinical cases of mushroom hypersensitivity pneumonitis. This update reviews the recent literature and examines changing trends of mushroom worker's lung, with increased movement of commercial product and labour markets worldwide.

  4. Lutetium-177 - Broad Production Capabilities are Expected to Stimulate Clinical Applications of this Important Therapeutic Radioisotope

    International Nuclear Information System (INIS)

    Knapp, F.F. Jr.


    though the effort and expense increase exponentially as higher levels of nca Lu-177 are required, with more experience, these methods would be expected to be optimized and automated. Effective clinical results of targeted therapy exemplified with Lu-177-DOTAT-TOC and other peptides have been widely reported for neuroendocrine tumors. For this application, SA of probably > 10 Ci/mg is required. For arthritis therapy with Lu-177-EDTMP, much lower SA is sufficient (∼ 0.5 Ci Lu-177/mg). Although not yet realized, the unique opportunity to produce high activity levels/high SA Lu-177 essentially anywhere in the world would be expected to catalyze broader clinical use of Lu-177. In fact, this is a unique situation where production capabilities for both HSA and LSA Lu-177 far exceed current demand. The goals of this presentation are to discuss the issues associated with the routine production and processing of high activity levels of lutetium-177 and current and expected clinical applications. Research at the Oak Ridge National Laboratory (ORNL) is supported by the U.S. Department of Energy (DOE) under contract DE-AC05-00OR22725 with UT-Battelle, LLC. 'The submitted manuscript has been authored by a contractor of the U.S. Government under contract DE-AC05-00OR22725. Accordingly, the U.S. Government retains a nonexclusive, royalty-free license to publish or reproduce the published form of this contribution, or allow others to do so, for U.S. Government purposes.' (author)


    Directory of Open Access Journals (Sweden)

    L. Yu. Glukhova


    Full Text Available The electroencephalographic activating methods are widely used during the EEG investigation to detect the reactivity of normal electric activity of the brain and for provocation of pathological (especially epileptiform activity. The most common activating procedures are intermittent photic stimulation, hyperventilation, the probe "opening – closing" of the eyes, sleep deprivation and sleep. The more different activation methods are used during EEG investigation the more information EEG-method can propose in diagnostics of various pathological conditions , especially epilepsy, since epileptiform activity typically occur under certain conditions. In practice it is desirable to apply the activating procedures that are easily achievable with the available equipment and without possible adverse effects for the patients. The use of activating methods during EEG helps to establish correct diagnosis and to improve the efficacy of the treatment. The authors proposed a detailed review, devoted to the clinical aspects of these activating methods, combined with their own illustrations of EEG- responses to a variety of activating procedures.

  6. Anatomical variations within the deep posterior compartment of the leg and important clinical consequences. (United States)

    Hislop, M; Tierney, P


    The management of musculoskeletal conditions makes up a large part of a sports medicine practitioner's practice. A thorough knowledge of anatomy is an essential component of the armament necessary to decipher the large number of potential conditions that may confront these practitioners. To cloud the issue further, anatomical variations may be present, such as supernumerary muscles, thickened fascial bands or variant courses of nerves and blood vessels, which can themselves manifest as acute or chronic conditions that lead to significant morbidity or limitation of activity. There are a number of contentious areas within the literature surrounding the anatomy of the leg, particularly involving the deep posterior compartment. Conditions such as chronic exertional compartment syndrome, tibial periostitis (shin splints), peripheral nerve entrapment and tarsal tunnel syndrome may all be affected by subtle anatomical variations. This paper primarily focuses on the deep posterior compartment of the leg and uses the gross dissection of cadaveric specimens to describe definitively the anatomy of the deep posterior compartment. Variant fascial attachments of flexor digitorum longus are documented and potential clinical sequelae such as chronic exertional compartment syndrome and tarsal tunnel syndrome are discussed.

  7. Clinical importance of appearance of cesarean hysterotomy scar at transvaginal ultrasonography in nonpregnant women. (United States)

    Vikhareva Osser, Olga; Valentin, Lil


    To estimate the association between the appearance of cesarean hysterotomy scars at transvaginal ultrasound examination of nonpregnant women and the outcome of subsequent pregnancies and deliveries. A total of 162 women who had ever given birth by cesarean underwent transvaginal ultrasound examination of the hysterotomy scar 6 to 9 months after the latest cesarean delivery. Published ultrasound definitions of large scar defects were used. The appearance of the hysterotomy scar at ultrasound examination was compared with the outcome of subsequent pregnancies and deliveries. Clinical information on subsequent pregnancies was obtained from medical records. Six women were lost to follow-up, leaving 156 for analysis. Of these 156 women, 69 became pregnant after the ultrasound examination (99 pregnancies, 65 deliveries). There were no placental complications or scar pregnancies. At the first repeat cesarean delivery after the ultrasound examination, 5.3% (1/19) of the women with an intact scar or a small scar defect had uterine dehiscence or rupture compared with 42.9% (3/7) of those with a large defect (P=.047), odds ratio 11.8 (95% confidence interval 0.7-746). Our results point toward a likely association between large defects in the hysterotomy scar after cesarean delivery detected by transvaginal ultrasonography in nonpregnant women and uterine rupture or dehiscence in subsequent pregnancy.

  8. Clinically Important Features of Porphyrin and Heme Metabolism and the Porphyrias

    Directory of Open Access Journals (Sweden)

    Siddesh Besur


    Full Text Available Heme, like chlorophyll, is a primordial molecule and is one of the fundamental pigments of life. Disorders of normal heme synthesis may cause human diseases, including certain anemias (X-linked sideroblastic anemias and porphyrias. Porphyrias are classified as hepatic and erythropoietic porphyrias based on the organ system in which heme precursors (5-aminolevulinic acid (ALA, porphobilinogen and porphyrins are chiefly overproduced. The hepatic porphyrias are further subdivided into acute porphyrias and chronic hepatic porphyrias. The acute porphyrias include acute intermittent, hereditary copro-, variegate and ALA dehydratase deficiency porphyria. Chronic hepatic porphyrias include porphyria cutanea tarda and hepatoerythropoietic porphyria. The erythropoietic porphyrias include congenital erythropoietic porphyria (Gűnther’s disease and erythropoietic protoporphyria. In this review, we summarize the key features of normal heme synthesis and its differing regulation in liver versus bone marrow. In both organs, principal regulation is exerted at the level of the first and rate-controlling enzyme, but by different molecules (heme in the liver and iron in the bone marrow. We also describe salient clinical, laboratory and genetic features of the eight types of porphyria.

  9. Clinical Importance of Morphological Appearance of Seminiferous Tubules During MicroTESE in NOA Cases

    Directory of Open Access Journals (Sweden)

    A. H. Haliloglu


    Full Text Available Design: Clinical study. Setting: Research Center on Infertility, Ankara University; and Urology Department. Patients: 65 men with nonobstructive azoospermia (NOA.\tInterventions: Microscopical appearance of seminiferous tubules was recorded during TESE surgery. Differing from others, the largest opaque-white in color tubules were cut and removed. When all the tubules have no discriminating appearance, randomized biopsies were obtained. Removed tissue pieces were subjected to mechanical mincing under the stereomicroscope and then enzymatic digestion processes. Using inversion microscope (x32 magnification spermatozoa were searched. Main Outcome Measures: Morphological appearance of seminiferous tubules under optical magnification, spermatozoa recovery rates and histopathological findings were compared.\tRESULTS: In cases of Sertoli cell-only syndrome (SCOS, maturation arrest, hypospermatogenesis and focal spermatogenesis TESE yielded at least one spermatozoon in 37%, 52%, 100% and 63% of the cases, respectively. When all the seminiferous tubules were homogenously swollen, histopathological diagnosis was hypospermatogenesis in 100% of the cases. Homogenously thin and transparent tubules corresponded to SCOS or maturation arrest in 90% and 10% of the cases, respectively. Mature spermatozoa recovery rates were 100% and zero in homogenously-swollen observed and homogenously-thin observed tubules, respectively. CONCLUSIONS: Present data indicate that in cases of all tubules are homogenous in appearance and none of them can be discriminated from others, using microscope has no advantage in selection of the tubuli to be removed, but randomizely selection would also be sufficient. MicroTESE significantly increases the success in NOA cases with seminiferous tubules dispersed heterogeneously.

  10. In Vitro Activity of E1210, a Novel Antifungal, against Clinically Important Yeasts and Molds▿ (United States)

    Miyazaki, Mamiko; Horii, Takaaki; Hata, Katsura; Watanabe, Nao-aki; Nakamoto, Kazutaka; Tanaka, Keigo; Shirotori, Syuji; Murai, Norio; Inoue, Satoshi; Matsukura, Masayuki; Abe, Shinya; Yoshimatsu, Kentaro; Asada, Makoto


    E1210 is a new antifungal compound with a novel mechanism of action and broad spectrum of antifungal activity. We investigated the in vitro antifungal activities of E1210 compared to those of fluconazole, itraconazole, voriconazole, amphotericin B, and micafungin against clinical fungal isolates. E1210 showed potent activities against most Candida spp. (MIC90 of ≤0.008 to 0.06 μg/ml), except for Candida krusei (MICs of 2 to >32 μg/ml). E1210 showed equally potent activities against fluconazole-resistant and fluconazole-susceptible Candida strains. E1210 also had potent activities against various filamentous fungi, including Aspergillus fumigatus (MIC90 of 0.13 μg/ml). E1210 was also active against Fusarium solani and some black molds. Of note, E1210 showed the greatest activities against Pseudallescheria boydii (MICs of 0.03 to 0.13 μg/ml), Scedosporium prolificans (MIC of 0.03 μg/ml), and Paecilomyces lilacinus (MICs of 0.06 μg/ml) among the compounds tested. The antifungal action of E1210 was fungistatic, but E1210 showed no trailing growth of Candida albicans, which has often been observed with fluconazole. In a cytotoxicity assay using human HK-2 cells, E1210 showed toxicity as low as that of fluconazole. Based on these results, E1210 is likely to be a promising antifungal agent for the treatment of invasive fungal infections. PMID:21825291

  11. The Importance of Conditional Probability in Diagnostic Reasoning and Clinical Decision Making: A Primer for the Eye Care Practitioner. (United States)

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


    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.

  12. PCR-RFLP on β-tubulin gene for rapid identification of the most clinically important species of Aspergillus. (United States)

    Nasri, Tuba; Hedayati, Mohammad Taghi; Abastabar, Mahdi; Pasqualotto, Alessandro C; Armaki, Mojtaba Taghizadeh; Hoseinnejad, Akbar; Nabili, Mojtaba


    Aspergillus species are important agents of life-threatening infections in immunosuppressed patients. Proper speciation in the Aspergilli has been justified based on varied fungal virulence, clinical presentations, and antifungal resistance. Accurate identification of Aspergillus species usually relies on fungal DNA sequencing but this requires expensive equipment that is not available in most clinical laboratories. We developed and validated a discriminative low-cost PCR-based test to discriminate Aspergillus isolates at the species level. The Beta tubulin gene of various reference strains of Aspergillus species was amplified using the universal fungal primers Bt2a and Bt2b. The PCR products were subjected to digestion with a single restriction enzyme AlwI. All Aspergillus isolates were subjected to DNA sequencing for final species characterization. The PCR-RFLP test generated unique patterns for six clinically important Aspergillus species, including Aspergillus flavus, Aspergillus fumigatus, Aspergillus nidulans, Aspergillus terreus, Aspergillus clavatus and Aspergillus nidulans. The one-enzyme PCR-RFLP on Beta tubulin gene designed in this study is a low-cost tool for the reliable and rapid differentiation of the clinically important Aspergillus species. Copyright © 2015 Elsevier B.V. All rights reserved.

  13. Clinical characteristics of importance to outcome in patients with axial spondyloarthritis

    DEFF Research Database (Denmark)

    Andreasen, Rikke Asmussen; Kristensen, Lars Erik; Ellingsen, Torkell


    the PDQ and other phenotypical patient characteristics are prognostically important for response to biological therapy according to established response criteria like 50% improvement in the Bath Ankylosing Spondylitis Disease Activity Index (50%) and Ankylosing Spondylitis Disease Activity Score. ETHICS......-radiographic axSpA (nr-axSpA). Tumour necrosis factor-α inhibitors have revolutionised the treatment of patients with axSpA who failed to respond to non-steroidal anti-inflammatory drugs and physical therapy. Chronic pain is common in patients with SpA and may still persist despite the lack of signs...... of the PDQ regarding treatment response in patients with axSpA 3 months after initiating a biological agent. Secondary aim is to evaluate the impact of extra-articular manifestations, comorbidities and patient-reported outcomes and elucidate if these factors influence treatment response. METHOD AND ANALYSIS...

  14. [The importance of early exercise therapy in the treatment of Colles' fracture. A clinically controlled study]. (United States)

    Grønlund, B; Harreby, M S; Kofoed, R; Rasmussen, L


    Forty patients participated in a study of the importance of early occupational therapy for the prognosis in stable Colles' fractures. Seventeen patients were treated by an occupational therapist 1-3 days after the injury, and the need for appliances and home-care was estimated. Twenty-three patients completed the usual treatment. Five weeks after the injury, we found significantly (p less than 0.05) better function of the hand in the 17 patients with early occupational therapy. This difference in function could not be found after 13 weeks. The rate of complications was the same in the two groups. The results indicate that contact with the occupational therapist shortly after the injury is valuable in patients with stable Colles' fractures.

  15. Importance of dosimetry of irradiators for pre-clinical radiobiological experiments

    International Nuclear Information System (INIS)

    Vikram, Bhadrasain


    Importance of radiation dose in radiation biology has been increasingly recognized due to translational use of beyond 2Gy dose is in current practice. Hence, accurate dosimetry of biological irradiators is warranted. To address these problems and propose recommendations, the National Cancer Institute (NCI) along with the National Institute of Allergy and Infectious Diseases (NIAID) as well as the National Institute of Standards and Technology (NIST) highlighted a number of recommendations that will be presented in this talk that includes creating dosimetry standard operating procedures (SOPs) for both in-vitro as well as in-vivo experiments. Other recommendations include for journals (as well as to funding agencies) mandating the reporting of dosimetry of biological irradiators. (author)

  16. Leidenfrost phenomenon on conical surfaces (United States)

    Hidalgo-Caballero, S.; Escobar-Ortega, Y.; Pacheco-Vázquez, F.


    The Leidenfrost state is typically studied by placing droplets on flat or slightly curved surfaces. Here this phenomenon is investigated by depositing water in hot conical bowls. We found that this phase exists even for large amounts of liquid in very narrow cones without considerable effect of the confinement on the Leidenfrost transition temperature TL. At a fixed temperature, T >TL , the total evaporation time τ has a nonmonotonic dependence on the angle of confinement θ : for large volumes (˜20 ml) on flat surfaces (θ ˜0∘ ), vapor chimneys appear and accelerate the evaporation rate, their frequency diminishes as θ augments and becomes zero at a certain angle θc, at which τ reaches its maximum value; then, τ decreases again at larger angles because the vapor layer holding up the water becomes thinner due to the increase of hydrostatic pressure and because the geometry facilitates the vapor expulsion along the conical wall. For small volumes (˜1 ml), surface tension mainly determines the drop curvature and the lifetime is practically independent of θ . Different chimney regimes and oscillation patterns were observed and summarized in a phase diagram. Finally, we developed a simple model to decipher the shape adopted by the liquid volume and its evolution as a function of time, and the predictions are in good agreement with the experimental results.

  17. Public health and clinical importance of amoebiasis in Malaysia: a review. (United States)

    Tengku, S A; Norhayati, M


    Entamoeba histolytica, the causative agent of human amoebiasis remains a significant cause of morbidity and mortality in developing countries and is responsible for up to 100,000 deaths worldwide each year. Entamoeba dispar, morphologically indistinguishable from E. histolytica is more common in humans in many parts of the world. Similarly Entamoeba moshkovskii, which was long considered to be a free-living amoeba is also morphologically identical to E. histolytica and E. dispar, and is highly prevalent in some E. histolytica endemic countries. Humans are the host of infection and there would not appear to be other meaningful animal reservoirs of E. histolytica. Entamoeba. histolytica can be present in sewage and contaminated water. The infection is mainly transmitted via ingestion of water or food contaminated by faeces containing E. histolytica cysts. Clinical features of amoebiasis range from asymptomatic colonization to amoebic dysentery and invasive extraintestinal amoebiasis, which is manifested most commonly in the form of abscesses in liver and lungs. The epidemiology of amoebiasis has dramatically changed since the separation of E. histolytica and E. dispar species and the worldwide prevalence of these species has not been estimated until recently. Morever, E. moshkovskii, another morphologically indistinguishable human parasitic Entamoeba was not mentioned or considered as a contributor to the prevalence figures in endemic areas. Amoebiasis is still a major health problem especially in aboriginal settlements and amongst people living in remote area in Malaysia. However, until now there is only one data currently available to indicate the true prevalence and incidence of E. histolytica and E. dispar. Further studies are needed to determine the burden of E. histolytica, E. dispar and E. moshkovskii infections in Malaysia. In the present review, we briefly summarize all methods use in diagnosing Entamoeba species, ranging from microscopic identification to

  18. The clinical importance of axillary lymphadenopathy detected on screening mammography: revisited

    International Nuclear Information System (INIS)

    Patel, T.; Given-Wilson, R.M.; Thomas, V.


    AIM: The aim of this study was to re-evaluate our protocol for the management of isolated axillary lymphadenopathy (ALP) on mammographic screening. METHODS: In a retrospective review of 200,716 women screened at the South West London Breast Screening Service (SWLBSS) over 7 years, 72 women with ALP with an otherwise normal mammogram were identified. Thirteen patients were not recalled, nine of who had a known underlying diagnosis and the remainder had longstanding unchanged mammograms. Fifty-nine patients were recalled for further clinical assessment and investigations, including ultrasound, further mammographic views, fine-needle aspiration cytology (FNAC), blood tests and a chest radiograph. Those with a definite diagnosis were referred for appropriate management and those with benign reactive cytology on FNAC reviewed at 6 weeks with subsequent referral for excision of persisting abnormal nodes. RESULTS: The ultimate diagnosis was benign in 45 cases: 26 benign reactive changes, 11 arthritides, five with dermatological and viral conditions and three with tuberculosis. Malignancy was diagnosed in 13 cases: four with metastatic breast carcinoma and nine with lymphoma/leukaemia. The total number of newly diagnosed malignancies was 20% of women recalled. Another 5% of patients had active tuberculosis. Of the 22 patients with benign reactive cytology, one had significant pathology on excision biopsy: tuberculosis. Over 95% of the results from excision biopsy in these patients did not alter management. CONCLUSION: In the majority of patients, the FNAC results were representative of the final excision pathology. The present study suggests that excision biopsy could be omitted for those patients whose FNAC and culture are negative

  19. The happy victimizer phenomenon: Not found here

    Directory of Open Access Journals (Sweden)

    Jevtić Ana


    Full Text Available Children’s attribution of emotions to a moral transgressor is an important research topic in the psychology of moral and emotional development. This is especially because of the so-called Happy Victimizer Phenomenon (HVP where younger children attribute positive emotions to a moral transgressor described in a story. In the two studies that we have conducted (children aged 5, 7 and 9, 20 of each age; 10 of each age in the second study we have tested the possible influence of the fear of sanctions and the type of transgression (stealing and inflicting body injuries on the attribution of emotions. Children were presented with stories that described transgressions and they were asked to answer how the transgressor felt. The fear of sanctions did not make a significant difference in attribution but the type of transgression did - more negative emotions were attributed for inflicting body injuries than for stealing. Positive emotions were explained with situational-instrumental explanations in 84% of cases while negative emotions were explained with moral explanations in 63,5%. Girls attributed more positive emotions (61% than boys (39%. However, our main finding was that, for the aforementioned age groups, we did not find the HVP effect although it has regularly been registered in foreign studies. This finding denies the generalizability of the phenomenon and points to the significance of disciplining styles and, even more so, culture for children’s attribution of emotions to moral transgressors.

  20. Clinical importance of serum HE4 and MMP2 levels in endometrial cancer patients

    Directory of Open Access Journals (Sweden)

    Cymbaluk-Ploska A


    Full Text Available Aneta Cymbaluk-Płoska,1 Anita Chudecka-Głaz,1 Ewa Pius-Sadowska,2 Agnieszka Sompolska-Rzechuła,3 Bogusław Machaliński,2 Anna Surowiec,1 Janusz Menkiszak1 1Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, 2Department of General Pathology, Pomeranian Medical University, 3Department of Statistics, West Pomeranian University of Technology, Szczecin, Poland Introduction: Endometrial cancer is the one of the most common cancers of the genital organ. HE4 and MMP2 are both proteins whose serum levels increase in endometrial cancer.Aim: To explore the diagnostic potential of the serum levels of HE4 and MMP2 in patients with endometrial cancer and benign endometrial diseases. To assess the relationship between the serum levels of HE4 and MMP2 and the typical prognostic factors in patients with endometrial cancer.Materials and methods: Included in the study was a group of 112 patients presenting with bleeding abnormalities at the Pomeranian Medical University in years 2012–2016. Serum HE4 concentrations were measured using the Elecsys Electrochemiluminescence Immunoassay (ECLIA. MMP2 concentrations were quantified in the serum using multiplex immunoassays.Results: We observed statistically significant differences in mean serum levels of HE4 and MMP2 between the group of endometrial cancer patients and the group of patients with no changes in the endometrium (P=0.002/0.003. The diagnostic potential of HE4 and MMP2 in differentiation of high (International Federation of Gynecology and Obstetrics [FIGO] III and IV vs low (FIGO I and II clinical stage of tumor and prediction of cellular differentiation grade (G1 vs G3 on the basis of the analysis of the area under the curve is, respectively, 0.86 and 0.82 for HE4 and 0.82 and 0.74 for MMP2. The HE4 marker was significantly more specific than MMP2 in every study group and amounted to 93% vs 86% in all patients included in the analysis, 94% vs 84% in pre

  1. Import and visualization of clinical medical imagery into multiuser VR environments (United States)

    Mehrle, Andreas H.; Freysinger, Wolfgang; Kikinis, Ron; Gunkel, Andreas; Kral, Florian


    The graphical representation of three-dimensional data obtained from tomographic imaging has been the central problem since this technology is available. Neither the representation as a set of two-dimensional slices nor the 2D projection of three-dimensional models yields satisfactory results. In this paper a way is outlined which permits the investigation of volumetric clinical data obtained from standard CT, MR, PET, SPECT or experimental very high resolution CT-scanners in a three dimensional environment within a few worksteps. Volumetric datasets are converted into surface data (segmentation process) using the 3D-Slicer software tool and saved as .vtk files and exported as a collection of primitives in any common file format (.iv, .pfb). Subsequently this files can be displayed and manipulated in the CAVE virtual reality center. The CAVE is a multiuser walkable virtual room consisting of several walls on which stereoscopic images are projected by rear panel beamers. Adequate tracking of the head position and separate image calculation for each eye yields a vivid impression for one or several users. With the use of a seperately tracked 6D joystick manipulations such as rotation, translation, zooming, decomposition or highlighting can be done intuitively. The usage of the CAVE technology opens new possibilities especially in surgical training ("hands-on-effect") and as an educational tool (availability of pathological data). Unlike concurring technologies the CAVE permits a walk-through into the virtual scene but preserves enough physical perception to allow interaction between multiple users, e.g. gestures and movements. By training in a virtual environment on one hand the learning process of students in complex anatomic findings may be improved considerably and on the other hand unaccustomed views such as the one through a microscope or endoscope can be trained in advance. The availability of low-cost PC based CAVE-like systems and the rapidly decreasing price

  2. [Calcium and vitamin D in bone metabolism: Clinical importance for fracture treatment]. (United States)

    Amling, M


    A balanced calcium homeostasis is of critical importance not only for bone remodeling, the physiological process of bone resorption and bone formation that constantly renews bone throughout life but also for normal fracture healing. Given that disturbances of calcium homeostasis are present in 50 % of the German population and that this might result in delayed fracture healing after correct surgical treatment, this paper focusses on calcium and vitamin D in the daily practice in orthopedics and trauma surgery. To ensure the required enteral calcium uptake the following three conditions are required: (1) sufficient calcium intake via the nutrition, (2) a 25-hydroxyvitamin D serum level > 30 µg/l and (3) the presence of sufficient gastric acidification. Given the endemic vitamin D deficiency in Germany as well as the constantly increasing number of people using proton pump inhibitors on a regular basis, it is necessary to closely connect trauma orthopedic surgery and osteological treatment. The first issue to be dealt with is to control and if needed normalize calcium homeostasis in order to allow a normal undisturbed fracture healing process after both conservative as well as operative treatment of fractures.

  3. The use of Fluorescence Resonance Energy Transfer (FRET peptidesfor measurement of clinically important proteolytic enzymes

    Directory of Open Access Journals (Sweden)

    Adriana K. Carmona


    Full Text Available Proteolytic enzymes have a fundamental role in many biological processes and are associated with multiple pathological conditions. Therefore, targeting these enzymes may be important for a better understanding of their function and development of therapeutic inhibitors. Fluorescence Resonance Energy Transfer (FRET peptides are convenient tools for the study of peptidases specificity as they allow monitoring of the reaction on a continuous basis, providing a rapid method for the determination of enzymatic activity. Hydrolysis of a peptide bond between the donor/acceptor pair generates fluorescence that permits the measurement of the activity of nanomolar concentrations of the enzyme. The assays can be performed directly in a cuvette of the fluorimeter or adapted for determinations in a 96-well fluorescence plate reader. The synthesis of FRET peptides containing ortho-aminobenzoic acid (Abz as fluorescent group and 2, 4-dinitrophenyl (Dnp or N-(2, 4-dinitrophenylethylenediamine (EDDnp as quencher was optimized by our group and became an important line of research at the Department of Biophysics of the Federal University of São Paulo. Recently, Abz/Dnp FRET peptide libraries were developed allowing high-throughput screening of peptidases substrate specificity. This review presents the consolidation of our research activities undertaken between 1993 and 2008 on the synthesis of peptides and study of peptidases specificities.As enzimas proteolíticas têm um papel fundamental em muitos processos biológicos e estão associadas a vários estados patológicos. Por isso, o estudo da especificidade das peptidases pode ser importante para uma melhor compreensão da função destas enzimas e para o desenvolvimento de inibidores. Os substratos com supressão intramolecular de fluorescência constituem uma excelente ferramenta, pois permitem o monitoramento da reação de forma contínua, proporcionando um método prático e rápido para a determinação da

  4. Seizure semiology: an important clinical clue to the diagnosis of autoimmune epilepsy. (United States)

    Lv, Rui-Juan; Ren, Hai-Tao; Guan, Hong-Zhi; Cui, Tao; Shao, Xiao-Qiu


    The purpose of this study is to analyze the seizure semiologic characteristics of patients with autoimmune epilepsy (AE) and describe the investigation characteristics of AE using a larger sample size. This observational retrospective case series study was conducted from a tertiary epilepsy center between May 2014 and March 2017. Cases of new-onset seizures were selected based on laboratory evidence of autoimmunity. At the same time, typical mesial temporal lobe epilepsy (MTLE) patients with hippocampal sclerosis (HS) were recruited as the control group from the subjects who underwent presurgical evaluation during the same period. A total of 61 patients with AE were identified. Specific autoimmune antibodies were detected in 39 patients (63.93%), including anti-VGKC in 23 patients (37.70%), anti-NMDA-R in 9 patients (14.75%), anti-GABA B -R in 6 patients (9.84%), and anti-amphiphysin in 1 patient (1.64%). Regarding the seizure semiology, no significant differences were noted between AE patients with autoantibody and patients with suspected AE without antibody. Compared to typical MTLE patients with HS, both AE patients with autoantibody and patients with suspected AE without antibody had the same seizure semiologic characteristics, including more frequent SPS or CPS, shorter seizure duration, rare postictal confusion, and common sleeping SGTC seizures. This study highlights important seizure semiologic characteristics of AE. Patients with autoimmune epilepsy had special seizure semiologic characteristics. For patients with autoimmune epilepsy presenting with new-onset seizures in isolation or with a seizure-predominant neurological disorder, the special seizure semiologic characteristics may remind us to test neuronal nuclear/cytoplasmic antibodies early and initiate immunomodulatory therapies as soon as possible. Furthermore, the absence of neural-specific autoantibodies does not rule out AE.

  5. The importance of clinical monitoring for compliance with Continuous Positive Airway Pressure. (United States)

    Pelosi, Lucas B; Silveira, Mariana L C; Eckeli, Alan L; Chayamiti, Emilia M P C; Almeida, Leila A; Sander, Heidi H; Küpper, Daniel S; Valera, Fabiana C P

    Obstructive sleep apnea syndrome is currently a public health problem of great importance. When misdiagnosed or improperly treated, it can lead to serious consequences on patients' quality of life. The gold standard treatment for cases of obstructive sleep apnea syndrome, especially in mild to severe and symptomatic cases, is continuous positive airway pressure therapy. Compliance with continuous positive airway pressure therapy is directly dependent on the active participation of the patient, which can be influenced by several factors. The objective of this study is to describe the factors related to compliance with continuous positive airway pressure therapy, and to analyze which associated factors directly influence the efficiency of the treatment. Patients who received continuous positive airway pressure therapy through the Municipal Health Department of the city of Ribeirão Preto were recruited. A structured questionnaire was administered to the patients. Compliance with continuous positive airway pressure therapy was assessed by average hours of continuous positive airway pressure therapy usage per night. Patients with good compliance (patients using continuous positive airway pressure therapy ≥4h/night) were compared to those with poor compliance (patients using <4h/night). 138 patients were analyzed: 77 (55.8%) were considered compliant while 61 (44.2%) were non-compliant. The comparison between the two groups showed that regular monitoring by a specialist considerably improved compliance with continuous positive airway pressure therapy (odds ratio, OR=2.62). Compliance with continuous positive airway pressure therapy is related to educational components, which can be enhanced with continuous and individualized care to patients with obstructive sleep apnea syndrome. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  6. Morphometry of A1 segment of the anterior cerebral artery and its clinical importance. (United States)

    Krishnamurthy, A; Nayak, S R; Bagoji, I B; D'Costa, S; Pai, M M; Jiji, P J; Kumar, C G; Rai, R


    Anterior cerebral artery, one of the terminal branches of the internal carotid artery is an important vessel taking part in the formation of circle of Willis. It supplies a large part of the medial surface of the cerebral hemisphere containing the areas of motor and somatosensory cortices of the lower limb. Aim of this study was the morphometry of A1 segment of the anterior cerebral artery. 93 formalin fixed brain specimen of either sex and of Indian origin were studied. The mean length, mean external diameter and the anomalies present in A1 segment of the vessel were studied in detail and photographed. The mean length of A1 segment of the vessel was 14.49+/-0.28 mm and 14.22+/-0.22 mm on right and left side respectively. The mean external diameter of the vessel on right and left side was 2.12+/-0.07 mm and 2.32+/-0.06 mm respectively. Narrowing, aneurysm formation, buttonhole formation and median anterior cerebral artery were the anomalies seen with an occurrence of 15.05%, 5.37%, 3.22% and 12.9%, respectively. The above anomalies did not have any sex or side predilection. Knowledge of morphometry of the vessel will be of use to neurosurgeons while performing the shunt operation, in assessing the feasibility of such operations and in the choice of patients. From this study we infer that the morphometry of anterior cerebral artery varies in different population and that the neurosurgeons operating should have a thorough knowledge of the possible variations.

  7. A Study of the Incidence of the Minor Psychoses-their Clinical and Industrial Importance. (United States)

    Culpin, M


    percentage of high assessments as clerical workers, but illness rates are low. Satisfaction of the workers with their work seems an important factor in illness.Since the incidence of the minor psychoses varies little from group to group, and does not seem to be statistically related to the incidence of psychoneurotic illness, other factors must be at work and should be investigated.

  8. Investigating the mobilome in clinically important lineages of Enterococcus faecium and Enterococcus faecalis. (United States)

    Mikalsen, Theresa; Pedersen, Torunn; Willems, Rob; Coque, Teresa M; Werner, Guido; Sadowy, Ewa; van Schaik, Willem; Jensen, Lars Bogø; Sundsfjord, Arnfinn; Hegstad, Kristin


    possible functional CRISPR-Cas systems, and still resistance and prophage sequences were generally well represented. The targeted MGEs were highly prevalent among the selected STs, underlining their potential importance in the evolution of hospital-adapted lineages of enterococci. Although the propensity of inter-species horizontal gene transfer (HGT) must be emphasized, the considerable species-specificity of these MGEs indicates a separate vertical evolution of MGEs within each species, and for E. faecalis within each ST.

  9. A Customizable Importer for the Clinical Data Warehouses PaDaWaN and I2B2. (United States)

    Fette, Georg; Kaspar, Mathias; Dietrich, Georg; Ertl, Maximilian; Krebs, Jonathan; Stoerk, Stefan; Puppe, Frank


    In recent years, clinical data warehouses (CDW) storing routine patient data have become more and more popular to support scientific work in the medical domain. Although CDW systems provide interfaces to import new data, these interfaces have to be used by processing tools that are often not included in the systems themselves. In order to establish an extraction-transformation-load (ETL) workflow, already existing components have to be taken or new components have to be developed to perform the load part of the ETL. We present a customizable importer for the two CDW systems PaDaWaN and I2B2, which is able to import the most common import formats (plain text, CSV and XML files). In order to be run, the importer only needs a configuration file with the user credentials for the target CDW and a list of XML import configuration files, which determine how already exported data is indented to be imported. The importer is provided as a Java program, which has no further software requirements.

  10. The clinical importance and prediction of steal following femoro-femoral cross-over bypass: study of the donor iliac artery by intravascular ultrasound, arteriography, duplex scanning and pressure measurements

    DEFF Research Database (Denmark)

    Vogt, K C; Rasmussen, J G; Schroeder, T V


    to evaluate the clinical significance of the steal phenomenon following femoro-femoral bypass, and whether the addition of intravascular ultrasound (IVUS) to the established examinations of the donor iliac artery can improve the prediction of patients who will develop evaluate the clinical significance of the steal phenomenon following femoro-femoral bypass, and whether the addition of intravascular ultrasound (IVUS) to the established examinations of the donor iliac artery can improve the prediction of patients who will develop steal....

  11. Multicenter Evaluation of the Bruker MALDI Biotyper CA System for the Identification of Clinically Important Bacteria and Yeasts. (United States)

    Wilson, Deborah A; Young, Stephen; Timm, Karen; Novak-Weekley, Susan; Marlowe, Elizabeth M; Madisen, Neil; Lillie, Jennifer L; Ledeboer, Nathan A; Smith, Rebecca; Hyke, Josh; Griego-Fullbright, Christen; Jim, Patricia; Granato, Paul A; Faron, Matthew L; Cumpio, Joven; Buchan, Blake W; Procop, Gary W


    A report on the multicenter evaluation of the Bruker MALDI Biotyper CA System (MBT-CA; Bruker Daltonics, Billerica, MA) for the identification of clinically important bacteria and yeasts. In total, 4,399 isolates of medically important bacteria and yeasts were assessed in the MBT-CA. These included 2,262 aerobic gram-positive (AGP) bacteria, 792 aerobic gram-negative (AGN) bacteria 530 anaerobic (AnA) bacteria, and 815 yeasts (YSTs). Three processing methods were assesed. Overall, 98.4% (4,329/4,399) of all bacterial and yeast isolates were correctly identified to the genus and species/species complex level, and 95.7% of isolates were identified with a high degree of confidence. The percentage correctly identified and the percentage identified correctly with a high level of confidence, respectively, were as follows: AGP bacteria (98.6%/96.5%), AGN bacteria (98.5%/96.8%), AnA bacteria (98.5%/97.4%), and YSTs (97.8%/87.6%). The extended direct transfer method was only minimally superior to the direct transfer method for bacteria (89.9% vs 86.8%, respectively) but significantly superior for yeast isolates (74.0% vs 48.9%, respectively). The Bruker MALDI Biotyper CA System accurately identifies most clinically important bacteria and yeasts and has optional processing methods to improve isolate characterization. © American Society for Clinical Pathology, 2017. All rights reserved. For permissions, please e-mail:


    Directory of Open Access Journals (Sweden)

    Florin-Alexandru LUCA


    Full Text Available Hybrid war is a reality; war does not depend only on conventional means, but includes communication and propaganda strategies whose role is increasingly important. In the last few years, terrorist cells have spent and keep spending many energies in a global propaganda business. This activity is a fundamental aspect of the conflict. This promotion campaign serves several purposes: legitimating its authority, recruiting militants and motivating sympathizers, and intimidating and conditioning those whose cells they consider enemies. What draws our attention is the sophisticated level of professionalism they demonstrate in managing propaganda and terror. This paper seeks to provide a broader view of the European Foreign Fighters (FF phenomenon by analyzing this target group from a marketing point of view in order to lay the foundations for a strategy to counteract them.


    Directory of Open Access Journals (Sweden)

    Pavel Nikolaevich Vlasov


    Full Text Available The purpose of the investigation was to study the clinical value of the deja vu phenomenon in healthy examinees as it may occur in healthy individuals, on the one hand, and is a symptom of a number of psychoneurological diseases, on the other. One hundred and twenty-nine subjects, mean age 25,2±4,4 years, were examined. All the examinees were questioned by the original questionnaire developed by the authors, which was to reveal the characteristics of the phenomenon, and the Cambridge depersonalization questionnaire; standard electroencephalography was also performed. The deja vu phenomenon was detected in 97% of the respondents. In healthy individuals, the phenomenon was most common at the age of 21-25 years; 52,2% experienced deja vu several times a year; 64,5% of the respondents reported the 10-sec state; 85% did not associate the occurrence of the phenomenon with any provoking factor; 66% perceived deja vu with a positive emotional tinge, and only 4% of the respondents were afraid of the onset of this phenomenon. These criteria may be used to rule out pathological deja vu

  14. Risk as a social phenomenon. (United States)

    Jamison, Wesley V


    What do nuclear power, smoking, and eating beef have in common? The answer is multifaceted. They all share aspects of mass production and consumption, and therefore consumer confidence comes into play in evaluating each of the products' merits. They all produce some level of anxiety--be it in response to adverse media coverage, or the successes of adversarial interest groups in publicizing those products' weaknesses--among consumers who wonder what if any level of the product should be consumed. Finally, nuclear power, smoking, and eating beef all share risk; that is, the perceived and real detriments of producing and consuming those products. Whether or not the associated risks--from increased cancer to increased heart disease--are real is beside the point. When talking about risk, scientific education must deal with the perception of risk as much as its reality. Risk is a socially defined phenomenon, and as such, the successful scientists/communicator must understand the social evaluations of it. While many scientists take a rational view of risk evaluation and consumers often make rational decisions about technological and scientific risk based upon the costs and benefits of that technology, this approach is problematic for three reasons. First, the nature of modern risks has changed in that risk is complex, incomprehensible and uncontrollable to the average person. Second, the rational approach assumes that all costs and benefits of a technology, both real and potential, both current and future, can be known and therefore rationally evaluated. This is not the case. Third, evidence from Europe indicates that trust in information sources about risk has fallen, and thus classic scientific education campaigns that rely upon increasing public knowledge and acceptance of technological and scientific risk are problematic. Because of these factors we argue that effective scientific response must begin to understand the social components of risk if campaigns to shape


    Dyatlov, I A; Mironov, A Yu; Shepelin, A P; Aleshkin, V A


    The import substitution becomes one of the strategic tasks of national economy as a result of prolongation of economic sanctions concerning the Russian Federation of part of the USA, EU countries, Japan and number of other countries. It is not proper to be limited in import substitution only by goods because in conditions ofsanctions when access toforeign technologies is complicated Russia is needed to substitute foreign technologies by national designs in faster manner One of directions of effective import substitution is localization of production of laboratory equipment and consumables for clinical and sanitary microbiology on the territory ofthe Russian Federation and countries of Customs union. In Russia, in the field ofdiagnostic of dangerous and socially significant infections, all components for import substitution to implement gene diagnostic, immune diagnostic. bio-sensory and biochip approaches, isolation and storage of live microbial cultures, implementation of high-tech methods of diagnostic are available. At the same time, national diagnostic instrument-making industry for microbiology is factually absent. The few devices of national production more than on 50% consist of import components. The microbiological laboratories are to be equipped only with import devices of open type for applying national components. The most perspective national designs to be implemented are multiplex polimerase chain reaction test-systems and biochips on the basis of national plotters and readers. The modern development of diagnostic equipment and diagnostic instruments requires supplement of national collections of bacterial and viral pathogens and working-through of organizational schemes of supplying collections with strains. The presented data concerning justification of nomenclature of laboratory equipment and consumables permits to satisfy in fill scope the needs of clinical and sanitary microbiology in devices, growth mediums, consumables of national production


    Directory of Open Access Journals (Sweden)

    Marina Ivanovna Ilyushina


    Full Text Available The article is devoted to the moment the subject – resources of a person. Be caused, “loss” possible resources: lack of personal self-realization, the maladjustment of the individual in a social environment, obstructed line of identity, which in some cases is accompanied by incomplete personal self-actualization and self-sufficiency. The article emphasizes the importance of the subjective component in understanding, identifying, understanding, mobilization, conservation and accumulation of resources of the individual. Man is an active Converter to your reality, where he and reality are the result of the conversion and source conversion. The author proposed the concept of “subjective resource” as a necessary factor for quality of life of the individual, achievement of tops of her self-improvement and self-development, both professionally and personally. Subjective component emphasizes the role of the individual in the conservation, transformation, accumulation, the reallocation of resources. Purpose. The subject of analysis is the awareness, understanding person own resources – the subjective resourcest. The author aims to describe the subjective resourcest as psychological and acmeological phenomenon to reveal its essence and to suggest the methodology of the study of this phenomenon, showing the importance of verbalization resources through associative image without relying on the visibility and relying on her. Methodology. The basis of the study form a General theoretical methods (theoretical analysis, including psychological analysis, generalization, systematization, system description. Results. The results of the work lies in the fact that the author has defined the concept of “subjective resourcesthe” and proposed methodology of the study. The obtained results may be of interest to improve the efficiency of the work to define the resources of the individual. The results and method of determining a subjective resource

  17. Deep brain stimulation may reduce the relative risk of clinically important worsening in early stage Parkinson's disease. (United States)

    Hacker, Mallory L; Tonascia, James; Turchan, Maxim; Currie, Amanda; Heusinkveld, Lauren; Konrad, Peter E; Davis, Thomas L; Neimat, Joseph S; Phibbs, Fenna T; Hedera, Peter; Wang, Lily; Shi, Yaping; Shade, David M; Sternberg, Alice L; Drye, Lea T; Charles, David


    The Vanderbilt pilot trial of deep brain stimulation (DBS) in early Parkinson's disease (PD) enrolled patients on medications six months to four years without motor fluctuations or dyskinesias. We conducted a patient-centered analysis based on clinically important worsening of motor symptoms and complications of medical therapy for all subjects and a subset of subjects with a more focused medication duration. Continuous outcomes were also analyzed for this focused cohort. A post hoc analysis was conducted on all subjects from the pilot and a subset of subjects taking PD medications 1-4 years at enrollment. Clinically important worsening is defined as both a ≥ 3 point increase in UPDRS Part III and a ≥ 1 point increase in Part IV. DBS plus optimal drug therapy (DBS + ODT) subjects experienced a 50-80% reduction in the relative risk of worsening after two years. The DBS + ODT group was improved compared to optimal drug therapy (ODT) at each time point on Total UPDRS and Part III (p = 0.04, p = 0.02, respectively, at 24 months). Total UPDRS, Part IV, and PDQ-39 scores significantly worsened in the ODT group after two years (p < 0.003), with no significant change in the DBS + ODT group. DBS + ODT in early PD may reduce the risk of clinically important worsening. These findings further confirm the need to determine if DBS + ODT is superior to medical therapy for managing symptoms, reducing the complications of medications, and improving quality of life. The FDA has approved the conduct of a large-scale, pivotal clinical trial of DBS in early stage PD. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Phenomenon of mucous retention in the incisive canal. (United States)

    Keith, D A


    Mucous glands are rarely found in the anterior palate but may be observed in the incisive canal. A case history is presented of a lesion that resembled a nasopalatine cyst both clinically and radiographically but which was in fact an intra-bony extravasation phenomenon.

  19. Raynaud\\'s Phenomenon in a Black African Woman | Oguntona ...

    African Journals Online (AJOL)

    Scleroderma is the commonest autoimmune disease associated with Raynaud's phenomenon. The presence of Raynaud's is synonymous with tissue ischaemia. It is a multi-systemic disorder and the clinical manifestations are as a result of excessive proliferation and accumulation of collagen. Definitive management of ...

  20. Epidemiological survey of mucus extravasation phenomenon at an oral pathology referral center during a 43 year period

    Directory of Open Access Journals (Sweden)

    Thâmara Manoela Marinho Bezerra

    Full Text Available ABSTRACT INTRODUCTION: Mucoceles are common benign pseudocystic lesions of the oral cavity; their main etiological factors are trauma and ductal obstruction. Two histological patterns are found: mucus retention phenomenon (MRP and mucus extravasation phenomenon (MEP. Mucus extravasation phenomenon is the more common histological subtype and it mainly affects the lower lip. The knowledge of its main clinical features and management is important to assist health professionals in clinical practice. OBJECTIVE: This study aimed to determine the relative frequency and distribution of oral mucoceles in an oral pathology reference center. METHODS: Cross-sectional historical study that analyzed all cases pathologically diagnosed as mucus extravasation phenomenon by the department of anatomic pathology of an oral pathology referral center from June of 1970 to May of 2014, considering the clinical characteristics of the lesion and those relating to the patient. SPSS v. 20.0 software for Windows was used for descriptive analysis. RESULTS: During 43 years, 719 cases of mucus extravasation phenomenon (54.7% men and 45.3% women were registered, with the lower lip as the most commonly affected site (n = 484; 67.3%. The average age of patients was 20.8 years (SD ± 14.4 with a peak occurrence in the second decade of life. Most professionals had oral mucocele/ranula (n = 606; 84.3% as the initial clinical impression. CONCLUSION: Mucus extravasation phenomenon is a lesion that primarily affects young patients, affecting mainly the lower lip, and is commonly found in oral diagnostic services.

  1. Biological activities of Allium sativum and Zingiber officinale extracts on clinically important bacterial pathogens, their phytochemical and FT-IR spectroscopic analysis. (United States)

    Awan, Uzma Azeem; Ali, Shaukat; Shahnawaz, Amna Mir; Shafique, Irsa; Zafar, Atiya; Khan, Muhammad Abdul Rauf; Ghous, Tahseen; Saleem, Azhar; Andleeb, Saiqa


    The spread of bacterial infectious diseases is a major public threat. Herbs and spices have offered an excellent, important and useful source of antimicrobial agents against many pathological infections. In the current study, the antimicrobial potency of fresh, naturally and commercial dried Allium sativum and Zingiber officinale extracts had been investigated against seven local clinical bacterial isolates such as Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumonia, Staphylococcus aureus, Streptococcus pyogenes, Staphylococcus epidermidis, and Serratia marcesnces by the agar disc diffusion method. All tested pathogens except P. aeruginosa and E. coli were most susceptible to ethanolic and methanolic extracts of A. sativum. Similarly, chloroform and diethyl ether extracts of Z. officinale showed a greater zone of inhibition of tested pathogens except for P. aeruginosa and E. coli. We found that all extracts of A. sativum and Z. officinale have a strong antibacterial effect compared to recommended standard antibiotics through activity index. All results were evaluated statistically and a significant difference was recorded at Psativum and Z. officinale proposed the presence of various phytochemicals such as tannins, phenols, alkaloids, steroids and saponins. Retention factor of diverse phytochemicals provides a valuable clue regarding their polarity and the selection of solvents for separation of phytochemicals. Significant inhibition of S. aureus was also observed through TLC-Bioautography. FT-IR Spectrometry was also performed to characterize both natural and commercial extracts of A. sativum and Z. officinale to evaluate bioactive compounds. These findings provide new insights to use A. sativum and Z. officinale as potential plant sources for controlling pathogenic bacteria and potentially considered as cost-effective in the management of diseases and to the threat of drug resistance phenomenon.

  2. Statistical Agent Based Modelization of the Phenomenon of Drug Abuse (United States)

    di Clemente, Riccardo; Pietronero, Luciano


    We introduce a statistical agent based model to describe the phenomenon of drug abuse and its dynamical evolution at the individual and global level. The agents are heterogeneous with respect to their intrinsic inclination to drugs, to their budget attitude and social environment. The various levels of drug use were inspired by the professional description of the phenomenon and this permits a direct comparison with all available data. We show that certain elements have a great importance to start the use of drugs, for example the rare events in the personal experiences which permit to overcame the barrier of drug use occasionally. The analysis of how the system reacts to perturbations is very important to understand its key elements and it provides strategies for effective policy making. The present model represents the first step of a realistic description of this phenomenon and can be easily generalized in various directions.

  3. Telescoping phenomenon in pathological gambling

    DEFF Research Database (Denmark)

    Grant, Jon E; Odlaug, Brian Lawrence; Mooney, Marc E


    The course of pathological gambling (PG) in women has been described as having a later age of initiation but a shorter time to problematic gambling ("telescoped"). This study examined evidence for telescoping and its relationship with comorbidities. Seventy-one treatment-seeking individuals with PG...... underwent a diagnostic interview to examine gambling behaviors, age at initiation of gambling, and time from initiation to meeting criteria for PG. The women had a higher mean age at gambling initiation compared with that of the men (mean [SD] age, 31.3 [13.0] years, compared with 22.4 [7.9] years; p = 0.......0003) and a significantly shorter time from initiation of gambling to meeting the criteria for PG (8.33 [8.7] years compared with 11.97 [9.1] years; p = 0.0476) after controlling for demographic and clinical variables. This study presents evidence for a gender-specific course of PG unrelated to psychiatric comorbidities...

  4. Gorlin syndrome: Importance of clinical signs and danger of delayed diagnosis - A case report with eight years follow-up

    Directory of Open Access Journals (Sweden)

    Erica Dorigatti de-Avila


    Full Text Available Nevoid basal cell carcinoma (NBCCS or Gorlin-Goltz syndrome (GS is a multidisciplinary problem, the early diagnosis of which allows secondary prophylaxis that follows an appropriate regimen to delay progression of the syndrome. The aim of this study was to present a case of delayed diagnosis of GS in a young patient who received multidisciplinary treatment 5 years after onset. The patient presented for evaluation with painless swelling of the left maxilla. Histological examination confirmed the diagnosis of a keratocyst odontogenic tumor (KOT that was enucleated. On presentation, the patient's symptoms and clinical signs were not related to complications of GS, and the possibility of GS was initially rejected, as he did not have a family history of the syndrome. Four years after the first surgery to remove the lesion, the patient came to our clinic with a brown, pigmented lesion. Computed tomography revealed ectopic lamellar calcification of the falx cerebri, which was the conclusive factor for the diagnosis of GS. It is important that clinicians recognize the clinical signs of GS, which mainly manifests itself as multiple basal cell carcinomas in the skin. [Arch Clin Exp Surg 2015; 4(1.000: 49-53

  5. Kierkegaard and the Sheer Phenomenon of Love

    DEFF Research Database (Denmark)

    Søltoft, Pia


    In this article we will argue that Kierkegaard has a positive view of love as a sheer natural and universal phenomenon. This sheer phenomenon of love is rooted in God’s love and is implanted in human nature by its Creator. Therefore this natural urge to love, that manifests itself both as a lack...

  6. Terrorism as a Social and Legal Phenomenon (United States)

    Serebrennikova, Anna; Mashkova, Yekaterina


    This article examines the concept of terrorism as a social and legal phenomenon, its international legal and criminal-legal characteristics. Highlighted are the main aspects of cooperation of the states and the international community to counter terrorist activities. Terrorism as a social phenomenon is determined by paragraph 1 of article 3 of the…

  7. The importance of the concepts of disaster, catastrophe, violence, trauma and barbarism in defining posttraumatic stress disorder in clinical practice

    Directory of Open Access Journals (Sweden)

    Mello Marcelo F


    Full Text Available Abstract Background Several terms in the scientific literature about posttraumatic stress disorder are used with different meanings in studies conducted by different authors. Words such as trauma, violence, catastrophe, disaster and barbarism are often used vaguely or confusingly, and their meanings change in different articles. The lack of conceptual references for these expressions complicates the organization of literature. Furthermore, the absence of clear concepts may be an obstacle to clinical treatment because the use of these words by the patients does not necessarily point to a diagnosis of posttraumatic stress disorder. Discussion A critical review of scientific literature showed that stress can be divided in stages to facilitate specific terminological adjustments to the event itself, to the subject-event interaction and to psychological responses. Moreover, it demonstrated that the varying concept of trauma expands into fundamental psychotherapeutic definitions and that the meanings of violence associated with barbarism are an obstacle to resilience. Therefore, this study updates the etymological origins and applications of these words, connects them to the expansions of meanings that can be operated in the clinical care of patients with posttraumatic stress disorder, and analyzes them critically according to the criterion A of DSM-IV and ICD-10. Summary The terminology in the literature about posttraumatic stress disorder includes a plethora of terms whose meanings are not fully understood, and that, therefore, limit this terminology. The analysis of these terms suggested that the transformation of the concept of trauma led to a broader understanding of this phenomenon in its psychic dimensions, that a barbarian type of violence constitutes an obstacle to resilience, and that the criterion A of the DSM-IV and ICD-10 shows imprecision and conceptual fragilities. Methods To develop this debate article, a current specialized literature

  8. The importance of the concepts of disaster, catastrophe, violence, trauma and barbarism in defining posttraumatic stress disorder in clinical practice. (United States)

    Braga, Luciana L; Fiks, Jose P; Mari, Jair J; Mello, Marcelo F


    Several terms in the scientific literature about posttraumatic stress disorder are used with different meanings in studies conducted by different authors. Words such as trauma, violence, catastrophe, disaster and barbarism are often used vaguely or confusingly, and their meanings change in different articles. The lack of conceptual references for these expressions complicates the organization of literature. Furthermore, the absence of clear concepts may be an obstacle to clinical treatment because the use of these words by the patients does not necessarily point to a diagnosis of posttraumatic stress disorder. A critical review of scientific literature showed that stress can be divided in stages to facilitate specific terminological adjustments to the event itself, to the subject-event interaction and to psychological responses. Moreover, it demonstrated that the varying concept of trauma expands into fundamental psychotherapeutic definitions and that the meanings of violence associated with barbarism are an obstacle to resilience. Therefore, this study updates the etymological origins and applications of these words, connects them to the expansions of meanings that can be operated in the clinical care of patients with posttraumatic stress disorder, and analyzes them critically according to the criterion A of DSM-IV and ICD-10. The terminology in the literature about posttraumatic stress disorder includes a plethora of terms whose meanings are not fully understood, and that, therefore, limit this terminology. The analysis of these terms suggested that the transformation of the concept of trauma led to a broader understanding of this phenomenon in its psychic dimensions, that a barbarian type of violence constitutes an obstacle to resilience, and that the criterion A of the DSM-IV and ICD-10 shows imprecision and conceptual fragilities. To develop this debate article, a current specialized literature review was achieved by searching and retrieving the key terms from

  9. Cognitive performance is of clinical importance, but is unrelated to pain severity in women with chronic fatigue syndrome. (United States)

    Ickmans, Kelly; Meeus, Mira; Kos, Daphne; Clarys, Peter; Meersdom, Geert; Lambrecht, Luc; Pattyn, Nathalie; Nijs, Jo


    In various chronic pain populations, decreased cognitive performance is known to be related to pain severity. Yet, this relationship has not been investigated in patients with chronic fatigue syndrome (CFS). This study investigated the relationship between cognitive performance and (1) pain severity, (2) level of fatigue, and (3) self-reported symptoms and health status in women with CFS. Examining the latter relationships is important for clinical practice, since people with CFS are often suspected to exaggerate their symptoms. A sample of 29 female CFS patients and 17 healthy controls aged 18 to 45 years filled out three questionnaires (Medical Outcomes Study 36-Item Short-Form Health Survey, Checklist Individual Strength (CIS), and CFS Symptom List) and performed three performance-based cognitive tests (psychomotor vigilance task, Stroop task, and operation span task), respectively. In both groups, pain severity was not associated with cognitive performance. In CFS patients, the level of fatigue measured with the CFS Symptom List, but not with the CIS, was significantly correlated with sustained attention. Self-reported mental health was negatively correlated with all investigated cognitive domains in the CFS group. These results provide evidence for the clinical importance of objectively measured cognitive problems in female CFS patients. Furthermore, a state-like measure (CFS Symptom List) appears to be superior over a trait-like measure (CIS) in representing cognitive fatigue in people with CFS. Finally, the lack of a significant relationship between cognitive performance and self-reported pain severity suggests that pain in CFS might be unique.

  10. The importance of academic literacy for undergraduate nursing students and its relationship to future professional clinical practice: A systematic review. (United States)

    Jefferies, Diana; McNally, Stephen; Roberts, Katriona; Wallace, Anna; Stunden, Annette; D'Souza, Suzanne; Glew, Paul


    This systematic review was designed to assess the importance of academic literacy for undergraduate nursing students and its relationship to future professional clinical practice. It aimed to explore the link between academic literacy and writing in an undergraduate nursing degree and the development of critical thinking skills for their future professional clinical practice. A systematic review of qualitative studies and expert opinion publications. A systematic literature search was undertaken of the following databases: ERIC, PubMed, CINAHL, MEDLINE and Scopus. All papers reviewed were from 2000 to 2016 and were written in English. We identified 981 studies and expert opinion papers from the selected databases. After reviewing key words and abstracts for the inclusion and exclusion criteria, 48 papers were selected for review. These were read and reread, with 22 papers, including one thesis, selected for quality appraisal. One paper was discarded due to the exclusion criteria. Three major themes were evident from this study. First, students need assistance to develop tertiary level academic literacy skills when they commence their undergraduate nursing degree. Second, that teaching practices need to be consistent in both designing assessments and in giving feedback to students, in order to assist improvement of academic literacy skills. And finally, academic literacy can facilitate critical thinking when students are assessed using discipline specific genres that relate to their future professional nursing practice. This review highlights the importance of critical thinking in clinical nursing practice and its strong relationship with academic writing skills. It has shown critical thinking is discipline specific and nursing students need to be taught discipline specific literacy genres in undergraduate nursing degrees. Nursing has a diverse educational and cultural mix of students, and educators should not assume academic literacy skills upon commencement of an


    Directory of Open Access Journals (Sweden)



    Full Text Available This article focuses on exemplifying the features of discrimination phenomenon in the workplace, a phenomenon that has appeared in the Romanian social studies only in the last 4 years. Mobbing phenomenon has been analyzed by several countries in Europe such as England, France, Germany; after these analyzes it has been found that this phenomenon refers only to actions of intense psychological pressure. Actions are geared to a single employee, in order to cause it to leave its job. Without these measures, dismissal of the employee would lead to numerous legal problems on the employer. In conclusion, employee who is the subject of mobbing phenomenon must endure a long period of time a series of injustices focused on himself, but also extremely high humiliation, which determines him to mentally give up and take the decision to resign.

  12. Raynaud's phenomenon and nailfold capillaroscopic findings in anorexia nervosa. (United States)

    De Martinis, Massimo; Sirufo, Maria Maddalena; Ginaldi, Lia


    Peripheral vascular abnormalities caused by a dysregulation between peripheral vasoconstriction and vasodilatation, clinically appearing with Raynaud's phenomenon, have been described in anorexia nervosa but specific characteristics of microcirculation in anorexic patients have not yet been studied. We performed nailfold videocapillaroscopy to assess microcirculatory alteration in anorexic patients and found three different patterns: normal, aspecific and early scleroderma pattern. We also evaluated several laboratory and clinical parameters to better assess our capillaroscopic findings. None of the clinical parameters examined correlated with specific capillaroscopic findings. An increased risk of autoimmune diseases in eating disorder patients has been described. Our results evidenced an association between early scleroderma capillaroscopic pattern and Raynaud's phenomenon that occurs in anorexia nervosa patients, whereas no significant association was found between all three capillaroscopic patterns and the presence of autoantibodies, as well as ESR and CRP values. Our study reveals that patients with AN suffering from RP exhibit NVC findings typical of connective tissue diseases.

  13. Importance of clinical examination in diagnostics of Osgood-Schlatter Disease in boys playing soccer or basketball

    Directory of Open Access Journals (Sweden)

    Amela Halilbasic


    Full Text Available Introduction: Osgood–Schlatter disease is an irritation of the patellar tendon at the tibial tubercle. Sports with jumps, running, and repeated contractions of knee extension apparatus are considered to be importantexternal risk-factors which could cause Osgood–Schlatter disease.Objectives of the study are to draw attention to the importance of clinical examination in diagnostics of Osgood–Schlatter disease in boys playing soccer or basketball.Methods: The research included data obtained from 120 boys, average age of 14 years. Examinees were split into two groups, one with young athletes which regularly have soccer or basketball trainings and thesecond one with boys who do not participating in sports. We performed anthropological measurements and clinical examinations of both knees and hips for both groups. For the statistical analysis we used pointbiserialcorrelation coefficient.Results: Based on clinical examination, Osgood–Schlatter disease was diagnosed in 51 examinees (42.5%. In “athletic group” Osgood–Schlatter disease had 31 boys or 52%, comparing with “non-athletic group” wherewe found 20 adolescents with disease (33%. Number of boys with Osgood–Schlatter disease was higher for 19% in “athletic group” comparing with “non-athletic group”. Comparing incidence rate for boys in both groups with diagnosed II and III level of Osgood–Schlatter disease we found that rate is higher in “athletic group” 2.25 times comparing with “non-athletic group”.Conclusions: Clinical examination is critical method in the process of diagnosing Osgood–Schlatter disease especially for identifying II and III level of this disease.

  14. Molecular characterization of NRXN1 deletions from 19,263 clinical microarray cases identifies exons important for neurodevelopmental disease expression (United States)

    Lowther, Chelsea; Speevak, Marsha; Armour, Christine M.; Goh, Elaine S.; Graham, Gail E.; Li, Chumei; Zeesman, Susan; Nowaczyk, Malgorzata J.M.; Schultz, Lee-Anne; Morra, Antonella; Nicolson, Rob; Bikangaga, Peter; Samdup, Dawa; Zaazou, Mostafa; Boyd, Kerry; Jung, Jack H.; Siu, Victoria; Rajguru, Manjulata; Goobie, Sharan; Tarnopolsky, Mark A.; Prasad, Chitra; Dick, Paul T.; Hussain, Asmaa S.; Walinga, Margreet; Reijenga, Renske G.; Gazzellone, Matthew; Lionel, Anath C.; Marshall, Christian R.; Scherer, Stephen W.; Stavropoulos, Dimitri J.; McCready, Elizabeth; Bassett, Anne S.


    Purpose The purpose of the current study was to assess the penetrance of NRXN1 deletions. Methods We compared the prevalence and genomic extent of NRXN1 deletions identified among 19,263 clinically referred cases to that of 15,264 controls. The burden of additional clinically relevant CNVs was used as a proxy to estimate the relative penetrance of NRXN1 deletions. Results We identified 41 (0.21%) previously unreported exonic NRXN1 deletions ascertained for developmental delay/intellectual disability, significantly greater than in controls [OR=8.14 (95% CI 2.91–22.72), p< 0.0001)]. Ten (22.7%) of these had a second clinically relevant CNV. Subjects with a deletion near the 3′ end of NRXN1 were significantly more likely to have a second rare CNV than subjects with a 5′ NRXN1 deletion [OR=7.47 (95% CI 2.36–23.61), p=0.0006]. The prevalence of intronic NRXN1 deletions was not statistically different between cases and controls (p=0.618). The majority (63.2%) of intronic NRXN1 deletion cases had a second rare CNV, a two-fold greater prevalence than for exonic NRXN1 deletion cases (p=0.0035). Conclusions The results support the importance of exons near the 5′ end of NRXN1 in the expression of neurodevelopmental disorders. Intronic NRXN1 deletions do not appear to substantially increase the risk for clinical phenotypes. PMID:27195815

  15. Initial non-weight-bearing therapy is important for preventing vertebral body collapse in elderly patients with clinical vertebral fractures

    Directory of Open Access Journals (Sweden)

    Kishikawa Y


    group.Conclusion: These results suggest that initial non-weight-bearing therapy is important for preventing vertebral body collapse and for relieving pain among elderly patients with clinical vertebral fractures.Keywords: clinical vertebral fracture, non-weight-bearing, brace, osteoporosis

  16. Different minimally important clinical difference (MCID) scores lead to different clinical prediction rules for the Oswestry disability index for the same sample of patients. (United States)

    Schwind, Julie; Learman, Kenneth; O'Halloran, Bryan; Showalter, Christopher; Cook, Chad


    Minimal clinically important difference (MCID) scores for outcome measures are frequently used evidence-based guides to gage meaningful changes. There are numerous outcome instruments used for analyzing pain, disability, and dysfunction of the low back; perhaps the most common of these is the Oswestry disability index (ODI). A single agreed-upon MCID score for the ODI has yet to be established. What is also unknown is whether selected baseline variables will be universal predictors regardless of the MCID used for a particular outcome measure. To explore the relationship between predictive models and the MCID cutpoint on the ODI. Data were collected from 16 outpatient physical therapy clinics in 10 states. Secondary database analysis using backward stepwise deletion logistic regression of data from a randomized controlled trial (RCT) to create prognostic clinical prediction rules (CPR). One hundred and forty-nine patients with low back pain (LBP) were enrolled in the RCT. All were treated with manual therapy, with a majority also receiving spine-strengthening exercises. The resultant predictive models were dependent upon the MCID used and baseline sample characteristics. All CPR were statistically significant (P < 001). All six MCID cutpoints used resulted in completely different significant predictor variables with no predictor significant across all models. The primary limitations include sub-optimal sample size and study design. There is extreme variability among predictive models created using different MCIDs on the ODI within the same patient population. Our findings highlight the instability of predictive modeling, as these models are significantly affected by population baseline characteristics along with the MCID used. Clinicians must be aware of the fragility of CPR prior to applying each in clinical practice.

  17. A suggestion for multidisciplinarity: the fluorescence phenomenon observation

    Directory of Open Access Journals (Sweden)

    Jorge Roberto Pimentel


    Full Text Available Multidisciplinary approaches involving daily phenomena are valuable teaching tools to stimulate reflections in order to comprehend that scientific knowledge is developed in a collective process, as well as to understand the importance that scientific research cannot be done in a unique area of knowledge for the full understanding of any phenomenon. We suggest the fluorescence phenomenon observation in some materials, objects and living organisms so that students realize the interaction between Physics, Chemistry and Biology, generally regarded as not correlated disciplines.

  18. Florid cemento-osseous dysplasia: review of an uncommon fibro-osseous lesion of the jaw with important clinical implications. (United States)

    Fenerty, Sarah; Shaw, Wei; Verma, Rahul; Syed, Ali B; Kuklani, Riya; Yang, Jie; Ali, Sayed


    Florid cemento-osseous dysplasia (FCOD) is a rare, benign, multifocal fibro-osseous dysplastic process affecting tooth-bearing areas of the jaw, characterized by replacement of normal trabecular bone with osseous tissue and dense acellular cementum in a fibrous stroma. It is one clinicopathologic variant in a spectrum of related non-neoplastic fibro-osseous lesions known as cemento-osseous dysplasias (CODs), thought to arise from elements of the periodontal ligament. Diagnosis primarily relies upon radiographic and clinical findings; unnecessary biopsy should be avoided, as inoculation with oral pathogens may precipitate chronic infection in these hypovascular lesions. Appropriate management of uncomplicated FCOD consists of periodic radiographic follow-up. Accordingly, it is important that both radiologists and clinicians performing endodontic interventions possess familiarity with this entity in order to prevent misdiagnosis and inappropriate intervention, which may result in a protracted clinical course. Lesions are usually asymptomatic in the absence of infection, typically discovered on routine dental radiographs or imaging performed for unrelated indications. Radiographically, the condition typically manifests as widespread non-expansile intraosseous masses of varying internal lucency and sclerosis that surround the root apices of vital teeth or edentulous areas in the posterior jaw. While all CODs share similar microscopic features, FCOD is distinguished by its multifocal distribution, involving two or more quadrants of the maxilla and mandible, often in a bilateral symmetric fashion. The vast majority of cases are sporadic, though few exhibit an autosomal dominant familial inheritance pattern. In this pictorial review, we discuss the radiologic characteristics of this entity, pertinent clinical and histologic features, differential diagnoses, and management options.

  19. Comparisons between the attitudes of medical and dental students toward the clinical importance of gross anatomy and physiology. (United States)

    Olowo-Ofayoku, Anthony; Moxham, Bernard John


    Marked changes are occurring within both the medical and dental curricula and new ways of teaching the basic sciences have been devised and traditional methods (e.g., dissection for gross anatomy and of bench-based animal preparations for physiology) are increasingly no longer the norm. Although there is much anecdotal evidence that students are not in favor of such changes, there is little evidence for this based on quantitative analyses of students' attitudes. Using Thurstone and Chave attitude analyses, we assessed the attitudes of first year medical and dental students at Cardiff University toward gross anatomy and physiology in terms of their perceived clinical importance. In addition, we investigated the appropriateness ("fitness for purpose") of teaching methodologies used for anatomy and physiology. The hypotheses tested recognized the possibility that medical and dental students differed in their opinions, but that they had a preference to being taught gross anatomy through the use of dissection and had no preference for physiology teaching. It was found that both medical and dental students displayed positive attitudes toward the clinical relevance of gross anatomy and that they preferred to be taught by means of dissection. Although both medical and dental students displayed positives attitudes toward the clinical relevance of physiology, this was greater for the medical students. Both medical and dental students showed a preference for being taught physiology through didactic teaching in small groups but the medical students also appreciated being taught by means of practicals. Overall, this study highlights the expectations that students have for the basic science foundation teaching within their professional training and signals a preference for being taught experientially/practically. Differences were discerned between medical and dental students that might reflect the direct association between systems physiology and pathophysiology and the

  20. [Serum uric acid is associated with disease severity and an important predictor for clinical outcome in patients with pulmonary hypertension]. (United States)

    Luo, D L; Zhang, C J; Huang, Y G; Huang, T; Li, H Z


    Objective: The growing body of literature showed a link between uric acid and pulmonary hypertension (PH), but the impact of hyperuremia on outcome of patients with PH has not been well defined. Therefore, the present study was performed to analyze the impact of uric acid on outcome of PH patients. Methods: One hundred seventy-three PH patients (112 females, mean age 38 years old), who were hospitalized in our department between January 2010 and December 2015, were included in our study, the PH diagnosis was made based on right heart catheterization examination result (mean pulmonary artery pressure≥25 mmHg(1 mmHg=0.133 kPa)). PH patients were divided into mild to moderate PH group (Rp/Rs≤0.6, n =97) and severe PH group (Rp/Rs>0.6, n =76). Fifty-one patients (33 females, mean age 45 years old) without PH based on right heart catheterization were included as control subjects. All participants were followed up for a median of 24 months(6-71 months). Clinical endpoints were defined as cardiogenic death or heart-and-lung transplantation. Results: Uric acid was positively correlated with pulmonary vascular resistance( r =0.398, P uric acid level was significantly higher in patients with severe PH than in patients with mild-to-moderate PH and the control subjects (both P uric acid level to predict the outcome of PH patients (sensitivity 50%, specificity 72%). During follow-up, patients with higher level of uric acid (>425.5 μmol/L) were linked with poorer clinical outcome compared to patients with uric acid uric acid is associated with the severity of PH and higher uric acid level serves as an important predictor for poor clinical outcome of PH patients.

  1. Assessment of first-year veterinary students' communication skills using an objective structured clinical examination: the importance of context. (United States)

    Hecker, Kent G; Adams, Cindy L; Coe, Jason B


    Communication skills are considered to be a core clinical skill in veterinary medicine and essential for practice success, including outcomes of care for patients and clients. While veterinary schools include communication skills training in their programs, there is minimal knowledge on how best to assess communication competence throughout the undergraduate program. The purpose of this study was to further our understanding of the reliability, utility, and suitability of a communication skills Objective Structured Clinical Examination (OSCE). Specifically we wanted to (1) identify the greatest source of variability (student, rater, station, and track) within a first-year, four station OSCE using exam scores and scores from videotape review by two trained raters, and (2) determine the effect of different stations on students' communication skills performance. Reliability of the scores from both the exam data and the two expert raters was 0.50 and 0.46 respectively, with the greatest amount of variance attributable to student by station. The percentage of variance due to raters in the exam data was 16.35%, whereas the percentage of variance for the two expert raters was 0%. These results have three important implications. First, the results reinforce the need for communication educators to emphasize that use of communication skills is moderated by the context of the clinical interaction. Second, by increasing rater training the amount of error in the scores due to raters can be reduced and inter-rater reliability increases. Third, the communication assessment method (in this case the OSCE checklist) should be built purposefully, taking into consideration the context of the case.

  2. Elimination of importance factors for clinically accurate selection of beam orientations, beam weights and wedge angles in conformal radiation therapy

    International Nuclear Information System (INIS)

    Bedford, James L.; Webb, Steve


    A method of simultaneously optimizing beam orientations, beam weights, and wedge angles for conformal radiotherapy is presented. This method removes the need for importance factors by optimizing one objective only, subject to a set of rigid constraints. This facilitates the production of inverse solutions which, without trial-and-error modification of importance factors, precisely satisfy the specified constraints. The algorithm minimizes an objective function which is based upon the single objective to be optimized, but which is forced to an artificially high value when the constraints are not met, so that only satisfactory solutions are allowed. Due to the complex nature of the objective function space, including multiple local minima separated by large regions of plateau, a random search technique equivalent to fast simulated annealing is used for producing inverse plans. To illustrate the novel features of the new algorithm, a simulation is first presented, for the case of a cylindrical phantom. The morphology of the objective function space is shown to be significantly different for the new algorithm, compared to that for a conventional quadratic objective function. Clinical cases for prostate and craniopharyngioma are then presented. For the prostate case, the objective is to reduce irradiated rectal volume. Three-field, four-field, and six-field optimizations, with or without orientation optimization, are shown to provide solutions which are consistent with previously reported plans and class solutions. For the craniopharyngioma case, which involves the use of a high-precision stereotactic conformal technique, the objective is to reduce the irradiated volume of normal brain. Practically feasible beam angles are produced which, compared to a standard plan, provide a small but worthwhile sparing of normal brain. The algorithm is thereby shown to be robust and suitable for clinical application


    African Journals Online (AJOL)

    Although its clinical course is often considered trivial, this disease frequently becomes refractory and recurrent. Variable prevalence has been reported among healthy school children1,2. Its clinical importance derives from the morbidity caused by its itch-scratch phenomenon, the resultant skin disfiguration, its propensity for.

  4. Atomistic understanding of hydrogen loading phenomenon into ...

    Indian Academy of Sciences (India)

    IASBS), ... ically through various electrochemical methods and high-level quantum ... ton) by applying a constant anodic voltage. .... phenomenon being occurred at metal | solution inter- .... cationic form and extra energy is released by occupying.

  5. Koebner phenomenon of the ear canal skin.

    LENUS (Irish Health Repository)

    Young, O


    The Koebner phenomenon originally described the appearance of psoriatic lesions in the uninvolved skin of patients with psoriasis as a consequence of trauma. We describe a case of concurrent lichen planus and sarcoidosis in the auditory canal, which represents an unusual manifestation of the Koebner phenomenon. This is the first case of concurrent lichen planus and sarcoidosis in the head and neck region and highlights the need for biopsy to allow accurate histopathological diagnosis and treatment.

  6. Koebner phenomenon of the ear canal skin.

    LENUS (Irish Health Repository)

    Young, O


    The Koebner phenomenon originally described the appearance of psoriatic lesions in the uninvolved skin of patients with psoriasis as a consequence of trauma. We describe a case of concurrent lichen planus and sarcoidosis in the auditory canal, which represents an unusual manifestation of the Koebner phenomenon. This is the first case of concurrent lichen planus and sarcoidosis in the head and neck region and highlights the need for biopsy to allow accurate histopathological diagnosis and treatment.

  7. Job Insecurity as a Social Psychological Phenomenon

    Directory of Open Access Journals (Sweden)

    Chuykova T.S.


    Full Text Available The paper addresses a relatively new phenomenon of job insecurity. It provides an analysis of the various interpretations of the phenomenon given by Russian and foreign researchers, focuses on its social economical determinants and consequences for individuals and organizations. The paper concludes with an outline of some possible ways of overcoming the negative consequences of job insecurity — as for individuals, as for organizations, as for the society as a whole.

  8. Validation of the Impostor Phenomenon among Managers. (United States)

    Rohrmann, Sonja; Bechtoldt, Myriam N; Leonhardt, Mona


    Following up on earlier investigations, the present research aims at validating the construct impostor phenomenon by taking other personality correlates into account and to examine whether the impostor phenomenon is a construct in its own right. In addition, gender effects as well as associations with dispositional working styles and strain are examined. In an online study we surveyed a sample of N = 242 individuals occupying leadership positions in different sectors. Confirmatory factor analyses provide empirical evidence for the discriminant validity of the impostor phenomenon. In accord with earlier studies we show that the impostor phenomenon is accompanied by higher levels of anxiety, dysphoric moods, emotional instability, a generally negative self-evaluation, and perfectionism. The study does not reveal any gender differences concerning the impostor phenomenon. With respect to working styles, persons with an impostor self-concept tend to show perfectionist as well as procrastinating behaviors. Moreover, they report being more stressed and strained by their work. In sum, the findings show that the impostor phenomenon constitutes a dysfunctional personality style. Practical implications are discussed.

  9. PP composites with Hybrid Nanofillers: NTC phenomenon

    International Nuclear Information System (INIS)

    Sarlin, Juha; Immonen, Kirsi


    Electric conductive plastic composites have a wide potential for commercial applications, some examples are EMI shielding housings and components in automotive industry and in consumer electronics, equipments in health care sector and fuel cell components. A phenomenon in conductive composites, especially in composites with carbon based fillers, is change of thermal induced change in conductivity as a result of morphological transitions. Usually the observed changes are practically irreversible. The phenomenon may cause increasing resistivity, usually called as 'positive temperature coefficient' (PTC) or decreasing resistivity, called 'negative temperature coefficient' (NTC), where the new morphology created by heat treatment is more favorable for electric conductivity compared to the original state. The existence of NTC is a sing of the lost potential in material design and processing. Therefore detailed information about the phenomenon gives us tools to develop high performance conductive materials. It this paper we discuss about NTC phenomenon observed in PP composites with CNT or in-situ synthesized CNT-PANi hybrid nanofiller with an amphiphilic dispersing agent. The goal of the paper is not to present a comprehensive model of this phenomenon; we present some experimental results which may be related to polymer-filler interactions. These details are a part of this complicated phenomenon.

  10. Minimal Clinically Important Difference in Parkinson’s Disease as Assessed in Pivotal Trials of Pramipexole Extended Release

    Directory of Open Access Journals (Sweden)

    Robert A. Hauser


    Full Text Available Background. The minimal clinically important difference (MCID is the smallest change in an outcome measure that is meaningful for patients. Objectives. To calculate the MCID for Unified Parkinson’s Disease Rating Scale (UPDRS scores in early Parkinson’s disease (EPD and for UPDRS scores and “OFF” time in advanced Parkinson’s disease (APD. Methods. We analyzed data from two pivotal, double-blind, parallel-group trials of pramipexole ER that included pramipexole immediate release (IR as an active comparator. We calculated MCID as the mean change in subjects who received active treatment and rated themselves “a little better” on patient global impression of improvement (PGI-I minus the mean change in subjects who received placebo and rated themselves unchanged. Results. MCIDs in EPD (pramipexole ER, pramipexole IR for UPDRS II were −1.8 and −2.0, for UPDRS III −6.2 and −6.1, and for UPDRS II + III −8.0 and −8.1. MCIDs in APD for UPDRS II were −1.8 and −2.3, for UPDRS III −5.2 and −6.5, and for UPDRS II + III −7.1 and −8.8. MCID for “OFF” time (pramipexole ER, pramipexole IR was −1.0 and −1.3 hours. Conclusions. A range of MCIDs is emerging in the PD literature that provides the basis for power calculations and interpretation of clinical trials.

  11. Antimicrobial activity of extracts from macroalgae Ulva lactuca against clinically important Staphylococci is impacted by lunar phase of macroalgae harvest. (United States)

    Deveau, A M; Miller-Hope, Z; Lloyd, E; Williams, B S; Bolduc, C; Meader, J M; Weiss, F; Burkholder, K M


    Staphylococcus aureus is a common human bacterial pathogen that causes skin and soft tissue infections. Methicillin-resistant Staph. aureus (MRSA) are increasingly drug-resistant, and thus there is great need for new therapeutics to treat Staph. aureus infections. Attention has focused on potential utility of natural products, such as extracts of marine macroalgae, as a source of novel antimicrobial compounds. The green macroalgae Ulva lactuca produces compounds inhibitory to human pathogens, although the effectiveness of U. lactuca extracts against clinically relevant strains of Staph. aureus is poorly understood. In addition, macroalgae produce secondary metabolites that may be influenced by exogenous factors including lunar phase, but whether lunar phase affects U. lactuca antimicrobial capacity is unknown. We sought to evaluate the antibacterial properties of U. lactuca extracts against medically important Staphylococci, and to determine the effect of lunar phase on antimicrobial activity. We report that U. lactuca methanolic extracts inhibit a range of Staphylococci, and that lunar phase of macrolagae harvest significantly impacts antimicrobial activity, suggesting that antimicrobial properties can be maximized by manipulating time of algal harvest. These findings provide useful parameters for future studies aimed at isolating and characterizing U. lactuca anti-Staphylococcal agents. The growing prevalence of antibiotic-resistant human pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) has intensified efforts towards discovery and development of novel therapeutics. Marine macroalgae like Ulva lactuca are increasingly recognized as potential sources of antimicrobials, but the efficacy of U. lactuca extracts against common, virulent strains of Staph. aureus is poorly understood. We demonstrate that U. lactuca methanolic extracts inhibit a variety of clinically relevant Staphylococcus strains, and that the antimicrobial activity can

  12. Distinguishing papillary endothelial hyperplasia and angiosarcoma on core needle biopsy of the breast: The importance of clinical and radiologic correlation. (United States)

    Guilbert, Marie-Christine; Frost, Elisabeth P; Brock, Jane E; Lester, Susan C


    Papillary endothelial hyperplasia (PEH) is a rare non-neoplastic exuberant organizing hematoma that can closely mimic angiosarcoma due to a resemblance to malignant anastomosing blood vessels. It could be particularly difficult to distinguish PEH from angiosarcoma in breast core needle biopsies. We identified all cases of these lesions diagnosed on core needle biopsy in order to identify clinical, radiologic, and pathologic features that could prove helpful to arrive at the correct diagnosis. Four cases of PEH and 4 cases of angiosarcoma were identified. The mean age at diagnosis was 62 for PEH and 33 for primary angiosarcoma. All cases of PEH formed small masses with circumscribed or lobulated margins by imaging (mean size 0.9 cm). In 3 cases, the masses were difficult or impossible to identify after the biopsy. Angiosarcomas presented as larger masses with ill-defined margins (mean size 2.8 cm) that were unchanged in size after biopsy. PEH was surrounded by adipose tissue, whereas angiosarcoma invaded into fibrous stroma and involved lobules. The pseudopapillary structures of PEH were composed mainly of collagen, and thus, additional histologic stains for fibrin were not helpful for diagnosis. The 4 patients with PEH received no further treatment and are alive and disease-free at 2-11 years of follow-up. In contrast, the patients with angiosarcoma underwent mastectomy and chemotherapy or radiation therapy. Two of the patients with angiosarcoma died 3 years after diagnosis and the other 2 patients are alive without disease at 5 and 6 years. Therefore, distinguishing PEH and angiosarcoma is essential for appropriate management. This is the first series to compare these lesions on core needle biopsy and the first to note important clinical, imaging, and histologic differences that aid in making a diagnosis of PEH with confidence on breast core needle biopsy. © 2018 Wiley Periodicals, Inc.

  13. Prognostic importance of HPV and p16 in patients with oropharyngeal carcinoma in ENT clinic in Nove Zamky

    International Nuclear Information System (INIS)

    Kurinec, F.


    Purpose: The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is rising in contrast to the decreasing incidence of carcinomas in other subsides of the head and neck, in spite of the reduced prevalence of smoking in developed countries. Human papilloma virus (HPV) infection, is now recognized as a significant marker in the onset of HPV positive OPSCC, with different epidemiological, clinical, anatomical, radiological, behavioural, biological and prognostic characteristics from HPV negative OPSCC. Aim: The aim of our work was to measure the impact of HPV infection and anti-oncogene p16 on survival and analyze lifestyles in our sample of patients. Material and methods: 61 patients with newly diagnosed oropharyngeal cancer in ENT clinic in Nove Zamky included in our study from March 2011 till February 2014. They were divided into two categories- HPV positive and HPV negative patients (n-39 versus 22). Results: HPV infection was analysed by DNA detection viral DNA with PCR (Cobas 4800 HPV Test) and expression E6/E7 oncogenes by mRNA. In addition, we detected p16 overexpression immunohistochemistry as a surrogate marker for high risk HPV(HR HPV). We analysed clinicopatological characteristic, smoking and alcohol abuse history, sexual behaviours and compared treatment and overall survival between HPV positive and HPV negative patients. The 2- year rates of overall survival were 86% versus 41% in HPV + and HPV – patients and 88% versus 25% in p16+ and p16- tumors, respectively. Conclusion: These observations lead to questions regarding management choices for patients based on tumour HPV and p16status with important consequences on treatment and on the role of targeted therapy and vaccines and over the upcoming years. (author)

  14. Minimal clinically important difference and the effect of clinical variables on the ankle osteoarthritis scale in surgically treated end-stage ankle arthritis. (United States)

    Coe, Marcus P; Sutherland, Jason M; Penner, Murray J; Younger, Alastair; Wing, Kevin J


    There is much debate regarding the best outcome tool for use in foot and ankle surgery, specifically in patients with ankle arthritis. The Ankle Osteoarthritis Scale (AOS) is a validated, disease-specific score. The goals of this study were to investigate the clinical performance of the AOS and to determine a minimal clinically important difference (MCID) for it, using a large cohort of 238 patients undergoing surgery for end-stage ankle arthritis. Patients treated with total ankle arthroplasty or ankle arthrodesis were prospectively followed for a minimum of two years at a single site. Data on demographics, comorbidities, AOS score, Short Form-36 results, and the relationship between expectations and satisfaction were collected at baseline (preoperatively), at six and twelve months, and then yearly thereafter. A linear regression analysis examined the variables affecting the change in AOS scores between baseline and the two-year follow-up. An MCID in the AOS change score was then determined by employing an anchor question, which asked patients to rate their relief from symptoms after surgery. Surgical treatment of end-stage ankle arthritis resulted in a mean improvement (and standard deviation) of 31.2 ± 22.7 points in the AOS score two years after surgery. The MCID of the AOS change score was a mean of 28.0 ± 17.9 points. The change in AOS score was significantly affected by the preoperative AOS score, smoking, back pain, and age. Patients undergoing arthroplasty or arthrodesis for end-stage ankle arthritis experienced a mean improvement in AOS score that was greater than the estimated MCID (31.2 versus 28.0 points). Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

  15. Trunk sway analysis to quantify the warm-up phenomenon in myotonia congenita patients.

    NARCIS (Netherlands)

    Horlings, G.C.; Drost, G.; Bloem, B.R.; Trip, J.; Pieterse, A.J.; Engelen, B.G.M. van; Allum, J.H.J.


    OBJECTIVE: Patients with autosomal recessive myotonia congenita display myotonia and transient paresis that diminish with repetitive muscle contractions (warm-up phenomenon). A new approach is presented to quantify this warm-up phenomenon under clinically relevant gait and balance tasks. METHODS:

  16. Importância da avaliação genético-clínica na hidrocefalia Importance of the clinical genetics evaluation on hydrocephalus

    Directory of Open Access Journals (Sweden)

    Marta Wey-Vieira


    hydrocephalus and reinforce the importance of dysmphology evaluation as an important complementary investigation.

  17. Determining the minimal clinically important difference and responsiveness of the Dermatology Life Quality Index (DLQI): further data. (United States)

    Basra, M K A; Salek, M S; Camilleri, L; Sturkey, R; Finlay, A Y


    To determine the minimal clinically important difference (MCID) of the Dermatology Life Quality Index (DLQI) and its responsiveness to change in inflammatory skin diseases. A longitudinal study: at stage 1, patients completed the DLQI and a disease severity global question; at stage 2, a global rating of change in quality of life (QoL; Global Rating of Change Questionnaire, GRCQ) was added and used as an anchor to measure the MCID of the DLQI. 192 patients completed stage 1 and 107 completed stage 2. The mean DLQI score at stage 1 was 9.8 and 7.4 at stage 2 with a mean change of 2.4 (p < 0.0001). 31 patients experienced a 'small change' in their QoL (±3 and ±2) on the GRCQ. The mean corresponding change in DLQI scores was 3.3, which is regarded as the approximate MCID. Previous estimates of the MCID of the DLQI have varied from 3 to 5. Although this study demonstrated a MCID of 3.3, we recommend that the MCID in inflammatory skin diseases should be 4. © 2015 S. Karger AG, Basel.

  18. Performance of Rapid Diagnostic Tests for Imported Malaria in Clinical Practice: Results of a National Multicenter Study (United States)

    Houzé, Sandrine; Boutron, Isabelle; Marmorat, Anne; Dalichampt, Marie; Choquet, Christophe; Poilane, Isabelle; Godineau, Nadine; Le Guern, Anne-Sophie; Thellier, Marc; Broutier, Hélène; Fenneteau, Odile; Millet, Pascal; Dulucq, Stéphanie; Hubert, Véronique; Houzé, Pascal; Tubach, Florence; Le Bras, Jacques; Matheron, Sophie


    We compared the performance of four rapid diagnostic tests (RDTs) for imported malaria, and particularly Plasmodium falciparum infection, using thick and thin blood smears as the gold standard. All the tests are designed to detect at least one protein specific to P. falciparum ( Plasmodium histidine-rich protein 2 (PfHRP2) or Plasmodium LDH (PfLDH)) and one pan-Plasmodium protein (aldolase or Plasmodium LDH (pLDH)). 1,311 consecutive patients presenting to 9 French hospitals with suspected malaria were included in this prospective study between April 2006 and September 2008. Blood smears revealed malaria parasites in 374 cases (29%). For the diagnosis of P. falciparum infection, the three tests detecting PfHRP2 showed high and similar sensitivity (96%), positive predictive value (PPV) (90%) and negative predictive value (NPV) (98%). The PfLDH test showed lower sensitivity (83%) and NPV (80%), despite good PPV (98%). For the diagnosis of non-falciparum species, the PPV and NPV of tests targeting pLDH or aldolase were 94–99% and 52–64%, respectively. PfHRP2-based RDTs are thus an acceptable alternative to routine microscopy for diagnosing P. falciparum malaria. However, as malaria may be misdiagnosed with RDTs, all negative results must be confirmed by the reference diagnostic method when clinical, biological or other factors are highly suggestive of malaria. PMID:24098699

  19. The importance of least restrictive care: the clinical implications of a recent High Court decision on negligence. (United States)

    Ryan, Christopher James; Callaghan, Sascha; Large, Matthew


    This paper aims to explain the meaning and implications for practice of the High Court of Australia's finding in the negligence case, Hunter and New England Local Health District v McKenna [2014] HCA 44. The facts of the case and the law of negligence are reviewed before reporting the Court's decision. The High Court found that the obligation upon doctors to provide the least restrictive option for care that was imposed by the, then applicable, Mental Health Act 1990 (NSW) was inconsistent with an obligation that might otherwise be imposed by a common law duty to have regard to the interests of those with whom a psychiatric patient may come into contact if not detained. The Court's finding underlines the importance of clinicians documenting their clinical reasoning around why their negotiated management plan was the option least restrictive of the patient's freedom and most protective of his or her human rights. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  20. Historical Aspects in Tolerance Phenomenon Research

    Directory of Open Access Journals (Sweden)

    Janat A. Karmanova


    Full Text Available The article examines the historical aspect of the tolerance phenomenon research, particularly the study of tolerance in the age of Antiquity, Middle Ages, New Times, Enlightenment. It is remarkable that the problem of tolerance, emerged in Western civilization on religious grounds, laid the foundation for all other freedoms, attained in many countries. Besides, the article attaches special attention to the researchers of the East, such as Abu Nasr al-Farabi, Khoja Ahmed Yasawi, studies the historical aspect of works by Kazakhstan thinkers A. Kunanbayev, C. Valikhanova, K.B. Zharikbayev, S.K. Kaliyev, A.N. Nysanbayev, A.I. Artemev and others. The analysis of historical research of the tolerance phenomenon brings the author to the conclusion that religious freedom was the starting point for the emergence of new areas of tolerance display. The content of this phenomenon changed according to the historical peculiarities of the societies’ development

  1. Hysteresis phenomenon in nuclear reactor dynamics

    Energy Technology Data Exchange (ETDEWEB)

    Pirayesh, Behnam; Pazirandeh, Ali [Islamic Azad Univ., Tehran (Iran, Islamic Republic of). Dept. of Nuclear Engineering, Science and Research Branch; Akbari, Monireh [Shahid Rajaee Teacher Training Univ., Tehran (Iran, Islamic Republic of). Dept. of Mathematics


    This paper applies a nonlinear analysis method to show that hysteresis phenomenon, due to the Saddle-node bifurcation, may occur in the nuclear reactor. This phenomenon may have significant effects on nuclear reactor dynamics and can even be the beginning of a nuclear reactor accident. A system of four dimensional nonlinear ordinary differential equations was considered to study the hysteresis phenomenon in a typical nuclear reactor. It should be noted that the reactivity was considered as a nonlinear function of state variables. The condition for emerging hysteresis was investigated using Routh-Hurwitz criterion and Sotomayor's theorem for saddle node bifurcation. A numerical analysis is also provided to illustrate the analytical results.

  2. Defining the minimum clinically important difference for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database. (United States)

    Asher, Anthony L; Kerezoudis, Panagiotis; Mummaneni, Praveen V; Bisson, Erica F; Glassman, Steven D; Foley, Kevin T; Slotkin, Jonathan; Potts, Eric A; Shaffrey, Mark E; Shaffrey, Christopher I; Coric, Domagoj; Knightly, John J; Park, Paul; Fu, Kai-Ming; Devin, Clinton J; Archer, Kristin R; Chotai, Silky; Chan, Andrew K; Virk, Michael S; Bydon, Mohamad


    OBJECTIVE Patient-reported outcomes (PROs) play a pivotal role in defining the value of surgical interventions for spinal disease. The concept of minimum clinically important difference (MCID) is considered the new standard for determining the effectiveness of a given treatment and describing patient satisfaction in response to that treatment. The purpose of this study was to determine the MCID associated with surgical treatment for degenerative lumbar spondylolisthesis. METHODS The authors queried the Quality Outcomes Database registry from July 2014 through December 2015 for patients who underwent posterior lumbar surgery for grade I degenerative spondylolisthesis. Recorded PROs included scores on the Oswestry Disability Index (ODI), EQ-5D, and numeric rating scale (NRS) for leg pain (NRS-LP) and back pain (NRS-BP). Anchor-based (using the North American Spine Society satisfaction scale) and distribution-based (half a standard deviation, small Cohen's effect size, standard error of measurement, and minimum detectable change [MDC]) methods were used to calculate the MCID for each PRO. RESULTS A total of 441 patients (80 who underwent laminectomies alone and 361 who underwent fusion procedures) from 11 participating sites were included in the analysis. The changes in functional outcome scores between baseline and the 1-year postoperative evaluation were as follows: 23.5 ± 17.4 points for ODI, 0.24 ± 0.23 for EQ-5D, 4.1 ± 3.5 for NRS-LP, and 3.7 ± 3.2 for NRS-BP. The different calculation methods generated a range of MCID values for each PRO: 3.3-26.5 points for ODI, 0.04-0.3 points for EQ-5D, 0.6-4.5 points for NRS-LP, and 0.5-4.2 points for NRS-BP. The MDC approach appeared to be the most appropriate for calculating MCID because it provided a threshold greater than the measurement error and was closest to the average change difference between the satisfied and not-satisfied patients. On subgroup analysis, the MCID thresholds for laminectomy-alone patients were

  3. Social Media: A Phenomenon to be Analyzed

    Directory of Open Access Journals (Sweden)

    danah boyd


    Full Text Available The phenomenon of “social media” has more to do with its cultural positioning than its technological affordances. Rooted in the broader “Web 2.0” landscape, social media helped engineers, entrepreneurs, and everyday people reimagine the role that technology could play in information dissemination, community development, and communication. While the technologies invoked by the phrase social media have a long history, what unfolded in the 2000s reconfigured socio-technical practices in significant ways. Reflecting on the brief history of social media, this essay argues for the need to better understand this phenomenon.

  4. “Love” Phenomenon and Neurobiology of Love Relations

    Directory of Open Access Journals (Sweden)

    Ali Evren Tufan


    Full Text Available The biology; especially the neurobiological features of the “love” phenomenon has recently started to attract attention. Love relations and attachment, which is closely related with them, are known to be important in health and disease. Love and love relations are found to be complex neurobiological phenomena based on activation of the limbic system of the brain. Those processes involve oxytocin, vasopressin, dopamine and serotonergic functions. Additionally, endorphine and endogenous opiate systems as well as nitrous oxide play role in those processes. The stages of love and love relations may demonstrate different neurochemical and neurophysiological features and may partially overlap with m aternal, romantic and sexual love and attachments. The aim of this article is to evaluate the common neurobiological pathways underlying the “love” phenomenon as well as their importance in medicine and health.

  5. Indirect immunofluorescence assay for the simultaneous detection of antibodies against clinically important old and new world hantaviruses.

    Directory of Open Access Journals (Sweden)

    Sabine Lederer

    Full Text Available In order to detect serum antibodies against clinically important Old and New World hantaviruses simultaneously, multiparametric indirect immunofluorescence assays (IFAs based on biochip mosaics were developed. Each of the mosaic substrates consisted of cells infected with one of the virus types Hantaan (HTNV, Puumala (PUUV, Seoul (SEOV, Saaremaa (SAAV, Dobrava (DOBV, Sin Nombre (SNV or Andes (ANDV. For assay evaluation, serum IgG and IgM antibodies were analyzed using 184 laboratory-confirmed hantavirus-positive sera collected at six diagnostic centers from patients actively or previously infected with the following hantavirus serotypes: PUUV (Finland, n=97; SEOV (China, n=5; DOBV (Romania, n=7; SNV (Canada, n=23; ANDV (Argentina and Chile, n=52. The control panel comprised 89 sera from healthy blood donors. According to the reference tests, all 184 patient samples were seropositive for hantavirus-specific IgG (n=177; 96% and/or IgM (n=131; 72%, while all control samples were tested negative. In the multiparametric IFA applied in this study, 183 (99% of the patient sera were IgG and 131 (71% IgM positive (accordance with the reference tests: IgG, 96%; IgM, 93%. Overall IFA sensitivity for combined IgG and IgM analysis amounted to 100% for all serotypes, except for SNV (96%. Of the 89 control sera, 2 (2% showed IgG reactivity against the HTNV substrate, but not against any other hantavirus. Due to the high cross-reactivity of hantaviral nucleocapsid proteins, endpoint titrations were conducted, allowing serotype determination in >90% of PUUV- and ANDV-infected patients. Thus, multiparametric IFA enables highly sensitive and specific serological diagnosis of hantavirus infections and can be used to differentiate PUUV and ANDV infection from infections with Murinae-borne hantaviruses (e.g. DOBV and SEOV.

  6. Validity, responsiveness, and minimal clinically important difference of EQ-5D-5L in stroke patients undergoing rehabilitation. (United States)

    Chen, Poyu; Lin, Keh-Chung; Liing, Rong-Jiuan; Wu, Ching-Yi; Chen, Chia-Ling; Chang, Ku-Chou


    To examine the criterion validity, responsiveness, and minimal clinically important difference (MCID) of the EuroQoL 5-Dimensions Questionnaire (EQ-5D-5L) and visual analog scale (EQ-VAS) in people receiving rehabilitation after stroke. The EQ-5D-5L, along with four criterion measures-the Medical Research Council scales for muscle strength, the Fugl-Meyer assessment, the functional independence measure, and the Stroke Impact Scale-was administered to 65 patients with stroke before and after 3- to 4-week therapy. Criterion validity was estimated using the Spearman correlation coefficient. Responsiveness was analyzed by the effect size, standardized response mean (SRM), and criterion responsiveness. The MCID was determined by anchor-based and distribution-based approaches. The percentage of patients exceeding the MCID was also reported. Concurrent validity of the EQ-Index was better compared with the EQ-VAS. The EQ-Index has better power for predicting the rehabilitation outcome in the activities of daily living than other motor-related outcome measures. The EQ-Index was moderately responsive to change (SRM = 0.63), whereas the EQ-VAS was only mildly responsive to change. The MCID estimation of the EQ-Index (the percentage of patients exceeding the MCID) was 0.10 (33.8 %) and 0.10 (33.8 %) based on the anchor-based and distribution-based approaches, respectively, and the estimation of EQ-VAS was 8.61 (41.5 %) and 10.82 (32.3 %). The EQ-Index has shown reasonable concurrent validity, limited predictive validity, and acceptable responsiveness for detecting the health-related quality of life in stroke patients undergoing rehabilitation, but not for EQ-VAS. Future research considering different recovery stages after stroke is warranted to validate these estimations.

  7. Paradoxical, Cupping-Induced Localized Psoriasis: A Koebner Phenomenon. (United States)

    Vender, Reid; Vender, Ronald


    Cupping therapy is a traditional Chinese medicine used to heal psoriasis. The Koebner phenomenon is the occurrence of psoriatic lesions at the site of cutaneous injury. To describe the first case of biopsy-proven cupping-induced localized psoriasis, an example of the Koebner phenomenon. The histopathology of the lesions is described. A brief review of the literature regarding cupping therapy and its efficacy are discussed. A 45-year-old Asian male presented himself to the dermatology clinic for further treatment of his psoriasis. Four unusually circular plaques on the lower back were discovered. Pathologic diagnosis revealed an early lesion of psoriasis. on further inquiry, the patient admitted to undergoing a recent "cupping" procedure in an attempt to cure his condition. The efficacy of cupping therapy is controversial, and psoriatic patients may develop localized psoriasis through koebnerization as a result of cupping therapy rather than achieve desirable therapeutic benefits. © 2014 Canadian Dermatology Association.

  8. Talbot self-imaging phenomenon under Bessel beam illumination (United States)

    Chakraborty, Rijuparna; Chowdhury, Subhajit Dutta; Chakraborty, Ajoy Kumar


    In this paper, we report the results of our theoretical studies on the phenomenon of self-imaging of periodic object under the illumination of zero-order Bessel beam. Our theoretical analysis indicates that the self-images are visible only after the walk-off distance of the Bessel beam used. It is also observed that the self-images bend around the optical axis of the setup. Besides, the present study justifies the importance of the conditions stipulated by Montgomery.

  9. Competitors' Cluster - A Phenomenon in the Field of Retail Locating


    Wang, Libo (Michael); Zhu, Bo (Pritt)


    Cluster is a common phenomenon in developed countries. Horizontal clusters and vertical clusters are often seen in these countries. In the domestic retailing, a particular type of cluster—competitors’ cluster plays an important role in the past, nowadays and in the future. Though many researchers have investigated into clusters and talked a lot about the benefits firms could share by clustering together, few of them explained directly why the competitors of the same trade cluster together for...

  10. Mesoscale Phenomenon Revealed by an Acoustic Sounder

    DEFF Research Database (Denmark)

    Lundtang Petersen, Erik; Jensen, Niels Otto


    A particular phenomenon observed on an acoustic sounder record is analyzed, and is interpreted as being associated with the passing of a land breeze front. A simple physical explanation of the frontal movements is suggested. The actual existence of the land breeze is demonstrated by examination...

  11. Methods to Minimize Zero-Missing Phenomenon

    DEFF Research Database (Denmark)

    da Silva, Filipe Miguel Faria; Bak, Claus Leth; Gudmundsdottir, Unnur Stella


    With the increasing use of high-voltage AC cables at transmission levels, phenomena such as current zero-missing start to appear more often in transmission systems. Zero-missing phenomenon can occur when energizing cable lines with shunt reactors. This may considerably delay the opening of the ci...

  12. Key-Phenomenon and Religious Meaning

    Directory of Open Access Journals (Sweden)

    Lomuscio Vincenzo


    Full Text Available In this paper I develop a phenomenology of religious experience through the notion of keyphenomenon. My analysis moves from a general phenomenology of situation, in which we have to relate different phenomena according to a sense. What does “according to a sense” mean? My suggestion is that we should look for a relationship among these data when we find a key-phenomenon (among a series of phenomena that would enlighten all the others. This key-phenomenon would show a non-phenomenal meaning which would make all the others understandable. Each other datum, therefore, becomes the witness of invisible meaning through a key-witness. The key-phenomenon we choose determines the role (i.e., the truth of each datum within its situation. This phenomenological relationship belongs to both the sense of day-life situations, and that one of possible religious situations. If the religious interpretation of a situation depends on our choice of key-phenomenon, or key-witness, we have to define what kind of keyphenomenon constitutes a religious intuition.

  13. Concept "Medical Museum" as a Sociocultural Phenomenon (United States)

    Chizh, Nina V.; Slyshkin, Gennady G.; Zheltukhina, Marina R.; Privalova, Irina V.; Kravchenko, Olga A.


    The article examines the concept "medical museum" as a sociocultural phenomenon. The register of medical museums in Russia makes the material of research. The complex methods of analysis of the concept "medical museum" are used. The philosophical, historical, cultural, structural, communicative and semantic analysis is carried…

  14. Geometrical optics and the diffraction phenomenon

    International Nuclear Information System (INIS)

    Timofeev, Aleksandr V


    This note outlines the principles of the geometrical optics of inhomogeneous waves whose description necessitates the use of complex values of the wave vector. Generalizing geometrical optics to inhomogeneous waves permits including in its scope the analysis of the diffraction phenomenon. (methodological notes)

  15. Laser Sintering Technology and Balling Phenomenon. (United States)

    Oyar, Perihan


    The aim of this review was to evaluate the balling phenomenon which occurs typically in Selective Laser Sintering (SLS). The balling phenomenon is a typical SLS defect, and observed in laser sintered powder, significantly reduces the quality of SLS, and hinders the further development of SLS Technology. Electronic database searches were performed using Google Scholar. The keywords "laser sintering, selective laser sintering, direct metal laser melting, and balling phenomenon" were searched in title/abstract of publications, limited to December 31, 2016. The inclusion criteria were SLS, balling phenomenon, some alloys (such as Cr-Co, iron, stainless steel, and Cu-based alloys) mechanical properties, microstructure and bond strength between metal-ceramic crown, laboratory studies, full text, and in English language. A total of 100 articles were found the initial search and yielded a total of 50 studies, 30 of which did not fulfill the inclusion criteria and were therefore excluded. In addition, 20 studies were found by screening the reference list of all included publications. Finally, 40 studies were selected for this review. The method in question is regulated by powder material characteristics and the conditions of laser processing. The procedure of formation, affecting factors, and the mechanism of the balling effect are very complex.

  16. Orgasm Induced Seizures: A Rare Phenomenon

    African Journals Online (AJOL)

    testing of the brain revealed no structural abnormality. His blood examination findings were ... A variety of stimuli can cause reflex seizures, Some triggers include light, music and cognitive phenomenon. There are case reports ... seizures cause great personal distress and significantly affect marital relationships. Though ...

  17. Trust, moral responsibility, the self, and well-ordered societies: the importance of basic philosophical concepts for clinical ethics. (United States)

    Mccullough, Laurence B


    Although the work of clinical ethics is intensely practical, it employs and presumes philosophical concepts from the central branches of philosophy, including metaphysics, epistemology, ethics, and political philosophy. This essay introduces this issue in the Journal on clinical ethics by considering how the papers and book reviews included in it illuminate four such concepts: trust, moral responsibility, the self and well-ordered societies.

  18. Sex-Divergent Clinical Outcomes and Precision Medicine: An Important New Role for Institutional Review Boards and Research Ethics Committees

    Directory of Open Access Journals (Sweden)

    Ignacio Segarra


    Full Text Available The efforts toward individualized medicine have constantly increased in an attempt to improve treatment options. These efforts have led to the development of small molecules which target specific molecular pathways involved in cancer progression. We have reviewed preclinical studies of sunitinib that incorporate sex as a covariate to explore possible sex-based differences in pharmacokinetics and drug–drug interactions (DDI to attempt a relationship with published clinical outputs. We observed that covariate sex is lacking in most clinical outcome reports and suggest a series of ethic-based proposals to improve research activities and identify relevant different sex outcomes. We propose a deeper integration of preclinical, clinical, and translational research addressing statistical and clinical significance jointly; to embed specific sex-divergent endpoints to evaluate possible gender differences objectively during all stages of research; to pay greater attention to sex-divergent outcomes in polypharmacy scenarios, DDI and bioequivalence studies; the clear reporting of preclinical and clinical findings regarding sex-divergent outcomes; as well as to encourage the active role of scientists and the pharmaceutical industry to foster a new scientific culture through their research programs, practice, and participation in editorial boards and Institutional Ethics Review Boards (IRBs and Research Ethics Committees (RECs. We establish the IRB/REC as the centerpiece for the implementation of these proposals. We suggest the expansion of its competence to follow up clinical trials to ensure that sex differences are addressed and recognized; to engage in data monitoring committees to improve clinical research cooperation and ethically address those potential clinical outcome differences between male and female patients to analyze their social and clinical implications in research and healthcare policies.

  19. Quantifying the importance of disease burden on perceived general health and depressive symptoms in patients within the Mayo Clinic Biobank. (United States)

    Ryu, Euijung; Takahashi, Paul Y; Olson, Janet E; Hathcock, Matthew A; Novotny, Paul J; Pathak, Jyotishman; Bielinski, Suzette J; Cerhan, James R; Sloan, Jeff A


    Deficits in health-related quality of life (HRQOL) may be associated with worse patient experiences, outcomes and even survival. While there exists evidence to identify risk factors associated with deficits in HRQOL among patients with individual medical conditions such as cancer, it is less well established in more general populations without attention to specific illnesses. This study used patients with a wide range of medical conditions to identify contributors with the greatest influence on HRQOL deficits. Self-perceived general health and depressive symptoms were assessed using data from 21,736 Mayo Clinic Biobank (MCB) participants. Each domain was dichotomized into categories related to poor health: deficit (poor/fair for general health and ≥3 for PHQ-2 depressive symptoms) or non-deficit. Logistic regression models were used to test the association of commonly collected demographic characteristics and disease burden with each HRQOL domain, adjusting for age and gender. Gradient boosting machine (GBM) models were applied to quantify the relative influence of contributors on each HRQOL domain. The prevalence of participants with a deficit was 9.5 % for perception of general health and 4.6 % for depressive symptoms. For both groups, disease burden had the strongest influence for deficit in HRQOL (63 % for general health and 42 % for depressive symptoms). For depressive symptoms, age was equally influential. The prevalence of a deficit in general health increased slightly with age for males, but remained stable across age for females. Deficit in depressive symptoms was inversely associated with age. For both HRQOL domains, risk of a deficit was associated with higher disease burden, lower levels of education, no alcohol consumption, smoking, and obesity. Subjects with deficits were less likely to report that they were currently working for pay than those without a deficit; this association was stronger among males than females. Comorbid health burden has the

  20. A cross-cultural convergent parallel mixed methods study of what makes a cancer-related symptom or functional health problem clinically important. (United States)

    Giesinger, Johannes M; Aaronson, Neil K; Arraras, Juan I; Efficace, Fabio; Groenvold, Mogens; Kieffer, Jacobien M; Loth, Fanny L; Petersen, Morten Aa; Ramage, John; Tomaszewski, Krzysztof A; Young, Teresa; Holzner, Bernhard


    In this study, we investigated what makes a symptom or functional impairment clinically important, that is, relevant for a patient to discuss with a health care professional (HCP). This is the first part of a European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group project focusing on the development of thresholds for clinical importance for the EORTC QLQ-C30 questionnaire and its corresponding computer-adaptive version. We conducted interviews with cancer patients and HCPs in 6 European countries. Participants were asked to name aspects of a symptom or problem that make it clinically important and to provide importance ratings for a predefined set of aspects (eg, need for help and limitations of daily functioning). We conducted interviews with 83 cancer patients (mean age, 60.3 y; 50.6% men) and 67 HCPs. Participants related clinical importance to limitations of everyday life (patients, 65.1%; HCPs, 77.6%), the emotional impact of a symptom/problem (patients, 53.0%; HCPs, 64.2%), and duration/frequency (patients, 51.8%; HCPs, 49.3%). In the patient sample, importance ratings were highest for worries by partner or family, limitations in everyday life, and need for help from the medical staff. Health care professionals rated limitations in everyday life and need for help from the medical staff to be most important. Limitations in everyday life, need for (medical) help, and emotional impact on the patient or family/partner were found to be relevant aspects of clinical importance. Based on these findings, we will define anchor items for the development of thresholds for clinical importance for the EORTC measures in a Europe-wide field study. Copyright © 2017 John Wiley & Sons, Ltd.

  1. Legal socialization of personality as a phenomenon of legal psychology

    Directory of Open Access Journals (Sweden)

    Borisova S.E.


    Full Text Available The relevance of the topic to the continuing importance of legal regulation of human behavior, the necessity of foreseeing the adverse consequences of social disorders and urgency of the prevention of deconditioning and deviant behavioral manifestations. In this regard, it is important to examine the phenomenon of legal socialization, causing interest among the representatives of the human Sciences and specialists in different branches of psychological knowledge. Taking into account the multidimensional nature of this phenomenon, it is an essential consideration of the trajectories of its occurrence in correlation with different interacting with other determinants. Such determinants include age psychological characteristics, experience crises of mental development, socially conditioned factors, and the influence of the professional environment. In article are characterized by individual patterns of legal socialization of a personality, revealing its essence, on the basis of summarizing opinions of scientists based on their own point of view. On the basis of the theoretical analysis made assumptions about the peculiarities of legal socialization of the individual occurring in different age periods of life; formulated likely areas for further study the phenomenon under research legal psychology.

  2. Phase transition phenomenon: A compound measure analysis (United States)

    Kang, Bo Soo; Park, Chanhi; Ryu, Doojin; Song, Wonho


    This study investigates the well-documented phenomenon of phase transition in financial markets using combined information from both return and volume changes within short time intervals. We suggest a new measure for the phase transition behaviour of markets, calculated as a return distribution conditional on local variance in volume imbalance, and show that this measure successfully captures phase transition behaviour under various conditions. We analyse the intraday trade and quote dataset from the KOSPI 200 index futures, which includes detailed information on the original order size and the type of each initiating investor. We find that among these two competing factors, the submitted order size yields more explanatory power on the phenomenon of market phase transition than the investor type.

  3. The veining phenomenon in unalloyed plutonium

    International Nuclear Information System (INIS)

    White, J.S.


    An investigation has been made of the veining phenomenon in unalloyed plutonium. The surface markings, or veins, which are sometimes seen on α-phase plutonium samples, arise as a result of the β→α transformation. As far as is known, this veining is unrivalled in its scale and form as compared with the solid state surface transformation effects shown by any other metal. The phenomenon has been explained by the application of the Le Chatelier principle to the phase change. In this instance, the large (10%) volume contraction associated with the β→α reaction and the anisotropy of the nonoclinic α-phase structure, account for the fact that the veins are so prominent in plutonium. On the basis of the proposed model, the veins can only form at temperatures where the transformation mechanism is non-martensitic. (Auth.)

  4. Diffusion phenomenon for linear dissipative wave equations

    KAUST Repository

    Said-Houari, Belkacem


    In this paper we prove the diffusion phenomenon for the linear wave equation. To derive the diffusion phenomenon, a new method is used. In fact, for initial data in some weighted spaces, we prove that for {equation presented} decays with the rate {equation presented} [0,1] faster than that of either u or v, where u is the solution of the linear wave equation with initial data {equation presented} [0,1], and v is the solution of the related heat equation with initial data v 0 = u 0 + u 1. This result improves the result in H. Yang and A. Milani [Bull. Sci. Math. 124 (2000), 415-433] in the sense that, under the above restriction on the initial data, the decay rate given in that paper can be improved by t -γ/2. © European Mathematical Society.

  5. Multiplayer computer games as youth's leisure phenomenon


    HADERKOVÁ, Barbora


    The thesis is dedicated to multiplayer computer games as youth's leisure phenomenon of this time. The theoretical part is focused on computer games history, multiplayer computer games and their types, gaming platforms, community of multiplayer games players and potential negatives and positives, which follows from playing this type of games. The practical part contains a qualitative survey using interviews with multiplayer computer games players aged from 15 to 26 years from city of České Bud...

  6. Provider Initiated Testing and Counseling (PITC for HIV in resource-limited clinical settings: important questions unanswered

    Directory of Open Access Journals (Sweden)

    Peter Twyman


    Full Text Available Testing is the gateway to HIV care and support services, and efforts to broaden treatment must include a proactive and inclusive approach to testing. Provider Initiated Testing and Counseling (PITC for HIV utilizes the opportunity afforded by the clinical encounter for the care provider to make a clinical recommendation that the patient have a voluntary HIV test. It is hoped that by broadening testing by such strategies as PITC more patients may be identified and linked to treatment and support. However, there exist multiple challenges and questions regarding the provision of routine HIV testing and counseling in clinical facilities. In order to support further PITC efforts and scale up of current testing programs, a research agenda that addresses the ethical, social and operational components of PITC programming in health facilities, is critically needed to further guide its expansion.

  7. Predicting failing performance on a standardized patient clinical performance examination: the importance of communication and professionalism skills deficits. (United States)

    Chang, Anna; Boscardin, Christy; Chou, Calvin L; Loeser, Helen; Hauer, Karen E


    The purpose is to determine which assessment measures identify medical students at risk of failing a clinical performance examination (CPX). Retrospective case-control, multiyear design, contingency table analysis, n = 149. We identified two predictors of CPX failure in patient-physician interaction skills: low clerkship ratings (odds ratio 1.79, P = .008) and student progress review for communication or professionalism concerns (odds ratio 2.64, P = .002). No assessments predicted CPX failure in clinical skills. Performance concerns in communication and professionalism identify students at risk of failing the patient-physician interaction portion of a CPX. This correlation suggests that both faculty and standardized patients can detect noncognitive traits predictive of failing performance. Early identification of these students may allow for development of a structured supplemental curriculum with increased opportunities for practice and feedback. The lack of predictors in the clinical skills portion suggests limited faculty observation or feedback.

  8. Rudimentary horn pregnancy in the first trimester; importance of ultrasound and clinical suspicion in early diagnosis: A case report

    Directory of Open Access Journals (Sweden)

    Hasan Terzi


    Full Text Available We aimed to present 7-8 weeks rudimentary horn pregnancy detected preoperatively. A 37-year-old woman, gravida 3, para 2, at 7-8 weeks’ gestation referred to our clinic with a complaint of abdominal pain. The patient was primarily infertile, and she had unicornuate uterus detected during infertility investigation. Due to abnormal ultrasonographic image, rudimentary horn pregnancy was considered. Accurate diagnosis was made by laparoscopy, and rudimentary horn excision was performed. Prerupture diagnosis is very difficult in rudimentary horn pregnancies. The key role in preoperative diagnosis is suspicion. Ultrasonographic examination and clinical suspicion are sufficient in most cases.

  9. Phenomenon of political actionism in modern society

    Directory of Open Access Journals (Sweden)

    V. M. Bavykina


    Full Text Available Political actionism is the fenomen in social and art space, that appeared in middle of XX century as the practice of critic and protest with using different artistic methods and techniques. Political actionism as art and political tradition exist in postsoviet space, especially in Russia where actionism appeared in 1990 years and develops for actually days. In other countries this phenomenon not such systematic.  But analyze and compare actions in different countries appears the possibility to understand social and cultural context, their difference and similarity. Actionism is a reaction to external public, social and political situation, but its appearance more like the symptom of some problem than its critic or display – traditional approaches in art.  Appearance of actionism also connected with inability of manifestation of personal and civil liberty, that’s why in actions liberty affairs in such radical and hyperbolized forms. First volume of Russian political actionism began in 1990 years (Oleg Kulik, Alexander Brener, Anatoly Osmolovsky etc. and Second volume in 2010 (art-group Voina, Pussy Riot, Pyotr Pavlensky. This process not only a transformation of artistic and traditional space, but also modification of reaction on social and political situation. Actionism becomes a source of new type of knowledge, that give a possibility to see the habitual reality from another side and find in it new pointes and concepts. Political actionism contracting own interpretation of already well-established phenomenon. Usual concepts of liberty, authority, social control are deconstructed in actions. Those destructions of reality and cultural reorientation destroys traditional imposed patterns of interaction and social structure. But new views, that appeared in daily life from actions, often has mistaken interpretations. Exist a problem about identification of actions, its correct interpretations and understanding of its causes. In article was

  10. Importance of Clinical and Laboratory Findings in the Diagnosis and Surgical Prognosis of Patients with Constrictive Pericarditis

    Directory of Open Access Journals (Sweden)

    Fábio Fernandes


    Full Text Available Abstract Background: International studies have reported the value of the clinical profile and laboratory findings in the diagnosis of constrictive pericarditis. However, Brazilian population data are scarce. Objective: To assess the clinical characteristics, sensitivity of imaging tests and factors related to the death of patients with constrictive pericarditis undergoing pericardiectomy. Methods: Patients with constrictive pericarditis surgically confirmed were retrospectively assessed regarding their clinical and laboratory variables. Two methods were used: transthoracic echocardiography and cardiac magnetic resonance imaging. Mortality predictors were determined by use of univariate analysis with Cox proportional hazards model and hazard ratio. All tests were two-tailed, and an alpha error ≤ 5% was considered statically significant. Results: We studied 84 patients (mean age, 44 ± 17.9 years; 67% male. Signs and symptoms of predominantly right heart failure were present with jugular venous distention, edema and ascites in 89%, 89% and 62% of the cases, respectively. Idiopathic etiology was present in 69.1%, followed by tuberculosis (21%. Despite the advanced heart failure degree, low BNP levels (median, 157 pg/mL were found. The diagnostic sensitivities for constriction of echocardiography and magnetic resonance imaging were 53.6% and 95.9%, respectively. There were 9 deaths (10.7%, and the risk factors were: anemia, BNP and C reactive protein levels, pulmonary hypertension >55 mm Hg, and atrial fibrillation. Conclusions: Magnetic resonance imaging had better diagnostic sensitivity. Clinical, laboratory and imaging markers were associated with death.

  11. Bottom–up protein identifications from microliter quantities of individual human tear samples. Important steps towards clinical relevance.

    Directory of Open Access Journals (Sweden)

    Peter Raus


    With 375 confidently identified proteins in the healthy adult tear, the obtained results are comprehensive and in large agreement with previously published observations on pooled samples of multiple patients. We conclude that, to a limited extent, bottom–up tear protein identifications from individual patients may have clinical relevance.

  12. Growth hormone receptor exon 3 isoforms may have no importance in the clinical setting of multiethnic Brazilian acromegaly patients. (United States)

    de Oliveira Machado, Evelyn; Lima, Carlos Henrique Azeredo; Ogino, Liana Lumi; Kasuki, Leandro; Gadelha, Mônica R


    Acromegaly is associated with significant morbidity and increased mortality, but has a variable severity phenotype. The presence of the exon 3-deleted isoform of the growth hormone receptor (d3-GHR) may influence the disease phenotype and treatment outcomes, including the frequency of biochemical discordance after medical treatment. The objective of this study was to analyze the influence of the d3-GHR isoform on clinical and biochemical characteristics and in the treatment outcomes of Brazilian multiethnic acromegaly patients. We retrospectively analyzed our acromegaly outpatient clinic databank and collected demographic, clinical, biochemical and treatment outcome data from those patients who agreed to participate in the study. A blood sample was collected from all patients, the DNA was extracted and the GHR isoforms were evaluated by PCR, with the full length (fl)-GHR represented by a 935-bp fragment and the d3-GHR represented by a 532-bp fragment. A total of 121 patients were included. Fifty-six patients (46.3 %) were full-length homozygous (fl/fl), 48 (39.7 %) were heterozygous (fl/d3) and 17 (14.0 %) were d3-GHR homozygous (d3/d3). There was no difference between patients homozygous for the fl isoform and those harboring at least one d3-GHR allele in the demographic, clinical and biochemical data or in the treatment outcomes, including somatostatin receptor ligands (SRL) monotherapy, combination therapy with SRL and cabergoline and pegvisomant treatment. There was also no difference between the groups for the frequency of GH and IGF-I discordance after medical treatment. GHR exon 3 genotyping appears to have no clinical significance, at least in Brazilian acromegaly patients.

  13. Incidental abdominopelvic findings on expanded field-of-view lumbar spinal MRI: frequency, clinical importance, and concordance in interpretation by neuroimaging and body imaging radiologists

    International Nuclear Information System (INIS)

    Maxwell, A.W.P.; Keating, D.P.; Nickerson, J.P.


    Aim: To characterize the frequency of identification, clinical importance, and concordance in interpretation of incidental abdominopelvic findings identified on routine lumbar spinal MRI using supplemental expanded field-of-view (FOV) coronal imaging. Materials and methods: All lumbar spinal MRI reports over a 12-month period were retrospectively reviewed for the presence of incidental abdominopelvic findings identified using expanded FOV coronal imaging. Medical records were used to identify those findings that received follow-up, which were then categorized according to final diagnosis and classified as “indeterminate,” “likely clinically unimportant,” and “likely clinically important”. All cases that received follow-up were blindly and independently re-reviewed by a neuroimaging radiologist and body-imaging radiologist, and reviewer performances were compared to assess for agreement with regard to lesion significance, need for follow-up, and other parameters. Results: In total, 2067 reports were reviewed: 687 (33.2%) featured one or more incidental abdominopelvic findings, and 102 (4.9%) findings received further evaluation. Of these, 11 (10.9%) were classified as “indeterminate,” 50 (49%) as “likely clinically unimportant,” and 41 (40.1%) were classified as “likely clinically important.” Excellent agreement was observed between the reviewing radiologists for all evaluated parameters. Conclusion: The addition of an expanded FOV coronal sequence to the standard lumbar spinal MRI protocol was associated with the identification of a large number of incidental abdominopelvic findings, the minority of which represent likely clinically important findings. Most incidental findings were confidently dismissed by a neuroimaging radiologist as likely clinically unimportant without utilization of additional clinical or radiographic resources. - Highlights: • Expanded field-of-view (FOV) MRI improves detection of important incidental findings.

  14. Perspectives of biotechnologies based on dormancy phenomenon for space researches (United States)

    Alekseev, V.; Sychev, V.; Layus, D.; Levinsky, M.; Novikova, N.; Zakhodnova, T.

    Long term space missions will require a renewable source of food and an efficient method to recycle oxygen Plants especially aquatic micro algae provide an obvious solution to these problems However long duration plant growth and reproduction in space that is necessary for transportation of a control ecological life support system CELSS from Earth to other planets are problematic The introduction of heterotrophs in space CELSS is a more formidable problem as the absence of gravity creates additional difficulties for their life Dormancy phenomenon protected a great many animals and plants in harsh environmental conditions within a special resting phases of life cycle lasting from months up to hundred years This phenomenon can be quite perspective as a tool to overcome difficulties with CELSS transportation in space missions Cryptobiotic stages of microbes fungi unicellular algae and protists can survive in open space conditions that is important for interplanetary quarantine and biological security inside spacecraft Searching for life outside the Earth at such planet like Mars with extremely variable environment should be oriented on dormancy as crucial phases of a life cycle in such organisms Five major research programs aimed on study dormancy phenomenon for exobiology purposes and creation of new biotechnologies are discussed List of species candidate components of CELSS with dormancy in their life cycle used in space experiments at the Russian segment of International Space Station now includes 26 species from bacteria to fish The

  15. Simulation of the AC corona phenomenon with experimental validation

    International Nuclear Information System (INIS)

    Villa, Andrea; Barbieri, Luca; Marco, Gondola; Malgesini, Roberto; Leon-Garzon, Andres R


    The corona effect, and in particular the Trichel phenomenon, is an important aspect of plasma physics with many technical applications, such as pollution reduction, surface and medical treatments. This phenomenon is also associated with components used in the power industry where it is, in many cases, the source of electro-magnetic disturbance, noise and production of undesired chemically active species. Despite the power industry to date using mainly alternating current (AC) transmission, most of the studies related to the corona effect have been carried out with direct current (DC) sources. Therefore, there is technical interest in validating numerical codes capable of simulating the AC phenomenon. In this work we describe a set of partial differential equations that are comprehensive enough to reproduce the distinctive features of the corona in an AC regime. The model embeds some selectable chemical databases, comprising tens of chemical species and hundreds of reactions, the thermal dynamics of neutral species and photoionization. A large set of parameters—deduced from experiments and numerical estimations—are compared, to assess the effectiveness of the proposed approach. (paper)

  16. The importance of clinical pharmacokinetic–pharmacodynamic studies in unraveling the determinants of early and late tuberculosis outcomes


    McCallum, Andrew; Sloan, Derek


    Tuberculosis remains a major infectious cause of morbidity and mortality worldwide. Current antibiotic regimens, constructed prior to the development of modern pharmacokinetic-pharmacodynamic (PK–PD) tools, are based on incomplete understanding of exposure–response relationships in drug susceptible and multidrug resistant tuberculosis. Preclinical and population PK data suggest that clinical PK–PD studies may enable therapeutic drug monitoring for some agents and revised dosingf or others. Fu...

  17. The importance of acoustic radiation force impulse (ARFI) elastography in the diagnosis and clinical course of acute pancreatitis. (United States)

    Kaya, Muhsin; Değirmenci, Serdar; Göya, Cemil; Tuncel, Elif Tuba; Uçmak, Feyzullah; Kaplan, Mehmet Ali


    Acute pancreatitis (AP) is characterized by acute inflammation of the pancreas and it has a highly variable clinical course. The aim of our study was to evaluate the value of acoustic radiation force impulse (ARFI) elastography in the diagnosis and clinical course of AP. Consecutive patients with a diagnosis of AP (patients group) and healthy subject (control group) were prospectively enrolled to the study. Demographic features and clinical, laboratory, and radiological data were recorded. Virtual Touch Tissue Quantification (VTQ) was used to implement ARFI elastography. The tissue elasticity is proportional to the square of the wave velocity (SWV). A total of 108 patients (age, 57±1.8 y) and 79 healthy subjects (age, 53.6±1.81 y) were included in the study. There were 100 (92.5%) edematous and 8 (7.4%) necrotizing AP. The mean SWV was significantly higher in the patient group than in the control group (2.43±0.08 vs. 1.27±0.025 m/s, p < 0.001). There was not significant difference between patient and control group regarding age and gender. SWV cutoff value of 1.63 m/s was associated with 100% sensitivity and 98% specificity for the diagnosis of AP. There was not significant difference between patients with and without complications and patients with edematous and necrotizing AP regarding mean SWV value. There was also not significant correlation between mean SWV value and age, mean length of hospital stay, and mean amylase level. ARFI elastography may be a feasible method for the diagnosis of AP, but it has no value for the prediction of clinical course of AP.

  18. Diagnostic yield of preoperative computed tomography imaging and the importance of a clinical decision for lung cancer surgery

    International Nuclear Information System (INIS)

    Sato, Shuichi; Koike, Teruaki; Yamato, Yasushi


    This study aimed to evaluate the diagnostic yield of preoperative computed tomography (CT) imaging and the validity of surgical intervention based on the clinical decision to perform surgery for lung cancer or suspected lung cancer. We retrospectively evaluated 1755 patients who had undergone pulmonary resection for lung cancer or suspected lung cancer. CT scans were performed on all patients. Surgical intervention to diagnose and treat was based on a medical staff conference evaluation for the suspected lung cancer patients who were pathologically undiagnosed. We evaluated the relation between resected specimens and preoperative CT imaging in detail. A total of 1289 patients were diagnosed with lung cancer by preoperative pathology examination; another 466 were not pathologically diagnosed preoperatively. Among the 1289 patients preoperatively diagnosed with lung cancer, the diagnoses were confirmed postoperatively in 1282. Among the 466 patients preoperatively undiagnosed, 435 were definitively diagnosed with lung cancer, and there were 383 p-stage I disease patients. There were 38 noncancerous patients who underwent surgery with a diagnosis of confirmed or suspected lung cancer. Among the 1755 patients who underwent surgery, 1717 were pathologically confirmed with lung cancer, and the diagnostic yield of preoperative CT imaging was 97.8%. Among the 466 patients who were preoperatively undiagnosed, 435 were compatible with the predicted findings of lung cancer. Diagnostic yields of preoperative CT imaging based on clinical evaluation are sufficiently reliable. Diagnostic surgical intervention was acceptable when the clinical probability of malignancy was high and the malignancy was pathologically undiagnosed. (author)

  19. The importance of bony impingement in restricting flexion after total knee arthroplasty: computer simulation model with clinical correlation. (United States)

    Mizu-Uchi, Hideki; Colwell, Clifford W; Fukagawa, Shingo; Matsuda, Shuichi; Iwamoto, Yukihide; D'Lima, Darryl D


    We constructed patient-specific models from computed tomography data after total knee arthroplasty to predict knee flexion based on implant-bone impingement. The maximum flexion before impingement between the femur and the tibial insert was computed using a musculoskeletal modeling program (KneeSIM; LifeModeler, Inc, San Clemente, California) during a weight-bearing deep knee bend. Postoperative flexion was measured in a clinical cohort of 21 knees (low-flex group: 6 knees with 125° of flexion at 2 years). Average predicted flexion angles were within 2° of clinical measurements for the high-flex group. In the low-flex group, 4 cases had impingement involving the bone cut at the posterior condyle, and the average predicted knee flexion was 102° compared with 93° measured clinically. These results indicate that the level of the distal femoral resection should be carefully planned and that exposed bone proximal to the tips of the posterior condyles of the femoral component should be removed if there is risk of impingement. Copyright © 2012 Elsevier Inc. All rights reserved.

  20. A case of Balint syndrome: the importance of a specific neuropsychological appraisal in the clinical diagnosis of visuospatial disorders

    Directory of Open Access Journals (Sweden)

    Giuseppe Caravaglios


    Full Text Available Balint syndrome is characterized by a severe disturbance of visual spatial analysis including impaired oculomotor behaviour, optic ataxia, and simultanagnosia. The complete syndrome is relatively rare, and partial syndromes have been reported more frequently. The present study aims to describe a case of Balint syndrome who displayed all the three main neuropsychological features as a consequence of infarction in the watershed between the anterior and posterior cerebral artery territories. In this case report three days post stroke the clinical assessment showed a severe impairment in several visual spatial tasks (e.g. reading, writing, description of a visual scene, voluntary gaze-shift. Twelve weeks post-stroke the clinical assessment showed a significant improvement in reading, writing, as well as in verbal delayed recall processes, but only a mild improvement in visual spatial tasks like the description of a complex visual scene was registered. Balint’s syndrome is rare and is not easy to assess with standard clinical tools. The classical neurological examination evaluates in detail the senses, motility, balance, and to some extent language, but, sometimes, it is much less concerned with cognitive functions. The case discussed here is a good example of the need to emphasize that an acutely ill patient should also be accurately evaluated for the presence of cognitive and behavioural disturbances.

  1. [Serological and clinical proof of freedom from Equine Infectious Anemia (EIA) in imported and domestic horses in Switzerland]. (United States)

    Kaiser, A; Meier, H P; Doherr, M G; Perler, L; Zanoni, R; Gerber, V


    Since 1991, no cases of Equine Infectious Anemia (EIA) have been reported in Switzerland. Risk factors for introduction of the virus into Switzerland are still present or have even increased as frequent inapparent infections, large numbers of imported horses, (since 2003) absence of compulsory testing prior to importation, EIA cases in surrounding Europe, possible illegal importation of horses, frequent short-term stays, poor knowledge of the disease among horse owners and even veterinarians. The aim of this study was to provide evidence of freedom from EIA in imported and domestic horses in Switzerland. The serum samples from 434 horses imported since 2003 as well as from 232 domestic horses fifteen years of age or older (since older horses have naturally had a longer time of being exposed to the risk of infection) were analysed using a commercially available ELISA test. All samples were seronegative, indicating that the maximum possible prevalence that could have been missed with this sample was 0.5% (95% confidence).

  2. Nothingness and the placebo effect phenomenon

    DEFF Research Database (Denmark)

    Jensen, Tine

    The placebo effect is a pharmacological conundrum, since it is a medical effect that is produced by “nothing” because no pharmacologically active substance is present in placebo. Placebo has, among other things, been defined as an inert substance, often a calcium pill. Simultaneously it presents...... a posthuman angle, applying Karen Barad’s concept of agential realism to tackle the issue of nothingness. I argue that the placebo effect produces specific agencies in the placebo effect phenomenon – that is, both the subject under treatment and the placebo emerge in the placebo effect in the act of measuring it...

  3. Memoirs as Cultural Phenomenon and Historical Source

    Directory of Open Access Journals (Sweden)

    Наталия Георгиевна Георгиева


    Full Text Available The article analyzes the role of memoirs as the native culture phenomenon, process and means of introducing memoirs to the social and scientific and educational practice. The author considers the Russian historians' views development on theoretical and methodological problems of memoirs studies. There are shown the offered variants and achieved results of development of defining «memoirs», studies of their specific peculiarities, principles and schemes of memoirs systematization as well as the criteria of defining their scientific and educational value as historical sources.

  4. Magnetic poles and a still unexplained phenomenon

    International Nuclear Information System (INIS)

    Trower, W.P.


    A review is given of ideas about magnetic monopoles. Attention is drawn to the still unexplained observations of Schein, Haskin and Glasser (1954), in which electron-positron pairs were produced in large numbers by a cosmic-ray interaction. Their experiment has been simulated in 300 GeV pN interactions at Fermilab, giving a production limit of 10 -7 per proton interaction. The explanation for this phenomenon may lie in magnetic monopoles, or it may be similar to that invoked to explain the so-called Centauro events. (A.W.)

  5. The clinical and virological features of the first imported case causing MERS-CoV outbreak in South Korea, 2015. (United States)

    Lee, Ji Yeon; Kim, You-Jin; Chung, Eun Hee; Kim, Dae-Won; Jeong, Ina; Kim, Yeonjae; Yun, Mi-Ran; Kim, Sung Soon; Kim, Gayeon; Joh, Joon-Sung


    In 2015, the largest outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection outside the Middle East occurred in South Korea. We summarized the epidemiological, clinical, and laboratory findings of the first Korean case of MERS-CoV and analyzed whole-genome sequences of MERS-CoV derived from the patient. A 68-year-old man developed fever and myalgia 7 days after returning to Korea, following a 10-day trip to the Middle East. Before diagnosis, he visited 4 hospitals, potentially resulting in secondary transmission to 28 patients. On admission to the National Medical Center (day 9, post-onset of clinical illness), he presented with drowsiness, hypoxia, and multiple patchy infiltrations on the chest radiograph. He was intubated (day 12) because of progressive acute respiratory distress syndrome (ARDS) and INF-α2a and ribavirin treatment was commenced. The treatment course was prolonged by superimposed ventilator associated pneumonia. MERS-CoV PCR results converted to negative from day 47 and the patient was discharged (day 137), following rehabilitation therapy. The complete genome sequence obtained from a sputum sample (taken on day 11) showed the highest sequence similarity (99.59%) with the virus from an outbreak in Riyadh, Saudi Arabia, in February 2015. The first case of MERS-CoV infection had high transmissibility and was associated with a severe clinical course. The patient made a successful recovery after early treatment with antiviral agents and adequate supportive care. This first case in South Korea became a super-spreader because of improper infection control measures, rather than variations of the virus.

  6. A Pilot Study Exploring the Plasma Potassium Variation in Dogs Undergoing Steroid Therapy and Its Clinical Importance. (United States)

    Baltar, Marina; Costa, Alexandra; Carreira, L Miguel


    In most situations in veterinary medicine, glucocorticoids are the drugs of choice used, that is, to reduce the inflammatory response or limit an inappropriate immune response. Their use in long-term therapy may cause side effects that may weaken the patient. The aim of the study was to evaluate possible variations in the plasma potassium concentrations and their clinical relevance in dogs undergoing steroid therapy with methylprednisolone in anti-inflammatory doses. The study used a sample of 21 dogs (n = 21) presented for consultation, with a clinical condition requiring a corticosteroid therapeutic protocol with an anti-inflammatory dose of methylprednisolone. All the individuals were submitted to a corticosteroid therapeutic protocol administered orally during 18 days. During this period, 3 time points were considered: T0 (the day the prescription was first given), T1 (3 days later), and T2 (8 days later). Blood samples were collected from a peripheral vein to measure plasma potassium concentrations in T0, T1, and T2. Corticosteroid therapy on an outpatient basis statistically significantly decreased plasma potassium levels, especially between T1 and T2 (P = .03). The plasma potassium levels decreased in 12.5% of the males, compared with a decrease of 23.1% in the females. No statistically significant relationships were observe between the decreased plasma potassium levels and age, clinical condition, and patient׳s body weight. However, we found a statistically significant association between decreased plasma potassium levels and sex. The study results may justify the need for the systematic prescription of potassium supplements in patients undergoing steroid therapy, similar to what already occurs in human medicine. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Technical Note: Display window setting: An important factor for detecting subtle but clinically relevant artifacts in daily CT quality control. (United States)

    Long, Zaiyang; Bruesewitz, Michael R; Sheedy, Emily N; Powell, Michele A; Kramer, Jacqualynn C; Supalla, Randall R; Colvin, Chance M; Bechel, Jessica R; Favazza, Christopher P; Kofler, James M; Leng, Shuai; McCollough, Cynthia H; Yu, Lifeng


    This study aimed to investigate the influence of display window setting on technologist performance detecting subtle but clinically relevant artifacts in daily computed tomography (CT) quality control (dQC) images. Fifty three sets of dQC images were retrospectively selected, including 30 sets without artifacts, and 23 with subtle but clinically relevant artifacts. They were randomized and shown to six CT technologists (two new and four experienced). Each technologist reviewed all images in each of two sessions, one with a display window width (WW) of 100 HU, which is currently recommended by the American College of Radiology, and the other with a narrow WW of 40 HU, both at a window level of 0 HU. For each case, technologists rated the presence of image artifacts based on a five point scale. The area under the receiver operating characteristic curve (AUC) was used to evaluate the artifact detection performance. At a WW of 100 HU, the AUC (95% confidence interval) was 0.658 (0.576, 0.740), 0.532 (0.429, 0.635), and 0.616 (0.543, 0.619) for the experienced, new, and all technologists, respectively. At a WW of 40 HU, the AUC was 0.768 (0.687, 0.850), 0.546 (0.433, 0.658), and 0.694 (0.619, 0.769), respectively. The performance significantly improved at WW of 40 HU for experienced technologists (p = 0.009) and for all technologists (p = 0.040). Use of a narrow display WW significantly improved technologists' performance in dQC for detecting subtle but clinically relevant artifacts as compared to that using a 100 HU display WW.

  8. A quantum-like model of homeopathy clinical trials: importance of in situ randomization and unblinding. (United States)

    Beauvais, Francis


    The randomized controlled trial (RCT) is the 'gold standard' of modern clinical pharmacology. However, for many practitioners of homeopathy, blind RCTs are an inadequate research tool for testing complex therapies such as homeopathy. Classical probabilities used in biological sciences and in medicine are only a special case of the generalized theory of probability used in quantum physics. I describe homeopathy trials using a quantum-like statistical model, a model inspired by quantum physics and taking into consideration superposition of states, non-commuting observables, probability interferences, contextuality, etc. The negative effect of blinding on success of homeopathy trials and the 'smearing effect' ('specific' effects of homeopathy medicine occurring in the placebo group) are described by quantum-like probabilities without supplementary ad hoc hypotheses. The difference of positive outcome rates between placebo and homeopathy groups frequently vanish in centralized blind trials. The model proposed here suggests a way to circumvent such problems in masked homeopathy trials by incorporating in situ randomization/unblinding. In this quantum-like model of homeopathy clinical trials, success in open-label setting and failure with centralized blind RCTs emerge logically from the formalism. This model suggests that significant differences between placebo and homeopathy in blind RCTs would be found more frequently if in situ randomization/unblinding was used. Copyright © 2013. Published by Elsevier Ltd.

  9. [Virchowian Hansen's disease, Lucio's phenomenon, cryptococcosis]. (United States)


    A 75 years old white male, for 3 years on treatment for virchowian hanseniasis, was admitted with active HD lesions, infiltration on the base of right lung, leg ulcer and malaise. After two days he developed purpura and hemorrhagic blisters in the limbs. The biopsy of these lesions revealed Lucio phenomenon. The patient worsened with mental confusion, psychomotor agitation and anisocoric pupils. In the 18th day of internation the patient died. Necropsy revealed virchowian infiltration plenty of bacilli in the skin and viscera as well as tuberculoid granuloma with acid-fast bacilli in the liver, spleen and bone marrow. These findings lead us to review the patient's classification from virchowian to borderline. In the lungs, leptomeninge, renal papile, prostate and thyroid it was found loose tuberculoid granuloma with a great amount of fungi surrounded by a gelly halo resembling Criptococcus neoformans. These findings and the onset of Lucio phenomenon are discussed in a patient that has been treated for 3 years and still having several virchowian lesions and a great amount of acid-fast bacilli.

  10. Color doppler imaging of subclavian steal phenomenon

    International Nuclear Information System (INIS)

    Cho, Nari Ya; Chung, Tae Sub; Kim, Jai Keun


    To evaluate the characteristic color doppler imaging of vertebral artery flow in the subclavian steal phenomenon. The study group consisted of eight patients with reversed vertebral artery flow proved by color Doppler imaging. We classified this flow into two groups:(1) complete reversal;(2) partial reversal, as shown by Doppler velocity waveform. Vertebral angiography was performed in six of eight patients;color Doppler imaging and angiographic findings were compared. On color Doppler imaging, all eight cases with reversed vertebral artery flow showed no signal at the proximal subclavian or brachiocephalic artery. We confirmed shunting of six cases by performing angiography from the contralateral vertebral and basilar artery to the ipsilateral vertebral artery. On the Doppler spectrum, six cases showed complete reversal and two partial reversal. On angiography, one partial reversal case showed complete occlusion of the subclavian artery with abundant collateral circulation of muscular branches of the vertebral artery. On color Doppler imaging, a reversed vertebral artery suggests the subclavian steal phenomenon. In particular, partial reversal waveform may reflect collateral circulation

  11. Turnpike phenomenon and infinite horizon optimal control

    CERN Document Server

    Zaslavski, Alexander J


    This book is devoted to the study of the turnpike phenomenon and describes the existence of solutions for a large variety of infinite horizon optimal control classes of problems.  Chapter 1 provides introductory material on turnpike properties. Chapter 2 studies the turnpike phenomenon for discrete-time optimal control problems. The turnpike properties of autonomous problems with extended-value intergrands are studied in Chapter 3. Chapter 4 focuses on large classes of infinite horizon optimal control problems without convexity (concavity) assumptions. In Chapter 5, the turnpike results for a class of dynamic discrete-time two-player zero-sum game are proven. This thorough exposition will be very useful  for mathematicians working in the fields of optimal control, the calculus of variations, applied functional analysis, and infinite horizon optimization. It may also be used as a primary text in a graduate course in optimal control or as supplementary text for a variety of courses in other disciplines. Resea...

  12. Nursing care systematization as a multidimensional and interactive phenomenon. (United States)

    Backes, Dirce Stein; Koerich, Magda Santos; Nascimento, Keyla Cristiane do; Erdmann, Alacoque Lorenzini


    This study aimed to understand the meaning of Nursing Care Systematization (NCS) for multiprofessional health team professionals based on the relationships, interactions and associations of Complex thought. This qualitative study uses Grounded Theory as a methodological reference framework. Data were obtained through interviews with three sample groups, totaling 15 professionals from different institutions. Simultaneous data codification and analysis identified the central theme: 'Glimpsing nursing care systematization as an interactive and multidimensional phenomenon' and the respective reference model. NCS appoints, in addition to interactivity and professional complementarity, the importance of dialog and connection between the academy, health practices and regulatory offices, based on new reference frameworks for the organization of health practices.

  13. Culture phenomenon analysis on the forest tour activity of China

    Institute of Scientific and Technical Information of China (English)

    Jiang Minjin


    This paper analyzes culture and forest culture, the intension of culture and forest culture, combines the understanding of the main cultural factor with the forest tour activity of China, analyzes the compatible phenomenon of Chinese forest culture and traditional culture, and explores culture of forest tourist site containing the meaning in forest tour. The author thinks the tour of forest culture which will be the important component of forest tour in forest culture,This paper puts forward simple questions existing in exploitation and advantage of forest tour culture, and proposes some countermeasures.

  14. Distribution-based estimates of minimum clinically important difference in cognition, arm function and lower body function after slow release-fampridine treatment of patients with multiple sclerosis

    DEFF Research Database (Denmark)

    Jensen, H B; Mamoei, Sepehr; Ravnborg, M.


    OBJECTIVE: To provide distribution-based estimates of the minimal clinical important difference (MCID) after slow release fampridine treatment on cognition and functional capacity in people with MS (PwMS). METHOD: MCID values were determined after SR-Fampridine treatment in 105 PwMS. Testing...

  15. A cross-cultural convergent parallel mixed methods study of what makes a cancer-related symptom or functional health problem clinically important

    NARCIS (Netherlands)

    Giesinger, J.M.; Aaronson, N.K.; Arraras, J.I.; Efficace, F.; Groenvold, M.; Kieffer, J.M.; Loth, F.L.; Petersen, M.A.; Ramage, J.; Tomaszewski, K.A.; Young, T.; Holzner, B.


    Objective: In this study, we investigated what makes a symptom or functional impairment clinically important, that is, relevant for a patient to discuss with a health care professional (HCP). This is the first part of a European Organisation for Research and Treatment of Cancer (EORTC) Quality of

  16. The importance of clinical mistletoe cancer therapy and korean mistletoe pharmacopuncture preparation development and application possibility for oriental medicine

    Directory of Open Access Journals (Sweden)

    Ok-Byung Choi


    Full Text Available Objectives : Mistletoe extracts have been in use for around 85 years, predominantly in the area of cancer therapy. Today mistletoe preparations are among the most prescribed drugs in cancer medicine, thus constituting a standard biological therapy in the area of oncology. The purpose of this study is to analyze the practical implications of mistletoe cancer therapy, their clinical status, their preparation techniques and companies. Contents : Mistletoe therapy for cancer has been developed within the context of anthroposophical medicine. One major effect of mistletoe extract is that it stimulates the immune system and cancer defences. In Germany, a total of eight different mistletoe preparations are available, five developed by Anthroposophic Medicine and three evolved from research in phytotherapy. Therapy always consists of an introductory phase in order to test the patient′s tolerance, find the right dosage and choose the most suitable preparation. This paper covers the background of mistletoe medical plant materials, mistletoe therapy for cancer, the anthroposophical medicine and clinical research, the practical regulation of treatment, preparation of mistletoe drugs. Result & suggestion : Mistletoe extracts are a complementary teratment of cancer, widely used in intergrative cancer care. The study of the integration of korean mistletoe extracts to oriental cancer medicine, its development and feasibility in Korea are urgently needed. The products, substances, compositions of european mistletoe drugs are very similar to those of oriental medicine theory. Applying the mistletoe cancer therapy and its preparation techniques to oriental medicine, the herbal acupuncture preparation should be modernized and korean mistletoe products are to be developed. To this end, government and herbal acupuncture society need to interact each other for the development of oriental mistletoe cancer medicine.

  17. How common is clinically inactive disease in a prospective cohort of patients with juvenile idiopathic arthritis? The importance of definition. (United States)

    Shoop-Worrall, Stephanie J W; Verstappen, Suzanne M M; Baildam, Eileen; Chieng, Alice; Davidson, Joyce; Foster, Helen; Ioannou, Yiannis; McErlane, Flora; Wedderburn, Lucy R; Thomson, Wendy; Hyrich, Kimme L


    Many criteria for clinically inactive disease (CID) and minimal disease activity (MDA) have been proposed for juvenile idiopathic arthritis (JIA). It is not known to what degree each of these criteria overlap within a single patient cohort. This study aimed to compare the frequency of MDA and CID across different criteria in a cohort of children with JIA at 1 year following presentation. The Childhood Arthritis Prospective Study recruits children at initial presentation to paediatric or adolescent rheumatology in seven UK centres. Children recruited between October 2001 and December 2013 were included. The proportions of children with CID and MDA at 1 year were calculated using four investigator-defined and eight published composite criteria. Missing data were accounted for using multiple imputation under different assumptions. In a cohort of 1415 children and adolescents, 67% patients had no active joints at 1 year. Between 48% and 61% achieved MDA and between 25% and 38% achieved CID using published criteria. Overlap between criteria varied. Of 922 patients in MDA by either the original composite criteria, Juvenile Arthritis Disease Activity Score (JADAS) or clinical JADAS cut-offs, 68% were classified as in MDA by all 3 criteria. Similarly, 44% of 633 children with CID defined by either Wallace's preliminary criteria or the JADAS cut-off were in CID according to both criteria. In a large JIA prospective inception cohort, a majority of patients have evidence of persistent disease activity after 1 year. Published criteria to capture MDA and CID do not always identify the same groups of patients. This has significant implications when defining and applying treat-to-target strategies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  18. The United States pork niche market phenomenon. (United States)

    Honeyman, M S; Pirog, R S; Huber, G H; Lammers, P J; Hermann, J R


    After the broad industrialization of the US pork industry, there has been a development of niche markets for export and domestic pork; that is, there is a pork niche market phenomenon. The US pork niche market phenomenon is characterized, and 2 of the major markets are explained in detail. With the Midwest's tradition of a diversified family-based agriculture and record low hog prices of the late 1990s, the conditions were conducive for this phenomenon to develop. Pork niche markets utilize various sales methods including Internet sales, local abattoir sales, direct marketing, farmer networks, and targeting to organized groups. In 2003, there were approximately 35 to 40 active pork niche marketing efforts in Iowa. The Berkshire breed is an example of a swine breed that has had a recent resurgence because of niche markets. Berkshire pork is known for tenderness and excellent quality. Berkshire registrations have increased 4-fold in the last 10 yr. One of the larger niche marketers of "natural pork" is Niman Ranch Pork, which has more than 400 farmer-producers and processes about 2,500 pigs weekly. Many US consumers of pork are interested in issues concerning the environment, food safety, pig welfare, and pig farm ownership and structure. These consumers may be willing to pay more for pork from farmers who are also concerned about these issues. Small- and medium-sized swine farmers are active in pork niche markets. Niche markets claim product differentiation by superior or unique product quality and social attributes. Quality attributes include certain swine breeds, and meat quality, freshness, taste or flavor, and tenderness. Social or credence attributes often are claimed and include freedom from antibiotics and growth promotants; local family farm production; natural, organic, outdoor, or bedded rearing; humane rearing; known origin; environmentally friendly production; and the absence of animal by-products in the feed. Niche pork markets and alternative swine

  19. Moe fenomen. The Phenomenon of Fashion

    Directory of Open Access Journals (Sweden)

    Ines Piibeleht


    Full Text Available Since the last quarter of the 20th century, particularly after the “cultural turn”, the interest in fashion has been increasing in a variety of different disciplines. Fashion has begun to be investigated in many different contexts, using new theoretical approaches. Fashion can be regarded as a social phenomenon, a sign system, as art, myth, or the product of the fashion industry. The purpose of this article is not to provide a definition of fashion, but rather to raise the question of how to approach the experience of fashion analytically. The methodological issues discussed here emerged in the course of preparing for empirical research on fashion. The observations and comparisons that constitute the core of this article are the result of efforts to juxtapose different methods. The traditional history of fashion used a historical-epistemological strategy but, depending on how one defines culture, the meaning of fashion can also be analysed using methods based on different epistemological strategies. The phenomenological method elaborated by Edmund Husserl, which I have chosen for my analysis of the experience of fashion, defines culture through the experiential acts of individuals. Simply stated, phenomenology considers the world as it is given to us in our consciousness. What is most important for empirical research is that the phenomenological method makes it possible to study the structure of a concrete experience and to focus on the mechanisms of the subjective creation of meaning. Thus this article has two main foci: a theoretical analysis of how the experience of fashion can be analytically revealed using the phenomenological method, and a comparison of the phenomenological approach with methods based on other strategies. The analysis of descriptions in the first person makes it possible to highlight how experience has been constructed. People “see” fashion based on structures of meaning; when they describe their own experience

  20. The information sources and journals consulted or read by UK paediatricians to inform their clinical practice and those which they consider important: a questionnaire survey. (United States)

    Jones, Teresa H; Hanney, Steve; Buxton, Martin J


    Implementation of health research findings is important for medicine to be evidence-based. Previous studies have found variation in the information sources thought to be of greatest importance to clinicians but publication in peer-reviewed journals is the traditional route for dissemination of research findings. There is debate about whether the impact made on clinicians should be considered as part of the evaluation of research outputs. We aimed to determine first which information sources are generally most consulted by paediatricians to inform their clinical practice, and which sources they considered most important, and second, how many and which peer-reviewed journals they read. We inquired, by questionnaire survey, about the information sources and academic journals that UK medical paediatric specialists generally consulted, attended or read and considered important to their clinical practice. The same three information sources--professional meetings & conferences, peer-reviewed journals and medical colleagues--were, overall, the most consulted or attended and ranked the most important. No one information source was found to be of greatest importance to all groups of paediatricians. Journals were widely read by all groups, but the proportion ranking them first in importance as an information source ranged from 10% to 46%. The number of journals read varied between the groups, but Archives of Disease in Childhood and BMJ were the most read journals in all groups. Six out of the seven journals previously identified as containing best paediatric evidence are the most widely read overall by UK paediatricians, however, only the two most prominent are widely read by those based in the community. No one information source is dominant, therefore a variety of approaches to Continuing Professional Development and the dissemination of research findings to paediatricians should be used. Journals are an important information source. A small number of key ones can be

  1. Diffuse sclerosing variant of papillary carcinoma of the thyroid. Clinical importance, surgical treatment, and follow-up study

    Energy Technology Data Exchange (ETDEWEB)

    Fujimoto, Y.; Obara, T.; Ito, Y.; Kodama, T.; Aiba, M.; Yamaguchi, K. (Tokyo Women' s Medical College (Japan))


    A diffuse sclerosing variant is not very rare among papillary carcinomas of the thyroid when the patients are female and younger than 30 years of age. The variant is characterized by diffuse involvement of one or both thyroid lobes, with dense sclerosis, patchy lymphocytic infiltration, and abundant psammoma bodies. Controversy still exists concerning its prognosis. We reviewed our experience with 14 patients treated between 1958 and 1988. All patients were young females, their age being from 10 to 28 years with a mean of 19.6. Hashimoto's thyroiditis had been suspected in nine patients before they came to our clinic. Nowadays the diagnosis of this cancer is possible when we have this entity in mind and detect abundant psammoma bodies either by ultrasonography or by soft-tissue roentgenography of the neck. Total thyroidectomy with modified neck dissection was carried out in eight patients, subtotal thyroidectomy with neck dissection in five, and lobectomy with neck dissection in one. All of them are alive and well without distant metastasis at a mean follow-up of 16 years. Because most of the patients with this variant of papillary carcinoma are young women and the prognosis is favorable, a complete resection without causing later recurrence, but also cosmetic and complication-free surgery, should be considered.

  2. Improving the accuracy of self-assessment of practical clinical skills using video feedback--the importance of including benchmarks. (United States)

    Hawkins, S C; Osborne, A; Schofield, S J; Pournaras, D J; Chester, J F


    Isolated video recording has not been demonstrated to improve self-assessment accuracy. This study examines if the inclusion of a defined standard benchmark performance in association with video feedback of a student's own performance improves the accuracy of student self-assessment of clinical skills. Final year medical students were video recorded performing a standardised suturing task in a simulated environment. After the exercise, the students self-assessed their performance using global rating scales (GRSs). An identical self-assessment process was repeated following video review of their performance. Students were then shown a video-recorded 'benchmark performance', which was specifically developed for the study. This demonstrated the competency levels required to score full marks (30 points). A further self-assessment task was then completed. Students' scores were correlated against expert assessor scores. A total of 31 final year medical students participated. Student self-assessment scores before video feedback demonstrated moderate positive correlation with expert assessor scores (r = 0.48, p benchmark performance demonstration, self-assessment scores demonstrated a very strong positive correlation with expert scores (r = 0.83, p benchmark performance in combination with video feedback may significantly improve the accuracy of students' self-assessments.

  3. Phenomenon of Uncertainty as a Subjective Experience

    Directory of Open Access Journals (Sweden)

    Lifintseva A.A.


    Full Text Available The phenomenon of uncertainty in illness of patients is discussed and analyzed in this article. Uncertainty in illness is a condition that accompanies the patient from the moment of appearance of the first somatic symptoms of the disease and could be strengthened or weakened thanks to many psychosocial factors. The level of uncertainty is related to the level of stress, emotional disadaptation, affective states, coping strategies, mechanisms of psychological defense, etc. Uncertainty can perform destructive functions, acting as a trigger for stressful conditions and launching negative emotional experiences. As a positive function of uncertainty, one can note a possible positive interpretation of the patient's disease. In addition, the state of uncertainty allows the patient to activate the resources of coping with the disease, among which the leading role belongs to social support.

  4. Melting phenomenon and laser annealing in semiconductors

    International Nuclear Information System (INIS)

    Narayan, J.


    The work on annealing of displacement damage, dissolution of boron precipitates, and the broadening of dopant profiles in semiconductors after treating with ruby and dye laser pulses is reviewed in order to provide convincing evidence for the melting phenomenon and illustrate the mechanism associated with laser annealing. The nature of the solid-liquid interface and the interface instability during rapid solidification is considered in detail. It is shown that solute concentrations after pulsed laser annealing can far exceed retrograde maxima values. However, there is a critical solute concentration above which a planar solid-liquid interface becomes unstable and breaks into a cellular structure. The solute concentrations and cell sizes associated with this instability are calculated using a perturbation theory, and compared with experimental results

  5. [Electroencephalographic characteristics of the deja vu phenomenon]. (United States)

    Vlasov, P N; Cherviakov, A V; Gnezdinsiĭ, V V


    Déjà vu (DV, from French "already seen") is an aberration of psychic activity associated with transitory erroneous perception of novel circumstances, objects, or people as already known. An aim of the study was to investigate EEG characteristics of DV in patients with epilepsy. We studied 166 people (63.2% women, mean age 25.17±9.19 years). The DV phenomenon was studied in patients (27 people) and in a control group (139 healthy people). Patients were interviewed for DV characteristics and underwent a long (12-16 h) ambulatory EEG-monitoring study. In EEG, DV episodes in patients began with polyspike activity in the right temporal lobe and, in some cases, ended with the slow-wave theta-delta activity in the right hemisphere.

  6. Physics of cryogenics an ultralow temperature phenomenon

    CERN Document Server

    Zohuri, Bahman


    Physics of Cryogenics: An Ultralow Temperature Phenomenon discusses the significant number of advances that have been made during the last few years in a variety of cryocoolers, such as Brayton, Joule-Thomson, Stirling, pulse tube, Gifford-McMahon and magnetic refrigerators. The book reviews various approaches taken to improve reliability, a major driving force for new research areas. The advantages and disadvantages of different cycles are compared, and the latest improvements in each of these cryocoolers is discussed. The book starts with the thermodynamic fundamentals, followed by the definition of cryogenic and the associated science behind low temperature phenomena and properties. This book is an ideal resource for scientists, engineers and graduate and senior undergraduate students who need a better understanding of the science of cryogenics and related thermodynamics.


    Directory of Open Access Journals (Sweden)

    TKACH L. M.


    Full Text Available Formulation of the problem. If public relations as a phenomenon of information management are examined, we deal with the question of knowledge content and nature of relationship of PR with environment, ability to manage the perception and attitude of people to events in the environment; ensure priority of information over other resources. Goal. To investigate the concept of "public relations" of foreign and domestic experts; consider the typology of the public and the "laws" of public opinion; define the basic principles according to which relations with public should be built, and to identify PR activities as a kind of social communication. Conclusions. Public relations on the basis of advanced information and communication technologies create fundamentally new opportunities for information control and influence on public consciousness.

  8. Prussian phenomenon and its historical distortion

    Directory of Open Access Journals (Sweden)

    Oleg Y. Plenkov


    Full Text Available The article deals with the phenomenon of Prussia. Once, Prussia had been the largest continental Protestant state in Europe. The main issue of this phenomenon is that upon the tragic events of the World War II Prussian history and heritage had been considerably distorted, in order to compensate somehow for the dreadful casualties suffered by the victorious powers. The common European misconception implied that Prussia had been the bulwark of militarism, and therefore had to bear all the responsibility for the atrocities of war. Unfortunately, the majority of modern German historians share such misinterpretation of Prussian heritage in order to please false political correctness, perhaps, as an act of contrition for National Socialism and its crimes. However, the Prussian tradition and history go far beyond this militarism, and this article explains what ways. The authors believe that there should not be any prejudices and biases, that any subject should be examined sine ira et studio. Moreover, given that it is possible to characterize the Great French Revolution as a juristic one, and the Great October revolution – as a social one, the Prussian revolution “from above”, led by the first representatives of the Hohenzollern family, may be well considered as a pedagogical revolution. This revolution did bring definitely positive changes; they are surveyed in the article. The French Revolution has not eliminated the covetousness of the bourgeoisie after 1789; despotism of the authorities and people’s passiveness similarly have remained unaltered in Russia after 1917. On the contrary, Federal Republic of Germany of nowadays, distinctive for its law, order and effective responsible government is unthinkable without Prussian heritage.

  9. Medical physics in radiotherapy: The importance of preserving clinical responsibilities and expanding the profession's role in research, education, and quality control. (United States)

    Malicki, Julian


    Medical physicists have long had an integral role in radiotherapy. In recent decades, medical physicists have slowly but surely stepped back from direct clinical responsibilities in planning radiotherapy treatments while medical dosimetrists have assumed more responsibility. In this article, I argue against this gradual withdrawal from routine therapy planning. It is essential that physicists be involved, at least to some extent, in treatment planning and clinical dosimetry for each and every patient; otherwise, physicists can no longer be considered clinical specialists. More importantly, this withdrawal could negatively impact treatment quality and patient safety. Medical physicists must have a sound understanding of human anatomy and physiology in order to be competent partners to radiation oncologists. In addition, they must possess a thorough knowledge of the physics of radiation as it interacts with body tissues, and also understand the limitations of the algorithms used in radiotherapy. Medical physicists should also take the lead in evaluating emerging challenges in quality and safety of radiotherapy. In this sense, the input of physicists in clinical audits and risk assessment is crucial. The way forward is to proactively take the necessary steps to maintain and advance our important role in clinical medicine.

  10. Medical physics in radiotherapy: The importance of preserving clinical responsibilities and expanding the profession's role in research, education, and quality control (United States)

    Malicki, Julian


    Medical physicists have long had an integral role in radiotherapy. In recent decades, medical physicists have slowly but surely stepped back from direct clinical responsibilities in planning radiotherapy treatments while medical dosimetrists have assumed more responsibility. In this article, I argue against this gradual withdrawal from routine therapy planning. It is essential that physicists be involved, at least to some extent, in treatment planning and clinical dosimetry for each and every patient; otherwise, physicists can no longer be considered clinical specialists. More importantly, this withdrawal could negatively impact treatment quality and patient safety. Medical physicists must have a sound understanding of human anatomy and physiology in order to be competent partners to radiation oncologists. In addition, they must possess a thorough knowledge of the physics of radiation as it interacts with body tissues, and also understand the limitations of the algorithms used in radiotherapy. Medical physicists should also take the lead in evaluating emerging challenges in quality and safety of radiotherapy. In this sense, the input of physicists in clinical audits and risk assessment is crucial. The way forward is to proactively take the necessary steps to maintain and advance our important role in clinical medicine. PMID:25949219

  11. Atypical Clinical Presentation of Xeroderma Pigmentosum in a Patient Harboring a Novel Missense Mutation in the XPC Gene: The Importance of Clinical Suspicion. (United States)

    Meneses, Marina; Chavez-Bourgeois, Marion; Badenas, Celia; Villablanca, Salvador; Aguilera, Paula; Bennàssar, Antoni; Alos, Llucia; Puig, Susana; Malvehy, Josep; Carrera, Cristina


    Xeroderma pigmentosum (XP) is a genodermatosis caused by abnormal DNA repair. XP complementation group C (XPC) is the most frequent type in Mediterranean countries. We describe a case with a novel mutation in the XPC gene. A healthy Caucasian male patient was diagnosed with multiple primary melanomas. Digital follow-up and molecular studies were carried out. During digital follow-up 8 more additional melanomas were diagnosed. Molecular studies did not identify mutations in CDKN2A, CDK4 or MITF genes. Two heterozygous mutations in the XPC gene were detected: c.2287delC (p.Leu763Cysfs*4) frameshift and c.2212A>G (p.Thr738Ala) missense mutations. The p.Thr738Ala missense mutation has not been previously described. Missense mutations in the XPC gene may allow partial functionality that could explain this unusual late onset XP. Atypical clinical presentation of XPC could be misdiagnosed when genetic aberrations allow partial DNA repair capacity. © 2015 S. Karger AG, Basel.

  12. Long term outcomes following achievement of clinically inactive disease in juvenile idiopathic arthritis: the importance of definition. (United States)

    Shoop-Worrall, Stephanie Jw; Verstappen, Suzanne Mm; McDonagh, Janet E; Baildam, Eileen; Chieng, Alice; Davidson, Joyce; Foster, Helen; Ioannou, Yiannis; McErlane, Flora; Wedderburn, Lucy R; Thomson, W; Hyrich, Kimme L


    Potential targets for treat-to-target strategies in JIA are minimal disease activity (MDA) and clinically inactive disease (CID). Short and long-term outcomes following achievement of MDA and CID on the cJADAS10 and CID on Wallace's preliminary criteria were compared. Children recruited to the Childhood Arthritis Prospective Study, a UK multicentre inception cohort, were selected if recruited prior to January 2011 and diagnosed with oligoarthritis or rheumatoid factor negative or positive polyarthritis. At one year following diagnosis, children were assessed for MDA on the cJADAS10 and CID on both Wallace's preliminary criteria and the cJADAS10. Associations were tested between these disease states and i) functional ability, ii) absence of limited joints, iii) psychosocial health and v) pain at one year and annually to five years. Of 832 children, 70% were female and the majority had oligoarthritis (68%). At one year, 21% had achieved CID according to both definitions, 7% on Wallace's preliminary criteria only, 16% on cJADAS10 only and 56% on neither. Only 10% of children in the entire cohort achieved MDA without also having CID. Achieving either early CID state was associated with greater absence of limited joints. However, only CID on cJADAS10 was associated with improved functional ability and psychosocial health. Achieving CID was superior to MDA in terms of short and long-term pain and the absence of limited joints. CID on the cJADAS10 may be a preferable treatment target to CID on Wallace's preliminary criteria in terms of both feasibility of application and long-term outcomes. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  13. [Biological markers for the status of vitamins B12 and D: the importance of some analytical aspects in relation to clinical interpretation of results]. (United States)

    Boulat, O; Rey, F; Mooser, V


    Biological markers for the status of vitamins B12 and D: the importance of some analytical aspects in relation to clinical interpretation of results When vitamin B12 deficiency is expressed clinically, the diagnostic performance of total cobalamin is identical to that of holotranscobalamin II. In subclinical B12 deficiency, the two aforementioned markers perform less well. Additional analysis of a second, functional marker (methylmalonate or homocysteine) is recommended. Different analytical approaches for 25-hydroxyvitamin D quantification, the marker of vitamin D deficiency, are not yet standardized. Measurement biases of up to +/- 20% compared with the original method used to establish threshold values are still observed.

  14. [Importance of Post-Marketing Studies in Gathering of Clinical Evidences for Proper Usage of Anti-Cancer Drugs, and the StudyRequirements for Their Credibility]. (United States)

    Inagaki, Osamu


    Pharmaceutical companies recognize the importance of post-marketing studies because they are crucial in the generation of clinical evidences for the usage of new medicines. To generate clinical evidences, quality of post-marketing studies should be well controlled from view point of "ethical conduction" and "reliability of results". In addition, control of conflict of interest (COI) between researchers and industries is also indispensable and is requested for the transparency of the studies. Japan Pharmaceutical Manufacturers Association(JPMA)stresses its commitment to the progressof transparency in post-marketing studies.


    Directory of Open Access Journals (Sweden)

    María Victoria Flores Trujillo


    Full Text Available Globalization is defined as a process that integrates knowledge worldwide, has its historical reference on changes in the ways processes, methods and information are addressed; documented its inception in the late twentieth century, Castells, M. (2001 beyond the discrepancy about whether it is a product of technological development or an inevitable evolution of capitalism, research arises from the formulation of the following questions: How important is the study of globalization ?, What has produced important contributions in the scientific community about globalization? And What are the perspectives or approaches addressed? . This work aims to show how the scientific community has produced knowledge about this phenomenon addressing the political, economic and social approaches: From the economic point of view reconfigures how to address the processes of production, distribution and consumption of goods and services in the world, permeating this way all international economic events. From the political point of view, besides the redistribution of emerging geopolitical blocs, it establishes a new category of state, transnational state. From the social point of view, it shows evidence of the negative effects of globalization on resizing the category personal, local or regional or even in global risk-Global group. The research is documentary literature, their contribution to social science evidence to characterize globalization as political, economic and social phenomenon of the century that permeates all areas of study applied.

  16. Importance of Metastatic Lymph Node Ratio in Non-Metastatic, Lymph Node-Invaded Colon Cancer: A Clinical Trial (United States)

    Isik, Arda; Peker, Kemal; Firat, Deniz; Yilmaz, Bahri; Sayar, Ilyas; Idiz, Oguz; Cakir, Coskun; Demiryilmaz, Ismail; Yilmaz, Ismayil


    Background The aim of this study was to evaluate the prognostic importance of the metastatic lymph node ratio for stage III colon cancer patients and to find a cut-off value at which the overall survival and disease-free survival change. Material/Methods Patients with pathological stage III colon cancer were retrospectively evaluated for: age; preoperative values of Crp, Cea, Ca 19-9, and Afp; pathologic situation of vascular, perineural, lymphatic, and serosal involvement; and metastatic lymph node ratio values were calculated. Results The study included 58 stage III colon cancer patients: 20 (34.5%) females and 38 (65.5%) males were involved in the study. Multivariate analysis was applied to the following variables to evaluate significance for overall survival and disease-free survival: age, Crp, Cea, perineural invasion, and metastatic lymph node ratio. The metastatic lymph node ratio (<0.25 or ≥0.25) is the only independent variable significant for overall and disease-free survival. Conclusions Metastatic lymph node ratio is an ideal prognostic marker for stage III colon cancer patients, and 0.25 is the cut-off value for prognosis. PMID:25087904

  17. Raynaud’s phenomenon in the rheumatologist’s practice

    Directory of Open Access Journals (Sweden)

    R.T. Alekperov


    Full Text Available Raynaud’s phenomenon (RP is a common condition that predominantly occurs among women. The onset age in most cases is under 30 years. The phenomenon was first described by M. Raynaud over 150 years ago. Primary (Raynaud’s disease and secondary RP were subsequently distinguished. Pathophysiology of RP has not been fully elucidated yet; RP seems to be a multifactor disease. A pronounced vasospasm in response to stimuli is believed to be caused by disruption in the central and local mechanisms of regulation of vascular tonus. Vascular endothe- lial, intravascular, and neuronal disorders are the key ones among these factors. Structural changes in vessels that can be observed by nailfold capillaroscopy play a significant role in pathophysiology of secondary RP. The key step in the diagnosis of RP is identifying its clinical variant, since secondary RP may be a sign or a premonitory symptom of certain autoimmune, hematologic, endocrine, neoplastic, and other disorders. Secondary RP is most frequently observed in patients with systemic rheumatoid diseases. Therapy of secondary RP provides no satisfactory out- comes, since there is no complete conception about the pathophysiological mechanisms of its development. Different groups of drugs are cur- rently used to treat RP, including calcium channels blockers, phosphodiesterase type 5 inhibitors, endothelin receptor antagonists, etc. This review focuses on pathogenesis, the algorithm of early and differential diagnosis of RP, and current approaches to therapy based on the analysis of the published and our own data. 

  18. Raynaud’s phenomenon in the rheumatologist’s practice

    Directory of Open Access Journals (Sweden)

    R.T. Alekperov


    Full Text Available Raynaud’s phenomenon (RP is a common condition that predominantly occurs among women. The onset age in most cases is under 30 years. The phenomenon was first described by M. Raynaud over 150 years ago. Primary (Raynaud’s disease and secondary RP were subsequently distinguished. Pathophysiology of RP has not been fully elucidated yet; RP seems to be a multifactor disease. A pronounced vasospasm in response to stimuli is believed to be caused by disruption in the central and local mechanisms of regulation of vascular tonus. Vascular endothe- lial, intravascular, and neuronal disorders are the key ones among these factors. Structural changes in vessels that can be observed by nailfold capillaroscopy play a significant role in pathophysiology of secondary RP. The key step in the diagnosis of RP is identifying its clinical variant, since secondary RP may be a sign or a premonitory symptom of certain autoimmune, hematologic, endocrine, neoplastic, and other disorders. Secondary RP is most frequently observed in patients with systemic rheumatoid diseases. Therapy of secondary RP provides no satisfactory out- comes, since there is no complete conception about the pathophysiological mechanisms of its development. Different groups of drugs are cur- rently used to treat RP, including calcium channels blockers, phosphodiesterase type 5 inhibitors, endothelin receptor antagonists, etc. This review focuses on pathogenesis, the algorithm of early and differential diagnosis of RP, and current approaches to therapy based on the analysis of the published and our own data. 

  19. The Phenomenon of Climate Change in Organization and HR- Related Literature: A Conceptual Brief Analysis

    Directory of Open Access Journals (Sweden)

    Mousa Mohamed


    Full Text Available Climate change has become one of the main challenges facing humanity. Over the past decade, this phenomenon, which may have been caused by natural variability and/or human activity, has attracted many scholars from different scientific disciplines to warn of its potential consequences. The author of this paper has decided to address the existence of this important phenomenon in organizational literature. However, upon exploring different academic databases, the rarity of research focusing on climate change and its relationship and/or effect on HR or organizational aspects became obvious. Accordingly, the author recommends other HR and organizational scholars devote considerable space to this phenomenon in their field.

  20. Effect of Erica sp. Honey against Microorganisms of Clinical Importance: Study of the Factors Underlying this Biological Activity

    Directory of Open Access Journals (Sweden)

    Leticia M. Estevinho


    Full Text Available This study aimed to determine the factors (phenolic compounds, flavonoids, sugars or H2O2 that contribute the most to the antimicrobial activity of heather honey samples against four yeasts and four bacteria with medical importance. To discard the effect of H2O2 in the antimicrobial activity, catalase was added. To evaluate the osmotic pressure’s effect, artificial honey was also used. Phenolic compounds and flavonoids were determined and Pearson’s correlation analysis was performed to assess whether these correlated with antimicrobial activity. The amount of phenolic compounds ranged from 630.89 ± 5.21 GAE kg−1 to 718.92 ± 4.41 GAE kg−1, while the flavonoids varied between 450.72 ± 5.67 CAE kg−1 and 673.98 ± 4.33 CAE kg−1. For the bacteria, the minimum inhibitory concentration (MIC of the honey without catalase ranged from 1.01 ± 0.50% to 10.00 ± 4.72% and was between 2.00 ± 0.94% and 13.27 ± 5.23% for honey with catalase. Concerning the yeasts, the MICs was between 13.16 ± 4.08% and 20.00 ± 5.09% for honey without catalase and between 14.95 ± 4.16% and 25.67 ± 5.50% for honey with catalase. The elucidation of the antimicrobial factors and action mechanisms is essential for the correct use of honey in therapeutic applications.

  1. The Hurst Phenomenon in Error Estimates Related to Atmospheric Turbulence (United States)

    Dias, Nelson Luís; Crivellaro, Bianca Luhm; Chamecki, Marcelo


    The Hurst phenomenon is a well-known feature of long-range persistence first observed in hydrological and geophysical time series by E. Hurst in the 1950s. It has also been found in several cases in turbulence time series measured in the wind tunnel, the atmosphere, and in rivers. Here, we conduct a systematic investigation of the value of the Hurst coefficient H in atmospheric surface-layer data, and its impact on the estimation of random errors. We show that usually H > 0.5 , which implies the non-existence (in the statistical sense) of the integral time scale. Since the integral time scale is present in the Lumley-Panofsky equation for the estimation of random errors, this has important practical consequences. We estimated H in two principal ways: (1) with an extension of the recently proposed filtering method to estimate the random error (H_p ), and (2) with the classical rescaled range introduced by Hurst (H_R ). Other estimators were tried but were found less able to capture the statistical behaviour of the large scales of turbulence. Using data from three micrometeorological campaigns we found that both first- and second-order turbulence statistics display the Hurst phenomenon. Usually, H_R is larger than H_p for the same dataset, raising the question that one, or even both, of these estimators, may be biased. For the relative error, we found that the errors estimated with the approach adopted by us, that we call the relaxed filtering method, and that takes into account the occurrence of the Hurst phenomenon, are larger than both the filtering method and the classical Lumley-Panofsky estimates. Finally, we found that there is no apparent relationship between H and the Obukhov stability parameter. The relative errors, however, do show stability dependence, particularly in the case of the error of the kinematic momentum flux in unstable conditions, and that of the kinematic sensible heat flux in stable conditions.

  2. Modeling the Pineapple Express phenomenon via Multivariate Extreme Value Theory (United States)

    Weller, G.; Cooley, D. S.


    The pineapple express (PE) phenomenon is responsible for producing extreme winter precipitation events in the coastal and mountainous regions of the western United States. Because the PE phenomenon is also associated with warm temperatures, the heavy precipitation and associated snowmelt can cause destructive flooding. In order to study impacts, it is important that regional climate models from NARCCAP are able to reproduce extreme precipitation events produced by PE. We define a daily precipitation quantity which captures the spatial extent and intensity of precipitation events produced by the PE phenomenon. We then use statistical extreme value theory to model the tail dependence of this quantity as seen in an observational data set and each of the six NARCCAP regional models driven by NCEP reanalysis. We find that most NCEP-driven NARCCAP models do exhibit tail dependence between daily model output and observations. Furthermore, we find that not all extreme precipitation events are pineapple express events, as identified by Dettinger et al. (2011). The synoptic-scale atmospheric processes that drive extreme precipitation events produced by PE have only recently begun to be examined. Much of the current work has focused on pattern recognition, rather than quantitative analysis. We use daily mean sea-level pressure (MSLP) fields from NCEP to develop a "pineapple express index" for extreme precipitation, which exhibits tail dependence with our observed precipitation quantity for pineapple express events. We build a statistical model that connects daily precipitation output from the WRFG model, daily MSLP fields from NCEP, and daily observed precipitation in the western US. Finally, we use this model to simulate future observed precipitation based on WRFG output driven by the CCSM model, and our pineapple express index derived from future CCSM output. Our aim is to use this model to develop a better understanding of the frequency and intensity of extreme

  3. Minimal clinically important improvement (MCII) and patient-acceptable symptom state (PASS) in total hip arthroplasty (THA) patients 1 year postoperatively

    DEFF Research Database (Denmark)

    Paulsen, Aksel; Roos, Ewa M.; Pedersen, Alma Becic


    -55% improvement from mean baseline PRO score and PASSs corresponded to absolute follow-up scores of 57-91% of the maximum score in THA patients 1 year after surgery. Interpretation - This study improves the interpretability of PRO scores. The different estimation approaches presented may serve as a guide......Background and purpose - The increased use of patient-reported outcomes (PROs) in orthopedics requires data on estimated minimal clinically important improvements (MCIIs) and patient-acceptable symptom states (PASSs). We wanted to find cut-points corresponding to minimal clinically important PRO...... change score and the acceptable postoperative PRO score, by estimating MCII and PASS 1 year after total hip arthroplasty (THA) for the Hip Dysfunction and Osteoarthritis Outcome Score (HOOS) and the EQ-5D. Patients and methods - THA patients from 16 different departments received 2 PROs and additional...

  4. The Importance of Integrating Clinical Relevance and Statistical Significance in the Assessment of Quality of Care--Illustrated Using the Swedish Stroke Register.

    Directory of Open Access Journals (Sweden)

    Anita Lindmark

    Full Text Available When profiling hospital performance, quality inicators are commonly evaluated through hospital-specific adjusted means with confidence intervals. When identifying deviations from a norm, large hospitals can have statistically significant results even for clinically irrelevant deviations while important deviations in small hospitals can remain undiscovered. We have used data from the Swedish Stroke Register (Riksstroke to illustrate the properties of a benchmarking method that integrates considerations of both clinical relevance and level of statistical significance.The performance measure used was case-mix adjusted risk of death or dependency in activities of daily living within 3 months after stroke. A hospital was labeled as having outlying performance if its case-mix adjusted risk exceeded a benchmark value with a specified statistical confidence level. The benchmark was expressed relative to the population risk and should reflect the clinically relevant deviation that is to be detected. A simulation study based on Riksstroke patient data from 2008-2009 was performed to investigate the effect of the choice of the statistical confidence level and benchmark value on the diagnostic properties of the method.Simulations were based on 18,309 patients in 76 hospitals. The widely used setting, comparing 95% confidence intervals to the national average, resulted in low sensitivity (0.252 and high specificity (0.991. There were large variations in sensitivity and specificity for different requirements of statistical confidence. Lowering statistical confidence improved sensitivity with a relatively smaller loss of specificity. Variations due to different benchmark values were smaller, especially for sensitivity. This allows the choice of a clinically relevant benchmark to be driven by clinical factors without major concerns about sufficiently reliable evidence.The study emphasizes the importance of combining clinical relevance and level of statistical

  5. The Importance of Integrating Clinical Relevance and Statistical Significance in the Assessment of Quality of Care--Illustrated Using the Swedish Stroke Register. (United States)

    Lindmark, Anita; van Rompaye, Bart; Goetghebeur, Els; Glader, Eva-Lotta; Eriksson, Marie


    When profiling hospital performance, quality inicators are commonly evaluated through hospital-specific adjusted means with confidence intervals. When identifying deviations from a norm, large hospitals can have statistically significant results even for clinically irrelevant deviations while important deviations in small hospitals can remain undiscovered. We have used data from the Swedish Stroke Register (Riksstroke) to illustrate the properties of a benchmarking method that integrates considerations of both clinical relevance and level of statistical significance. The performance measure used was case-mix adjusted risk of death or dependency in activities of daily living within 3 months after stroke. A hospital was labeled as having outlying performance if its case-mix adjusted risk exceeded a benchmark value with a specified statistical confidence level. The benchmark was expressed relative to the population risk and should reflect the clinically relevant deviation that is to be detected. A simulation study based on Riksstroke patient data from 2008-2009 was performed to investigate the effect of the choice of the statistical confidence level and benchmark value on the diagnostic properties of the method. Simulations were based on 18,309 patients in 76 hospitals. The widely used setting, comparing 95% confidence intervals to the national average, resulted in low sensitivity (0.252) and high specificity (0.991). There were large variations in sensitivity and specificity for different requirements of statistical confidence. Lowering statistical confidence improved sensitivity with a relatively smaller loss of specificity. Variations due to different benchmark values were smaller, especially for sensitivity. This allows the choice of a clinically relevant benchmark to be driven by clinical factors without major concerns about sufficiently reliable evidence. The study emphasizes the importance of combining clinical relevance and level of statistical confidence when

  6. Social capital among healthcare professionals: A prospective study of its importance for job satisfaction, work engagement and engagement in clinical improvements. (United States)

    Strömgren, Marcus; Eriksson, Andrea; Bergman, David; Dellve, Lotta


    Social capital can be an important resource to facilitate the needed improvements in quality of care and efficiency in hospitals. To assess the importance of social capital (recognition, vertical trust, horizontal trust and reciprocity) for job satisfaction, work engagement and engagement in clinical improvements. A prospective cohort design was used. Intensive care units and emergency, surgical and medical units at five Swedish hospitals with ongoing development of their processes of care. Healthcare professionals (physicians, registered nurses, assistant nurses) at five Swedish midsize hospitals. The participants answered a questionnaire at two occasions, NN=1602 at baseline and NN=1548 at one-year follow-up. Mean hospital response rate was 53% at baseline and 59% at follow-up. Univariate, multivariate and logistic regression analyses were performed, and the prospective analysis was based on 477 respondents. Social capital was associated with healthcare professionals' general work engagement and job satisfaction. Analysis showed positive associations between all measured aspects of social capital and engagement in clinical improvements of patient safety and quality of care. The prospective analysis showed that increased social capital predicted increased job satisfaction, work engagement and engagement in clinical improvements of patient safety. Social capital is strongly related to job satisfaction and active engagement with clinical improvements. The findings contribute to a deeper knowledge of social capital as a predictive factor that influences patient safety and health among healthcare staff. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Defining patient-based minimal clinically important effect sizes: a study in palliative radiotherapy for painful unresectable pelvic recurrences from rectal cancer

    International Nuclear Information System (INIS)

    Wong, Rebecca K.S.; Gafni, Amiram; Whelan, Tim; Franssen, Edmee; Fung, Karen


    Purpose: To measure patient-based minimal clinically important effect sizes (minimal incremental benefit that an individual would require to accept one treatment option over another) for pain relief between two contrasting palliative radiotherapy regimens for painful pelvic recurrences from rectal cancer. Methods and Materials: Forty-three patients with a history of cancer pain without prior pelvic radiotherapy participated in decision aid-facilitated trade-off exercises. The clinical scenario and treatment options of a 5-day vs. a 20-day course of radiotherapy were described. The duration of pain relief for the 20-day regimen was increased until the respondents' preferences switched to the 20-day regimen. The exercises were repeated for different probabilities of benefit and pain intensity at the time of decision making. Results: When the probability of pain relief was unchanged, the median switch point for the duration of pain relief was 6.7 and 7.2 months for severe and mild pain, respectively. The cumulative percentage frequency curve for the switch points approximated a sigmoid distribution. Conclusion: Determining the minimal clinically important effect sizes for symptom relief for palliative therapies is feasible. This type of information can be used to incorporate patient values into clinical trial designs. Modification of this method can be used to improve our understanding of shared (physician and patient) decision making

  8. Seizure freedom after lamotrigine rash: a peculiar phenomenon in epilepsy. (United States)

    Kakisaka, Yosuke; Jin, Kazutaka; Kato, Kazuhiro; Iwasaki, Masaki; Nakasato, Nobukazu


    A 57-year-old right-handed woman with a history of left frontal lobe stroke had experienced episodes of language-expression difficulty followed by paraphasia lasting for approximately 30 seconds two years earlier. She was diagnosed with left frontal lobe epilepsy, and a lamotrigine regimen was initiated. This treatment had to be stopped five weeks after initiation because she developed a rash, and her drug lymphocyte stimulation test result was positive. Interestingly, she has since remained seizure free without requiring any antiepileptic medications. This adult case with a peculiar clinical course provides support for the hypothesis of immunomodulation process involvement in epilepsy, a phenomenon that was previously mainly seen in pediatric patients.

  9. A importância da qualidade da água reagente no laboratório clínico The importance of water quality in clinical laboratory reagent

    Directory of Open Access Journals (Sweden)

    Maria Elizabete Mendes


    Full Text Available A água é um reagente utilizado na maioria dos testes laboratoriais e por isso deve seguir um padrão de controle de qualidade rigoroso. O fornecimento urbano de água apresenta moléculas orgânicas, íons inorgânicos, partículas, coloides, gases, bactérias e seus produtos, que podem alterar os resultados dos exames laboratoriais e causar eventuais erros e falhas mecânicas em equipamentos analíticos. Para remover essas impurezas, é necessário recorrer a uma combinação de tecnologias de purificação. Há várias organizações que especificam normas sobre a água reagente, a fim de minimizar sua interferência nos ensaios laboratoriais. A maioria dos laboratórios utiliza as normas estabelecidas pelo Clinical and Laboratory Standards Institute (CLSI que classifica a água em: clinical laboratory reagent water (CLRW, special reagent water (SRW e instrumental feed water (IFW. O monitoramento da qualidade é realizado pela determinação de resistividade, condutividade, carbono orgânico total (TOC, controle microbiológico e endotoxinas. Os parâmetros são avaliados de acordo com a periodicidade estabelecida pela norma utilizada. Neste artigo, discutem-se a importância da água utilizada nos procedimentos laboratoriais, o controle da qualidade e as interferências nos ensaios laboratoriais.Water is a reagent used in most laboratory tests and, therefore, must follow stringent quality control standards. The urban water supply has organic molecules, inorganic ions, particles, colloids, gases, bacteria and their products, which may alter laboratory test results and cause occasional errors and mechanical failures in diagnostic equipment. To remove these impurities, it is necessary to use a combination of purification technologies. There are several organizations that specify reagent water standards to minimize its interference in laboratory assays. Most laboratories set standards established by the Clinical and Laboratory Standards

  10. Priming intelligent behavior: an elusive phenomenon.

    Directory of Open Access Journals (Sweden)

    David R Shanks

    Full Text Available Can behavior be unconsciously primed via the activation of attitudes, stereotypes, or other concepts? A number of studies have suggested that such priming effects can occur, and a prominent illustration is the claim that individuals' accuracy in answering general knowledge questions can be influenced by activating intelligence-related concepts such as professor or soccer hooligan. In 9 experiments with 475 participants we employed the procedures used in these studies, as well as a number of variants of those procedures, in an attempt to obtain this intelligence priming effect. None of the experiments obtained the effect, although financial incentives did boost performance. A Bayesian analysis reveals considerable evidential support for the null hypothesis. The results conform to the pattern typically obtained in word priming experiments in which priming is very narrow in its generalization and unconscious (subliminal influences, if they occur at all, are extremely short-lived. We encourage others to explore the circumstances in which this phenomenon might be obtained.

  11. Informal worker phenomenon in housing construction project (United States)

    Wijayaningtyas, Maranatha; Sipan, Ibrahim; Lukiyanto, Kukuh


    The informal workers phenomenon on housing construction projects in Indonesia is different from workers in other sectors who would always request as permanent employees. Substantively, the informal workers are disinclined to be bound as permanent employees which different from the general labor paradigm. Hence, the objective of this study is to find out how the labour selection process, the factors that affected their performance, and the suitable wage system to achieve the target completion of housing construction project. The qualitative method is used to uncover and understand the meaning behind the phenomena (numina) of informal workers action and their influence on housing construction project which called phenomenological approach. Five informal workers and two project managers were selected as informants based on predetermined criteria with in-depth interviews. The results showed that the informal worker were more satisfied with the wage based on unit price while working in the housing construction project for the flexibility in working hours. In addition, the developer was also relieved because they only control the quality and the achievement of the project completion time which supported by informal worker leader. Therefore, these findings are beneficial for both of developer and government as policy maker to succeed the housing program in Indonesia.

  12. Virtual reality as a social phenomenon

    Directory of Open Access Journals (Sweden)

    Markova T. V.


    Full Text Available the article is devoted to the study of virtual reality as a social phenomenon. Through an appeal to the past, its genesis is analyzed, as well as its significance in modern realities. The latter is viewed from both a social and a personal point of view. Comparing the number of supporters of virtual communication with the number of people of conservative views, conclusions are drawn about the tendency to depart from the usual communication. It allows to assert that the problem of the termination of live communication is relevant to this day. Inferences allow us to assert that the problem of replacing real communication is different. After looking at the positive consequences, the introduction of the mind into virtual reality, it is affirmed that there are good sides to this action. Through analysis, the causes of entering the World Wide Web are generated. In conclusion, the question is raised about the need for virtual reality in everyday life, its problems, as well as the prospects for development.

  13. Klein tunneling phenomenon with pair creation process (United States)

    Wu, G. Z.; Zhou, C. T.; Fu, L. B.


    In this paper, we study the Klein tunneling phenomenon with electron-positron pair creation process. Pairs can be created from the vacuum by a supercritical single-well potential (for electrons). In the time region, the time-dependent growth pattern of the created pairs can be characterized by four distinct regimes which can be considered as four different statuses of the single well. We find that if positrons penetrate the single well by Klein tunneling in different statuses, the total number of the tunneling positrons will be different. If Klein tunneling begins at the initial stage of the first status i.e. when the sing well is empty, the tunneling process and the total number of tunneling positrons are similar to the traditional Klein tunneling case without considering the pair creation process. As the tunneling begins later, the total tunneling positron number increases. The number will finally settle to an asymptotic value when the tunneling begins later than the settling-down time t s of the single well which has been defined in this paper.

  14. The Sexting Phenomenon in Spanish Nursing Students. (United States)

    Gutiérrez-Puertas, Vanesa; Gutiérrez-Puertas, Lorena; Aguilera-Manrique, Gabriel; Baños-Martín, María Del Mar; Granados-Gámez, Genoveva; Márquez-Hernández, Verónica V


    One of the adverse effects arising among young people who engage in various social practices is the phenomenon of sexting. Sexting involves the production and delivery of sexual content voluntarily and freely and, in many cases, without the consent of the recipient. The aim of this study was to describe the presence of sexting in undergraduate students at the College of Nursing of the University of Almeria in Spain. It is a descriptive cross-sectional quantitative study. A total of 105 undergraduate nursing students completed the sexuality and technology questionnaire. The questionnaire consists of seven dimensions with 59 items. Depending on size, statistically significant differences between the use of social networks and the dimension "sexting actions completed" and the dimension "position on statements about sexting" were found. No statistically significant differences between gender and the practice of sexting were found. The three main reasons for sexting match in both genders, these being "to draw attention," "as a sexy gift," and "to feel sexy." Nursing students associated behaviors to show sexting, being a standard practice, common in both genders. Future research should consider the possible influence of this behavior on future professionals and on the field of nursing.

  15. The Outsider Phenomenon in Teenage Groups

    Directory of Open Access Journals (Sweden)

    Kuminskya E.A.


    Full Text Available The article is devoted to the problem of outsidership in groups of younger and older adolescents. We assumed that there are personal qualities that distinguish outsiders from other students, which allows us to speak of outsidership as a separate group and personal phenomenon. The study involved 246 students of Moscow schools of younger and older adolescents, 60 of whom took an outsider position in the group. To test the hypothesis were used: a personal questionnaire for adolescents HSPQ (R. Cattell, questionnaire Emin to determine the level of emotional intelligence (D.V. Lyusin, the technique of " Suggestibility " (O.E. Rybakov. To identify statistical differences, the Student's t-test and the Mann-Whitney U-test were used, p ≤ 0.05. The results of the study showed that outsiders of adolescence are indeed characterized by a number of personal characteristics that distinguish them from their peers. Differences in personal characteristics of outsiders at different stages of adolescence have their own characteristics.

  16. Lung tissue mechanics as an emergent phenomenon. (United States)

    Suki, Béla; Bates, Jason H T


    The mechanical properties of lung parenchymal tissue are both elastic and dissipative, as well as being highly nonlinear. These properties cannot be fully understood, however, in terms of the individual constituents of the tissue. Rather, the mechanical behavior of lung tissue emerges as a macroscopic phenomenon from the interactions of its microscopic components in a way that is neither intuitive nor easily understood. In this review, we first consider the quasi-static mechanical behavior of lung tissue and discuss computational models that show how smooth nonlinear stress-strain behavior can arise through a percolation-like process in which the sequential recruitment of collagen fibers with increasing strain causes them to progressively take over the load-bearing role from elastin. We also show how the concept of percolation can be used to link the pathologic progression of parenchymal disease at the micro scale to physiological symptoms at the macro scale. We then examine the dynamic mechanical behavior of lung tissue, which invokes the notion of tissue resistance. Although usually modeled phenomenologically in terms of collections of springs and dashpots, lung tissue viscoelasticity again can be seen to reflect various types of complex dynamic interactions at the molecular level. Finally, we discuss the inevitability of why lung tissue mechanics need to be complex.

  17. Empirical Study on the Creative Accounting Phenomenon

    Directory of Open Access Journals (Sweden)

    Cernusca Lucian


    Full Text Available The present study aims to analyze the accounting professionals’ point of view as opposed to the students and master students’ one, regarding the creative accounting phenomenon existence and manifestation forms. In order to accomplish this objective, there has been used the poll/investigation, as a research method and the questionnaire, as a research instrument. Within the study, there is suggested the testing of more hypotheses that contribute to the clarifying of the aspects wished to be analyzed through the research. These hypotheses’ acceptance or rejection is based on the „chi-square“ (Karl Pearson statistical test and rank ordering method. Trying to elaborate a global conclusion of the questionnaire, there could be noticed the fact that over 50% from the questioned accounting students are not tempted to use the creative accounting practices and techniques in order to optimize the taxation without breaking the actual law regulations. At the opposite side, more than a half from the questioned accounting professionals would use these practices without breaking the law regulations that lead to the taxation’s optimization. The creative accounting has a negative connotation if the accurate image of the financial position and of the performance is not targeted because it represents the essential factor for elaborating and grounding the accounting policies. However, the positive side of the creative accounting is not excluded, given that one appeals to the „fair“ professional judgment of the accounting professionals and to the good faith of managers.

  18. Mapping The Phenomenon Of Students’ Entrepreneurial Intention

    Directory of Open Access Journals (Sweden)

    Yud Buana


    Full Text Available This research mapped the phenomena that occured in students who are taking classes entrepreneurship that was limited by entrepreneurial knowledge, personal attitude, social norms and self-efficacy. Using descriptive statistics on the answers of 794 respondents, who were students of Bina Nusantara University, produced a variety of results. Based on entrepreneurial knowledge, students still felt hesitant to be able to start and run the entrepreneurial process. On the other hand, self-efficacy and personal attitude reflect a positive thing associated, while the support of family and the environment around where they livevalued invariety. Although this research discovered phenomenon using all the attributes having impacts on entrepreneurship intention, potential students who are properly trained have a probability of playing a leading role in this regard. The benefits that can be expected from this research are useful in identifying suitable students for any entrepreneurial activity in the future with the support of educational institutions, families, and the government as a whole to form the atmosphere of an entrepreneurial culture.

  19. Evolution as a molecular cooperative phenomenon

    International Nuclear Information System (INIS)

    Chela-Flores, J.


    We discuss an hypothesis according to which microscopic mechanisms due to cooperation, at the molecular level, may have been key factors in the evolution of life on Earth. We view our hypothesis as a natural extension to the molecular level of viewing cooperation (symbiosis) as an evolutionary driving force; this does not restrict the interpretation of the evolutionary process to be the result of slow accumulation of mutations in the DNA. Some evidence supporting this hypothesis is discussed: (a) The Salam enhancement factor. This molecular phenomenon was recently introduced in order to understand the bases of the first unifying principle of biochemistry, namely that transcription of all known genes in prokaryotes, protists, metazoan, and metaphytes are translated into L-amino acids, except for some bacterial membrane proteins. (b) The role that cooperative phenomena may have played in the origin of evolution itself, i.e., in the resolution of Sagan's ultraviolet paradox. (c) The relationship between evolution and the constraints imposed by embryonic development. This is considered from the point of view of molecular cooperative phenomena. (author). Refs

  20. Priming Intelligent Behavior: An Elusive Phenomenon (United States)

    Shanks, David R.; Newell, Ben R.; Lee, Eun Hee; Balakrishnan, Divya; Ekelund, Lisa; Cenac, Zarus; Kavvadia, Fragkiski; Moore, Christopher


    Can behavior be unconsciously primed via the activation of attitudes, stereotypes, or other concepts? A number of studies have suggested that such priming effects can occur, and a prominent illustration is the claim that individuals' accuracy in answering general knowledge questions can be influenced by activating intelligence-related concepts such as professor or soccer hooligan. In 9 experiments with 475 participants we employed the procedures used in these studies, as well as a number of variants of those procedures, in an attempt to obtain this intelligence priming effect. None of the experiments obtained the effect, although financial incentives did boost performance. A Bayesian analysis reveals considerable evidential support for the null hypothesis. The results conform to the pattern typically obtained in word priming experiments in which priming is very narrow in its generalization and unconscious (subliminal) influences, if they occur at all, are extremely short-lived. We encourage others to explore the circumstances in which this phenomenon might be obtained. PMID:23637732

  1. Temporo-mandibular disorders are an important comorbidity of migraine and may be clinically difficult to distinguish them from tension-type headache

    Directory of Open Access Journals (Sweden)

    Ariovaldo Alberto da Silva Júnior


    Full Text Available Clinical differentiation between the primary headaches and temporomandibular disorders (TMD can be challenging. Objectives : To investigate the relationship between TMD and primary headaches by conducting face to face assessments in patients from an orofacial pain clinic and a headache tertiary center. Method : Sample consists of 289 individuals consecutively identified at a headache center and 78 individuals seen in an orofacial pain clinic because of symptoms suggestive of TMD. Results : Migraine was diagnosed in 79.8% of headache sufferers, in headache tertiary center, and 25.6% of those in orofacial pain clinic (p<0.001. Tension-type headache was present in 20.4% and 46.1%, while the TMD painful occurred in 48.1% and 70.5% respectively (p<0.001. Conclusion : TMD is an important comorbidity of migraine and difficult to distinguish clinically from tension-type headache, and this headache was more frequent in the dental center than at the medical center.

  2. Vacuum phenomenon in the metatarsophalangeal joint of a horse

    International Nuclear Information System (INIS)

    Specht, T.E.; Poulos, P.W.; Metcalf, M.R.; Robertson, I.D.


    Vacuum phenomenon was induced inadvertently during radiographic examination of a metatarsophalangeal joint of a lame horse. The phenomenon was recreated in a sound horse when a metacarpophalangeal joint was radiographed in a stress-flexed position. Distraction of apposing articular surfaces may induce the vacuum phenomenon, which could result in misdiagnosis of an osteochondral defect or fracture

  3. Tyrosine isomers mediate the classical phenomenon of concomitant tumor resistance. (United States)

    Ruggiero, Raúl A; Bruzzo, Juan; Chiarella, Paula; di Gianni, Pedro; Isturiz, Martín A; Linskens, Susana; Speziale, Norma; Meiss, Roberto P; Bustuoabad, Oscar D; Pasqualini, Christiane D


    Concomitant tumor resistance (CR) is a phenomenon originally described in 1906 in which a tumor-bearing host is resistant to the growth of secondary tumor implants and metastasis. Although recent studies have indicated that T-cell-dependent processes mediate CR in hosts bearing immunogenic small tumors, manifestations of CR induced by immunogenic and nonimmunogenic large tumors have been associated with an elusive serum factor. In this study, we identify this serum factor as tyrosine in its meta and ortho isoforms. In three different murine models of cancer that generate CR, both meta-tyrosine and ortho-tyrosine inhibited tumor growth. In addition, we showed that both isoforms of tyrosine blocked metastasis in a fourth model that does not generate CR but is sensitive to CR induced by other tumors. Mechanistic studies showed that the antitumor effects of the tyrosine isoforms were mediated, in part, by early inhibition of mitogen-activated protein/extracellular signal-regulated kinase pathway and inactivation of STAT3, potentially driving tumor cells into a state of dormancy. By revealing a molecular basis for the classical phenomenon of CR, our findings may stimulate new generalized approaches to limit the development of metastases that arise after resection of primary tumors, an issue of pivotal importance to oncologists and their patients. ©2011 AACR

  4. [The knowledge of animal respiration as a combustion phenomenon]. (United States)

    de Micheli, Alfredo


    The different stages leading to knowledge of the phenomenon of animal breathing are going from some writings in Corpus Hippocraticum to Aristoteles' and Galen's works, who considered the heart as the source of the animal heat. Later, Miguel Servet suggested that the inspired air can achieve other functions besides cooling the blood. After that, different explications of the animal heat were raised. About 1770, due to progress of knowledge in the chemistry field, first Mayow and later Black began to consider the animal respiration as a combustion. The important treatise Méthode de nomenclature chimique, published by Guyton de Morveau et al. in 1787 and soon after the Traité élémentaire de chimie de Lavoisier (1789) provided a solid support to Lavoisier's thought. This way on arrived to consider analogous the respiration and combustion phenomena. Studies on the animal respiration phenomenon continued in xix century and in the following century it was possible to apply thermodynamic principles to biology: "generalized thermodynamics". Copyright © 2013 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  5. A suspicious reason for Raynaud's phenomenon: Intrauterine device. (United States)

    Diken, Adem I; Yalçınkaya, Adnan; Aksoy, Eray; Yılmaz, Seyhan; Çağlı, Kerim


    Primary Raynaud's phenomenon may be insistent in patients under medical therapy, and intrauterine devices may be an unnoticed reason in these patients. Fluctuations in female sex hormone status were reported to be associated with the emergence of primary Raynaud's phenomenon symptoms. The use of intrauterine devices was not reported to be associated with Raynaud's phenomenon previously. Intrauterine device may stimulate vascular hyperactivity regarding hormonal or unknown mechanisms that result in Raynaud's phenomenon. We present a postmenopausal patient who complained of primary Raynaud's phenomenon symptoms and had recovery after the removal of her copper intrauterine device. © The Author(s) 2014 Reprints and permissions:

  6. Cognitive approach in studying of entrepreneur phenomenon

    Directory of Open Access Journals (Sweden)

    Kulakovsky T.Yu.


    Full Text Available The research indicates that there is no prospect of searching specific entrepreneurial traits that are necessary for conducting successful entrepreneurial activity. It is pointed on the impossibility to fully explain the negative state of domestic business exclusively by the influence of environmental factors. The paper points on the necessity of concentrating the scientific search on the cognitive features of personality, as factors that contribute to success of entrepreneurial activities. It is revealed that the decision-making process directed on problem-solving in entrepreneurial activity, from an entrepreneurial idea to obtaining an appropriate result, cannot be algorithmized. The author points out on the insufficiency of attempts to model cognitive processes of entrepreneurs, in which their cognitive activity is regarded as an information processing system that resembles a computer. The results obtained in the framework of the cognitive approach in studying the phenomenon of the entrepreneur are analyzed. Particular emphasis is placed on the features of heuristics and cognitive biases. It is stated that the high levels of uncertainty, novelty, time deficit, information overload and emotional tension facilitate influence of cognitive biases on the cognitive processes of the entrepreneur. The role of «availability heuristic», «anchoring and adjustment heuristic», «confirmation bias», «hindsight bias» and self-efficacy in making decisions about starting an entrepreneurial activity are considered. The article points to the role of «belief in the law of small numbers» and the illusion of control in establishing optimistic bias (overly positive self-esteem, excessive optimism about future plans and events that lead to reducing the subjective perception of entrepreneurial risk.

  7. Electron string phenomenon: physics and use (United States)

    Donets, Evgeny D.


    Electron string phenomenon arises as a result of phase transition of a state of multiply reflected electron beam to this new discovered state of one component electron plasma and can be easily observed in the reflex mode of EBIS operation. The transition goes via a strong instability, which causes considerable electron energy spread, which in its turn suppresses the instability. Electron string state is a stationary state of hot pure electron plasma, which is heated by injected electron beam and cooled because of electron loses. Electron string is quiet in broad regions of experimental parameters, so that it is used for confinement and ionization of positive ions by electron impact to highly charge states similar to electron beams in EBIS. Application of electron strings instead of electron beams for ion production allows to save about 99% of electric power of electron beam and simultaneously to improve reliability of an ion source considerably. The JINR EBIS `Krion-2' in the string mode of operation is used for production of N7+, Ar16+ and Fe24+ ion beams and their acceleration to relativistic energies on the facility of the JINR super conducting one turn injection synchrotron `Nuklotron'. The tubular electron string possibly can exist and it is under study now theoretically and experiments are prepared now. Estimations show that a Tubular Electron String Ion Source (TESIS) could have up to three orders of magnitude higher ion output then a Linear one (LESIS). In frames of nuclear astrophysics electron strings can be used for research of fusion nuclear reactions at low energies in conditions when both beam and target nuclei do not carry orbital electrons. The project NARITA — Nuclear Astrophysics Researches in an Ion Trap Apparatus is proposed. Polarization effects also can be studied.

  8. Electron string phenomenon: physics and use

    International Nuclear Information System (INIS)

    Donets, Evgeny D


    Electron string phenomenon arises as a result of phase transition of a state of multiply reflected electron beam to this new discovered state of one component electron plasma and can be easily observed in the reflex mode of EBIS operation. The transition goes via a strong instability, which causes considerable electron energy spread, which in its turn suppresses the instability. Electron string state is a stationary state of hot pure electron plasma, which is heated by injected electron beam and cooled because of electron loses. Electron string is quiet in broad regions of experimental parameters, so that it is used for confinement and ionization of positive ions by electron impact to highly charge states similar to electron beams in EBIS. Application of electron strings instead of electron beams for ion production allows to save about 99% of electric power of electron beam and simultaneously to improve reliability of an ion source considerably. The JINR EBIS 'Krion-2' in the string mode of operation is used for production of N 7+ , Ar 16+ and Fe 24+ ion beams and their acceleration to relativistic energies on the facility of the JINR super conducting one turn injection synchrotron 'Nuklotron'. The tubular electron string possibly can exist and it is under study now theoretically and experiments are prepared now. Estimations show that a Tubular Electron String Ion Source (TESIS) could have up to three orders of magnitude higher ion output then a Linear one (LESIS). In frames of nuclear astrophysics electron strings can be used for research of fusion nuclear reactions at low energies in conditions when both beam and target nuclei do not carry orbital electrons. The project NARITA - Nuclear Astrophysics Researches in an Ion Trap Apparatus is proposed. Polarization effects also can be studied

  9. Shifted identical bands: A new phenomenon

    International Nuclear Information System (INIS)

    Jones, E.F.; Lima, A.P. de; Gore, P.M.; Hamilton, J.H.; Ramayya, A.V.; Dodder, R.S.; Kormicki, J.; Hwang, J.K.; Beyer, C.J.; Zhang, X.Q.; Zhu, S.J.; Ter-Akopian, G.M.; Oganessian, Yu.Ts.; Daniel, A.V.; Rasmussen, J.O.; Lee, I.Y.; Cole, J.D.; Drigert, M.W.; Ma, W.-C.


    The levels in 162 Gd were identified in spontaneous fission studies. Its transition energies are remarkably similar to those in 160 Gd. From that work, an analysis of yrast bands in even-even proton to neutron-rich Ba to Pb nuclei led to the discovery of a new phenomenon, shifted identical bands (SIB). SIBs are yrast bands in neighboring nuclei (a, b) with moments of inertia which are identical when shifted by a constant amount κ, so J 1a (1 + κ) = J 1b , from 2 + to 8 + and higher to 16 + . Out of over 700 comparisons, 55 SIBs were found from stable to the most neutron-rich Ce-W nuclei with |κ-bar| between 1.5% and 13%, where the spread in κ is less than ± 1%, and only four identical bands (κ-bar congruent with 0). As examples, we found for 158 Sm- 160 Gd, κ-bar (-3.2 +0.1 -0.2 )% (where the ± is the total spread in κ from -3.1 to -3.4); 156 Nd- 160 Gd, (-10.6 +0.4 -0.2 )%; 158 Sm- 160 Sm, (3.4 +0.5 -0.3 )%. The J 1 values were fitted to a variable moment of inertia model with parameters J 0 and C whose values correlate with the SIB J 1 values. The SIBs are not correlated either with deformation or with the N p N n product of the IBA model

  10. Weight-based discrimination: an ubiquitary phenomenon? (United States)

    Sikorski, C; Spahlholz, J; Hartlev, M; Riedel-Heller, S G


    Despite strong indications of a high prevalence of weight-related stigmatization in individuals with obesity, limited attention has been given to the role of weight discrimination in examining the stigma obesity. Studies, up to date, rely on a limited basis of data sets and additional studies are needed to confirm the findings of previous studies. In particular, data for Europe are lacking, and are needed in light of a recent ruling of the European Court of Justice that addressed weight-based discrimination. The data were derived from a large representative telephone survey in Germany (n=3003). The dependent variable, weight-based discrimination, was assessed with a one-item question. The lifetime prevalence of weight discrimination across different sociodemographic variables was determined. Logistic regression models were used to assess the association of independent and dependent variables. A sub-group analysis was conducted analyzing all participants with a body mass index ⩾25 kg m(-)(2). The overall prevalence of weight-based discrimination was 7.3%. Large differences, however, were observed regarding weight status. In normal weight and overweight participants the prevalence was 5.6%, but this number doubled in participants with obesity class I (10.2%), and quadrupled in participants with obesity class II (18.7%) and underweight (19.7%). In participants with obesity class III, every third participant reported accounts of weight-based discrimination (38%). In regression models, after adjustment, the associations of weight status and female gender (odds ratio: 2.59, PDiscrimination seems to be an ubiquitary phenomenon at least for some groups that are at special risk, such as heavier individuals and women. Our findings therefore emphasize the need for research and intervention on weight discrimination among adults with obesity, including anti-discrimination legislation.

  11. The Trump phenomenon: An explanation from sociophysics (United States)

    Galam, Serge


    The Trump phenomenon is argued to depart from current populist rise in Europe. According to a model of opinion dynamics from sociophysics the machinery of Trump’s amazing success obeys well-defined counter-intuitive rules. Therefore, his success was in principle predictable from the start. The model uses local majority rule arguments and obeys a threshold dynamics. The associated tipping points are found to depend on the leading collective beliefs, cognitive biases and prejudices of the social group which undertakes the public debate. And here comes the open sesame of the Trump campaign, which develops along two successive steps. During a first moment, Trump’s statement produces a majority of voters against him. But at the same time, according to the model the shocking character of the statement modifies the prejudice balance. In case the prejudice is present even being frozen among voters, the tipping point is lowered at Trump’s benefit. Nevertheless, although the tipping point has been lowered by the activation of frozen prejudices it is instrumental to preserve enough support from openly prejudiced people to be above the threshold. Then, as infuriated voters launch intense debate, occurrence of ties will drive progressively hostile people to shift their voting intention without needing to endorse the statement which has infuriated them. The ongoing debate does drive towards a majority for Trump. The possible Trump victory at November Presidential election is discussed. In particular, the model shows that to eventually win the Presidential election, Trump must not modify his past shocking attitude but to appeal to a different spectrum of frozen prejudices, which are common to both Democrats and Republicans.

  12. Identification of cultured isolates of clinically important yeast species using fluorescent fragment length analysis of the amplified internally transcribed rRNA spacer 2 region

    Directory of Open Access Journals (Sweden)

    Muylaert An


    Full Text Available Abstract Background The number of patients with yeast infection has increased during the last years. Also the variety of species of clinical importance has increased. Correct species identification is often important for efficient therapy, but is currently mostly based on phenotypic features and is sometimes time-consuming and depends largely on the expertise of technicians. Therefore, we evaluated the feasibility of PCR-based amplification of the internally transcribed spacer region 2 (ITS2, followed by fragment size analysis on the ABI Prism 310 for the identification of clinically important yeasts. Results A rapid DNA-extraction method, based on simple boiling-freezing was introduced. Of the 26 species tested, 22 could be identified unambiguously by scoring the length of the ITS2-region. No distinction could be made between the species Trichosporon asteroides and T. inkin or between T. mucoides and T. ovoides. The two varieties of Cryptococcus neoformans (var. neoformans and var. gattii could be differentiated from each other due to a one bp length difference of the ITS2 fragment. The three Cryptococcus laurentii isolates were split into two groups according to their ITS2-fragment lengths, in correspondence with the phylogenetic groups described previously. Since the obtained fragment lengths compare well to those described previously and could be exchanged between two laboratories, an internationally usable library of ITS2 fragment lengths can be constructed. Conclusions The existing ITS2 size based library enables identification of most of the clinically important yeast species within 6 hours starting from a single colony and can be easily updated when new species are described. Data can be exchanged between laboratories.

  13. Integration of DPC and clinical microbiological data in Japan reveals importance of confirming a negative follow-up blood culture in patients with MRSA bacteremia. (United States)

    Miyamoto, Naoki; Yahara, Koji; Horita, Rie; Yano, Tomomi; Tashiro, Naotaka; Morii, Daiichi; Tsutsui, Atsuko; Yaita, Kenichiro; Shibayama, Keigo; Watanabe, Hiroshi


    Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is one of the commonest and most life-threatening of all infectious diseases. The morbidity and mortality rates associated with MRSA bacteremia are higher than those associated with bacteremia caused by other pathogens. A common guideline in MRSA bacteremia treatment is to confirm bacteremia clearance through additional blood cultures 2-4 days after initial positive cultures and as needed thereafter. However, no study has presented statistical evidence of how and to what extent confirming a negative follow-up blood culture impacts clinical outcome. We present this evidence for the first time, by combining clinical microbiological data of blood cultures and the DPC administrative claims database; both had been systematically accumulated through routine medical care in hospitals. We used electronic medical records to investigate the clinical background and infection source in detail. By analyzing data from a university hospital, we revealed how survival curves change when a negative follow-up blood culture is confirmed. We also demonstrated confirmation of a negative culture is significantly associated with clinical outcomes: there was a more than three-fold increase in mortality risk (after adjusting for clinical background) if a negative blood culture was not confirmed within 14 days of the initial positive blood culture. Although we used data from only one university hospital, our novel approach and results will be a basis for future studies in several hospitals in Japan to provide statistical evidence of the clinical importance of confirming a negative follow-up blood culture in bacteremia patients, including those with MRSA infections. Copyright © 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  14. An Assessment in SpondyloArthritis International Society (ASAS)-endorsed definition of clinically important worsening in axial spondyloarthritis based on ASDAS. (United States)

    Molto, Anna; Gossec, Laure; Meghnathi, Bhowmik; Landewé, Robert B M; van der Heijde, Désirée; Atagunduz, Pamir; Elzorkany, Bassel Kamal; Akkoc, Nurullah; Kiltz, Uta; Gu, Jieruo; Wei, James Cheng Chung; Dougados, Maxime


    In a previous phase, 12 draft definitions for clinically important worsening in axial spondyloarthritis (axSpA) were selected, of which 3 were based on absolute changes in Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP (ASDAS). The objective here was to select the best cut-off for ASDAS for clinically important worsening in axSpA for use in clinical trials and observational studies. An international longitudinal prospective study evaluating stable patients with axSpA was conducted. Data necessary to calculate ASDAS were collected at two consecutive visits (spaced 7 days to 6 months). Sensitivity and specificity of the three cut-offs for change in ASDAS were tested against the patient's subjective assessment of worsening as the external standard (ie, the patient reporting that he had worsened and felt a need for treatment intensification). Final selection was made by a consensus and voting procedure among Assessment of SpondyloArthritis International Society (ASAS) members. In total, 1169 patients with axSpA were analysed: 64.8% were male and had a mean age of 41.7 (SD 12.4) years. At the second visit, 127 (10.9%) patients judged their situation as worsened.Sensitivity and specificity for an increase of at least 0.6, 0.9 and 1.1 ASDAS points to detect patient-reported worsening were 0.55 (Se) and 0.91 (Sp), 0.38 (Se) and 0.96 (Sp), and 0.33 (Se) and 0.98 (Sp), respectively. The ASAS consensus was to define clinically important worsening as an increase in ASDAS of at least 0.9 points. This data-driven ASAS consensus process resulted in an ASDAS-based cut-off value defining clinically important worsening in axSpA for use in trials. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  15. Measuring mental health in the clinical setting: what is important to service users? The Mini-Service user Recovery Evaluation scale (Mini-SeRvE). (United States)

    Barber, Joanna M; Parsons, Helen; Wilson, Carol A; Cook, Christopher C H


    Since 2001, a policy of positive mental health recovery has been promoted in the UK, with service user involvement. This has not been easy to implement in the clinical setting. To develop and validate a brief self-report, service user-designed, outcome measure (Mini-SeRvE), for clinical use, including spiritual and religious issues. From the previously developed Service user Recovery Evaluation scale (SeRvE), 15 questions were selected for Mini-SeRvE which was self-completed by 207 people; 100 service users and, for comparison, 107 staff. Results were analysed using SPSS software (SPSS Inc., Chicago, IL). Mini-SeRvE is reliable, Cronbach's alpha 0.852. Correlation with another recovery scale, Mental Health Recovery Measure, was high, r = 0.819. Three reliable subscales emerged; existential well-being (EWB), mental ill-being (MIB) and religious well-being (RWB). Scores of the EWB and MIB subscales were higher for staff, consistent with higher mental well-being. Religious well-being scores were higher in service users, who also rated religion as more important to them. Mini-SeRvE is a valid measure of service user recovery. The importance of religion/spiritual belief for our users is highlighted, this being reflected in the subject matter of Mini-SeRvE. Mini-SeRvE assessments could show individual priorities, evaluate therapy and aid clinical decision-making.

  16. Student travel health and the role of universities and health clinics in New Zealand to prevent imported infections: a cross-sectional study. (United States)

    Neave, Penny E; Nair, Balakrishnan; Heywood, Anita E


    Tertiary students are at risk of acquiring infectious diseases during overseas travel as they visit low-income countries, have low perceptions of risk and are unlikely to access travel health advice. Some will visit friends and relatives abroad, a group identified as disproportionately affected by imported infections. There is no national student travel health policy in NZ. This study aimed to explore travel health training of university-based health providers; academics' practices and perceptions of travel health; reasons for travel and countries visited by NZ university students, their travel health uptake and factors affecting decision making about this. A cross-sectional study consisting of surveys sent in 2014 to university clinics, senior academics and students. Surveys were completed by 251 respondents. Three of nine clinicians had only undertaken a short course in travel health. Competing resources and time constraints in health clinics were amongst the barriers to providing optimal services. Of the senior academics, only 14% were able to confirm their university collaborated with health clinics. Sixty seven percent of students were unaware that clinics provided travel health services and 19% had or intended to seek professional travel health advice. A national policy is warranted involving all stakeholders, utilizing innovative technologies to increase uptake of student travel health services. © International Society of Travel Medicine, 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail:

  17. Importance of diagnostic laboratory methods of beta hemolytic streptococcus group A in comparison with clinical findings in the diagnosis of streptococcal sore throat and unnecessary antibacterial therapy

    Directory of Open Access Journals (Sweden)

    Peiman Eini


    Full Text Available Background: Streptococcus Pyogenes (group A streptococcus, GAS is the most important cause of bacterial pharyngitis in children and adolescents. Acute pharyngitis is one of the most common conditions in all ages but it is most common in children. Over diagnosis of acute pharyngitis represents one of the major causes of antibiotic abuse. The goal of this study is to make an estimate of the frequency of group A streptococcus in sore throat patients in Farshchian hospital emergency department and clinic in Hamadan. Methods: For estimation of the clinical features role in diagnosis of streptococcal sore throat, we took samples of 100 patients with average age of 32.96±29.86 years with sore throat. We took samples from pharynx and used standard methods of bacteriology in order to detect streptococcus. Results: Group A Streptococcus (GAS accounts for 3 percent of all cases of pharyngitis. Clinically, all of the patients had sore throat. The percent breakdowns are as follows: 30% had exudate, 78% had fever, 8% had lymphadenopathy and 7.7 percent of exudative pharyngitis was streptococcal. The cost for unnecessary antibiotic therapy for every single patient who had negative pharynx culture was approximately 32160 Rails. Conclusion: The low frequency of streptococcus pharyngitis in treated patients reveal that diagnosis based on clinical features is not reliable. We recommend use of other diagnostic methods such as Rapid Antigen Detection Tests (RATs. Only reliable and scientific protocols for antibiotic to therapy.

  18. Matrix-assisted laser desorption/ionization-time of flight mass spectrometry: protocol standardization and database expansion for rapid identification of clinically important molds. (United States)

    Paul, Saikat; Singh, Pankaj; Rudramurthy, Shivaprakash M; Chakrabarti, Arunaloke; Ghosh, Anup K


    To standardize the matrix-assisted laser desorption ionization-time of flight mass spectrometry protocols and expansion of existing Bruker Biotyper database for mold identification. Four different sample preparation methods (protocol A, B, C and D) were evaluated. On analyzing each protein extraction method, reliable identification and best log scores were achieved through protocol D. The same protocol was used to identify 153 clinical isolates. Of these 153, 123 (80.3%) were accurately identified by using existing database and remaining 30 (19.7%) were not identified due to unavailability in database. On inclusion of missing main spectrum profile in existing database, all 153 isolates were identified. Matrix-assisted laser desorption ionization-time of flight mass spectrometry can be used for routine identification of clinically important molds.

  19. Powerful Radio Burst Indicates New Astronomical Phenomenon (United States)


    Astronomers studying archival data from an Australian radio telescope have discovered a powerful, short-lived burst of radio waves that they say indicates an entirely new type of astronomical phenomenon. Region of Strong Radio Burst Visible-light (negative greyscale) and radio (contours) image of Small Magellanic Cloud and area where burst originated. CREDIT: Lorimer et al., NRAO/AUI/NSF Click on image for high-resolution file ( 114 KB) "This burst appears to have originated from the distant Universe and may have been produced by an exotic event such as the collision of two neutron stars or the death throes of an evaporating black hole," said Duncan Lorimer, Assistant Professor of Physics at West Virginia University (WVU) and the National Radio Astronomy Observatory (NRAO). The research team led by Lorimer consists of Matthew Bailes of Swinburne University in Australia, Maura McLaughlin of WVU and NRAO, David Narkevic of WVU, and Fronefield Crawford of Franklin and Marshall College in Lancaster, Pennsylvania. The astronomers announced their findings in the September 27 issue of the online journal Science Express. The startling discovery came as WVU undergraduate student David Narkevic re-analyzed data from observations of the Small Magellanic Cloud made by the 210-foot Parkes radio telescope in Australia. The data came from a survey of the Magellanic Clouds that included 480 hours of observations. "This survey had sought to discover new pulsars, and the data already had been searched for the type of pulsating signals they produce," Lorimer said. "We re-examined the data, looking for bursts that, unlike the usual ones from pulsars, are not periodic," he added. The survey had covered the Magellanic Clouds, a pair of small galaxies in orbit around our own Milky Way Galaxy. Some 200,000 light-years from Earth, the Magellanic Clouds are prominent features in the Southern sky. Ironically, the new discovery is not part of these galaxies, but rather is much more distant

  20. Clinical importance of cine-MRI assessment of small bowel motility in patients with chronic intestinal pseudo-obstruction: a retrospective study of 33 patients. (United States)

    Fuyuki, Akiko; Ohkubo, Hidenori; Higurashi, Takuma; Iida, Hiroshi; Inoh, Yumi; Inamori, Masahiko; Nakajima, Atsushi


    Although chronic intestinal pseudo-obstruction (CIPO) is a rare and extremely severe functional digestive disorder, its clinical course and severity show various patterns. We assessed small bowel peristalsis in CIPO patients using cine-MRI (video-motion MRI) and their clinical characteristics to evaluate the clinical importance of performing cine-MRI in patients with this intractable disease. The medical records of 131 patients referred to our institution with a suspected diagnosis of CIPO between 2010 and 2015 were retrospectively evaluated. Thirty-three patients (22 female/11 male; age range 16-79 years) who met the criteria for CIPO and underwent cine-MRI were enrolled. Mean luminal diameter (MLD), contraction ratio (CR), and contraction cycle (CC) were determined and compared with these parameters in healthy volunteers. Clinical outcomes in patients with CIPO were also evaluated. The median follow-up time was 25.2 months (range, 1-65 months). Of the 33 patients with CIPO, 23 (70 %) showed apparently disturbed small intestinal peristalsis, whereas 10 (30 %) did not. The percentage of patients requiring intravenous alimentation was significantly higher (p = 0.03), and the mean serum albumin level was significantly lower (p = 0.04), in patients with than without impaired small intestinal peristalsis. Although both cine-MRI and CT findings in the latter ten cases were within the normal range, MLD and CR differed significantly from healthy volunteers. Cine-MRI is useful in predicting severe clinical features in patients with CIPO, and in detecting slightly impaired small contractility that cannot be detected on CT.

  1. Estimation of minimal clinically important change of the Japanese version of EQ-5D in patients with chronic noncancer pain: a retrospective research using real-world data


    Yoshizawa, Kazutake; Kobayashi, Hisanori; Fujie, Motoko; Ogawa, Yoshimasa; Yajima, Tsutomu; Kawai, Koji


    Background Quality of life (QoL) is routinely assessed and evaluated in medical research. However, in Japan, there is a lack of solid cutoff criteria for evaluating QoL improvement in chronic noncancer pain management. The present study was conducted to identify the minimal clinically important change (MCIC) of the Japanese version of EuroQol-5D 3L(EQ-5D) utility score and numeric rating scale (NRS) with an emphasis on chronic noncancer pain. Methods The data source for this post hoc research...

  2. Importância clínica e laboratorial do volume plaquetário médio The clinical and laboratory importance of mean platelet volume

    Directory of Open Access Journals (Sweden)

    Mariela Granero Farias


    Full Text Available Os índices plaquetários fornecidos pelos analisadores hematológicos são provavelmente os parâmetros mais ignorados pela maioria dos laboratórios clínicos, em virtude da dificuldade de sua padronização. Desses índices, o volume plaquetário médio (VPM vem merecendo destaque por sua grande utilidade, não só em casos de trombose e hemostasia, mas também em uma série de patologias, como diabetes, doenças da tireoide, doenças vasculares, entre outras. O VPM é um parâmetro plaquetário fornecido no hemograma que não gera custos adicionais para o laboratório. Junto com a contagem de plaquetas, ele é um sensível indicador de desordens plaquetárias in vivo, mas pode ser tecnicamente difícil de analisá-lo in vitro por causa dos interferentes pré-analíticos, como tempo de armazenamento da amostra e artefatos gerados pelos anticoagulantes. Neste artigo descrevemos as principais metodologias e seus interferentes na determinação da contagem plaquetária e do VPM, destacando a importância do laboratório de análises clínicas em validar esse parâmetro, proporcionando sua utilização no diagnóstico de desordens hematológicas e de outras patologias.The platelet indices provided by the hematological analyzers are probably the parameters mostly ignored by most clinical laboratories due to standardization difficulties. Among those indices, the mean platelet volume (MPV has stood out due to its usefulness not only in cases of thrombosis and hemostasy, but also in a series of pathologies, such as diabetes, thyroid and vascular diseases, among others. MPV is a platelet parameter provided by the hemogram, which does not represent additional costs to the laboratory. Along with platelet count, it is a sensitive indicator of platelet disorders in vivo. However, it may be technically difficult to analyze it in vitro owing to preanalytical interferences, such as sample storage time and anticoagulant artifacts. In this article we described

  3. Clinical and molecular investigation of a canine distemper outbreak and vector-borne infections in a group of rescue dogs imported from Hungary to Switzerland. (United States)

    Willi, Barbara; Spiri, Andrea M; Meli, Marina L; Grimm, Felix; Beatrice, Laura; Riond, Barbara; Bley, Tim; Jordi, Rolf; Dennler, Matthias; Hofmann-Lehmann, Regina


    Canine distemper virus (CDV) is a major pathogen of dogs and wild carnivores worldwide. In Switzerland, distemper in domestic dogs is rarely reported. In recent years, the import of dogs from Eastern Europe to Switzerland has steadily increased. In the present study, we describe a distemper outbreak in 15 rescue dogs that were imported from Hungary to Switzerland by an animal welfare organisation. The data on vaccination and medical history were recorded (14 dogs), and the samples were collected to investigate CDV and vector-borne infections (13 dogs) and canine parvovirus infection (12 dogs). The dogs were monitored for six months. One dog was euthanised directly after import. Thirteen dogs showed clinical signs after arrival, i.e., diarrhoea (57 %), coughing (43 %) and nasal and/or ocular discharge (21 %); radiographic findings that were compatible with bronchopneumonia were present in four dogs. CDV infection was diagnosed in 11 dogs (85 %); 10 dogs (91 %) tested PCR-positive in conjunctival swabs. Vector-borne infections (Babesia spp., Leishmania infantum, Dirofilaria immitis) were found in 4 dogs (31 %). Three dogs were hospitalized, and six dogs received ambulatory therapy for up to two months until recovery. None of the dogs developed neurological disease. CDV shedding was detected for a period of up to four months. Because dogs were put under strict quarantine until CDV shedding ceased, CDV did not spread to any other dogs. The CDV isolates showed 99 % sequence identity in the HA gene among each other and belonged to the Arctic-like lineage of CDV. The present study highlights the imminent risks of spreading contagious viral and vector-borne infections through the non-selective import of sick dogs and dogs with incomplete vaccination from Eastern Europe. CDV shedding was detected for several months after the cessation of clinical signs, which emphasised the roles of asymptomatic carriers in CDV epidemiology. A long-term follow-up using sensitive PCR and

  4. The paramedian diencephalic syndrome: a dynamic phenomenon. (United States)

    Meissner, I; Sapir, S; Kokmen, E; Stein, S D


    The paramedian diencephalic syndrome is characterized by a clinical triad: hypersomnolent apathy, amnesic syndrome, and impaired vertical gaze. We studied 4 cases with computed tomography evidence of bilateral diencephalic infarctions. Each case began abruptly with hypersomnolent apathy followed by fluctuations from appropriate affect, full orientation, and alertness to labile mood, confabulation, and apathy. Speech varied from hypophonia to normal; handwriting varied from legible script to gross scrawl. Psychological testing revealed poor learning and recall, with low performance scores. In 3 patients the predominant abnormality was in downward gaze.

  5. Defining a minimal clinically important difference for endometriosis-associated pelvic pain measured on a visual analog scale: analyses of two placebo-controlled, randomized trials

    Directory of Open Access Journals (Sweden)

    Schmitz Heinz


    Full Text Available Abstract Background When comparing active treatments, a non-inferiority (or one-sided equivalence study design is often used. This design requires the definition of a non-inferiority margin, the threshold value of clinical relevance. In recent studies, a non-inferiority margin of 15 mm has been used for the change in endometriosis-associated pelvic pain (EAPP on a visual analog scale (VAS. However, this value was derived from other chronic painful conditions and its validation in EAPP was lacking. Methods Data were analyzed from two placebo-controlled studies of active treatments in endometriosis, including 281 patients with laparoscopically-confirmed endometriosis and moderate-to-severe EAPP. Patients recorded EAPP on a VAS at baseline and the end of treatment. Patients also assessed their satisfaction with treatment on a modified Clinical Global Impression scale. Changes in VAS score were compared with patients' self-assessments to derive an empirically validated non-inferiority margin. This anchor-based value was compared to a non-inferiority margin derived using the conventional half standard deviation rule for minimal clinically important difference (MCID in patient-reported outcomes. Results Anchor-based and distribution-based MCIDs were-7.8 mm and-8.6 mm, respectively. Conclusions An empirically validated non-inferiority margin of 10 mm for EAPP measured on a VAS is appropriate to compare treatments in endometriosis.

  6. Defining clinically important perioperative blood loss and transfusion for the Standardised Endpoints for Perioperative Medicine (StEP) collaborative: a protocol for a scoping review. (United States)

    Bartoszko, Justyna; Vorobeichik, Leon; Jayarajah, Mohandas; Karkouti, Keyvan; Klein, Andrew A; Lamy, Andre; Mazer, C David; Murphy, Mike; Richards, Toby; Englesakis, Marina; Myles, Paul S; Wijeysundera, Duminda N


    'Standardised Endpoints for Perioperative Medicine' (StEP) is an international collaboration undertaking development of consensus-based consistent definitions for endpoints in perioperative clinical trials. Inconsistency in endpoint definitions can make interpretation of trial results more difficult, especially if conflicting evidence is present. Furthermore, this inconsistency impedes evidence synthesis and meta-analyses. The goals of StEP are to harmonise definitions for clinically meaningful endpoints and specify standards for endpoint reporting in clinical trials. To help inform this endeavour, we aim to conduct a scoping review to systematically characterise the definitions of clinically important endpoints in the existing published literature on perioperative blood loss and transfusion. The scoping review will be conducted using the widely adopted framework developed by Arksey and O'Malley, with modifications from Levac. We refined our methods with guidance from research librarians as well as researchers and clinicians with content expertise. The electronic literature search will involve several databases including Medline, PubMed-not-Medline and Embase. Our review has three objectives, namely to (1) identify definitions of significant blood loss and transfusion used in previously published large perioperative randomised trials; (2) identify previously developed consensus-based definitions for significant blood loss and transfusion in perioperative medicine and related fields; and (3) describe the association between different magnitudes of blood loss and transfusion with postoperative outcomes. The multistage review process for each question will involve two reviewers screening abstracts, reading full-text articles and performing data extraction. The abstracted data will be organised and subsequently analysed in an iterative process. This scoping review of the previously published literature does not require research ethics approval. The results will be used

  7. Enthalpy–entropy compensation: a phantom phenomenon

    Indian Academy of Sciences (India)


    of activation obtained by Johnson and Goldspink (1975) for the temperature dependences of the myofibrillar. ATPases of various fishes, which provides the data for figure 7⋅5 of Gutfreund (1995). To avoid being misled into seeing a real biological relationship where none exists, it is therefore important to understand how ...

  8. Monitoring somatic symptoms in patients with mental disorders: Sensitivity to change and minimal clinically important difference of the Somatic Symptom Scale - 8 (SSS-8). (United States)

    Gierk, Benjamin; Kohlmann, Sebastian; Hagemann-Goebel, Marion; Löwe, Bernd; Nestoriuc, Yvonne


    The SSS-8 is a brief questionnaire for the assessment of somatic symptom burden. This study examines its sensitivity to change and the minimal clinically important difference (MCID) in patients with mental disorders. 55 outpatients with mental disorders completed the SSS-8 and measures of anxiety, depression, and disability before and after receiving treatment. Effect sizes and correlations between the change scores were calculated. The MCID was estimated using a one standard error of measurement threshold and the change in disability as an external criterion. There was a medium decline in somatic symptom burden for the complete sample (n=55, d z =0.53) and a large decline in a subgroup with very high somatic symptom burden at baseline (n=11, d z =0.94). Decreases in somatic symptom burden were associated with decreases in anxiety (r=0.68, pSSS-8 is sensitive to change. A 3-point decrease reflects a clinically important improvement. Due to its brevity and sound psychometric properties, the SSS-8 is useful for monitoring somatic symptom burden. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Importância da avaliação da hemoglobina fetal na clínica da anemia falciforme The importance of the evaluation of fetal hemoglobin in the clinical assessment of sickle cell disease

    Directory of Open Access Journals (Sweden)

    Rita de Cassia Mousinho-Ribeiro


    Full Text Available A anemia falciforme está entre as doenças genéticas mais comuns e mais estudadas em todo o mundo. Ela é causada por mutação no gene β, produzindo alteração estrutural na molécula da hemoglobina. As moléculas de HbS, decorrentes da mutação, sofrem processo de polimerização fisiologicamente provocado pela baixa tensão de oxigênio, acidose e desidratação. Com isso, os eritrócitos passam a apresentar a forma de foice, causando vaso-oclusão e outras conseqüências. O objetivo desse estudo foi revisar a importância da hemoglobina fetal na clínica de pacientes portadores de anemia falciforme. O significado clínico da associação da elevação da hemoglobina fetal na anemia falciforme mostra-se favorável em termos hematológicos, pois, nessa interação, as células-F têm baixas concentrações de HbS e, com isso, inibem a polimerização da HbS e a alteração da morfologia dos eritrócitos. O tratamento com hidroxiuréia, em função do aumento na expressão da hemoglobina fetal que este fármaco proporciona, traz aos pacientes falcêmicos uma melhora significativa em sua clínica. Portanto, a hemoglobina fetal consiste no maior inibidor da polimerização da desoxi-HbS e, com isso, evita a falcização do eritrócito, a anemia hemolítica crônica, as crises dolorosas vaso-oclusivas, o infarto e a necrose em diversos órgãos, melhorando a clínica e a expectativa de vida dos pacientes.Sickle cell disease is one of the commonest and most studied genetic diseases in the world. Caused by a mutation of the β gene, it changes the molecular structure of hemoglobin. Abnormal Hb S molecules suffer polymerization physiologically provoked by a low oxygen tension, acidosis and dehydration. As a result, red blood cells take on a sickle cell form, which causes microvascular occlusion with varying consequences. The objective of this study was to review the importance of fetal hemoglobin in the clinical assessment of sickle cell

  10. Correlation between cytomegalovirus infection and Raynaud's phenomenon in lupus nephritis. (United States)

    Stratta, P; Canavese, C; Ciccone, G; Santi, S; Quaglia, M; Ghisetti, V; Marchiaro, G; Barbui, A; Fop, F; Cavallo, R; Piccoli, G


    Relationships between viruses and autoimmune diseases such as systemic lupus erythematosus (SLE) are still elusive. Recent reports demonstrated the association of some viral infections with peculiar clinical events in the general population, such as cytomegalovirus (CMV) with arterial damage and Parvovirus B19 (PV-B19) with hematologic abnormalities. We planned to look for this kind of viral imprinting in SLE, hypothesizing that traces of specific features of some viral infections might be found in some subsets of seropositive SLE patients. In 60 SLE patients recruited at our nephrologic center, serology for CMV, PV-B19, Epstein-Barr virus viral capsid antigen (EBV-VCA), Epstein-Barr nuclear antigen (EBNA) and Epstein-Barr virus early antigen (EBV-EA) was performed. chi2 and ANOVA were employed to compare the frequency and titers of antiviral antibodies in SLE patients with groups of transplant, hemodialysis and blood donor subjects. chi2, Fisher's test, Bonferroni and Scheffe's test were employed to compare the different biochemical/clinical features between seropositive and seronegative SLE patients. Univariate and multivariate analysis (logistic regression models) were employed to evaluate the odds ratio (OR) of different risk factors for vascular events (including Raynaud's phenomenon, deep venous thrombosis) and hematologic abnormalities (including severe anemia, leukopenia and thrombocytopenia). Anti-CMV (82%), anti-PV-B19 (60%), anti-EBV-VCA (92%) and EBV-EA (45%) IgG antibodies were frequent in SLE, with higher prevalence in comparison with the blood donor group and higher titers in comparison with transplant and hemodialysis groups. CMV seropositivity was a highly significant risk factor for Raynaud's phenomenon (OR +alpha in univariate and multivariate analysis = 13.51 using a correction of 0.5 in case of a zero event), but not for venous vascular events (OR = 1.31). An increased though not significant risk factor was found for antiphospholipid antibodies

  11. Khuzestan dust phenomenon: a content analysis of most widely circulated newspapers. (United States)

    Mojadam, Mehdi; Matlabi, Mohammad; Haji, Alireza; Cheraghi, Maria; Bitaraf, Saeid; Khafaie, Morteza Abdullatif


    Dust is an atmospheric phenomenon that causes adverse environmental effects. It is deemed to have harmful effects on health, economics, and climate. This study aimed to analyze the content published on the phenomenon of dust in the widely circulated newspapers in Iran. We investigated the content of all national and provincial newspapers that were published between July and August 2014. Data on the materials related to the dust phenomenon in the newspapers were categorized and coded. From a total of 510 newspaper issues, 143 articles were devoted to the dust phenomenon which 74.1% of them were published in provincial newspapers. Among the national newspapers, Hamshahri newspaper with 16 headlines and from the provincial newspapers; Karoon with 23 headlines published the highest number of articles on dust phenomenon. 45.5% of content on dust were printed on the first page of the newspapers. The most common approach to the type of content published in these newspapers was an interview. Moreover, we noticed that 28.7% of the content published in the newspapers was related to the health issue. The media plays an important role in the transmission of health information. Weaknesses in addressing the causes of dust occurrence and also in providing solutions for the dust control and prevention were noticeable in the content published in the newspaper. It seems necessary to take practical measures to disseminate relevant information to dust and also address the needs of the target audience community influenced by the dust phenomenon properly.

  12. The Minimally Important Difference for the Fatigue Visual Analog Scale in Patients with Rheumatoid Arthritis followed in an Academic Clinical Practice (United States)

    Khanna, Dinesh; Pope, Janet; Khanna, Puja P.; Maloney, Michelle; Samedi, Nooshin; Norrie, Debbie; Ouimet, Gillian; Hays, Ron D


    Introduction Fatigue is a common symptom in RA and used as an outcome measure in RA clinical trials. We studied a large academic clinical practice to estimate the minimally important difference (MID) for a fatigue visual analog scale using patient-reported anchors (fatigue, pain and overall health). Methods RA patients (N=307) had clinic visits at 2 time points at a median of 5.9 months apart. They completed fatigue visual analog scale (VAS; 0–10) and retrospective anchor items, “How would you describe your overall fatigue/pain/overall health since the last visit?” Much worsened, Somewhat worsened, Same, Somewhat better, or Much better. The fatigue anchor was used for primary analysis and the pain/ overall health anchors for sensitivity analyses. The minimally changed group was defined by those reporting they were somewhat better or somewhat worsened. Results The mean (SD) age was 59.4 (13.2) years, disease duration was 14.1 (11.5) years, and 83% of patients were women. The baseline mean (SD) HAQ-DI score was 0.84 (0.75). The baseline fatigue VAS score was 4.2 (2.9) and at follow up was 4.3 (2.8) (mean change of −0.07 [2.5], p=NS). The fatigue change score (0–10 scale) for somewhat better and somewhat worsened for fatigue anchor averaged −1.12 and 1.26, respectively. Using pain anchor, the fatigue changed score for somewhat better and somewhat worsened averaged −0.87 and 1.13 and using global anchor, the fatigue changed score for somewhat better and somewhat worsened averaged −0.82 and 1.17, respectively. Effect size (ES) estimates using 3 anchors were small for somewhat better (range: 0.27 to 0.39) and somewhat worsened (range: 0.40 to 0.44) groups but larger than the no-change group (range: 0.03 to 0.08). Conclusions The MID for fatigue VAS is between −0.82 to −1.12 for improvement and 1.13 to 1.26 for worsening on 0–10 scale in a large RA clinical practice and similar to that seen in RA clinical trials. This information can aid in

  13. Sessile Drop Evaporation and Leidenfrost Phenomenon


    A. K. Mozumder; M. R. Ullah; A. Hossain; M. A. Islam


    Problem statement: Quenching and cooling are important process in manufacturing industry for controlling the mechanical properties of materials, where evaporation is a vital mode of heat transfer. Approach: This study experimentally investigated the evaporation of sessile drop for four different heated surfaces of Aluminum, Brass, Copper and Mild steel with a combination of four different liquids as Methanol, Ethanol, Water and NaCl solution. The time of evaporation for the droplet on the hot...



    Mijalce Gjorgievski; Sinolicka Melles Trpkova


    At the turn of the century, the tourism industry underwent a transformation triggered by the sweeping processes of globalization. The traditional forms of tourism were supplemented and expanded by the introduction of new postmodern tourist forms, bringing new and different tourist offers to the marketplace. One of these new forms is the film tourism, a rapidly growing and important new tourism trend, in which the choice of the tourist destination is directly motivated and inspired by the movi...

  15. Predictive value of nailfold capillaroscopy in patients with Raynaud's phenomenon. (United States)

    Meli, Madeleine; Gitzelmann, Gabriela; Koppensteiner, Renate; Amann-Vesti, Beatrice R


    The objective of this study was to evaluate the long-term follow-up of patients with Raynaud's phenomenon (RP) and pathological nailfold capillaroscopy (NC) in order to analyse the predictive value of specific features of capillaroscopy for the development of a connective tissue disease (CTD). From 1992 to 2002, NC alone or combined with fluorescence videomicroscopy with sodium fluorescein (NaF) was performed in 1024 consecutive patients because of RP. We analysed the follow-up and pathological features of NC in all patients who had neither clinical nor serological signs of a CTD at the time of NC. Of 308 patients with neither serological findings nor clinical signs of CTD but with RP and pathological features in NC suspicious for CTD, follow-up data were available for 133 patients. An additional NaF test had been performed in 51 (38.4%) patients. After a mean follow-up of 6.5 years (range: 1-15 years), 109 patients had developed a CTD and 24 patients did not show any clinical signs or serological markers for a CTD after a mean follow-up of 8.5 years (range: 2-15 years). There were no differences in age, duration of RP or of follow-up in patients who developed a CTD compared to patients who did not. Significantly more giant capillaries (p=0.0001), avascular fields (p=0.02) and irregular architecture (p=0.0001) had been observed in patients who had developed a CTD during the follow-up of 6.5 years. The presence of giant capillaries, avascular fields and irregular architecture of nailfold capillaries is predictive for the development of a CTD in patients with RP.

  16. The phenomenon of claimed memories of previous lives: possible interpretations and importance. (United States)

    Stevenson, I


    Several disorders or abnormalities observed in medicine and psychology are not explicable (or not fully explicable) by genetics and environmental influences, either alone or together. These include phobias and philias observed in early infancy, unusual play in childhood, homosexuality, gender identity disorder, a child's idea of having parents other than its own, differences in temperament manifested soon after birth, unusual birthmarks and their correspondence with wounds on a deceased person, unusual birth defects, and differences (physical and behavioral) between monozygotic twins. The hypothesis of previous lives can contribute to the further understanding of these phenomena. Copyright 2000 Harcourt Publishers Ltd.

  17. Patient-ventilator trigger dys-synchrony: a common phenomenon with important implications


    MacIntyre, Neil


    Patient-ventilator trigger dys-synchronies are common with the use of assisted forms of mechanical ventilatory support, including non-invasive mechanical ventilatory support (NIV). Future system designs need to address this in order to improve the effectiveness of NIV.

  18. Patients receiving anti-TNF therapies experience clinically important improvements in RA-related fatigue: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. (United States)

    Druce, Katie L; Jones, Gareth T; Macfarlane, Gary J; Basu, Neil


    Pro-inflammatory cytokines such as TNF-α are important in the pathogenesis of fatigue in conditions such as RA. This study aimed to determine whether fatigue improved in a cohort of RA patients with clinically relevant fatigue commencing anti-TNF-α therapy and, if so, to identify predictors of improvement. Participants recruited to a long-term observational cohort study (the British Society for Rheumatology Biologics Register for RA) provided information on fatigue using the 36-item Short Form Health Survey (SF-36) vitality subscale. The prevalence of severe baseline fatigue (SF-36 vitality ≤12.5) was calculated and improvements, considered as (i) absolute values and (ii) improvement from severe to non-severe fatigue (SF-36 vitality >12.5), were examined 6 months subsequently. A comprehensive set of putative predictors of fatigue improvement were evaluated using multivariable logistic regression. In 6835 participants the prevalence of severe baseline fatigue was 38.8%. Of those with severe fatigue, 70% reported clinically relevant improvement and 66% moved to the non-severe fatigue category (i.e. improvers). The mean change for improvers was three times the minimum clinically important difference for improvement (33.0 U). Independent baseline predictors of improvement were female sex [odds ratio (OR) 1.3 (95% CI 1.1, 1.7)], not being unemployed due to ill health [OR 1.5 (95% CI 1.2, 1.7)], low disability [OR 1.2 (95% CI 1.001, 1.5)], seropositivity [OR 1.2 (95% CI 0.98, 1.4)], not using steroids [OR 1.2 (95% CI 1.03, 1.5)], no history of hypertension [OR 1.4 (95% CI 1.1, 1.6)] or depression [OR 1.3 (95% CI 1.1, 1.5)] and good mental health [SF-36 mental health subscale >35; OR 1.4 (95% CI 1.2, 1.7)]. Fatigued RA patients reported substantial improvement in their fatigue after commencing anti-TNF-α therapy. Further, a number of clinical and psychosocial baseline factors identified those most likely to improve, supporting future stratified approaches to RA

  19. The 'Dr Google' phenomenon--missed appendicitis. (United States)

    Avery, Neil; Ghandi, Jamish; Keating, John


    Self-diagnosis has been around for many years. In today's society with free access to information, particularly through the Internet, it is more prominent than ever. With new information sources available to patients, doctors may have their diagnostic process influenced. This is the case of a gentleman who self-diagnosed, and subsequently influenced his doctor's diagnostic process, with results detrimental to his outcome. It illustrates the importance of awareness of the risks of self diagnosis, and management of patients who present with information and preconceived ideas regarding their condition.

  20. A putative biomarker signature for clinically effective AKT inhibition: correlation of in vitro, in vivo and clinical data identifies the importance of modulation of the mTORC1 pathway. (United States)

    Cheraghchi-Bashi, Azadeh; Parker, Christine A; Curry, Ed; Salazar, Jean-Frederic; Gungor, Hatice; Saleem, Azeem; Cunnea, Paula; Rama, Nona; Salinas, Cristian; Mills, Gordon B; Morris, Shannon R; Kumar, Rakesh; Gabra, Hani; Stronach, Euan A


    Our identification of dysregulation of the AKT pathway in ovarian cancer as a platinum resistance specific event led to a comprehensive analysis of in vitro, in vivo and clinical behaviour of the AKT inhibitor GSK2141795. Proteomic biomarker signatures correlating with effects of GSK2141795 were developed using in vitro and in vivo models, well characterised for related molecular, phenotypic and imaging endpoints. Signatures were validated in temporally paired biopsies from patients treated with GSK2141795 in a clinical study. GSK2141795 caused growth-arrest as single agent in vitro, enhanced cisplatin-induced apoptosis in vitro and reduced tumour volume in combination with platinum in vivo. GSK2141795 treatment in vitro and in vivo resulted in ~50-90% decrease in phospho-PRAS40 and 20-80% decrease in fluoro-deoxyglucose (FDG) uptake. Proteomic analysis of GSK2141795 in vitro and in vivo identified a signature of pathway inhibition including changes in AKT and p38 phosphorylation and total Bim, IGF1R, AR and YB1 levels. In patient biopsies, prior to treatment with GSK2141795 in a phase 1 clinical trial, this signature was predictive of post-treatment changes in the response marker CA125. Development of this signature represents an opportunity to demonstrate the clinical importance of AKT inhibition for re-sensitisation of platinum resistant ovarian cancer to platinum.

  1. The minimally important difference for the health assessment questionnaire in rheumatoid arthritis clinical practice is smaller than in randomized controlled trials. (United States)

    Pope, Janet E; Khanna, Dinesh; Norrie, Deborah; Ouimet, Janine M


    Patient-reported outcomes are used in clinical practice and trials. We studied a large clinical practice to determine the minimally important difference (MID) estimates for (1) the Health Assessment Questionnaire-Damage Index (HAQ-DI): improvement and worsening using patient global assessment anchor; and (2) pain using a patient-reported pain anchor. Patients with rheumatoid arthritis (RA; N = 225) had clinic visits at 2 timepoints within 1 year, completed the HAQ-DI and pain visual analog scale (VAS; 0-100 mm), and answered the question, "How would you describe your overall status/overall pain since the last visit?", as much worsened, somewhat worsened, the same, somewhat improved, or much improved. If rated as somewhat improved or worsened, they were defined as the minimally changed subgroups. Eighty-three percent were women, mean age 60 years, with disease duration 11.7 +/- 10.7 years. The baseline HAQ-DI was 0.97 +/- SD 0.76, and at followup 1.0 +/- 0.77 (mean change +0.03 +/- 0.40). The baseline pain VAS was 42.3 +/- 28.8, and at followup 38.5 +/- 27.9 (mean change -2.8 +/- 25.9). The mean (SD) HAQ-DI change score was -0.09 (0.42) for somewhat improved and 0.15 (0.33) for somewhat worsened. The HAQ-DI change for somewhat/much better was -0.20 +/- 0.52, and for somewhat/much worse +0.21 +/- 0.33. For pain, somewhat improved changed by -11.9 mm on the VAS, and somewhat worsened by 6.8 mm. Estimates for HAQ-DI and pain were larger than the for no-change group, 0.03 (0.32) and -3.2 (20.9). The MID for HAQ-DI in clinical practice is smaller than it is in trials. This may have implications for observational studies and clinical care.

  2. The Psychophys behind the “Banariu visual phenomenon” - A particular case of Entoptic Phenomenon

    Directory of Open Access Journals (Sweden)

    Mihaela Rus


    Full Text Available To describe the psychophysics behind the Banariu visual phenomenon is a delight. Scientifically, a phenomenon is any event that is observable. In this case we will be describing an entoptic phenomenon (ent means within and optic means the eye. Before starting to experience the phenomenon, ask yourself: Does the eye lie? It is certainly undeniable that it does not, anyway, not voluntarily. Even if it may not lie, it does not mean that for a moment at least it can’t be lied to. In this case the patient suddenly experiences dizziness and a feeling of falling on his back accompanied by a brief moment of slight brightness. Because of this “brightness”, it is obvious that Banariu visual phenomenon is a particular case of Phosphene. In fact, Phosphene appears as the movement of multiple light sensations. But that Banariu visual phenomenon when expressed, at least in descriptions, gives the illusion of light growth. This will generate the sensation of falling, especially when the head is tilted back to look upward. These clinical observations have led to the working out of a method to establish when the phenomenon occurs, but it relies basically on the sincerity of the subject analyzed (Banariu method. In this method the subject studied is asked to look up quickly at a fixed point which should preferably be at the equivalent height of a second or third floor of a building. Meanwhile, a medical team should be standing behind the patient to catch him if he falls back.

  3. Myeloproliferative Disease: An Unusual Cause of Raynaud’s Phenomenon and Digital Ischaemia

    Directory of Open Access Journals (Sweden)

    Celia Beynon


    Full Text Available We describe a 59-year-old female who presented with ischaemic digits, preceded by a 6-month history of Raynaud’s phenomenon affecting her fingers and toes. There were no clinical or laboratory features of primary vasculitis or connective tissue disease, Doppler imaging was normal, and bloods were unremarkable aside from a platelet count of 786 × 109/L (150–400 and white cells of 16 × 109/L (4–11. In view of the thrombocytosis a JAK2 mutation assay was requested which confirmed a JAK2 V617F mutation, suggesting essential thrombocytosis (ET as the cause. She received treatment with hydroxycarbamide which normalised her platelet count and led to a complete resolution of her Raynaud’s symptoms. Raynaud’s phenomenon is a rare manifestation of ET. Myeloproliferative disorders such as ET should be considered in the differential diagnosis of Raynaud’s phenomenon and vasculitis.

  4. El Nino phenomenon, effects on the tree of coffee

    International Nuclear Information System (INIS)

    Jaramillo Robledo, Alvaro; Baldion Rincon, Jose Vicente; Guzman Martinez, Orlando


    El Nino phenomenon is manifested in the coffee by a deficiency of water in the plant, that which affects its normal development in its fruits; the author describes other alterations that affect the plants of coffee due to El Nino phenomenon

  5. Chinchirisi: The Phenomenon of "Spirit Children" Among the ...

    African Journals Online (AJOL)

    ... what others say or do, 'it is in our blood', they say. This raises concerns. In what ways and to what extent is this religio-cultural phenomenon a challenge to euthanasia, human rights and rural development in the contemporary society? This paper examines the phenomenon of 'spirit children' from an insider perspective.

  6. An Evaluation of the 'New History' Phenomenon | Moyo | Zimbabwe ...

    African Journals Online (AJOL)

    The purpose of this article was to evaluate the 'New History' approach. This paper explores the argument that the new 'New History' phenomenon was an attempt to rejuvenate an interest in History. The 'New History' phenomenon was launched because of the fear that History was in danger as it faced possible extinction ...

  7. Can people with Raynaud's phenomenon travel to high altitude? (United States)

    Luks, Andrew M; Grissom, Colin K; Jean, Dominique; Swenson, Erik R


    To determine whether high altitude travel adversely affects mountain enthusiasts with Raynaud's phenomenon. Volunteers with Raynaud's phenomenon were recruited using announcements disseminated by organizations dedicated to climbing or wilderness travel and Internet discussion boards dedicated to mountain activities to complete an online, anonymous survey. Survey questions addressed demographic variables, aspects of their Raynaud's phenomenon, and features of their mountain activities. Respondents compared experiences with Raynaud's phenomenon between high (>2440 m; 8000 feet) and low elevations and rated agreement with statements concerning their disease and the effects of high altitude. One hundred forty-two people, 98% of whom had primary Raynaud's phenomenon, completed the questionnaire. Respondents spent 5 to 7 days per month at elevations above 2440 m and engaged in 5.4 +/- 2.0 different activities. Eighty-nine percent of respondents engaged in winter sports and only 22% reported changing their mountain activities because of Raynaud's phenomenon. Respondents reported a variety of tactics to prevent and treat Raynaud's attacks, but only 12% used prophylactic medications. Fifteen percent of respondents reported an episode of frostbite following a Raynaud's phenomenon attack at high altitude. There was considerable heterogeneity in participants' perceptions of the frequency, duration, and severity of attacks at high altitude compared to their home elevation. Motivated individuals with primary Raynaud's phenomenon, employing various prevention and treatment strategies, can engage in different activities, including winter sports, at altitudes above 2440 m. Frostbite may be common in this population at high altitude, and care must be taken to prevent its occurrence.

  8. Potential clinical impact of advanced imaging and computer-aided diagnosis in chest radiology: importance of radiologist's role and successful observer study. (United States)

    Li, Feng


    This review paper is based on our research experience in the past 30 years. The importance of radiologists' role is discussed in the development or evaluation of new medical images and of computer-aided detection (CAD) schemes in chest radiology. The four main topics include (1) introducing what diseases can be included in a research database for different imaging techniques or CAD systems and what imaging database can be built by radiologists, (2) understanding how radiologists' subjective judgment can be combined with technical objective features to improve CAD performance, (3) sharing our experience in the design of successful observer performance studies, and (4) finally, discussing whether the new images and CAD systems can improve radiologists' diagnostic ability in chest radiology. In conclusion, advanced imaging techniques and detection/classification of CAD systems have a potential clinical impact on improvement of radiologists' diagnostic ability, for both the detection and the differential diagnosis of various lung diseases, in chest radiology.

  9. A warning to the Brazilian Speech-Language Pathology and Audiology community about the importance of scientific and clinical activities in primary progressive aphasia. (United States)

    Beber, Bárbara Costa; Brandão, Lenisa; Chaves, Márcia Lorena Fagundes


    This article aims to warn the Brazilian Speech-Language Pathology and Audiology scientific community about the importance and necessity of scientific and clinical activities regarding Primary Progressive Aphasia. This warning is based on a systematic literature review of the scientific production on Primary Progressive Aphasia, from which nine Brazilian articles were selected. It was observed that there is an obvious lack of studies on the subject, as all the retrieved articles were published in medical journals and much of it consisted of small samples; only two articles described the effectiveness of speech-language therapy in patients with Primary Progressive Aphasia. A perspective for the future in the area and characteristics of Speech-Language Therapy for Primary Progressive Aphasia are discussed. As a conclusion, it is evident the need for greater action by Speech-Language Pathology and Audiology on Primary Progressive Aphasia.

  10. An embedded longitudinal multi-faceted qualitative evaluation of a complex cluster randomized controlled trial aiming to reduce clinically important errors in medicines management in general practice

    Directory of Open Access Journals (Sweden)

    Cresswell Kathrin M


    Full Text Available Abstract Background There is a need to shed light on the pathways through which complex interventions mediate their effects in order to enable critical reflection on their transferability. We sought to explore and understand key stakeholder accounts of the acceptability, likely impact and strategies for optimizing and rolling-out a successful pharmacist-led information technology-enabled (PINCER intervention, which substantially reduced the risk of clinically important errors in medicines management in primary care. Methods Data were collected at two geographical locations in central England through a combination of one-to-one longitudinal semi-structured telephone interviews (one at the beginning of the trial and another when the trial was well underway, relevant documents, and focus group discussions following delivery of the PINCER intervention. Participants included PINCER pharmacists, general practice staff, researchers involved in the running of the trial, and primary care trust staff. PINCER pharmacists were interviewed at three different time-points during the delivery of the PINCER intervention. Analysis was thematic with diffusion of innovation theory providing a theoretical framework. Results We conducted 52 semi-structured telephone interviews and six focus group discussions with 30 additional participants. In addition, documentary data were collected from six pharmacist diaries, along with notes from four meetings of the PINCER pharmacists and feedback meetings from 34 practices. Key findings that helped to explain the success of the PINCER intervention included the perceived importance of focusing on prescribing errors to all stakeholders, and the credibility and appropriateness of a pharmacist-led intervention to address these shortcomings. Central to this was the face-to-face contact and relationship building between pharmacists and a range of practice staff, and pharmacists’ explicitly designated role as a change agent


    Ruhdorfer, Anja; Wirth, Wolfgang; Eckstein, Felix


    Objective To determine the relationship between thigh muscle strength and clinically relevant differences in self-assessed lower limb function. Methods Isometric knee extensor and flexor strength of 4553 Osteoarthritis Initiative participants (2651 women/1902 men) was related to Western Ontario McMasters Universities (WOMAC) physical function scores by linear regression. Further, groups of Male and female participant strata with minimal clinically important differences (MCIDs) in WOMAC function scores (6/68) were compared across the full range of observed values, and to participants without functional deficits (WOMAC=0). The effect of WOMAC knee pain and body mass index on the above relationships was explored using stepwise regression. Results Per regression equations, a 3.7% reduction in extensor and a 4.0% reduction in flexor strength were associated with an MCID in WOMAC function in women, and a 3.6%/4.8% reduction in men. For strength divided by body weight, reductions were 5.2%/6.7% in women and 5.8%/6.7% in men. Comparing MCID strata across the full observed range of WOMAC function confirmed the above estimates and did not suggest non-linear relationships across the spectrum of observed values. WOMAC pain correlated strongly with WOMAC function, but extensor (and flexor) muscle strength contributed significant independent information. Conclusion Reductions of approximately 4% in isometric muscle strength and of 6% in strength/weight were related to a clinically relevant difference in WOMAC functional disability. Longitudinal studies will need to confirm these relationships within persons. Muscle extensor (and flexor) strength (per body weight) provided significant independent information in addition to pain in explaining variability in lower limb function. PMID:25303012

  12. Relationship between isometric thigh muscle strength and minimum clinically important differences in knee function in osteoarthritis: data from the osteoarthritis initiative. (United States)

    Ruhdorfer, Anja; Wirth, Wolfgang; Eckstein, Felix


    To determine the relationship between thigh muscle strength and clinically relevant differences in self-assessed lower leg function. Isometric knee extensor and flexor strength of 4,553 Osteoarthritis Initiative participants (2,651 women and 1,902 men) was related to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function scores by linear regression. Further, groups of male and female participant strata with minimum clinically important differences (MCIDs) in WOMAC function scores (6 of 68 units) were compared across the full range of observed values and to participants without functional deficits (WOMAC score 0). The effect of WOMAC knee pain and body mass index on the above relationships was explored using stepwise regression. Per regression equations, a 3.7% reduction in extensor strength and a 4.0% reduction in flexor strength were associated with an MCID in WOMAC function in women, and, respectively, a 3.6% and 4.8% reduction in men. For strength divided by body weight, reductions were 5.2% and 6.7%, respectively, in women and 5.8% and 6.7%, respectively, in men. Comparing MCID strata across the full observed range of WOMAC function confirmed the above estimates and did not suggest nonlinear relationships across the spectrum of observed values. WOMAC pain correlated strongly with WOMAC function, but extensor (and flexor) muscle strength contributed significant independent information. Reductions of approximately 4% in isometric muscle strength and of 6% in strength per body weight were related to a clinically relevant difference in WOMAC functional disability. Longitudinal studies will need to confirm these relationships within persons. Muscle extensor (and flexor) strength (per body weight) provided significant independent information in addition to pain in explaining variability in lower leg function. Copyright © 2015 by the American College of Rheumatology.

  13. Evaluation of the measurement model and clinically important differences for menopause-specific quality of life associated with bazedoxifene/conjugated estrogens. (United States)

    Bushmakin, Andrew G; Abraham, Lucy; Pinkerton, JoAnn V; Cappelleri, Joseph C; Mirkin, Sebastian


    This study aims to confirm the factor structure of the Menopause-Specific Quality of Life (MENQOL) questionnaire by using confirmatory factor analysis (CFA) and to determine whether improvements in menopause-specific health-related quality of life (HRQOL) observed with bazedoxifene (BZA)/conjugated estrogens (CE) relative to placebo are clinically meaningful. Postmenopausal women with seven or more moderate to severe hot flushes per day (or ≥50 per wk) received BZA 20 mg/CE 0.45 mg, BZA 20 mg/CE 0.625 mg, or placebo for 12 weeks. HRQOL and treatment satisfaction were evaluated using the MENQOL questionnaire and the Menopause Symptoms Treatment Satisfaction Questionnaire, respectively. The structure of the MENQOL questionnaire was evaluated using CFA. To estimate clinically important differences (CIDs) in HRQOL, we used a repeated-measures model to estimate changes in MENQOL domain and total scores using Menopause Symptoms Treatment Satisfaction Questionnaire items as anchors. The CFA model fits the MENQOL data (Bentler's comparative fit index >0.9). CID estimates ranged from 0.5 to 1.2 for the MENQOL domains and total score. Change from baseline in MENQOL vasomotor domain score for BZA 20 mg/CE 0.45 mg and BZA 20 mg/CE 0.625 mg compared with placebo was greater than the estimated CID, as were changes in MENQOL physical domain and total scores for BZA 20 mg/CE 0.625 mg compared with placebo. CFA confirms the factor structure of the MENQOL questionnaire. Treatment with BZA/CE provides clinically meaningful improvements in HRQOL in a population of postmenopausal women with bothersome vasomotor symptoms.

  14. Prevalence Rates of the Incubus Phenomenon: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Marc L. Molendijk


    Full Text Available BackgroundThe incubus phenomenon is a paroxysmal sleep-related disorder characterized by compound hallucinations experienced during brief phases of (apparent wakefulness. The condition has an almost stereotypical presentation, characterized by a hallucinated being that exerts pressure on the thorax, meanwhile carrying out aggressive and/or sexual acts. It tends to be accompanied by sleep paralysis, anxiety, vegetative symptoms, and feelings of suffocation. Its prevalence rate is unknown since, in prior analyses, cases of recurrent isolated sleep paralysis with/without an incubus phenomenon have been pooled together. This is unfortunate, since the incubus phenomenon has a much greater clinical relevance than isolated sleep paralysis.MethodsPubMed, Embase, and PsycINFO were searched for prevalence studies of the incubus phenomenon, and a meta-analysis was performed.ResultsOf the 1,437 unique records, 13 met the inclusion criteria, reporting on 14 (k independent prevalence estimates (total N = 6,079. The pooled lifetime prevalence rate of the incubus phenomenon was 0.19 [95% confidence interval (CI = 0.14–0.25, k = 14, N = 6,079] with heterogeneous estimates over different samples. In selected samples (e.g., patients with a psychiatric disorder, refugees, and students, prevalence rates were nearly four times higher (0.41, 95% CI = 0.25–0.56, k = 4, n = 1,275 than in the random samples (0.11, 95% CI = 0.08–0.14, k = 10, n = 4,804. This difference was significant (P < 0.001.ConclusionThis review and meta-analysis yielded a lifetime prevalence of the incubus phenomenon in the general population of 0.11 and, in selected samples, of 0.41. This is slightly higher than the prevalence rates in previous analyses that included cases of recurrent isolated sleep paralysis without an incubus phenomenon. Based on the condition’s robust clinical presentation and the relatively high prevalence rates, we advocate

  15. Comparison of the clinical and microbiological characteristics of Campylobacter and Helicobacter bacteremia: the importance of time to blood culture positivity using the BACTEC blood culture systems. (United States)

    Yamamoto, Kei; Hayakawa, Kayoko; Nagashima, Maki; Shimada, Kayo; Kutsuna, Satoshi; Takeshita, Nozomi; Kato, Yasuyuki; Kanagawa, Shuzo; Yamada, Koji; Mezaki, Kazuhisa; Kirikae, Teruo; Ohmagari, Norio


    Campylobacter spp. and Helicobacter spp. are rare but important causes of bacteremia in humans. Distinguishing these bacteria is complicated because of their similar phenotypic profiles. We conducted clinical and microbiological investigations of Campylobacter spp. or Helicobacter spp. bacteremia. Patients diagnosed with bacteremia from 2008 to 2014 were included. The clinical and microbiological characteristics of Campylobacter spp. and Helicobacter spp. bacteremia were compared. The BACTEC system was used in blood cultures. A receiver operating characteristic curve was plotted based on the time to blood culture positivity. Sixteen cases of Helicobacter spp. bacteremia (patient age: 61 ± 18 years) and 14 cases of Campylobacter spp. bacteremia (patient age: 49 ± 21 years) were identified. Median time to blood culture positivity was longer for the Helicobacter spp. cases than the Campylobacter spp. cases (91.4 h vs 55.3 h, p culture positivity > 75 h predicted Helicobacter spp. bacteremia with a sensitivity of 0.88 and a specificity of 0.93 (area under the receiver operating characteristic curve of 0.90). In conclusion, a time to blood culture positivity was useful in distinguishing Helicobacter spp. bacteremia from Campylobacter spp. bacteremia.

  16. What are the effects of varenicline compared with nicotine replacement therapy on long-term smoking cessation and clinically important outcomes? Protocol for a prospective cohort study. (United States)

    Davies, Neil M; Taylor, Gemma; Taylor, Amy E; Thomas, Kyla H; Windmeijer, Frank; Martin, Richard M; Munafò, Marcus R


    Smoking is a major avoidable cause of ill-health and premature death. Treatments that help patients successfully quit smoking have an important effect on health and life expectancy. Varenicline is a medication that can help smokers successfully quit smoking. However, there are concerns that it may cause adverse effects, such as increase in the occurrence of depression, self-harm and suicide and cardiovascular disease. In this study we aim to examine the effects of varenicline versus other smoking cessation pharmacotherapies on smoking cessation, health service use, all-cause and cause-specific mortality and physical and mental health conditions. In this project we will investigate the effects of varenicline compared to nicotine replacement therapies on: (1) long-term smoking cessation and whether these effects differ by area level deprivation; and (2) the following clinically-important outcomes: rate of general practice and hospital attendance; all-cause mortality and death due to diseases of the respiratory system and cardiovascular disease; and a primary care diagnosis of respiratory illness, myocardial infarction or depression and anxiety. The study is based on a cohort of patients prescribed these smoking cessation medications from the Clinical Practice Research Datalink (CPRD). We will use three methods to overcome confounding: multivariable adjusted Cox regression, propensity score matched Cox regression, and instrumental variable regression. The total expected sample size for analysis will be at least 180,000. Follow-up will end with the earliest of either an 'event' or censoring due to the end of registration or death. Ethics approval was not required for this study. This project has been approved by the CPRD's Independent Scientific Advisory Committee (ISAC). We will disseminate our findings via publications in international peer-reviewed journals and presentations at international conferences. Published by the BMJ Publishing Group Limited. For permission

  17. Responsiveness, minimal detectable change, and minimal clinically important difference of the Nottingham Extended Activities of Daily Living Scale in patients with improved performance after stroke rehabilitation. (United States)

    Wu, Ching-yi; Chuang, Li-ling; Lin, Keh-chung; Lee, Shin-da; Hong, Wei-hsien


    To determine the responsiveness, minimal detectable change (MDC), and minimal clinically important differences (MCIDs) of the Nottingham Extended Activities of Daily Living (NEADL) scale and to assess percentages of patients' change scores exceeding the MDC and MCID after stroke rehabilitation. Secondary analyses of patients who received stroke rehabilitation therapy. Medical centers. Patients with stroke (N=78). Secondary analyses of patients who received 1 of 4 rehabilitation interventions. Responsiveness (standardized response mean [SRM]), 90% confidence that a change score at this threshold or higher is true and reliable rather than measurement error (MDC(90)), and MCID on the NEADL score and percentages of patients exceeding the MDC(90) and MCID. The SRM of the total NEADL scale was 1.3. The MDC(90) value for the total NEADL scale was 4.9, whereas minima and maxima of the MCID for total NEADL score were 2.4 and 6.1 points, respectively. Percentages of patients exceeding the MDC(90) and MCID of the total NEADL score were 50.0%, 73.1%, and 32.1%, respectively. The NEADL is a responsive instrument relevant for measuring change in instrumental activities of daily living after stroke rehabilitation. A patient's change score has to reach 4.9 points on the total to indicate a true change. The mean change score of a stroke group on the total NEADL scale should achieve 6.1 points to be regarded as clinically important. Our findings are based on patients with improved NEADL performance after they received specific interventions. Future research with larger sample sizes is warranted to validate these estimates. Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  18. Importance measures

    International Nuclear Information System (INIS)

    Gomez Cobo, A.


    The presentation discusses the following: general concepts of importance measures; example fault tree, used to illustrate importance measures; Birnbaum's structural importance; criticality importance; Fussel-Vesely importance; upgrading function; risk achievement worth; risk reduction worth

  19. Cyberbullying: a 21st Century Health Care Phenomenon. (United States)

    Carter, Jemica M; Wilson, Feleta L


    This study examined bullying and cyberbullying prevalence among 367 adolescents 10 to 18 years of age who were attending schools and community organizations in suburban and urban neighborhoods in the Midwest United States. The correlational design investigated adolescents' daily use of technology that could be used to cyberbully peers, such as cell phones, computers, email, and the Internet. Results showed that 30% of participants had been bullied during school, and 17% had been cyberbullied, with online social networking sites the most common media employed (68%). The majority of participants owned or had access to computers (92%), email accounts (88%), social networking accounts (e.g., Facebook or MySpace) (82%), and cell phones (79%). Daily technology use included an average of two hours on a computer and a median of 71 text messages per day. Logistic regression analysis revealed no significant differences in bullying or cyberbullying prevalence based on location (urban or suburban) or demographic characteristics. Given the substantial presence of cyberbullying and the increase in technology use among adolescents in the 21st century, nurses need knowledge of the phenomenon to plan assessments in clinical practice. Early identification and assessment of cyberbullying victims and perpetrators, and development and implementation of effective interventions are needed to reduce this form of bullying among adolescents.

  20. The Electrophysiological Phenomenon of Alzheimer's Disease: A Psychopathology Theory. (United States)

    Holston, Ezra C


    The current understanding of Alzheimer's disease (AD) is based on the Aβ and tau pathology and the resulting neuropathological changes, which are associated with manifested clinical symptoms. However, electrophysiological brain changes may provide a more expansive understanding of AD. Hence, the objective of this systematic review is to propose a theory about the electrophysiological phenomenon of Alzheimer's disease (EPAD). The review of literature resulted from an extensive search of PubMed and MEDLINE databases. One-hundred articles were purposively selected. They provided an understanding of the concepts establishing the theory of EPAD (neuropathological changes, neurochemical changes, metabolic changes, and electrophysiological brain changes). Changes in the electrophysiology of the brain are foundational to the association or interaction of the concepts. Building on Berger's Psychophysical Model, it is evident that electrophysiological brain changes occur and affect cortical areas to generate or manifest symptoms from onset and across the stages of AD, which may be prior to pathological changes. Therefore, the interaction of the concepts demonstrates how the psychopathology results from affected electrophysiology of the brain. The theory of the EPAD provides a theoretical foundation for appropriate measurements of AD without dependence on neuropathological changes. Future research is warranted to further test this theory. Ultimately, this theory contributes to existing knowledge because it shows how electrophysiological changes are useful in understanding the risk and progression of AD across the stages.

  1. CD3-positive B cells: a storage-dependent phenomenon.

    Directory of Open Access Journals (Sweden)

    Angela Nagel

    Full Text Available The majority of clinical studies requires extensive management of human specimen including e.g. overnight shipping of blood samples in order to convey the samples in a central laboratory or to simultaneously analyze large numbers of patients. Storage of blood samples for periods of time before in vitro/ex vivo testing is known to influence the antigen expression on the surface of lymphocytes. In this context, the present results show for the first time that the T cell antigen CD3 can be substantially detected on the surface of human B cells after ex vivo storage and that the degree of this phenomenon critically depends on temperature and duration after blood withdrawal. The appearance of CD3 on the B cell surface seems to be a result of contact-dependent antigen exchange between T and B lymphocytes and is not attributed to endogenous production by B cells. Since cellular subsets are often classified by phenotypic analyses, our results indicate that ex vivo cellular classification in peripheral blood might result in misleading interpretations. Therefore, in order to obtain results reflecting the in vivo situation, it is suggested to minimize times of ex vivo blood storage after isolation of PBMC. Moreover, to enable reproducibility of results between different research groups and multicenter studies, we would emphasize the necessity to specify and standardize the storage conditions, which might be the basis of particular findings.

  2. Obesity and risk taking. A male phenomenon. (United States)

    Koritzky, Gilly; Yechiam, Eldad; Bukay, Irit; Milman, Uzi


    There is a growing tendency to regard overeating as an addiction, with obesity as its primary symptom. We propose that similar to other addictions, obesity is associated with excessive risk-taking in men, though not in women. To examine this suggestion we conducted two studies, one involving a sample of overweight and normal-weight students, and the other involving obese adults drawn from a dataset of health care clients, and a control sample of normal-weight adults. In both of these studies, we found that overweight and obese men took more risk in a laboratory task than normal-weight men, while overweight and obese women did not differ from normal-weight women in this respect. At the same time, obese women (but not overweight women) displayed higher impulsivity levels than normal-weight women. These findings shed light on the cognitive characteristics of obesity in men, and accent the importance of taking gender into account when developing research paradigms and treatment methods for obesity. Copyright © 2012 Elsevier Ltd. All rights reserved.

  3. Animal Rights as a Mainstream Phenomenon

    Directory of Open Access Journals (Sweden)

    Bernard E. Rollin


    Full Text Available Businesses and professions must stay in accord with social ethics, or risk losing their autonomy.A major social ethical issue that has emerged in the past four decades is the treatment of animals in various areas of human use. Society’s moral concern has outgrown the traditional ethic of animal cruelty that began in biblical times and is encoded in the laws of all civilized societies. There are five major reasons for this new social concern, most importantly, the replacement of husbandry-based agriculture with industrial agriculture. This loss of husbandry to industry has threatened the traditional fair contract between humans and animals, and resulted in significant amounts of animal suffering arising on four different fronts. Because such suffering is not occasioned by cruelty, a new ethic for animals was required to express social concerns. Since ethics proceed from preexisting ethics rather than ex nihilo, society has looked to its ethic for humans, appropriately modified, to find moral categories applicable to animals. This concept of legally encoded rights for animals has emerged as a plausible vehicle for reform.

  4. Animal Rights as a Mainstream Phenomenon. (United States)

    Rollin, Bernard E


    Businesses and professions must stay in accord with social ethics, or risk losing their autonomy.A major social ethical issue that has emerged in the past four decades is the treatment of animals in various areas of human use. Society's moral concern has outgrown the traditional ethic of animal cruelty that began in biblical times and is encoded in the laws of all civilized societies. There are five major reasons for this new social concern, most importantly, the replacement of husbandry-based agriculture with industrial agriculture. This loss of husbandry to industry has threatened the traditional fair contract between humans and animals, and resulted in significant amounts of animal suffering arising on four different fronts. Because such suffering is not occasioned by cruelty, a new ethic for animals was required to express social concerns. Since ethics proceed from preexisting ethics rather than ex nihilo, society has looked to its ethic for humans, appropriately modified, to find moral categories applicable to animals. This concept of legally encoded rights for animals has emerged as a plausible vehicle for reform.


    Directory of Open Access Journals (Sweden)

    Mijalce Gjorgievski


    Full Text Available At the turn of the century, the tourism industry underwent a transformation triggered by the sweeping processes of globalization. The traditional forms of tourism were supplemented and expanded by the introduction of new postmodern tourist forms, bringing new and different tourist offers to the marketplace. One of these new forms is the film tourism, a rapidly growing and important new tourism trend, in which the choice of the tourist destination is directly motivated and inspired by the movies. Film tourism establishes a link between the movie characters, locations and stories, and the film-tourists, who are inspired to immerse themselves and relive again the movie-generated and movie-driven emotions at the location of the movie. The film tourism increases the overall economic effects of tourism and establishes a new link between the film and the tourism industry, both of which provide not only pleasure and satisfaction for the film tourist, but also spiritual enrichment and novel learning experience.

  6. Is the Phenomenon Political Consumption Overrated?

    DEFF Research Database (Denmark)

    Grünbaum, Niels Nolsøe; Stenger, Marianne


    The aim of this paper is to create a more complex and holistic understanding of the value system of the political consumer. A case study was undertaken were the unit of analysis constituted 12 high users of organic food products. The empirical data was analysed by utilizing Reynolds and Gutman’s ...... or services will enable companies to better understand consumers need and expectations. The latter being a necessity if confirmation of expectations, satisfaction, retention of customers and customer loyalty are goals of importance for the selling company.......The aim of this paper is to create a more complex and holistic understanding of the value system of the political consumer. A case study was undertaken were the unit of analysis constituted 12 high users of organic food products. The empirical data was analysed by utilizing Reynolds and Gutman......’s laddering technique. The results revealed that the purposive selected informants activate different cognitive structures when buycotting organic food. In other words, the informants activate different values for similar attributes and consequences. This means that consumption of organic food is related...

  7. Is the phenomenon political consumption overrated?

    DEFF Research Database (Denmark)

    Grünbaum, Niels Nolsøe; Stenger, Marianne


    The aim of this paper is to create a more complex and holistic understanding of the value system of the political consumer. A case study was undertaken were the unit of analysis constituted 12 high users of organic food products. The empirical data was analysed by utilizing Reynolds and Gutman’s ...... or services will enable companies to better understand consumers need and expectations. The latter being a necessity if confirmation of expectations, satisfaction, retention of customers and customer loyalty are goals of importance for the selling company.......The aim of this paper is to create a more complex and holistic understanding of the value system of the political consumer. A case study was undertaken were the unit of analysis constituted 12 high users of organic food products. The empirical data was analysed by utilizing Reynolds and Gutman......’s laddering technique. The results revealed that the purposive selected informants activate different cognitive structures when buycotting organic food. In other words, the informants activate different values for similar attributes and consequences. This means that consumption of organic food is related...

  8. Corruption as a social-economic phenomenon

    Directory of Open Access Journals (Sweden)

    Pejanović Radovan


    Full Text Available The author discusses corruption as a primarily socio-economic construction. This paper tests the hypothesis of corruption as a systemic problem. The system is (economic, political, legal the main source of corruption. There are, regarding to this, the system generators of corruption: state, property and market. They are the key institutions of society that are placed in a destructive political system, create corruption, which undermines the economic, political, legal and moral foundations of society. Corruption is the inevitable partner of administrative, bureaucratic, party, non-market societies, societies in which dominate monopoly on coercion and obligation (and the prohibition of coercion. Disorganized, monopolized markets and asymmetric information is also an important source of corruption. All this, in terms of the collective (public, government property, which is 'used as its own, and kept as others', on a system of vicious cycle, develop and rise corruption. Therefore, the system changes (reforms are necessary at all levels of government, and introduction of ethical standards in order to eradicate the causes of this social scourge.

  9. Understanding and addressing the Schoolies phenomenon. (United States)

    Pettigrew, Simone; Biagioni, Nicole; Daube, Mike; Jones, Sandra C; Chikritzhs, Tanya; Kirby, Gary


    This study qualitatively explored Western Australian school leavers' alcohol-related experiences during the Schoolies period to generate insights for the purpose of intervention design. This is in the context of an impending change in the age of Western Australian students completing secondary school which, for the first time, will see around half being of legal age to purchase alcohol. Fifty-four 18-21-year-olds provided reflections via an emailed introspection on their experiences in the immediate post-school period. This provided access to the views of those who chose to attend events and consume large amounts of alcohol, those who attended events but refrained from excessive alcohol consumption, and those who elected to either avoid Schoolies events or engage in alternative celebrations. The data were coded and analysed using NVivo10. Three primary themes were identified that related to the perceived role of alcohol during Schoolies, the range of associated rite-of-passage rituals, and the strategies used by some Leavers to avoid alcohol and its consequences during the Schoolies period. Students and parents constitute important target groups for interventions designed to address alcohol-related harms during Schoolies. In the WA context, legislation on secondary supply and controlled purchase, as recommended by health and police authorities, could reduce harms that are likely to result from the change in the age of school leavers. Suggestions for alternative pastimes to promote to school leavers are provided. © 2015 Public Health Association of Australia.

  10. Assessing the stroke-specific quality of life for outcome measurement in stroke rehabilitation: minimal detectable change and clinically important difference. (United States)

    Lin, Keh-chung; Fu, Tiffany; Wu, Ching-yi; Hsieh, Ching-ju


    This study was conducted to establish the minimal detectable change (MDC) and clinically important differences (CIDs) of the physical category of the Stroke-Specific Quality of Life Scale in patients with stroke. MDC and CIDs scores were calculated from the data of 74 participants enrolled in randomized controlled trials investigating the effects of two rehabilitation programs in patients with stroke. These participants received treatments for 3 weeks and underwent clinical assessment before and after treatment. To obtain test-retest reliability for calculating MDC, another 25 patients with chronic stroke were recruited. The MDC was calculated from the standard error of measurement (SEM) to indicate a real change with 95% confidence for individual patients (MDC95). Distribution-based and anchor-based methods were adopted to triangulate the ranges of minimal CIDs. The percentage of scale width was calculated by dividing the MDC and CIDs by the total score range of each physical category. The percentage of patients exceeding MDC95 and minimal CIDs was also reported. The MDC95 of the mobility, self-care, and upper extremity (UE) function subscales were 5.9, 4.0, and 5.3 respectively. The minimal CID ranges for these 3 subscales were 1.5 to 2.4, 1.2 to 1.9, and 1.2 to 1.8. The percentage of patients exceeding MDC95 and minimal CIDs of the mobility, self-care, and UE function subscales were 9.5% to 28.4%, 6.8% to 28.4%, and 12.2% to 33.8%, respectively. The change score of an individual patient has to reach 5.9, 4.0, and 5.3 on the 3 subscales to indicate a true change. The mean change scores of a group of patients with stroke on these subscales should reach the lower bound of CID ranges of 1.5 (6.3% scale width), 1.2 (6.0% scale width), and 1.2 (6.0% scale width) to be regarded as clinically important change. This information may facilitate interpretations of patient-reported outcomes after stroke rehabilitation. Future research is warranted to validate these findings.

  11. The minimally important difference for the fatigue visual analog scale in patients with rheumatoid arthritis followed in an academic clinical practice. (United States)

    Khanna, Dinesh; Pope, Janet E; Khanna, Puja P; Maloney, Michelle; Samedi, Nooshin; Norrie, Debbie; Ouimet, Gillian; Hays, Ron D


    To estimate the minimally important difference (MID) for a fatigue visual analog scale (VAS) using patient-reported anchors (fatigue, pain, and overall health). Patients with rheumatoid arthritis (RA; n = 307) had 2 clinic visits at a median of 5.9 months apart. They completed a fatigue VAS (0-10 scale) and the retrospective anchor items, "How would you describe your overall fatigue/pain/overall health since the last visit?" with response options: Much worsened, Somewhat worsened, Same, Somewhat better, or Much better. The fatigue anchor was used for primary analysis and the pain/overall health anchors for sensitivity analyses. The minimally changed group was defined by those reporting they were somewhat better or somewhat worsened. The mean [standard deviation (SD)] age was 59.4 (13.2) years, disease duration was 14.1 (11.5) years, and 83% of patients were women. The baseline mean (SD) Health Assessment Questionnaire-Disability Index score was 0.84 (0.75). The baseline fatigue VAS score was 4.2 (2.9) and at followup was 4.3 (2.8) [mean change of -0.07 (2.5); p = not significant]. The fatigue change score (0-10 scale) for Somewhat better and Somewhat worsened for the fatigue anchor averaged -1.12 and 1.26, respectively. Using the pain anchor, the fatigue change score for Somewhat better and Somewhat worsened averaged -0.87 and 1.13; and using the global anchor, the fatigue change score for Somewhat better and Somewhat worsened averaged -0.82 and 1.17, respectively. Effect size estimates using 3 anchors were small for the Somewhat better (range 0.27-0.39) and Somewhat worsened (0.40-0.44) groups, but larger than for the no-change group (0.03-0.08). The MID for fatigue VAS is between -0.82 for -1.12 for improvement and is 1.13 to 1.26 for worsening on a 0-10 scale in a large RA clinical practice, and is similar to that seen in RA clinical trials. This information can aid in interpreting fatigue VAS in day-to-day care in clinical practice.

  12. Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. (United States)

    Copay, Anne G; Glassman, Steven D; Subach, Brian R; Berven, Sigurd; Schuler, Thomas C; Carreon, Leah Y


    The impact of lumbar spinal surgery is commonly evaluated with three patient-reported outcome measures: Oswestry Disability Index (ODI), the physical component summary (PCS) of the Short Form of the Medical Outcomes Study (SF-36), and pain scales. A minimum clinically important difference (MCID) is a threshold used to measure the effect of clinical treatments. Variable threshold values have been proposed as MCID for those instruments despite a lack of agreement on the optimal MCID calculation method. This study has three purposes. First, to illustrate the range of values obtained by common anchor-based and distribution-based methods to calculate MCID. Second, to determine a statistically sound and clinically meaningful MCID for ODI, PCS, back pain scale, and leg pain scale in lumbar spine surgery patients. Third, to compare the discriminative ability of two anchors: a global health assessment and a rating of satisfaction with the results of the surgery. This study is a review of prospectively collected patient-reported outcomes data. A total of 454 patients from a large database of surgeries performed by the Lumbar Spine Study Group with a 1-year follow-up on either ODI or PCS were included in the study. Preoperative and 1-year postoperative scores for ODI, PCS, back pain scale, leg pain scale, health transition item (HTI) of the SF-36, and Satisfaction with Results scales. ODI, SF-36, and pain scales were administered before and 1 year after spinal surgery. Several candidate MCID calculation methods were applied to the data and the resulting values were compared. The HTI of the SF-36 was used as the anchor and compared with a second anchor (Satisfaction with Results scale). Potential MCID calculations yielded a range of values: fivefold for ODI, PCS, and leg pain, 10-fold for back pain. Threshold values obtained with the two anchors were very similar. The minimum detectable change (MDC) appears as a statistically and clinically appropriate MCID value. MCID values

  13. Magnetocaloric cooling: the phenomenon and materials (United States)

    Pecharsky, Vitalij


    The discovery of the giant magnetocaloric effect in Gd5Si2Ge2 and other R5T4 compounds (R = rare earth metal and T is a Group 14 element) generated a broad interest in the magnetocaloric effect and magnetic refrigeration near room temperature in particular, and in magnetostructural transitions in general. Reports on the giant magnetocaloric effect in other systems soon followed. These include MnFePxAs1-x and related compounds, La(Fe1-xSix)13 and their hydrides, Mn(AsxSb1-x) , CoMnSixGe1-x and related compounds, Ni2MnGa and some closely related Heusler phases, and a few non-metallic systems. A common feature observed in all giant magnetocaloric effect materials is the enhancement of the magnetic entropy change by the overlapping contribution from the lattice. In addition to the interplay between magnetic and lattice entropies, both of which are intrinsic materials' parameters that in principle can be modeled theoretically from first principles, extrinsic parameters such as microstructure and nanostructure, have been found to play a role in controlling both the magnetostructural transition(s) and magnetocaloric effect. Both the intrinsic and extrinsic parameters are, therefore, important in order to maximize magnetocaloric effect. The role of different control parameters and the potential pathways towards materials exhibiting advanced magnetocaloric effect will be discussed. This work is supported by the Division of Materials Science and Engineering, Office of Basic Energy Sciences of the U.S. Department of Energy under Contract No. DE-AC02-07CH11358 with Iowa State University.

  14. FACE Analysis as a Fast and Reliable Methodology to Monitor the Sulfation and Total Amount of Chondroitin Sulfate in Biological Samples of Clinical Importance

    Directory of Open Access Journals (Sweden)

    Evgenia Karousou


    Full Text Available Glycosaminoglycans (GAGs due to their hydrophilic character and high anionic charge densities play important roles in various (pathophysiological processes. The identification and quantification of GAGs in biological samples and tissues could be useful prognostic and diagnostic tools in pathological conditions. Despite the noteworthy progress in the development of sensitive and accurate methodologies for the determination of GAGs, there is a significant lack in methodologies regarding sample preparation and reliable fast analysis methods enabling the simultaneous analysis of several biological samples. In this report, developed protocols for the isolation of GAGs in biological samples were applied to analyze various sulfated chondroitin sulfate- and hyaluronan-derived disaccharides using fluorophore-assisted carbohydrate electrophoresis (FACE. Applications to biologic samples of clinical importance include blood serum, lens capsule tissue and urine. The sample preparation protocol followed by FACE analysis allows quantification with an optimal linearity over the concentration range 1.0–220.0 µg/mL, affording a limit of quantitation of 50 ng of disaccharides. Validation of FACE results was performed by capillary electrophoresis and high performance liquid chromatography techniques.

  15. Clinically-Important Brain Injury and CT Findings in Pediatric Mild Traumatic Brain Injuries: A Prospective Study in a Chinese Reference Hospital

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    Huiping Zhu


    Full Text Available This study investigated injury patterns and the use of computed tomography (CT among Chinese children with mild traumatic brain injury (MTBI. We enrolled children with MTBI who were treated within 24 hours of head trauma in the emergency department of Wuhan Medical Care Center for Women and Children in Wuhan, China. Characteristics of MTBIs were analyzed by age and gender. Results of cranial CT scan and clinically-important brain injury (ciTBI for children were obtained. The definition of ciTBI was: death from TBI, intubation for more than 24 h for TBI, neurosurgery, or hospital admission of 2 nights or more. Of 455 eligible patients with MTBI, ciTBI occurred in two, and no one underwent neurosurgical intervention. CT scans were performed for 441 TBI patients (96.9%, and abnormal findings were reported for 147 patients (33.3%, 95% CI 29.0–37.8. Falls were the leading cause of MTBI (61.5%, followed by blows (18.9% and traffic collisions (14.1% for children in the 0–2 group and 10–14 group. For children aged between 3 and 9, the top three causes of TBI were falls, traffic collisions and blows. Leisure activity was the most reported activity when injuries occurred for all age groups. Sleeping/resting and walking ranked in the second and third place for children between 0 and 2 years of age, and walking and riding for the other two groups. The places where the majority injuries occurred were the home for the 0–2 and 3–9 years of age groups, and school for the 10–14 years of age group. There was no statistical difference between boys and girls with regard to the activity that caused the MTBI. This study highlights the important roles that parents and school administrators in the development of preventive measures to reduce the risk of traumatic brain injury in children. Also, identifying children who had a head trauma at very low risk of clinically important TBI for whom CT might be unnecessary is a priority area of research in China.

  16. The phenomenon of mobbing in the opinion of the professionally active

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    Ewelina Firlej


    Mobbing is a dangerous phenomenon that negatively affects the worker's efficiency and involvement in the job. It is very important to make employers aware of the consequences of mobbing and educate workers on the actions they should take to become victims.

  17. The phenomenon of domestic servants in the State of Qatar


    Alshafai, Nedham


    Of new phenomena that emerged in the State of Qatar, and on a large scale in the post-oil era (after 1950) is domestic servant's phenomenon. Historically, the phenomenon was presented in the pre-oil and limited to the homes of the royal families, pearls' merchants, senior traders and tribal leaders. However, today the phenomenon exists in all Qatari families, under the name of maids, drivers, educators, nurses and others, recently; it began spreading in non-citizenship families as well. Base...

  18. Theoretical aspects on the phenomenon of contamination of ground waters

    International Nuclear Information System (INIS)

    Echeverri, G.E.


    The phenomenon of contamination of ground waters and the destination of certain constituents of the water keep in mind diverse mechanisms of physical nature, chemistry and biological; in this work it is consigned in a concise way, the theoretical aspects of these topics, that is to say, the basic principles of the ground water hydraulics, the fundamental concepts of the physics of the movement and the chemistry of the ground water, as well as the equations that govern the phenomenon of contamination of the mass of water contained in the interstices of the floors and the rocks, broadly used in the mathematical modeling of the phenomenon

  19. The Relative Importance of Family History, Gender, Mode of Onset, and Age at Onsetin Predicting Clinical Features of First-Episode Psychotic Disorders. (United States)

    Compton, Michael T; Berez, Chantal; Walker, Elaine F

    Family history of psychosis, gender, mode of onset, and age at onset are considered prognostic factors important to clinicians evaluating first-episode psychosis; yet, clinicians have little guidance as to how these four factors differentially predict early-course substance abuse, symptomatology, and functioning. We conducted a "head-to-head comparison" of these four factors regarding their associations with key clinical features at initial hospitalization. We also assessed potential interactions between gender and family history with regard to age at onset of psychosis and symptom severity. Consecutively admitted first-episode patients (n=334) were evaluated in two studies that rigorously assessed a number of early-course variables. Associations among variables of interest were examined using Pearson correlations, χ 2 tests, Student's t-tests, and 2×2 factorial analyses of variance. Substance (nicotine, alcohol, and cannabis) abuse and positive symptom severity were predicted only by male gender. Negative symptom severity and global functioning impairments were predicted by earlier age at onset of psychosis. General psychopathology symptom severity was predicted by both mode of onset and age at onset. Interaction effects were not observed with regard to gender and family history in predicting age at onset or symptom severity. The four prognostic features have differential associations with substance abuse, domains of symptom severity, and global functioning. Gender and age at onset of psychosis appear to be more predictive of clinical features at the time of initial evaluation (and thus presumably longer term outcomes) than the presence of a family history of psychosis and a more gradual mode of onset.

  20. Estimation of minimal clinically important change of the Japanese version of EQ-5D in patients with chronic noncancer pain: a retrospective research using real-world data. (United States)

    Yoshizawa, Kazutake; Kobayashi, Hisanori; Fujie, Motoko; Ogawa, Yoshimasa; Yajima, Tsutomu; Kawai, Koji


    Quality of life (QoL) is routinely assessed and evaluated in medical research. However, in Japan, there is a lack of solid cutoff criteria for evaluating QoL improvement in chronic noncancer pain management. The present study was conducted to identify the minimal clinically important change (MCIC) of the Japanese version of EuroQol-5D 3L(EQ-5D) utility score and numeric rating scale (NRS) with an emphasis on chronic noncancer pain. The data source for this post hoc research was the post-marketing surveillance (PMS) data for a tramadol/acetaminophen combination tablet, which was previously conducted in real-world settings. The parameters extracted from the PMS data were sociodemographic characteristics, NRS, EQ-5D, and dichotomous physician's global impression of treatment effectiveness (PGI). The optimal cutoff points of MCIC for EQ-5D utility and NRS scores were evaluated using receiver operating characteristics (ROC) analysis. An anchor-based approach using PGI was applied. Data of 710 patients with chronic noncancer pain were extracted from the PMS database. The NRS score decreased by 2.7 (standard deviation, 2.3) points, whereas the EQ-5D score increased by 0.16 (0.20) points at 4 weeks from baseline. The changes from baseline in NRS and EQ-5D were significantly correlated (r = 0.53, p 0.80 in both analyses. These results demonstrated novel cutoff criteria for the Japanese version of EQ-5D, focusing on patients with chronic noncancer pain. The obtained criteria were fairly consistent and can be confidently utilized as an evaluation tool in medical research on chronic noncancer pain in Japan, with additional functionality and usability for QoL assessment in pain management practice. The data source of this post hoc research was a PMS study with the identifier number UMIN000015901 at, UMIN clinical trial registry (UMIN-CTR).