Sample records for clinically meaningful threshold

  1. Is the diagnostic threshold for bulimia nervosa clinically meaningful? (United States)

    Chapa, Danielle A N; Bohrer, Brittany K; Forbush, Kelsie T


    The DSM-5 differentiates full- and sub-threshold bulimia nervosa (BN) according to average weekly frequencies of binge eating and inappropriate compensatory behaviors. This study was the first to evaluate the modified frequency criterion for BN published in the DSM-5. The purpose of this study was to test whether community-recruited adults (N=125; 83.2% women) with current full-threshold (n=77) or sub-threshold BN (n=48) differed in comorbid psychopathology and eating disorder (ED) illness duration, symptom severity, and clinical impairment. Participants completed the Clinical Impairment Assessment and participated in semi-structured clinical interviews of ED- and non-ED psychopathology. Differences between the sub- and full-threshold BN groups were assessed using MANOVA and Chi-square analyses. ED illness duration, age-of-onset, body mass index (BMI), alcohol and drug misuse, and the presence of current and lifetime mood or anxiety disorders did not differ between participants with sub- and full-threshold BN. Participants with full-threshold BN had higher levels of clinical impairment and weight concern than those with sub-threshold BN. However, minimal clinically important difference analyses suggested that statistically significant differences between participants with sub- and full-threshold BN on clinical impairment and weight concern were not clinically significant. In conclusion, sub-threshold BN did not differ from full-threshold BN in clinically meaningful ways. Future studies are needed to identify an improved frequency criterion for BN that better distinguishes individuals in ways that will more validly inform prognosis and effective treatment planning for BN. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. A clinically meaningful fetal hemoglobin threshold for children with sickle cell anemia during hydroxyurea therapy. (United States)

    Estepp, Jeremie H; Smeltzer, Matthew P; Kang, Guolian; Li, Chen; Wang, Winfred C; Abrams, Christina; Aygun, Banu; Ware, Russell E; Nottage, Kerri; Hankins, Jane S


    Hydroxyurea has proven clinical benefits and is recommended to be offered to all children with sickle cell anemia (SCA), but the optimal dosing regimen remains controversial. Induction of red blood cell fetal hemoglobin (HbF) by hydroxyurea appears to be dose-dependent. However, it is unknown whether maximizing HbF% improves clinical outcomes. HUSTLE (NCT00305175) is a prospective observational study with a primary goal of describing the long-term clinical effects of hydroxyurea escalated to maximal tolerated dose (MTD) in children with SCA. In 230 children, providing 610 patient-years of follow up, the mean attained HbF% at MTD was >20% for up to 4 years of follow-up. When HbF% values were ≤20%, children had twice the odds of hospitalization for any reason (P 20% was associated with fewer hospitalizations without significant toxicity. These data support the use of hydroxyurea in children, and suggest that the preferred dosing strategy is one that targets a HbF endpoint >20%. © 2017 Wiley Periodicals, Inc.

  3. Thymoma calcification: Is it clinically meaningful?

    Directory of Open Access Journals (Sweden)

    Alkaied Homam


    Full Text Available Abstract Among anterior mediastinal lesions, thymoma is the most common. Thymomas are tumors of thymic epithelial cell origin that are distinguished by inconsistent histological and biologic behavior. Chest imaging studies typically show a round or lobulated tumor in the anterior mediastinum. Calcifications in thymomas are classically punctuate or amorphous, positioned within the lesion. Chest computed tomography (CT features suggesting higher risk thymoma consist of tumor heterogeneity, vascular involvement, lobulation, pulmonary nodules, lymphadenopathy, and pleural manifestations. Imaging findings have an imperfect ability to predict stage and prognosis for thymoma patients. Our objective is to highlight the clinical implications of thymoma calcifications on the diagnosis, clinical manifestation and prognosis. A pubmed and google search was performed using the following words: thymoma calcification, calcified thymus, mediastinal calcification, anterior mediastinal calcification, and calcified thymoma. After reviewing 370 articles, 32 eligible articles describing thymoma calcifications were found and included in this review. Although the presence of thymus calcifications was more common in patients with invasive thymomas, they were present in significant portion of non-invasive thymomas. The presence of calcifications was not a significant factor in differentiating between benign and malignant thymoma. As a result, the type, location, size or other characteristics of thymus gland calcifications were not relevant features in clinical and radiologic diagnosis of thymoma. The histopathological diagnosis is still the only possible way to confirm the neoplastic nature of thymoma. All types of thymomas should be evaluated and managed independently of the presence of calcifications.

  4. Cluster Analysis of an International Pressure Pain Threshold Database Identifies 4 Meaningful Subgroups of Adults With Mechanical Neck Pain

    DEFF Research Database (Denmark)

    Walton, David M; Kwok, Timothy S H; Mehta, Swati


    OBJECTIVE: To determine pressure pain detection threshold (PPDT) related phenotypes of individuals with mechanical neck pain that may be identifiable in clinical practice. METHODS: This report describes a secondary analysis of 5 independent, international mechanical neck pain databases of PPDT...... values taken at both a local and distal region (total N=1176). Minor systematic differences in mean PPDT values across cohorts necessitated z-transformation before analysis, and each cohort was split into male and female sexes. Latent profile analysis (LPA) using the k-means approach was undertaken...... to identify the most parsimonious set of PPDT-based phenotypes that were both statistically and clinically meaningful. RESULTS: LPA revealed 4 distinct clusters named according to PPDT levels at the local and distal zones: low-low PPDT (67%), mod-mod (25%), mod-high (4%), and high-high (4%). Secondary...

  5. Early- versus Late-Onset Dysthymia: A Meaningful Clinical Distinction?


    Sansone, Randy A.; Sansone, Lori A.


    In the current Diagnostic and Statistical Manual of Mental Disorders, dysthymic disorder is categorized as either early-onset or late-onset, based upon the emergence of symptoms before or after the age of 21, respectively. Does this diagnostic distinction have any meaningful clinical implications? In this edition of The Interface, we present empirical studies that have, within a single study, compared individuals with early-versus late-onset dysthymia. In this review, we found that, compared ...

  6. Identifying biologically meaningful hot-weather events using threshold temperatures that affect life-history.

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    Susan J Cunningham

    Full Text Available Increases in the frequency, duration and intensity of heat waves are frequently evoked in climate change predictions. However, there is no universal definition of a heat wave. Recent, intense hot weather events have caused mass mortalities of birds, bats and even humans, making the definition and prediction of heat wave events that have the potential to impact populations of different species an urgent priority. One possible technique for defining biologically meaningful heat waves is to use threshold temperatures (T(thresh above which known fitness costs are incurred by species of interest. We set out to test the utility of this technique using T(thresh values that, when exceeded, affect aspects of the fitness of two focal southern African bird species: the southern pied babbler Turdiodes bicolor (T(thresh = 35.5 °C and the common fiscal Lanius collaris (T(thresh = 33 °C. We used these T(thresh values to analyse trends in the frequency, duration and intensity of heat waves of magnitude relevant to the focal species, as well as the annual number of hot days (maximum air temperature > T(thresh, in north-western South Africa between 1961 and 2010. Using this technique, we were able to show that, while all heat wave indices increased during the study period, most rapid increases for both species were in the annual number of hot days and in the maximum intensity (and therefore intensity variance of biologically meaningful heat waves. Importantly, we also showed that warming trends were not uniform across the study area and that geographical patterns in warming allowed both areas of high risk and potential climate refugia to be identified. We discuss the implications of the trends we found for our focal species, and the utility of the T(thresh technique as a conservation tool.

  7. Association between clinically meaningful behavior problems and overweight in children. (United States)

    Lumeng, Julie C; Gannon, Kate; Cabral, Howard J; Frank, Deborah A; Zuckerman, Barry


    To determine whether there is a relationship between clinically meaningful behavior problems and concurrent and future overweight in 8- to 11-year-old children. 1998 National Longitudinal Survey of Youth interview data for 8- to 11-year-old children and their mothers were analyzed. A Behavior Problems Index score >90th percentile was considered clinically meaningful. Child overweight was defined as a body mass index (BMI) >or=95th percentile for age and sex. Multiple logistic regression was used to control for potential confounders (selected a priori): child's sex, race, use of behavior-modifying medication, history of academic retention, and hours of television per day; maternal obesity, smoking status, marital status, education, and depressive symptoms; family poverty status; and Home Observation for Measurement of the Environment-Short Form (HOME-SF) cognitive stimulation score. In an attempt to elucidate temporal sequence, a second analysis was conducted with a subsample of normal-weight children who became overweight between 1996 and 1998 while controlling for BMI z score in 1996. The sample included 755 mother-child pairs. Of the potential confounding variables, race, maternal obesity, academic grade retention, maternal education, poverty status, and HOME-SF cognitive stimulation score acted as joint confounders, altering the relationship between behavior problems and overweight in the multiple logistic regression model. With these covariates in the final model, behavior problems were independently associated with concurrent child overweight (adjusted odds ratio: 2.95; 95% confidence interval: 1.34-6.49). The relationship was strengthened in the subsample of previously normal-weight children, with race, maternal obesity, HOME-SF cognitive stimulation score, and 1996 BMI z score acting as confounders (adjusted odds ratio: 5.23; 95% confidence interval: 1.37-19.9). Clinically meaningful behavior problems in 8- to 11-year-old children were independently

  8. 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,

  9. Imaging studies and biomarkers to detect clinically meaningful vesicoureteral reflux

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    Michaella Maloney Prasad


    Full Text Available The work-up of a febrile urinary tract infection is generally performed to detect vesicoureteral reflux (VUR and its possible complications. The imaging modalities most commonly used for this purpose are renal-bladder ultrasound, voiding cystourethrogram and dimercapto-succinic acid scan. These studies each contribute valuable information, but carry individual benefits and limitations that may impact their efficacy. Biochemical markers are not commonly used in pediatric urology to diagnose or differentiate high-risk disease, but this is the emerging frontier, which will hopefully change our approach to VUR in the future. As it becomes more apparent that there is tremendous clinical variation within grades of VUR, the need to distinguish clinically significant from insignificant disease grows. The unfortunate truth about VUR is that recommendations for treatment may be inconsistent. Nuances in clinical decision-making will always exist, but opinions for medical versus surgical intervention should be more standardized, based on risk of injury to the kidney.

  10. Clinically Meaningful Use of Blood Tumor Markers in Oncology. (United States)

    Holdenrieder, Stefan; Pagliaro, Lance; Morgenstern, David; Dayyani, Farshid


    Before the introduction of modern imaging techniques and the recent developments in molecular diagnosis, tumor markers (TMs) were among the few available diagnostic tools for the management of cancer patients. Easily obtained from serum or plasma samples, TMs are minimally invasive and convenient, and the associated costs are low. Single TMs were traditionally used but these have come under scrutiny due to their low sensitivity and specificity when used, for example, in a screening setting. However, recent research has shown superior performance using a combination of multiple TMs as a panel for assessment, or as part of validated algorithms that also incorporate other clinical factors. In addition, newer TMs have been discovered that have an increased sensitivity and specificity profile for defined malignancies. The aim of this review is to provide a concise overview of the appropriate uses of both traditional and newer TMs and their roles in diagnosis, prognosis, and the monitoring of patients in current clinical practice. We also look at the future direction of TMs and their integration with other diagnostic modalities and other emerging serum based biomarkers, such as circulating nucleic acids, to ultimately advance diagnostic performance and improve patient management.

  11. Clinically Meaningful Use of Blood Tumor Markers in Oncology

    Directory of Open Access Journals (Sweden)

    Stefan Holdenrieder


    Full Text Available Before the introduction of modern imaging techniques and the recent developments in molecular diagnosis, tumor markers (TMs were among the few available diagnostic tools for the management of cancer patients. Easily obtained from serum or plasma samples, TMs are minimally invasive and convenient, and the associated costs are low. Single TMs were traditionally used but these have come under scrutiny due to their low sensitivity and specificity when used, for example, in a screening setting. However, recent research has shown superior performance using a combination of multiple TMs as a panel for assessment, or as part of validated algorithms that also incorporate other clinical factors. In addition, newer TMs have been discovered that have an increased sensitivity and specificity profile for defined malignancies. The aim of this review is to provide a concise overview of the appropriate uses of both traditional and newer TMs and their roles in diagnosis, prognosis, and the monitoring of patients in current clinical practice. We also look at the future direction of TMs and their integration with other diagnostic modalities and other emerging serum based biomarkers, such as circulating nucleic acids, to ultimately advance diagnostic performance and improve patient management.

  12. The thresholds for statistical and clinical significance

    DEFF Research Database (Denmark)

    Jakobsen, Janus Christian; Gluud, Christian; Winkel, Per


    BACKGROUND: Thresholds for statistical significance are insufficiently demonstrated by 95% confidence intervals or P-values when assessing results from randomised clinical trials. First, a P-value only shows the probability of getting a result assuming that the null hypothesis is true and does...... not reflect the probability of getting a result assuming an alternative hypothesis to the null hypothesis is true. Second, a confidence interval or a P-value showing significance may be caused by multiplicity. Third, statistical significance does not necessarily result in clinical significance. Therefore...... of the probability that a given trial result is compatible with a 'null' effect (corresponding to the P-value) divided by the probability that the trial result is compatible with the intervention effect hypothesised in the sample size calculation; (3) adjust the confidence intervals and the statistical significance...

  13. Health information technology: integration of clinical workflow into meaningful use of electronic health records. (United States)

    Bowens, Felicia M; Frye, Patricia A; Jones, Warren A


    This article examines the role that clinical workflow plays in successful implementation and meaningful use of electronic health record (EHR) technology in ambulatory care. The benefits and barriers of implementing EHRs in ambulatory care settings are discussed. The researchers conclude that widespread adoption and meaningful use of EHR technology rely on the successful integration of health information technology (HIT) into clinical workflow. Without successful integration of HIT into clinical workflow, clinicians in today's ambulatory care settings will continue to resist adoption and implementation of EHR technology.

  14. Assessing clinically meaningful treatment effects in controlled trials: chronic migraine as an example. (United States)

    Dodick, David W; Turkel, Catherine C; DeGryse, Ronald E; Diener, Hans-Christoph; Lipton, Richard B; Aurora, Sheena K; Nolan, Marissa E; Silberstein, Stephen D


    In addition to headache, persons with chronic migraine (CM) experience multiple symptoms, both ictal and interictal, that may contribute to their suffering. Translating clinical trial results into practice requires assessment of the results' clinical meaningfulness. When examining treatment benefit in this disabled patient population, multiple headache-symptom measures should be considered to fully reflect clinical relevance. Currently, only onabotulinumtoxinA is approved specifically for headache prophylaxis in adults with CM. Topiramate is the only other therapeutic agent with double-blind, placebo-controlled evidence in this population. Herein we evaluate the clinical meaningfulness of onabotulinumtoxinA and topiramate as headache prophylaxis in CM by comparing primary endpoints from the placebo-controlled, double-blind phase of the Phase 3 REsearch Evaluating Migraine Prophylaxis Therapy (PREEMPT) clinical program and the topiramate clinical trial (frequency of headache days [primary endpoint in PREEMPT; secondary in topiramate trial] and migraine/migrainous days [primary in topiramate trial, or "migraine/probable-migraine days"; secondary in PREEMPT]). Additionally, outcome measures such as responder rates, health-related quality of life, discontinuation rates, safety, and tolerability profiles are important clinical considerations. The clinical data indicate that statistically significant, clinically relevant treatment benefits exist for both onabotulinumtoxinA and topiramate. These data support these treatments as meaningful headache prophylaxis in adults with CM. CM is a chronic pain condition. We sought to determine the clinical relevance of recent trials in this disabled population. Clinical data indicate that statistically significant, clinically relevant treatment benefits exist for both onabotulinumtoxinA and topiramate, and support use of these treatments as meaningful headache prophylaxis in CM. Copyright © 2015 American Pain Society. Published

  15. The ADAS-cog and clinically meaningful change in the VISTA clinical trial of galantamine for Alzheimer's disease. (United States)

    Rockwood, Kenneth; Fay, Sherri; Gorman, Mary


    A minimum 4-point change at 6 months on the Alzheimer's disease assessment scale-cognitive subscale (ADAS-cog) is deemed clinically important, but this cut-point has been little studied in relation to clinical meaningfulness. In an investigator-initiated, clinical trial of galantamine, we investigated the extent to which a 4-point change classifies goal attainment by individual patients. Secondary analysis of the video imaging synthesis of treating Alzheimer's disease (VISTA) study: a 4-month, multi-centre, parallel-group, double-blind, placebo-controlled, trial of galantamine in 130 mild-moderate Alzheimer's disease patients (4-month open-label follow-up). ADAS-cog responses at 6 months were compared with outcomes on three clinical measures: clinician's interview based impression of change-plus caregiver input (CIBIC+), patient/carer-goal attainment scaling (PGAS) and clinician-GAS (CGAS). Thirty-seven of 99 patients improved by > or = 4 points on the ADAS-cog at 6 months, and 16/99 showed > or = 4-point worsening. ADAS-cog change scores correlated notionally to modestly with changes on the CGAS (r = -0.31), the PGAS (r = -0.29) and the CIBIC+ (r = 0.31). As a group, patients with ADAS-cog improvement were significantly more likely to improve on the clinical measures; those who worsened showed non-significant clinical decline. Individually, about half were misclassified in relation to each clinical measure; often when the ADAS-Cog detected 'no change', clinically meaningful effects could be detected. Even so, no ADAS-Cog cut-point optimally classified patients' clinical responses. A 4-point ADAS-cog change at 6 months is clinically meaningful for groups. Substantial individual misclassification between the ADAS-cog and clinical measures suggests no inherent meaning to a 4-point ADAS-cog change for a given patient.

  16. Predicting loss of employment over three years in multiple sclerosis: clinically meaningful cognitive decline. (United States)

    Morrow, Sarah A; Drake, Allison; Zivadinov, Robert; Munschauer, Frederick; Weinstock-Guttman, Bianca; Benedict, Ralph H B


    Cognitive dysfunction is common in multiple sclerosis (MS), yet the magnitude of change on objective neuropsychological (NP) tests that is clinically meaningful is unclear. We endeavored to determine NP markers of the transition from employment to work disability in MS, as indicated by degree of decline on individual tests. Participants were 97 employed MS patients followed over 41.3 ± 17.6 months with a NP battery covering six domains of cognitive function. Deterioration at follow-up was designated as documented and paid disability benefits (conservative definition) or a reduction in hours/work responsibilities (liberal definition). Using the conservative definition, 28.9% reported deteriorated employment status and for the liberal definition, 45.4%. The Symbol Digit Modalities Test (SDMT) and California Verbal Learning Test, Total Learning (CVLT2-TL) measures distinguished employed and disabled patients at follow-up. Controlling for demographic and MS characteristics, the odds ratio of a deterioration based on a change of 2.0 on the CVLT2-TL was 3.7 (95% CI 1.2-11.4 and SDMT by 4.0 was 4.2 (95% CI 1.2-14.8), accounting for 86.7% of the area under the ROC curve. We conclude that decline on NP testing over time is predictive of deterioration in vocational status, establishing a magnitude of decline on NP tests that is clinically meaningful.

  17. Identifying clinically meaningful symptom response cut-off values on the SANS in predominant negative symptoms. (United States)

    Levine, Stephen Z; Leucht, Stefan


    The treatment and measurement of negative symptoms are currently at issue in schizophrenia, but the clinical meaning of symptom severity and change is unclear. To offer a clinically meaningful interpretation of severity and change scores on the Scale for the Assessment of Negative Symptoms (SANS). Patients were intention-to-treat participants (n=383) in two double-blind randomized placebo-controlled clinical trials that compared amisulpride with placebo for the treatment of predominant negative symptoms. Equipercentile linking was used to examine extrapolation from (a) CGI-S to SANS severity ratings, and (b) CGI-I to SANS percentage change (n=383). Linking was conducted at baseline, 8-14 days, 28-30 days, and 56-60 days of the trials. Across visits, CGI-S ratings of 'not ill' linked to SANS scores of 0-13, and ranged to 'extreme' ratings that linked to SANS scores of 102-105. The relationship between the CGI-S and the SANS severity scores assumed a linear trend (1=0-13, 2=15-56, 3=37-61, 4=49-66, 5=63-75, 6=79-89, 7=102-105). Similarly the relationship between CGI-I ratings and SANS percentage change followed a linear trend. For instance, CGI-I ratings of 'very much improved' were linked to SANS percent changes of -90 to -67, 'much improved' to -50 to -42, and 'minimally improved' to -21 to -13. The current results uniquely contribute to the debate surrounding negative symptoms by providing clinical meaning to SANS severity and change scores and so offer direction regarding clinically meaningful response cut-off scores to guide treatment targets of predominant negative symptoms. Copyright © 2013 Elsevier B.V. All rights reserved.

  18. A business case for HIT adoption: effects of "meaningful use" EHR financial incentives on clinic revenue. (United States)

    Behkami, Nima A; Dorr, David A; Morrice, Stuart


    The goal of this study is to describe a framework that allows decision makers to efficiently evaluate factors that affect Electronic Health Record (EHR) adoption and test suitable interventions; specifically financial incentives. The United States healthcare delivery system is experiencing a transformation to improve population health. There is strong agreement that "meaningful use" of Health Information Technology (HIT) is a major enabler in this effort. However it's also understood that the high cost of implementing an EHR is an obstacle for adoption. To help understand these complexities we developed a simulation model designed to capture the dynamic nature of policy interventions that affect the adoption of EHR. We found that "Effective" use of HIT approaches break-even-point and larger clinic revenue many times faster that "average" or "poor" use of HIT. This study uses a systems perspective to the evaluate EHR adoption process through the "meaningful use" redesign as proposed in the American Reinvestment and Recovery Act 2009 in the United States healthcare industry by utilizing the System Dynamics methodology and Scenario Analysis.

  19. "Meaningful use" of EHR in dental school clinics: how to benefit from the U.S. HITECH Act's financial and quality improvement incentives. (United States)

    Kalenderian, Elsbeth; Walji, Muhammad; Ramoni, Rachel B


    Through the 2009 HITECH (Health Information Technology for Economic and Clinical Health) Act, the U.S. government committed $27 billion to incentivize the adoption and "meaningful use" of certified electronic health records (EHRs) by providers, including dentists. Given their patient profiles, dental school clinics are in a position to benefit from this time-delimited commitment to support the adoption and use of certified EHR technology under the Medicaid-based incentive. The benefits are not merely financial: rather, the meaningful use objectives and clinical quality measures can drive quality improvement initiatives within dental practices and help develop a community of medical and dental professionals focused on quality. This article describes how dentists can qualify as eligible providers and the set of activities that must be undertaken and attested to in order to obtain this incentive. Two case studies describe the approaches that can be used to meet the Medicaid threshold necessary to be eligible for the incentive. Dentists can and have successfully applied for meaningful use incentive payments. Given the diverse set of patients who are treated at dental schools, these dental practices are among those most likely to benefit from the incentive programs.

  20. Assessing Abnormal Uterine Bleeding: Are Physicians Taking a Meaningful Clinical History? (United States)

    Lam, Christina; Anderson, Britta; Lopes, Vrishali; Schulkin, Jay; Matteson, Kristen


    Women with abnormal uterine bleeding (AUB) report significant reductions in quality of life (QOL), which can be attributed in many cases to the fear of embarrassing episodes of bleeding. We performed this study to determine whether or not during clinical encounters physicians addressed the impact of AUB on patient-reported QOL. Between October 2008 and May 2009, we conducted a cross-sectional study of members of the American College of Obstetricians and Gynecologists. Surveys were distributed using a mixed method (web- and mail-based) and included questions about physician characteristics and types of questions used when obtaining a clinical history from a patient with AUB. We calculated the proportion of physicians who endorsed asking each type of clinical question with 95% confidence intervals (CIs). Four hundred seventeen questionnaires were returned (52%). Ninety-nine percent (95% CI 98.4%-99.9%) reported always asking a bleeding heaviness question, 87.2% (95% CI 83.2%-90.5%) reported always asking a QOL question, and 17.5% (95% CI 13.6%-21.9%) reported always asking a mood associated with bleeding question. Seventy-eight percent specifically asked patients about bleeding through their clothes, and 55% asked about changing social plans because of bleeding. Only 18% endorsed that asking about QOL was most essential for the evaluation of women with AUB. No physician characteristics such as years since completing residency, geography, or gender were associated with how commonly providers reported asking questions regarding impact of bleeding on QOL. Physicians may not be optimizing patient-provider interactions during menstrual history taking with patients with AUB by failing to assess impact of AUB on QOL in a way that is meaningful to patients.

  1. Initial validation of a proxy indicator of functioning as a potential tool for establishing a clinically meaningful cocaine use outcome. (United States)

    Kiluk, Brian D; Babuscio, Theresa A; Nich, Charla; Carroll, Kathleen M


    Establishing a non-abstinence cocaine use outcome as clinically meaningful has been elusive, in part due to the lack of association between cocaine use outcomes and meaningful indicators of long-term functioning. Using data pooled across 7 clinical trials evaluating treatments for cocaine (N=718), a dichotomous indicator of functioning was created to represent a meaningful outcome ('problem-free functioning' - PFF), defined as the absence of problems across non-substance-related domains on the Addiction Severity Index. Its validity was evaluated at multiple time points (baseline, end-of-treatment, terminal follow-up) and used to explore associations with cocaine use. The percentage of participants meeting PFF criteria increased over time (baseline=18%; end-of-treatment=32%; terminal follow-up=37%). At each time point, ANOVAs indicated those who met PFF criteria reported significantly less distress on the Brief Symptom Inventory and less perceived stress on the Perceived Stress Scale. Generalized linear models indicated categorical indices of self-reported cocaine use at the end of treatment were predictive of the probability of meeting PFF criteria during follow-up (β=-0.01, pcocaine use in the final month of treatment was associated with PFF during follow-up, with strongest associations between PFF and abstinence or 'occasional' use. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. The OnyCOE-t™ questionnaire: responsiveness and clinical meaningfulness of a patient-reported outcomes questionnaire for toenail onychomycosis

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    Kianifard Farid


    Full Text Available Abstract Background This research was conducted to confirm the validity and reliability and to assess the responsiveness and clinical meaningfulness of the OnyCOE-t™, a questionnaire specifically designed to measure patient-reported outcomes (PRO associated with toenail onychomycosis. Methods 504 patients with toenail onychomycosis randomized to receive 12 weeks of terbinafine 250 mg/day with or without target toenail debridement in the IRON-CLAD® trial completed the OnyCOE-t™ at baseline, weeks 6, 12, 24, and 48. The OnyCOE-t™ is composed of 6 multi-item scales and 1 single-item scale. These include a 7-item Toenail Symptom assessment, which comprises both Symptom Frequency and Symptom Bothersomeness scales; an 8-item Appearance Problems scale; a 7-item Physical Activities Problems scale; a 1-item Overall Problem scale; a 7-item Stigma scale; and a 3-item Treatment Satisfaction scale. In total, 33 toenail onychomycosis-specific items are included in the OnyCOE-t™. Clinical data, in particular the percent clearing of mycotic involvement in the target toenail, and OnyCOE-t™ responses were used to evaluate the questionnaire's reliability, validity, responsiveness, and the minimally clinical important difference (MCID. Results The OnyCOE-t™ was shown to be reliable and valid. Construct validity and known groups validity were acceptable. Internal consistency reliability of multi-item scales was demonstrated by Cronbach's alpha > .84. Responsiveness was good, with the Treatment Satisfaction, Symptom Frequency, Overall Problem, and Appearance Problem scales demonstrating the most responsiveness (Guyatt's statistic of 1.72, 1.31, 1.13, and 1.11, respectively. MCID was evaluated for three different clinical measures, and indicated that approximately an 8.5-point change (on a 0 to 100 scale was clinically meaningful based on a 25% improvement in target nail clearing. Conclusion The OnyCOE-t™ questionnaire is a unique, toenail-specific PRO

  3. Inter-observer reliability assessments in time motion studies: the foundation for meaningful clinical workflow analysis. (United States)

    Lopetegui, Marcelo A; Bai, Shasha; Yen, Po-Yin; Lai, Albert; Embi, Peter; Payne, Philip R O


    Understanding clinical workflow is critical for researchers and healthcare decision makers. Current workflow studies tend to oversimplify and underrepresent the complexity of clinical workflow. Continuous observation time motion studies (TMS) could enhance clinical workflow studies by providing rich quantitative data required for in-depth workflow analyses. However, methodological inconsistencies have been reported in continuous observation TMS, potentially reducing the validity of TMS' data and limiting their contribution to the general state of knowledge. We believe that a cornerstone in standardizing TMS is to ensure the reliability of the human observers. In this manuscript we review the approaches for inter-observer reliability assessment (IORA) in a representative sample of TMS focusing on clinical workflow. We found that IORA is an uncommon practice, inconsistently reported, and often uses methods that provide partial and overestimated measures of agreement. Since a comprehensive approach to IORA is yet to be proposed and validated, we provide initial recommendations for IORA reporting in continuous observation TMS.

  4. A clinically meaningful training effect in walking speed using functional electrical stimulation for motor-incomplete spinal cord injury. (United States)

    Street, Tamsyn; Singleton, Christine


    The study aimed to investigate the presence of a training effect for rehabilitation of walking function in motor-incomplete spinal cord injury (SCI) through daily use of functional electrical stimulation (FES). A specialist FES outpatient centre. Thirty-five participants (mean age 53, SD 15, range 18-80; mean years since diagnosis 9, range 5 months - 39 years) with drop foot and motor-incomplete SCI (T12 or higher, ASIA Impairment Scale C and D) able to ambulate 10 metres with the use of a walking stick or frame. FES of the peroneal nerve, glutei and hamstrings as clinically indicated over six months in the community. The data was analysed for a training effect (difference between unassisted ten metre walking speed at baseline and after six months) and orthotic effects (difference between walking speed with and without FES) initially on day one and after six months. The data was further analysed for a minimum clinically important difference (MCID) (>0.06 m/s). A clinically meaningful, significant change was observed for initial orthotic effect (0.13m/s, CI: 0.04-0.17, P = 0.013), total orthotic effect (0.11m/s, CI: 0.04-0.18, P = 0.017) and training effect (0.09m/s, CI: 0.02-0.16, P = 0.025). The results suggest that daily independent use of FES may produce clinically meaningful changes in walking speed which are significant for motor-incomplete SCI. Further research exploring the mechanism for the presence of a training effect may be beneficial in targeting therapies for future rehabilitation.

  5. Towards meaningful medication-related clinical decision support: recommendations for an initial implementation. (United States)

    Phansalkar, S; Wright, A; Kuperman, G J; Vaida, A J; Bobb, A M; Jenders, R A; Payne, T H; Halamka, J; Bloomrosen, M; Bates, D W


    Clinical decision support (CDS) can improve safety, quality, and cost-effectiveness of patient care, especially when implemented in computerized provider order entry (CPOE) applications. Medication-related decision support logic forms a large component of the CDS logic in any CPOE system. However, organizations wishing to implement CDS must either purchase the computable clinical content or develop it themselves. Content provided by vendors does not always meet local expectations. Most organizations lack the resources to customize the clinical content and the expertise to implement it effectively. In this paper, we describe the recommendations of a national expert panel on two basic medication-related CDS areas, specifically, drug-drug interaction (DDI) checking and duplicate therapy checking. The goals of this study were to define a starter set of medication-related alerts that healthcare organizations can implement in their clinical information systems. We also draw on the experiences of diverse institutions to highlight the realities of implementing medication decision support. These findings represent the experiences of institutions with a long history in the domain of medication decision support, and the hope is that this guidance may improve the feasibility and efficiency CDS adoption across healthcare settings.

  6. A patent extension proposal to end the underrepresentation of women in clinical trials and secure meaningful drug guidance for women. (United States)

    Hathaway, Cynthia


    Historically, women have been systematically excluded from or underrepresented in human clinical trials of new drugs. Due to fundamental physiological differences between women and men with regard to how drugs work in the human body, testing of drugs in men alone can both deny women the full benefit of a drug and cause them to suffer from increased adverse side effects. Attempts to reform drug development law and agency practices to resolve this problem have met with only partial success. Proposed herein is a patent term extension and for studies in women, modeled upon the pediatric patent term extension, but with several key differences intended to reduce the cost to the public and fund auxiliary programs to address off-patent medicines as well. Such an extension would incentivize this research and provide meaningful guidance to women and their physicians.

  7. Distinguishing between statistical significance and practical/clinical meaningfulness using statistical inference. (United States)

    Wilkinson, Michael


    Decisions about support for predictions of theories in light of data are made using statistical inference. The dominant approach in sport and exercise science is the Neyman-Pearson (N-P) significance-testing approach. When applied correctly it provides a reliable procedure for making dichotomous decisions for accepting or rejecting zero-effect null hypotheses with known and controlled long-run error rates. Type I and type II error rates must be specified in advance and the latter controlled by conducting an a priori sample size calculation. The N-P approach does not provide the probability of hypotheses or indicate the strength of support for hypotheses in light of data, yet many scientists believe it does. Outcomes of analyses allow conclusions only about the existence of non-zero effects, and provide no information about the likely size of true effects or their practical/clinical value. Bayesian inference can show how much support data provide for different hypotheses, and how personal convictions should be altered in light of data, but the approach is complicated by formulating probability distributions about prior subjective estimates of population effects. A pragmatic solution is magnitude-based inference, which allows scientists to estimate the true magnitude of population effects and how likely they are to exceed an effect magnitude of practical/clinical importance, thereby integrating elements of subjective Bayesian-style thinking. While this approach is gaining acceptance, progress might be hastened if scientists appreciate the shortcomings of traditional N-P null hypothesis significance testing.

  8. 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.

  9. Detecting a clinically meaningful change in tic severity in Tourette syndrome: a comparison of three methods. (United States)

    Jeon, Sangchoon; Walkup, John T; Woods, Douglas W; Peterson, Alan; Piacentini, John; Wilhelm, Sabine; Katsovich, Lily; McGuire, Joseph F; Dziura, James; Scahill, Lawrence


    To compare three statistical strategies for classifying positive treatment response based on a dimensional measure (Yale Global Tic Severity Scale [YGTSS]) and a categorical measure (Clinical Global Impression-Improvement [CGI-I] scale). Subjects (N=232; 69.4% male; ages 9-69years) with Tourette syndrome or chronic tic disorder participated in one of two 10-week, randomized controlled trials comparing behavioral treatment to supportive therapy. The YGTSS and CGI-I were rated by clinicians blind to treatment assignment. We examined the percent reduction in the YGTSS-Total Tic Score (TTS) against Much Improved or Very Much Improved on the CGI-I, computed a signal detection analysis (SDA) and built a mixture model to classify dimensional response based on the change in the YGTSS-TTS. A 25% decrease on the YGTSS-TTS predicted positive response on the CGI-I during the trial. The SDA showed that a 25% reduction in the YGTSS-TTS provided optimal sensitivity (87%) and specificity (84%) for predicting positive response. Using a mixture model without consideration of the CGI-I, the dimensional response was defined by 23% (or greater) reduction on the YGTSS-TTS. The odds ratio (OR) of positive response (OR=5.68, 95% CI=[2.99, 10.78]) on the CGI-I for behavioral intervention was greater than the dimensional response (OR=2.86, 95% CI=[1.65, 4.99]). A 25% reduction on the YGTSS-TTS is highly predictive of positive response by all three analytic methods. For trained raters, however, tic severity alone does not drive the classification of positive response. identifiers: NCT00218777; NCT00231985. © 2013.

  10. Evaluation of Short-Term Changes in Serum Creatinine Level as a Meaningful End Point in Randomized Clinical Trials. (United States)

    Coca, Steven G; Zabetian, Azadeh; Ferket, Bart S; Zhou, Jing; Testani, Jeffrey M; Garg, Amit X; Parikh, Chirag R


    Observational studies have shown that acute change in kidney function (specifically, AKI) is a strong risk factor for poor outcomes. Thus, the outcome of acute change in serum creatinine level, regardless of underlying biology or etiology, is frequently used in clinical trials as both efficacy and safety end points. We performed a meta-analysis of clinical trials to quantify the relationship between positive or negative short-term effects of interventions on change in serum creatinine level and more meaningful clinical outcomes. After a thorough literature search, we included 14 randomized trials of interventions that altered risk for an acute increase in serum creatinine level and had reported between-group differences in CKD and/or mortality rate ≥3 months after randomization. Seven trials assessed interventions that, compared with placebo, increased risk of acute elevation in serum creatinine level (pooled relative risk, 1.52; 95% confidence interval, 1.22 to 1.89), and seven trials assessed interventions that, compared with placebo, reduced risk of acute elevation in serum creatinine level (pooled relative risk, 0.57; 95% confidence interval, 0.44 to 0.74). However, pooled risks for CKD and mortality associated with interventions did not differ from those with placebo in either group. In conclusion, several interventions that affect risk of acute, mild to moderate, often temporary elevation in serum creatinine level in placebo-controlled randomized trials showed no appreciable effect on CKD or mortality months later, raising questions about the value of using small to moderate changes in serum creatinine level as end points in clinical trials. Copyright © 2016 by the American Society of Nephrology.

  11. Adverse pregnancy outcome in women with mild glucose intolerance: is there a clinically meaningful threshold value for glucose?

    DEFF Research Database (Denmark)

    Jensen, Dorte; Lauridsen, Lars Korsholm; Ovesen, Per Glud


    The diagnostic criteria of gestational diabetes mellitus (GDM) have been based on the risk of future maternal diabetes rather than the short-term risk of mother and infant. Our aim was to illustrate the relation between various adverse pregnancy outcomes and maternal glucose levels in women with ...

  12. Corpus callosum atrophy as a marker of clinically meaningful cognitive decline in secondary progressive multiple sclerosis. Impact on employment status. (United States)

    Papathanasiou, Athanasios; Messinis, Lambros; Zampakis, Petros; Papathanasopoulos, Panagiotis


    Cognitive impairment in Multiple Sclerosis (MS) is more frequent and pronounced in secondary progressive MS (SPMS). Cognitive decline is an important predictor of employment status in patients with MS. Magnetic Resonance Imaging (MRI) markers have been used to associate tissue damage with cognitive dysfunction. The aim of the study was to designate the MRI marker that predicts cognitive decline in SPMS and explore its effect on employment status. 30 SPMS patients and 30 healthy participants underwent neuropsychological assessment using the Trail Making Test (TMT) parts A and B, semantic and phonological verbal fluency task and a computerized cognitive screening battery (Central Nervous System Vital Signs). Employment status was obtained as a quality of life measure. Brain MRI was performed in all participants. We measured total lesion volume, third ventricle width, thalamic and corpus callosum atrophy. The frequency of cognitive decline for our SPMS patients was 80%. SPMS patients differed significantly from controls in all neuropsychological measures. Corpus callosum area was correlated with cognitive flexibility, processing speed, composite memory, executive functions, psychomotor speed, reaction time and phonological verbal fluency task. Processing speed and composite memory were the most sensitive markers for predicting employment status. Corpus callosum area was the most sensitive MRI marker for memory and processing speed. Corpus callosum atrophy predicts a clinically meaningful cognitive decline, affecting employment status in our SPMS patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Rett Syndrome: Crossing the Threshold to Clinical Translation (United States)

    Katz, David M.; Bird, Adrian; Coenraads, Monica; Gray, Steven J.; Menon, Debashish U.; Philpot, Benjamin D.; Tarquinio, Daniel C.


    Lying at the intersection between neurobiology and epigenetics, Rett syndrome (RTT) has garnered intense interest in recent years, not only from a broad range of academic scientists, but also from the pharmaceutical and biotechnology industries. In addition to the critical need for treatments for this devastating disorder, optimism for developing RTT treatments derives from a unique convergence of factors, including a known monogenic cause, reversibility of symptoms in preclinical models, a strong clinical research infrastructure highlighted by an NIH-funded natural history study and well-established clinics with significant patient populations. Here, we review recent advances in understanding the biology of RTT, particularly promising preclinical findings, lessons from past clinical trials, and critical elements of trial design for rare disorders. PMID:26830113

  14. A patient and public involvement (PPI) toolkit for meaningful and flexible involvement in clinical trials - a work in progress. (United States)

    Bagley, Heather J; Short, Hannah; Harman, Nicola L; Hickey, Helen R; Gamble, Carrol L; Woolfall, Kerry; Young, Bridget; Williamson, Paula R


    Funders of research are increasingly requiring researchers to involve patients and the public in their research. Patient and public involvement (PPI) in research can potentially help researchers make sure that the design of their research is relevant, that it is participant friendly and ethically sound. Using and sharing PPI resources can benefit those involved in undertaking PPI, but existing PPI resources are not used consistently and this can lead to duplication of effort. This paper describes how we are developing a toolkit to support clinical trials teams in a clinical trials unit. The toolkit will provide a key 'off the shelf' resource to support trial teams with limited resources, in undertaking PPI. Key activities in further developing and maintaining the toolkit are to: ● listen to the views and experience of both research teams and patient and public contributors who use the tools; ● modify the tools based on our experience of using them; ● identify the need for future tools; ● update the toolkit based on any newly identified resources that come to light; ● raise awareness of the toolkit and ● work in collaboration with others to either develop or test out PPI resources in order to reduce duplication of work in PPI. Background Patient and public involvement (PPI) in research is increasingly a funder requirement due to the potential benefits in the design of relevant, participant friendly, ethically sound research. The use and sharing of resources can benefit PPI, but available resources are not consistently used leading to duplication of effort. This paper describes a developing toolkit to support clinical trials teams to undertake effective and meaningful PPI. Methods The first phase in developing the toolkit was to describe which PPI activities should be considered in the pathway of a clinical trial and at what stage these activities should take place. This pathway was informed through review of the type and timing of PPI activities within

  15. Young Mania Rating Scale: how to interpret the numbers? Determination of a severity threshold and of the minimal clinically significant difference in the EMBLEM cohort. (United States)

    Lukasiewicz, Michael; Gerard, Stephanie; Besnard, Adeline; Falissard, Bruno; Perrin, Elena; Sapin, Helene; Tohen, Mauricio; Reed, Catherine; Azorin, Jean-Michel


    The aim of this analysis was to identify Young Mania Rating Scale (YMRS) meaningful benchmarks for clinicians (severity threshold, minimal clinically significant difference [MCSD]) using the Clinical Global Impressions Bipolar (CGI-BP) mania scale, to provide a clinical perspective to randomized clinical trials (RCTs) results. We used the cohort of patients with acute manic/mixed state of bipolar disorders (N = 3459) included in the European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM) study. A receiver-operating characteristic analysis was performed on randomly selected patients to determine the YMRS optimal severity threshold with CGI-BP mania score ≥ "Markedly ill" defining severity. The MCSD (clinically meaningful change in score relative to one point difference in CGI-BP mania for outcome measures) of YMRS, was assessed with a linear regression on baseline data. At baseline, YMRS mean score was 26.4 (±9.9), CGI-BP mania mean score was 4.8 (±1.0) and 61.7% of patients had a score ≥ 5. The optimal YMRS severity threshold of 25 (positive predictive value [PPV] = 83.0%; negative predictive value [NPV] = 66.0%) was determined. In this cohort, a YMRS score of 20 (typical cutoff for RCTs inclusion criteria) corresponds to a PPV of 74.6% and to a NPV of 77.6%, meaning that the majority of patients included would be classified as severely ill. The YMRS minimal clinically significant difference was 6.6 points. Copyright © 2013 John Wiley & Sons, Ltd.

  16. Parasite threshold associated with clinical malaria in areas of different transmission intensities in north eastern Tanzania

    DEFF Research Database (Denmark)

    Mmbando, Bruno P; Lusingu, John P; Vestergaard, Lasse S


    BACKGROUND: In Sub-Sahara Africa, malaria due to Plasmodium falciparum is the main cause of ill health. Evaluation of malaria interventions, such as drugs and vaccines depends on clinical definition of the disease, which is still a challenge due to lack of distinct malaria specific clinical...... features. Parasite threshold is used in definition of clinical malaria in evaluation of interventions. This however, is likely to be influenced by other factors such as transmission intensity as well as individual level of immunity against malaria. METHODS: This paper describes step function and dose...... response model with threshold parameter as a tool for estimation of parasite threshold for onset of malaria fever in highlands (low transmission) and lowlands (high transmission intensity) strata. These models were fitted using logistic regression stratified by strata and age groups (0-1, 2-3, 4-5, 6...

  17. Radiographic Progression-Free Survival as a Clinically Meaningful End Point in Metastatic Castration-Resistant Prostate Cancer: The PREVAIL Randomized Clinical Trial. (United States)

    Rathkopf, Dana E; Beer, Tomasz M; Loriot, Yohann; Higano, Celestia S; Armstrong, Andrew J; Sternberg, Cora N; de Bono, Johann S; Tombal, Bertrand; Parli, Teresa; Bhattacharya, Suman; Phung, De; Krivoshik, Andrew; Scher, Howard I; Morris, Michael J


    Drug development for metastatic castration-resistant prostate cancer has been limited by a lack of clinically relevant trial end points short of overall survival (OS). Radiographic progression-free survival (rPFS) as defined by the Prostate Cancer Clinical Trials Working Group 2 (PCWG2) is a candidate end point that represents a clinically meaningful benefit to patients. To demonstrate the robustness of the PCWG2 definition and to examine the relationship between rPFS and OS. PREVAIL was a phase 3, randomized, double-blind, placebo-controlled multinational study that enrolled 1717 chemotherapy-naive men with metastatic castration-resistant prostate cancer from September 2010 through September 2012. The data were analyzed in November 2016. Patients were randomized 1:1 to enzalutamide 160 mg or placebo until confirmed radiographic disease progression or a skeletal-related event and initiation of either cytotoxic chemotherapy or an investigational agent for prostate cancer treatment. Sensitivity analyses (SAs) of investigator-assessed rPFS were performed using the final rPFS data cutoff (May 6, 2012; 439 events; SA1) and the interim OS data cutoff (September 16, 2013; 540 events; SA2). Additional SAs using investigator-assessed rPFS from the final rPFS data cutoff assessed the impact of skeletal-related events (SA3), clinical progression (SA4), a confirmatory scan for soft-tissue disease progression (SA5), and all deaths regardless of time after study drug discontinuation (SA6). Correlations between investigator-assessed rPFS (SA2) and OS were calculated using Spearman ρ and Kendall τ via Clayton copula. In the 1717 men (mean age, 72.0 [range, 43.0-93.0] years in enzalutamide arm and 71.0 [range, 42.0-93.0] years in placebo arm), enzalutamide significantly reduced risk of radiographic progression or death in all SAs, with hazard ratios of 0.22 (SA1; 95% CI, 0.18-0.27), 0.31 (SA2; 95% CI, 0.27-0.35), 0.21 (SA3; 95% CI, 0.18-0.26), 0.21 (SA4; 95% CI, 0.17-0.26), 0

  18. Poisson versus threshold models for genetic analysis of clinical mastitis in US Holsteins. (United States)

    Vazquez, A I; Weigel, K A; Gianola, D; Bates, D M; Perez-Cabal, M A; Rosa, G J M; Chang, Y M


    Typically, clinical mastitis is coded as the presence or absence of disease in a given lactation, and records are analyzed with either linear models or binary threshold models. Because the presence of mastitis may include cows with multiple episodes, there is a loss of information when counts are treated as binary responses. Poisson models are appropriated for random variables measured as the number of events, and although these models are used extensively in studying the epidemiology of mastitis, they have rarely been used for studying the genetic aspects of mastitis. Ordinal threshold models are pertinent for ordered categorical responses; although one can hypothesize that the number of clinical mastitis episodes per animal reflects a continuous underlying increase in mastitis susceptibility, these models have rarely been used in genetic analysis of mastitis. The objective of this study was to compare probit, Poisson, and ordinal threshold models for the genetic evaluation of US Holstein sires for clinical mastitis. Mastitis was measured as a binary trait or as the number of mastitis cases. Data from 44,908 first-parity cows recorded in on-farm herd management software were gathered, edited, and processed for the present study. The cows were daughters of 1,861 sires, distributed over 94 herds. Predictive ability was assessed via a 5-fold cross-validation using 2 loss functions: mean squared error of prediction (MSEP) as the end point and a cost difference function. The heritability estimates were 0.061 for mastitis measured as a binary trait in the probit model and 0.085 and 0.132 for the number of mastitis cases in the ordinal threshold and Poisson models, respectively; because of scale differences, only the probit and ordinal threshold models are directly comparable. Among healthy animals, MSEP was smallest for the probit model, and the cost function was smallest for the ordinal threshold model. Among diseased animals, MSEP and the cost function were smallest

  19. Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage. (United States)

    Carson, Jeffrey L; Guyatt, Gordon; Heddle, Nancy M; Grossman, Brenda J; Cohn, Claudia S; Fung, Mark K; Gernsheimer, Terry; Holcomb, John B; Kaplan, Lewis J; Katz, Louis M; Peterson, Nikki; Ramsey, Glenn; Rao, Sunil V; Roback, John D; Shander, Aryeh; Tobian, Aaron A R


    More than 100 million units of blood are collected worldwide each year, yet the indication for red blood cell (RBC) transfusion and the optimal length of RBC storage prior to transfusion are uncertain. To provide recommendations for the target hemoglobin level for RBC transfusion among hospitalized adult patients who are hemodynamically stable and the length of time RBCs should be stored prior to transfusion. Reference librarians conducted a literature search for randomized clinical trials (RCTs) evaluating hemoglobin thresholds for RBC transfusion (1950-May 2016) and RBC storage duration (1948-May 2016) without language restrictions. The results were summarized using the Grading of Recommendations Assessment, Development and Evaluation method. For RBC transfusion thresholds, 31 RCTs included 12 587 participants and compared restrictive thresholds (transfusion not indicated until the hemoglobin level is 7-8 g/dL) with liberal thresholds (transfusion not indicated until the hemoglobin level is 9-10 g/dL). The summary estimates across trials demonstrated that restrictive RBC transfusion thresholds were not associated with higher rates of adverse clinical outcomes, including 30-day mortality, myocardial infarction, cerebrovascular accident, rebleeding, pneumonia, or thromboembolism. For RBC storage duration, 13 RCTs included 5515 participants randomly allocated to receive fresher blood or standard-issue blood. These RCTs demonstrated that fresher blood did not improve clinical outcomes. It is good practice to consider the hemoglobin level, the overall clinical context, patient preferences, and alternative therapies when making transfusion decisions regarding an individual patient. Recommendation 1: a restrictive RBC transfusion threshold in which the transfusion is not indicated until the hemoglobin level is 7 g/dL is recommended for hospitalized adult patients who are hemodynamically stable, including critically ill patients, rather than when the hemoglobin level

  20. Clinical meaningfulness of Alzheimer's Disease Assessment Scale-Cognitive subscale change in relation to goal attainment in patients on cholinesterase inhibitors. (United States)

    Rockwood, Kenneth; Howlett, Susan E; Hoffman, Deborah; Schindler, Rachel; Mitnitski, Arnold


    The clinical meaningfulness of Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog) subscale change is disputed. We compared 2- to 4-point ADAS-Cog changes with changes in Goal Attainment Scaling (GAS) and everyday function across initial ADAS-Cog scores and treatment responses. This exploratory analysis evaluated mild-moderate Alzheimer's disease patients treated with donepezil (12 months) or galantamine (8 months). Clinical meaningfulness was defined as concomitant ADAS-Cog and GAS changes of ±3 points and/or functional improvement. Patients with ≥3-point ADAS-Cog improvement significantly improved on GAS but not on standard tests of everyday function. ADAS-Cog "no change" (≤±3 points) was seen with mean GAS improvement. Initial ADAS-Cog improvement made endpoint improvement (ADAS-Cog 3 points and GAS 1 point) more likely (odds ratio = 6.9; 95% confidence interval = 2.5-19.5). In contrast, initial deterioration made endpoint improvement unlikely (0.33; 0.14-0.64). ADAS-Cog improvement and no change were each associated with GAS improvement. Initial ADAS-Cog worsening was unlikely to result in later improvement. ISRCTN26167328. Copyright © 2017. Published by Elsevier Inc.

  1. A system dynamics model of clinical decision thresholds for the detection of developmental-behavioral disorders

    Directory of Open Access Journals (Sweden)

    R. Christopher Sheldrick


    Full Text Available Abstract Background Clinical decision-making has been conceptualized as a sequence of two separate processes: assessment of patients’ functioning and application of a decision threshold to determine whether the evidence is sufficient to justify a given decision. A range of factors, including use of evidence-based screening instruments, has the potential to influence either or both processes. However, implementation studies seldom specify or assess the mechanism by which screening is hypothesized to influence clinical decision-making, thus limiting their ability to address unexpected findings regarding clinicians’ behavior. Building on prior theory and empirical evidence, we created a system dynamics (SD model of how physicians’ clinical decisions are influenced by their assessments of patients and by factors that may influence decision thresholds, such as knowledge of past patient outcomes. Using developmental-behavioral disorders as a case example, we then explore how referral decisions may be influenced by changes in context. Specifically, we compare predictions from the SD model to published implementation trials of evidence-based screening to understand physicians’ management of positive screening results and changes in referral rates. We also conduct virtual experiments regarding the influence of a variety of interventions that may influence physicians’ thresholds, including improved access to co-located mental health care and improved feedback systems regarding patient outcomes. Results Results of the SD model were consistent with recent implementation trials. For example, the SD model suggests that if screening improves physicians’ accuracy of assessment without also influencing decision thresholds, then a significant proportion of children with positive screens will not be referred and the effect of screening implementation on referral rates will be modest—results that are consistent with a large proportion of published

  2. Effect of comorbid tics on a clinically meaningful response to 8-week open-label trial of fluoxetine in obsessive compulsive disorder. (United States)

    Husted, David S; Shapira, Nathan A; Murphy, Tanya K; Mann, Giselle D; Ward, Herbert E; Goodman, Wayne K


    Currently, there are limited published data evaluating the effects of tics on serotonin reuptake inhibitor (SRI) monotherapy responses in treating obsessive-compulsive disorder (OCD). One retrospective case-controlled analysis of OCD patients treated with SRI monotherapy showed lesser improvement in OCD symptoms in patients with tics than those without. However, more recently there were preliminary reports of OCD subjects treated with SRI monotherapy which did not demonstrate poorer response in subjects with tics or Tourette's Syndrome (TS). The specific aim of this study was to investigate whether the presence of comorbid chronic tics affected "clinically meaningful improvement" [McDougle, C.J., Goodman, W.K., Leckman, J.F., Barr, L.C., Heninger, G.R., Price, L.H., 1993. The efficacy of fluvoxamine in obsessive-compulsive disorder: effects of comorbid chronic tic disorder. Journal of Clinical Psychopharmacology 13, 354-358] of OCD in an 8-week open-label trial of fluoxetine monotherapy. Seventy-four adult subjects (13 patients with comorbid chronic tics and 61 patients without tics) with a primary DSM-IV OCD diagnosis were treated with up to 40mg fluoxetine for 8 weeks and had at least one post-baseline evaluation. The results indicate that there was a significant response by time in both fluoxetine-with-tic subjects and fluoxetine-without-tic subjects. Additionally, there were 3 (23.0%) OCD subjects with tics who had clinically meaningful improvement versus 16 (26.2%) OCD subjects without tics that demonstrated similar levels of improvement. These findings indicate that OCD patients with or without chronic tic disorders did not have a differential response to an 8-week open-label trial of fluoxetine. Limitations include the relatively low number of tic subjects and the open-label nature of the study. Additional data are needed on how comorbid tics may affect SRI treatment response in OCD.

  3. Tramadol effects on clinical variables and the mechanical nociceptive threshold in horses


    Franco,Leandro Guimarães; Moreno,Juan Carlos Duque; Teixeira Neto,Antônio Raphael; Souza,Moisés Caetano e; Silva,Luiz Antônio Franco da


    This study assessed the clinical effects and the mechanical antinociceptive potential of intravenous (IV) tramadol in horses.A blinded and randomized study was designed with 7 horses treated with 1 (Tr1), 2 (Tr2) or 3 (Tr3) mg kg-1 of tramadol IV. The heart rate, respiratory rate (fR), arterial pressure, degree of sedation, gastrointestinal motility (GI), behavior changes and the mechanical nociceptive threshold (MNT) were evaluated. The MNT was determined with von Frey device method.Tr3 had ...

  4. Nonorganic hearing loss in children: audiometry, clinical characteristics, biographical history and recovery of hearing thresholds. (United States)

    Schmidt, Claus-Michael; am Zehnhoff-Dinnesen, Antoinette; Matulat, Peter; Knief, Arne; Rosslau, Ken; Deuster, Dirk


    The term "nonorganic hearing loss" (NOHL) (pseudohypacusis, functional or psychogenic hearing loss) describes a hearing loss without a detectable corresponding pathology in the auditory system. It is characterized by a discrepancy between elevated pure tone audiometry thresholds and normal speech discrimination. The recommended audiological management of NOHL in children comprises history taking, diagnosis, and counseling. According to the literature, prognosis depends on the severity of the patient's school and/or personal problems. Routine referral to a child psychiatrist is discussed as being controversial. The clinical history of 34 children with NOHL was retrospectively evaluated. In 15 children, follow up audiometry was performed. Results of biographical history, subjective and objective audiometry, additional speech and language assessment, psychological investigations and follow up audiometry are presented and discussed. The prevalence of NOHL was 1.8% in children with suspected hearing loss. Mean age at diagnosis was 10.8 years. Girls were twice as often affected as boys. Patient history showed a high prevalence of emotional and school problems. Pre-existing organic hearing loss can be worsened by nonorganic causes. Children with a fast recovery of hearing thresholds (n=6) showed a high rate (4/6) of family, social and emotional problems. In children with continuous threshold elevation (n=9), biographical history showed no recognizable or obvious family, social or emotional problems; learning disability (4/9) was the most frequently presented characteristic. Due to advances in objective audiometry, the diagnosis of NOHL is less challenging than management and counseling. Considering the high frequency of personal and school problems, a multidisciplinary setting is helpful. On the basis of our results, drawing conclusions from hearing threshold recovery on the severity of underlying psychic problems seems inappropriate. As a consequence, a referral to a

  5. The clinical meaningfulness of ADAS-Cog changes in Alzheimer's disease patients treated with donepezil in an open-label trial. (United States)

    Rockwood, Kenneth; Fay, Sherri; Gorman, Mary; Carver, Daniel; Graham, Janice E


    In 6-month anti-dementia drug trials, a 4-point change in the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) is held to be clinically important. We examined how this change compared with measures of clinical meaningfulness. This is a secondary analysis of a 12 month open-label study of 100 patients (71 women) diagnosed with mild to moderate AD treated with 5-10 mg of donepezil daily. We studied the observed case, 6-month change from baseline on the ADAS-Cog, the Clinician's Interview Based Impression of Change-Plus Caregiver Input (CIBIC-Plus), patient-Goal Attainment Scaling (PGAS) and clinician-GAS (CGAS). At 6 months, donepezil-treated patients (n = 95) were more likely to show no change (+/- 3 points) on the ADAS-Cog (56%) than to improve (20%) or decline (24%) by 4-points. ADAS-Cog change scores were little correlated with other measures: from -0.09 for PGAS to 0.27 for the CIBIC-Plus. While patients who improved on the ADAS-Cog were less likely to decline on the clinical measures (26%), 43% of patients who declined on the ADAS-Cog improved on at least two of the clinical measures. The ADAS-Cog did not capture all clinically important effects. In general, ADAS-Cog improvement indicates clinical improvement, whereas many people with ADAS-Cog decline do not show clinical decline. The open-label design of this study does not allow us to know whether this is a treatment effect, which requires further investigation.

  6. T1- Thresholds in Black Holes Increase Clinical-Radiological Correlation in Multiple Sclerosis Patients. (United States)

    Thaler, Christian; Faizy, Tobias; Sedlacik, Jan; Holst, Brigitte; Stellmann, Jan-Patrick; Young, Kim Lea; Heesen, Christoph; Fiehler, Jens; Siemonsen, Susanne


    Magnetic Resonance Imaging (MRI) is an established tool in diagnosing and evaluating disease activity in Multiple Sclerosis (MS). While clinical-radiological correlations are limited in general, hypointense T1 lesions (also known as Black Holes (BH)) have shown some promising results. The definition of BHs is very heterogeneous and depends on subjective visual evaluation. We aimed to improve clinical-radiological correlations by defining BHs using T1 relaxation time (T1-RT) thresholds to achieve best possible correlation between BH lesion volume and clinical disability. 40 patients with mainly relapsing-remitting MS underwent MRI including 3-dimensional fluid attenuated inversion recovery (FLAIR), magnetization-prepared rapid gradient echo (MPRAGE) before and after Gadolinium (GD) injection and double inversion-contrast magnetization-prepared rapid gradient echo (MP2RAGE) sequences. BHs (BHvis) were marked by two raters on native T1-weighted (T1w)-MPRAGE, contrast-enhancing lesions (CE lesions) on T1w-MPRAGE after GD and FLAIR lesions (total-FLAIR lesions) were detected separately. BHvis and total-FLAIR lesion maps were registered to MP2RAGE images, and the mean T1-RT were calculated for all lesion ROIs. Mean T1 values of the cortex (CTX) were calculated for each patient. Subsequently, Spearman rank correlations between clinical scores (Expanded Disability Status Scale and Multiple Sclerosis Functional Composite) and lesion volume were determined for different T1-RT thresholds. Significant differences in T1-RT were obtained between all different lesion types with highest T1 values in visually marked BHs (BHvis: 1453.3±213.4 ms, total-FLAIR lesions: 1394.33±187.38 ms, CTX: 1305.6±35.8 ms; p1500 ms (Expanded Disability Status Scale vs. lesion volume: rBHvis = 0.442 and rtotal-FLAIR = 0.497, p<0.05; Multiple Sclerosis Functional Composite vs. lesion volume: rBHvis = -0.53 and rtotal-FLAIR = -0.627, p<0.05). Clinical-radiological correlations in MS patients are

  7. Avoidance of androgen deprivation therapy in radiorecurrent prostate cancer as a clinically meaningful endpoint for salvage cryoablation. (United States)

    Ginsburg, Kevin B; Elshafei, Ahmed; Yu, Changhong; Jones, J Stephen; Cher, Michael L


    To investigate the ability of salvage cryoablation of the prostate (SCAP) to delay the need for androgen deprivation therapy (ADT) in local recurrence after radiation therapy to the prostate using the Cryo-On-Line Database (COLD) registry. The COLD registry is comprised of a combination of retrospectively and prospectively collected data on patients undergoing primary and SCAP. Patients with local recurrence after radiation therapy were identified. Kaplan-Meier analysis was used to calculate ADT-free survival. We identified 898 patients that have undergone SCAP in the COLD registry. Overall, the calculated 5-year ADT-free survival probability was 0.713. When stratified by D'Amico risk group, 264 high-risk patients (71.9%), 234 intermediate-risk (86.7%),and 228 low-risk (87.7%) were free of ADT post-SCAP. This correlates with a 5-year ADT-free survival of 60.7, 73.9, and 82.4%, respectively. Patients with post-SCAP PSA nadir of <0.2 ng/mL had a 5 year ADT-free survival of 87.1% compared to 48.7% with a PSA nadir ≥0.2 ng/mL. Pre-operative ADT use or full versus partial gland SCAP did not have an effect on ADT use post-operatively. In 118 (55.4%) of patients with post-operative biochemical recurrence, ADT was not used. For patients with local recurrence after radiation, SCAP is an option that provides a high chance of avoiding or delaying ADT. The potential to delay ADT and its associated side effects should be a part of counseling sessions with the patient when discussing treatment options for locally recurrent prostate cancer after radiation. Avoidance of ADT is more clinically relevant than PSA elevation. © 2017 Wiley Periodicals, Inc.

  8. Clinically meaningful scores on pain catastrophizing before and after multidisciplinary rehabilitation: a prospective study of individuals with subacute pain after whiplash injury. (United States)

    Scott, Whitney; Wideman, Timothy H; Sullivan, Michael J L


    Pain catastrophizing has emerged as a significant risk factor for problematic recovery after musculoskeletal injury. As such, there has been an increased focus on interventions that target patients' levels of catastrophizing. However, it is not presently clear how clinicians might best interpret scores on catastrophizing before and after treatment. Thus, the purpose of this study was to provide preliminary guidelines for the clinical interpretation of scores on pain catastrophizing among individuals with subacute pain after musculoskeletal injury. A sample of 166 occupationally disabled individuals with subacute pain due to a whiplash injury participated in this study. Participants completed a 7-week standardized multidisciplinary rehabilitation program aimed at fostering functional recovery. Participants completed the Pain Catastrophizing Scale (PCS) upon program commencement and completion. One year later, participants indicated their pain severity and involvement in employment activities. Separate receiver operating characteristic curve analyses were conducted to determine absolute pretreatment and posttreatment and percent change scores on the PCS that were best associated with clinically important levels of pain and employment status at the follow-up. An absolute pretreatment PCS score of 24 best identified patients according to follow-up clinical outcomes. Posttreatment PCS scores of 14 and 15 best identified patients with high follow-up pain intensity ratings and those who did not return to work, respectively. PCS reductions of approximately 38% to 44% were best associated with return to work and low pain intensity ratings at follow-up. The results indicate scores on catastrophizing before and after treatment that are clinically meaningful. These results may serve as preliminary guidelines to assess the clinical significance of interventions targeting pain catastrophizing in patients with subacute pain after musculoskeletal injury.

  9. The use of a responder analysis to identify clinically meaningful differences in chronic urticaria patients following placebo- controlled treatment with rupatadine 10 and 20 mg. (United States)

    Giménez-Arnau, A; Izquierdo, I; Maurer, M


    According to the EAACI/GA(2)LEN/EDF guidelines for urticaria management, modern non-sedating H1-antihistamines are the first-line symptomatic treatment for chronic urticaria. Two previous randomized clinical trials demonstrated rupatadine efficacy and safety in chronic urticaria treatment. However, a responder analysis to identify clinically meaningful differences in patients with chronic urticaria has not yet been performed. This analysis includes the pooled data from two randomized, double-blind, placebo-controlled, multicentre studies in which chronic urticaria patients were treated with rupatadine at different doses. Responder rates were defined as the percentage of patients after 4 weeks of treatment who exhibited a reduction of symptoms by at least 50% or 75% as compared to baseline. The variables analysed were as follows: Mean Pruritus Score (MPS), Mean Number of Wheals (MNW), and Mean Urticaria Activity Score (UAS). A total of 538 patients were included. This responder analysis, using different response levels, shows that the efficacy of rupatadine 10 mg and 20 mg is significantly better as compared to placebo in the treatment of chronic urticaria patients. Notably, treatment with rupatadine 20 mg daily resulted in a higher percentage of patients with response of 75% symptom reduction or better than rupatadine 10 mg. Our results support the use of higher than standard doses of non sedating antihistamines in chronic urticaria. We strongly recommend performing and reporting responder analyses for established and new drugs used by patients with chronic urticaria.

  10. Thresholds for statistical and clinical significance in systematic reviews with meta-analytic methods

    DEFF Research Database (Denmark)

    Jakobsen, Janus Christian; Wetterslev, Jorn; Winkel, Per


    BACKGROUND: Thresholds for statistical significance when assessing meta-analysis results are being insufficiently demonstrated by traditional 95% confidence intervals and P-values. Assessment of intervention effects in systematic reviews with meta-analysis deserves greater rigour. METHODS......: Methodologies for assessing statistical and clinical significance of intervention effects in systematic reviews were considered. Balancing simplicity and comprehensiveness, an operational procedure was developed, based mainly on The Cochrane Collaboration methodology and the Grading of Recommendations...... Assessment, Development, and Evaluation (GRADE) guidelines. RESULTS: We propose an eight-step procedure for better validation of meta-analytic results in systematic reviews (1) Obtain the 95% confidence intervals and the P-values from both fixed-effect and random-effects meta-analyses and report the most...

  11. Clinically meaningful differences in pain, disability and quality of life for chronic nonspecific neck pain - a reanalysis of 4 randomized controlled trials of cupping therapy. (United States)

    Lauche, Romy; Langhorst, Jost; Dobos, Gustav J; Cramer, Holger


    The assessment of clinically meaningful differences in patients' self-reported outcomes has become increasingly important when interpreting the results of clinical studies. Although these assessments have become quite common there are hardly any data for nonspecific neck pain, especially in the context of complementary and alternative medicine. The aim of this analysis is the determination of minimal clinically important differences (MCID) and substantial clinical benefits (SCB) in patients with chronic nonspecific neck pain after cupping treatment. The data set comprised a total of 200 patients with chronic nonspecific neck pain participating in clinical trials on cupping therapy. The MCID and SCB for pain intensity (VAS), neck disability index (NDI) and the subscale bodily pain (SF-36-BP) as well as physical component summary (SF-36-PCS) of the SF-36 were determined using receiver operating characteristic (ROC) curve analysis with an adapted assessment of change in health status (SF-36), i.e. a 5-point Likert scale ranging from "much better" to "much worse", as anchor. MCID derived from the ROC was the score to distinguish "somewhat better" from "about the same", and the SCB was the score to distinguish "much better" from "somewhat better". The calculated MCIDs were: -8mm (-21%) for VAS, -3 points (-10.2%) for NDI, +10 points (+20.5%) for SF-36-BP and +2.6 points (+7.7%) for SF-36-PCS. The SCBs were: -26.5mm (-66.8%) for VAS, -8.4 points (-29%) for NDI, +15.5 points (+43.1%) for SF-36-BP and +5.1 points (+12.9%) for SF-36-PCS. Accuracy of the estimations was good for MCID in general and for SCB regarding VAS and NDI. The results support the assumption that patients' perceptions of treatment benefits measured by VAS in these trials might be comparable to others in conventional therapies. For NDI and SF-36-PCS the estimated differences were smaller than in previous reports indicating that context factors such as patient characteristics and specific treatment

  12. Pressure pain thresholds, clinical assessment, and differential diagnosis: reliability and validity in patients with myogenic pain. (United States)

    Ohrbach, R; Gale, E N


    Four studies are presented testing the validity and reliability of pressure pain thresholds (PPTs) and of examination parameters believed to be important in the clinical assessment of sites commonly used for such measures in patient samples. Forty-five patients with a myogenous temporomandibular disorder were examined clinically prior to PPT measures. Criteria for history and examination included functional aspects of the pain, tissue quality of the pain site, and the type of pain elicited from palpation. Control sites within the same muscle and in the contralateral muscle were also examined. PPTs were measured as an index of tenderness using a strain gauge algometer at these sites. The data from the 5 male subjects were excluded from subsequent analyses due to the higher PPT in the males and to their unequal distribution among the various factorial conditions. The first study demonstrated strong validity in PPT measures between patients (using pain sites replicating the patients' pain) and matched controls (n = 11). The PPT was not significantly different between the primary pain site (referred pain and non-referred pain collapsed) and the no-pain control site in the same muscle (n = 16). The PPT was significantly lower at the pain site compared to the no-pain control site in the contralateral muscle (n = 13). The second study indicated adequate reliability in patient samples of the PPT measures. In the third study, the PPT was significantly lower at sites producing referred pain on palpation compared to sites producing localized pain on palpation. The PPT findings from the control sites were inconsistent on this factor. The fourth study presented preliminary evidence that palpable bands and nodular areas in muscle were most commonly associated with muscle regions that produce pain; such muscle findings were not specific, however, for regions that produce pain. Further, the intraexaminer reliability in reassessing these pain sites qualitatively was only fair

  13. Tramadol effects on clinical variables and the mechanical nociceptive threshold in horses

    Directory of Open Access Journals (Sweden)

    Leandro Guimarães Franco


    Full Text Available This study assessed the clinical effects and the mechanical antinociceptive potential of intravenous (IV tramadol in horses.A blinded and randomized study was designed with 7 horses treated with 1 (Tr1, 2 (Tr2 or 3 (Tr3 mg kg-1 of tramadol IV. The heart rate, respiratory rate (fR, arterial pressure, degree of sedation, gastrointestinal motility (GI, behavior changes and the mechanical nociceptive threshold (MNT were evaluated. The MNT was determined with von Frey device method.Tr3 had a significant increase in their fR and more pronounced behavioral changes than other treatments.The Tr1 showed a significant increase in arterial pressure. The GI reduced significantly, mainly in Tr2. The tramadol did not change the MNT of the horses.The clinical alterations observed with the different treatments were considered mild and transitory, being most evident in Tr2. However the tramadol did not have any analgesic effect with any of the doses evaluated.

  14. Meaningful and Purposeful Practice (United States)

    Clementi, Donna


    This article describes a graphic, designed by Clementi and Terrill, the authors of "Keys to Planning for Learning" (2013), visually representing the components that contribute to meaningful and purposeful practice in learning a world language, practice that leads to greater proficiency. The entire graphic is centered around the letter…

  15. Life is pretty meaningful. (United States)

    Heintzelman, Samantha J; King, Laura A


    The human experience of meaning in life is widely viewed as a cornerstone of well-being and a central human motivation. Self-reports of meaning in life relate to a host of important functional outcomes. Psychologists have portrayed meaning in life as simultaneously chronically lacking in human life as well as playing an important role in survival. Examining the growing literature on meaning in life, we address the question "How meaningful is life, in general?" We review possible answers from various psychological sources, some of which anticipate that meaning in life should be low and others that it should be high. Summaries of epidemiological data and research using two self-report measures of meaning in life suggest that life is pretty meaningful. Diverse samples rate themselves significantly above the midpoint on self-reports of meaning in life. We suggest that if meaning in life plays a role in adaptation, it must be commonplace, as our analysis suggests. (c) 2014 APA, all rights reserved.

  16. Paresthesia thresholds in spinal cord stimulation: a comparison of theoretical results with clinical data

    NARCIS (Netherlands)

    Struijk, J.J.; Struijk, Johannes J.; Holsheimer, J.; Barolat, Giancarlo; He, Jiping; Boom, H.B.K.


    The potential distributions produced in the spinal cord and surrounding tissues by dorsal epidural stimulation at the midcervical, midthoracic, and low thoracic levels were calculated with the use of a volume conductor model. Stimulus thresholds of myelinated dorsal column fibers and dorsal root

  17. An odor-specific threshold deficit implicates abnormal cAMP signaling in youths at clinical risk for psychosis. (United States)

    Kamath, Vidyulata; Moberg, Paul J; Calkins, Monica E; Borgmann-Winter, Karin; Conroy, Catherine G; Gur, Raquel E; Kohler, Christian G; Turetsky, Bruce I


    While olfactory deficits have been reported in schizophrenia and youths at-risk for psychosis, few studies have linked these deficits to current pathophysiological models of the illness. There is evidence that disrupted cyclic adenosine 3',5'-monophosphate (cAMP) signaling may contribute to schizophrenia pathology. As cAMP mediates olfactory signal transduction, the degree to which this disruption could manifest in olfactory impairment was ascertained. Odor-detection thresholds to two odorants that differ in the degree to which they activate intracellular cAMP were assessed in clinical risk and low-risk participants. Birhinal assessments of odor-detection threshold sensitivity to lyral and citralva were acquired in youths experiencing prodromal symptoms (n=17) and controls at low risk for developing psychosis (n=15). Citralva and lyral are odorants that differ in cAMP activation; citralva is a strong cAMP activator and lyral is a weak cAMP activator. The overall group-by-odor interaction was statistically significant. At-risk youths showed significantly reduced odor detection thresholds for lyral, but showed intact detection thresholds for citralva. This odor-specific threshold deficit was uncorrelated with deficits in odor identification or discrimination, which were also present. ROC curve analysis revealed that olfactory performance correctly classified at-risk and low-risk youths with greater than 97% accuracy. This study extends prior findings of an odor-specific hyposmia implicating cAMP-mediated signal transduction in schizophrenia and unaffected first-degree relatives to include youths at clinical risk for developing the disorder. These results suggest that dysregulation of cAMP signaling may be present during the psychosis prodrome. Copyright © 2012 Elsevier B.V. All rights reserved.

  18. Application of the Korean version of the Modified Barthel Index: Development of a keyform for use in clinical practice

    Directory of Open Access Journals (Sweden)

    Ickpyo Hong


    Conclusions: The findings suggest that a Rasch keyform can be applied to clinical practice in Korean settings by identifying clinically and statistically meaningful test items and their step thresholds as short- and long-term goals.

  19. Does sensory stimulation threshold affect lumbar facet radiofrequency denervation outcomes? A prospective clinical correlational study. (United States)

    Cohen, Steven P; Strassels, Scott A; Kurihara, Connie; Lesnick, Ivan K; Hanling, Steven R; Griffith, Scott R; Buckenmaier, Chester C; Nguyen, Conner


    Radiofrequency facet denervation is one of the most frequently performed procedures for chronic low back pain. Although sensory stimulation is generally used as a surrogate measure to denote sufficient proximity of the electrode to the nerve, no study has examined whether stimulation threshold influences outcome. We prospectively recorded data in 61 consecutive patients undergoing lumbar facet radiofrequency denervation who experienced significant pain relief after medial branch blocks. For each nerve lesioned, multiple attempts were made to maximize sensory stimulation threshold (SST). Mean SST was calculated on the basis of the lowest stimulation perceived at 0.1-V increments for each medial branch. A positive outcome was defined as a ≥50% reduction in back pain coupled with a positive satisfaction score lasting ≥3 months. The relationship between mean SST and denervation outcomes was evaluated via a receiver's operating characteristic (ROC) curve, and stratifying outcomes on the basis of various cutoff values. No correlation was noted between mean SST and pain relief at rest (Pearson's r=-0.01, 95% confidence interval [CI]: -0.24 to 0.23, P=0.97), with activity (r=-0.17, 95% CI: -0.40 to 0.07, P=0.20), or a successful outcome. No optimal SST could be identified. There is no significant relationship between mean SST during lumbar facet radiofrequency denervation and treatment outcome, which may be due to differences in general sensory perception. Because stimulation threshold was optimized for each patient, these data cannot be interpreted to suggest that sensory testing should not be performed, or that high sensory stimulation thresholds obtained on the first attempt should be deemed acceptable.

  20. Speech-in-Noise Tests and Supra-threshold Auditory Evoked Potentials as Metrics for Noise Damage and Clinical Trial Outcome Measures. (United States)

    Le Prell, Colleen G; Brungart, Douglas S


    In humans, the accepted clinical standards for detecting hearing loss are the behavioral audiogram, based on the absolute detection threshold of pure-tones, and the threshold auditory brainstem response (ABR). The audiogram and the threshold ABR are reliable and sensitive measures of hearing thresholds in human listeners. However, recent results from noise-exposed animals demonstrate that noise exposure can cause substantial neurodegeneration in the peripheral auditory system without degrading pure-tone audiometric thresholds. It has been suggested that clinical measures of auditory performance conducted with stimuli presented above the detection threshold may be more sensitive than the behavioral audiogram in detecting early-stage noise-induced hearing loss in listeners with audiometric thresholds within normal limits. Supra-threshold speech-in-noise testing and supra-threshold ABR responses are reviewed here, given that they may be useful supplements to the behavioral audiogram for assessment of possible neurodegeneration in noise-exposed listeners. Supra-threshold tests may be useful for assessing the effects of noise on the human inner ear, and the effectiveness of interventions designed to prevent noise trauma. The current state of the science does not necessarily allow us to define a single set of best practice protocols. Nonetheless, we encourage investigators to incorporate these metrics into test batteries when feasible, with an effort to standardize procedures to the greatest extent possible as new reports emerge.

  1. Aligning institutional priorities: engaging house staff in a quality improvement and safety initiative to fulfill Clinical Learning Environment Review objectives and electronic medical record Meaningful Use requirements. (United States)

    Flanagan, Meghan R; Foster, Carolyn C; Schleyer, Anneliese; Peterson, Gene N; Mandell, Samuel P; Rudd, Kristina E; Joyner, Byron D; Payne, Thomas H


    House staff quality improvement projects are often not aligned with training institution priorities. House staff are the primary users of inpatient problem lists in academic medical centers, and list maintenance has significant patient safety and financial implications. Improvement of the problem list is an important objective for hospitals with electronic health records under the Meaningful Use program. House staff surveys were used to create an electronic problem list manager (PLM) tool enabling efficient problem list updating. Number of new problems added and house staff perceptions of the problem list were compared before and after PLM intervention. The PLM was used by 654 house staff after release. Surveys demonstrated increased problem list updating (P = .002; response rate 47%). Mean new problems added per day increased from 64 pre-PLM to 125 post-PLM (P house staff in institutional quality and safety initiatives with tangible institutional benefits. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Threshold electrical stimulation (TES) in ambulant children with CP: a randomized double-blind placebo-controlled clinical trial

    DEFF Research Database (Denmark)

    Dali, Christine í; Hansen, Flemming Juul; Pedersen, Søren Anker


    A randomized double-blind placebo-controlled clinical trial was carried out to determine whether a group of stable children with cerebral palsy (36 males, 21 females; mean age 10 years 11 months, range 5 to 18 years) would improve their motor skills after 12 months of threshold electrical...... stimulation (TES). Two thirds received active and one third received inactive stimulators. For the primary outcome we constructed a set of plausible motor function tests and studied the change in summary indices of the performance measurements. Tests were videotaped and assessed blindly to record qualitative...

  3. Fitness and Independence after SCI: Defining Meaningful Change and Thresholds (United States)


    would you prefer to get this report from a health care provider, like a Doctor or Physical Therapist, or would you prefer to be able to get this...month. Lack of participant transportation and cancellations secondary to health issues are the primary barriers. MIA has over N=200 screen passes. The...3 update: Accrual rates at both centers are below target secondary to participation barriers, primarily transportation and short term health issues

  4. Fitness and Independence after SCI: Defining Meaningful Change and Thresholds (United States)


    information will not be linked to your survey responses. All electronic records from the online survey will be stored on Miami Project to Cure Paralysis...quality of life. Examples include: • data or databases; • physical collections; • audio or video products; • software; • models; • educational business creation; and • other. 7. PARTICIPANTS & OTHER COLLABORATING ORGANIZATIONS What individuals have worked on the

  5. Fitness and Independence after SCI: Defining Meaningful Change and Thresholds (United States)


    Advertise and interview for RA-TBD position  Allocate space for and acquire workstation for RA-TBD Key Outcomes: UM RA-TBD hired iii. Major...Yes other) No Wheelchair manufacturer & model ( Colours , Yes Invacare/Top End, Quickie, Tilite, etc.) No Wheelchair frame type (Rigid or folding) Yes No...model ( Colours , Yes Invacare/Top End, Quickie, Tilite, etc.) No Wheelchair frame type (Rigid or folding) Yes No Front wheel size/tire type (3", 4", 5", 6

  6. Beyond meaningful use: getting meaningful value from IT. (United States)

    Fortin, Jason; Zywiak, Walt


    The HITECH provisions of ARRA include financial incentives for providers to demonstrate meaningful use of certified EHR technology. However, to maximize the value of IT under new payment models, provider organizations will need to go beyond meaningful use criteria in three key areas: Delivering high-quality care. Ensuring coordinated care. Integrating financial systems.

  7. Carotid Artery Stenosis at MSCT: Is there a Threshold in Millimeters that Determines Clinical Significance?

    International Nuclear Information System (INIS)

    Saba, Luca; Sanfilippo, Roberto; Montisci, Roberto; Mallarini, Giorgio


    Purpose: The purpose of this work was to determine whether it is possible to identify a reliable carotid stenosis threshold—measured in millimeters (mm)—that is associated with cerebrovascular symptoms. Methods: Written, informed consent was obtained for each patient; 149 consecutive patients (98 men; median age, 68 years) were studied for suspected pathology of the carotid arteries by using MDCTA. In each patient, carotid artery stenosis was quantified using the mm-method. Continuous data were described as the mean value ± standard deviation (SD), and they were compared by using the Student’s t test. A ROC curve was calculated to test the study hypothesis and identify a specific mm-stenosis threshold. Logistic regression analysis was performed to include other MDCTA findings, such as plaque type and ulcerations. A P value < 0.05 was considered to indicate statistical significance. Results: Twenty-six patients were excluded. Of those remaining, 75 patients suffered cerebrovascular symptoms (61%). There was a statistically significant difference (P = 0.0046) in the mm-carotid stenosis between patients with symptoms (1.31 ± 0.64 mm SD) and without symptoms (1.68 ± 0.79 mm SD). Multiple logistic regression analysis confirmed that symptoms were associated with increased luminal stenosis (P = 0.013) and with the presence of fatty plaques (P = 0.0491). Moreover, the ROC curve (Az = 0.669; ±0.051 SD; P = 0.0009) indicated that a threshold of 1.6 mm stenosis was associated with a sensitivity to symptoms of 76%. Conclusions: The results of our study suggest an association between luminal stenosis (measure in mm) and the presence of cerebrovascular symptoms. Luminal stenosis of 1.6 mm is associated, with a sensitivity of 76%, with cerebrovascular symptoms.

  8. Is There a Clinically Meaningful Change in the Blood Pressure of Osteoarthritis Patients with Comorbid Hypertension During the Course of Balneotherapy? (United States)

    Hayta, Emrullah; Yılmaz, Mehmet Birhan; Yayıkçı, İlker; Özer, Zafer; Şahin, Özlem


    Background: Balneotherapy (BT) is a treatment modality that uses the physical and chemical effects of water, including thermomineral, acratothermal, and acratopegal waters. It has many effects on cardiovascular system. Aim: The aim of the study is to investigate the effects of 3-week BT on blood pressure of osteoarthritis (OA) patients with no hypertension (HT), and controlled or uncontrolled HT. Materials and Methods: The OA patients (n = 270) were divided into three groups: No HT, controlled HT, and uncontrolled HT. All the groups received BT in the facilities of our university hospital at the same time every day (10:00-11:30 AM) for 10 min per day, 5 days per week, for a total duration of 15 days in a 3-week period. Systolic and diastolic blood pressures and pulse rates were measured before and after BT on daily basis. Results: Overall, (1) the pulse rates of study groups measured after BT were significantly increased compared to before BT; (2) the systolic blood pressures of study groups measured before and after BT were found as comparable; and (3) the diastolic blood pressures of no HT and controlled HT groups measured before and after BT were not statistically significant (P > 0.05); however, in the uncontrolled HT group, the diastolic blood pressure showed a decreasing trend after BT (P < 0.05). Conclusions: In patients with OA, BT can be safely used without resulting in any meaningful changes in systolic and diastolic blood pressures in patients with normal and controlled HT but a decrease in diastolic blood pressure of patients with uncontrolled HT. This may be an advantage in OA patients having HT as comorbid disease. PMID:26713300

  9. Microbial environmental contamination in Italian dental clinics: A multicenter study yielding recommendations for standardized sampling methods and threshold values. (United States)

    Pasquarella, Cesira; Veronesi, Licia; Napoli, Christian; Castiglia, Paolo; Liguori, Giorgio; Rizzetto, Rolando; Torre, Ida; Righi, Elena; Farruggia, Patrizia; Tesauro, Marina; Torregrossa, Maria V; Montagna, Maria T; Colucci, Maria E; Gallè, Francesca; Masia, Maria D; Strohmenger, Laura; Bergomi, Margherita; Tinteri, Carola; Panico, Manuela; Pennino, Francesca; Cannova, Lucia; Tanzi, Marialuisa


    A microbiological environmental investigation was carried out in ten dental clinics in Italy. Microbial contamination of water, air and surfaces was assessed in each clinic during the five working days, for one week per month, for a three-month period. Water and surfaces were sampled before and after clinical activity; air was sampled before, after, and during clinical activity. A wide variation was found in microbial environmental contamination, both within the participating clinics and for the different sampling times. Before clinical activity, microbial water contamination in tap water reached 51,200cfu/mL (colony forming units per milliliter), and that in Dental Unit Water Systems (DUWSs) reached 872,000cfu/mL. After clinical activity, there was a significant decrease in the Total Viable Count (TVC) in tap water and in DUWSs. Pseudomonas aeruginosa was found in 2.38% (7/294) of tap water samples and in 20.06% (59/294) of DUWS samples; Legionella spp. was found in 29.96% (89/297) of tap water samples and 15.82% (47/297) of DUWS samples, with no significant difference between pre- and post-clinical activity. Microbial air contamination was highest during dental treatments, and decreased significantly at the end of the working activity (p<0.05). The microbial buildup on surfaces increased significantly during the working hours. This study provides data for the establishment of standardized sampling methods, and threshold values for contamination monitoring in dentistry. Some very critical situations have been observed which require urgent intervention. Furthermore, the study emphasizes the need for research aimed at defining effective managing strategies for dental clinics. Copyright © 2012 Elsevier B.V. All rights reserved.

  10. The Effect of Clinical Simulation with Debriefing for Meaningful Learning in Courses of Nursing Theory and Practicum on Student Knowledge and Perception of Instruction (United States)

    Shea, Kathleen


    Nursing students are expected to apply knowledge from lectures and laboratories to the clinical setting. One major challenge of nursing educators is facilitating the transfer of knowledge to the clinical-practice setting. Simulation-based education provides students with an experiential-learning activity within the context of a simulated clinical…

  11. Comparison on taste threshold between adult male white cigarette and clove cigarette smokers using Murphy clinical test method

    Directory of Open Access Journals (Sweden)

    Ronald Reyses Tapilatu


    Full Text Available The habit of smoking white cigarettes and clove cigarettes may affect the gustatory function, that is, it will cause damage to taste buds, resulting in an increase in gustatory threshold. This research used the descriptive comparative method and had the purpose of obtaining an illustration of gustatory threshold and compare gustatory threshold in white cigarette smokers and clove cigarette smokers in young, male adults. For gustatory threshold evaluation, the Murphy method was used to obtain a value for perception threshold and taste identification threshold using sucrose solution of 0.0006 M-0.06 M concentration. Research results indicate that the perception threshold and identification threshold of young, male adult smokers are 0.0119 M and 0.0292 M. Young, male adult clove cigarette smokers have a perception threshold and identification threshold of 0.0151 M and 0.0348 M. The conclusion of this research is that the perception threshold of young, male adult white cigarette smokers and clove cigarette smokers are the same, whereas the identification threshold of young, male adult white cigarette smokers and clove cigarette smokers are different, that is, the identification threshold of clove cigarette smokers is higher than that of white cigarette smokers.

  12. Comparison on taste threshold between adult male white cigarette and clove cigarette smokers using Murphy clinical test method


    Ronald Reyses Tapilatu; Edeh Rolleta Haroen; Rosiliwati Wihardja


    The habit of smoking white cigarettes and clove cigarettes may affect the gustatory function, that is, it will cause damage to taste buds, resulting in an increase in gustatory threshold. This research used the descriptive comparative method and had the purpose of obtaining an illustration of gustatory threshold and compare gustatory threshold in white cigarette smokers and clove cigarette smokers in young, male adults. For gustatory threshold evaluation, the Murphy method was used to obtain ...

  13. Clinical and histological evaluation of thermal injury thresholds in human teeth: a preliminary study. (United States)

    Baldissara, P; Catapano, S; Scotti, R


    The effect on healthy dental pulp of thermal increases ranging from 8.9 to 14.7 degrees C was evaluated. These temperature increases correspond approximately to those caused by certain restorative procedures, such as tooth preparation with high-speed instruments and the fabrication of direct provisional crowns. Two criteria of evaluation have been used in conjunction, a clinical (symptomatic) and a histological one, to assert with greater precision potential damage to the pulp. The results suggest a low susceptibility of cells to heat, which does not appear to be a major factor of injury, at least in the short term. The main cause of postoperative inflammation or necrosis of the pulp is probably the injury of the dentine, a tissue in direct functional and physiological connection with the pulp.

  14. The discrepancy between social isolation and loneliness as a clinically meaningful metric: findings from the Irish and English longitudinal studies of ageing (TILDA and ELSA). (United States)

    McHugh, J E; Kenny, R A; Lawlor, B A; Steptoe, A; Kee, F


    Scant evidence is available on the discordance between loneliness and social isolation among older adults. We aimed to investigate this discordance and any health implications that it may have. Using nationally representative datasets from ageing cohorts in Ireland (TILDA) and England (ELSA), we created a metric of discordance between loneliness and social isolation, to which we refer as Social Asymmetry. This metric was the categorised difference between standardised scores on a scale of loneliness and a scale of social isolation, giving categories of: Concordantly Lonely and Isolated, Discordant: Robust to Loneliness, or Discordant: Susceptible to Loneliness. We used regression and multilevel modelling to identify potential relationships between Social Asymmetry and cognitive outcomes. Social Asymmetry predicted cognitive outcomes cross-sectionally and at a two-year follow-up, such that Discordant: Robust to Loneliness individuals were superior performers, but we failed to find evidence for Social Asymmetry as a predictor of cognitive trajectory over time. We present a new metric and preliminary evidence of a relationship with clinical outcomes. Further research validating this metric in different populations, and evaluating its relationship with other outcomes, is warranted. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  15. Psychological context of work meaningfulness

    Directory of Open Access Journals (Sweden)

    Karel Paulík


    Full Text Available There is a significant shift of approach to the management of organizations and workers in recent decades. This shift in management philosophy is characterized by converting from traditional, conventional (rather bureaucratic management models to rather humanistic/existential oriented models. This transition comes partly from the understanding that human resources are the most promising and effective way for organization development, partly from a shift in the understanding of the role of organizations in society. The key point of these approaches has become a "meaning" or "meaningfulness" in relation to the work and organization. The importance of work meaningfulness is not only in its potential to increase the competitiveness of organizations, but especially in its major (mostly positive impacts on the employee himself and his work (and by that the organization and its performance. Work meaningfulness is strongly connected to the work engagement, which represents the active personal participation in the work process, manifested by vigor, active cooperation, willingness to contribute to the company's success and dedication to work. Work engagement seems to be next important factor affecting work attitudes and achievements of employees. The paper gives an overview of various approaches to work meaningfulness and work engagement, on the basis of which authors propose new model of work meaningfulness with overlap to work engagement. The work meaningfulness is not seen as one-dimensional variable, but consists of complex of interacting factors and processes that define an individual perceived meaning and importance of the work. Meaningful work is influenced by three areas. The first is the organizational culture. This is defined as a specific pattern of values, norms, beliefs, attitudes and assumptions that are often not clearly expressed, but affect the way individuals behave in an organization and how things are done. The second area is the work

  16. National turnaround time survey: professional consensus standards for optimal performance and thresholds considered to compromise efficient and effective clinical management. (United States)

    McKillop, Derek J; Auld, Peter


    Background Turnaround time can be defined as the time from receipt of a sample by the laboratory to the validation of the result. The Royal College of Pathologists recommends that a number of performance indicators for turnaround time should be agreed with stakeholders. The difficulty is in arriving at a goal which has some evidence base to support it other than what may simply be currently achievable technically. This survey sought to establish a professional consensus on the goals and meaning of targets for laboratory turnaround time. Methods A questionnaire was circulated by the National Audit Committee to 173 lead consultants for biochemistry in the UK. The survey asked each participant to state their current target turnaround time for core investigations in a broad group of clinical settings. Each participant was also asked to provide a professional opinion on what turnaround time would pose an unacceptable risk to patient safety for each departmental category. A super majority (2/3) was selected as the threshold for consensus. Results The overall response rate was 58% ( n = 100) with a range of 49-72% across the individual Association for Clinical Biochemistry and Laboratory Medicine regions. The consensus optimal turnaround time for the emergency department was 2 h considered unacceptable. The times for general practice and outpatient department were 48 h and for Wards 12 h, respectively. Conclusions We consider that the figures provide a useful benchmark of current opinion, but clearly more empirical standards will have to develop alongside other aspects of healthcare delivery.

  17. The effects of anger and sadness on clinical pain reports and experimentally-induced pain thresholds in women with and without fibromyalgia.

    NARCIS (Netherlands)

    Middendorp, H. van; Lumley, M.A.; Jacobs, J.W.G.; Bijlsma, J.W.J.; Geenen, R.


    OBJECTIVE: Negative emotions are commonly experienced in fibromyalgia and may affect pain. This study examined the effects of anger and sadness on clinical pain reports and on pain threshold and tolerance in response to electrical stimulation in women with and without fibromyalgia. METHODS: In an

  18. Diagnostic thresholds for ambulatory blood pressure moving lower: a review based on a meta-analysis-clinical implications

    DEFF Research Database (Denmark)

    Hansen, T.W.; Kikuya, M.; Thijs, L.


    Upper limits of normal ambulatory blood pressure (ABP) have been a matter of debate in recent years. Current diagnostic thresholds for ABP rely mainly on statistical parameters derived from reference populations. Recent findings from the International Database of Ambulatory Blood Pressure...... in Relation to Cardiovascular Outcome (IDACO) provide outcome-driven thresholds for ABP. Rounded systolic/diastolic thresholds for optimal ABP were found to be 115/75 mm Hg for 24 hours, 120/80 mm Hg for daytime, and 100/65 mm Hg for nighttime. The corresponding rounded thresholds for normal ABP were 125...... database is therefore being updated with additional population cohorts to enable the construction of multifactorial risk score charts, which also include ABP Udgivelsesdato: 2008/5...

  19. Clinical feasibility of a myocardial signal intensity threshold-based semi-automated cardiac magnetic resonance segmentation method

    Energy Technology Data Exchange (ETDEWEB)

    Varga-Szemes, Akos; Schoepf, U.J.; Suranyi, Pal; De Cecco, Carlo N.; Fox, Mary A. [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); Muscogiuri, Giuseppe [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); University of Rome ' ' Sapienza' ' , Department of Medical-Surgical Sciences and Translational Medicine, Rome (Italy); Wichmann, Julian L. [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany); Cannao, Paola M. [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); University of Milan, Scuola di Specializzazione in Radiodiagnostica, Milan (Italy); Renker, Matthias [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); Kerckhoff Heart and Thorax Center, Bad Nauheim (Germany); Mangold, Stefanie [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); Eberhard-Karls University Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany); Ruzsics, Balazs [Royal Liverpool and Broadgreen University Hospitals, Department of Cardiology, Liverpool (United Kingdom)


    To assess the accuracy and efficiency of a threshold-based, semi-automated cardiac MRI segmentation algorithm in comparison with conventional contour-based segmentation and aortic flow measurements. Short-axis cine images of 148 patients (55 ± 18 years, 81 men) were used to evaluate left ventricular (LV) volumes and mass (LVM) using conventional and threshold-based segmentations. Phase-contrast images were used to independently measure stroke volume (SV). LV parameters were evaluated by two independent readers. Evaluation times using the conventional and threshold-based methods were 8.4 ± 1.9 and 4.2 ± 1.3 min, respectively (P < 0.0001). LV parameters measured by the conventional and threshold-based methods, respectively, were end-diastolic volume (EDV) 146 ± 59 and 134 ± 53 ml; end-systolic volume (ESV) 64 ± 47 and 59 ± 46 ml; SV 82 ± 29 and 74 ± 28 ml (flow-based 74 ± 30 ml); ejection fraction (EF) 59 ± 16 and 58 ± 17 %; and LVM 141 ± 55 and 159 ± 58 g. Significant differences between the conventional and threshold-based methods were observed in EDV, ESV, and LVM measurements; SV from threshold-based and flow-based measurements were in agreement (P > 0.05) but were significantly different from conventional analysis (P < 0.05). Excellent inter-observer agreement was observed. Threshold-based LV segmentation provides improved accuracy and faster assessment compared to conventional contour-based methods. (orig.)

  20. Effect of burst TENS and conventional TENS combined with cryotherapy on pressure pain threshold: randomised, controlled, clinical trial. (United States)

    Macedo, L B; Josué, A M; Maia, P H B; Câmara, A E; Brasileiro, J S


    To assess the immediate effect of conventional and burst transcutaneous electrical nerve stimulation (TENS) in combination with cryotherapy on pain threshold and tolerance in healthy individuals. Randomised, controlled trial. University laboratory. One hundred and twelve healthy women. Volunteers were allocated at random to seven groups (n=16): (1) control, (2) placebo TENS, (3) conventional TENS, (4) burst TENS, (5) cryotherapy, (6) cryotherapy in combination with burst TENS, and (7) cryotherapy in combination with conventional TENS. Pain threshold and tolerance were measured by applying a pressure algometer at the lateral epicondyle of the humerus, before and after each intervention. The primary outcome measure was pressure pain threshold. A significant increase in pain threshold and tolerance at the 5% level of significance was recorded as follows: burst TENS {pain threshold: mean difference 1.3 [95% confidence interval (CI) 1.4 to 1.2]; pain tolerance: mean difference 3.8 (95% CI 3.9 to 3.7)}, cryotherapy [pain threshold: mean difference 1.3 (95% CI 1.4 to 1.2); pain tolerance: mean difference 1.9 (95% CI 1.8 to 2.0)] and cryotherapy in combination with burst TENS [pain threshold: mean difference 2.6 (95% CI 2.4 to 2.8); pain tolerance: mean difference 4.9 (95% CI 5.0 to 4.8)]. Cryotherapy in combination with burst TENS provided greater analgesia compared with the other groups (Pcryotherapy in combination with burst TENS to reduce induced pain, and suggest a potentiating effect when these techniques are combined. No such association was found between cryotherapy and conventional TENS. Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  1. Clinical multiple sclerosis occurs at one end of a spectrum of CNS pathology: a modified threshold liability model leads to new ways of thinking about the cause of clinical multiple sclerosis. (United States)

    Haegert, David G


    Multiple sclerosis (MS) is a complex trait, the causes of which are elusive. A threshold liability model influences thinking about the causes of this disorder. According to this model, a population has a normal distribution of genetic liability to MS. In addition, a threshold exists, so that MS begins when an individual's liability exceeds the MS threshold; environmental and other causative factors may increase or decrease an individual's MS liability. It is argued here, however, that this model is misleading, as it is based on the incorrect assumption that MS is a disorder that one either has or does not have. This paper hypothesizes, instead, that patients with a diagnosis of MS share identical CNS pathology, termed MS pathology, with some individuals who have a diagnosis of possible MS and with some apparently healthy individuals, who may never have a diagnosis of MS. In order to accommodate this hypothesis, the current threshold liability model is modified as follows. (1) In addition to a normal distribution of MS liability within a population, a spectrum of MS pathology occurs in some who have a high MS liability. (2) A clinical MS threshold exists at a point on this liability distribution, where the burden and distribution of MS pathology permits a diagnosis of clinical MS. (3) Additional thresholds exist that correspond to a lower MS liability and a lesser burden of MS pathology than occur at the clinical MS threshold. This modified threshold model leads to the postulate that causes act at various time points to increase MS liability and induce MS pathology. The accumulation of MS pathology sometimes leads to a diagnosis of clinical MS. One implication of this model is that the MS pathology in clinical MS and in some with possible MS differs only in the extent but not in the type of CNS injury. Thus, it may be possible to obtain insight into the causative environmental factors that increase MS liability and induce MS pathology by focusing on patients who

  2. A threshold concentration of anti-merozoite antibodies is required for protection from clinical episodes of malaria

    DEFF Research Database (Denmark)

    Murungi, Linda M; Kamuyu, Gathoni; Lowe, Brett


    Antibodies to selected Plasmodium falciparum merozoite antigens are often reported to be associated with protection from malaria in one epidemiological cohort, but not in another. Here, we sought to understand this paradox by exploring the hypothesis that a threshold concentration of antibodies i...

  3. Should the threshold for expired-air carbon monoxide concentration as a means of verifying self-reported smoking abstinence be reduced in clinical treatment programmes? Evidence from a Malaysian smokers' clinic. (United States)

    Wee, Lei-Hum; West, Robert; Mariapun, Jeevitha; Chan, Caryn Mei-Hsien; Bulgiba, Awang; Peramalah, Devi; Jit, Swinder


    It has been proposed that the expired-air carbon monoxide (CO) threshold for confirming smoking abstinence in clinical practice be reduced below 10 ppm. Optimal thresholds may vary across regions. Data are needed to assess the impact of such a change on claimed success. A total of 253 smokers who attended the Tanglin quit smoking clinic in Malaysia were followed-up 1, 3 and 6 months after the target quit date. All participants received a standard behavioural support programme and were prescribed either varenicline or nicotine replacement therapy. Expired-air CO was measured at every visit. Respondents' smoking status was assessed using a range of different CO thresholds (3, 5 and 10 ppm) and the impact on quit rates was calculated. Predictors of success as defined using the different thresholds were assessed. The 6-month abstinence rates were: 1 month - 54.9% at 10 ppm, 54.9% at 5 ppm and 48.6% at 3 ppm; 3 months - 36.0% at 10 ppm, 35.2% at 5 ppm and 30.4% at 3 ppm; 6 months - 24.1% at 10 ppm, 24.1% at 5 ppm and 20.6% at 3 ppm. Older smokers were more likely to be recorded as abstinent at 6 months regardless of the threshold used. Reducing the threshold for expired-air carbon monoxide concentrations to verify claimed smoking abstinence from 10 ppm to 5 ppm makes minimal difference to documented success rates in Malaysian smoker's clinic patients. Reducing to 3 ppm decreases success rates slightly. Predictors of success at stopping appear to be unaffected by the threshold used. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Building Bridges Through Meaningful Occupation

    Directory of Open Access Journals (Sweden)

    Jennifer Fortuna


    Full Text Available Mary Block, MS, OTR/L, an occupational therapist and artist based in Illinois, provided the cover art for the Summer 2017 issue of The Open Journal of Occupational Therapy (OJOT. Generations is a sculpture made from concrete that measures 240 x100 in. (6.096 x 2.54 m. The piece was commissioned by Mary’s home town, the Village of Deerfield, IL. Mary always knew she wanted to be an artist. When competing paradigms altered Mary’s career path, the field of occupational therapy helped her to shape a new worldview. In uncertain times, meaningful occupation empowered Mary to start over again where she originally began

  5. Influence of skin cold sensation threshold in the occurrence of dental sensitivity during dental bleaching: a placebo controlled clinical trial


    Vanessa Rahal; Marjorie de Oliveira Gallinari; Juliana Stuginski Barbosa; Reynaldo Leite Martins-Junior; Paulo Henrique dos Santos; Luciano Tavares Angelo Cintra; André Luiz Fraga Briso


    Abstract Objective This study verified the occurrence of dental sensitivity in patients submitted to a 35% hydrogen peroxide based product (Whiteness HP Maxx 35% – FGM), skin cold sensation threshold (SCST) and its influence on dental sensitivity. Material and Methods Sixty volunteers were divided into 4 groups (n = 15), according to SCST (low: GI and GIII, and high: GII and IV) and bleaching treatment (hydrogen peroxide: GI and GII, and placebo: GIII and GIV). SCST was determined in the in...

  6. Standardizing Clinically Meaningful Outcome Measures Beyond HbA1c for Type 1 Diabetes: A Consensus Report of the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, the American Diabetes Association, the Endocrine Society, JDRF International, The Leona M. and Harry B. Helmsley Charitable Trust, the Pediatric Endocrine Society, and the T1D Exchange. (United States)

    Agiostratidou, Gina; Anhalt, Henry; Ball, Dana; Blonde, Lawrence; Gourgari, Evgenia; Harriman, Karen N; Kowalski, Aaron J; Madden, Paul; McAuliffe-Fogarty, Alicia H; McElwee-Malloy, Molly; Peters, Anne; Raman, Sripriya; Reifschneider, Kent; Rubin, Karen; Weinzimer, Stuart A


    To identify and define clinically meaningful type 1 diabetes outcomes beyond hemoglobin A 1c (HbA 1c ) based upon a review of the evidence, consensus from clinical experts, and input from researchers, people with type 1 diabetes, and industry. Priority outcomes include hypoglycemia, hyperglycemia, time in range, diabetic ketoacidosis (DKA), and patient-reported outcomes (PROs). While priority outcomes for type 1 and type 2 diabetes may overlap, type 1 diabetes was the focus of this work. A Steering Committee-comprising representatives from the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, the American Diabetes Association, the Endocrine Society, JDRF International, The Leona M. and Harry B. Helmsley Charitable Trust, the Pediatric Endocrine Society, and the T1D Exchange-was the decision-making body for the Type 1 Diabetes Outcomes Program. Their work was informed by input from researchers, industry, and people with diabetes through Advisory Committees representing each stakeholder group. Stakeholder surveys were used to identify priority outcomes. The outcomes prioritized in the surveys were hypoglycemia, hyperglycemia, time in range, DKA, and PROs. To develop consensus on the definitions of these outcomes, the Steering Committee relied on published evidence, their clinical expertise, and feedback from the Advisory Committees. The Steering Committee developed definitions for hypoglycemia, hyperglycemia, time in range, and DKA in type 1 diabetes. The definitions reflect their assessment of the outcome's short- and long-term clinical impact on people with type 1 diabetes. Knowledge gaps to be addressed by future research were identified. The Steering Committee discussed PROs and concluded that further type 1 diabetes-specific development is needed. The Steering Committee recommends use of the defined clinically meaningful outcomes beyond HbA 1c in the research, development, and evaluation of type 1 diabetes

  7. Subgroups based on thermal and pressure pain thresholds in women with chronic whiplash display differences in clinical presentation – an explorative study

    Directory of Open Access Journals (Sweden)

    Börsbo B


    Full Text Available Björn Börsbo,1,2 Gunilla M Liedberg,3 Mia Wallin,1,3 Björn Gerdle1,41Department of Medicine and Health Sciences, University of Linköping, Linköping, Sweden; 2Clinical Department of Rehabilitation Medicine, County Hospital Ryhov, Jönköping, Sweden; 3Department of Social and Welfare Studies, University of Linköping, Norrköping, Sweden; 4Pain and Rehabilitation Centre, UHL, Östergötland County Council, Linköping, SwedenPurpose: To investigate the presence of subgroups in chronic whiplash-associated disorders (WAD based on pain thresholds for pressure (PPT, cold (CPT, and heat (HPT and to compare these subgroups with respect to symptomatology, disability, and health aspects. Methods: Two groups of female subjects – patients with chronic WAD (n = 28 and healthy controls (CON; n = 29 – were investigated. Quantitative sensory testing (QST for thermal thresholds and algometry for PPT at four sites in the body (over the trapezius and tibialis anterior bilaterally were determined. Habitual pain intensities, psychological strain, disability, and health aspects were registered using a questionnaire.Results: A cluster analysis based on PPT, CPT, and HPT identified two subgroups of chronic WAD: one sensitive subgroup (s-WAD; n = 21, and one less sensitive subgroup (ls-WAD; n = 6. S-WAD displayed widespread hyperalgesia, whereas ls-WAD had localized hyperalgesia in the neck area, with tendencies to supernormal values in remote areas of the body. Generally, s-WAD had a significantly worse situation than the CON with respect to symptomatology, disability, and health aspects. The ls-WAD group was intermediary between s-WAD and CON in these aspects.Conclusion: Different explanations, eg, severity of the pain condition per se, etiological factors, and pre-trauma differences in pain sensitivity, may exist for the differences in pain thresholds between the two subgroups. Future research should investigate the role of pain thresholds in the chronic

  8. The challenge of a meaningful job

    DEFF Research Database (Denmark)

    Jepsen, Ingrid

    and the feeling of doing high quality care generate job satisfaction. The obligation and pressure to perform well and the disadvantages on the midwives’ private lives is counterbalanced by the feeling of doing a meaningful and important job. Working in caseload midwifery creates a feeling of working in a self....... The methodology was inspired by ethnography, and applied methods were field observations followed by interviews. Participants: Thirteen out of eighteen midwives working in caseloads were observed during one or two days in the antenatal clinic and interviewed at a later occasion. Findings: The recognition......-governing model within the public hospital, without losing the technological benefits of a modern birth unit. For pregnant women with a challenging personality or attitude towards others, Caseload midwifery may provide an extra opportunity to feel recognized and respected. Key conclusions: Caseload midwifery...

  9. Influence of skin cold sensation threshold in the occurrence of dental sensitivity during dental bleaching: a placebo controlled clinical trial. (United States)

    Rahal, Vanessa; Gallinari, Marjorie de Oliveira; Barbosa, Juliana Stuginski; Martins-Junior, Reynaldo Leite; Santos, Paulo Henrique Dos; Cintra, Luciano Tavares Angelo; Briso, André Luiz Fraga


    This study verified the occurrence of dental sensitivity in patients submitted to a 35% hydrogen peroxide based product (Whiteness HP Maxx 35% - FGM), skin cold sensation threshold (SCST) and its influence on dental sensitivity. Sixty volunteers were divided into 4 groups (n = 15), according to SCST (low: GI and GIII, and high: GII and IV) and bleaching treatment (hydrogen peroxide: GI and GII, and placebo: GIII and GIV). SCST was determined in the inner forearm for 6 different times using a neurosensory analyzer, the TSA II (Medoc Advanced Medical Systems, Ramat Yishai, Northern District, Israel). Dental sensitivity measurements were performed 10 different times using a thermal stimulus and an intraoral device attached to TSA II, positioned in the buccal surface of the upper right central incisor. Spontaneous dental sensitivity was also determined using the Visual Analogue Scale (VAS). Data were submitted to Student's t-test and Pearson's Correlation Test (α=0.05). SCST remained the same during bleaching treatment. Distinct responses of dental sensitivity were found in patients with low and high SCST during the first and third bleaching session (p≤0.05). The teeth submitted to the bleaching treatment became more sensitive to cold than those treated with placebo. Moreover, data obtained with TSA and VAS presented moderate correlation. Bleaching treatment increased dental sensitivity and skin cold sensation threshold might represent a determining factor in this occurrence, since low and high SCST patients had different responses to the thermal stimulus in the teeth.

  10. Reliability, standard error, and minimum detectable change of clinical pressure pain threshold testing in people with and without acute neck pain. (United States)

    Walton, David M; Macdermid, Joy C; Nielson, Warren; Teasell, Robert W; Chiasson, Marco; Brown, Lauren


    Clinical measurement. To evaluate the intrarater, interrater, and test-retest reliability of an accessible digital algometer, and to determine the minimum detectable change in normal healthy individuals and a clinical population with neck pain. Pressure pain threshold testing may be a valuable assessment and prognostic indicator for people with neck pain. To date, most of this research has been completed using algometers that are too resource intensive for routine clinical use. Novice raters (physiotherapy students or clinical physiotherapists) were trained to perform algometry testing over 2 clinically relevant sites: the angle of the upper trapezius and the belly of the tibialis anterior. A convenience sample of normal healthy individuals and a clinical sample of people with neck pain were tested by 2 different raters (all participants) and on 2 different days (healthy participants only). Intraclass correlation coefficient (ICC), standard error of measurement, and minimum detectable change were calculated. A total of 60 healthy volunteers and 40 people with neck pain were recruited. Intrarater reliability was almost perfect (ICC = 0.94-0.97), interrater reliability was substantial to near perfect (ICC = 0.79-0.90), and test-retest reliability was substantial (ICC = 0.76-0.79). Smaller change was detectable in the trapezius compared to the tibialis anterior. This study provides evidence that novice raters can perform digital algometry with adequate reliability for research and clinical use in people with and without neck pain.

  11. Influence of skin cold sensation threshold in the occurrence of dental sensitivity during dental bleaching: a placebo controlled clinical trial

    Directory of Open Access Journals (Sweden)

    Vanessa Rahal


    Full Text Available Abstract Objective This study verified the occurrence of dental sensitivity in patients submitted to a 35% hydrogen peroxide based product (Whiteness HP Maxx 35% – FGM, skin cold sensation threshold (SCST and its influence on dental sensitivity. Material and Methods Sixty volunteers were divided into 4 groups (n = 15, according to SCST (low: GI and GIII, and high: GII and IV and bleaching treatment (hydrogen peroxide: GI and GII, and placebo: GIII and GIV. SCST was determined in the inner forearm for 6 different times using a neurosensory analyzer, the TSA II (Medoc Advanced Medical Systems, Ramat Yishai, Northern District, Israel. Dental sensitivity measurements were performed 10 different times using a thermal stimulus and an intraoral device attached to TSA II, positioned in the buccal surface of the upper right central incisor. Spontaneous dental sensitivity was also determined using the Visual Analogue Scale (VAS. Data were submitted to Student's t-test and Pearson's Correlation Test (α=0.05. SCST remained the same during bleaching treatment. Results Distinct responses of dental sensitivity were found in patients with low and high SCST during the first and third bleaching session (p≤0.05. The teeth submitted to the bleaching treatment became more sensitive to cold than those treated with placebo. Moreover, data obtained with TSA and VAS presented moderate correlation. Conclusions Bleaching treatment increased dental sensitivity and skin cold sensation threshold might represent a determining factor in this occurrence, since low and high SCST patients had different responses to the thermal stimulus in the teeth.

  12. A single CD4 test with 250 cells/mm3 threshold predicts viral suppression in HIV-infected adults failing first-line therapy by clinical criteria. (United States)

    Gilks, Charles F; Walker, A Sarah; Munderi, Paula; Kityo, Cissy; Reid, Andrew; Katabira, Elly; Goodall, Ruth L; Grosskurth, Heiner; Mugyenyi, Peter; Hakim, James; Gibb, Diana M


    In low-income countries, viral load (VL) monitoring of antiretroviral therapy (ART) is rarely available in the public sector for HIV-infected adults or children. Using clinical failure alone to identify first-line ART failure and trigger regimen switch may result in unnecessary use of costly second-line therapy. Our objective was to identify CD4 threshold values to confirm clinically-determined ART failure when VL is unavailable. 3316 HIV-infected Ugandan/Zimbabwean adults were randomised to first-line ART with Clinically-Driven (CDM, CD4s measured but blinded) or routine Laboratory and Clinical Monitoring (LCM, 12-weekly CD4s) in the DART trial. CD4 at switch and ART failure criteria (new/recurrent WHO 4, single/multiple WHO 3 event; LCM: CD4tiebreaker' of ≥250 cells/mm(3) for clinically-monitored patients failing first-line could identify ∼80% with VL<400 copies/ml, who are unlikely to benefit from second-line. Targeting CD4s to single WHO stage 3 'clinical failures' would particularly avoid premature, costly switch to second-line ART.

  13. Evaluation of a Low-Threshold/High-Tolerance Methadone Maintenance Treatment Clinic in Saint John, New Brunswick, Canada: One Year Retention Rate and Illicit Drug Use

    Directory of Open Access Journals (Sweden)

    Timothy K. S. Christie


    Full Text Available Objective. To report the one-year retention rate and the prevalence of illicit opioid use and cocaine use in the Low-Threshold/High-Tolerance (LTHT methadone maintenance treatment (MMT clinic located in Saint John, New Brunswick, Canada. Methods. A description of the LTHT MMT clinic is provided. The one-year retention rate was determined by collecting data on patients who enrolled in the LTHT MMT clinic between August 04, 2009 and August 04, 2010. The prevalence of illicit drug use was determined using a randomly selected retrospective cohort of 84 participants. For each participant the results of six consecutive urine tests for the most recent three months were compared to the results of the first six consecutive urine tests after program entry. Results. The one-year retention rate was 95%, 67% of the cohort achieved abstinence from illicit opioids and an additional 13% abstained from cocaine use. Conclusion. The novel feature of the LTHT MMT clinic is that patients are not denied methadone because of lack of ancillary services. Traditional comprehensive MMT programs invest the majority of financial resources in ancillary services that support the biopsychosocial model, whereas the LTHT approach utilizes a medical model and directs resources at medical management.

  14. A single CD4 test with 250 cells/mm3 threshold predicts viral suppression in HIV-infected adults failing first-line therapy by clinical criteria.

    Directory of Open Access Journals (Sweden)

    Charles F Gilks

    Full Text Available In low-income countries, viral load (VL monitoring of antiretroviral therapy (ART is rarely available in the public sector for HIV-infected adults or children. Using clinical failure alone to identify first-line ART failure and trigger regimen switch may result in unnecessary use of costly second-line therapy. Our objective was to identify CD4 threshold values to confirm clinically-determined ART failure when VL is unavailable.3316 HIV-infected Ugandan/Zimbabwean adults were randomised to first-line ART with Clinically-Driven (CDM, CD4s measured but blinded or routine Laboratory and Clinical Monitoring (LCM, 12-weekly CD4s in the DART trial. CD4 at switch and ART failure criteria (new/recurrent WHO 4, single/multiple WHO 3 event; LCM: CD4<100 cells/mm(3 were reviewed in 361 LCM, 314 CDM participants who switched over median 5 years follow-up. Retrospective VLs were available in 368 (55% participants.Overall, 265/361 (73% LCM participants failed with CD4<100 cells/mm(3; only 7 (2% switched with CD4≥250 cells/mm(3, four switches triggered by WHO events. Without CD4 monitoring, 207/314 (66% CDM participants failed with WHO 4 events, and 77(25%/30(10% with single/multiple WHO 3 events. Failure/switching with single WHO 3 events was more likely with CD4≥250 cells/mm(3 (28/77; 36% (p = 0.0002. CD4 monitoring reduced switching with viral suppression: 23/187 (12% LCM versus 49/181 (27% CDM had VL<400 copies/ml at failure/switch (p<0.0001. Amongst CDM participants with CD4<250 cells/mm(3 only 11/133 (8% had VL<400 copies/ml, compared with 38/48 (79% with CD4≥250 cells/mm(3 (p<0.0001.Multiple, but not single, WHO 3 events predicted first-line ART failure. A CD4 threshold 'tiebreaker' of ≥250 cells/mm(3 for clinically-monitored patients failing first-line could identify ∼80% with VL<400 copies/ml, who are unlikely to benefit from second-line. Targeting CD4s to single WHO stage 3 'clinical failures' would particularly avoid premature, costly

  15. Reflections on Meaningfulness and its Social Relevance

    Directory of Open Access Journals (Sweden)

    Nicole Note


    Full Text Available Philosophers who write about the meaning of life are few nowadays. Thesubject has lost its attractiveness. Perceived from a viewpoint of logical positivism or language philosophy, the whole issue of meaningfulness seems rather pointless. It is often considered to be related to metaphysics, making it less suitable for philosophical inquiry. The topic of meaningfulness seems too intangible. Indeed, the few philosophers that have embarked on examining meaningfulness have proven to be well aware of the challenges this poses. At times they acknowledge that the more they concentrate on the subject, the more it seems to fall apart into unintelligible pieces about whichnothing of philosophical value can be said.

  16. Identification of threshold prostate specific antigen levels to optimize the detection of clinically significant prostate cancer by magnetic resonance imaging/ultrasound fusion guided biopsy. (United States)

    Shakir, Nabeel A; George, Arvin K; Siddiqui, M Minhaj; Rothwax, Jason T; Rais-Bahrami, Soroush; Stamatakis, Lambros; Su, Daniel; Okoro, Chinonyerem; Raskolnikov, Dima; Walton-Diaz, Annerleim; Simon, Richard; Turkbey, Baris; Choyke, Peter L; Merino, Maria J; Wood, Bradford J; Pinto, Peter A


    Prostate specific antigen sensitivity increases with lower threshold values but with a corresponding decrease in specificity. Magnetic resonance imaging/ultrasound targeted biopsy detects prostate cancer more efficiently and of higher grade than standard 12-core transrectal ultrasound biopsy but the optimal population for its use is not well defined. We evaluated the performance of magnetic resonance imaging/ultrasound targeted biopsy vs 12-core biopsy across a prostate specific antigen continuum. We reviewed the records of all patients enrolled in a prospective trial who underwent 12-core transrectal ultrasound and magnetic resonance imaging/ultrasound targeted biopsies from August 2007 through February 2014. Patients were stratified by each of 4 prostate specific antigen cutoffs. The greatest Gleason score using either biopsy method was compared in and across groups as well as across the population prostate specific antigen range. Clinically significant prostate cancer was defined as Gleason 7 (4 + 3) or greater. Univariate and multivariate analyses were performed. A total of 1,003 targeted and 12-core transrectal ultrasound biopsies were performed, of which 564 diagnosed prostate cancer for a 56.2% detection rate. Targeted biopsy led to significantly more upgrading to clinically significant disease compared to 12-core biopsy. This trend increased more with increasing prostate specific antigen, specifically in patients with prostate specific antigen 4 to 10 and greater than 10 ng/ml. Prostate specific antigen 5.2 ng/ml or greater captured 90% of upgrading by targeted biopsy, corresponding to 64% of patients who underwent multiparametric magnetic resonance imaging and subsequent fusion biopsy. Conversely a greater proportion of clinically insignificant disease was detected by 12-core vs targeted biopsy overall. These differences persisted when controlling for potential confounders on multivariate analysis. Prostate cancer upgrading with targeted biopsy increases

  17. A meaningful workplace: Framework, space and context ...

    African Journals Online (AJOL)

    A meaningful workplace: Framework, space and context. ... PL Steenkamp, JS Basson ... The organisation experiences a loss of productivity, quality, innovation, et cetera ... This is what this article is about: to conceptualise the workplace as ...

  18. Making Social Studies Meaningful to Elementary Students. (United States)

    Klein, Susan


    Describes a unit on Ancient Greece designed to make social studies meaningful to fourth and fifth graders. Individual projects and group activities helped students learn about ancient Greek culture. (AM)

  19. Verification of the sensitivity of functional scores for treatment results - Substantial clinical benefit thresholds for the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). (United States)

    Kasai, Yuichi; Fukui, Mitsuru; Takahashi, Kazuhisa; Ohtori, Seiji; Takeuchi, Daisaku; Hashizume, Hiroshi; Kanamori, Masahiko; Hosono, Noboru; Kanchiku, Tsukasa; Wada, Eiji; Sekiguchi, Miho; Konno, Shinichi; Kawakami, Mamoru


    Validity and reliability of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) had already been verified as the patients' self-rating assessment of low back pain and lumbar spinal disease and, the present study demonstrated the responsiveness of this measure. 192 subjects who were determined by medical instructors of the Japanese Society for Spine Surgery and Related Research were analyzed. They had completed a series of treatment and both surveys before and after the treatment. Authors investigated rates of concordance between assessment by physicians and subjective assessment by patients. The mean, standard deviation, minimum, 25th percentile, median, 75th percentile and maximum values for pre-treatment, post-treatment, and acquired points were calculated, and then, we also investigated the trend between subjective assessment by patients and mean acquired points for each JOABPEQ domain and substantial clinical benefit thresholds for the JOABPEQ. Symptom changes as assessed by physicians did not coincide with those by patients, and acquired points in each JOABPEQ domain were significantly increased with improved self-rating by patients. In addition, patients who rated symptom changes as "slightly improved" showed a mean acquired points of ≥20, and those reporting "improved" showed a 25th percentile points of the acquired points of ≥20 approximately. A significant correlation was noted between the self-rating of patients and acquired points JOABPEQ, suggesting that ≥20 acquired points can be interpreted as substantial clinical benefit thresholds for the JOABPEQ. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  20. Meaningful work, work engagement and organisational commitment

    Directory of Open Access Journals (Sweden)

    Madelyn Geldenhuys


    Research purpose: The aim of the study was to investigate the relationships amongst psychological meaningfulness, work engagement and organisational commitment and to test for a possible mediation effect of work engagement on the relationship between psychological meaningfulness and organisational commitment. Motivation for the study: Managers have to rethink ways of improving productivity and performance at work, due to the diverse, and in some instances escalating, needs of employees (e.g. financial support to uphold their interest in and enjoyment of working. Research approach, design and method: A quantitative approach was employed to gather the data for the study, utilising a cross-sectional survey design. The sample (n = 415 consisted of working employees from various companies and positions in Gauteng, South Africa. Main findings: The results confirmed a positive relationship between psychological meaningfulness, work engagement and organisational commitment. Further, psychological meaningfulness predicts work engagement, whilst psychological meaningfulness and work engagement predict organisational commitment. Practical/managerial implications: Employers identifying their employees’ commitment patterns and mapping out strategies for enhancing those that are relevant to organisational goals will yield positive work outcomes (e.g. employees who are creative, seek growth or challenges for themselves. Contribution/value-add: This study contributes to the literature through highlighting the impact that meaningful work has on sustaining employee commitment to the organisation.

  1. Operating Room Delays: Meaningful Use in Electronic Health Record. (United States)

    Van Winkle, Rachelle A; Champagne, Mary T; Gilman-Mays, Meri; Aucoin, Julia


    Perioperative areas are the most costly to operate and account for more than 40% of expenses. The high costs prompted one organization to analyze surgical delays through a retrospective review of their new electronic health record. Electronic health records have made it easier to access and aggregate clinical data; 2123 operating room cases were analyzed. Implementing a new electronic health record system is complex; inaccurate data and poor implementation can introduce new problems. Validating the electronic health record development processes determines the ease of use and the user interface, specifically related to user compliance with the intent of the electronic health record development. The revalidation process after implementation determines if the intent of the design was fulfilled and data can be meaningfully used. In this organization, the data fields completed through automation provided quantifiable, meaningful data. However, data fields completed by staff that required subjective decision making resulted in incomplete data nearly 24% of the time. The ease of use was further complicated by 490 permutations (combinations of delay types and reasons) that were built into the electronic health record. Operating room delay themes emerged notwithstanding the significant complexity of the electronic health record build; however, improved accuracy could improve meaningful data collection and a more accurate root cause analysis of operating room delays. Accurate and meaningful use of data affords a more reliable approach in quality, safety, and cost-effective initiatives.

  2. Efficacy of long-term milnacipran treatment in patients meeting different thresholds of clinically relevant pain relief: subgroup analysis of a randomized, double-blind, placebo-controlled withdrawal study

    Directory of Open Access Journals (Sweden)

    Mease PJ


    Full Text Available Philip J Mease,1 Daniel J Clauw,2 Joel M Trugman,3 Robert H Palmer,3 Yong Wang3 1Swedish Medical Center and University of Washington, Seattle, WA, USA; 2Chronic Pain and Fatigue Research Center, University of Michigan Health System, Ann Arbor, MI, USA; 3Forest Research Institute, Jersey City, NJ, USA Background: Fibromyalgia patients from a long-term, open-label study of milnacipran (50–200 mg/day were eligible to participate in a 12-week, randomized, placebo-controlled withdrawal study. The withdrawal study evaluated loss of therapeutic response in patients who achieved ≥50% pain improvements after receiving up to 3.25 years of milnacipran. This post-hoc analysis investigated whether patients who met lower thresholds of pain improvement also experienced worsening of fibromyalgia symptoms upon treatment withdrawal. Method: Among patients who received milnacipran ≥100 mg/day during the long-term study, three subgroups were identified based on percentage of pain reduction at randomization: ≥50% (protocol-defined "responders"; n=150; ≥30% to <50% (patients with clinically meaningful pain improvement; n=61; and <30% (n=110. Efficacy assessments included the visual analog scale (VAS for pain, Fibromyalgia Impact Questionnaire-Revised (FIQR, 36-Item Short-Form Health Survey Physical Component Summary (SF-36 PCS, and Beck Depression Inventory (BDI. Results: In the ≥30 to <50% subgroup, significant worsening in pain was detected after treatment withdrawal. The difference between placebo and milnacipran in mean VAS score changes for this subgroup (+9.0, P<0.05 was similar to the difference in protocol-defined responders (+9.4, P<0.05. In the <30% subgroup, no worsening in pain was observed in either treatment arm. However, patients in this subgroup experienced significant worsening in FIQR scores after treatment withdrawal (placebo, +6.9; milnacipran, -2.8; P<0.001, as well as worsening in SF-36 PCS and BDI scores. Conclusion: Patients who

  3. Comparison of the intradermal irritant threshold concentrations of nine allergens from two different manufacturers in clinically nonallergic dogs in the USA. (United States)

    Foust-Wheatcraft, Desirae A; Dell, Darin L; Rosenkrantz, Wayne S; Griffin, Craig E


    The intradermal irritant threshold concentration for many allergens is unknown. To determine the intradermal irritant threshold concentration (ITC) of nine allergens from two different manufacturers. Twenty privately owned clinically nonallergic dogs. Alternaria, cat dander, Dermatophagoides farinae, Chenopodium album (lamb's quarter), Xanthium strumarium (cocklebur), Prosopis glandulosa (mesquite), Morus alba (white mulberry), Cynodon dactylon (Bermuda grass) and Phleum pretense (Timothy grass) from two manufacturers (ALK; Round Rock, TX, USA and Greer ® Laboratories; Lenoir, NC, USA) were injected intradermally at two dilutions and at 15 and 30 min evaluated subjectively (1-4) and objectively (horizontal wheal diameter) by two blinded investigators. A subjective score of 3 or 4 by either investigator at either timed reading was considered positive. If both concentrations resulted in positive reactions, two additional dilutions were performed. The ITC was defined as the lowest tested concentration that elicited a positive reaction in ≥10% of animals. The ITCs were Alternaria >2,000 PNU/mL; cat dander 750 PNU/mL (ALK) and 2,000 PNU/mL (Greer ® ); D. farinae strumarium <6,000 PNU/mL; P. glandulosa <500 PNU/mL; M. alba <6,000 PNU/mL; C. dactylon <10,000 PNU/mL (ALK) and <6,000 PNU/mL (Greer ® ); and P. pretense <6,000 PNU/mL. There were significant differences in subjective scoring and objective measurement between manufacturers for Alternaria, cat dander and P. pretense. Results revealed significant positive correlation between subjective scoring and objective measurement for each time, investigator and manufacturer separately. © 2017 ESVD and ACVD.

  4. The importance of staphylococci and threshold value of somatic cell count for diagnosis of sub-clinical mastitis in Pirlak sheep at mid-lactation. (United States)

    Ozenc, E; Seker, E; Baki Acar, D; Birdane, M K; Darbaz, I; Dogan, N


    This study investigated the bacterial agents causing sub-clinical mastitis and the mean somatic cell counts (SCC) of milk in Pirlak sheep at mid-lactation. The percentage of infected udder halves was 11.4% (53/464). The most frequently isolated species were coagulase-negative staphylococci (CNS) (64.2%), followed by Staphylococcus aureus (24.5%) and Escherichia coli (11.3%). Among the CNS, the most common species was Staphylococcus epidermidis (38.2%). The other species isolated from milk samples were Staphylococcus xylosus (17.7%), Staphylococcus chromogenes (14.7%), Staphylococcus simulans (8.8%) and Staphylococcus hyicus (8.8%). The mean SCC for culture positive and negative samples was 1742×10(3) and 161×10(3) cells/ml, respectively. A significant difference (pmastitis in Pirlak sheep. This is the first study to describe the bacterial agents causing sub-clinical mastitis and threshold limit for SCC in Pirlak sheep in Turkey. © 2011 Blackwell Verlag GmbH.

  5. Are students ready for meaningful use?

    Directory of Open Access Journals (Sweden)

    Gary S. Ferenchick


    Full Text Available Background: The meaningful use (MU of electronic medical records (EMRs is being implemented in three stages. Key objectives of stage one include electronic analysis of data entered into structured fields, using decision-support tools (e.g., checking drug–drug interactions [DDI] and electronic information exchange. Objective: The authors assessed the performance of medical students on 10 stage-one MU tasks and measured the correlation between students’ MU performance and subsequent end-of-clerkship professionalism assessments and their grades on an end-of-year objective structured clinical examination. Participants: Two-hundred and twenty-two third-year medical students on the internal medicine (IM clerkship. Design/main measures: From July 2010 to February 2012, all students viewed 15 online tutorials covering MU competencies. The authors measured student MU documentation and performance in the chart of a virtual patient using a fully functional training EMR. Specific MU measurements included, adding: a new problem, a new medication, an advanced directive, smoking status, the results of screening tests; and performing a DDI (in which a major interaction was probable, and communicating a plan for this interaction. Key results: A total of 130 MU errors were identified. Sixty-eight (30.6% students had at least one error, and 30 (13.5% had more than one (range 2–6. Of the 130 errors, 90 (69.2% were errors in structured data entry. Errors occurred in medication dosing and instructions (18%, DDI identification (12%, documenting smoking status (15%, and colonoscopy results (23%. Students with MU errors demonstrated poorer performance on end-of-clerkship professionalism assessments (r=−0.112, p=0.048 and lower observed structured clinical examination (OSCE history-taking skills (r=−0.165, p=0.008 and communication scores (r=− 0.173, p=0.006. Conclusions: MU errors among medical students are common and correlate with subsequent poor

  6. The measurement of water scarcity: Defining a meaningful indicator. (United States)

    Damkjaer, Simon; Taylor, Richard


    Metrics of water scarcity and stress have evolved over the last three decades from simple threshold indicators to holistic measures characterising human environments and freshwater sustainability. Metrics commonly estimate renewable freshwater resources using mean annual river runoff, which masks hydrological variability, and quantify subjectively socio-economic conditions characterising adaptive capacity. There is a marked absence of research evaluating whether these metrics of water scarcity are meaningful. We argue that measurement of water scarcity (1) be redefined physically in terms of the freshwater storage required to address imbalances in intra- and inter-annual fluxes of freshwater supply and demand; (2) abandons subjective quantifications of human environments and (3) be used to inform participatory decision-making processes that explore a wide range of options for addressing freshwater storage requirements beyond dams that include use of renewable groundwater, soil water and trading in virtual water. Further, we outline a conceptual framework redefining water scarcity in terms of freshwater storage.

  7. Meaningful Interaction in a Local Context

    DEFF Research Database (Denmark)

    Holck, Ulla


    This keynote is based on a Ph.D. thesis on development of socially meaningful interaction in music therapy with children with very poor communication skills (Holck 2002). The aim was to identify some of the conditions, whereby actions can be understood as meaningful - that is, whereby the child......’ Samspil i Musikterapi [Eng.: ’Commusical’ Interplay in Music Therapy. Qualitative Video Analyses of Musical and Gestural Interactions with Children with Severe Functional Limitations, including Children with Autism]. Unpubl. PhD thesis, Aalborg Universitet. Holck, U. (2004) Interaction Themes in Music...

  8. Students' Meaningful Learning Orientation and Their Meaningful Understandings of Meiosis and Genetics. (United States)

    Cavallo, Ann Liberatore

    This 1-week study explored the extent to which high school students (n=140) acquired meaningful understanding of selected biological topics (meiosis and the Punnett square method) and the relationship between these topics. This study: (1) examined "mental modeling" as a technique for measuring students' meaningful understanding of the…

  9. Protestant ethic: Contributing towards a meaningful workplace ...

    African Journals Online (AJOL)

    The article also indicates that the Protestant ethic can indeed contribute towards a meaningful experience whilst performing work-related tasks in workspace. The Protestant work ethic is more than a cultural norm that places a positive moral value on doing a good job. Based on a belief that work has intrinsic value for its own ...

  10. Remedial principles and meaningful engagement in education ...

    African Journals Online (AJOL)

    This article evaluates the meaningful engagement doctrine in the education rights jurisprudence of the Constitutional Court in the light of a set of normative principles developed by Susan Sturm for evaluating participatory public law remedies. It commences by identifying four principles for evaluating participatory remedies ...

  11. Meaningful Learning in the Cooperative Classroom (United States)

    Sharan, Yael


    Meaningful learning is based on more than what teachers transmit; it promotes the construction of knowledge out of learners' experience, feelings and exchanges with other learners. This educational view is based on the constructivist approach to learning and the co-operative learning approach. Researchers and practitioners in various…

  12. Meaningful Use of School Health Data (United States)

    Johnson, Kathleen Hoy; Bergren, Martha Dewey


    Meaningful use (MU) of Electronic Health Records (EHRs) is an important development in the safety and security of health care delivery in the United States. Advancement in the use of EHRs occurred with the passage of the American Recovery and Reinvestment Act of 2009, which provides incentives for providers to support adoption and use of EHRs.…

  13. Wonderful Life : Exploring Wonder in Meaningful Moments

    NARCIS (Netherlands)

    van de Goor, Marie Jacqueline; Sools, Anna Maria; Westerhof, Gerben Johan; Bohlmeijer, Ernst Thomas

    In this article, we bring the study of meaning together with the emerging field of study focusing on the emotions of wonder: wonder, enchantment, awe, and being moved. It is in meaningful moments that these two meet, and in our empirical study, we used the emotions of wonder as a lens to investigate

  14. Assessing Assessment: In Pursuit of Meaningful Learning (United States)

    Rootman-le Grange, Ilse; Blackie, Margaret A. L.


    The challenge of supporting the development of meaningful learning is prevalent in chemistry education research. One of the core activities used in the learning process is assessments. The aim of this paper is to illustrate how the semantics dimension of Legitimation Code Theory can be a helpful tool to critique the quality of assessments and…

  15. Fishing for meaningful units in connected speech

    DEFF Research Database (Denmark)

    Henrichsen, Peter Juel; Christiansen, Thomas Ulrich


    In many branches of spoken language analysis including ASR, the set of smallest meaningful units of speech is taken to coincide with the set of phones or phonemes. However, fishing for phones is difficult, error-prone, and computationally expensive. We present an experiment, based on machine...

  16. A cost effectiveness study establishing the impact and accuracy of implementing the NICE guidelines lowering plasma NTproBNP threshold in patients with clinically suspected heart failure at our institution. (United States)

    Webb, Jessica; Draper, Jane; Rua, Tiago; Yiu, Yee; Piper, Susan; Teall, Thomas; Fovargue, Lauren; Bolca, Elena; Jackson, Tom; Claridge, Simon; Sieniewicz, Ben; Porter, Bradley; McDiarmid, Adam; Rajani, Ronak; Kapetanakis, Stamatis; Rinaldi, Christopher A; Razavi, Reza; McDonagh, Theresa A; Carr-White, Gerald


    The 2014 National Institute of Clinical Excellence (NICE) guidelines on the management of acute heart failure recommended using a plasma NT-proBNP threshold of 300pg/ml to assist in ruling out the diagnosis of heart failure (HF), updating previous guidelines recommending using a threshold of 400pg/ml. NICE based their recommendations on 6 studies performed in other countries. This study sought to determine the diagnostic and economic implications of using these thresholds in a large unselected UK population. Patient and clinical demographics were recorded for all consecutive suspected HF patients over 12months, as well as clinical outcomes including time to HF hospitalisation and time to death (follow up 15.8months). Of 1995 unselected patients admitted with clinically suspected HF, 1683 (84%) had a NTproBNP over the current NICE recommended threshold, of which 35% received a final diagnosis of HF. Lowering the threshold from 400 to 300pg/ml would have involved screening an additional 61 patients and only would have identified one new patient with HF (sensitivity 0.985, NPV 0.976, area under the curve (AUC) at 300pg/ml 0.67; sensitivity 0.983, NPV 0.977, AUC 0.65 at 400pg/ml). The economic implications of lowering the threshold would have involved additional costs of £42,842.04 (£702.33 per patient screened, or £ 42,824.04 per new HF patient). Applying the recent updated NICE guidelines to an unselected real world population increases the AUC but would have a significant economic impact and only identified one new patient with heart failure. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Merit-Based Incentive Payment System: Meaningful Changes in the Final Rule Brings Cautious Optimism. (United States)

    Manchikanti, Laxmaiah; Helm Ii, Standiford; Calodney, Aaron K; Hirsch, Joshua A


    The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) eliminated the flawed Sustainable Growth Rate (SGR) act formula - a longstanding crucial issue of concern for health care providers and Medicare beneficiaries. MACRA also included a quality improvement program entitled, "The Merit-Based Incentive Payment System, or MIPS." The proposed rule of MIPS sought to streamline existing federal quality efforts and therefore linked 4 distinct programs into one. Three existing programs, meaningful use (MU), Physician Quality Reporting System (PQRS), value-based payment (VBP) system were merged with the addition of Clinical Improvement Activity category. The proposed rule also changed the name of MU to Advancing Care Information, or ACI. ACI contributes to 25% of composite score of the four programs, PQRS contributes 50% of the composite score, while VBP system, which deals with resource use or cost, contributes to 10% of the composite score. The newest category, Improvement Activities or IA, contributes 15% to the composite score. The proposed rule also created what it called a design incentive that drives movement to delivery system reform principles with the inclusion of Advanced Alternative Payment Models (APMs).Following the release of the proposed rule, the medical community, as well as Congress, provided substantial input to Centers for Medicare and Medicaid Services (CMS),expressing their concern. American Society of Interventional Pain Physicians (ASIPP) focused on 3 important aspects: delay the implementation, provide a 3-month performance period, and provide ability to submit meaningful quality measures in a timely and economic manner. The final rule accepted many of the comments from various organizations, including several of those specifically emphasized by ASIPP, with acceptance of 3-month reporting period, as well as the ability to submit non-MIPS measures to improve real quality and make the system meaningful. CMS also provided a mechanism for

  18. The journey of primary care practices to meaningful use: a Colorado Beacon Consortium study. (United States)

    Fernald, Douglas H; Wearner, Robyn; Dickinson, W Perry


    The Health Information Technology for Economic and Clinical Health Act of 2009 provides for incentive payments through Medicare and Medicaid for clinicians who implement electronic health records (EHRs) and use this technology meaningfully to improve patient care. There are few comprehensive descriptions of how primary care practices achieve the meaningful use of clinical data, including the formal stage 1 meaningful use requirements. Evaluation of the Colorado Beacon Consortium project included iterative qualitative analysis of practice narratives, provider and staff interviews, and separate focus groups with quality improvement (QI) advisors and staff from the regional health information exchange (HIE). Most practices described significant realignment of practice priorities and aims, which often required substantial education and training of physicians and staff. Re-engineering office processes, data collection protocols, EHRs, staff roles, and practice culture comprised the primary effort and commitment to attest to stage 1 meaningful use and subsequent meaningful use of clinical data. While realizing important benefits, practices bore a significant burden in learning the true capabilities of their EHRs with little effective support from vendors. Attestation was an important initial milestone in the process, but practices faced substantial ongoing work to use their data meaningfully for patient care and QI. Key resources were instrumental to these practices: local technical EHR expertise; collaborative learning mechanisms; and regular contact and support from QI advisors. Meeting the stage 1 requirements for incentives under Medicare and Medicaid meaningful use criteria is the first waypoint in a longer journey by primary care practices to the meaningful use of electronic data to continuously improve the care and health of their patients. The intensive re-engineering effort for stage 1 yielded practice changes consistent with larger practice aims and goals

  19. Preclinical endoscopic training using a part-task simulator: learning curve assessment and determination of threshold score for advancement to clinical endoscopy. (United States)

    Jirapinyo, Pichamol; Abidi, Wasif M; Aihara, Hiroyuki; Zaki, Theodore; Tsay, Cynthia; Imaeda, Avlin B; Thompson, Christopher C


    Preclinical simulator training has the potential to decrease endoscopic procedure time and patient discomfort. This study aims to characterize the learning curve of endoscopic novices in a part-task simulator and propose a threshold score for advancement to initial clinical cases. Twenty novices with no prior endoscopic experience underwent repeated endoscopic simulator sessions using the part-task simulator. Simulator scores were collected; their inverse was averaged and fit to an exponential curve. The incremental improvement after each session was calculated. Plateau was defined as the session after which incremental improvement in simulator score model was less than 5%. Additionally, all participants filled out questionnaires regarding simulator experience after sessions 1, 5, 10, 15, and 20. A visual analog scale and NASA task load index were used to assess levels of comfort and demand. Twenty novices underwent 400 simulator sessions. Mean simulator scores at sessions 1, 5, 10, 15, and 20 were 78.5 ± 5.95, 176.5 ± 17.7, 275.55 ± 23.56, 347 ± 26.49, and 441.11 ± 38.14. The best fit exponential model was [time/score] = 26.1 × [session #] -0.615 ; r 2  = 0.99. This corresponded to an incremental improvement in score of 35% after the first session, 22% after the second, 16% after the third and so on. Incremental improvement dropped below 5% after the 12th session corresponding to the predicted score of 265. Simulator training was related to higher comfort maneuvering an endoscope and increased readiness for supervised clinical endoscopy, both plateauing between sessions 10 and 15. Mental demand, physical demand, and frustration levels decreased with increased simulator training. Preclinical training using an endoscopic part-task simulator appears to increase comfort level and decrease mental and physical demand associated with endoscopy. Based on a rigorous model, we recommend that novices complete a minimum of 12 training

  20. Patient-perceived satisfactory improvement (PPSI): interpreting meaningful change in pain from the patient's perspective

    NARCIS (Netherlands)

    ten Klooster, Peter M.; Drossaers-Bakker, K.W.; Taal, Erik; van de Laar, Mart A F J


    The assessment of clinically meaningful changes in patient-reported pain has become increasingly important when interpreting results of clinical studies. However, proposed response criteria, such as the minimal clinically important difference, do not correspond with the growing need for information

  1. CARA Risk Assessment Thresholds (United States)

    Hejduk, M. D.


    Warning remediation threshold (Red threshold): Pc level at which warnings are issued, and active remediation considered and usually executed. Analysis threshold (Green to Yellow threshold): Pc level at which analysis of event is indicated, including seeking additional information if warranted. Post-remediation threshold: Pc level to which remediation maneuvers are sized in order to achieve event remediation and obviate any need for immediate follow-up maneuvers. Maneuver screening threshold: Pc compliance level for routine maneuver screenings (more demanding than regular Red threshold due to additional maneuver uncertainty).

  2. Repeated noxious stimulation of the skin enhances cutaneous pain perception of migraine patients in-between attacks: clinical evidence for continuous sub-threshold increase in membrane excitability of central trigeminovascular neurons. (United States)

    Weissman-Fogel, Irit; Sprecher, Elliot; Granovsky, Yelena; Yarnitsky, David


    Recent clinical studies showed that acute migraine attacks are accompanied by increased periorbital and bodily skin sensitivity to touch, heat and cold. Parallel pre-clinical studies showed that the underlying mechanism is sensitization of primary nociceptors and central trigeminovascular neurons. The present study investigates the sensory state of neuronal pathways that mediate skin pain sensation in migraine patients in between attacks. The assessments of sensory perception included (a) mechanical and thermal pain thresholds of the periorbital area, electrical pain threshold of forearm skin, (b) pain scores to phasic supra-threshold stimuli in the same modalities and areas as above, and (c) temporal summation of pain induced by applying noxious tonic heat pain and brief trains of noxious mechanical and electrical pulses to the above skin areas. Thirty-four pain-free migraine patients and 28 age- and gender-matched controls were studied. Patients did not differ from controls in their pain thresholds for heat (44+/-2.6 vs. 44.6+/-1.9 degrees C), and electrical (4.8+/-1.6 vs. 4.3+/-1.6 mA) stimulation, and in their pain scores for supra-threshold phasic stimuli for all modalities. They did, however, differ in their pain threshold for mechanical stimulation, just by one von Frey filament (P=0.01) and in their pain scores of the temporal summation tests. Increased summation of pain was found in migraineurs for repeated mechanical stimuli (delta visual analog scale (VAS) +2.32+/-0.73 in patients vs. +0.16+/-0.83 in controls, P=0.05) and repeated electrical stimuli (delta VAS +3.83+/-1.91 vs -3.79+/-2.31, P=0.01). Increased summation corresponded with more severe clinical parameters of migraine and tended to depend on interval since last migraine attack. The absence of clinically or overt laboratory expressed allodynia suggests that pain pathways are not sensitized in the pain-free migraine patients. Nevertheless, the increased temporal summation, and the slight

  3. End user programming with personally meaningful objects

    CSIR Research Space (South Africa)

    Smith, Andrew C


    Full Text Available (Kimchi et al., 2003). Perceptual organisation is a neuro-cognitive process that dictates how we perceive objects in physical space and how we interpret some objects as being distinct from others and yet other objects as part of a whole (Helm, 2014... called the designer-cum-user. Using this approach, the user creates a personally meaningful artefact that represents the target product. Although not confirmed, we anticipate that this approach reduces the initial cognitive load on the user when he uses...

  4. Threshold quantum cryptography

    International Nuclear Information System (INIS)

    Tokunaga, Yuuki; Okamoto, Tatsuaki; Imoto, Nobuyuki


    We present the concept of threshold collaborative unitary transformation or threshold quantum cryptography, which is a kind of quantum version of threshold cryptography. Threshold quantum cryptography states that classical shared secrets are distributed to several parties and a subset of them, whose number is greater than a threshold, collaborates to compute a quantum cryptographic function, while keeping each share secretly inside each party. The shared secrets are reusable if no cheating is detected. As a concrete example of this concept, we show a distributed protocol (with threshold) of conjugate coding

  5. Meaningful radiation worker training for temporary craftsmen

    International Nuclear Information System (INIS)

    Williams, S.L.


    The carefully organized Radiation Worker Training Program presented to permanently assigned personnel at a power reactor facility too often falls by the wayside when temporary craftsmen are brought in for an outage. Even though these temporary workers will frequently be assigned to outage jobs with high radiation and/or contamination exposures, their Radiation Worker Training is often squeezed into an already busy schedule, thus reducing its effectiveness. As an aid for evaluating the effectiveness of an existing Radiation Worker Training Program for temporary craftsmen or for setting up a new program, the following guides are presented and discussed in this paper: the training environment; the interest and meaningfulness of the presentation; the method or methods used for presentation of the training information; the use of demonstrations; trainee participation; and, measuring the amount and type of information retained by a trainee. Meaningful Radiation Worker Training for temporary craftsmen can pay big dividends. Craftsmen can be expected to make fewer mistakes, thus reducing radiation exposure and lessening the chance for the spread of contamination. The craftsmen will also benefit by being able to work longer and utility management will benefit by having lower outage costs

  6. Theory of threshold phenomena

    International Nuclear Information System (INIS)

    Hategan, Cornel


    Theory of Threshold Phenomena in Quantum Scattering is developed in terms of Reduced Scattering Matrix. Relationships of different types of threshold anomalies both to nuclear reaction mechanisms and to nuclear reaction models are established. Magnitude of threshold effect is related to spectroscopic factor of zero-energy neutron state. The Theory of Threshold Phenomena, based on Reduced Scattering Matrix, does establish relationships between different types of threshold effects and nuclear reaction mechanisms: the cusp and non-resonant potential scattering, s-wave threshold anomaly and compound nucleus resonant scattering, p-wave anomaly and quasi-resonant scattering. A threshold anomaly related to resonant or quasi resonant scattering is enhanced provided the neutron threshold state has large spectroscopic amplitude. The Theory contains, as limit cases, Cusp Theories and also results of different nuclear reactions models as Charge Exchange, Weak Coupling, Bohr and Hauser-Feshbach models. (author)

  7. The Retention of Meaningful Understanding of Meiosis and Genetics. (United States)

    Cavallo, Ann Liberatore

    This study investigated the retention of meaningful understanding of the biological topics of meiosis, the Punnett square method and the relations between these two topics. This study also explored the predictive influence of students' general tendency to learn meaningfully or by rote (meaningful learning orientation), prior knowledge of meiosis,…

  8. Myasthenia Gravis Impairment Index: Responsiveness, meaningful change, and relative efficiency. (United States)

    Barnett, Carolina; Bril, Vera; Kapral, Moira; Kulkarni, Abhaya V; Davis, Aileen M


    To study responsiveness and meaningful change of the Myasthenia Gravis Impairment Index (MGII) and its relative efficiency compared to other measures. We enrolled 95 patients receiving prednisone, IV immunoglobulin (IVIg), or plasma exchange (PLEX) and 54 controls. Patients were assessed with the MGII and other measures-including the Quantitative Myasthenia Gravis Score, Myasthenia Gravis Composite, and Myasthenia Gravis Activities of Daily Living-at baseline and 3-4 weeks after treatment. Statistical markers of responsiveness included between-groups and within-group differences, and we estimated the relative efficiency of the MGII compared to other measures. Patient-meaningful change was assessed with an anchor-based method, using the patient's impression of change. We determined the minimal detectable change (MDC) and the minimal important difference (MID) at the group and individual level. Treated patients had a higher change in MGII scores than controls (analysis of covariance p 1 favoring the MGII. The MGII demonstrated responsiveness to prednisone, IVIg, and PLEX in patients with myasthenia. There is a differential response in ocular and generalized symptoms to type of therapy. The MGII has higher relative efficiency than comparison measures and is viable for use in clinical trials. Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

  9. Clinically Meaningful Use of Blood Tumor Markers in Oncology


    Holdenrieder, Stefan; Pagliaro, Lance; Morgenstern, David; Dayyani, Farshid


    Before the introduction of modern imaging techniques and the recent developments in molecular diagnosis, tumor markers (TMs) were among the few available diagnostic tools for the management of cancer patients. Easily obtained from serum or plasma samples, TMs are minimally invasive and convenient, and the associated costs are low. Single TMs were traditionally used but these have come under scrutiny due to their low sensitivity and specificity when used, for example, in a screening setting. H...

  10. Towards a mathematical theory of meaningful communication (United States)

    Corominas-Murtra, Bernat; Fortuny, Jordi; Solé, Ricard V.


    Meaning has been left outside most theoretical approaches to information in biology. Functional responses based on an appropriate interpretation of signals have been replaced by a probabilistic description of correlations between emitted and received symbols. This assumption leads to potential paradoxes, such as the presence of a maximum information associated to a channel that creates completely wrong interpretations of the signals. Game-theoretic models of language evolution and other studies considering embodied communicating agents show that the correct (meaningful) match resulting from agent-agent exchanges is always achieved and natural systems obviously solve the problem correctly. Inspired by the concept of duality of the communicative sign stated by the swiss linguist Ferdinand de Saussure, here we present a complete description of the minimal system necessary to measure the amount of information that is consistently decoded. Several consequences of our developments are investigated, such as the uselessness of a certain amount of information properly transmitted for communication among autonomous agents.

  11. Creating Visual Design and Meaningful Audience Experiences

    DEFF Research Database (Denmark)

    Steijn, Arthur; Ion Wille, Jakob


    The main purpose of the EU Interreg funded Classical Composition Music and Experience Design project, was to rethink audience experiences and develop knowledge of applied technologies connected to classical music and live concerts. The project and its main objectives was motivated by at least thee...... conditions. The most important being 1) the development in new technology creating new expectations in audiences attending cultural events, including classical concerts, 2) resent decline in audiences attending classical music and 3) a will to strengthen relations between cultural institutions, creative...... businesses and educational institutions in the Øresund region (including the city and surroundings of Malmø and Copenhagen). Therefore the project Classical Composition Music and Experience Design focused on developing new and meaningful audience experiences where live classical music meets new digital...

  12. Meaningful Academic Work as Praxis in Emergence

    Directory of Open Access Journals (Sweden)

    Keijo Räsänen


    Full Text Available The managerial form of university governance has changed the conditions of academic work in many countries. While some academics consider this a welcome development, others experience it as a threat to their autonomy and to the meaningfulness of their work. This essay suggests a stance in response to the current conditions that should serve especially the latter group of academics. The claim is that by approaching academic work as a potential praxis in emergence, it is possible to appreciate local, autonomous activity in renewing academic work. Even if such efforts remain difficult, dispersed in space, discontinuous in time, and incomplete, they may provide a sense of direction and keep up hope. The conception of praxis is a way of articulating the mission of such efforts; simultaneously, it is also a way of defining an epistemic object for research on academic work.

  13. Time-efficient multidimensional threshold tracking method

    DEFF Research Database (Denmark)

    Fereczkowski, Michal; Kowalewski, Borys; Dau, Torsten


    Traditionally, adaptive methods have been used to reduce the time it takes to estimate psychoacoustic thresholds. However, even with adaptive methods, there are many cases where the testing time is too long to be clinically feasible, particularly when estimating thresholds as a function of anothe...

  14. Motivational reading on education, meaningful reading realisation

    Directory of Open Access Journals (Sweden)

    Adriana Qafa


    Full Text Available In this study I will present some ideas on today’s educational practice for motivation, the realization of the meaningful reading. There is a special place for the methodical ranking of the reading process, starting in school. Main requests of this reading, consist of the deep meaning of the subject, exploration of the idea, and other elements of the subject, implementation of the technique’s rules of the expressive reading, such as breathing, voice, diction, intonation, spelling, stoppages, logical emphasizes, emotional expressions, temper, timber, gesticulations, and mimic. There is also highlighted the fact that the used method comes from the pupils’ results and depends on the capability and level of the teacher, from the programming’s scale, the tools that are put into disposition, the age and the level of the pupils, and from the environment that the teacher creates during courses. At the end there are some practical guidelines for the realization of the expressive reading in the literature subject.

  15. Threshold Signature Schemes Application

    Directory of Open Access Journals (Sweden)

    Anastasiya Victorovna Beresneva


    Full Text Available This work is devoted to an investigation of threshold signature schemes. The systematization of the threshold signature schemes was done, cryptographic constructions based on interpolation Lagrange polynomial, elliptic curves and bilinear pairings were examined. Different methods of generation and verification of threshold signatures were explored, the availability of practical usage of threshold schemes in mobile agents, Internet banking and e-currency was shown. The topics of further investigation were given and it could reduce a level of counterfeit electronic documents signed by a group of users.

  16. Particles near threshold

    International Nuclear Information System (INIS)

    Bhattacharya, T.; Willenbrock, S.


    We propose returning to the definition of the width of a particle in terms of the pole in the particle's propagator. Away from thresholds, this definition of width is equivalent to the standard perturbative definition, up to next-to-leading order; however, near a threshold, the two definitions differ significantly. The width as defined by the pole position provides more information in the threshold region than the standard perturbative definition and, in contrast with the perturbative definition, does not vanish when a two-particle s-wave threshold is approached from below

  17. A meaningful MESS (Medical Education Scholarship Support

    Directory of Open Access Journals (Sweden)

    Shari A. Whicker


    Full Text Available Background: Graduate medical education faculty bear the responsibility of demonstrating active research and scholarship; however, faculty who choose education-focused careers may face unique obstacles related to the lack of promotion tracks, funding, career options, and research opportunities. Our objective was to address education research and scholarship barriers by providing a collaborative peer-mentoring environment and improve the production of research and scholarly outputs. Methods: We describe a Medical Education Scholarship Support (MESS group created in 2013. MESS is an interprofessional, multidisciplinary peer-mentoring education research community that now spans multiple institutions. This group meets monthly to address education research and scholarship challenges. Through this process, we develop new knowledge, research, and scholarly products, in addition to meaningful collaborations. Results: MESS originated with eight founding members, all of whom still actively participate. MESS has proven to be a sustainable unfunded local community of practice, encouraging faculty to pursue health professions education (HPE careers and fostering scholarship. We have met our original objectives that involved maintaining 100% participant retention; developing increased knowledge in at least seven content areas; and contributing to the development of 13 peer-reviewed publications, eight professional presentations, one Masters of Education project, and one educational curriculum. Discussion: The number of individuals engaged in HPE research continues to rise. The MESS model could be adapted for use at other institutions, thereby reducing barriers HPE researchers face, providing an effective framework for trainees interested in education-focused careers, and having a broader impact on the education research landscape.

  18. Perspective: Uses and misuses of thresholds in diagnostic decision making. (United States)

    Warner, Jeremy L; Najarian, Robert M; Tierney, Lawrence M


    The concept of thresholds plays a vital role in decisions involving the initiation, continuation, and completion of diagnostic testing. Much research has focused on the development of explicit thresholds, in the form of practice guidelines and decision analyses. However, these tools are used infrequently; most medical decisions are made at the bedside, using implicit thresholds. Study of these thresholds can lead to a deeper understanding of clinical decision making. The authors examine some factors constituting individual clinicians' implicit thresholds. They propose a model for static thresholds using the concept of situational gravity to explain why some thresholds are high, and some low. Next, they consider the hypothetical effects of incorrect placement of thresholds (miscalibration) and changes to thresholds during diagnosis (manipulation). They demonstrate these concepts using common clinical scenarios. Through analysis of miscalibration of thresholds, the authors demonstrate some common maladaptive clinical behaviors, which are nevertheless internally consistent. They then explain how manipulation of thresholds gives rise to common cognitive heuristics including premature closure and anchoring. They also discuss the case where no threshold has been exceeded despite exhaustive collection of data, which commonly leads to application of the availability or representativeness heuristics. Awareness of implicit thresholds allows for a more effective understanding of the processes of medical decision making and, possibly, to the avoidance of detrimental heuristics and their associated medical errors. Research toward accurately defining these thresholds for individual physicians and toward determining their dynamic properties during the diagnostic process may yield valuable insights.

  19. Thresholds in chemical respiratory sensitisation. (United States)

    Cochrane, Stella A; Arts, Josje H E; Ehnes, Colin; Hindle, Stuart; Hollnagel, Heli M; Poole, Alan; Suto, Hidenori; Kimber, Ian


    There is a continuing interest in determining whether it is possible to identify thresholds for chemical allergy. Here allergic sensitisation of the respiratory tract by chemicals is considered in this context. This is an important occupational health problem, being associated with rhinitis and asthma, and in addition provides toxicologists and risk assessors with a number of challenges. In common with all forms of allergic disease chemical respiratory allergy develops in two phases. In the first (induction) phase exposure to a chemical allergen (by an appropriate route of exposure) causes immunological priming and sensitisation of the respiratory tract. The second (elicitation) phase is triggered if a sensitised subject is exposed subsequently to the same chemical allergen via inhalation. A secondary immune response will be provoked in the respiratory tract resulting in inflammation and the signs and symptoms of a respiratory hypersensitivity reaction. In this article attention has focused on the identification of threshold values during the acquisition of sensitisation. Current mechanistic understanding of allergy is such that it can be assumed that the development of sensitisation (and also the elicitation of an allergic reaction) is a threshold phenomenon; there will be levels of exposure below which sensitisation will not be acquired. That is, all immune responses, including allergic sensitisation, have threshold requirement for the availability of antigen/allergen, below which a response will fail to develop. The issue addressed here is whether there are methods available or clinical/epidemiological data that permit the identification of such thresholds. This document reviews briefly relevant human studies of occupational asthma, and experimental models that have been developed (or are being developed) for the identification and characterisation of chemical respiratory allergens. The main conclusion drawn is that although there is evidence that the

  20. Comparison of the Efficacy of Dry Needling and High-Power Pain Threshold Ultrasound Therapy with Clinical Status and Sonoelastography in Myofascial Pain Syndrome. (United States)

    Aridici, Rifat; Yetisgin, Alparslan; Boyaci, Ahmet; Tutoglu, Ahmet; Bozdogan, Erol; Sen Dokumaci, Dilek; Kilicaslan, Nihat; Boyaci, Nurefsan


    The aim of this study was to compare the therapeutic efficacy of high-power pain threshold (HPPT) ultrasound therapy applied to the trigger points and dry needling (DN) in myofascial pain syndrome. Sixty-one patients were randomly assigned to an HPPT (n = 30) and dry needling (n = 31) groups. The primary outcome measures were the Visual Analog Scale (VAS) and Neck Pain and Disability Scale (NPDS), both at 1 week and 4 weeks after treatment. The secondary outcome measures were the number of painful trigger points, range of the tragus-acromioclavicular joint, the Short Form-36, the Beck Depression Inventory, the Beck Anxiety Inventory, and sonoelastographic tests after a 1-week treatment. More improvement was seen in anxiety in the HPPT group (P 0.05). A decrease in tissue stiffness was only seen in the HPPT group (P pain syndrome. Although a significant decrease was shown in tissue stiffness with HPPT, neither of these treatments had an apparent superiority.

  1. The Omaha system and meaningful use: applications for practice, education, and research. (United States)

    Martin, Karen S; Monsen, Karen A; Bowles, Kathryn H


    Meaningful use has become ubiquitous in the vocabulary of health information technology. It suggests that better healthcare does not result from the adoption of technology and electronic health records, but by increasing interoperability and informing clinical decisions at the point of care. Although the initial application of meaningful use was limited to eligible professionals and hospitals, it incorporates complex processes and workflow that involve all nurses, other healthcare practitioners, and settings. The healthcare community will become more integrated, and interdisciplinary practitioners will provide enhanced patient-centered care if electronic health records adopt the priorities of meaningful use. Standardized terminologies are a necessary component of such electronic health records. The Omaha System is an exemplar of a standardized terminology that enables meaningful use of clinical data to support and improve patient-centered clinical practice, education, and research. It is user-friendly, generates data that can be shared with patients and their families, and enables healthcare providers to analyze and exchange patient-centered coded data. Use of the Omaha System is increasing steadily in diverse practice, education, and research settings nationally and internationally.

  2. Job enrichment: creating meaningful career development opportunities for nurses. (United States)

    Duffield, Christine; Baldwin, Richard; Roche, Michael; Wise, Sarah


    This paper presents an evaluation of a career development policy in South Australia which increased the number of senior staff nurse positions and provided senior registered nurses with time away from clinical duties to undertake agreed projects. We use Kanter's model of structural power and commitment theory to understand the dimensions of this policy. Development strategies for experienced staff who wish to remain at the bedside are needed, especially in smaller health services with limited opportunities for horizontal or vertical mobility. Face-to-face semistructured interviews were conducted with 54 senior staff nurses who participated in the career structure arrangements. The policy enhanced the structure of opportunity in three ways: by increasing the number of senior staff nurse positions, the ladder steps were improved; undertaking strategic projects developed new skills; and the job enrichment approach facilitated time out from the immediate pressures of ward work and challenged nurses in a different way. Through job enrichment, South Australia has found a novel way of providing meaningful career development opportunities for experienced nurses. Methods of job enrichment need to be considered as part of career development policy, especially where movement between clinical facilities is limited and staff wish to remain at the bedside. © 2013 John Wiley & Sons Ltd.

  3. Double Photoionization Near Threshold (United States)

    Wehlitz, Ralf


    The threshold region of the double-photoionization cross section is of particular interest because both ejected electrons move slowly in the Coulomb field of the residual ion. Near threshold both electrons have time to interact with each other and with the residual ion. Also, different theoretical models compete to describe the double-photoionization cross section in the threshold region. We have investigated that cross section for lithium and beryllium and have analyzed our data with respect to the latest results in the Coulomb-dipole theory. We find that our data support the idea of a Coulomb-dipole interaction.

  4. Thresholds in radiobiology

    International Nuclear Information System (INIS)

    Katz, R.; Hofmann, W.


    Interpretations of biological radiation effects frequently use the word 'threshold'. The meaning of this word is explored together with its relationship to the fundamental character of radiation effects and to the question of perception. It is emphasised that although the existence of either a dose or an LET threshold can never be settled by experimental radiobiological investigations, it may be argued on fundamental statistical grounds that for all statistical processes, and especially where the number of observed events is small, the concept of a threshold is logically invalid. (U.K.)

  5. Meaningfulness of Service and Marital Satisfaction in Army Couples (United States)

    Bergmann, Jeffrey S.; Renshaw, Keith D.; Allen, Elizabeth S.; Markman, Howard J.; Stanley, Scott M.


    The vast numbers of military service members who have been deployed since 2001 highlights the need to better understand relationships of military couples. A unique consideration in military couples is the concept of meaningfulness of service, or the value service members and their partners place on military service in spite of the sacrifices it requires. In a sample of 606 Army couples, we used path analysis to examine how male service members’ and female spouses’ perceived meaningfulness of service added to the prediction of marital satisfaction in both members of the couple, when accounting for service members’ PTSD symptoms. Spouses’ perceived meaningfulness of service was linked with higher marital satisfaction in spouses, regardless of service member’s perceived meaningfulness of service. Service members’ perceived meaningfulness of service was also associated with increased marital satisfaction in service members, but only when their spouses also perceived higher meaningfulness. There were no significant interactions between service members’ PTSD and either partner’s perceived meaningfulness. Implications for enhanced attention to spousal perceptions of meaningfulness of service are discussed. PMID:25046347

  6. Intrinsic Value and a Meaningful Life | Audi | Philosophical Papers

    African Journals Online (AJOL)

    I distinguish various ways in which human life may be thought to be meaningful and present an account of what might be called existential meaningfulness. The account is neutral with respect to both theism and naturalism, but each is addressed in several places and the paper's main points are harmonious with certain ...

  7. Meaningfulness of service and marital satisfaction in Army couples. (United States)

    Bergmann, Jeffrey S; Renshaw, Keith D; Allen, Elizabeth S; Markman, Howard J; Stanley, Scott M


    The vast numbers of military service members who have been deployed since 2001 highlights the need to better understand relationships of military couples. A unique consideration in military couples is the concept of meaningfulness of service, or the value service members and their partners place on military service in spite of the sacrifices it requires. In a sample of 606 Army couples, the authors used path analysis to examine how male service members' and female spouses' perceived meaningfulness of service added to the prediction of marital satisfaction in both members of the couple, when accounting for service members' PTSD symptoms. Spouses' perceived meaningfulness of service was linked with higher marital satisfaction in spouses, regardless of service member's perceived meaningfulness of service. Service members' perceived meaningfulness of service was also associated with increased marital satisfaction in service members, but only when their spouses also perceived higher meaningfulness. There were no significant interactions between service members' PTSD and either partner's perceived meaningfulness. Implications for enhanced attention to spousal perceptions of meaningfulness of service are discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

  8. Meaningful Use of Health Information Technology by Rural Hospitals (United States)

    McCullough, Jeffrey; Casey, Michelle; Moscovice, Ira; Burlew, Michele


    Purpose: This study examines the current status of meaningful use of health information technology (IT) in Critical Access Hospitals (CAHs), other rural, and urban US hospitals, and it discusses the potential role of Medicare payment incentives and disincentives in encouraging CAHs and other rural hospitals to achieve meaningful use. Methods: Data…

  9. Characteristics of meaningful chemistry education - The case of water quality

    NARCIS (Netherlands)

    Westbroek, Hanna Barbara


    This thesis addresses the question of how to involve students in meaningful chemistry education by a proper implementation of three characteristics of meaningful: a context, a need-to-know approach and attention for student input. The characteristics were adopted as solution strategies for

  10. Relationship between meaningful work and job performance in nurses. (United States)

    Tong, Ling


    The present study was designed to determine the relationship between meaningful work and job performance, and the impact of meaningful work on nursing care quality. Meaningful work has been suggested as a significant factor affecting job performance, but the relationship has never been studied in nurses in China. A descriptive correlational study was designed to assess the level of meaningful work, tasks, and contextual performance as well as their relationships. We used a stratified random-sampling approach to enrol nurses from hospitals. Multivariate regression analysis was applied to determine the relationship between meaningful work and their demographic data. There were significant, positive relationships between meaningful work and task performance and contextual performance. Education level, work unit, and employment type influenced meaningful work. The work motivation score of the nurses was lower than that of the other 2 dimensions, and a negative work motivation score negatively influenced job performance. Improving meaningful work and providing more support and assistance could improve nurse performance, thereby improving the quality of nursing care. © 2018 John Wiley & Sons Australia, Ltd.

  11. Self-Determination and Meaningful Work: Exploring Socioeconomic Constraints

    Directory of Open Access Journals (Sweden)

    Blake A Allan


    Full Text Available This study examined a model of meaningful work among a diverse sample of working adults. From the perspectives of Self-Determination Theory and the Psychology of Working Framework, we tested a structural model with social class and work volition predicting SDT motivation variables, which in turn predicted meaningful work. Partially supporting hypotheses, work volition was positively related to internal regulation and negatively related to amotivation, whereas social class was positively related to external regulation and amotivation. In turn, internal regulation was positively related to meaningful work, whereas external regulation and amotivation were negatively related to meaningful work. Indirect effects from work volition to meaningful work via internal regulation and amotivation were significant, and indirect effects from social class to meaningful work via external regulation and amotivaiton were significant. This study highlights the important relations between SDT motivation variables and meaningful work, especially the large positive relation between internal regulation and meaningful work. However, results also reveal that work volition and social class may play critical roles in predicting internal regulation, external regulation, and amotivation.

  12. Self-Determination and Meaningful Work: Exploring Socioeconomic Constraints. (United States)

    Allan, Blake A; Autin, Kelsey L; Duffy, Ryan D


    This study examined a model of meaningful work among a diverse sample of working adults. From the perspectives of Self-Determination Theory and the Psychology of Working Framework, we tested a structural model with social class and work volition predicting SDT motivation variables, which in turn predicted meaningful work. Partially supporting hypotheses, work volition was positively related to internal regulation and negatively related to amotivation, whereas social class was positively related to external regulation and amotivation. In turn, internal regulation was positively related to meaningful work, whereas external regulation and amotivation were negatively related to meaningful work. Indirect effects from work volition to meaningful work via internal regulation and amotivation were significant, and indirect effects from social class to meaningful work via external regulation and amotivation were significant. This study highlights the important relations between SDT motivation variables and meaningful work, especially the large positive relation between internal regulation and meaningful work. However, results also reveal that work volition and social class may play critical roles in predicting internal regulation, external regulation, and amotivation.

  13. Meaningful work and secondary school teachers' intention to leave ...

    African Journals Online (AJOL)

    The following measuring instruments were used: Work-role Fit Scale, Job Enrichment Scale, Co-worker and Supervisor Relationships Scales, Psychological Meaningfulness Scale and Turnover Intention Scale. Work-role fit and job enrichment both had direct positive effect on experiences of psychological meaningfulness at ...

  14. Between order and chaos: The quest for meaningful information

    NARCIS (Netherlands)

    Adriaans, P.


    The notion of meaningful information seems to be associated with the sweet spot between order and chaos. This form of meaningfulness of information, which is primarily what science is interested in, is not captured by both Shannon information and Kolmogorov complexity. In this paper I develop a

  15. Meaningful spatial and temporal sequences of activities in dwelling

    NARCIS (Netherlands)

    Hematalikeikha, M.A.; Coolen, H.C.C.H.; Pourdeihimi, S.


    Human activities based on human needs are affected by affordances and meanings that occur in the dwelling. Activities over time and space have meaningful sequences. The meaningfulness of activities in the cultural framework is conditioned by its special temporality and spatiality. Also, temporal or

  16. Meaningful work and secondary school teachers' intention to leave

    Directory of Open Access Journals (Sweden)

    M. Janik


    Full Text Available The study investigates the relations between secondary school teachers' work-role fit, job enrichment, supervisor relationships, co-worker relationships, psychological meaningfulness of work and intention to leave. A cross-sectional survey was used. The participants were 502 secondary school teachers in Namibia. The following measuring instruments were used: Work-role Fit Scale, Job Enrichment Scale, Co-worker and Supervisor Relationships Scales, Psychological Meaningfulness Scale and Turnover Intention Scale. Work-role fit and job enrichment both had direct positive effect on experiences of psychological meaningfulness at work, while poor work-role fit and low psychological meaningfulness both had a direct effect on teachers' intentions to leave. An analysis of the indirect effects showed that poor work-role fit and poor job enrichment affected intention to leave due to the concomitant experience of low psychological meaningfulness. These findings have implications for the retention of teachers in secondary schools.


    Directory of Open Access Journals (Sweden)

    Sanjo Zlobec


    Full Text Available The derivative of a function f in n variables at a point x* is one of the most important tools in mathematical modelling. If this object exists, it is represented by the row n-tuple f(x* = [∂f/∂xi(x*] called the gradient of f at x*, abbreviated: “the gradient”. The evaluation of f(x* is usually done in two stages, first by calculating the n partials and then their values at x = x*. In this talk we give an alternative approach. We show that one can characterize the gradient without differentiation! The idea is to fix an arbitrary row n-tuple G and answer the following question: What is a necessary and sufficient condition such that G is the gradient of a given f at a given x*? The answer is given after adjusting the quadratic envelope property introduced in [3]. We work with smooth, i.e., continuously differentiable, functions with a Lipschitz derivative on a compact convex set with a non-empty interior. Working with this class of functions is not a serious restriction. In fact, loosely speaking, “almost all” smooth meaningful functions used in modelling of real life situations are expected to have a bounded “acceleration” hence they belong to this class. In particular, the class contains all twice differentiable functions [1]. An important property of the functions from this class is that every f can be represented as the difference of some convex function and a convex quadratic function. This decomposition was used in [3] to characterize the zero derivative points. There we obtained reformulations and augmentations of some well known classic results on optimality such as Fermats extreme value theorem (known from high school and the Lagrange multiplier theorem from calculus [2, 3]. In this talk we extend the results on zero derivative points to characterize the relation G = f(x*, where G is an arbitrary n-tuple. Some special cases: If G = O, we recover the results on zero derivative points. For functions of a single

  18. Regional Seismic Threshold Monitoring

    National Research Council Canada - National Science Library

    Kvaerna, Tormod


    ... model to be used for predicting the travel times of regional phases. We have applied these attenuation relations to develop and assess a regional threshold monitoring scheme for selected subregions of the European Arctic...

  19. Trigemino-gustatory interactions: a randomized controlled clinical trial assessing the effects of selective anesthesia of dental afferents on taste thresholds. (United States)

    Lecor, Papa Abdou; Touré, Babacar; Boucher, Yves


    This study aimed at analyzing the effect of the temporary removal of trigeminal dental afferents on electrogustometric thresholds (EGMt). EGMt were measured in 300 healthy subjects randomized in three groups, in nine loci on the right and left side (RS, LS) of the tongue surface before and after anesthesia. Group IAN (n = 56 RS, n = 44 LS) received intraosseous local anesthesia of the inferior alveolar nerve (IAN). Group MdN received mandibular nerve (MdN) block targeting IAN before its entrance into the mandibular foramen (n = 60, RS, and n = 40, LS); group MxN receiving maxillary nerve (MxN) anesthesia (n = 56 RS and n = 44 LS) was the control group. Differences between mean EGMt were analyzed with the Wilcoxon test; correlation between type of anesthesia and EGMt was performed with Spearman's rho, all with a level of significance set at p ≤ 0.05. Significant EGMt (μA) differences before and after anesthesia were found in all loci with MdN and IAN on the ipsilateral side (p Anesthesia of the MdN was positively correlated with the increase in EGMt (p anesthesia of IAN was positively correlated only with the increase in EGMt measured at posterior and dorsal loci of the tongue surface (p anesthesia suggests a participation of dental afferents in taste perception. Extraction of teeth may impair food intake not only due to impaired masticatory ability but also to alteration of neurological trigemino-gustatory interactions. PACTR201602001452260.

  20. Thresholding magnetic resonance images of human brain

    Institute of Scientific and Technical Information of China (English)

    Qing-mao HU; Wieslaw L NOWINSKI


    In this paper, methods are proposed and validated to determine low and high thresholds to segment out gray matter and white matter for MR images of different pulse sequences of human brain. First, a two-dimensional reference image is determined to represent the intensity characteristics of the original three-dimensional data. Then a region of interest of the reference image is determined where brain tissues are present. The non-supervised fuzzy c-means clustering is employed to determine: the threshold for obtaining head mask, the low threshold for T2-weighted and PD-weighted images, and the high threshold for T1-weighted, SPGR and FLAIR images. Supervised range-constrained thresholding is employed to determine the low threshold for T1-weighted, SPGR and FLAIR images. Thresholding based on pairs of boundary pixels is proposed to determine the high threshold for T2- and PD-weighted images. Quantification against public data sets with various noise and inhomogeneity levels shows that the proposed methods can yield segmentation robust to noise and intensity inhomogeneity. Qualitatively the proposed methods work well with real clinical data.

  1. Color difference thresholds in dentistry. (United States)

    Paravina, Rade D; Ghinea, Razvan; Herrera, Luis J; Bona, Alvaro D; Igiel, Christopher; Linninger, Mercedes; Sakai, Maiko; Takahashi, Hidekazu; Tashkandi, Esam; Perez, Maria del Mar


    The aim of this prospective multicenter study was to determine 50:50% perceptibility threshold (PT) and 50:50% acceptability threshold (AT) of dental ceramic under simulated clinical settings. The spectral radiance of 63 monochromatic ceramic specimens was determined using a non-contact spectroradiometer. A total of 60 specimen pairs, divided into 3 sets of 20 specimen pairs (medium to light shades, medium to dark shades, and dark shades), were selected for psychophysical experiment. The coordinating center and seven research sites obtained the Institutional Review Board (IRB) approvals prior the beginning of the experiment. Each research site had 25 observers, divided into five groups of five observers: dentists-D, dental students-S, dental auxiliaries-A, dental technicians-T, and lay persons-L. There were 35 observers per group (five observers per group at each site ×7 sites), for a total of 175 observers. Visual color comparisons were performed using a viewing booth. Takagi-Sugeno-Kang (TSK) fuzzy approximation was used for fitting the data points. The 50:50% PT and 50:50% AT were determined in CIELAB and CIEDE2000. The t-test was used to evaluate the statistical significance in thresholds differences. The CIELAB 50:50% PT was ΔEab  = 1.2, whereas 50:50% AT was ΔEab  = 2.7. Corresponding CIEDE2000 (ΔE00 ) values were 0.8 and 1.8, respectively. 50:50% PT by the observer group revealed differences among groups D, A, T, and L as compared with 50:50% PT for all observers. The 50:50% AT for all observers was statistically different than 50:50% AT in groups T and L. A 50:50% perceptibility and ATs were significantly different. The same is true for differences between two color difference formulas ΔE00 /ΔEab . Observer groups and sites showed high level of statistical difference in all thresholds. Visual color difference thresholds can serve as a quality control tool to guide the selection of esthetic dental materials, evaluate clinical performance, and

  2. Community-based medical education: is success a result of meaningful personal learning experiences? (United States)

    Kelly, Len; Walters, Lucie; Rosenthal, David


    Community-based medical education (CBME) is the delivery of medical education in a specific social context. Learners become a part of social and medical communities where their learning occurs. Longitudinal integrated clerkships (LICs) are year-long community-based placements where the curriculum and clinical experience is typically delivered by primary care physicians. These programs have proven to be robust learning environments, where learners develop strong communication skills and excellent clinical reasoning. To date, no learning model has been offered to describe CBME. The characteristics of CBME are explored by the authors who suggest that the social and professional context provided in small communities enhances medical education. The authors postulate that meaningfulness is engendered by the authentic context, which develops over time. These relationships with preceptors, patients and the community provide meaningfulness, which in turn enhances learning. The authors develop a novel learning model. They propose that the context-rich environment of CBME allows for meaningful relationships and experiences for students and that such meaningfulness enhances learning.

  3. "Meaningful use" of electronic health records and its relevance to laboratories and pathologists

    Directory of Open Access Journals (Sweden)

    Walter H Henricks


    Full Text Available Electronic health records (EHRs have emerged as a major topic in health care and are central to the federal government′s strategy for transforming healthcare delivery in the United States. Recent federal actions that aim to promote the use of EHRs promise to have significant implications for laboratories and for pathology practices. Under the HITECH (Health Information Technology Economic and Clinical Health Act, an EHR incentive program has been established through which individual physicians and hospitals can qualify to receive incentive payments if they achieve "meaningful use" of "certified" EHR technology. The rule also establishes payment penalties in future years for eligible providers who have not met the requirements for meaningful use of EHRs. Meaningful use must be achieved using EHR technology that has been certified in accordance with functional and technical criteria that are set forth a regulation that parallels the meaningful use criteria in the incentive program. These actions and regulations are important to laboratories and pathologists for a number of reasons. Several of the criteria and requirements in the meaningful use rules and EHR certification criteria relate directly or indirectly to laboratory testing and laboratory information management, and future stage requirements are expected to impact the laboratory as well. Furthermore, as EHR uptake expands, there will be greater expectations for electronic interchange of laboratory information and laboratory information system (LIS-EHR interfaces. Laboratories will need to be aware of the technical, operational, and business challenges that they may face as expectations for LIS-EHR increase. This paper reviews the important recent federal efforts aimed at accelerating EHR use, including the incentive program for EHR meaningful use, provider eligibility, and EHR certification criteria, from a perspective of their relevance for laboratories and pathology practices.

  4. Antecedents and outcomes of meaningful work among school teachers

    Directory of Open Access Journals (Sweden)

    Elmari Fouché


    Research purpose: The aim of this study was to investigate antecedents and outcomes of meaningful work among school teachers. Motivation for the study: Meaningful work underpins people’s motivation and affects their well-being and job satisfaction. Furthermore, it is a significant pathway to healthy and authentic organisations. However, a research gap exists regarding the effects of different antecedents and outcomes of meaningful work. Research approach, design and method: A cross-sectional survey was used with a convenience sample of 513 teachers. The Work-Life Questionnaire, Revised Job Diagnostic Survey, Co-worker Relations Scale, Work and Meaning Inventory, Personal Resources Scale, Work Engagement Scale, Turnover Intention Scale and a measure of self-rated performance were administered. Main findings: A calling orientation, job design and co-worker relations were associated with meaningful work. A low calling orientation and poor co-worker relationships predicted burnout. A calling orientation, a well-designed job, good co-worker relationships and meaningful work predicted work engagement. Job design was moderately associated with self-ratings of performance. The absence of a calling orientation predicted teachers’ intention to leave the organisation. Practical/managerial implications: Educational managers should consider implementing interventions to affect teachers’ calling orientation (through job crafting, perceptions of the nature of their jobs (by allowing autonomy and co-worker relations (through teambuilding to promote perceptions of meaningful work. Promoting perceptions of meaningful work might contribute to lower burnout, higher work engagement, better self-ratings of performance and retention of teachers. Contribution/value-add: This study contributes to scientific knowledge regarding the effects of three antecedents, namely a calling orientation, job design and co-worker relationships on meaningful work. It also contributed to knowledge

  5. Redefining meaningful age groups in the context of disease. (United States)

    Geifman, Nophar; Cohen, Raphael; Rubin, Eitan


    Age is an important factor when considering phenotypic changes in health and disease. Currently, the use of age information in medicine is somewhat simplistic, with ages commonly being grouped into a small number of crude ranges reflecting the major stages of development and aging, such as childhood or adolescence. Here, we investigate the possibility of redefining age groups using the recently developed Age-Phenome Knowledge-base (APK) that holds over 35,000 literature-derived entries describing relationships between age and phenotype. Clustering of APK data suggests 13 new, partially overlapping, age groups. The diseases that define these groups suggest that the proposed divisions are biologically meaningful. We further show that the number of different age ranges that should be considered depends on the type of disease being evaluated. This finding was further strengthened by similar results obtained from clinical blood measurement data. The grouping of diseases that share a similar pattern of disease-related reports directly mirrors, in some cases, medical knowledge of disease-age relationships. In other cases, our results may be used to generate new and reasonable hypotheses regarding links between diseases.

  6. Threshold guidance update

    International Nuclear Information System (INIS)

    Wickham, L.E.


    The Department of Energy (DOE) is developing the concept of threshold quantities for use in determining which waste materials must be handled as radioactive waste and which may be disposed of as nonradioactive waste at its sites. Waste above this concentration level would be managed as radioactive or mixed waste (if hazardous chemicals are present); waste below this level would be handled as sanitary waste. Last years' activities (1984) included the development of a threshold guidance dose, the development of threshold concentrations corresponding to the guidance dose, the development of supporting documentation, review by a technical peer review committee, and review by the DOE community. As a result of the comments, areas have been identified for more extensive analysis, including an alternative basis for selection of the guidance dose and the development of quality assurance guidelines. Development of quality assurance guidelines will provide a reasonable basis for determining that a given waste stream qualifies as a threshold waste stream and can then be the basis for a more extensive cost-benefit analysis. The threshold guidance and supporting documentation will be revised, based on the comments received. The revised documents will be provided to DOE by early November. DOE-HQ has indicated that the revised documents will be available for review by DOE field offices and their contractors

  7. Near threshold fatigue testing (United States)

    Freeman, D. C.; Strum, M. J.


    Measurement of the near-threshold fatigue crack growth rate (FCGR) behavior provides a basis for the design and evaluation of components subjected to high cycle fatigue. Typically, the near-threshold fatigue regime describes crack growth rates below approximately 10(exp -5) mm/cycle (4 x 10(exp -7) inch/cycle). One such evaluation was recently performed for the binary alloy U-6Nb. The procedures developed for this evaluation are described in detail to provide a general test method for near-threshold FCGR testing. In particular, techniques for high-resolution measurements of crack length performed in-situ through a direct current, potential drop (DCPD) apparatus, and a method which eliminates crack closure effects through the use of loading cycles with constant maximum stress intensity are described.

  8. Callings, work role fit, psychological meaningfulness and work ...

    African Journals Online (AJOL)

    meaningful work experiences, which also impact individuals' work .... group 25 to 29 years. .... significant chi-squared difference tests, after these path deletions, indicated that .... Counseling Psychology, 59:479-485. doi: 10.1037/a0028949.

  9. Poignancy: Mixed Emotional Experience in the Face of Meaningful Endings (United States)

    Ersner-Hershfield, Hal; Mikels, Joseph A.; Sullivan, Sarah J.; Carstensen, Laura L.


    The experience of mixed emotions increases with age. Socioemotional selectivity theory suggests that mixed emotions are associated with shifting time horizons. Theoretically, perceived constraints on future time increase appreciation for life, which, in turn, elicits positive emotions such as happiness. Yet, the very same temporal constraints heighten awareness that these positive experiences come to an end, thus yielding mixed emotional states. In 2 studies, the authors examined the link between the awareness of anticipated endings and mixed emotional experience. In Study 1, participants repeatedly imagined being in a meaningful location. Participants in the experimental condition imagined being in the meaningful location for the final time. Only participants who imagined “last times” at meaningful locations experienced more mixed emotions. In Study 2, college seniors reported their emotions on graduation day. Mixed emotions were higher when participants were reminded of the ending that they were experiencing. Findings suggest that poignancy is an emotional experience associated with meaningful endings. PMID:18179325

  10. Readiness for Meaningful Use of Health Information Tech... (United States)

    U.S. Department of Health & Human Services — According to findings reported in Readiness for Meaningful Use of Health Information Technology and Patient Centered Medical Home Recognition Survey Results,...

  11. Meaningful work and secondary school teachers' intention to leave


    Janik, M.; Rothmann, S.


    The study investigates the relations between secondary school teachers' work-role fit, job enrichment, supervisor relationships, co-worker relationships, psychological meaningfulness of work and intention to leave. A cross-sectional survey was used. The participants were 502 secondary school teachers in Namibia. The following measuring instruments were used: Work-role Fit Scale, Job Enrichment Scale, Co-worker and Supervisor Relationships Scales, Psychological Meaningfulness Scale and Turnove...

  12. Design democratization with communities: Drawing toward locally meaningful design

    DEFF Research Database (Denmark)

    Winschiers-Goagoses, Naska; Winschiers-Theophilus, Heike; Rodil, Kasper


    The authors present community drawing as meaningful representations to inform locally valid technology design. They investigate recognition within and across cultural borders, thereby exposing variances of localities. The study contributes to the still scarce body of empirical work on culturally...... meaningful development of visual representations and recognition, as part of a longitudinal research project in which we co-design a 3D visualization for a specific Namibian pilot site....



    Sailin, Siti Nazuar; Mahmor, Noor Aida


    Students in this 21st century are required to acquire these 4C skills: Critical thinking, Communication, Collaboration and Creativity. These skills can be integrated in the teaching and learning through innovative teaching that promotes active and meaningful learning. One way of integrating these skills is through collaborative knowledge creation and sharing. This paper providesan example of meaningful teaching and learning activities designed within the Create-Share-Collaborate instructional...

  14. Self-Determination and Meaningful Work: Exploring Socioeconomic Constraints


    Allan, Blake A.; Autin, Kelsey L.; Duffy, Ryan D.


    This study examined a model of meaningful work among a diverse sample of working adults. From the perspectives of Self-Determination Theory and the Psychology of Working Framework, we tested a structural model with social class and work volition predicting SDT motivation variables, which in turn predicted meaningful work. Partially supporting hypotheses, work volition was positively related to internal regulation and negatively related to amotivation, whereas social class was positively relat...

  15. The effect of occupational meaningfulness on occupational commitment

    Directory of Open Access Journals (Sweden)

    Itai Ivtzan


    Full Text Available Existing research lacks a scholarly consensus on how to define and validly measure ‘meaningful work’ (e.g., Rosso, Dekas & Wrzesniewski, 2010. The following correlational study highlights the value of investigating meaningfulness in the context of occupational commitment. The study hypothesizes that occupational commitment is positively correlated with occupational meaningfulness, where meaningfulness is defined as the extent to which people’s occupations contribute to personal meaning in life. One-hundred and fifty-six full-time office based UK workers completed an online questionnaire including 18 questions measuring levels of occupational commitment (Meyer, Allen & Smith, 1993, in addition to six novel items measuring occupational meaningfulness. The results supported the hypothesis and also showed that the affective sub-type of occupational commitment had the highest correlation with occupational meaningfulness. Such results exhibit the importance of finding meaning at work, as well as the relevance of this to one’s level of commitment to his or her job. This paper argues that individuals should consider OM before choosing to take a specific role, whereas organizations ought to consider the OM of their potential candidates before recruiting them into a role. Possible directions for future research directions are also discussed.

  16. Helping others increases meaningful work: Evidence from three experiments. (United States)

    Allan, Blake A; Duffy, Ryan D; Collisson, Brian


    The aim of the current research was to examine whether manipulating task significance increased the meaningfulness of work among students (Study 1), an online sample of working adults (Study 2), and public university employees (Study 3). In Study 1, students completed a typing task for the benefit of themselves, a charity, or someone they knew would directly benefit from their work. People who worked to benefit someone else, rather than themselves, reported greater task meaningfulness. In Study 2, a representative, online sample of employees reflected on a time when they worked to benefit themselves or someone else at work. Results revealed that people who reflected on working to benefit someone else, rather than themselves, reported greater work meaningfulness. In Study 3, public university employees participated in a community intervention by working as they normally would, finding new ways to help people each day, or finding several new ways to help others on a single day. People who helped others many times in a single day experienced greater gains in work meaningfulness over time. Across 3 experimental studies, we found that people who perceived their work as helping others experienced more meaningfulness in their work. This highlights the potential mechanisms practitioners, employers, and other parties can use to increase the meaningfulness of work, which has implications for workers' well-being and productivity. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  17. Meaningful work and mental health: job satisfaction as a moderator. (United States)

    Allan, Blake A; Dexter, Chelsea; Kinsey, Rebecca; Parker, Shelby


    Depression, anxiety and stress are common problems for modern workers. Although having meaningful work, or work that is significant, facilitates personal growth, and contributes to the greater good, has been linked to better mental health, people's work might also need to be satisfying or enjoyable to improve outcomes. The purpose of the present study was to examine meaningful work's relation to mental health (i.e. depression, anxiety and stress) and investigate job satisfaction as a moderator of this relation. The study hypotheses were tested with a large, diverse sample recruited from an online source. Partially supporting hypotheses, when controlling for job satisfaction, meaningful work negatively correlated with depression but did not have a significant relation with anxiety and stress. Similarly, job satisfaction negatively predicted depression and stress. Furthermore, the relations between meaningful work and both anxiety and stress were moderated by job satisfaction. Specifically, only people perceiving their work as meaningful and satisfying reported less anxiety and stress. Although continued research is needed, employers and employees may have to target both the meaningfulness and job satisfaction to address the issues of stress and anxiety among working adults.

  18. Threshold factorization redux (United States)

    Chay, Junegone; Kim, Chul


    We reanalyze the factorization theorems for the Drell-Yan process and for deep inelastic scattering near threshold, as constructed in the framework of the soft-collinear effective theory (SCET), from a new, consistent perspective. In order to formulate the factorization near threshold in SCET, we should include an additional degree of freedom with small energy, collinear to the beam direction. The corresponding collinear-soft mode is included to describe the parton distribution function (PDF) near threshold. The soft function is modified by subtracting the contribution of the collinear-soft modes in order to avoid double counting on the overlap region. As a result, the proper soft function becomes infrared finite, and all the factorized parts are free of rapidity divergence. Furthermore, the separation of the relevant scales in each factorized part becomes manifest. We apply the same idea to the dihadron production in e+e- annihilation near threshold, and show that the resultant soft function is also free of infrared and rapidity divergences.

  19. Elaborating on Threshold Concepts (United States)

    Rountree, Janet; Robins, Anthony; Rountree, Nathan


    We propose an expanded definition of Threshold Concepts (TCs) that requires the successful acquisition and internalisation not only of knowledge, but also its practical elaboration in the domains of applied strategies and mental models. This richer definition allows us to clarify the relationship between TCs and Fundamental Ideas, and to account…

  20. Identifying thresholds for relationships between impacts of rationing of nursing care and nurse- and patient-reported outcomes in Swiss hospitals: a correlational study. (United States)

    Schubert, Maria; Clarke, Sean P; Glass, Tracy R; Schaffert-Witvliet, Bianca; De Geest, Sabina


    In the Rationing of Nursing Care in Switzerland Study, implicit rationing of care was the only factor consistently significantly associated with all six studied patient outcomes. These results highlight the importance of rationing as a new system factor regarding patient safety and quality of care. Since at least some rationing of care appears inevitable, it is important to identify the thresholds of its influences in order to minimize its negative effects on patient outcomes. To describe the levels of implicit rationing of nursing care in a sample of Swiss acute care hospitals and to identify clinically meaningful thresholds of rationing. Descriptive cross-sectional multi-center study. Five Swiss-German and three Swiss-French acute care hospitals. 1338 nurses and 779 patients. Implicit rationing of nursing care was measured using the newly developed Basel Extent of Rationing of Nursing Care (BERNCA) instrument. Other variables were measured using survey items from the International Hospital Outcomes Study battery. Data were summarized using appropriate descriptive measures, and logistic regression models were used to define a clinically meaningful rationing threshold level. For the studied patient outcomes, identified rationing threshold levels varied from 0.5 (i.e., between 0 ('never') and 1 ('rarely') to 2 ('sometimes')). Three of the identified patient outcomes (nosocomial infections, pressure ulcers, and patient satisfaction) were particularly sensitive to rationing, showing negative consequences anywhere it was consistently reported (i.e., average BERNCA scores of 0.5 or above). In other cases, increases in negative outcomes were first observed from the level of 1 (average ratings of rarely). Rationing scores generated using the BERNCA instrument provide a clinically meaningful method for tracking the correlates of low resources or difficulties in resource allocation on patient outcomes. Thresholds identified here provide parameters for administrators to

  1. Hadron production near threshold

    Indian Academy of Sciences (India)

    Abstract. Final state interaction effects in pp → pΛK+ and pd → 3He η reactions are explored near threshold to study the sensitivity of the cross-sections to the pΛ potential and the ηN scattering matrix. The final state scattering wave functions between Λ and p and η and 3He are described rigorously. The Λ production is ...

  2. Casualties and threshold effects

    International Nuclear Information System (INIS)

    Mays, C.W.; National Cancer Inst., Bethesda


    Radiation effects like cancer are denoted as casualties. Other radiation effects occur almost in everyone when the radiation dose is sufficiently high. One then speaks of radiation effects with a threshold dose. In this article the author puts his doubt about this classification of radiation effects. He argues that some effects of exposure to radiation do not fit in this classification. (H.W.). 19 refs.; 2 figs.; 1 tab

  3. Resonance phenomena near thresholds

    International Nuclear Information System (INIS)

    Persson, E.; Mueller, M.; Rotter, I.; Technische Univ. Dresden


    The trapping effect is investigated close to the elastic threshold. The nucleus is described as an open quantum mechanical many-body system embedded in the continuum of decay channels. An ensemble of compound nucleus states with both discrete and resonance states is investigated in an energy-dependent formalism. It is shown that the discrete states can trap the resonance ones and also that the discrete states can directly influence the scattering cross section. (orig.)

  4. Hospital budget increase for information technology during phase 1 meaningful use. (United States)

    Neumeier, Harold; Berner, Eta S; Burke, Darrell E; Azuero, Andres


    Federal policies have a significant effect on how businesses spend money. The 2009 HITECH (Health Information Technology for Economic and Clinical Health Act) authorized incentive payments through Medicare and Medicaid to clinicians and hospitals when they use certified electronic health records privately and securely to achieve specified improvements in care delivery. Federal incentive payments were offered in 2011 for hospitals that had satisfied "meaningful use" criteria. A longitudinal study of nonfederal hospital information technology (IT) budgets (N = 493) during the years 2009 to 2011 found increases in the percentage of hospital annual operating budgets allocated to IT in the years leading up to these federal incentives. This increase was most pronounced among hospitals receiving high proportions of their reimbursements from Medicaid, followed by hospitals receiving high proportions of their reimbursements from Medicare, possibly indicating a budget shift during this period to more IT spending to achieve meaningful-use policy guidelines.

  5. Designing Meaningful Game Experiences for Rehabilitation and Sustainable Mobility Settings

    Directory of Open Access Journals (Sweden)

    Silvia Gabrielli


    Full Text Available This paper presents the approach followed in two ongoing research projects aimed to designing meaningful game-based experiences to support home rehabilitation, eco-sustainable mobility goals and more in general better daily lifestyles. We first introduce the need for designing meaningful game-based experiences that are well-connected to the relevant non-game settings and can be customized by/for users, then, we show examples of how this approach can be realized in the rehabilitation and sustainable mobility contexts.

  6. Meaningful Work and Secondary School Teachers' Intention to Leave (United States)

    Janik, M.; Rothmann, S.


    The study investigates the relations between secondary school teachers' work-role fit, job enrichment, supervisor relationships, co-worker relationships, psychological meaningfulness of work and intention to leave. A cross-sectional survey was used. The participants were 502 secondary school teachers in Namibia. The following measuring instruments…

  7. Meaningful community involvement in protected area issues: a dialogue session (United States)

    Laurie Yung


    The current effort to rethink public involvement in decision-making processes for federal lands is gaining momentum. Advocates of alternative decision-making processes seek to involve communities in more meaningful ways than traditional NEPA-style public participation. These new processes take the form of citizen monitoring, partnerships, and most often, collaboration...

  8. Pedagogical Principles of Learning to Teach Meaningful Physical Education (United States)

    Ní Chróinín, Déirdre; Fletcher, Tim; O'Sullivan, Mary


    Background: Concerns that current forms of physical education teacher education (PETE) are not adequately providing teachers with the tools necessary for working with the realities and challenges of teaching physical education in contemporary schools has led some scholars to advocate for an approach that prioritises meaningfulness in physical…

  9. Callings, work role fit, psychological meaningfulness and work ...

    African Journals Online (AJOL)

    Our aim in this study was to investigate the relationships among a calling orientation, work role fit, psychological meaningfulness and work engagement of teachers in Zambia. A quantitative approach was followed and a cross-sectional survey was used. The sample (n = 150) included 75 basic and 75 secondary school ...

  10. Morality and a Meaningful Life | Thomas | Philosophical Papers

    African Journals Online (AJOL)

    ... healthy dovetail with respect to leading a meaningful life. With this argument regarding psychological health I draw upon, and extend, P. F. Strawson's seminal essay “Freedom and Resentment”. Also in this regard, I extend Wittgenstein's argument against the possibility of a private language to social behavior generally.

  11. Water Habitat Study: Prediction Makes It More Meaningful. (United States)

    Glasgow, Dennis R.


    Suggests a teaching strategy for water habitat studies to help students make a meaningful connection between physiochemical data (dissolved oxygen content, pH, and water temperature) and biological specimens they collect. Involves constructing a poster and using it to make predictions. Provides sample poster. (DC)

  12. Cultural study in design : In search of a meaningful approach

    NARCIS (Netherlands)

    van Boeijen, A.G.C.


    Does the Circuit of Culture help design students to do a cultural study that is meaningful for their design project? Indeed, it provides a good view on the phenomenon culture, its complexity and how contemporary cultures can be studied, providing an overview and structure of the processes that

  13. Meaningful Gamification in an Industrial/Organizational Psychology Course (United States)

    Stansbury, Jessica A.; Earnest, David R.


    Motivation and game research continue to demonstrate that the implementation of game design characteristics in the classroom can be engaging and intrinsically motivating. The present study assessed the extent to which an industrial organizational psychology course designed learning environment created with meaningful gamification elements can…

  14. Using Meaningful Contexts to Promote Understanding of Pronumerals (United States)

    Linsell, Chris; Cavanagh, Michael; Tahir, Salma


    Developing a conceptual understanding of elementary algebra has been the focus of a number of recent articles in this journal. Baroudi (2006) advocated problem solving to assist students' transition from arithmetic to algebra, and Shield (2008) described the use of meaningful contexts for developing the concept of function. Samson (2011, 2012)…

  15. Comprehension for What? Preparing Students for Their Meaningful Future (United States)

    Conley, Mark W.; Wise, Antoinette


    Researchers, policymakers, and educators face a daunting task these days concerning literacy education for the here and now and literacy for the future. Even though one clings to the romantic notion that education provides the building blocks in a straight line to a meaningful future, the reality is that mixed goals and instructional messages…

  16. Concept maps and the meaningful learning of science

    Directory of Open Access Journals (Sweden)

    José Antonio C. S. Valadares


    Full Text Available The foundations of the Meaningful Learning Theory (MLT were laid by David Ausubel. The MLT was highly valued by the contributions of Joseph Novak and D. B. Gowin. Unlike other learning theories, the MLT has an operational component, since there are some instruments based on it and with the meaningful learning facilitation as aim. These tools were designated graphic organizers by John Trowbridge and James Wandersee (2000, pp. 100-129. One of them is the concept map created by Novak to extract meanings from an amalgam of information, having currently many applications. The other one is the Vee diagram or knowledge Vee, also called epistemological Vee or heuristic Vee. It was created by Gowin, and is an excellent organizer, for example to unpack and make transparent the unclear information from an information source. Both instruments help us in processing and becoming conceptually transparent the information, to facilitate the cognitive process of new meanings construction. In this work, after a brief introduction, it will be developed the epistemological and psychological grounds of MLT, followed by a reference to constructivist learning environments facilitators of the meaningful learning, the characterization of concept maps and exemplification of its use in various applications that have proved to be very effective from the standpoint of meaningful learning.

  17. Synonyms, Antonyms, and Retroactive Inhibition with Meaningful Material (United States)

    Weisshed, Ethel


    The determination of the extent to which generalizations derived from studies of rote verbal learning, particularly paired-associate learning applied to highly meaningful materials, was the focus of this study. It was found that discriminating tags to synonyms and antonyms permitting the application of appropriate transfer rules may be attached.…

  18. Types of Meaningfulness of Life and Values of Future Teachers (United States)

    Salikhova, Nailia R.


    The leading role of meaning of life in regulation of human's activity of all types provides the relevance of the research. The goal of the paper is to identify and describe types of meaningfulness of life in future teachers, and to reveal the specificity of values hierarchy indicative of each type. The leading approach applied in the research was…

  19. How Do Novice Art Teachers Define and Implement Meaningful Curriculum? (United States)

    Bain, Christina; Newton, Connie; Kuster, Deborah; Milbrandt, Melody


    Four researchers collaborated on this qualitative case study that examined 11 first-year novice art teachers' understanding and implementation of meaningful curriculum. Participants were selected through a criterion method sampling strategy; the subjects were employed in rural, urban, and suburban public school districts. In order to conduct a…

  20. Authentic Leadership and Altruism: The Mediating Role of Meaningfulness (United States)

    Sagnak, Mesut; Kuruöz, Mehmet


    The purpose of this study was to investigate the mediating effects of meaningfulness on the relationship between authentic leadership and altruistic behavior. The participants consisted of 356 teachers randomly selected from 14 primary and secondary schools in Nigde. Three different instruments were used in this study. The scales were translated…

  1. Modeling Meaningful Learning in Chemistry Using Structural Equation Modeling (United States)

    Brandriet, Alexandra R.; Ward, Rose Marie; Bretz, Stacey Lowery


    Ausubel and Novak's construct of "meaningful learning" stipulates that substantive connections between new knowledge and what is already known requires the integration of thinking, feeling, and performance (Novak J. D., (2010), "Learning, creating, and using knowledge: concept maps as facilitative tools in schools and…

  2. Intermediate structure and threshold phenomena

    International Nuclear Information System (INIS)

    Hategan, Cornel


    The Intermediate Structure, evidenced through microstructures of the neutron strength function, is reflected in open reaction channels as fluctuations in excitation function of nuclear threshold effects. The intermediate state supporting both neutron strength function and nuclear threshold effect is a micro-giant neutron threshold state. (author)

  3. Work engagement and meaningful work across generational cohorts

    Directory of Open Access Journals (Sweden)

    Crystal Hoole


    Full Text Available Orientation: Engaging employees and providing employees with a sense of meaning at work is not a one-size-fits-all approach. Although research has shown that differences between work engagement and meaningful work amongst generational cohorts exist, results are still inconclusive. With age becoming increasingly more important as a diversity factor, a better understanding of the dynamics between work engagement and meaningful work across different generational cohorts is necessary to design the right strategy for each organisation’s unique parameters. Research purpose: The aim of this study was to determine whether there is a relationship between work engagement and meaningful work and whether there are significant variances between the levels of work engagement and meaningful work between different generational cohorts. Motivation for study: Work engagement has consistently been highlighted by researchers and human resources experts as a recommended solution to provide companies with the upper hand when it comes to creating a competitive edge. Yet, levels of work engagement are far from ideal, requiring intensified efforts to identify solutions towards raising overall engagement levels. In recent years, much of the focus in terms of generating engagement has been aimed in the direction of financial rewards and other benefits; some organisational experts are of the opinion that a shift is occurring towards meaningful work instead of monetary rewards as the driver of engagement. The changing nature of the work landscape also suggests that generational cohorts experience work engagement and meaningful work differently. Understanding these complexities is mandatory in creating solutions towards improving levels of engagement and meaningful work. Research approach, design and method: A cross-sectional quantitative research approach has been followed. The Utrecht Work Engagement Scale (UWES and Psychological Meaningful Scale (PMS were administered

  4. Coloring geographical threshold graphs

    Energy Technology Data Exchange (ETDEWEB)

    Bradonjic, Milan [Los Alamos National Laboratory; Percus, Allon [Los Alamos National Laboratory; Muller, Tobias [EINDHOVEN UNIV. OF TECH


    We propose a coloring algorithm for sparse random graphs generated by the geographical threshold graph (GTG) model, a generalization of random geometric graphs (RGG). In a GTG, nodes are distributed in a Euclidean space, and edges are assigned according to a threshold function involving the distance between nodes as well as randomly chosen node weights. The motivation for analyzing this model is that many real networks (e.g., wireless networks, the Internet, etc.) need to be studied by using a 'richer' stochastic model (which in this case includes both a distance between nodes and weights on the nodes). Here, we analyze the GTG coloring algorithm together with the graph's clique number, showing formally that in spite of the differences in structure between GTG and RGG, the asymptotic behavior of the chromatic number is identical: {chi}1n 1n n / 1n n (1 + {omicron}(1)). Finally, we consider the leading corrections to this expression, again using the coloring algorithm and clique number to provide bounds on the chromatic number. We show that the gap between the lower and upper bound is within C 1n n / (1n 1n n){sup 2}, and specify the constant C.

  5. Evaluating meaningful learning using concept mapping in dental hygiene education: a pilot study. (United States)

    Canasi, Dina M; Amyot, Cynthia; Tira, Daniel


    Concept mapping, as a teaching strategy, has been shown to promote critical thinking and problem solving in educational settings. Dental clinicians must distinguish between critical and irrelevant characteristics in the delivery of care, thus necessitating reasoning skills to do so. One of the aims of the American Dental Education Association Commission on Change and Innovation (ADEA-CCI) is to identify deficiencies in curriculum which were meant to improve critical thinking and problem solving skills necessary in clinical practice. The purpose of this study was to compare 2 teaching strategies, traditional lecture and lecture supported by concept mapping exercises within collaborative working groups, to determine if there is a beneficial effect on meaningful learning. For this pilot study, the study population consisted of students from 2 geographically separated associate level dental hygiene programs in the southeastern U.S. A quasi-experimental control group pre- and post-test design was used. The degree of meaningful learning achieved by both programs was assessed by comparing pre- and post-test results. Both programs experienced a significant degree of meaningful learning from pre- to post-test. However, there was no statistically significant difference between the programs on the post-test. These results were in direct contrast to research in other disciplines on concept mapping and its effect on promoting meaningful learning. Further investigation into the study's outcome was obtained through a follow-up focus group. In spite of careful attention to methodology in the development of this research project, the focus group illuminated methodological failings that potentially impacted the outcome of the study. Recommendations are underscored for future conduct of educational research of this kind.

  6. Crossing the Petawatt threshold

    International Nuclear Information System (INIS)

    Perry, M.


    A revolutionary new laser called the Petawatt, developed by Lawrence Livermore researchers after an intensive three-year development effort, has produced more than 1,000 trillion (open-quotes petaclose quotes) watts of power, a world record. By crossing the petawatt threshold, the extraordinarily powerful laser heralds a new age in laser research. Lasers that provide a petawatt of power or more in a picosecond may make it possible to achieve fusion using significantly less energy than currently envisioned, through a novel Livermore concept called open-quotes fast ignition.close quotes The petawatt laser will also enable researchers to study the fundamental properties of matter, thereby aiding the Department of Energy's Stockpile Stewardship efforts and opening entirely new physical regimes to study. The technology developed for the Petawatt has also provided several spinoff technologies, including a new approach to laser material processing

  7. Meaningful Human Control over Autonomous Systems: A Philosophical Account

    Directory of Open Access Journals (Sweden)

    Filippo Santoni de Sio


    Full Text Available Debates on lethal autonomous weapon systems have proliferated in the past 5 years. Ethical concerns have been voiced about a possible raise in the number of wrongs and crimes in military operations and about the creation of a “responsibility gap” for harms caused by these systems. To address these concerns, the principle of “meaningful human control” has been introduced in the legal–political debate; according to this principle, humans not computers and their algorithms should ultimately remain in control of, and thus morally responsible for, relevant decisions about (lethal military operations. However, policy-makers and technical designers lack a detailed theory of what “meaningful human control” exactly means. In this paper, we lay the foundation of a philosophical account of meaningful human control, based on the concept of “guidance control” as elaborated in the philosophical debate on free will and moral responsibility. Following the ideals of “Responsible Innovation” and “Value-sensitive Design,” our account of meaningful human control is cast in the form of design requirements. We identify two general necessary conditions to be satisfied for an autonomous system to remain under meaningful human control: first, a “tracking” condition, according to which the system should be able to respond to both the relevant moral reasons of the humans designing and deploying the system and the relevant facts in the environment in which the system operates; second, a “tracing” condition, according to which the system should be designed in such a way as to grant the possibility to always trace back the outcome of its operations to at least one human along the chain of design and operation. As we think that meaningful human control can be one of the central notions in ethics of robotics and AI, in the last part of the paper, we start exploring the implications of our account for the design and use of non

  8. In search of meaningfulness: nostalgia as an antidote to boredom. (United States)

    van Tilburg, Wijnand A P; Igou, Eric R; Sedikides, Constantine


    We formulated, tested, and supported, in 6 studies, a theoretical model according to which individuals use nostalgia as a way to reinject meaningfulness in their lives when they experience boredom. Studies 1-3 established that induced boredom causes increases in nostalgia when participants have the opportunity to revert to their past. Studies 4 and 5 examined search for meaning as a mediator of the effect of boredom on nostalgia. Specifically, Study 4 showed that search for meaning mediates the effect of state boredom on nostalgic memory content, whereas Study 5 demonstrated that search for meaning mediates the effect of dispositional boredom on dispositional nostalgia. Finally, Study 6 examined the meaning reestablishment potential of nostalgia during boredom: Nostalgia mediates the effect of boredom on sense of meaningfulness and presence of meaning in one's life. Nostalgia counteracts the meaninglessness that individuals experience when they are bored.

  9. Concept Mapping Using Cmap Tools to Enhance Meaningful Learning (United States)

    Cañas, Alberto J.; Novak, Joseph D.

    Concept maps are graphical tools that have been used in all facets of education and training for organizing and representing knowledge. When learners build concept maps, meaningful learning is facilitated. Computer-based concept mapping software such as CmapTools have further extended the use of concept mapping and greatly enhanced the potential of the tool, facilitating the implementation of a concept map-centered learning environment. In this chapter, we briefly present concept mapping and its theoretical foundation, and illustrate how it can lead to an improved learning environment when it is combined with CmapTools and the Internet. We present the nationwide “Proyecto Conéctate al Conocimiento” in Panama as an example of how concept mapping, together with technology, can be adopted by hundreds of schools as a means to enhance meaningful learning.

  10. Meaningful Use of a Confidential Adolescent Patient Portal. (United States)

    Thompson, Lindsay A; Martinko, Thomas; Budd, Pamela; Mercado, Rebeccah; Schentrup, Anzeela M


    To design and evaluate the usage of an adolescent patient portal specifically adapted for adolescent health care needs that also satisfied institutional meaningful use guidelines regarding electronic health records. Key stakeholders at one academic health care center adopted an online portal and opted to designate a patient portal specifically for adolescents to maximize confidentiality in compliance with state privacy laws. This study analyzed aggregate electronic health record data of adolescents' (ages 12-17.9 years) uptake, usage, and functionality of this portal and compared it to parent portal usage for younger children (ages 0-11 years). Differences in means were calculated using paired t tests. The portal was used similarly between parents of young children and adolescents, with almost 1,000 enrollees in each group from September 1, 2012 to March 31, 2015. There were no gender differences in enrollment. Adolescents were less likely than parents of younger children to review appointments (73% vs. 85%), laboratory tests (67% vs. 79%), problem lists (40% vs. 78%), or allergies (45% vs. 77%, all p values adolescents sent 1,397 confidential messages. Institutional decisions for implementing meaningful use requirements can align with goals of adolescent health. Patient portals can enhance adolescent health care quality and adolescents readily use a confidential portal. Implementation of meaningful use requirements should be checked against adolescent health care needs to maximize confidentiality and promote health communication. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  11. Crossing the threshold (United States)

    Bush, John; Tambasco, Lucas


    First, we summarize the circumstances in which chaotic pilot-wave dynamics gives rise to quantum-like statistical behavior. For ``closed'' systems, in which the droplet is confined to a finite domain either by boundaries or applied forces, quantum-like features arise when the persistence time of the waves exceeds the time required for the droplet to cross its domain. Second, motivated by the similarities between this hydrodynamic system and stochastic electrodynamics, we examine the behavior of a bouncing droplet above the Faraday threshold, where a stochastic element is introduced into the drop dynamics by virtue of its interaction with a background Faraday wave field. With a view to extending the dynamical range of pilot-wave systems to capture more quantum-like features, we consider a generalized theoretical framework for stochastic pilot-wave dynamics in which the relative magnitudes of the drop-generated pilot-wave field and a stochastic background field may be varied continuously. We gratefully acknowledge the financial support of the NSF through their CMMI and DMS divisions.

  12. Albania - Thresholds I and II (United States)

    Millennium Challenge Corporation — From 2006 to 2011, the government of Albania (GOA) received two Millennium Challenge Corporation (MCC) Threshold Programs totaling $29.6 million. Albania received...

  13. Smartphone threshold audiometry in underserved primary health-care contexts. (United States)

    Sandström, Josefin; Swanepoel, De Wet; Carel Myburgh, Hermanus; Laurent, Claude


    To validate a calibrated smartphone-based hearing test in a sound booth environment and in primary health-care clinics. A repeated-measure within-subject study design was employed whereby air-conduction hearing thresholds determined by smartphone-based audiometry was compared to conventional audiometry in a sound booth and a primary health-care clinic environment. A total of 94 subjects (mean age 41 years ± 17.6 SD and range 18-88; 64% female) were assessed of whom 64 were tested in the sound booth and 30 within primary health-care clinics without a booth. In the sound booth 63.4% of conventional and smartphone thresholds indicated normal hearing (≤15 dBHL). Conventional thresholds exceeding 15 dB HL corresponded to smartphone thresholds within ≤10 dB in 80.6% of cases with an average threshold difference of -1.6 dB ± 9.9 SD. In primary health-care clinics 13.7% of conventional and smartphone thresholds indicated normal hearing (≤15 dBHL). Conventional thresholds exceeding 15 dBHL corresponded to smartphone thresholds within ≤10 dB in 92.9% of cases with an average threshold difference of -1.0 dB ± 7.1 SD. Accurate air-conduction audiometry can be conducted in a sound booth and without a sound booth in an underserved community health-care clinic using a smartphone.

  14. Meaningful Ways of Understanding and Measuring Change for People with Borderline Personality Disorder: A Thematic Analysis. (United States)

    McCusker, Louise; Turner, Marie-Louise; Pike, Georgina; Startup, Helen


    The effective treatment of Borderline Personality Disorder (BPD) presents healthcare providers with a significant challenge. The evidence base remains limited partially due to a lack of professional consensus and service user involvement regarding ways of measuring change. As a result, the limited evidence that is available draws on such a wide range of outcome measures, that comparison across treatment types is hindered, maintaining a lack of clarity regarding the clinical needs of this group. This investigation aimed to follow the National Institute of Clinical Excellence (NICE, 2009) research recommendations by asking service users about meaningful change within their recovery. This forms a starting point for the future development of a tailored outcome measure. Fifteen service users with a diagnosis of BPD participated in three focus groups across two specialist Personality Disorder services. The focus groups were analysed using Thematic Analysis. Two superordinate themes were synthesized from the data: (1) recovery to what?: 'How do you rewrite who you are?'; and (2) conditions for change. Each superordinate theme further consisted of three subordinate themes which elucidated the over-arching themes. This investigation highlights the complex nature of measuring change in people who have received a BPD diagnosis. Further research is needed to develop meaningful ways of measuring change according to the needs and priorities of people with BPD.

  15. Threshold Concepts and Information Literacy (United States)

    Townsend, Lori; Brunetti, Korey; Hofer, Amy R.


    What do we teach when we teach information literacy in higher education? This paper describes a pedagogical approach to information literacy that helps instructors focus content around transformative learning thresholds. The threshold concept framework holds promise for librarians because it grounds the instructor in the big ideas and underlying…

  16. Measuring meaningful learning in the undergraduate chemistry laboratory (United States)

    Galloway, Kelli R.

    The undergraduate chemistry laboratory has been an essential component in chemistry education for over a century. The literature includes reports on investigations of singular aspects laboratory learning and attempts to measure the efficacy of reformed laboratory curriculum as well as faculty goals for laboratory learning which found common goals among instructors for students to learn laboratory skills, techniques, experimental design, and to develop critical thinking skills. These findings are important for improving teaching and learning in the undergraduate chemistry laboratory, but research is needed to connect the faculty goals to student perceptions. This study was designed to explore students' ideas about learning in the undergraduate chemistry laboratory. Novak's Theory of Meaningful Learning was used as a guide for the data collection and analysis choices for this research. Novak's theory states that in order for meaningful learning to occur the cognitive, affective, and psychomotor domains must be integrated. The psychomotor domain is inherent in the chemistry laboratory, but the extent to which the cognitive and affective domains are integrated is unknown. For meaningful learning to occur in the laboratory, students must actively integrate both the cognitive domain and the affective domains into the "doing" of their laboratory work. The Meaningful Learning in the Laboratory Instrument (MLLI) was designed to measure students' cognitive and affective expectations and experiences within the context of conducting experiments in the undergraduate chemistry laboratory. Evidence for the validity and reliability of the data generated by the MLLI were collected from multiple quantitative studies: a one semester study at one university, a one semester study at 15 colleges and universities across the United States, and a longitudinal study where the MLLI was administered 6 times during two years of general and organic chemistry laboratory courses. Results from

  17. An integrative approach to inferring biologically meaningful gene modules

    Directory of Open Access Journals (Sweden)

    Wang Kai


    Full Text Available Abstract Background The ability to construct biologically meaningful gene networks and modules is critical for contemporary systems biology. Though recent studies have demonstrated the power of using gene modules to shed light on the functioning of complex biological systems, most modules in these networks have shown little association with meaningful biological function. We have devised a method which directly incorporates gene ontology (GO annotation in construction of gene modules in order to gain better functional association. Results We have devised a method, Semantic Similarity-Integrated approach for Modularization (SSIM that integrates various gene-gene pairwise similarity values, including information obtained from gene expression, protein-protein interactions and GO annotations, in the construction of modules using affinity propagation clustering. We demonstrated the performance of the proposed method using data from two complex biological responses: 1. the osmotic shock response in Saccharomyces cerevisiae, and 2. the prion-induced pathogenic mouse model. In comparison with two previously reported algorithms, modules identified by SSIM showed significantly stronger association with biological functions. Conclusions The incorporation of semantic similarity based on GO annotation with gene expression and protein-protein interaction data can greatly enhance the functional relevance of inferred gene modules. In addition, the SSIM approach can also reveal the hierarchical structure of gene modules to gain a broader functional view of the biological system. Hence, the proposed method can facilitate comprehensive and in-depth analysis of high throughput experimental data at the gene network level.

  18. Perioperative transfusion threshold and ambulation after hip revision surgery

    DEFF Research Database (Denmark)

    Nielsen, Kamilla; Johansson, Pär I; Dahl, Benny


    BACKGROUND: Transfusion with red blood cells (RBC) may be needed during hip revision surgery but the appropriate haemoglobin concentration (Hb) threshold for transfusion has not been well established. We hypothesized that a higher transfusion threshold would improve ambulation after hip revision...... surgery. METHODS: The trial was registered at ( NCT00906295). Sixty-six patients aged 18 years or older undergoing hip revision surgery were randomized to receive RBC at a Hb threshold of either 7.3 g/dL (restrictive group) or 8.9 g/dL (liberal group). Postoperative ambulation...... received RBC. CONCLUSIONS: A Hb transfusion threshold of 8.9 g/dL was associated with a statistically significantly faster TUG after hip revision surgery compared to a threshold of 7.3 g/dL but the clinical importance is questionable and the groups did not differ in Hb at the time of testing....

  19. Music effect on pain threshold evaluated with current perception threshold

    Institute of Scientific and Technical Information of China (English)


    AIM: Music relieves anxiety and psychotic tension. This effect of music is applied to surgical operation in the hospital and dental office. It is still unclear whether this music effect is only limited to the psychological aspect but not to the physical aspect or whether its music effect is influenced by the mood or emotion of audience. To elucidate these issues, we evaluated the music effect on pain threshold by current perception threshold (CPT) and profile of mood states (POMC) test. METHODS: Healthy 30 subjects (12 men, 18 women, 25-49 years old, mean age 34.9) were tested. (1)After POMC test, all subjects were evaluated pain threshold with CPT by Neurometer (Radionics, USA) under 6 conditions, silence, listening to the slow tempo classic music, nursery music, hard rock music, classic paino music and relaxation music with 30 seconds interval. (2)After Stroop color word test as the stresser, pain threshold was evaluated with CPT under 2 conditions, silence and listening to the slow tempo classic music. RESULTS: Under litening to the music, CPT sores increased, especially 2 000 Hz level related with compression, warm and pain sensation. Type of music, preference of music and stress also affected CPT score. CONCLUSION: The present study demonstrated that the concentration on the music raise the pain threshold and that stress and mood influence the music effect on pain threshold.

  20. Parton distributions with threshold resummation

    CERN Document Server

    Bonvini, Marco; Rojo, Juan; Rottoli, Luca; Ubiali, Maria; Ball, Richard D.; Bertone, Valerio; Carrazza, Stefano; Hartland, Nathan P.


    We construct a set of parton distribution functions (PDFs) in which fixed-order NLO and NNLO calculations are supplemented with soft-gluon (threshold) resummation up to NLL and NNLL accuracy respectively, suitable for use in conjunction with any QCD calculation in which threshold resummation is included at the level of partonic cross sections. These resummed PDF sets, based on the NNPDF3.0 analysis, are extracted from deep-inelastic scattering, Drell-Yan, and top quark pair production data, for which resummed calculations can be consistently used. We find that, close to threshold, the inclusion of resummed PDFs can partially compensate the enhancement in resummed matrix elements, leading to resummed hadronic cross-sections closer to the fixed-order calculation. On the other hand, far from threshold, resummed PDFs reduce to their fixed-order counterparts. Our results demonstrate the need for a consistent use of resummed PDFs in resummed calculations.

  1. Livestock Helminths in a Changing Climate: Approaches and Restrictions to Meaningful Predictions. (United States)

    Fox, Naomi J; Marion, Glenn; Davidson, Ross S; White, Piran C L; Hutchings, Michael R


    Climate change is a driving force for livestock parasite risk. This is especially true for helminths including the nematodes Haemonchus contortus, Teladorsagia circumcincta, Nematodirus battus, and the trematode Fasciola hepatica, since survival and development of free-living stages is chiefly affected by temperature and moisture. The paucity of long term predictions of helminth risk under climate change has driven us to explore optimal modelling approaches and identify current bottlenecks to generating meaningful predictions. We classify approaches as correlative or mechanistic, exploring their strengths and limitations. Climate is one aspect of a complex system and, at the farm level, husbandry has a dominant influence on helminth transmission. Continuing environmental change will necessitate the adoption of mitigation and adaptation strategies in husbandry. Long term predictive models need to have the architecture to incorporate these changes. Ultimately, an optimal modelling approach is likely to combine mechanistic processes and physiological thresholds with correlative bioclimatic modelling, incorporating changes in livestock husbandry and disease control. Irrespective of approach, the principal limitation to parasite predictions is the availability of active surveillance data and empirical data on physiological responses to climate variables. By combining improved empirical data and refined models with a broad view of the livestock system, robust projections of helminth risk can be developed.

  2. Livestock Helminths in a Changing Climate: Approaches and Restrictions to Meaningful Predictions

    Directory of Open Access Journals (Sweden)

    Ross S. Davidson


    Full Text Available Climate change is a driving force for livestock parasite risk. This is especially true for helminths including the nematodes Haemonchus contortus, Teladorsagia circumcincta, Nematodirus battus, and the trematode Fasciola hepatica, since survival and development of free-living stages is chiefly affected by temperature and moisture. The paucity of long term predictions of helminth risk under climate change has driven us to explore optimal modelling approaches and identify current bottlenecks to generating meaningful predictions. We classify approaches as correlative or mechanistic, exploring their strengths and limitations. Climate is one aspect of a complex system and, at the farm level, husbandry has a dominant influence on helminth transmission. Continuing environmental change will necessitate the adoption of mitigation and adaptation strategies in husbandry. Long term predictive models need to have the architecture to incorporate these changes. Ultimately, an optimal modelling approach is likely to combine mechanistic processes and physiological thresholds with correlative bioclimatic modelling, incorporating changes in livestock husbandry and disease control. Irrespective of approach, the principal limitation to parasite predictions is the availability of active surveillance data and empirical data on physiological responses to climate variables. By combining improved empirical data and refined models with a broad view of the livestock system, robust projections of helminth risk can be developed.

  3. Conceptions of nuclear threshold status

    International Nuclear Information System (INIS)

    Quester, G.H.


    This paper reviews some alternative definitions of nuclear threshold status. Each of them is important, and major analytical confusions would result if one sense of the term is mistaken for another. The motives for nations entering into such threshold status are a blend of civilian and military gains, and of national interests versus parochial or bureaucratic interests. A portion of the rationale for threshold status emerges inevitably from the pursuit of economic goals, and another portion is made more attraction by the derives of the domestic political process. Yet the impact on international security cannot be dismissed, especially where conflicts among the states remain real. Among the military or national security motives are basic deterrence, psychological warfare, war-fighting and, more generally, national prestige. In the end, as the threshold phenomenon is assayed for lessons concerning the role of nuclear weapons more generally in international relations and security, one might conclude that threshold status and outright proliferation coverage to a degree in the motives for all of the states involved and in the advantages attained. As this paper has illustrated, nuclear threshold status is more subtle and more ambiguous than outright proliferation, and it takes considerable time to sort out the complexities. Yet the world has now had a substantial amount of time to deal with this ambiguous status, and this may tempt more states to exploit it

  4. School nurse evaluations: making the process meaningful and motivational. (United States)

    McDaniel, Kathryn H; Overman, Muriel; Guttu, Martha; Engelke, Martha Keehner


    The professional standards of school nursing practice provide a framework to help school nurses focus on their unique mission of promoting health and academic achievement for all students. Without the standards, the nurse's role can become task oriented and limited in scope. By using an evaluation tool that reflects the standards, nurses not only become aware and begin to understand the standards; they also become directly accountable for meeting them. In addition, developing an evaluation process based on the standards of school nurse practice increases the visibility of school nurses and helps school administrators understand the role of the school nurse. This article describes how one school district integrated the scope and standards of school nursing into the job description and performance evaluation of the nurse. The process which is used to complete the evaluation in a manner that is meaningful and motivational to the school nurse is described.

  5. Health Information Technology: Meaningful Use and Next Steps to Improving Electronic Facilitation of Medication Adherence. (United States)

    Bosworth, Hayden B; Zullig, Leah L; Mendys, Phil; Ho, Michael; Trygstad, Troy; Granger, Christopher; Oakes, Megan M; Granger, Bradi B


    The use of health information technology (HIT) may improve medication adherence, but challenges for implementation remain. The aim of this paper is to review the current state of HIT as it relates to medication adherence programs, acknowledge the potential barriers in light of current legislation, and provide recommendations to improve ongoing medication adherence strategies through the use of HIT. We describe four potential HIT barriers that may impact interoperability and subsequent medication adherence. Legislation in the United States has incentivized the use of HIT to facilitate and enhance medication adherence. The Health Information Technology for Economic and Clinical Health (HITECH) was recently adopted and establishes federal standards for the so-called "meaningful use" of certified electronic health record (EHR) technology that can directly impact medication adherence. The four persistent HIT barriers to medication adherence include (1) underdevelopment of data reciprocity across clinical, community, and home settings, limiting the capture of data necessary for clinical care; (2) inconsistent data definitions and lack of harmonization of patient-focused data standards, making existing data difficult to use for patient-centered outcomes research; (3) inability to effectively use the national drug code information from the various electronic health record and claims datasets for adherence purposes; and (4) lack of data capture for medication management interventions, such as medication management therapy (MTM) in the EHR. Potential recommendations to address these issues are discussed. To make meaningful, high quality data accessible, and subsequently improve medication adherence, these challenges will need to be addressed to fully reach the potential of HIT in impacting one of our largest public health issues.

  6. Cut points for identifying clinically significant diabetes distress in adolescents with type 1 diabetes using the PAID-T

    DEFF Research Database (Denmark)

    Hagger, Virginia; Hendrieckx, Christel; Cameron, Fergus


    OBJECTIVE To establish cut point(s) for the Problem Areas in Diabetes-teen version (PAID-T) scale to identify adolescents with clinically meaningful, elevated diabetes distress. RESEARCH DESIGN AND METHODS Data were available from the Diabetes Management and Impact for Long-term Empowerment...... variables were examined to identify a clinically meaningful threshold for elevated diabetes distress. ANOVA was used to test whether these variables differed by levels of distress. RESULTS Two cut points distinguished none-to-mild (90) diabetes distress.......Moderate distresswas experienced by 18%of adolescents and high distress by 36%. Mean depressive symptoms, self-reported HbA1c, and SMBG differed significantly across the three levels of diabetes distress (all P defined two...

  7. Binge eating as a meaningful experience in bulimia nervosa and anorexia nervosa: a qualitative analysis. (United States)

    Eli, Karin


    Clinical studies describe binge eating as a reaction to hunger, negative affect, or the need to dissociate. However, little is known about the meanings that women with bulimia nervosa and anorexia nervosa associate with binge eating. To examine how women with anorexia nervosa and bulimia nervosa interpret their experiences of binge eating. Sixteen women who engaged in binge eating and had been diagnosed with anorexia nervosa, bulimia nervosa, or their subclinical variants were interviewed about their experiences of eating disorder. Interview data were analyzed using phenomenologically-informed thematic analysis. Participants described binge eating as a practice through which the self experiences a sense of release, and existential emptiness is replaced by overwhelming fullness. Meaningful experiences of release and fullness are central to binge eating in bulimia nervosa and anorexia nervosa, and may contribute to the long-term maintenance of this practice.

  8. The electronic patient record as a meaningful audit tool - Accountability and autonomy in general practitioner work

    DEFF Research Database (Denmark)

    Winthereik, Brit Ross; van der Ploeg, I.; Berg, Marc


    Health authorities increasingly request that general practitioners (GPs) use information and communication technologies such as electronic patient records (EPR) for accountability purposes. This article deals with the use of EPRs among general practitioners in Britain. It examines two ways in which...... makes them active in finding ways that turn the EPR into a meaningful tool for them, that is, a tool that helps them provide what they see as good care. The article's main contribution is to show how accountability and autonomy are coproduced; less professional autonomy does not follow from more...... GPs use the EPR for accountability purposes. One way is to generate audit reports on the basis of the information that has been entered into the record. The other is to let the computer intervene in the clinical process through prompts. The article argues that GPs' ambivalence toward using the EPR...

  9. Factors affecting mechanical (nociceptive) thresholds in piglets. (United States)

    Janczak, Andrew M; Ranheim, Birgit; Fosse, Torunn K; Hild, Sophie; Nordgreen, Janicke; Moe, Randi O; Zanella, Adroaldo J


    To evaluate the stability and repeatability of measures of mechanical (nociceptive) thresholds in piglets and to examine potentially confounding factors when using a hand held algometer. Descriptive, prospective cohort. Forty-four piglets from four litters, weighing 4.6 ± 1.0 kg (mean ± SD) at 2 weeks of age. Mechanical thresholds were measured twice on each of 2 days during the first and second week of life. Data were analyzed using a repeated measures design to test the effects of behavior prior to testing, sex, week, day within week, and repetition within day. The effect of body weight and the interaction between piglet weight and behaviour were also tested. Piglet was entered into the model as a random effect as an additional test of repeatability. The effect of repeated testing was used to test the stability of measures. Pearson correlations between repeated measures were used to test the repeatability of measures. Variance component analysis was used to describe the variability in the data. Variance component analysis indicated that piglet explained only 17% of the variance in the data. All variables in the model (behaviour prior to testing, sex, week, day within week, repetition within day, body weight, the interaction between body weight and behaviour, piglet identity) except sex had a significant effect (p testing and measures changed with repeated testing and increased with increasing piglet weight, indicating that time (age) and animal body weight should be taken into account when measuring mechanical (nociceptive) thresholds in piglets. Mechanical (nociceptive) thresholds can be used both for testing the efficacy of anaesthetics and analgesics, and for assessing hyperalgesia in chronic pain states in research and clinical settings. © 2012 The Authors. Veterinary Anaesthesia and Analgesia. © 2012 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesiologists.

  10. Sacrifice: an ethical dimension of caring that makes suffering meaningful. (United States)

    Helin, Kaija; Lindström, Unni A


    This article is intended to raise the question of whether sacrifice can be regarded stituting a deep ethical structure in the relationship between patient and carer. The significance of sacrifice in a patient-carer relationship cannot, however, be fully understood from the standpoint of the consistently utilitarian ethic that characterizes today's ethical discourse. Deontological ethics, with its universal principles, also does not provide a suitable point of departure. Ethical recommendations and codices are important and serve as general sources of knowledge when making decisions, but they should be supplemented by an ethic that takes into consideration contextual and situational factors that make every encounter between patient and carer unique. Caring science research literature presents, on the whole, general agreement on the importance of responsibility and devotian with regard to sense of duty, warmth and genuine engagement in caring. That sacrifice may also constitute an important ethical element in the patient-carer relationship is, however, a contradictory and little considered theme. Caring literature that deals with sacrifice/self-sacrifice indicates contradictory import. It is nevertheless interesting to notice that both the negative and the positive aspects bring out importance of the concept for the professional character of caring. The tradition of ideas in medieval Christian mysticism with reference to Lévinas' ethic of responsibility offers a deeper perspective in which the meaningfulness of sacrifice in the caring relationship can be sought. The theme of sacrifice is not of interest merely as a carer's ethical outlook, but sacrifice can also be understood as a potential process of transformation health. The instinctive or conscious experience of sacrifice on the part of the individual patient can, on a symbolic level, be regarded as analogous to the cultic or religious sacrifice aiming at atonement. Sacrifice appears to the patient as an act of

  11. Language and motor function thresholds during pediatric extra-operative electrical cortical stimulation brain mapping. (United States)

    Zea Vera, Alonso; Aungaroon, Gewalin; Horn, Paul S; Byars, Anna W; Greiner, Hansel M; Tenney, Jeffrey R; Arthur, Todd M; Crone, Nathan E; Holland, Katherine D; Mangano, Francesco T; Arya, Ravindra


    To examine current thresholds and their determinants for language and motor mapping with extra-operative electrical cortical stimulation (ECS). ECS electrocorticograph recordings were reviewed to determine functional thresholds. Predictors of functional thresholds were found with multivariable analyses. In 122 patients (age 11.9±5.4years), average minimum, frontal, and temporal language thresholds were 7.4 (± 3.0), 7.8 (± 3.0), and 7.4 (± 3.1) mA respectively. Average minimum, face, upper and lower extremity motor thresholds were 5.4 (± 2.8), 6.1 (± 2.8), 4.9 (± 2.3), and 5.3 (± 3.3) mA respectively. Functional and after-discharge (AD)/seizure thresholds were significantly related. Minimum, frontal, and temporal language thresholds were higher than AD thresholds at all ages. Minimum motor threshold was higher than minimum AD threshold up to 8.0years of age, face motor threshold was higher than frontal AD threshold up to 11.8years age, and lower subsequently. UE motor thresholds remained below frontal AD thresholds throughout the age range. Functional thresholds are frequently above AD thresholds in younger children. These findings raise concerns about safety and neurophysiologic validity of ECS mapping. Functional and AD/seizure thresholds relationships suggest individual differences in cortical excitability which cannot be explained by clinical variables. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

  12. Doubler system quench detection threshold

    International Nuclear Information System (INIS)

    Kuepke, K.; Kuchnir, M.; Martin, P.


    The experimental study leading to the determination of the sensitivity needed for protecting the Fermilab Doubler from damage during quenches is presented. The quench voltage thresholds involved were obtained from measurements made on Doubler cable of resistance x temperature and voltage x time during quenches under several currents and from data collected during operation of the Doubler Quench Protection System as implemented in the B-12 string of 20 magnets. At 4kA, a quench voltage threshold in excess of 5.OV will limit the peak Doubler cable temperature to 452K for quenches originating in the magnet coils whereas a threshold of 0.5V is required for quenches originating outside of coils

  13. Thermotactile perception thresholds measurement conditions. (United States)

    Maeda, Setsuo; Sakakibara, Hisataka


    The purpose of this paper is to investigate the effects of posture, push force and rate of temperature change on thermotactile thresholds and to clarify suitable measuring conditions for Japanese people. Thermotactile (warm and cold) thresholds on the right middle finger were measured with an HVLab thermal aesthesiometer. Subjects were eight healthy male Japanese students. The effects of posture in measurement were examined in the posture of a straight hand and forearm placed on a support, the same posture without a support, and the fingers and hand flexed at the wrist with the elbow placed on a desk. The finger push force applied to the applicator of the thermal aesthesiometer was controlled at a 0.5, 1.0, 2.0 and 3.0 N. The applicator temperature was changed to 0.5, 1.0, 1.5, 2.0 and 2.5 degrees C/s. After each measurement, subjects were asked about comfort under the measuring conditions. Three series of experiments were conducted on different days to evaluate repeatability. Repeated measures ANOVA showed that warm thresholds were affected by the push force and the rate of temperature change and that cold thresholds were influenced by posture and push force. The comfort assessment indicated that the measurement posture of a straight hand and forearm laid on a support was the most comfortable for the subjects. Relatively high repeatability was obtained under measurement conditions of a 1 degrees C/s temperature change rate and a 0.5 N push force. Measurement posture, push force and rate of temperature change can affect the thermal threshold. Judging from the repeatability, a push force of 0.5 N and a temperature change of 1.0 degrees C/s in the posture with the straight hand and forearm laid on a support are recommended for warm and cold threshold measurements.

  14. DOE approach to threshold quantities

    International Nuclear Information System (INIS)

    Wickham, L.E.; Kluk, A.F.; Department of Energy, Washington, DC)


    The Department of Energy (DOE) is developing the concept of threshold quantities for use in determining which waste materials must be handled as radioactive waste and which may be disposed of as nonradioactive waste at its sites. Waste above this concentration level would be managed as radioactive or mixed waste (if hazardous chemicals are present); waste below this level would be handled as sanitary waste. Ideally, the threshold must be set high enough to significantly reduce the amount of waste requiring special handling. It must also be low enough so that waste at the threshold quantity poses a very small health risk and multiple exposures to such waste would still constitute a small health risk. It should also be practical to segregate waste above or below the threshold quantity using available instrumentation. Guidance is being prepared to aid DOE sites in establishing threshold quantity values based on pathways analysis using site-specific parameters (waste stream characteristics, maximum exposed individual, population considerations, and site specific parameters such as rainfall, etc.). A guidance dose of between 0.001 to 1.0 mSv/y (0.1 to 100 mrem/y) was recommended with 0.3 mSv/y (30 mrem/y) selected as the guidance dose upon which to base calculations. Several tasks were identified, beginning with the selection of a suitable pathway model for relating dose to the concentration of radioactivity in the waste. Threshold concentrations corresponding to the guidance dose were determined for waste disposal sites at a selected humid and arid site. Finally, cost-benefit considerations at the example sites were addressed. The results of the various tasks are summarized and the relationship of this effort with related developments at other agencies discussed

  15. A threshold for dissipative fission

    International Nuclear Information System (INIS)

    Thoennessen, M.; Bertsch, G.F.


    The empirical domain of validity of statistical theory is examined as applied to fission data on pre-fission data on pre-fission neutron, charged particle, and γ-ray multiplicities. Systematics are found of the threshold excitation energy for the appearance of nonstatistical fission. From the data on systems with not too high fissility, the relevant phenomenological parameter is the ratio of the threshold temperature T thresh to the (temperature-dependent) fission barrier height E Bar (T). The statistical model reproduces the data for T thresh /E Bar (T) thresh /E Bar (T) independent of mass and fissility of the systems

  16. Optimization Problems on Threshold Graphs

    Directory of Open Access Journals (Sweden)

    Elena Nechita


    Full Text Available During the last three decades, different types of decompositions have been processed in the field of graph theory. Among these we mention: decompositions based on the additivity of some characteristics of the graph, decompositions where the adjacency law between the subsets of the partition is known, decompositions where the subgraph induced by every subset of the partition must have predeterminate properties, as well as combinations of such decompositions. In this paper we characterize threshold graphs using the weakly decomposition, determine: density and stability number, Wiener index and Wiener polynomial for threshold graphs.

  17. Threshold current for fireball generation (United States)

    Dijkhuis, Geert C.


    Fireball generation from a high-intensity circuit breaker arc is interpreted here as a quantum-mechanical phenomenon caused by severe cooling of electrode material evaporating from contact surfaces. According to the proposed mechanism, quantum effects appear in the arc plasma when the radius of one magnetic flux quantum inside solid electrode material has shrunk to one London penetration length. A formula derived for the threshold discharge current preceding fireball generation is found compatible with data reported by Silberg. This formula predicts linear scaling of the threshold current with the circuit breaker's electrode radius and concentration of conduction electrons.

  18. Nuclear threshold effects and neutron strength function

    International Nuclear Information System (INIS)

    Hategan, Cornel; Comisel, Horia


    One proves that a Nuclear Threshold Effect is dependent, via Neutron Strength Function, on Spectroscopy of Ancestral Neutron Threshold State. The magnitude of the Nuclear Threshold Effect is proportional to the Neutron Strength Function. Evidence for relation of Nuclear Threshold Effects to Neutron Strength Functions is obtained from Isotopic Threshold Effect and Deuteron Stripping Threshold Anomaly. The empirical and computational analysis of the Isotopic Threshold Effect and of the Deuteron Stripping Threshold Anomaly demonstrate their close relationship to Neutron Strength Functions. It was established that the Nuclear Threshold Effects depend, in addition to genuine Nuclear Reaction Mechanisms, on Spectroscopy of (Ancestral) Neutron Threshold State. The magnitude of the effect is proportional to the Neutron Strength Function, in their dependence on mass number. This result constitutes also a proof that the origins of these threshold effects are Neutron Single Particle States at zero energy. (author)

  19. Establishing meaningful cut points for online user ratings. (United States)

    Hirschfeld, Gerrit; Thielsch, Meinald T


    Subjective perceptions of websites can be reliably measured with questionnaires. But it is unclear how such scores should be interpreted in practice, e.g. is an aesthetics score of 4 points on a seven-point-scale satisfactory? The current paper introduces a receiver-operating characteristic (ROC)-based methodology to establish meaningful cut points for the VisAWI (visual aesthetics of websites inventory) and its short form the VisAWI-S. In two studies we use users' global ratings (UGRs) and website rankings as anchors. A total of 972 participants took part in the studies which yielded similar results. First, one-item UGRs correlate highly with the VisAWI. Second, cut points on the VisAWI reliably differentiate between sites that are perceived as attractive versus unattractive. Third, these cut points are variable, but only within a certain range. Together the research presented here establishes a score of 4.5 on the VisAWI which is a reasonable goal for website designers and highlights the utility of the ROC methodology to derive relevant scores for rating scales.

  20. Contributions of meaningful experiences gatherings to artistic education field

    Directory of Open Access Journals (Sweden)

    Bernardo Bustamante Cardona


    Full Text Available This article shows a theoretical approach to and a description of some contributions of a work of transformation of educational and sociocultural reality carried out by a group of people and institutions, among which are San Buenaventura University, Antioquia Museum, Ediarte Inc. and Antioquia University. Such intervention aims at contributing to the improvement of Artistic Education quality in Antioquia and the nation. In order to understand the significance of these Gatherings, a short historical framework is explained in which global and regional processes of academic activities having an impact on the structure of the Artistic Education field are pointed out. Likewise, some perspectives in the definition of artistic education are tackled and then a definition of Pierre Bourdieu´s concept of fieldis presented. Therefore, Meaningful Experiences Gatherings in Artistic Education (MEGAE are presented and the three first gatherings are described. Finally, it is shown the panorama of the contributions of the gatherings both in the theoretical formulation and relational structure of the field.

  1. Do family physicians electronic health records support meaningful use? (United States)

    Peterson, Lars E; Blackburn, Brenna; Ivins, Douglas; Mitchell, Jason; Matson, Christine; Phillips, Robert L


    Spurred by government incentives, the use of electronic health records (EHRs) in the United States has increased; however, whether these EHRs have the functionality necessary to meet meaningful use (MU) criteria remains unknown. Our objective was to characterize family physician access to MU functionality when using a MU-certified EHR. Data were obtained from a convenience survey of family physicians accessing their American Board of Family Medicine online portfolio in 2011. A brief survey queried MU functionality. We used descriptive statistics to characterize the responses and bivariate statistics to test associations between MU and patient communication functions by presence of a MU-certified EHR. Out of 3855 respondents, 60% reported having an EHR that supports MU. Physicians with MU-certified EHRs were more likely than physicians without MU-certified EHRs to report patient registry activities (49.7% vs. 32.3%, p-valuevs. 56.4%, p-valuecommunication abilities were low regardless of EHR capabilities. Family physicians with MU-certified EHRs are more likely to report MU functionality; however, a sizeable minority does not report MU functions. Many family physicians with MU-certified EHRs may not successfully meet the successively stringent MU criteria and may face significant upgrade costs to do so. Cross sectional survey. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Measuring Patient Experiences: Is It Meaningful and Actionable? (United States)

    Wong, Sabrina T; Johnston, Sharon; Burge, Fred; McGrail, Kim; Hogg, William


    Performance measurement must be meaningful to those being asked to contribute data and to the clinicians who are collecting the information. It must be actionable if performance measurement and reporting is to influence health system transformation. To date, measuring patient experiences in all parts of the healthcare system in Canada lags behind other countries. More attention needs to be paid to capturing patients with complex intersecting health and social problems that result from inequitable distribution of wealth and/or underlying structural inequities related to systemic issues such as racism and discrimination, colonialism and patriarchy. Efforts to better capture the experiences of patients who do not regularly access care and who speak English or French as a second language are also needed. Before investing heavily into collecting patient experience data as part of a performance measurement system the following ought to be considered: (1) ensuring value for and buy-in from clinicians who are being asked to collect the data and/or act on the results; (2) investment in the infrastructure to administer iterative, cost-effective patient/family experience data collection, analysis and reporting (e.g., automated software tools) and (3) incorporating practice support (e.g., facilitation) and health system opportunities to integrate the findings from patient experience surveys into policy and practice. Investment into the infrastructure of measuring, reporting and engaging clinicians in improving practice is needed for patient/caregiver experiences to be acted upon. © 2017 Longwoods Publishing.

  3. Possibilities of creating meaningful encounters in anesthesia nursing

    DEFF Research Database (Denmark)

    Aagaard, Karin

    Anesthesia nursing is performed in a highly technological environment with restricted time for interaction with patients. Patients are in a vulnerable position, which can be characterized by anxiety regarding the anesthetic and surgical procedure. The bedrock of effective nursing care is to facil......Anesthesia nursing is performed in a highly technological environment with restricted time for interaction with patients. Patients are in a vulnerable position, which can be characterized by anxiety regarding the anesthetic and surgical procedure. The bedrock of effective nursing care...... of nursing. In this dissertation, focused ethnography is used to explore the interactions between patients and nurse anesthetists before general anesthesia. Moreover, it will explore the professional identity of nurse anesthetists, in relation to the situation of preparing patients for general anesthesia....... A micro-substantive theory is developed regarding the opportunities for creating meaningful encounters between patients and nurse anesthetists. The theory is based on three dominant motivations for interaction in anesthesia nursing. The context of care is not committed and responsive to the core elements...

  4. High-frequency (8 to 16 kHz) reference thresholds and intrasubject threshold variability relative to ototoxicity criteria using a Sennheiser HDA 200 earphone. (United States)

    Frank, T


    The first purpose of this study was to determine high-frequency (8 to 16 kHz) thresholds for standardizing reference equivalent threshold sound pressure levels (RETSPLs) for a Sennheiser HDA 200 earphone. The second and perhaps more important purpose of this study was to determine whether repeated high-frequency thresholds using a Sennheiser HDA 200 earphone had a lower intrasubject threshold variability than the ASHA 1994 significant threshold shift criteria for ototoxicity. High-frequency thresholds (8 to 16 kHz) were obtained for 100 (50 male, 50 female) normally hearing (0.25 to 8 kHz) young adults (mean age of 21.2 yr) in four separate test sessions using a Sennheiser HDA 200 earphone. The mean and median high-frequency thresholds were similar for each test session and increased as frequency increased. At each frequency, the high-frequency thresholds were not significantly (p > 0.05) different for gender, test ear, or test session. The median thresholds at each frequency were similar to the 1998 interim ISO RETSPLs; however, large standard deviations and wide threshold distributions indicated very high intersubject threshold variability, especially at 14 and 16 kHz. Threshold repeatability was determined by finding the threshold differences between each possible test session comparison (N = 6). About 98% of all of the threshold differences were within a clinically acceptable range of +/-10 dB from 8 to 14 kHz. The threshold differences between each subject's second, third, and fourth minus their first test session were also found to determine whether intrasubject threshold variability was less than the ASHA 1994 criteria for determining a significant threshold shift due to ototoxicity. The results indicated a false-positive rate of 0% for a threshold shift > or = 20 dB at any frequency and a false-positive rate of 2% for a threshold shift >10 dB at two consecutive frequencies. This study verified that the output of high-frequency audiometers at 0 dB HL using

  5. Percolation Threshold Parameters of Fluids

    Czech Academy of Sciences Publication Activity Database

    Škvor, J.; Nezbeda, Ivo


    Roč. 79, č. 4 (2009), 041141-041147 ISSN 1539-3755 Institutional research plan: CEZ:AV0Z40720504 Keywords : percolation threshold * universality * infinite cluster Subject RIV: CF - Physical ; Theoretical Chemistry Impact factor: 2.400, year: 2009

  6. Threshold analyses and Lorentz violation

    International Nuclear Information System (INIS)

    Lehnert, Ralf


    In the context of threshold investigations of Lorentz violation, we discuss the fundamental principle of coordinate independence, the role of an effective dynamical framework, and the conditions of positivity and causality. Our analysis excludes a variety of previously considered Lorentz-breaking parameters and opens an avenue for viable dispersion-relation investigations of Lorentz violation

  7. Threshold enhancement of diphoton resonances

    Directory of Open Access Journals (Sweden)

    Aoife Bharucha


    Full Text Available We revisit a mechanism to enhance the decay width of (pseudo-scalar resonances to photon pairs when the process is mediated by loops of charged fermions produced near threshold. Motivated by the recent LHC data, indicating the presence of an excess in the diphoton spectrum at approximately 750 GeV, we illustrate this threshold enhancement mechanism in the case of a 750 GeV pseudoscalar boson A with a two-photon decay mediated by a charged and uncolored fermion having a mass at the 12MA threshold and a small decay width, <1 MeV. The implications of such a threshold enhancement are discussed in two explicit scenarios: i the Minimal Supersymmetric Standard Model in which the A state is produced via the top quark mediated gluon fusion process and decays into photons predominantly through loops of charginos with masses close to 12MA and ii a two Higgs doublet model in which A is again produced by gluon fusion but decays into photons through loops of vector-like charged heavy leptons. In both these scenarios, while the mass of the charged fermion has to be adjusted to be extremely close to half of the A resonance mass, the small total widths are naturally obtained if only suppressed three-body decay channels occur. Finally, the implications of some of these scenarios for dark matter are discussed.

  8. Thresholds of allergenic proteins in foods

    International Nuclear Information System (INIS)

    Hourihane, Jonathan O'B.; Knulst, Andre C.


    Threshold doses or Estimated Eliciting Doses (EEDs) represent an important new field of research in food allergy. Clinicians and regulators have embraced some toxicological concepts such as LOAEL and NOAEL and applied them to an area of significant clinical uncertainty and interest. The impact of intrinsic human factors (e.g., asthma and exercise) and extrinsic event factors (e.g., season, location and especially dose of allergen) on a future allergic reaction in the community needs to be considered carefully when interpreting results of clinical and research low-dose food challenges. The ongoing cooperation of food allergy research groups in medicine, food science and government will surely deliver results of the highest importance to the wider communities of allergology, food science and technology and the increasing number of allergic consumers

  9. Cochlear neuropathy and the coding of supra-threshold sound. (United States)

    Bharadwaj, Hari M; Verhulst, Sarah; Shaheen, Luke; Liberman, M Charles; Shinn-Cunningham, Barbara G


    Many listeners with hearing thresholds within the clinically normal range nonetheless complain of difficulty hearing in everyday settings and understanding speech in noise. Converging evidence from human and animal studies points to one potential source of such difficulties: differences in the fidelity with which supra-threshold sound is encoded in the early portions of the auditory pathway. Measures of auditory subcortical steady-state responses (SSSRs) in humans and animals support the idea that the temporal precision of the early auditory representation can be poor even when hearing thresholds are normal. In humans with normal hearing thresholds (NHTs), paradigms that require listeners to make use of the detailed spectro-temporal structure of supra-threshold sound, such as selective attention and discrimination of frequency modulation (FM), reveal individual differences that correlate with subcortical temporal coding precision. Animal studies show that noise exposure and aging can cause a loss of a large percentage of auditory nerve fibers (ANFs) without any significant change in measured audiograms. Here, we argue that cochlear neuropathy may reduce encoding precision of supra-threshold sound, and that this manifests both behaviorally and in SSSRs in humans. Furthermore, recent studies suggest that noise-induced neuropathy may be selective for higher-threshold, lower-spontaneous-rate nerve fibers. Based on our hypothesis, we suggest some approaches that may yield particularly sensitive, objective measures of supra-threshold coding deficits that arise due to neuropathy. Finally, we comment on the potential clinical significance of these ideas and identify areas for future investigation.

  10. Cochlear Neuropathy and the Coding of Supra-threshold Sound

    Directory of Open Access Journals (Sweden)

    Hari M Bharadwaj


    Full Text Available Many listeners with hearing thresholds within the clinically normal range nonetheless complain of difficulty hearing in everyday settings and understanding speech in noise. Converging evidence from human and animal studies points to one potential source of such difficulties: differences in the fidelity with which supra-threshold sound is encoded in the early portions of the auditory pathway. Measures of auditory subcortical steady-state responses in humans and animals support the idea that the temporal precision of the early auditory representation can be poor even when hearing thresholds are normal. In humans with normal hearing thresholds, behavioral ability in paradigms that require listeners to make use of the detailed spectro-temporal structure of supra-threshold sound, such as selective attention and discrimination of frequency modulation, correlate with subcortical temporal coding precision. Animal studies show that noise exposure and aging can cause a loss of a large percentage of auditory nerve fibers without any significant change in measured audiograms. Here, we argue that cochlear neuropathy may reduce encoding precision of supra-threshold sound, and that this manifests both behaviorally and in subcortical steady-state responses in humans. Furthermore, recent studies suggest that noise-induced neuropathy may be selective for higher-threshold, lower-spontaneous-rate nerve fibers. Based on our hypothesis, we suggest some approaches that may yield particularly sensitive, objective measures of supra-threshold coding deficits that arise due to neuropathy. Finally, we comment on the potential clinical significance of these ideas and identify areas for future investigation.

  11. Lower versus higher hemoglobin threshold for transfusion in septic shock. (United States)

    Holst, Lars B; Haase, Nicolai; Wetterslev, Jørn; Wernerman, Jan; Guttormsen, Anne B; Karlsson, Sari; Johansson, Pär I; Aneman, Anders; Vang, Marianne L; Winding, Robert; Nebrich, Lars; Nibro, Helle L; Rasmussen, Bodil S; Lauridsen, Johnny R M; Nielsen, Jane S; Oldner, Anders; Pettilä, Ville; Cronhjort, Maria B; Andersen, Lasse H; Pedersen, Ulf G; Reiter, Nanna; Wiis, Jørgen; White, Jonathan O; Russell, Lene; Thornberg, Klaus J; Hjortrup, Peter B; Müller, Rasmus G; Møller, Morten H; Steensen, Morten; Tjäder, Inga; Kilsand, Kristina; Odeberg-Wernerman, Suzanne; Sjøbø, Brit; Bundgaard, Helle; Thyø, Maria A; Lodahl, David; Mærkedahl, Rikke; Albeck, Carsten; Illum, Dorte; Kruse, Mary; Winkel, Per; Perner, Anders


    Blood transfusions are frequently given to patients with septic shock. However, the benefits and harms of different hemoglobin thresholds for transfusion have not been established. In this multicenter, parallel-group trial, we randomly assigned patients in the intensive care unit (ICU) who had septic shock and a hemoglobin concentration of 9 g per deciliter or less to receive 1 unit of leukoreduced red cells when the hemoglobin level was 7 g per deciliter or less (lower threshold) or when the level was 9 g per deciliter or less (higher threshold) during the ICU stay. The primary outcome measure was death by 90 days after randomization. We analyzed data from 998 of 1005 patients (99.3%) who underwent randomization. The two intervention groups had similar baseline characteristics. In the ICU, the lower-threshold group received a median of 1 unit of blood (interquartile range, 0 to 3) and the higher-threshold group received a median of 4 units (interquartile range, 2 to 7). At 90 days after randomization, 216 of 502 patients (43.0%) assigned to the lower-threshold group, as compared with 223 of 496 (45.0%) assigned to the higher-threshold group, had died (relative risk, 0.94; 95% confidence interval, 0.78 to 1.09; P=0.44). The results were similar in analyses adjusted for risk factors at baseline and in analyses of the per-protocol populations. The numbers of patients who had ischemic events, who had severe adverse reactions, and who required life support were similar in the two intervention groups. Among patients with septic shock, mortality at 90 days and rates of ischemic events and use of life support were similar among those assigned to blood transfusion at a higher hemoglobin threshold and those assigned to blood transfusion at a lower threshold; the latter group received fewer transfusions. (Funded by the Danish Strategic Research Council and others; TRISS number, NCT01485315.).

  12. Knowledge construction in the classroom: a meaningful pedagogical dialogue

    Directory of Open Access Journals (Sweden)

    Jesuína Lopes de Almeida Pacca


    Full Text Available Teacher’s performance at their real classroom was analyzed in regard to the applied pedagogical interaction. These teachers were participating in a long range continuous formation course that uses the strategy of analyzing pedagogical planning while it was being elaborated , applied and continuously evaluated by the teacher; the course aimed to the construction of professional competence with an adequate sight of the classroom interaction, within constructivist parameters. The teacher pedagogical planning was the study object: it was discussed continuously by the peers group and the coordinator who intended to point out to the explicit pedagogical content and to the content objectives that were declared for every class plan. The learning objectives and the procedures contained within it were confronted with the real evidence of learning. In these discussions learning concepts that were coherent with constructivism were invoked in addition to science contents and their nature. Dialogue was important in these discussions and stressed as a means for teaching and continuous evaluation. In this dynamical process, the teacher planning was being constantly redrafted, changing the adjustment of that classroom students to the planned knowledge acquisition. This course dynamics, led by the coordinator, intended to be reproduced by participants with their students, at least in part. We noticed surprising results in these teachers professional development besides those that were concretely planned: the transference of the course procedures to the classroom seems to happen in regard to the presence of dialogue but the most meaningful part was individual and particular progress that was included in the development of their classes and led to an improvement of abilities. We concluded that unexpected results can be converted into poles of professional performance growth and performance evolution . These results have led us to give special importance to the

  13. Sensitivity of Claims-Based Algorithms to Ascertain Smoking Status More Than Doubled with Meaningful Use. (United States)

    Huo, Jinhai; Yang, Ming; Tina Shih, Ya-Chen


    The "meaningful use of certified electronic health record" policy requires eligible professionals to record smoking status for more than 50% of all individuals aged 13 years or older in 2011 to 2012. To explore whether the coding to document smoking behavior has increased over time and to assess the accuracy of smoking-related diagnosis and procedure codes in identifying previous and current smokers. We conducted an observational study with 5,423,880 enrollees from the year 2009 to 2014 in the Truven Health Analytics database. Temporal trends of smoking coding, sensitivity, specificity, positive predictive value, and negative predictive value were measured. The rate of coding of smoking behavior improved significantly by the end of the study period. The proportion of patients in the claims data recorded as current smokers increased 2.3-fold and the proportion of patients recorded as previous smokers increased 4-fold during the 6-year period. The sensitivity of each International Classification of Diseases, Ninth Revision, Clinical Modification code was generally less than 10%. The diagnosis code of tobacco use disorder (305.1X) was the most sensitive code (9.3%) for identifying smokers. The specificities of these codes and the Current Procedural Terminology codes were all more than 98%. A large improvement in the coding of current and previous smoking behavior has occurred since the inception of the meaningful use policy. Nevertheless, the use of diagnosis and procedure codes to identify smoking behavior in administrative data is still unreliable. This suggests that quality improvements toward medical coding on smoking behavior are needed to enhance the capability of claims data for smoking-related outcomes research. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  14. Improvement in clinical outcomes after dry needling versus myofascial release on pain pressure thresholds, quality of life, fatigue, pain intensity, quality of sleep, anxiety, and depression in patients with fibromyalgia syndrome. (United States)

    Castro Sánchez, Adelaida M; García López, Hector; Fernández Sánchez, Manuel; Pérez Mármol, José Manuel; Aguilar-Ferrándiz, María Encarnación; Luque Suárez, Alejandro; Matarán Peñarrocha, Guillermo Adolfo


    To compare the effectiveness of dry needling versus myofascial release on myofascial trigger points pain in cervical muscles, quality of life, impact of symptoms pain, quality of sleep, anxiety, depression, and fatigue in patients with fibromyalgia syndrome. A single-blind randomized controlled trial was conducted. Sixty-four subjects with fibromyalgia were randomly assigned to a dry needling group or a myofascial release group. Pain pressure thresholds of myofascial trigger points were evaluated in the cervical muscles. In addition, quality of life, impact of fibromyalgia symptoms, quality of sleep, intensity of pain, anxiety and depression symptoms, impact of fatigue at baseline and post treatment after four weeks of intervention were evaluated. Significant improvement was found in most pain pressure thresholds of the myofascial trigger points in cervical muscles in the dry needling group compared to myofascial release (p quality of life of physical function (F = 12.74, p = 0.001), physical role (F = 11.24, p = 0.001), body pain (F =30.26, p quality of sleep (F = 11.96, p = 0.001), state anxiety (F = 7.40, p = 0.009), and trait anxiety (F = -14.63, p quality of life of physical role, body pain, vitality and social function, as well as the total impact of FMS symptoms, quality of sleep, state and trait anxiety, hospital anxiety-depression, general pain intensity and fatigue. Implications for rehabilitation Dry needling therapy reduces myofascial trigger point pain in the short term in patients with fibromyalgia syndrome. This therapeutic approach improves anxiety, depression, fatigue symptoms, quality of life, and sleep after treatment. Dry needling and myofascial release therapies decrease intensity of pain, and the impact of fibromyalgia symptoms in this population. These intervention approaches should be considered in an independent manner as complementary therapies within a multidisciplinary setting.

  15. Evaluating the "Threshold Theory": Can Head Impact Indicators Help? (United States)

    Mihalik, Jason P; Lynall, Robert C; Wasserman, Erin B; Guskiewicz, Kevin M; Marshall, Stephen W


    This study aimed to determine the clinical utility of biomechanical head impact indicators by measuring the sensitivity, specificity, positive predictive value (PV+), and negative predictive value (PV-) of multiple thresholds. Head impact biomechanics (n = 283,348) from 185 football players in one Division I program were collected. A multidisciplinary clinical team independently made concussion diagnoses (n = 24). We dichotomized each impact using diagnosis (yes = 24, no = 283,324) and across a range of plausible impact indicator thresholds (10g increments beginning with a resultant linear head acceleration of 50g and ending with 120g). Some thresholds had adequate sensitivity, specificity, and PV-. All thresholds had low PV+, with the best recorded PV+ less than 0.4% when accounting for all head impacts sustained by our sample. Even when conservatively adjusting the frequency of diagnosed concussions by a factor of 5 to account for unreported/undiagnosed injuries, the PV+ of head impact indicators at any threshold was no greater than 1.94%. Although specificity and PV- appear high, the low PV+ would generate many unnecessary evaluations if these indicators were the sole diagnostic criteria. The clinical diagnostic value of head impact indicators is considerably questioned by these data. Notwithstanding, valid sensor technologies continue to offer objective data that have been used to improve player safety and reduce injury risk.

  16. The issue of threshold states

    International Nuclear Information System (INIS)

    Luck, L.


    The states which have not joined the Non-proliferation Treaty nor have undertaken any other internationally binding commitment not to develop or otherwise acquire nuclear weapons are considered a threshold states. Their nuclear status is rendered opaque as a conscious policy. Nuclear threshold status remains a key disarmament issue. For those few states, as India, Pakistan, Israel, who have put themselves in this position, the security returns have been transitory and largely illusory. The cost to them, and to the international community committed to the norm of non-proliferation, has been huge. The decisions which could lead to recovery from the situation in which they find themselves are essentially at their own hands. Whatever assistance the rest of international community is able to extend, it will need to be accompanied by a vital political signal

  17. Multiscalar production amplitudes beyond threshold

    CERN Document Server

    Argyres, E N; Kleiss, R H


    We present exact tree-order amplitudes for $H^* \\to n~H$, for final states containing one or two particles with non-zero three-momentum, for various interaction potentials. We show that there are potentials leading to tree amplitudes that satisfy unitarity, not only at threshold but also in the above kinematical configurations and probably beyond. As a by-product, we also calculate $2\\to n$ tree amplitudes at threshold and show that for the unbroken $\\phi^4$ theory they vanish for $n>4~$, for the Standard Model Higgs they vanish for $n\\ge 3~$ and for a model potential, respecting tree-order unitarity, for $n$ even and $n>4~$. Finally, we calculate the imaginary part of the one-loop $1\\to n$ amplitude in both symmetric and spontaneously broken $\\phi^4$ theory.

  18. Meaning in meaninglessness: The propensity to perceive meaningful patterns in coincident events and randomly arranged stimuli is linked to enhanced attention in early sensory processing. (United States)

    Rominger, Christian; Schulter, Günter; Fink, Andreas; Weiss, Elisabeth M; Papousek, Ilona


    Perception of objectively independent events or stimuli as being significantly connected and the associated proneness to perceive meaningful patterns constitute part of the positive symptoms of schizophrenia, which are associated with altered attentional processes in lateralized speech perception. Since perceiving meaningful patterns is to some extent already prevalent in the general population, the aim of the study was to investigate whether the propensity to experience meaningful patterns in co-occurring events and random stimuli may be associated with similar altered attentional processes in lateralized speech perception. Self-reported and behavioral indicators of the perception of meaningful patterns were assessed in non-clinical individuals, along with EEG auditory evoked potentials during the performance of an attention related lateralized speech perception task (Dichotic Listening Test). A greater propensity to perceive meaningful patterns was associated with higher N1 amplitudes of the evoked potentials to the onset of the dichotically presented consonant-vowel syllables, indicating enhanced automatic attention in early sensory processing. The study suggests that more basic mechanisms in how people associate events may play a greater role in the cognitive biases that are manifest in personality expressions such as positive schizotypy, rather than that positive schizotypy moderates these cognitive biases directly. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Behavioral meaningful opioidergic stimulation activates kappa receptor gene expression

    International Nuclear Information System (INIS)

    Teodorov, E.; Ferrari, M.F.R.; Fior-Chadi, D.R.; Camarini, R.; Felício, L.F.


    The periaqueductal gray (PAG) has been reported to be a location for opioid regulation of pain and a potential site for behavioral selection in females. Opioid-mediated behavioral and physiological responses differ according to the activity of opioid receptor subtypes. The present study investigated the effects of the peripheral injection of the kappa-opioid receptor agonist U69593 into the dorsal subcutaneous region of animals on maternal behavior and on Oprk1 gene activity in the PAG of female rats. Female Wistar rats weighing 200-250 g at the beginning of the study were randomly divided into 2 groups for maternal behavior and gene expression experiments. On day 5, pups were removed at 7:00 am and placed in another home cage that was distant from their mother. Thirty minutes after removing the pups, the dams were treated with U69593 (0.15 mg/kg, sc) or 0.9% saline (up to 1 mL/kg) and after 30 min were evaluated in the maternal behavior test. Latencies in seconds for pup retrieval, grouping, crouching, and full maternal behavior were scored. The results showed that U69593 administration inhibited maternal behavior (P < 0.05) because a lower percentage of U69593 group dams showed retrieval of first pup, retrieving all pups, grouping, crouching and displaying full maternal behavior compared to the saline group. Opioid gene expression was evaluated using real-time reverse-transcription polymerase chain reaction (RT-PCR). A single injection of U69593 increased Oprk1 PAG expression in both virgin (P < 0.05) and lactating female rats (P < 0.01), with no significant effect on Oprm1 or Oprd1 gene activity. Thus, the expression of kappa-opioid receptors in the PAG may be modulated by single opioid receptor stimulation and behavioral meaningful opioidergic transmission in the adult female might occur simultaneously to specific changes in gene expression of kappa-opioid receptor subtype. This is yet another alert for the complex role of the opioid system in female

  20. Behavioral meaningful opioidergic stimulation activates kappa receptor gene expression

    Energy Technology Data Exchange (ETDEWEB)

    Teodorov, E. [Centro de Matemática, Computação e Cognição, Universidade Federal do ABC, São Paulo, SP (Brazil); Ferrari, M.F.R. [Departamento de Genética e Biologia Evolutiva, Instituto de Biociências, Universidade de São Paulo, São Paulo, SP (Brazil); Fior-Chadi, D.R. [Departamento de Fisiologia, Instituto de Biociências, Universidade de São Paulo, São Paulo, SP (Brazil); Camarini, R. [Departamento de Farmacologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, SP (Brazil); Felício, L.F. [Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP (Brazil)


    The periaqueductal gray (PAG) has been reported to be a location for opioid regulation of pain and a potential site for behavioral selection in females. Opioid-mediated behavioral and physiological responses differ according to the activity of opioid receptor subtypes. The present study investigated the effects of the peripheral injection of the kappa-opioid receptor agonist U69593 into the dorsal subcutaneous region of animals on maternal behavior and on Oprk1 gene activity in the PAG of female rats. Female Wistar rats weighing 200-250 g at the beginning of the study were randomly divided into 2 groups for maternal behavior and gene expression experiments. On day 5, pups were removed at 7:00 am and placed in another home cage that was distant from their mother. Thirty minutes after removing the pups, the dams were treated with U69593 (0.15 mg/kg, sc) or 0.9% saline (up to 1 mL/kg) and after 30 min were evaluated in the maternal behavior test. Latencies in seconds for pup retrieval, grouping, crouching, and full maternal behavior were scored. The results showed that U69593 administration inhibited maternal behavior (P < 0.05) because a lower percentage of U69593 group dams showed retrieval of first pup, retrieving all pups, grouping, crouching and displaying full maternal behavior compared to the saline group. Opioid gene expression was evaluated using real-time reverse-transcription polymerase chain reaction (RT-PCR). A single injection of U69593 increased Oprk1 PAG expression in both virgin (P < 0.05) and lactating female rats (P < 0.01), with no significant effect on Oprm1 or Oprd1 gene activity. Thus, the expression of kappa-opioid receptors in the PAG may be modulated by single opioid receptor stimulation and behavioral meaningful opioidergic transmission in the adult female might occur simultaneously to specific changes in gene expression of kappa-opioid receptor subtype. This is yet another alert for the complex role of the opioid system in female

  1. Behavioral meaningful opioidergic stimulation activates kappa receptor gene expression

    Directory of Open Access Journals (Sweden)

    E. Teodorov


    Full Text Available The periaqueductal gray (PAG has been reported to be a location for opioid regulation of pain and a potential site for behavioral selection in females. Opioid-mediated behavioral and physiological responses differ according to the activity of opioid receptor subtypes. The present study investigated the effects of the peripheral injection of the kappa-opioid receptor agonist U69593 into the dorsal subcutaneous region of animals on maternal behavior and on Oprk1 gene activity in the PAG of female rats. Female Wistar rats weighing 200-250 g at the beginning of the study were randomly divided into 2 groups for maternal behavior and gene expression experiments. On day 5, pups were removed at 7:00 am and placed in another home cage that was distant from their mother. Thirty minutes after removing the pups, the dams were treated with U69593 (0.15 mg/kg, sc or 0.9% saline (up to 1 mL/kg and after 30 min were evaluated in the maternal behavior test. Latencies in seconds for pup retrieval, grouping, crouching, and full maternal behavior were scored. The results showed that U69593 administration inhibited maternal behavior (P < 0.05 because a lower percentage of kappa group dams showed retrieval of first pup, retrieving all pups, grouping, crouching and displaying full maternal behavior compared to the saline group. Opioid gene expression was evaluated using real-time reverse-transcription polymerase chain reaction (RT-PCR. A single injection of U69593 increased Oprk1 PAG expression in both virgin (P < 0.05 and lactating female rats (P < 0.01, with no significant effect on Oprm1 or Oprd1 gene activity. Thus, the expression of kappa-opioid receptors in the PAG may be modulated by single opioid receptor stimulation and behavioral meaningful opioidergic transmission in the adult female might occur simultaneously to specific changes in gene expression of kappa-opioid receptor subtype. This is yet another alert for the complex role of the opioid system in

  2. Realistic Realizations Of Threshold Circuits (United States)

    Razavi, Hassan M.


    Threshold logic, in which each input is weighted, has many theoretical advantages over the standard gate realization, such as reducing the number of gates, interconnections, and power dissipation. However, because of the difficult synthesis procedure and complicated circuit implementation, their use in the design of digital systems is almost nonexistant. In this study, three methods of NMOS realizations are discussed, and their advantages and shortcomings are explored. Also, the possibility of using the methods to realize multi-valued logic is examined.

  3. Root finding with threshold circuits

    Czech Academy of Sciences Publication Activity Database

    Jeřábek, Emil


    Roč. 462, Nov 30 (2012), s. 59-69 ISSN 0304-3975 R&D Projects: GA AV ČR IAA100190902; GA MŠk(CZ) 1M0545 Institutional support: RVO:67985840 Keywords : root finding * threshold circuit * power series Subject RIV: BA - General Mathematics Impact factor: 0.489, year: 2012

  4. Are the MDS-UPDRS-based composite scores clinically applicable? (United States)

    Makkos, Attila; Kovács, Márton; Aschermann, Zsuzsanna; Harmat, Márk; Janszky, József; Karádi, Kázmér; Kovács, Norbert


    The International Parkinson and Movement Disorder Society-sponsored UPDRS (MDS-UPDRS) is a powerful clinical outcome measure. To evaluate the feasibility of various MDS-UPDRS-based composite scores and determine their minimal clinically important difference threshold values. Overall, 1,113 paired investigations of 452 patients were reviewed implementing three different techniques simultaneously. Based on the ordinal regression modeling, the MDS-UPDRS II+III, MDS-UPDRS I+II+III, and the total score of MDS-UPDRS are clinically applicable outcome measures. Any improvement greater than 4.9 points or any worsening more than 4.2 points on MDS-UPDRS II+III represent a minimal, yet clinically meaningful, change. In reference to MDS-UPDRS I+II+III, the smallest changes considered clinically relevant were 6.7 and 5.2 points for improvement and deterioration, respectively. The thresholds for the total score of MDS-UPDRS were 7.1 points for improvement and 6.3 points for worsening. Our findings support the application of various MDS-UPDRS-based composite scores. © 2018 International Parkinson and Movement Disorder Society. © 2018 International Parkinson and Movement Disorder Society.

  5. Design proposal for door thresholds

    Directory of Open Access Journals (Sweden)

    Smolka Radim


    Full Text Available Panels for openings in structures have always been an essential and integral part of buildings. Their importance in terms of a building´s functionality was not recognised. However, the general view on this issue has changed from focusing on big planar segments and critical details to sub-elements of these structures. This does not only focus on the forms of connecting joints but also on the supporting systems that keep the panels in the right position and ensure they function properly. One of the most strained segments is the threshold structure, especially the entrance door threshold structure. It is the part where substantial defects in construction occur in terms of waterproofing, as well as in the static, thermal and technical functions thereof. In conventional buildings, this problem is solved by pulling the floor structure under the entrance door structure and subsequently covering it with waterproofing material. This system cannot work effectively over the long term so local defects occur. A proposal is put forward to solve this problem by installing a sub-threshold door coupler made of composite materials. The coupler is designed so that its variability complies with the required parameters for most door structures on the European market.

  6. Identifying health facilities outside the enterprise: challenges and strategies for supporting health reform and meaningful use. (United States)

    Dixon, Brian E; Colvard, Cyril; Tierney, William M


    Objective: To support collation of data for disability determination, we sought to accurately identify facilities where care was delivered across multiple, independent hospitals and clinics. Methods: Data from various institutions' electronic health records were merged and delivered as continuity of care documents to the United States Social Security Administration (SSA). Results: Electronic records for nearly 8000 disability claimants were exchanged with SSA. Due to the lack of standard nomenclature for identifying the facilities in which patients received the care documented in the electronic records, SSA could not match the information received with information provided by disability claimants. Facility identifiers were generated arbitrarily by health care systems and therefore could not be mapped to the existing international standards. Discussion: We propose strategies for improving facility identification in electronic health records to support improved tracking of a patient's care between providers to better serve clinical care delivery, disability determination, health reform and meaningful use. Conclusion: Accurately identifying the facilities where health care is delivered to patients is important to a number of major health reform and improvement efforts underway in many nations. A standardized nomenclature for identifying health care facilities is needed to improve tracking of care and linking of electronic health records.

  7. Midline Shift Threshold Value for Hemiparesis in Chronic Subdural Hematoma. (United States)

    Juković, Mirela F; Stojanović, Dejan B


    Chronic subdural hematoma (CSDH) has a variety of clinical presentations, with numerous neurological symptoms and signs. Hemiparesis is one of the leading signs that potentially indicates CSDH. Purpose of this study was to determine the threshold (cut-off) value of midsagittal line (MSL) shift after which hemiparesis is likely to appear. The study evaluated 83 patients with 53 unilateral and 30 bilateral CSDHs in period of three years. Evaluated computed tomography (CT) findings in patients with CSDH were diameter of the hematoma and midsagittal line shift, measured on non-contrast CT scan in relation with occurrence of hemiparesis. Threshold values of MSL shift for both types of CSDHs were obtained as maximal (equal) sensitivity and specificity (intersection of the curves). MSL is a good predictor for hemiparesis occurrence (total sample, AUROC 0.75, p=0.0001). Unilateral and bilateral CSDHs had different threshold values of the MSL for hemiparesis development. Results suggested that in unilateral CSDH the threshold values of MSL could be at 10 mm (AUROC=0.65; p=0.07). For bilateral CSDH the threshold level of MSL shift was 4.5 mm (AUROC=0.77; p=0.01). Our study pointed on the phenomenon that midsagittal line shift can predict hemiparesis occurrence. Hemiparesis in patients with bilateral CSDH was more related to midsagittal line shift compared with unilateral CSDH. When value of midsagittal line shift exceed the threshold level, hemiparesis occurs with certain probability.

  8. Bedding material affects mechanical thresholds, heat thresholds and texture preference (United States)

    Moehring, Francie; O’Hara, Crystal L.; Stucky, Cheryl L.


    It has long been known that the bedding type animals are housed on can affect breeding behavior and cage environment. Yet little is known about its effects on evoked behavior responses or non-reflexive behaviors. C57BL/6 mice were housed for two weeks on one of five bedding types: Aspen Sani Chips® (standard bedding for our institute), ALPHA-Dri®, Cellu-Dri™, Pure-o’Cel™ or TEK-Fresh. Mice housed on Aspen exhibited the lowest (most sensitive) mechanical thresholds while those on TEK-Fresh exhibited 3-fold higher thresholds. While bedding type had no effect on responses to punctate or dynamic light touch stimuli, TEK-Fresh housed animals exhibited greater responsiveness in a noxious needle assay, than those housed on the other bedding types. Heat sensitivity was also affected by bedding as animals housed on Aspen exhibited the shortest (most sensitive) latencies to withdrawal whereas those housed on TEK-Fresh had the longest (least sensitive) latencies to response. Slight differences between bedding types were also seen in a moderate cold temperature preference assay. A modified tactile conditioned place preference chamber assay revealed that animals preferred TEK-Fresh to Aspen bedding. Bedding type had no effect in a non-reflexive wheel running assay. In both acute (two day) and chronic (5 week) inflammation induced by injection of Complete Freund’s Adjuvant in the hindpaw, mechanical thresholds were reduced in all groups regardless of bedding type, but TEK-Fresh and Pure-o’Cel™ groups exhibited a greater dynamic range between controls and inflamed cohorts than Aspen housed mice. PMID:26456764

  9. Development of an Assessment Tool to Measure Students' Meaningful Learning in the Undergraduate Chemistry Laboratory (United States)

    Galloway, Kelli R.; Bretz, Stacey Lowery


    Research on learning in the undergraduate chemistry laboratory necessitates an understanding of students' perspectives of learning. Novak's Theory of Meaningful Learning states that the cognitive (thinking), affective (feeling), and psychomotor (doing) domains must be integrated for meaningful learning to occur. The psychomotor domain is the…

  10. Meaningful Experiences in Physical Education and Youth Sport: A Review of the Literature (United States)

    Beni, Stephanie; Fletcher, Tim; Ní Chróinín, Déirdre


    The purpose of this research is to review the literature about young people's meaningful experiences in physical education and youth sport. We reviewed 50 empirical peer-reviewed articles published in English since 1987. Five themes were identified as central influences to young people's meaningful experiences in physical education and sport:…

  11. Relationship between attachment to God and meaningful life parents of mentally retarded children in Zahedan city

    Directory of Open Access Journals (Sweden)

    H Jenaabadi


    Conclusion: Given a significant positive correlation between appeal to God and meaningful life, it is suggested including spirituality therapy sessions and teaching religious coping methods to reduce stress and thus make meaningful life in these parents by welfare, education of exceptional children, and radio and television organizations.

  12. The Meaningful Activity Participation Assessment: A Measure of Engagement in Personally Valued Activities (United States)

    Eakman, Aaron M.; Carlson, Mike E.; Clark, Florence A.


    The Meaningful Activity Participation Assessment (MAPA), a recently developed 28-item tool designed to measure the meaningfulness of activity, was tested in a sample of 154 older adults. The MAPA evidenced a sufficient level of internal consistency and test-retest reliability and correlated as theoretically predicted with the Life Satisfaction…

  13. A Continuum of Learning: From Rote Memorization to Meaningful Learning in Organic Chemistry (United States)

    Grove, Nathaniel P.; Bretz, Stacey Lowery


    The Assimilation Theory of Ausubel and Novak has typically been used in the research literature to describe two extremes to learning chemistry: meaningful learning "versus" rote memorization. It is unlikely, however, that such discrete categories of learning exist. Rote and meaningful learning, rather, are endpoints along a continuum of…

  14. Meaningful Watershed Experiences for Middle and High School Students (United States)

    Landry, Melinda; Smith, Cynthia; Greene, Joy


    Prince William County Public Schools and George Mason University in Virginia, USA, partnered to provide Meaningful Watershed Educational Experiences (MWEEs) for over 25,000 middle and high school students (11-18 year olds) across 34 schools. This school district, situated in a rapidly growing region 55 km southwest of Washington DC, has over 82,000 K-12 students. As native forest cover has been replaced with farming and urbanization, water quality has significantly degraded in the 166,534 km2 Chesapeake Bay watershed. This project was designed to increase student awareness of their impact on the land and waters of the largest estuary in the United States. MWEE is a long-term comprehensive project that incorporates a classroom preparation phase, a hands-on outdoor field investigation, and a reflection and data-sharing component. Training and technical assistance enhances the capacity of teachers of 6th grade, high school Earth Science and Environmental Science to deliver MWEEs which includes schoolyard stewardship, inquiry driven field study, use of hand-held technology and computer based mapping and analysis, project sharing and outreach. George Mason University researchers worked closely with K-12 science educators to create a comprehensive watershed-focused curriculum. Graduate and undergraduate students with strong interests in environmental science and education were trained to deliver the field investigation component of the MWEE. Representative teachers from each school were provided 3 days of professional development and were responsible for the training of their school's science education team. A comprehensive curriculum provided teachers with activities and tools designed to enhance students' mastery of state science objectives. Watershed concepts were used as the unifying theme to support student understanding of curriculum and STEM objectives including: scientific investigation, data collection and communication, chemistry, energy, erosion, human

  15. Understanding quantitative DCE-MRI of the breast : towards meaningful clinical application

    NARCIS (Netherlands)

    Heisen, M.


    In most industrialized countries breast cancer will affect one out of eight women during her lifetime. In the USA, after continuously increasing for more than two decades, incidence rates are slowly decreasing since 2001. Since 1990, death rates from breast cancer have steadily decreased in women,

  16. Analysis of Mitral Valve Replacement Outcomes is Enhanced by Meaningful Clinical Use of Electronic Health Records (United States)

    Chen, John C; Pfeffer, Thomas; Johnstone, Shelley; Chen, Yuexin; Kiley, Mary-Lou; Richter, Richard; Lee, Hon


    Objective: Cardiac surgical mortality has improved during the last decade despite the aging of the population. An integrated US health plan developed a heart valve registry to track outcomes and complications of heart valve operations. This database was used for longitudinal evaluation of mitral valve (MV) outcomes from 1999 to 2008 at four affiliated hospitals. Methods: We identified 3130 patients in the Apollo database who underwent 3180 initial MV procedures. Internal administrative and Social Security Administration databases were merged to determine survival rates. Electronic health records were searched to ascertain demographics, comorbidities, and postoperative complications. Cox regression was used to evaluate mean survival and identify risk factors. Results: The procedures included 1160 mechanical valve replacements, 1159 tissue valve replacements, and 861 annuloplasties. The mean age of patients undergoing these procedures was 58 ± 11 years, 69 ± 12 years, and 62 ± 12 years, respectively. Mean survival was 8.9 ± 0.1 years for mechanical valve replacement, 7.0 ± 0.1 years for tissue valve replacement, and 7.7 ± 0.1 years for annuloplasty. Early in the study, there was a preference for implanting mechanical MVs. Beginning in 2003, more patients received tissue valve replacements rather than mechanical valves. Over time, there was an increasing trend of annuloplasty. Cox regression analysis identified the following risk factors for increased ten-year mortality: tissue valve implantation; advanced age; female sex; nonelective, nonisolated procedure; diabetes; postoperative use of banked blood products; previous cardiovascular intervention; dialysis; and longer perfusion time. Hospital location, reoperation, preoperative anticoagulation, and cardiogenic shock were not statistically significant risk factors. Conclusions: When controlling for other risk factors, we observed a lower long-term survival rate for tissue valve replacement compared with mechanical valve replacement. Integrating electronic health records with existing electronic databases provided near-real-time analysis of longitudinal cardiac surgical outcomes. PMID:23704837

  17. Towards sophisticated learning from EHRs: increasing prediction specificity and accuracy using clinically meaningful risk criteria. (United States)

    Vasiljeva, Ieva; Arandjelovic, Ognjen


    Computer based analysis of Electronic Health Records (EHRs) has the potential to provide major novel insights of benefit both to specific individuals in the context of personalized medicine, as well as on the level of population-wide health care and policy. The present paper introduces a novel algorithm that uses machine learning for the discovery of longitudinal patterns in the diagnoses of diseases. Two key technical novelties are introduced: one in the form of a novel learning paradigm which enables greater learning specificity, and another in the form of a risk driven identification of confounding diagnoses. We present a series of experiments which demonstrate the effectiveness of the proposed techniques, and which reveal novel insights regarding the most promising future research directions.

  18. Optimizing Systems of Threshold Detection Sensors

    National Research Council Canada - National Science Library

    Banschbach, David C


    .... Below the threshold all signals are ignored. We develop a mathematical model for setting individual sensor thresholds to obtain optimal probability of detecting a significant event, given a limit on the total number of false positives allowed...

  19. 11 CFR 9036.1 - Threshold submission. (United States)


    ... credit or debit card, including one made over the Internet, the candidate shall provide sufficient... section shall not count toward the threshold amount. (c) Threshold certification by Commission. (1) After...

  20. Nuclear thermodynamics below particle threshold

    International Nuclear Information System (INIS)

    Schiller, A.; Agvaanluvsan, U.; Algin, E.; Bagheri, A.; Chankova, R.; Guttormsen, M.; Hjorth-Jensen, M.; Rekstad, J.; Siem, S.; Sunde, A. C.; Voinov, A.


    From a starting point of experimentally measured nuclear level densities, we discuss thermodynamical properties of nuclei below the particle emission threshold. Since nuclei are essentially mesoscopic systems, a straightforward generalization of macroscopic ensemble theory often yields unphysical results. A careful critique of traditional thermodynamical concepts reveals problems commonly encountered in mesoscopic systems. One of which is the fact that microcanonical and canonical ensemble theory yield different results, another concerns the introduction of temperature for small, closed systems. Finally, the concept of phase transitions is investigated for mesoscopic systems

  1. Increased trunk extension endurance is associated with meaningful improvement in balance among older adults with mobility problems. (United States)

    Suri, Pradeep; Kiely, Dan K; Leveille, Suzanne G; Frontera, Walter R; Bean, Jonathan F


    To determine whether trunk extension endurance changes with training are associated with clinically meaningful improvements in balance among mobility-limited older adults. Longitudinal data from a randomized controlled trial. Outpatient rehabilitation research center. Community-dwelling older adults (N=64; mean age, 75.9y) with mobility limitations as defined by a score of 4 to 10 on the Short Physical Performance Battery. Sixteen weeks of progressive resistance training. Outcomes were the Berg Balance Scale (BBS) and the Unipedal Stance Time (UST). Predictors included leg strength, leg power, trunk extension endurance, and the product of heart rate and blood pressure (RPP) at the final stage of an exercise tolerance test. We performed an analysis of data from participants who completed 16 weeks of training by using binary outcomes defined by a clinically meaningful change (CMC) from baseline to completion of the intervention (BBS=4 units; UST=5s). The association of predictor variables with balance outcomes was examined separately and together in multivariate adjusted logistic regression models. Trunk extension endurance in seconds (1.04 [1.00-1.09]) was independently associated with CMC on the BBS. Trunk extension endurance (1.02 [1.00-1.03]) was independently associated with CMC on the UST. Other physical attributes were not associated with meaningful change in balance. Improvements in trunk extension endurance were independently associated with CMCs in balance in older adults. Leg strength, leg power, and RPP were not associated with CMC in balance. Poor trunk extension endurance may be a rehabilitative impairment worthy of further study as a modifiable factor linked to balance among older adults. Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  2. What Is the Optimal Threshold at Which to Recommend Breast Biopsy?


    Burnside, Elizabeth S.; Chhatwal, Jagpreet; Alagoz, Oguzhan


    Background A 2% threshold, traditionally used as a level above which breast biopsy recommended, has been generalized to all patients from several specific situations analyzed in the literature. We use a sequential decision analytic model considering clinical and mammography features to determine the optimal general threshold for image guided breast biopsy and the sensitivity of this threshold to variation of these features. Methodology/Principal Findings We built a decision analytical model c...

  3. Raison d’être of insulin resistance: the adjustable threshold hypothesis


    Wang, Guanyu


    The epidemics of obesity and diabetes demand a deeper understanding of insulin resistance, for which the adjustable threshold hypothesis is formed in this paper. To test the hypothesis, mathematical modelling was used to analyse clinical data and to simulate biological processes at both molecular and organismal levels. I found that insulin resistance roots in the thresholds of the cell's bistable response. By assuming heterogeneity of the thresholds, single cells' all-or-none response can col...

  4. Compositional threshold for Nuclear Waste Glass Durability

    International Nuclear Information System (INIS)

    Kruger, Albert A.; Farooqi, Rahmatullah; Hrma, Pavel R.


    Within the composition space of glasses, a distinct threshold appears to exist that separates 'good' glasses, i.e., those which are sufficiently durable, from 'bad' glasses of a low durability. The objective of our research is to clarify the origin of this threshold by exploring the relationship between glass composition, glass structure and chemical durability around the threshold region

  5. Threshold Concepts in Finance: Student Perspectives (United States)

    Hoadley, Susan; Kyng, Tim; Tickle, Leonie; Wood, Leigh N.


    Finance threshold concepts are the essential conceptual knowledge that underpin well-developed financial capabilities and are central to the mastery of finance. In this paper we investigate threshold concepts in finance from the point of view of students, by establishing the extent to which students are aware of threshold concepts identified by…

  6. Epidemic threshold in directed networks (United States)

    Li, Cong; Wang, Huijuan; Van Mieghem, Piet


    Epidemics have so far been mostly studied in undirected networks. However, many real-world networks, such as the online social network Twitter and the world wide web, on which information, emotion, or malware spreads, are directed networks, composed of both unidirectional links and bidirectional links. We define the directionality ξ as the percentage of unidirectional links. The epidemic threshold τc for the susceptible-infected-susceptible (SIS) epidemic is lower bounded by 1/λ1 in directed networks, where λ1, also called the spectral radius, is the largest eigenvalue of the adjacency matrix. In this work, we propose two algorithms to generate directed networks with a given directionality ξ. The effect of ξ on the spectral radius λ1, principal eigenvector x1, spectral gap (λ1-λ2), and algebraic connectivity μN-1 is studied. Important findings are that the spectral radius λ1 decreases with the directionality ξ, whereas the spectral gap and the algebraic connectivity increase with the directionality ξ. The extent of the decrease of the spectral radius depends on both the degree distribution and the degree-degree correlation ρD. Hence, in directed networks, the epidemic threshold is larger and a random walk converges to its steady state faster than that in undirected networks with the same degree distribution.

  7. Computational gestalts and perception thresholds. (United States)

    Desolneux, Agnès; Moisan, Lionel; Morel, Jean-Michel


    In 1923, Max Wertheimer proposed a research programme and method in visual perception. He conjectured the existence of a small set of geometric grouping laws governing the perceptual synthesis of phenomenal objects, or "gestalt" from the atomic retina input. In this paper, we review this set of geometric grouping laws, using the works of Metzger, Kanizsa and their schools. In continuation, we explain why the Gestalt theory research programme can be translated into a Computer Vision programme. This translation is not straightforward, since Gestalt theory never addressed two fundamental matters: image sampling and image information measurements. Using these advances, we shall show that gestalt grouping laws can be translated into quantitative laws allowing the automatic computation of gestalts in digital images. From the psychophysical viewpoint, a main issue is raised: the computer vision gestalt detection methods deliver predictable perception thresholds. Thus, we are set in a position where we can build artificial images and check whether some kind of agreement can be found between the computationally predicted thresholds and the psychophysical ones. We describe and discuss two preliminary sets of experiments, where we compared the gestalt detection performance of several subjects with the predictable detection curve. In our opinion, the results of this experimental comparison support the idea of a much more systematic interaction between computational predictions in Computer Vision and psychophysical experiments.

  8. Threshold enhancement of diphoton resonances

    CERN Document Server

    Bharucha, Aoife; Goudelis, Andreas


    The data collected by the LHC collaborations at an energy of 13 TeV indicates the presence of an excess in the diphoton spectrum that would correspond to a resonance of a 750 GeV mass. The apparently large production cross section is nevertheless very difficult to explain in minimal models. We consider the possibility that the resonance is a pseudoscalar boson $A$ with a two--photon decay mediated by a charged and uncolored fermion having a mass at the $\\frac12 M_A$ threshold and a very small decay width, $\\ll 1$ MeV; one can then generate a large enhancement of the $A\\gamma\\gamma$ amplitude which explains the excess without invoking a large multiplicity of particles propagating in the loop, large electric charges and/or very strong Yukawa couplings. The implications of such a threshold enhancement are discussed in two explicit scenarios: i) the Minimal Supersymmetric Standard Model in which the $A$ state is produced via the top quark mediated gluon fusion process and decays into photons predominantly through...

  9. Meaningful Learning Moments on a Family Medicine Clerkship: When Students Are Patient Centered. (United States)

    Huang, William Y; Rogers, John C; Nelson, Elizabeth A; Wright, Crystal C; Teal, Cayla R


    Reflection after patient encounters is an important aspect of clinical learning. After our medical school instituted a reflection paper assignment for all clerkships, we wanted to learn about the types of encounters that students found meaningful on a family medicine clerkship and how they impacted students' learning. Family and Community Medicine Clerkship students completed a reflection paper after the clerkship, based on guidelines that were used for all clerkship reflection papers at our medical school. Two reviewers independently organized student responses into themes and then jointly prioritized common themes and negotiated any initial differences into other themes. A total of 272 reflection papers describing an actual learning moment in patient care were submitted during the study period of January 2011--December 2012. In describing actions performed, students most frequently wrote about aspects of patient-centered care such as listening to the patient, carefully assessing the patient's condition, or giving a detailed explanation to the patient. In describing effects of those actions, students wrote about what they learned about the patient-physician interaction, the trust that patients demonstrated in them, the approval they gained from their preceptors, and the benefits they saw from their actions. An important contribution of a family medicine clerkship is the opportunity for students to further their skills in patient-centered care and realize the outcomes of providing that type of care.

  10. Meaningful lives: Supporting young people with psychosis in education, training and employment: an international consensus statement. (United States)


    Unemployment is the major disability faced by people with psychotic illness. Unemployment rates of 75–95% are found among those with schizophrenia. Unemployment is associated with poorer social and economic inclusion, greater symptomatology, decreased autonomy and generally poorer life functioning. Unemployment also makes up over half of the total costs associated with psychotic illness. A meeting was convened in London in June 2008. Invitees to this meeting included people from the USA, Canada and the UK interested in vocational intervention in early psychosis from either a research, clinical, economic or policy point of view. From this meeting a larger group–the International First Episode Vocational Recovery (iFEVR) group–has developed an international consensus statement about vocational recovery in first episode psychosis. The document is a basic statement of the rights of young people with psychosis to pursue employment, education and training; the evidence which exists to help them do this; and ways in which individuals, organizations and governments can assist the attainment of these ends. It is hoped that the Meaningful Lives consensus statement will increase the focus on the area of functional recovery and lift it to be seen in parallel with symptomatic recovery in the approach to treating early psychosis.

  11. Values-led Participatory Design as a pursuit of meaningful alternatives

    DEFF Research Database (Denmark)

    Leong, Tuck Wah; Iversen, Ole Sejer


    Participatory Design (PD) is inherently concerned with inquiring into and supporting human values when designing IT. We argue that a PD approach that is led by a focus upon participants' values can allow participants to discover meaningful alternatives -- alternative uses and alternative...... conceptualizations for IT that are particularly meaningful to them. However, how PD works with values in the design process has not been made explicit. In this paper, we aim to (i) explicate this values-led PD approach, (ii) illustrate how this approach can lead to outcomes that are meaningful alternatives, and (iii...

  12. Ear surgery techniques results on hearing threshold improvement

    Directory of Open Access Journals (Sweden)

    Farhad Mokhtarinejad


    Full Text Available Background: Bone conduction (BC threshold depression is not always by means of sensory neural hearing loss and sometimes it is an artifact caused by middle ear pathologies and ossicular chain problems. In this research, the influences of ear surgeries on bone conduction were evaluated. Materials and Methods: This study was conducted as a clinical trial study. The ear surgery performed on 83 patients classified in four categories: Stapedectomy, tympanomastoid surgery and ossicular reconstruction partially or totally; Partial Ossicular Replacement Prosthesis (PORP and Total Ossicular Replacement Prosthesis (TORP. Bone conduction thresholds assessed in frequencies of 250, 500, 1000, 2000 and 4000 Hz pre and post the surgery. Results: In stapedectomy group, the average of BC threshold in all frequencies improved approximately 6 dB in frequency of 2000 Hz. In tympanomastoid group, BC threshold in the frequency of 500, 1000 and 2000 Hz changed 4 dB (P-value < 0.05. Moreover, In the PORP group, 5 dB enhancement was seen in 1000 and 2000 Hz. In TORP group, the results confirmed that BC threshold improved in all frequencies especially at 4000 Hz about 6.5 dB. Conclusion: In according to results of this study, BC threshold shift was seen after several ear surgeries such as stapedectomy, tympanoplasty, PORP and TORP. The average of BC improvement was approximately 5 dB. It must be considered that BC depression might happen because of ossicular chain problems. Therefore; by resolving middle ear pathologies, the better BC threshold was obtained, the less hearing problems would be faced.

  13. Quantifying the Arousal Threshold Using Polysomnography in Obstructive Sleep Apnea. (United States)

    Sands, Scott A; Terrill, Philip I; Edwards, Bradley A; Taranto Montemurro, Luigi; Azarbarzin, Ali; Marques, Melania; de Melo, Camila M; Loring, Stephen H; Butler, James P; White, David P; Wellman, Andrew


    Precision medicine for obstructive sleep apnea (OSA) requires noninvasive estimates of each patient's pathophysiological "traits." Here, we provide the first automated technique to quantify the respiratory arousal threshold-defined as the level of ventilatory drive triggering arousal from sleep-using diagnostic polysomnographic signals in patients with OSA. Ventilatory drive preceding clinically scored arousals was estimated from polysomnographic studies by fitting a respiratory control model (Terrill et al.) to the pattern of ventilation during spontaneous respiratory events. Conceptually, the magnitude of the airflow signal immediately after arousal onset reveals information on the underlying ventilatory drive that triggered the arousal. Polysomnographic arousal threshold measures were compared with gold standard values taken from esophageal pressure and intraoesophageal diaphragm electromyography recorded simultaneously (N = 29). Comparisons were also made to arousal threshold measures using continuous positive airway pressure (CPAP) dial-downs (N = 28). The validity of using (linearized) nasal pressure rather than pneumotachograph ventilation was also assessed (N = 11). Polysomnographic arousal threshold values were correlated with those measured using esophageal pressure and diaphragm EMG (R = 0.79, p < .0001; R = 0.73, p = .0001), as well as CPAP manipulation (R = 0.73, p < .0001). Arousal threshold estimates were similar using nasal pressure and pneumotachograph ventilation (R = 0.96, p < .0001). The arousal threshold in patients with OSA can be estimated using polysomnographic signals and may enable more personalized therapeutic interventions for patients with a low arousal threshold. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail

  14. Genetically meaningful phenotypic subgroups in autism spectrum disorders. (United States)

    Veatch, O J; Veenstra-Vanderweele, J; Potter, M; Pericak-Vance, M A; Haines, J L


    Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder with strong evidence for genetic susceptibility. However, the effect sizes for implicated chromosomal loci are small, hard to replicate and current evidence does not explain the majority of the estimated heritability. Phenotypic heterogeneity could be one phenomenon complicating identification of genetic factors. We used data from the Autism Diagnostic Interview-Revised, Autism Diagnostic Observation Schedule, Vineland Adaptive Behavior Scales, head circumferences, and ages at exams as classifying variables to identify more clinically similar subgroups of individuals with ASD. We identified two distinct subgroups of cases within the Autism Genetic Resource Exchange dataset, primarily defined by the overall severity of evaluated traits. In addition, there was significant familial clustering within subgroups (odds ratio, OR ≈ 1.38-1.42, P definition that should increase power to detect genetic factors influencing risk for ASD. © 2013 John Wiley & Sons Ltd and International Behavioural and Neural Genetics Society.

  15. Risk thresholds for alcohol consumption

    DEFF Research Database (Denmark)

    Wood, Angela M; Kaptoge, Stephen; Butterworth, Adam S


    previous cardiovascular disease. METHODS: We did a combined analysis of individual-participant data from three large-scale data sources in 19 high-income countries (the Emerging Risk Factors Collaboration, EPIC-CVD, and the UK Biobank). We characterised dose-response associations and calculated hazard......BACKGROUND: Low-risk limits recommended for alcohol consumption vary substantially across different national guidelines. To define thresholds associated with lowest risk for all-cause mortality and cardiovascular disease, we studied individual-participant data from 599 912 current drinkers without......·4 million person-years of follow-up. For all-cause mortality, we recorded a positive and curvilinear association with the level of alcohol consumption, with the minimum mortality risk around or below 100 g per week. Alcohol consumption was roughly linearly associated with a higher risk of stroke (HR per 100...

  16. Detection thresholds of macaque otolith afferents. (United States)

    Yu, Xiong-Jie; Dickman, J David; Angelaki, Dora E


    The vestibular system is our sixth sense and is important for spatial perception functions, yet the sensory detection and discrimination properties of vestibular neurons remain relatively unexplored. Here we have used signal detection theory to measure detection thresholds of otolith afferents using 1 Hz linear accelerations delivered along three cardinal axes. Direction detection thresholds were measured by comparing mean firing rates centered on response peak and trough (full-cycle thresholds) or by comparing peak/trough firing rates with spontaneous activity (half-cycle thresholds). Thresholds were similar for utricular and saccular afferents, as well as for lateral, fore/aft, and vertical motion directions. When computed along the preferred direction, full-cycle direction detection thresholds were 7.54 and 3.01 cm/s(2) for regular and irregular firing otolith afferents, respectively. Half-cycle thresholds were approximately double, with excitatory thresholds being half as large as inhibitory thresholds. The variability in threshold among afferents was directly related to neuronal gain and did not depend on spike count variance. The exact threshold values depended on both the time window used for spike count analysis and the filtering method used to calculate mean firing rate, although differences between regular and irregular afferent thresholds were independent of analysis parameters. The fact that minimum thresholds measured in macaque otolith afferents are of the same order of magnitude as human behavioral thresholds suggests that the vestibular periphery might determine the limit on our ability to detect or discriminate small differences in head movement, with little noise added during downstream processing.

  17. The categorisation of dysthymic disorder: can its constituents be meaningfully apportioned? (United States)

    Rhebergen, Didi; Graham, Rebecca; Hadzi-Pavlovic, Dusan; Stek, Max; Friend, Paul; Barrett, Melissa; Parker, Gordon


    Since its introduction in DSM-III, the validity of dysthymia has been debated. Our objective is to further examine the concept of dysthymia in an outpatient sample, and explore whether its constituents can be meaningfully apportioned. 318 patients attending the Black Dog Institute Depression Clinic were assessed by the Mini-International Neuropsychiatric Interview, and completed several self-report measures, in addition to a clinical assessment by an Institute psychiatrist. The characteristics of patients with major depressive disorder (MDD), dysthymic disorder and double depression were examined. Latent Class Analysis (LCA) and Latent Profile Analysis (LPA) were then conducted with the aim of detecting distinct classes based on depressive symptomatology and personality domains, respectively. Finally, clinicians' formulations of the study patients were examined. Depression groups mainly differed on parameters of severity. Although LCA and LPA analyses indicated the presence of distinct classes, these only moderately correlated with the MINI-diagnosed groups. Finally, there was evidence for considerable heterogeneity within clinicians' formulations of dysthymia. Inadequate sample numbers for various measures limited the power of the LPA and our sample was weighted to patients with a more severe depressive condition which may affect the detection of a distinct 'dysthymic' personality profile. Despite employing a variety of techniques, we were unable to obtain a clear homogeneous picture of dysthymia. Rather, there was evidence for a distinct heterogeneity in clinician-derived diagnoses. These findings allude to the questionable discriminant validity of dysthymia and may encourage future research and discussion on this important topic. Copyright © 2012 Elsevier B.V. All rights reserved.

  18. Using Community-Based Participatory Research to Investigate Meaningful Prenatal Care Among African American Women. (United States)

    Nypaver, Cynthia F; Shambley-Ebron, Donna


    In the United States, African American babies die more than twice as often as White babies. The cause for this difference remains elusive, yet is likely complex with one factor being inadequate cultural care of pregnant African American women. The purpose of this study was to explore African American women's perspectives of meaningful prenatal care. Community-based participatory research was employed for this study using photovoice. The sample included 11 African American mothers in an urban community in Midwestern United States. Five themes were abstracted from the data: (1) Access to Care; (2) Soul Nourishment; (3) Companionship; (4) Help Me, Teach Me; and (5) The Future. Meaningful prenatal care is influenced by culture. African American women need physical, social, and soulful support to enhance meaningfulness of care during pregnancy. The findings support that meaningfulness of prenatal care for African American women may be enhanced by accessible and uniquely designed, culturally congruent models of prenatal care. © The Author(s) 2015.

  19. Can Ausubel's Theory of Meaningful Learning Become an Alternative to Piagetian Psychology? (United States)

    Albert, Edna


    Discusses Novak's views that Ausubel's meaningful learning can become an alternative to Piagetian psychology and argues that Ausubel does not provide a theory that can be an alternative to Piaget's developmental psychology. (HM)

  20. Heard and valued: the development of a model to meaningfully engage marginalized populations in health services planning. (United States)

    Snow, M Elizabeth; Tweedie, Katherine; Pederson, Ann


    Recently, patient engagement has been identified as a promising strategy for supporting healthcare planning. However, the context and structure of universalistic, "one-size-fits-all" approaches often used for patient engagement may not enable diverse patients to participate in decision-making about programs intended to meet their needs. Specifically, standard patient engagement approaches are gender-blind and might not facilitate the engagement of those marginalized by, for example, substance use, low income, experiences of violence, homelessness, and/or mental health challenges-highly gendered health and social experiences. The project's purpose was to develop a heuristic model to assist planners to engage patients who are not traditionally included in healthcare planning. Using a qualitative research approach, we reviewed literature and conducted interviews with patients and healthcare planners regarding engaging marginalized populations in health services planning. From these inputs, we created a model and planning manual to assist healthcare planners to engage marginalized patients in health services planning, which we piloted in two clinical programs undergoing health services design. The findings from the pilots were used to refine the model. The analysis of the interviews and literature identified power and gender as barriers to participation, and generated suggestions to support diverse populations both to attend patient engagement events and to participate meaningfully. Engaging marginalized populations cannot be reduced to a single defined process, but instead needs to be understood as an iterative process of fitting engagement methods to a particular situation. Underlying this process are principles for meaningfully engaging marginalized people in healthcare planning. A one-size-fits-all approach to patient engagement is not appropriate given patients' diverse barriers to meaningful participation in healthcare planning. Instead, planners need a

  1. Meaningful coping with chronic pain: Exploring the interplay between goal violation, meaningful coping strategies and life satisfaction in chronic pain patients. (United States)

    Dezutter, Jessie; Dewitte, Laura; Thauvoye, Evalyne; Vanhooren, Siebrecht


    Trying to cope with chronic pain is a highly demanding and challenging task and pain patients often need to reformulate goals or aspirations due to their pain condition. This goal violation is often related with experienced distress and requires coping processes in order to decrease the distress and stimulate a healthy adaptation. Some scholars, however, argued that in so-called unsolvable or irreparable stressors such as chronic pain, conventional coping strategies like problem-focused coping might not be the most adaptive option. In these situations, meaningful coping strategies attempting to transform the meaning of the stressful experience would be more accurate. In this study, we aim to test if goal violation triggers meaningful coping strategies over time and whether engagement in these meaningful coping strategies result in improved life satisfaction, as an indicator of adaptation. A longitudinal three wave study in a sample of paint patients (n = 125) tests whether goal violation triggers positive reappraisal and downward comparison, two possible meaningful coping strategies. The study furthermore tests if engagement in these strategies results in a better adaptation to the pain condition, reflected in higher life satisfaction. Results partially supported our hypotheses by pointing to the benevolent role of downward comparison on life satisfaction via decreased goal violation of pain patients. Our findings however did also show that positive reappraisal predicted lower life satisfaction via increased levels of appraised goal violation which questions the role of positive reappraisal as a genuine meaningful coping strategy. Implications and limitations are discussed. © 2016 Scandinavian Psychological Associations and John Wiley & Sons Ltd.

  2. Measuring and communicating meaningful outcomes in neonatology: A family perspective. (United States)

    Janvier, Annie; Farlow, Barbara; Baardsnes, Jason; Pearce, Rebecca; Barrington, Keith J


    Medium- and long-term outcomes have been collected and described among survivors of neonatal intensive care units for decades, for a number of purposes: (1) quality control within units, (2) comparisons of outcomes between NICUs, (3) clinical trials (whether an intervention improves outcomes), (4) end-of-life decision-making, (5) to better understand the effects of neonatal conditions and/or interventions on organs and/or long-term health, and finally (6) to better prepare parents for the future. However, the outcomes evaluated have been selected by investigators, based on feasibility, availability, cost, stability, and on what investigators consider to be important. Many of the routinely measured outcomes have major limitations: they may not correlate well with long-term difficulties, they may artificially divide continuous outcomes into dichotomous ones, and may have no clear relationship with quality of life and functioning of children and their families. Several investigations, such as routine term cerebral resonance imaging for preterm infants, have also not yet been shown to improve the outcome of children nor their families. In this article, the most common variables used in neonatology as well as some variables which are rarely measured but may be of equal importance for families are presented. The manner in which these outcomes are communicated to families will be examined, as well as recommendations to optimize communication with parents. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Audio-Visual and Meaningful Semantic Context Enhancements in Older and Younger Adults.

    Directory of Open Access Journals (Sweden)

    Kirsten E Smayda

    Full Text Available Speech perception is critical to everyday life. Oftentimes noise can degrade a speech signal; however, because of the cues available to the listener, such as visual and semantic cues, noise rarely prevents conversations from continuing. The interaction of visual and semantic cues in aiding speech perception has been studied in young adults, but the extent to which these two cues interact for older adults has not been studied. To investigate the effect of visual and semantic cues on speech perception in older and younger adults, we recruited forty-five young adults (ages 18-35 and thirty-three older adults (ages 60-90 to participate in a speech perception task. Participants were presented with semantically meaningful and anomalous sentences in audio-only and audio-visual conditions. We hypothesized that young adults would outperform older adults across SNRs, modalities, and semantic contexts. In addition, we hypothesized that both young and older adults would receive a greater benefit from a semantically meaningful context in the audio-visual relative to audio-only modality. We predicted that young adults would receive greater visual benefit in semantically meaningful contexts relative to anomalous contexts. However, we predicted that older adults could receive a greater visual benefit in either semantically meaningful or anomalous contexts. Results suggested that in the most supportive context, that is, semantically meaningful sentences presented in the audiovisual modality, older adults performed similarly to young adults. In addition, both groups received the same amount of visual and meaningful benefit. Lastly, across groups, a semantically meaningful context provided more benefit in the audio-visual modality relative to the audio-only modality, and the presence of visual cues provided more benefit in semantically meaningful contexts relative to anomalous contexts. These results suggest that older adults can perceive speech as well as younger

  4. Pengaruh Job Enrichment terhadap Employee Engagement melalui Psychological Meaningfulness sebagai Mediator


    Sungkit, Flavia Norpina; Meiyanto, IJK Sito


    The purpose of the study is to investigate the influence of job enrichment toward employee engagement through psychological meaningfulness as the mediator. Research design used is a cross-sectional study of 112 employees. Data is analyzed by multiple linear regression analysis. Result shows job enrichment is able to influence employee engagement significantly through psychological meaningfulness as the mediator. The p=0,000 with significance level 0,05. The sig F change shows 0,006, which is

  5. Meaningful use in the safety net: a rapid ethnography of patient portal implementation at five community health centers in California. (United States)

    Ackerman, Sara L; Sarkar, Urmimala; Tieu, Lina; Handley, Margaret A; Schillinger, Dean; Hahn, Kenneth; Hoskote, Mekhala; Gourley, Gato; Lyles, Courtney


    US health care institutions are implementing secure websites (patient portals) to achieve federal Meaningful Use (MU) certification. We sought to understand efforts to implement portals in "safety net" health care systems that provide services for low-income populations. Our rapid ethnography involved visits at 4 California safety net health systems and in-depth interviews at a fifth. Visits included interviews with clinicians and executives ( n  = 12), informal focus groups with front-line staff ( n  = 35), observations of patient portal sign-up procedures and clinic work, review of marketing materials and portal use data, and a brief survey ( n  = 45). Our findings demonstrate that the health systems devoted considerable effort to enlisting staff support for portal adoption and integrating portal-related work into clinic routines. Although all health systems had achieved, or were close to achieving, MU benchmarks, patients faced numerous barriers to portal use and our participants were uncertain how to achieve and sustain "meaningful use" as defined by and for their patients. Health systems' efforts to achieve MU certification united clinic staff under a shared ethos of improved quality of care. However, MU's assumptions about patients' demand for electronic access to health information and ability to make use of it directed clinics' attention to enrollment and message routing rather than to the relevance and usability of a tool that is minimally adaptable to the safety net context. We found a mismatch between MU-based metrics of patient engagement and the priorities and needs of safety net patient populations. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email:

  6. A Fast Method for Measuring Psychophysical Thresholds Across the Cochlear Implant Array

    Directory of Open Access Journals (Sweden)

    Julie A. Bierer


    Full Text Available A rapid threshold measurement procedure, based on Bekesy tracking, is proposed and evaluated for use with cochlear implants (CIs. Fifteen postlingually deafened adult CI users participated. Absolute thresholds for 200-ms trains of biphasic pulses were measured using the new tracking procedure and were compared with thresholds obtained with a traditional forced-choice adaptive procedure under both monopolar and quadrupolar stimulation. Virtual spectral sweeps across the electrode array were implemented in the tracking procedure via current steering, which divides the current between two adjacent electrodes and varies the proportion of current directed to each electrode. Overall, no systematic differences were found between threshold estimates with the new channel sweep procedure and estimates using the adaptive forced-choice procedure. Test–retest reliability for the thresholds from the sweep procedure was somewhat poorer than for thresholds from the forced-choice procedure. However, the new method was about 4 times faster for the same number of repetitions. Overall the reliability and speed of the new tracking procedure provides it with the potential to estimate thresholds in a clinical setting. Rapid methods for estimating thresholds could be of particular clinical importance in combination with focused stimulation techniques that result in larger threshold variations between electrodes.

  7. Reaping the benefits of meaningful work: The mediating versus moderating role of work engagement. (United States)

    Johnson, Matthew J; Jiang, Lixin


    This study examined whether meaningful work may improve one's quality of life outside of the workplace (i.e., work-to-life enrichment). More importantly, we proposed and tested competing hypotheses regarding the role of work engagement in the relationship between meaningful work and work-to-life enrichment. Specifically, we investigated whether work engagement served as a mediator of this relationship, as suggested by the job demands-resources model, or instead a moderator, as suggested by conservation of resources theory. Two-wave survey data were collected from 194 respondents recruited via Amazon Mechanical Turk. Analyses showed that meaningful work was positively related to work-to-life enrichment over time (i.e., 3 months later). Additionally, work engagement mediated but did not moderate the relationship between meaningful work at Time 1 and work-to-life enrichment at Time 2. We suggest that organizations foster a sense of meaningfulness in employees to facilitate engagement and in turn enrich employees' lives beyond the workplace. Therefore, not only organizations, but individuals as well may reap the benefits of meaningful work. Copyright © 2016 John Wiley & Sons, Ltd.




    The Meaningful Activity Participation Assessment (MAPA), a recently developed 28-item tool designed to measure the meaningfulness of activity, was tested in a sample of 154 older adults. The MAPA evidenced a sufficient level of internal consistency and test-retest reliability and correlated as theoretically predicted with the Life Satisfaction Index-Z, the Satisfaction with Life Scale, the Engagement in Meaningful Activities Survey, the Purpose in Life Test, the Center for Epidemiologic Studies Depression Inventory and the Rand SF-36v2 Health Survey subscales. Zero-order correlations consistently demonstrated meaningful relationships between the MAPA and scales of psychosocial well-being and health-related quality of life. Results from multiple regression analyses further substantiated these findings, as greater meaningful activity participation was associated with better psychological well-being and health-related quality of life. The MAPA appears to be a reliable and valid measure of meaningful activity, incorporating both subjective and objective indicators of activity engagement. PMID:20649161

  9. A Mixed-Methods Study of the Recovery Concept, "A Meaningful Day," in Community Mental Health Services for Individuals with Serious Mental Illnesses. (United States)

    Myers, Neely A L; Smith, Kelly; Pope, Alicia; Alolayan, Yazeed; Broussard, Beth; Haynes, Nora; Compton, Michael T


    The recovery concept encompasses overcoming or managing one's illness, being physically and emotionally healthy, and finding meaningful purpose through work, school, or volunteering, which connects one to others in mutually fulfilling ways. Using a mixed-methods approach, we studied the emphasis on "a meaningful day" in the new Opening Doors to Recovery (ODR) program in southeast Georgia. Among 100 participants, we measured the meaningful day construct using three quantitative items at baseline (hospital discharge) and at 4-, 8-, and 12-month follow-up, finding statistically significant linear trends over time for all three measures. Complementary qualitative interviews with 30 individuals (ODR participants, family members, and ODR's Community Navigation Specialists and program leaders) revealed themes pertaining to companionship, productivity, achieving stability, and autonomy, as well as the concern about insufficient resources. The concept of "a meaningful day" can be a focus of clinical attention and measured as a person-centered outcome for clients served by recovery-oriented community mental health services.

  10. Threshold behavior in electron-atom scattering

    International Nuclear Information System (INIS)

    Sadeghpour, H.R.; Greene, C.H.


    Ever since the classic work of Wannier in 1953, the process of treating two threshold electrons in the continuum of a positively charged ion has been an active field of study. The authors have developed a treatment motivated by the physics below the double ionization threshold. By modeling the double ionization as a series of Landau-Zener transitions, they obtain an analytical formulation of the absolute threshold probability which has a leading power law behavior, akin to Wannier's law. Some of the noteworthy aspects of this derivation are that the derivation can be conveniently continued below threshold giving rise to a open-quotes cuspclose quotes at threshold, and that on both sides of the threshold, absolute values of the cross sections are obtained

  11. A numerical study of threshold states

    International Nuclear Information System (INIS)

    Ata, M.S.; Grama, C.; Grama, N.; Hategan, C.


    There are some experimental evidences of charged particle threshold states. On the statistical background of levels, some simple structures were observed in excitation spectrum. They occur near the coulombian threshold and have a large reduced width for the decay in the threshold channel. These states were identified as charged cluster threshold states. Such threshold states were observed in sup(15,16,17,18)O, sup(18,19)F, sup(19,20)Ne, sup(24)Mg, sup(32)S. The types of clusters involved were d, t, 3 He, α and even 12 C. They were observed in heavy-ions transfer reactions in the residual nucleus as strong excited levels. The charged particle threshold states occur as simple structures at high excitation energy. They could be interesting both from nuclear structure as well as nuclear reaction mechanism point of view. They could be excited as simple structures both in compound and residual nucleus. (author)

  12. Customization of Advia 120 thresholds for canine erythrocyte volume and hemoglobin concentration, and effects on morphology flagging results. (United States)

    Grimes, Carolyn N; Fry, Michael M


    This study sought to develop customized morphology flagging thresholds for canine erythrocyte volume and hemoglobin concentration [Hgb] on the ADVIA 120 hematology analyzer; compare automated morphology flagging with results of microscopic blood smear evaluation; and examine effects of customized thresholds on morphology flagging results. Customized thresholds were determined using data from 52 clinically healthy dogs. Blood smear evaluation and automated morphology flagging results were correlated with mean cell volume (MCV) and cellular hemoglobin concentration mean (CHCM) in 26 dogs. Customized thresholds were applied retroactively to complete blood (cell) count (CBC) data from 5 groups of dogs, including a reference sample group, clinical cases, and animals with experimentally induced iron deficiency anemia. Automated morphology flagging correlated more highly with MCV or CHCM than did blood smear evaluation; correlation with MCV was highest using customized thresholds. Customized morphology flagging thresholds resulted in more sensitive detection of microcytosis, macrocytosis, and hypochromasia than default thresholds.

  13. Meaningful work and work engagement : The mediating role of perceived opportunity to craft and job crafting behavior

    NARCIS (Netherlands)

    Van Wingerden, Jessica; van der Stoep, Joost; Poell, R.F.


    This study examines the impact of meaningful work on employees’ level of work engagement as mediated by perceived opportunities to craft and job crafting. Based on the literature on meaningful work and job crafting, we hypothesize that meaningful work has a positive relationship with an employee’s

  14. The Effect of Patient Portals on Quality Outcomes and Its Implications to Meaningful Use: A Systematic Review (United States)


    Background The Health Information Technology for Economic and Clinical Health (HITECH) Act imposes pressure on health care organizations to qualify for “Meaningful Use”. It is assumed that portals should increase patient participation in medical decisions, but whether or not the use of portals improves outcomes remains to be seen. Objective The purpose of this systemic review is to outline and summarize study results on the effect of patient portals on quality, or chronic-condition outcomes as defined by the Agency for Healthcare Research and Quality, and its implications to Meaningful Use since the beginning of 2011. This review updates and builds on the work by Ammenwerth, Schnell-Inderst, and Hoerbst. Methods We performed a systematic literature search in PubMed, CINAHL, and Google Scholar. We identified any data-driven study, quantitative or qualitative, that examined a relationship between patient portals, or patient portal features, and outcomes. We also wanted to relate the findings back to Meaningful Use criteria. Over 4000 articles were screened, and 27 were analyzed and summarized for this systematic review. Results We identified 26 studies and 1 review, and we summarized their findings and applicability to our research question. Very few studies associated use of the patient portal, or its features, to improved outcomes; 37% (10/27) of papers reported improvements in medication adherence, disease awareness, self-management of disease, a decrease of office visits, an increase in preventative medicine, and an increase in extended office visits, at the patient’s request for additional information. The results also show an increase in quality in terms of patient satisfaction and customer retention, but there are weak results on medical outcomes. Conclusions The results of this review demonstrate that more health care organizations today offer features of a patient portal than in the review published in 2011. Articles reviewed rarely analyzed a full

  15. The effect of patient portals on quality outcomes and its implications to meaningful use: a systematic review. (United States)

    Kruse, Clemens Scott; Bolton, Katy; Freriks, Greg


    The Health Information Technology for Economic and Clinical Health (HITECH) Act imposes pressure on health care organizations to qualify for "Meaningful Use". It is assumed that portals should increase patient participation in medical decisions, but whether or not the use of portals improves outcomes remains to be seen. The purpose of this systemic review is to outline and summarize study results on the effect of patient portals on quality, or chronic-condition outcomes as defined by the Agency for Healthcare Research and Quality, and its implications to Meaningful Use since the beginning of 2011. This review updates and builds on the work by Ammenwerth, Schnell-Inderst, and Hoerbst. We performed a systematic literature search in PubMed, CINAHL, and Google Scholar. We identified any data-driven study, quantitative or qualitative, that examined a relationship between patient portals, or patient portal features, and outcomes. We also wanted to relate the findings back to Meaningful Use criteria. Over 4000 articles were screened, and 27 were analyzed and summarized for this systematic review. We identified 26 studies and 1 review, and we summarized their findings and applicability to our research question. Very few studies associated use of the patient portal, or its features, to improved outcomes; 37% (10/27) of papers reported improvements in medication adherence, disease awareness, self-management of disease, a decrease of office visits, an increase in preventative medicine, and an increase in extended office visits, at the patient's request for additional information. The results also show an increase in quality in terms of patient satisfaction and customer retention, but there are weak results on medical outcomes. The results of this review demonstrate that more health care organizations today offer features of a patient portal than in the review published in 2011. Articles reviewed rarely analyzed a full patient portal but instead analyzed features of a portal

  16. Iran: the next nuclear threshold state?


    Maurer, Christopher L.


    Approved for public release; distribution is unlimited A nuclear threshold state is one that could quickly operationalize its peaceful nuclear program into one capable of producing a nuclear weapon. This thesis compares two known threshold states, Japan and Brazil, with Iran to determine if the Islamic Republic could also be labeled a threshold state. Furthermore, it highlights the implications such a status could have on U.S. nonproliferation policy. Although Iran's nuclear program is mir...

  17. Dynamical thresholds for complete fusion

    International Nuclear Information System (INIS)

    Davies, K.T.R.; Sierk, A.J.; Nix, J.R.


    It is our purpose here to study the effect of nuclear dissipation and shape parametrization on dynamical thresholds for compound-nucleus formation in symmetric heavy-ion reactions. This is done by solving numerically classical equations of motion for head-on collisions to determine whether the dynamical trajectory in a multidimensional deformation space passes inside the fission saddle point and forms a compound nucleus, or whether it passes outside the fission saddle point and reseparates in a fast-fission or deep-inelastic reaction. Specifying the nuclear shape in terms of smoothly joined portions of three quadratic surfaces of revolution, we take into account three symmetric deformation coordinates. However, in some cases we reduce the number of coordinates to two by requiring the ends of the fusing system to be spherical in shape. The nuclear potential energy of deformation is determined in terms of a Coulomb energy and a double volume energy of a Yukawa-plus-exponential folding function. The collective kinetic energy is calculated for incompressible, nearly irrotational flow by means of the Werner-Wheeler approximation. Four possibilities are studied for the transfer of collective kinetic energy into internal single-particle excitation energy: zero dissipation, ordinary two body viscosity, one-body wall-formula dissipation, and one-body wall-and-window dissipation

  18. Therapy-Induced Neuroplasticity of Language in Chronic Post Stroke Aphasia: A Mismatch Negativity Study of (A)Grammatical and Meaningful/less Mini-Constructions (United States)

    Lucchese, Guglielmo; Pulvermüller, Friedemann; Stahl, Benjamin; Dreyer, Felix R.; Mohr, Bettina


    Clinical language performance and neurophysiological correlates of language processing were measured before and after intensive language therapy in patients with chronic (time post stroke >1 year) post stroke aphasia (PSA). As event-related potential (ERP) measure, the mismatch negativity (MMN) was recorded in a distracted oddball paradigm to short spoken sentences. Critical ‘deviant’ sentence stimuli where either well-formed and meaningful, or syntactically, or lexico-semantically incorrect. After 4 weeks of speech-language therapy (SLT) delivered with high intensity (10.5 h per week), clinical language assessment with the Aachen Aphasia Test battery demonstrated significant linguistic improvements, which were accompanied by enhanced MMN responses. More specifically, MMN amplitudes to grammatically correct and meaningful mini-constructions and to ‘jabberwocky’ sentences containing a pseudoword significantly increased after therapy. However, no therapy-related changes in MMN responses to syntactically incorrect strings including agreement violations were observed. While MMN increases to well-formed meaningful strings can be explained both at the word and construction levels, the neuroplastic change seen for ‘jabberwocky’ sentences suggests an explanation in terms of constructions. The results confirm previous reports that intensive SLT leads to improvements of linguistic skills in chronic aphasia patients and now demonstrate that this clinical improvement is associated with enhanced automatic brain indexes of construction processing, although no comparable change is present for ungrammatical strings. Furthermore, the data confirm that the language-induced MMN is a useful tool to map functional language recovery in PSA. PMID:28111545

  19. Relationships between Flow Experience, Life Meaningfulness and Subjective Well-being in Music Students

    Directory of Open Access Journals (Sweden)

    Martin Sedlár


    Full Text Available The study examines relationships between flow experience in musical activities, life meaningfulness and subjective well – being. Life meaningfulness belongs to eudaimonic good life, subjective well–being belongs to hedonic good life and flow seems to be combination of both approaches. It is supposed that flow experience in musical activity and life meaningfulness should have positive impact on subjective well –being. The research sample consisted of 96 university music students (37 males, 59 females from the Music and Dance Faculty, Academy of Performing Arts in Bratislava, Slovakia. Dispositional Flow Scale–2, which measures nine dimension of flow, was used for measuring frequency o f flow experience. Life Meaningfulness Scale, which measures three dimensions of life meaningfulness, was used for measuring meaningfulness of life. Positive and Negative Affect Schedule measured affective components of subjective well–being, and Satisfaction with Life Scale measured cognitive component of subjective well–being. Categorization revealed that the most favourite performing musical activities are creative musical activities, such as reproduction and production, during which music students relatively often experience flow. The results of correlation analysis showed that total scores of flow experience, life meaningfulness and components of subjective well–being, significantly correlate each other. Aspects of flow, clear goals and autotelic experience are positively related to cognitive and motivational dimension of life meaningfulness and also to positive affectivity. Loss of self–consciousness and autotelic experience are positively related to emotional dimension of life meaningfulness. Challenge–skill balance, action–awareness merging, clear goals, concentration on task at hand, sense of control and autotelic experience are negatively related to negative affectivity. Challenge–skill balance and autotelic experience are related to

  20. Demands–abilities fit, work beliefs, meaningful work and engagement in nature-based jobs

    Directory of Open Access Journals (Sweden)

    Nellie de Crom


    Full Text Available Orientation: Meaningful work and personal engagement are important dimensions of flourishing of employees, especially when individuals work in challenging jobs. Research purpose: This study aimed to investigate the relationship between demands–abilities fit, work beliefs, meaningful work and engagement in individuals in nature-based jobs. Motivation for the study: Individuals working in nature often work under challenging circumstances without the necessary resources. A research gap exists regarding the effects of demands–abilities fit and work beliefs on meaningful work. It is also not clear how these antecedents and meaningful work will impact the engagement of individuals working in nature. Research approach, design and method: A cross-sectional survey was used with a convenience sample of 161 nature-based employees. Data were collected using a structured online questionnaire consisting of items from the demands–abilities fit scale, work–life questionnaire, work and meaning Inventory, work engagement scale and a biographical questionnaire. Main findings: Work beliefs (calling, career and job and demands–abilities fit predicted a large percentage of the variance in meaning making. Work beliefs (calling and job and demands–abilities fit also predicted a large percentage of the variance in greater good motivations. Demands–abilities fit and a calling work orientation indirectly affected work engagement via meaningful work. The scales which measured calling and job orientations showed insufficient discriminant validity in relation to the scales which measured positive meaning and work engagement. Practical and managerial implications: Managers should consider implementing interventions to affect the demands–abilities fit (through human resource management interventions and work beliefs of individuals working in nature (through job crafting. Promoting perceptions of meaningful work might contribute to higher personal engagement

  1. Meaningful task-specific training (MTST) for stroke rehabilitation: a randomized controlled trial. (United States)

    Arya, Kamal Narayan; Verma, Rajesh; Garg, R K; Sharma, V P; Agarwal, Monika; Aggarwal, G G


    The upper extremity motor deficit is one of the functional challenges in post stroke patients. The objective of the present study was to evaluate the effectiveness of the meaningful task-specific training (MTST) on the upper extremity motor recovery during the subacute phase after a stroke. This was a randomized, controlled, double-blinded trial in the neurology department of a university hospital and occupational therapy unit of a rehabilitation institute. A convenience sample of 103 people, 4 to 24 weeks (mean, 12.15 weeks) after the stroke, was randomized into 2 groups (MTST, 51; standard training group, 52). Subjects in the Brunnstrom stage of arm recovery of 2 to 5 were included in the study. Ninety-five participants completed the 8-week follow-up. Participants were assigned to receive either the MTST or dose-matched standard training program based on the Brunnstrom stage and Bobath neurodevelopmental technique, 4 to 5 days a week for 4 weeks. Fugl-Meyer assessment (FMA), Action Research Arm Test (ARAT), Graded Wolf Motor Function Test (GWMFT), and Motor Activity Log (MAL) were outcome measures The MTST group showed a positive improvement in the mean scores on the outcome measures at post and follow-up assessments in comparison to the control group. Further, statistically significant differences were observed in changes between the groups at post and follow-up assessment for FMA, ARAT, GWMFT, and MAL. The MTST produced statistically significant and clinically relevant improvements in the upper extremity motor recovery of the patients who had a subacute stroke.

  2. Meaningful use of health information technology and declines in in-hospital adverse drug events. (United States)

    Furukawa, Michael F; Spector, William D; Rhona Limcangco, M; Encinosa, William E


    Nationwide initiatives have promoted greater adoption of health information technology as a means to reduce adverse drug events (ADEs). Hospital adoption of electronic health records with Meaningful Use (MU) capabilities expected to improve medication safety has grown rapidly. However, evidence that MU capabilities are associated with declines in in-hospital ADEs is lacking. Data came from the 2010-2013 Medicare Patient Safety Monitoring System and the 2008-2013 Healthcare Information and Management Systems Society (HIMSS) Analytics Database. Two-level random intercept logistic regression was used to estimate the association of MU capabilities and occurrence of ADEs, adjusting for patient characteristics, hospital characteristics, and year of observation. Rates of in-hospital ADEs declined by 19% from 2010 to 2013. Adoption of MU capabilities was associated with 11% lower odds of an ADE (95% confidence interval [CI], 0.84-0.96). Interoperability capability was associated with 19% lower odds of an ADE (95% CI, 0.67- 0.98). Adoption of MU capabilities explained 22% of the observed reduction in ADEs, or 67,000 fewer ADEs averted by MU. Concurrent with the rapid uptake of MU and interoperability, occurrence of in-hospital ADEs declined significantly from 2010 to 2013. MU capabilities and interoperability were associated with lower occurrence of ADEs, but the effects did not vary by experience with MU. About one-fifth of the decline in ADEs from 2010 to 2013 was attributable to MU capabilities. Findings support the contention that adoption of MU capabilities and interoperability spurred by the Health Information Technology for Economic and Clinical Health Act contributed in part to the recent decline in ADEs. Published by Oxford University Press on behalf of the American Medical Informatics Association 2017. This work is written by US Government employees and is in the public domain in the United States.

  3. Pain thresholds, supra-threshold pain and lidocaine sensitivity in patients with erythromelalgia, including the I848Tmutation in NaV 1.7. (United States)

    Helås, T; Sagafos, D; Kleggetveit, I P; Quiding, H; Jönsson, B; Segerdahl, M; Zhang, Z; Salter, H; Schmelz, M; Jørum, E


    Nociceptive thresholds and supra-threshold pain ratings as well as their reduction upon local injection with lidocaine were compared between healthy subjects and patients with erythromelalgia (EM). Lidocaine (0.25, 0.50, 1.0 or 10 mg/mL) or placebo (saline) was injected intradermally in non-painful areas of the lower arm, in a randomized, double-blind manner, to test the effect on dynamic and static mechanical sensitivity, mechanical pain sensitivity, thermal thresholds and supra-threshold heat pain sensitivity. Heat pain thresholds and pain ratings to supra-threshold heat stimulation did not differ between EM-patients (n = 27) and controls (n = 25), neither did the dose-response curves for lidocaine. Only the subgroup of EM-patients with mutations in sodium channel subunits Na V 1.7, 1.8 or 1.9 (n = 8) had increased lidocaine sensitivity for supra-threshold heat stimuli, contrasting lower sensitivity to strong mechanical stimuli. This pattern was particularly clear in the two patients carrying the Na V 1.7 I848T mutations in whom lidocaine's hyperalgesic effect on mechanical pain sensitivity contrasted more effective heat analgesia. Heat pain thresholds are not sensitized in EM patients, even in those with gain-of-function mutations in Na V 1.7. Differential lidocaine sensitivity was overt only for noxious stimuli in the supra-threshold range suggesting that sensitized supra-threshold encoding is important for the clinical pain phenotype in EM in addition to lower activation threshold. Intracutaneous lidocaine dose-dependently blocked nociceptive sensations, but we did not identify EM patients with particular high lidocaine sensitivity that could have provided valuable therapeutic guidance. Acute pain thresholds and supra-threshold heat pain in controls and patients with erythromelalgia do not differ and have the same lidocaine sensitivity. Acute heat pain thresholds even in EM patients with the Na V 1.7 I848T mutation are normal and only nociceptor

  4. Log canonical thresholds of smooth Fano threefolds

    International Nuclear Information System (INIS)

    Cheltsov, Ivan A; Shramov, Konstantin A


    The complex singularity exponent is a local invariant of a holomorphic function determined by the integrability of fractional powers of the function. The log canonical thresholds of effective Q-divisors on normal algebraic varieties are algebraic counterparts of complex singularity exponents. For a Fano variety, these invariants have global analogues. In the former case, it is the so-called α-invariant of Tian; in the latter case, it is the global log canonical threshold of the Fano variety, which is the infimum of log canonical thresholds of all effective Q-divisors numerically equivalent to the anticanonical divisor. An appendix to this paper contains a proof that the global log canonical threshold of a smooth Fano variety coincides with its α-invariant of Tian. The purpose of the paper is to compute the global log canonical thresholds of smooth Fano threefolds (altogether, there are 105 deformation families of such threefolds). The global log canonical thresholds are computed for every smooth threefold in 64 deformation families, and the global log canonical thresholds are computed for a general threefold in 20 deformation families. Some bounds for the global log canonical thresholds are computed for 14 deformation families. Appendix A is due to J.-P. Demailly.

  5. 40 CFR 68.115 - Threshold determination. (United States)


    ... (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Regulated Substances for Accidental Release Prevention... process exceeds the threshold. (b) For the purposes of determining whether more than a threshold quantity... portion of the process is less than 10 millimeters of mercury (mm Hg), the amount of the substance in the...

  6. Applying Threshold Concepts to Finance Education (United States)

    Hoadley, Susan; Wood, Leigh N.; Tickle, Leonie; Kyng, Tim


    Purpose: The purpose of this paper is to investigate and identify threshold concepts that are the essential conceptual content of finance programmes. Design/Methodology/Approach: Conducted in three stages with finance academics and students, the study uses threshold concepts as both a theoretical framework and a research methodology. Findings: The…

  7. Twelve automated thresholding methods for segmentation of PET images: a phantom study

    International Nuclear Information System (INIS)

    Prieto, Elena; Peñuelas, Iván; Martí-Climent, Josep M; Lecumberri, Pablo; Gómez, Marisol; Pagola, Miguel; Bilbao, Izaskun; Ecay, Margarita


    Tumor volume delineation over positron emission tomography (PET) images is of great interest for proper diagnosis and therapy planning. However, standard segmentation techniques (manual or semi-automated) are operator dependent and time consuming while fully automated procedures are cumbersome or require complex mathematical development. The aim of this study was to segment PET images in a fully automated way by implementing a set of 12 automated thresholding algorithms, classical in the fields of optical character recognition, tissue engineering or non-destructive testing images in high-tech structures. Automated thresholding algorithms select a specific threshold for each image without any a priori spatial information of the segmented object or any special calibration of the tomograph, as opposed to usual thresholding methods for PET. Spherical 18 F-filled objects of different volumes were acquired on clinical PET/CT and on a small animal PET scanner, with three different signal-to-background ratios. Images were segmented with 12 automatic thresholding algorithms and results were compared with the standard segmentation reference, a threshold at 42% of the maximum uptake. Ridler and Ramesh thresholding algorithms based on clustering and histogram-shape information, respectively, provided better results that the classical 42%-based threshold (p < 0.05). We have herein demonstrated that fully automated thresholding algorithms can provide better results than classical PET segmentation tools. (paper)

  8. Summary of DOE threshold limits efforts

    International Nuclear Information System (INIS)

    Wickham, L.E.; Smith, C.F.; Cohen, J.J.


    The Department of Energy (DOE) has been developing the concept of threshold quantities for use in determining which waste materials may be disposed of as nonradioactive waste in DOE sanitary landfills. Waste above a threshold level could be managed as radioactive or mixed waste (if hazardous chemicals are present); waste below this level would be handled as sanitary waste. After extensive review of a draft threshold guidance document in 1985, a second draft threshold background document was produced in March 1986. The second draft included a preliminary cost-benefit analysis and quality assurance considerations. The review of the second draft has been completed. Final changes to be incorporated include an in-depth cost-benefit analysis of two example sites and recommendations of how to further pursue (i.e. employ) the concept of threshold quantities within the DOE. 3 references

  9. Ineffectiveness of commercial weight-loss programs for achieving modest but meaningful weight loss: Systematic review and meta-analysis. (United States)

    McEvedy, Samantha M; Sullivan-Mort, Gillian; McLean, Siân A; Pascoe, Michaela C; Paxton, Susan J


    This study collates existing evidence regarding weight loss among overweight but otherwise healthy adults who use commercial weight-loss programs. Systematic search of 3 databases identified 11 randomized controlled trials and 14 observational studies of commercial meal-replacement, calorie-counting, or pre-packaged meal programs which met inclusion criteria. In meta-analysis using intention-to-treat data, 57 percent of individuals who commenced a commercial weight program lost less than 5 percent of their initial body weight. One in two (49%) studies reported attrition ≥30 percent. A second meta-analysis found that 37 percent of program completers lost less than 5 percent of initial body weight. We conclude that commercial weight-loss programs frequently fail to produce modest but clinically meaningful weight loss with high rates of attrition suggesting that many consumers find dietary changes required by these programs unsustainable.

  10. A Threshold Continuum for Aeolian Sand Transport (United States)

    Swann, C.; Ewing, R. C.; Sherman, D. J.


    The threshold of motion for aeolian sand transport marks the initial entrainment of sand particles by the force of the wind. This is typically defined and modeled as a singular wind speed for a given grain size and is based on field and laboratory experimental data. However, the definition of threshold varies significantly between these empirical models, largely because the definition is based on visual-observations of initial grain movement. For example, in his seminal experiments, Bagnold defined threshold of motion when he observed that 100% of the bed was in motion. Others have used 50% and lesser values. Differences in threshold models, in turn, result is large errors in predicting the fluxes associated with sand and dust transport. Here we use a wind tunnel and novel sediment trap to capture the fractions of sand in creep, reptation and saltation at Earth and Mars pressures and show that the threshold of motion for aeolian sand transport is best defined as a continuum in which grains progress through stages defined by the proportion of grains in creep and saltation. We propose the use of scale dependent thresholds modeled by distinct probability distribution functions that differentiate the threshold based on micro to macro scale applications. For example, a geologic timescale application corresponds to a threshold when 100% of the bed in motion whereas a sub-second application corresponds to a threshold when a single particle is set in motion. We provide quantitative measurements (number and mode of particle movement) corresponding to visual observations, percent of bed in motion and degrees of transport intermittency for Earth and Mars. Understanding transport as a continuum provides a basis for revaluating sand transport thresholds on Earth, Mars and Titan.

  11. Meaningful Clusters

    Energy Technology Data Exchange (ETDEWEB)

    Sanfilippo, Antonio P.; Calapristi, Augustin J.; Crow, Vernon L.; Hetzler, Elizabeth G.; Turner, Alan E.


    We present an approach to the disambiguation of cluster labels that capitalizes on the notion of semantic similarity to assign WordNet senses to cluster labels. The approach provides interesting insights on how document clustering can provide the basis for developing a novel approach to word sense disambiguation.

  12. Perspective: The missing link in academic career planning and development: pursuit of meaningful and aligned work. (United States)

    Lieff, Susan J


    Retention of faculty in academic medicine is a growing challenge. It has been suggested that inattention to the humanistic values of the faculty is contributing to this problem. Professional development should consider faculty members' search for meaning, purpose, and professional fulfillment and should support the development of an ability to reflect on these issues. Ensuring the alignment of academic physicians' inner direction with their outer context is critical to professional fulfillment and effectiveness. Personal reflection on the synergy of one's strengths, passions, and values can help faculty members define meaningful work so as to enable clearer career decision making. The premise of this article is that an awareness of and the pursuit of meaningful work and its alignment with the academic context are important considerations in the professional fulfillment and retention of academic faculty. A conceptual framework for understanding meaningful work and alignment and ways in which that framework can be applied and taught in development programs are presented and discussed.

  13. Students’ Expectations and Experiences of Meaningful Simulation-Based Medical Education

    Directory of Open Access Journals (Sweden)

    Tuulikki Keskitalo


    Full Text Available This study aims to investigate students’ expectations and experiences of meaningful learning in simulation-based learning environments. We set the following research question: How do students’ experiences of meaningful simulation-based learning correspond to their expectations? The students’ (n = 87; male 51, female 36 pre- and post-questionnaires were analyzed using statistical methods. The results indicated that students’ expectations and experiences of meaningful learning were positive, and for most statements, there were statistically significant differences between the mean pre-questionnaire rating and the mean post-questionnaire rating, thereby indicating that students’ actual experiences of simulation-based learning were more positive than their expectations. Thus, students’ experiences exceeded their expectations.

  14. The consistency and complementarity between critical meaningful learning theory and the epistemology of Paul Feyerabend

    Directory of Open Access Journals (Sweden)

    Felipe Damasio


    Full Text Available Researchers in science teaching have advocated concomitant education about and of science. To approach the nature and history of science in basic education is necessary to have an epistemological approach that can go between of rationalism of Bunge and relativism of Feyerabend. In this paper, it is argued that Feyerabend's epistemological stance is that more can help promote meaningful learning critical, so as to form inquiring, flexible, creative, innovative, tolerant and liberal people. In addition, the suggestions Feyerabend's epistemology also complement the Theory of Meaningful Learning Critical to propose a curriculum and a context for the principles of the theory are in science classrooms.

  15. Pilot Study of Flow and Meaningfulness as Psychological Learning Concepts in Patient Education: A Short Report

    DEFF Research Database (Denmark)

    Nicic, Sara; Nørby, Karina; Bruun Johansen, Clea


    of this study was to investigate the applicability of these concepts of positive psychological theory in a patient education setting. Methods: This pilot study combines participating observation of group based patient education and 8 qualitative interviews with 4 patients with type 2 diabetes. Meaning......Abstract Background: The aim of this pilot study was to explore patient experiences of meaningfulness and flow related to group based patient education in type 2 diabetes. Meaningfulness and flow are underexposed as psychological learning concepts in patient education, and the ambition...

  16. Creating a meaningful infection control program: one home healthcare agency's lessons. (United States)

    Poff, Renee McCoy; Browning, Sarah Via


    Creating a meaningful infection control program in the home care setting proved to be challenging for agency leaders of one hospital-based home healthcare agency. Challenges arose when agency leaders provided infection control (IC) data to the hospital's IC Committee. The IC Section Chief asked for national benchmark comparisons to align home healthcare reporting to that of the hospital level. At that point, it was evident that the home healthcare IC program lacked definition and structure. The purpose of this article is to share how one agency built a meaningful IC program.


    Directory of Open Access Journals (Sweden)

    Iandra Maria Weirich da Silva Coelho


    Full Text Available This article describes a didactic proposal, mediated by the use of WhatsApp as a potential tool for the teaching of Spanish as an additional language. Activities are drawn from collaborative and meaningful practice with authentic situations of the language usage, taking by reference the theoretical construct of the Theory of Meaningful Learning (AUSUBEL, 2003 and Collaborative Practice of Writing. The results identify positive contributions about the increased interest and motivation of students, promotion of discursive competence, interactivity, autonomy, about actions involving the authorship and collaborative construction in information network for knowledge sharing.

  18. Improving students' meaningful learning on the predictive nature of quantum mechanics

    Directory of Open Access Journals (Sweden)

    Rodolfo Alves de Carvalho Neto


    Full Text Available This paper deals with research about teaching quantum mechanics to 3rd year high school students and their meaningful learning of its predictive aspect; it is based on the Master’s dissertation of one of the authors (CARVALHO NETO, 2006. While teaching quantum mechanics, we emphasized its predictive and essentially probabilistic nature, based on Niels Bohr’s complementarity interpretation (BOHR, 1958. In this context, we have discussed the possibility of predicting measurement results in well-defined experimental contexts, even for individual events. Interviews with students reveal that they have used quantum mechanical ideas, suggesting their meaningful learning of the essentially probabilistic predictions of quantum mechanics.

  19. Hyper-arousal decreases human visual thresholds.

    Directory of Open Access Journals (Sweden)

    Adam J Woods

    Full Text Available Arousal has long been known to influence behavior and serves as an underlying component of cognition and consciousness. However, the consequences of hyper-arousal for visual perception remain unclear. The present study evaluates the impact of hyper-arousal on two aspects of visual sensitivity: visual stereoacuity and contrast thresholds. Sixty-eight participants participated in two experiments. Thirty-four participants were randomly divided into two groups in each experiment: Arousal Stimulation or Sham Control. The Arousal Stimulation group underwent a 50-second cold pressor stimulation (immersing the foot in 0-2° C water, a technique known to increase arousal. In contrast, the Sham Control group immersed their foot in room temperature water. Stereoacuity thresholds (Experiment 1 and contrast thresholds (Experiment 2 were measured before and after stimulation. The Arousal Stimulation groups demonstrated significantly lower stereoacuity and contrast thresholds following cold pressor stimulation, whereas the Sham Control groups showed no difference in thresholds. These results provide the first evidence that hyper-arousal from sensory stimulation can lower visual thresholds. Hyper-arousal's ability to decrease visual thresholds has important implications for survival, sports, and everyday life.

  20. Repeated-Sprint Sequences During Female Soccer Matches Using Fixed and Individual Speed Thresholds. (United States)

    Nakamura, Fábio Y; Pereira, Lucas A; Loturco, Irineu; Rosseti, Marcelo; Moura, Felipe A; Bradley, Paul S


    Nakamura, FY, Pereira, LA, Loturco, I, Rosseti, M, Moura, FA, and Bradley, PS. Repeated-sprint sequences during female soccer matches using fixed and individual speed thresholds. J Strength Cond Res 31(7): 1802-1810, 2017-The main objective of this study was to characterize the occurrence of single sprint and repeated-sprint sequences (RSS) during elite female soccer matches, using fixed (20 km·h) and individually based speed thresholds (>90% of the mean speed from a 20-m sprint test). Eleven elite female soccer players from the same team participated in the study. All players performed a 20-m linear sprint test, and were assessed in up to 10 official matches using Global Positioning System technology. Magnitude-based inferences were used to test for meaningful differences. Results revealed that irrespective of adopting fixed or individual speed thresholds, female players produced only a few RSS during matches (2.3 ± 2.4 sequences using the fixed threshold and 3.3 ± 3.0 sequences using the individually based threshold), with most sequences composing of just 2 sprints. Additionally, central defenders performed fewer sprints (10.2 ± 4.1) than other positions (fullbacks: 28.1 ± 5.5; midfielders: 21.9 ± 10.5; forwards: 31.9 ± 11.1; with the differences being likely to almost certainly associated with effect sizes ranging from 1.65 to 2.72), and sprinting ability declined in the second half. The data do not support the notion that RSS occurs frequently during soccer matches in female players, irrespective of using fixed or individual speed thresholds to define sprint occurrence. However, repeated-sprint ability development cannot be ruled out from soccer training programs because of its association with match-related performance.

  1. The rubber hand illusion increases heat pain threshold. (United States)

    Hegedüs, G; Darnai, G; Szolcsányi, T; Feldmann, Á; Janszky, J; Kállai, J


    Accumulating evidence shows that manipulations of cortical body representation, for example, by simply viewing one's own body, can relieve pain in healthy subjects. Despite the widespread use of the rubber hand illusion (RHI) as an effective experimental tool for the manipulation of bodily awareness, previous studies examining the analgesic effect of the RHI have produced conflicting results. We used noxious heat stimuli to induce finger pain in 29 healthy subjects, and we recorded the participants' pain thresholds and subjective pain ratings during the RHI and during the control conditions. Two control conditions were included in our experiment - a standard one with reduced illusion strength (asynchronous stroking control) and an additional one in which the participants viewed their own hand. Raw data showed that both the RHI and the vision of the own hand resulted in slightly higher pain thresholds than the asynchronous stroking control (illusion: 47.79 °C; own-hand: 47.99 °C; asynchronous: 47.52 °C). After logarithmic transformation to achieve normality, paired t-tests revealed that both increases in pain threshold were significant (illusion/asynchronous: p = 0.036; own-hand/asynchronous: p = 0.007). In contrast, there was no significant difference in pain threshold between the illusion and the own-hand conditions (p = 0.656). Pain rating scores were not log-normal, and Wilcoxon singed-rank tests found no significant differences in pain ratings between the study conditions. The RHI increases heat pain threshold and the analgesic effect of the RHI is comparable with that of seeing one's own hand. The latter finding may have clinical implications. © 2014 European Pain Federation - EFIC®


    Energy Technology Data Exchange (ETDEWEB)

    Gerken, William W.; Duffey, Dick


    From American Nuclear Society Meeting, New York, Nov. 1963. The use of threshold detectors, which simultaneously undergo reactions with thermal neutrons and two or more fast neutron threshold reactions, was applied to measurements of the neutron spectrum in a reactor. A number of different materials were irradiated to determine the most practical ones for use as multiple threshold detectors. These results, as well as counting techniques and corrections, are presented. Some materials used include aluminum, alloys of Al -Ni, aluminum-- nickel oxides, and magesium orthophosphates. (auth)

  3. Reaction thresholds in doubly special relativity

    International Nuclear Information System (INIS)

    Heyman, Daniel; Major, Seth; Hinteleitner, Franz


    Two theories of special relativity with an additional invariant scale, 'doubly special relativity', are tested with calculations of particle process kinematics. Using the Judes-Visser modified conservation laws, thresholds are studied in both theories. In contrast with some linear approximations, which allow for particle processes forbidden in special relativity, both the Amelino-Camelia and Magueijo-Smolin frameworks allow no additional processes. To first order, the Amelino-Camelia framework thresholds are lowered and the Magueijo-Smolin framework thresholds may be raised or lowered

  4. Parent Perceptions of Time Spent Meaningfully by Young Adults with Pervasive Support Needs (United States)

    Rossetti, Zachary; Lehr, Donna; Lederer, Leslie; Pelerin, Dana; Huang, Shuoxi


    This article describes a qualitative study that examined how 23 young adults with pervasive support needs and limited functional communication spent their time and how their parents (n = 23) and direct support professionals (DSPs; n = 2) defined meaningfulness in relation to the young adults' experiences. Data were collected through…

  5. Measuring Meaningful Learning in the Undergraduate Chemistry Laboratory: A National, Cross-Sectional Study (United States)

    Galloway, Kelli R.; Bretz, Stacey Lowery


    Research on laboratory learning points to the need to better understand what and how students learn in the undergraduate chemistry laboratory. The Meaningful Learning in the Laboratory Instrument (MLLI) was administered to general and organic chemistry students from 15 colleges and universities across the United States in order to measure the…

  6. Pedagogical Background for Technology Education--Meaningful Learning in Theory and Practice (United States)

    Autio, Ossi


    One important theme in technology education is the growing need to develop the type of pedagogies that encourage pupils in authentic and meaningful learning experiences. Often, the teaching strategies of technology education are only a matter of teaching the handling of materials and tools, and the production of mere objects does not consider how…

  7. Using Cluster Analysis to Characterize Meaningful Learning in a First-Year University Chemistry Laboratory Course (United States)

    Galloway, Kelli R.; Bretz, Stacey Lowery


    The Meaningful Learning in the Laboratory Instrument (MLLI) was designed to measure students' cognitive and affective learning in the university chemistry laboratory. The MLLI was administered at the beginning and the end of the first semester to first-year university chemistry students to measure their expectations and experiences for learning in…

  8. Meaningful Gamification and Students' Motivation: A Strategy for Scaffolding Reading Material (United States)

    Ling, Lynette Tan Yuen


    Gamification is an innovative pedagogical strategy where digital games are used in an educational setting and as an aid to learning. Recent publications on gamification in the classroom investigate the concept of "meaningful gamification," where, in line with Ryan and Deci's self-determination theory, competency, autonomy, and…

  9. Meaningful Understanding and Systems Thinking in Organic Chemistry: Validating Measurement and Exploring Relationships (United States)

    Vachliotis, Theodoros; Salta, Katerina; Tzougraki, Chryssa


    The purpose of this study was dual: First, to develop and validate assessment schemes for assessing 11th grade students' meaningful understanding of organic chemistry concepts, as well as their systems thinking skills in the domain. Second, to explore the relationship between the two constructs of interest based on students' performance…

  10. What constitutes meaningful engagement for patients and families as partners on research teams? (United States)

    Black, Agnes; Strain, Kimberly; Wallsworth, Christine; Charlton, Sara-Grey; Chang, Wilma; McNamee, Kate; Hamilton, Clayon


    Objective There is growing emphasis on health care organizations to ensure that lay people are meaningfully engaged as partners on research teams. Our aim was to explore the perspectives of patients, family members and informal caregivers who have been involved on health care research teams in Canada and elicit their recommendations for meaningful engagement. Methods We conducted a qualitative study guided by thematic analysis of transcripts of focus groups and interviews of 19 experienced patient research partners in Canada. Results We identified four main themes: research environment, expectations, support and value, which highlight participants' combined perspectives on important factors to ensure their engagement in research is meaningful. Conclusions Our findings add to the evolving evidence base on the perspectives of lay people involved in health care research and their recommendations for research leaders on meaningful engagement. Our study suggests that research leaders should provide a welcoming research environment, outline appropriate expectations for patient research partners on research teams, support patient research partners' engagement in projects and recognize the value patient research partners bring to health research.

  11. 75 FR 28331 - Meaningful Access to United States Currency for Blind and Visually Impaired Persons (United States)


    ... feature is used in some foreign currency, and the Study's data indicated that this feature was more... Currency for Blind and Visually Impaired Persons AGENCY: Bureau of Engraving and Printing, Department of... meaningful access to U.S. currency to people who are blind and visually impaired pursuant to section 504 of...

  12. Identifying meaningful activities among elderly people with demenitia: the developing process of an observation taxonomy

    DEFF Research Database (Denmark)

    Andresen, Mette


    , values and beliefs in the center formed the base in the development of the tool. Aim: To develop an observational tool which can identify meaningful activities among elderly demented nursing home residents and thereby provide staff with more knowledge and possibilities for inviting and engaging residents...

  13. Callings, Work Role Fit, Psychological Meaningfulness and Work Engagement among Teachers in Zambia (United States)

    Rothmann, Sebastiaan; Hamukang'andu, Lukondo


    Our aim in this study was to investigate the relationships among a calling orientation, work role fit, psychological meaningfulness and work engagement of teachers in Zambia. A quantitative approach was followed and a cross-sectional survey was used. The sample (n = 150) included 75 basic and 75 secondary school teachers in the Choma district of…

  14. Doing the Project and Learning the Content: Designing Project-Based Science Curricula for Meaningful Understanding (United States)

    Kanter, David E.


    Project-based science curricula can improve students' usable or meaningful understanding of the science content underlying a project. However, such curricula designed around "performances" wherein students design or make something do not always do this. We researched ways to design performance project-based science curricula (pPBSc) to better…

  15. Towards a More Meaningful Involvement of Librarians in Academic Program Reviews (United States)

    Bowker, Lynne


    Purpose: Using a descriptive case study approach, this paper aims to validate academic librarians' perceptions that they are marginalized by faculty during academic program reviews, and recommends ways for the two groups to collaborate more effectively to make program reviews more meaningful. Design/methodology/approach: The paper describes a case…

  16. "Seeing the Whole Elephant": Changing Mindsets and Empowering Stakeholders to Meaningfully Manage Accountability and Improvement (United States)

    Bush-Mecenas, Susan; Marsh, Julie A.; Montes de Oca, David; Hough, Heather


    School accountability and improvement policy are on the precipice of a paradigm shift. While the multiple-measure dashboard accountability approach holds great promise for promoting more meaningful learning opportunities for all students, our research indicates that this can come with substantial challenges in practice. We reflect upon the lessons…

  17. Beyond Needs Analysis: Soft Systems Methodology for Meaningful Collaboration in EAP Course Design (United States)

    Tajino, Akira; James, Robert; Kijima, Kyoichi


    Designing an EAP course requires collaboration among various concerned stakeholders, including students, subject teachers, institutional administrators and EAP teachers themselves. While needs analysis is often considered fundamental to EAP, alternative research methodologies may be required to facilitate meaningful collaboration between these…

  18. Meaningfulness for creation of growth in Small- and Medium-sized enterprises

    DEFF Research Database (Denmark)

    Brink, Tove; Neville, Mette


    The research in this paper reveals how meaningfulness of growth can be created in Small- and Medium-sized Enterprises (SMEs). The research is conducted in a four-year period with 24 SMEs participating from different industry branches. The research is now in the late part of the 3rd. year starting...

  19. Meaningful Learning in the Teaching of Culture: The Project Based Learning Approach (United States)

    Kean, Ang Chooi; Kwe, Ngu Moi


    This paper reports on a collaborative effort taken by a team of three teacher educators in using the Project Based Learning (PBL) approach in the teaching of Japanese culture with the aim to investigate the presence of actual "meaningful learning" among 15 students of a 12-Week Preparatory Japanese Language course under a teacher…

  20. Magnitude and meaningfulness of change in SF-36 scores in four types of orthopedic surgery

    DEFF Research Database (Denmark)

    Busija, Lucy; Osborne, Richard H; Nilsdotter, Anna


    BACKGROUND: The Medical Outcomes General Health Survey (SF-36) is a widely used health status measure; however, limited evidence is available for its performance in orthopedic settings. The aim of this study was to examine the magnitude and meaningfulness of change and sensitivity of SF-36...

  1. Finding pathways to more equitable and meaningful public-scientist partnerships (United States)

    Daniela Soleri; Jonathan W. Long; Monica D. Ramirez-Andreotta; Ruth Eitemiller; Rajul Pandyaǁ


    For many, citizen science is exciting because of the possibility for more diverse, equitable partnerships in scientific research with outcomes considered meaningful and useful by all, including public participants. This was the focus of a symposium we organized at the 2015 conference of the Citizen Science Association. Here we synthesize points made by symposium...

  2. The categorisation of dysthymic disorder: Can its constituents be meaningfully apportioned?

    NARCIS (Netherlands)

    Rhebergen, D.; Graham, R.; Hadzi-Pavlovic, D.; Stek, M.L.; Friend, P.; Barrett, M.; Parker, G.


    Background: Since its introduction in DSM-III, the validity of dysthymia has been debated. Our objective is to further examine the concept of dysthymia in an outpatient sample, and explore whether its constituents can be meaningfully apportioned. Methods: 318 patients attending the Black Dog

  3. Mutually Beneficial Foreign Language Learning: Creating Meaningful Interactions through Video-Synchronous Computer-Mediated Communication (United States)

    Kato, Fumie; Spring, Ryan; Mori, Chikako


    Providing learners of a foreign language with meaningful opportunities for interactions, specifically with native speakers, is especially challenging for instructors. One way to overcome this obstacle is through video-synchronous computer-mediated communication tools such as Skype software. This study reports quantitative and qualitative data from…

  4. Meaningful Share Generation for Increased Number of Secrets in Visual Secret-Sharing Scheme

    Directory of Open Access Journals (Sweden)

    Mustafa Ulutas


    Full Text Available This paper presents a new scheme for hiding two halftone secret images into two meaningful shares created from halftone cover images. Meaningful shares are more desirable than noise-like (meaningless shares in Visual Secret Sharing because they look natural and do not attract eavesdroppers' attention. Previous works in the field focus on either increasing number of secrets or creating meaningful shares for one secret image. The method outlined in this paper both increases the number of secrets and creates meaningful shares at the same time. While the contrast ratio of shares is equal to that of Extended Visual Cryptography, two secrets are encoded into two shares as opposed to one secret in the Extended Visual Cryptography. Any two natural-looking images can be used as cover unlike the Halftone Visual Cryptography method where one cover should be the negative of the other cover image and can only encode one secret. Effectiveness of the proposed method is verified by an experiment.

  5. Mediating role of meaningful work between resources and work engagement in Bangladesh’s private banks

    Directory of Open Access Journals (Sweden)

    Nawrin Rubaba


    Full Text Available Engaged employees are considered as the most desired assets for the organization. Although significant contributions have been observed in the engagement literature, a holistic approach is yet to be untouched in terms of developing relationship between various resources, work engagement and psychological mechanism such as meaningful work. The purpose of this study is to explore the mediating role of meaningful work between resources and work engagement in private banks in Bangladesh. This study followed the quantitative methodological approach and based on Bakker and Demerouti’s (2007 Job demand-resources model. A survey questionnaire was prepared and used to collect data. 440 respondents participated in this study, who is currently working in private banks in Bangladesh. Multiple regression analysis along with Sobel test was performed to analyze the data. The findings confirmed that the relationships between organizational, job, personal resources and work engagement were partially mediated through meaningful work. It has been observed that all determinates had a significant influence on work engagement. For practical implications, the organization can align various resources to uplift the engagement level of the employees. Since meaningful work was found to be a significant predictor, managers can develop jobs where employees can relate their purpose to their work. This study recommends that future research can apply this model to different contexts as well as to different groups of respondents.

  6. Transforming City Schools through Art: Approaches to Meaningful K-12 Learning (United States)

    Hutzel, Karen; Bastos, Flavia M. C.; Cozier, Kimberly J.


    This anthology places art at the center of meaningful urban education reform. Providing a fresh perspective on urban education, the contributors describe a positive, asset-based community development model designed to tap into the teaching/learning potential already available in urban cities. Rather than focusing on a lack of resources, this…

  7. The association of meaningfulness, well-being, and engagement with absenteeism : A moderated mediation model

    NARCIS (Netherlands)

    Soane, E.; Shantz, A.; Alfes, K.; Truss, C.; Rees, C.; Gatenby, M.


    We theorized that absence from work is a resource-based process that is related to perceived meaningfulness of work, well-being, and engagement. Broaden-and-build theory (Fredrickson, 1998, 2001) and engagement theory (Bakker, Schaufeli, Leiter, & Taris, 2008; Kahn, 1990) were used to develop a

  8. The Right to Appropriate and Meaningful Education for Children with ASD (United States)

    Marshall, David; Goodall, Craig


    This paper will explore from a "child's rights perspective" the "right" of children with autistic spectrum disorder (ASD) to appropriate and meaningful education. Human "rights" principles within international law will be evaluated in relation to how they have been interpreted and applied in relation to achieving this…

  9. Measuring Meaningful Learning in the Undergraduate General Chemistry and Organic Chemistry Laboratories: A Longitudinal Study (United States)

    Galloway, Kelli R.; Bretz, Stacey Lowery


    Understanding how students learn in the undergraduate chemistry teaching laboratory is an essential component to developing evidence-based laboratory curricula. The Meaningful Learning in the Laboratory Instrument (MLLI) was developed to measure students' cognitive and affective expectations and experiences for learning in the chemistry…

  10. The Effect of Case Teaching on Meaningful and Retentive Learning When Studying Genetic Engineering (United States)

    Güccük, Ahmet; Köksal, Mustafa Serdar


    The purpose of this study is to investigate the effects of case teaching on how students learn about genetic engineering, in terms of meaningful learning and retention of learning. The study was designed as quasi-experimental research including 63 8th graders (28 boys and 35 girls). To collect data, genetic engineering achievement tests were…

  11. Does (Non-)Meaningful Sensori-Motor Engagement Promote Learning With Animated Physical Systems?

    NARCIS (Netherlands)

    Pouw, Wim T J L; Eielts, Charly; van Gog, Tamara; Zwaan, Rolf A.; Paas, Fred


    Previous research indicates that sensori-motor experience with physical systems can have a positive effect on learning. However, it is not clear whether this effect is caused by mere bodily engagement or the intrinsically meaningful information that such interaction affords in performing the

  12. Integrating Concept Mapping into Information Systems Education for Meaningful Learning and Assessment (United States)

    Wei, Wei; Yue, Kwok-Bun


    Concept map (CM) is a theoretically sound yet easy to learn tool and can be effectively used to represent knowledge. Even though many disciplines have adopted CM as a teaching and learning tool to improve learning effectiveness, its application in IS curriculum is sparse. Meaningful learning happens when one iteratively integrates new concepts and…

  13. Using Mobile Tools to Support Meaningful Work-based Learning in Vocational Education

    Directory of Open Access Journals (Sweden)

    Hanna Vuojärvi


    Full Text Available This case study focused on meaningful work-based learning (WBL and the pedagogical use of mobile information and communication technologies (ICTs in vocational tourism education. The aim was to reveal how teaching/tutoring and learning are realized and how the use of smartphones supports the realization of meaningful learning characteristics during WBL periods in highly versatile environments. Within a design-based research framework, the data was collected through learning journals written by students and qualitative interviews. The results of thematic analysis were used to develop a practice-oriented pedagogical model for meaningful WBL. The model visualizes the roles of students, teachers, and companies involved in WBL, the meaningful learning characteristics that can be amplified through the use of mobile ICTs, and the outcomes for each stakeholder. The model suggests structuring WBL through four negotiations involving a student, a teacher, and a company to assure that each student has clearly formulated learning goals and possibilities to pursue those goals regardless of the mobility of their work or facilities during their WBL period.

  14. Which role for Life Cycle Thinking in the definition of meaningful indicators for the circular economy?

    DEFF Research Database (Denmark)

    Niero, Monia


    at the micro level. We discuss the role of Life Cycle Thinking (LCT) in the development of meaningful circularity indicators at the product level taking into account the absolute perspective on CE. Our analysis is limited to the environmental aspect of sustainability with a focus on the climate change impact...

  15. Representing and Practising Meaningful Differences in a Well-Structured but Complex Art Curriculum (United States)

    Cunliffe, Leslie


    This paper conceptualizes the secondary art curriculum as a well-structured but complex knowledge-domain, with the aim of emphasizing meaningful differences in the way creative grammar operates in the following gatherings of art practices: Pre-historic and non-European cultures; Ancient and European cultures before c. 1800; Romantic and Modern…

  16. Application of Ausubel's Theory of Meaningful Verbal Learning to Curriculum, Teaching and Learning of Deaf Students. (United States)

    Biser, Eileen

    Implications of D. Ausubel's Theory of Meaningful Verbal Learning and its derivative, the Advance Organizer Model of Teaching, for deaf students are examined. Ausubel believes that complex intellectual processes (thinking, language, problem-solving, concept formation) are the major aspects of learning, and that primary emphasis should be placed on…

  17. Meaningful cultural learning by imitative participation: the case of abstract thinking in primary school

    NARCIS (Netherlands)

    van Oers, B.


    The article describes a theory-driven approach to meaningful learning in primary schools, based on the Vygotskian cultural-historical theory of human development and learning. This approach is elaborated into an educational concept called 'developmental education' that is implemented in the

  18. Security, Dignity, Caring Relationships, and Meaningful Work: Needs Motivating Participation in a Job-Training Program (United States)

    Ayers, David F.; Miller-Dyce, Cherrel; Carlone, David


    Researchers asked 17 participants in a job-training program to describe their personal struggles following an economic restructuring. Examined through a critical theoretical lens, findings indicate that the learners enrolled in the program to reclaim security, dignity, meaningful work, and caring relationships. Program planners at community…

  19. Approach to DOE threshold guidance limits

    International Nuclear Information System (INIS)

    Shuman, R.D.; Wickham, L.E.


    The need for less restrictive criteria governing disposal of extremely low-level radioactive waste has long been recognized. The Low-Level Waste Management Program has been directed by the Department of Energy (DOE) to aid in the development of a threshold guidance limit for DOE low-level waste facilities. Project objectives are concernd with the definition of a threshold limit dose and pathway analysis of radionuclide transport within selected exposure scenarios at DOE sites. Results of the pathway analysis will be used to determine waste radionuclide concentration guidelines that meet the defined threshold limit dose. Methods of measurement and verification of concentration limits round out the project's goals. Work on defining a threshold limit dose is nearing completion. Pathway analysis of sanitary landfill operations at the Savannah River Plant and the Idaho National Engineering Laboratory is in progress using the DOSTOMAN computer code. Concentration limit calculations and determination of implementation procedures shall follow completion of the pathways work. 4 references

  20. Pion photoproduction on the nucleon at threshold

    International Nuclear Information System (INIS)

    Cheon, I.T.; Jeong, M.T.


    Electric dipole amplitudes of pion photoproduction on the nucleon at threshold have been calculated in the framework of the chiral bag model. Our results are in good agreement with the existing experimental data

  1. Effect of dissipation on dynamical fusion thresholds

    International Nuclear Information System (INIS)

    Sierk, A.J.


    The existence of dynamical thresholds to fusion in heavy nuclei (A greater than or equal to 200) due to the nature of the potential-energy surface is shown. These thresholds exist even in the absence of dissipative forces, due to the coupling between the various collective deformation degrees of freedom. Using a macroscopic model of nuclear shape dynamics, It is shown how three different suggested dissipation mechanisms increase by varying amounts the excitation energy over the one-dimensional barrier required to cause compound-nucleus formation. The recently introduced surface-plus-window dissipation may give a reasonable representation of experimental data on fusion thresholds, in addition to properly describing fission-fragment kinetic energies and isoscalar giant multipole widths. Scaling of threshold results to asymmetric systems is discussed. 48 refs., 10 figs

  2. 40 CFR 98.411 - Reporting threshold. (United States)


    ...) MANDATORY GREENHOUSE GAS REPORTING Suppliers of Industrial Greenhouse Gases § 98.411 Reporting threshold. Any supplier of industrial greenhouse gases who meets the requirements of § 98.2(a)(4) must report GHG...

  3. Melanin microcavitation threshold in the near infrared (United States)

    Schmidt, Morgan S.; Kennedy, Paul K.; Vincelette, Rebecca L.; Schuster, Kurt J.; Noojin, Gary D.; Wharmby, Andrew W.; Thomas, Robert J.; Rockwell, Benjamin A.


    Thresholds for microcavitation of isolated bovine and porcine melanosomes were determined using single nanosecond (ns) laser pulses in the NIR (1000 - 1319 nm) wavelength regime. Average fluence thresholds for microcavitation increased non-linearly with increasing wavelength. Average fluence thresholds were also measured for 10-ns pulses at 532 nm, and found to be comparable to visible ns pulse values published in previous reports. Fluence thresholds were used to calculate melanosome absorption coefficients, which decreased with increasing wavelength. This trend was found to be comparable to the decrease in retinal pigmented epithelial (RPE) layer absorption coefficients reported over the same wavelength region. Estimated corneal total intraocular energy (TIE) values were determined and compared to the current and proposed maximum permissible exposure (MPE) safe exposure levels. Results from this study support the proposed changes to the MPE levels.

  4. Secure information management using linguistic threshold approach

    CERN Document Server

    Ogiela, Marek R


    This book details linguistic threshold schemes for information sharing. It examines the opportunities of using these techniques to create new models of managing strategic information shared within a commercial organisation or a state institution.

  5. Robust Adaptive Thresholder For Document Scanning Applications (United States)

    Hsing, To R.


    In document scanning applications, thresholding is used to obtain binary data from a scanner. However, due to: (1) a wide range of different color backgrounds; (2) density variations of printed text information; and (3) the shading effect caused by the optical systems, the use of adaptive thresholding to enhance the useful information is highly desired. This paper describes a new robust adaptive thresholder for obtaining valid binary images. It is basically a memory type algorithm which can dynamically update the black and white reference level to optimize a local adaptive threshold function. The results of high image quality from different types of simulate test patterns can be obtained by this algorithm. The software algorithm is described and experiment results are present to describe the procedures. Results also show that the techniques described here can be used for real-time signal processing in the varied applications.

  6. Recent progress in understanding climate thresholds

    NARCIS (Netherlands)

    Good, Peter; Bamber, Jonathan; Halladay, Kate; Harper, Anna B.; Jackson, Laura C.; Kay, Gillian; Kruijt, Bart; Lowe, Jason A.; Phillips, Oliver L.; Ridley, Jeff; Srokosz, Meric; Turley, Carol; Williamson, Phillip


    This article reviews recent scientific progress, relating to four major systems that could exhibit threshold behaviour: ice sheets, the Atlantic meridional overturning circulation (AMOC), tropical forests and ecosystem responses to ocean acidification. The focus is on advances since the

  7. Verifiable Secret Redistribution for Threshold Sharing Schemes

    National Research Council Canada - National Science Library

    Wong, Theodore M; Wang, Chenxi; Wing, Jeannette M


    .... Our protocol guards against dynamic adversaries. We observe that existing protocols either cannot be readily extended to allow redistribution between different threshold schemes, or have vulnerabilities that allow faulty old shareholders...

  8. Thresholding projection estimators in functional linear models


    Cardot, Hervé; Johannes, Jan


    We consider the problem of estimating the regression function in functional linear regression models by proposing a new type of projection estimators which combine dimension reduction and thresholding. The introduction of a threshold rule allows to get consistency under broad assumptions as well as minimax rates of convergence under additional regularity hypotheses. We also consider the particular case of Sobolev spaces generated by the trigonometric basis which permits to get easily mean squ...

  9. Noise thresholds for optical quantum computers. (United States)

    Dawson, Christopher M; Haselgrove, Henry L; Nielsen, Michael A


    In this Letter we numerically investigate the fault-tolerant threshold for optical cluster-state quantum computing. We allow both photon loss noise and depolarizing noise (as a general proxy for all local noise), and obtain a threshold region of allowed pairs of values for the two types of noise. Roughly speaking, our results show that scalable optical quantum computing is possible for photon loss probabilities <3 x 10(-3), and for depolarization probabilities <10(-4).

  10. Design of Threshold Controller Based Chaotic Circuits

    DEFF Research Database (Denmark)

    Mohamed, I. Raja; Murali, K.; Sinha, Sudeshna


    We propose a very simple implementation of a second-order nonautonomous chaotic oscillator, using a threshold controller as the only source of nonlinearity. We demonstrate the efficacy and simplicity of our design through numerical and experimental results. Further, we show that this approach...... of using a threshold controller as a nonlinear element, can be extended to obtain autonomous and multiscroll chaotic attractor circuits as well....

  11. Annotating spatio-temporal datasets for meaningful analysis in the Web (United States)

    Stasch, Christoph; Pebesma, Edzer; Scheider, Simon


    More and more environmental datasets that vary in space and time are available in the Web. This comes along with an advantage of using the data for other purposes than originally foreseen, but also with the danger that users may apply inappropriate analysis procedures due to lack of important assumptions made during the data collection process. In order to guide towards a meaningful (statistical) analysis of spatio-temporal datasets available in the Web, we have developed a Higher-Order-Logic formalism that captures some relevant assumptions in our previous work [1]. It allows to proof on meaningful spatial prediction and aggregation in a semi-automated fashion. In this poster presentation, we will present a concept for annotating spatio-temporal datasets available in the Web with concepts defined in our formalism. Therefore, we have defined a subset of the formalism as a Web Ontology Language (OWL) pattern. It allows capturing the distinction between the different spatio-temporal variable types, i.e. point patterns, fields, lattices and trajectories, that in turn determine whether a particular dataset can be interpolated or aggregated in a meaningful way using a certain procedure. The actual annotations that link spatio-temporal datasets with the concepts in the ontology pattern are provided as Linked Data. In order to allow data producers to add the annotations to their datasets, we have implemented a Web portal that uses a triple store at the backend to store the annotations and to make them available in the Linked Data cloud. Furthermore, we have implemented functions in the statistical environment R to retrieve the RDF annotations and, based on these annotations, to support a stronger typing of spatio-temporal datatypes guiding towards a meaningful analysis in R. [1] Stasch, C., Scheider, S., Pebesma, E., Kuhn, W. (2014): "Meaningful spatial prediction and aggregation", Environmental Modelling & Software, 51, 149-165.

  12. Enhancing the Meaningfulness of Work for Astronauts on Long Duration Space Exploration Missions. (United States)

    Britt, Thomas W; Sytine, Anton; Brady, Ashley; Wilkes, Russ; Pittman, Rebecca; Jennings, Kristen; Goguen, Kandice


    Numerous authors have identified the stressors likely to be encountered on long duration space exploration missions (e.g., to Mars), including the possibility of significant crises, separation from family, boredom/monotony, and interpersonal conflict. Although many authors have noted that meaningful work may be beneficial for astronauts on these missions, none have detailed the sources of meaningful work for astronauts and how these sources may differ between astronauts. The present article identifies how engagement in meaningful work during long duration missions may mitigate the adverse effects of demands and increase the potential for benefits resulting from the missions. Semistructured interviews were conducted with nine NASA personnel, including astronauts, flight directors, and flight surgeons. Questions addressed sources of meaning for astronauts, characteristics of tasks that enhance vs. detract from meaning, and recommendations for enhancing meaning. Personnel mentioned contributing to humanity and the next generation, contributing to the mission, and exploration as the most meaningful aspects of their work. Characteristics of tasks that enhanced meaning included using a variety of skills, feeling personal control over their schedule, autonomy in the execution of tasks, and understanding the importance of the experiments conducted on the mission. Top recommendations to sustain meaning were insuring social needs were met through such activities as the strategic use of social media, giving astronauts autonomy as well as structure, and conducting training during transit. Implications are addressed for tailoring meaning-based interventions for astronauts participating on long duration missions and assessing the effectiveness of these interventions.Britt TW, Sytine A, Brady A, Wilkes R, Pittman R, Jennings K, Goguen K. Enhancing the meaningfulness of work for astronauts on long duration space exploration missions. Aerosp Med Hum Perform. 2017; 88(8):779-783.

  13. Hospital IT adoption strategies associated with implementation success: implications for achieving meaningful use. (United States)

    Ford, Eric W; Menachemi, Nir; Huerta, Timothy R; Yu, Feliciano


    Health systems are facing significant pressure to either implement health information technology (HIT) systems that have "certified" electronic health record applications and that fulfill the federal government's definition of "meaningful use" or risk substantial financial penalties in the near future. To this end, hospitals have adopted one of three strategies, described as "best of breed," "best of suite," and "single vendor," to meet organizational and regulatory demands. The single-vendor strategy is used by the simple majority of U.S. hospitals, but is it the most effective mode for achieving full implementation? Moreover, what are the implications of adopting this strategy for achieving meaningful use? The simple answer to the first question is that the hospitals using the hybrid best of suite strategy had fully implemented HIT systems in significantly greater proportions than did hospitals employing either of the other strategies. Nonprofit and system-affiliated hospitals were more likely to have fully implemented their HIT systems. In addition, increased health maintenance organization market penetration rates were positively correlated with complete implementation rates. These results have ongoing implications for achieving meaningful use in the near term. The federal government's rewards and incentives program related to the meaningful use of HIT in hospitals has created an organizational imperative to implement such systems. For hospitals that have not begun systemwide implementation, pursuing a best of suite strategy may provide the greatest chance for achieving all or some of the meaningful use targets in the near term or at least avoiding future penalties scheduled to begin in 2015.

  14. Meaningful Words and Non-Words Repetitive Articulatory Rate (Oral Diadochokinesis) in Persian Speaking Children. (United States)

    Zamani, Peyman; Rezai, Hossein; Garmatani, Neda Tahmasebi


    Repetitive articulatory rate or Oral Diadochokinesis (oral-DDK) shows a guideline for appraisal and diagnosis of subjects with oral-motor disorder. Traditionally, meaningless words repetition has been utilized in this task and preschool children have challenges with them. Therefore, we aimed to determine some meaningful words in order to test oral-DDK in Persian speaking preschool children. Participants were 142 normally developing children, (age range 4-6 years), who were asked to produce /motæka, golabi/ as two meaningful Persian words and /pa-ta-ka/ as non-word in conventional oral-DDK task. We compared the time taken for 10-times fast repetitions of two meaningful Persian words and the tri-syllabic nonsense word /pa-ta-ka/. Praat software was used to calculate the average time that subjects took to produce the target items. In 4-5 year old children, [Formula: see text] of time taken for 10-times repetitions of /pa-ta-ka, motæka, golabi/ were [Formula: see text], and [Formula: see text] seconds respectively, and in 5-6 year old children were [Formula: see text], and [Formula: see text] seconds respectively. Findings showed that the main effect of type of words on oral diadochokinesis was significant ([Formula: see text]). Children repeated meaningful words /motæka, golabi/ faster than the non-word /pa-ta-ka/. Sex and age factors had no effect on time taken for repetition of oral-DDK test. It is suggested that Speech Therapists can use meaningful words to facilitate oral-DDK test for children.

  15. Modelling the regulatory system for diabetes mellitus with a threshold window (United States)

    Yang, Jin; Tang, Sanyi; Cheke, Robert A.


    Piecewise (or non-smooth) glucose-insulin models with threshold windows for type 1 and type 2 diabetes mellitus are proposed and analyzed with a view to improving understanding of the glucose-insulin regulatory system. For glucose-insulin models with a single threshold, the existence and stability of regular, virtual, pseudo-equilibria and tangent points are addressed. Then the relations between regular equilibria and a pseudo-equilibrium are studied. Furthermore, the sufficient and necessary conditions for the global stability of regular equilibria and the pseudo-equilibrium are provided by using qualitative analysis techniques of non-smooth Filippov dynamic systems. Sliding bifurcations related to boundary node bifurcations were investigated with theoretical and numerical techniques, and insulin clinical therapies are discussed. For glucose-insulin models with a threshold window, the effects of glucose thresholds or the widths of threshold windows on the durations of insulin therapy and glucose infusion were addressed. The duration of the effects of an insulin injection is sensitive to the variation of thresholds. Our results indicate that blood glucose level can be maintained within a normal range using piecewise glucose-insulin models with a single threshold or a threshold window. Moreover, our findings suggest that it is critical to individualise insulin therapy for each patient separately, based on initial blood glucose levels.

  16. A New Wavelet Threshold Function and Denoising Application

    Directory of Open Access Journals (Sweden)

    Lu Jing-yi


    Full Text Available In order to improve the effects of denoising, this paper introduces the basic principles of wavelet threshold denoising and traditional structures threshold functions. Meanwhile, it proposes wavelet threshold function and fixed threshold formula which are both improved here. First, this paper studies the problems existing in the traditional wavelet threshold functions and introduces the adjustment factors to construct the new threshold function basis on soft threshold function. Then, it studies the fixed threshold and introduces the logarithmic function of layer number of wavelet decomposition to design the new fixed threshold formula. Finally, this paper uses hard threshold, soft threshold, Garrote threshold, and improved threshold function to denoise different signals. And the paper also calculates signal-to-noise (SNR and mean square errors (MSE of the hard threshold functions, soft thresholding functions, Garrote threshold functions, and the improved threshold function after denoising. Theoretical analysis and experimental results showed that the proposed approach could improve soft threshold functions with constant deviation and hard threshold with discontinuous function problems. The proposed approach could improve the different decomposition scales that adopt the same threshold value to deal with the noise problems, also effectively filter the noise in the signals, and improve the SNR and reduce the MSE of output signals.

  17. Pain flare following external beam radiotherapy and meaningful change in pain scores in the treatment of bone metastases

    International Nuclear Information System (INIS)

    Chow, Edward; Ling, Alison; Davis, Lori; Panzarella, Tony; Danjoux, Cyril


    Background and purpose: To examine the incidence of pain flare following external beam radiotherapy and to determine what constitutes a meaningful change in pain scores in the treatment of bone metastases. Patients and methods: Patients with bone metastases treated with external beam radiotherapy were asked to score their pain on a scale of 0-10 before the treatment (baseline), daily during the treatment and for 10 days after completion of external beam radiation. Pain flare was defined as a two-point increase from baseline pain in the pain scale of 0-10 with no decrease in analgesic intake or a 25% increase in analgesic intake employing daily oral morphine equivalent with no decrease in pain score. To distinguish pain flare from progression of pain, we required the pain score and analgesic intake to return back to baseline levels after the increase/flare. They were also asked to indicate if their pain changed during that time compared to pre-treatment level. The change in pain score was compared with patient perception. Results: Eighty-eight patients were evaluated in this study. There were 49 male and 39 female patients with the median age of 70 years. Twelve of 88 patients (14%) had pain flare on day 1. The overall incidence of pain flare during the study period ranged from 2 to 16%. A total of 797 pain scorings were obtained. Patients perceived an improvement in pain when their self-reported pain score decreased by at least two points. Conclusions: Our study confirms the occurrence of pain flare following the external beam radiotherapy in the treatment of bone metastases. Further studies are required to predict who are at risk for flare. Appropriate measures can be taken to alleviate the pain flare. The finding in the meaningful change in pain scores supports the investigator-defined partial response used in some clinical trials

  18. Effects of programming threshold and maplaw settings on acoustic thresholds and speech discrimination with the MED-EL COMBI 40+ cochlear implant. (United States)

    Boyd, Paul J


    The principal task in the programming of a cochlear implant (CI) speech processor is the setting of the electrical dynamic range (output) for each electrode, to ensure that a comfortable loudness percept is obtained for a range of input levels. This typically involves separate psychophysical measurement of electrical threshold ([theta] e) and upper tolerance levels using short current bursts generated by the fitting software. Anecdotal clinical experience and some experimental studies suggest that the measurement of [theta]e is relatively unimportant and that the setting of upper tolerance limits is more critical for processor programming. The present study aims to test this hypothesis and examines in detail how acoustic thresholds and speech recognition are affected by setting of the lower limit of the output ("Programming threshold" or "PT") to understand better the influence of this parameter and how it interacts with certain other programming parameters. Test programs (maps) were generated with PT set to artificially high and low values and tested on users of the MED-EL COMBI 40+ CI system. Acoustic thresholds and speech recognition scores (sentence tests) were measured for each of the test maps. Acoustic thresholds were also measured using maps with a range of output compression functions ("maplaws"). In addition, subjective reports were recorded regarding the presence of "background threshold stimulation" which is occasionally reported by CI users if PT is set to relatively high values when using the CIS strategy. Manipulation of PT was found to have very little effect. Setting PT to minimum produced a mean 5 dB (S.D. = 6.25) increase in acoustic thresholds, relative to thresholds with PT set normally, and had no statistically significant effect on speech recognition scores on a sentence test. On the other hand, maplaw setting was found to have a significant effect on acoustic thresholds (raised as maplaw is made more linear), which provides some theoretical

  19. Variable threshold method for ECG R-peak detection. (United States)

    Kew, Hsein-Ping; Jeong, Do-Un


    In this paper, a wearable belt-type ECG electrode worn around the chest by measuring the real-time ECG is produced in order to minimize the inconvenient in wearing. ECG signal is detected using a potential instrument system. The measured ECG signal is transmits via an ultra low power consumption wireless data communications unit to personal computer using Zigbee-compatible wireless sensor node. ECG signals carry a lot of clinical information for a cardiologist especially the R-peak detection in ECG. R-peak detection generally uses the threshold value which is fixed. There will be errors in peak detection when the baseline changes due to motion artifacts and signal size changes. Preprocessing process which includes differentiation process and Hilbert transform is used as signal preprocessing algorithm. Thereafter, variable threshold method is used to detect the R-peak which is more accurate and efficient than fixed threshold value method. R-peak detection using MIT-BIH databases and Long Term Real-Time ECG is performed in this research in order to evaluate the performance analysis.

  20. Extended high-frequency thresholds in college students: effects of music player use and other recreational noise. (United States)

    Le Prell, Colleen G; Spankovich, Christopher; Lobariñas, Edward; Griffiths, Scott K


    Human hearing is sensitive to sounds from as low as 20 Hz to as high as 20,000 Hz in normal ears. However, clinical tests of human hearing rarely include extended high-frequency (EHF) threshold assessments, at frequencies extending beyond 8000 Hz. EHF thresholds have been suggested for use monitoring the earliest effects of noise on the inner ear, although the clinical usefulness of EHF threshold testing is not well established for this purpose. The primary objective of this study was to determine if EHF thresholds in healthy, young adult college students vary as a function of recreational noise exposure. A retrospective analysis of a laboratory database was conducted; all participants with both EHF threshold testing and noise history data were included. The potential for "preclinical" EHF deficits was assessed based on the measured thresholds, with the noise surveys used to estimate recreational noise exposure. EHF thresholds measured during participation in other ongoing studies were available from 87 participants (34 male and 53 female); all participants had hearing within normal clinical limits (≤25 HL) at conventional frequencies (0.25-8 kHz). EHF thresholds closely matched standard reference thresholds [ANSI S3.6 (1996) Annex C]. There were statistically reliable threshold differences in participants who used music players, with 3-6 dB worse thresholds at the highest test frequencies (10-16 kHz) in participants who reported long-term use of music player devices (>5 yr), or higher listening levels during music player use. It should be possible to detect small changes in high-frequency hearing for patients or participants who undergo repeated testing at periodic intervals. However, the increased population-level variability in thresholds at the highest frequencies will make it difficult to identify the presence of small but potentially important deficits in otherwise normal-hearing individuals who do not have previously established baseline data. American

  1. Why are clinicians not embracing the results from pivotal clinical trials in severe sepsis? A bayesian analysis.

    Directory of Open Access Journals (Sweden)

    Andre C Kalil

    Full Text Available BACKGROUND: Five pivotal clinical trials (Intensive Insulin Therapy; Recombinant Human Activated Protein C [rhAPC]; Low-Tidal Volume; Low-Dose Steroid; Early Goal-Directed Therapy [EGDT] demonstrated mortality reduction in patients with severe sepsis and expert guidelines have recommended them to clinical practice. Yet, the adoption of these therapies remains low among clinicians. OBJECTIVES: We selected these five trials and asked: Question 1--What is the current probability that the new therapy is not better than the standard of care in my patient with severe sepsis? Question 2--What is the current probability of reducing the relative risk of death (RRR of my patient with severe sepsis by meaningful clinical thresholds (RRR >15%; >20%; >25%? METHODS: Bayesian methodologies were applied to this study. Odds ratio (OR was considered for Question 1, and RRR was used for Question 2. We constructed prior distributions (enthusiastic; mild, moderate, and severe skeptic based on various effective sample sizes of other relevant clinical trials (unfavorable evidence. Posterior distributions were calculated by combining the prior distributions and the data from pivotal trials (favorable evidence. MAIN FINDINGS: Answer 1--The analysis based on mild skeptic prior shows beneficial results with the Intensive Insulin, rhAPC, and Low-Tidal Volume trials, but not with the Low-Dose Steroid and EGDT trials. All trials' results become unacceptable by the analyses using moderate or severe skeptic priors. Answer 2--If we aim for a RRR>15%, the mild skeptic analysis shows that the current probability of reducing death by this clinical threshold is 88% for the Intensive Insulin, 62-65% for the Low-Tidal Volume, rhAPC, EGDT trials, and 17% for the Low-Dose Steroid trial. The moderate and severe skeptic analyses show no clinically meaningful reduction in the risk of death for all trials. If we aim for a RRR >20% or >25%, all probabilities of benefits become lower

  2. Identifying Threshold Concepts for Information Literacy: A Delphi Study

    Directory of Open Access Journals (Sweden)

    Lori Townsend


    Full Text Available This study used the Delphi method to engage expert practitioners on the topic of threshold concepts for information literacy. A panel of experts considered two questions. First, is the threshold concept approach useful for information literacy instruction? The panel unanimously agreed that the threshold concept approach holds potential for information literacy instruction. Second, what are the threshold concepts for information literacy instruction? The panel proposed and discussed over fifty potential threshold concepts, finally settling on six information literacy threshold concepts.

  3. QRS Detection Based on Improved Adaptive Threshold

    Directory of Open Access Journals (Sweden)

    Xuanyu Lu


    Full Text Available Cardiovascular disease is the first cause of death around the world. In accomplishing quick and accurate diagnosis, automatic electrocardiogram (ECG analysis algorithm plays an important role, whose first step is QRS detection. The threshold algorithm of QRS complex detection is known for its high-speed computation and minimized memory storage. In this mobile era, threshold algorithm can be easily transported into portable, wearable, and wireless ECG systems. However, the detection rate of the threshold algorithm still calls for improvement. An improved adaptive threshold algorithm for QRS detection is reported in this paper. The main steps of this algorithm are preprocessing, peak finding, and adaptive threshold QRS detecting. The detection rate is 99.41%, the sensitivity (Se is 99.72%, and the specificity (Sp is 99.69% on the MIT-BIH Arrhythmia database. A comparison is also made with two other algorithms, to prove our superiority. The suspicious abnormal area is shown at the end of the algorithm and RR-Lorenz plot drawn for doctors and cardiologists to use as aid for diagnosis.

  4. Cost-effectiveness thresholds: pros and cons. (United States)

    Bertram, Melanie Y; Lauer, Jeremy A; De Joncheere, Kees; Edejer, Tessa; Hutubessy, Raymond; Kieny, Marie-Paule; Hill, Suzanne R


    Cost-effectiveness analysis is used to compare the costs and outcomes of alternative policy options. Each resulting cost-effectiveness ratio represents the magnitude of additional health gained per additional unit of resources spent. Cost-effectiveness thresholds allow cost-effectiveness ratios that represent good or very good value for money to be identified. In 2001, the World Health Organization's Commission on Macroeconomics in Health suggested cost-effectiveness thresholds based on multiples of a country's per-capita gross domestic product (GDP). In some contexts, in choosing which health interventions to fund and which not to fund, these thresholds have been used as decision rules. However, experience with the use of such GDP-based thresholds in decision-making processes at country level shows them to lack country specificity and this - in addition to uncertainty in the modelled cost-effectiveness ratios - can lead to the wrong decision on how to spend health-care resources. Cost-effectiveness information should be used alongside other considerations - e.g. budget impact and feasibility considerations - in a transparent decision-making process, rather than in isolation based on a single threshold value. Although cost-effectiveness ratios are undoubtedly informative in assessing value for money, countries should be encouraged to develop a context-specific process for decision-making that is supported by legislation, has stakeholder buy-in, for example the involvement of civil society organizations and patient groups, and is transparent, consistent and fair.

  5. At-Risk-of-Poverty Threshold

    Directory of Open Access Journals (Sweden)

    Táňa Dvornáková


    Full Text Available European Statistics on Income and Living Conditions (EU-SILC is a survey on households’ living conditions. The main aim of the survey is to get long-term comparable data on social and economic situation of households. Data collected in the survey are used mainly in connection with the evaluation of income poverty and determinationof at-risk-of-poverty rate. This article deals with the calculation of the at risk-of-poverty threshold based on data from EU-SILC 2009. The main task is to compare two approaches to the computation of at riskof-poverty threshold. The first approach is based on the calculation of the threshold for each country separately,while the second one is based on the calculation of the threshold for all states together. The introduction summarizes common attributes in the calculation of the at-risk-of-poverty threshold, such as disposable household income, equivalised household income. Further, different approaches to both calculations are introduced andadvantages and disadvantages of these approaches are stated. Finally, the at-risk-of-poverty rate calculation is described and comparison of the at-risk-of-poverty rates based on these two different approaches is made.

  6. Threshold concepts in finance: student perspectives (United States)

    Hoadley, Susan; Kyng, Tim; Tickle, Leonie; Wood, Leigh N.


    Finance threshold concepts are the essential conceptual knowledge that underpin well-developed financial capabilities and are central to the mastery of finance. In this paper we investigate threshold concepts in finance from the point of view of students, by establishing the extent to which students are aware of threshold concepts identified by finance academics. In addition, we investigate the potential of a framework of different types of knowledge to differentiate the delivery of the finance curriculum and the role of modelling in finance. Our purpose is to identify ways to improve curriculum design and delivery, leading to better student outcomes. Whilst we find that there is significant overlap between what students identify as important in finance and the threshold concepts identified by academics, much of this overlap is expressed by indirect reference to the concepts. Further, whilst different types of knowledge are apparent in the student data, there is evidence that students do not necessarily distinguish conceptual from other types of knowledge. As well as investigating the finance curriculum, the research demonstrates the use of threshold concepts to compare and contrast student and academic perceptions of a discipline and, as such, is of interest to researchers in education and other disciplines.

  7. Calculating the dim light melatonin onset: the impact of threshold and sampling rate. (United States)

    Molina, Thomas A; Burgess, Helen J


    The dim light melatonin onset (DLMO) is the most reliable circadian phase marker in humans, but the cost of assaying samples is relatively high. Therefore, the authors examined differences between DLMOs calculated from hourly versus half-hourly sampling and differences between DLMOs calculated with two recommended thresholds (a fixed threshold of 3 pg/mL and a variable "3k" threshold equal to the mean plus two standard deviations of the first three low daytime points). The authors calculated these DLMOs from salivary dim light melatonin profiles collected from 122 individuals (64 women) at baseline. DLMOs derived from hourly sampling occurred on average only 6-8 min earlier than the DLMOs derived from half-hourly saliva sampling, and they were highly correlated with each other (r ≥ 0.89, p 30 min from the DLMO derived from half-hourly sampling. The 3 pg/mL threshold produced significantly less variable DLMOs than the 3k threshold. However, the 3k threshold was significantly lower than the 3 pg/mL threshold (p < .001). The DLMOs calculated with the 3k method were significantly earlier (by 22-24 min) than the DLMOs calculated with the 3 pg/mL threshold, regardless of sampling rate. These results suggest that in large research studies and clinical settings, the more affordable and practical option of hourly sampling is adequate for a reasonable estimate of circadian phase. Although the 3 pg/mL fixed threshold is less variable than the 3k threshold, it produces estimates of the DLMO that are further from the initial rise of melatonin.

  8. Designing meaningful educational spaces for the development of competencies in childhood

    Directory of Open Access Journals (Sweden)

    Yenny Otálora Sevilla


    Full Text Available A meaningful educational space is a learning environment that promotes and strengthens the development of social and cognitive competencies in children. This article offers conceptual and methodological elements from Educational Psychology that facilitates the design of significant educational spaces for the development of child competencies, both in and out of school. On the one hand, the learning environment is defined as a dynamic and complex space of construction of knowledge. On the other it takes into account some considerations about child development which help set five criteria to characterize learning environments as meaningful educational spaces: They are structured, intensive, extensive, generative and interactive situations. Each of these criteria is illustrated through learning environments designed by educators in Colombia, based on the use of cultural practices inherent their communities of origin. Cultural practices were found to be relevant to the development of their children’s competencies.

  9. Meaningful metrics a 21st-century librarian's guide to bibliometrics, altmetrics, and research impact

    CERN Document Server

    Roemer, Robin Chin


    What does it mean to have meaningful metrics in today's complex higher education landscape? With a foreword by Heather Piwowar and Jason Priem, this highly engaging and activity-laden book serves to introduce readers to the fast-paced world of research metrics from the unique perspective of academic librarians and LIS practitioners. Starting with the essential histories of bibliometrics and altmetrics, and continuing with in-depth descriptions of the core tools and emerging issues at stake in the future of both fields, Meaningful Metrics is a convenient all-in-one resource that is designed to be used by a range of readers, from those with little to no background on the subject to those looking to become movers and shakers in the current scholarly metrics movement. Authors Borchardt and Roemer, offer tips, tricks, and real-world examples illustrate how librarians can support the successful adoption of research metrics, whether in their institutions or across academia as a whole.

  10. The co-creation of meaningful action: bridging enaction and interactional sociology (United States)

    Peräkylä, Anssi; Stevanovic, Melisa


    What makes possible the co-creation of meaningful action? In this paper, we go in search of an answer to this question by combining insights from interactional sociology and enaction. Both research schools investigate social interactions as such, and conceptualize their organization in terms of autonomy. We ask what it could mean for an interaction to be autonomous, and discuss the structures and processes that contribute to and are maintained in the so-called interaction order. We also discuss the role played by individual vulnerability as well as the vulnerability of social interaction processes in the co-creation of meaningful action. Finally, we outline some implications of this interdisciplinary fraternization for the empirical study of social understanding, in particular in social neuroscience and psychology, pointing out the need for studies based on dynamic systems approaches on origins and references of coordination, and experimental designs to help understand human co-presence. PMID:27069055

  11. Social networking for language learners: Creating meaningful output with Web 2.0 tools

    Directory of Open Access Journals (Sweden)

    Robert Chartrand


    Full Text Available The Internet has the potential to provide language learners with vast resources of authentic written, audio, and video materials to supplement lessons. Educators can find a wide assortment of materials for learners to study in class or after class for independent learning and to encourage learner autonomy. More recently, however, the immense popularity of social networking websites has created new opportunities for language learners to interact in authentic ways that were previously difficult to achieve. Advances in technology mean that today, learners of a language can easily interact with their peers in meaningful practice that helps foster language acquisition and motivation. That is, tasks that make use of Web 2.0 interactivity can significantly raise students’ potential to generate meaningful output and stimulate their interest in language learning.

  12. The Meaningful Roles Intervention: An Evolutionary Approach to Reducing Bullying and Increasing Prosocial Behavior. (United States)

    Ellis, Bruce J; Volk, Anthony A; Gonzalez, Jose-Michael; Embry, Dennis D


    Bullying is a problem that affects adolescents worldwide. Efforts to prevent bullying have been moderately successful at best, or iatrogenic at worst. We offer an explanation for this limited success by employing an evolutionary-psychological perspective to analyze antibullying interventions. We argue that bullying is a goal-directed behavior that is sensitive to benefits as well as costs, and that interventions must address these benefits. This perspective led us to develop a novel antibullying intervention, Meaningful Roles, which offers bullies prosocial alternatives-meaningful roles and responsibilities implemented through a school jobs program and reinforced through peer-to-peer praise notes-that effectively meet the same status goals as bullying behavior. We describe this new intervention and how its theoretical evolutionary roots may be applicable to other intervention programs. © 2015 The Authors. Journal of Research on Adolescence © 2015 Society for Research on Adolescence.

  13. The co-creation of meaningful action: bridging enaction and interactional sociology. (United States)

    De Jaegher, Hanne; Peräkylä, Anssi; Stevanovic, Melisa


    What makes possible the co-creation of meaningful action? In this paper, we go in search of an answer to this question by combining insights from interactional sociology and enaction. Both research schools investigate social interactions as such, and conceptualize their organization in terms of autonomy. We ask what it could mean for an interaction to be autonomous, and discuss the structures and processes that contribute to and are maintained in the so-called interaction order. We also discuss the role played by individual vulnerability as well as the vulnerability of social interaction processes in the co-creation of meaningful action. Finally, we outline some implications of this interdisciplinary fraternization for the empirical study of social understanding, in particular in social neuroscience and psychology, pointing out the need for studies based on dynamic systems approaches on origins and references of coordination, and experimental designs to help understand human co-presence. © 2016 The Authors.

  14. Engaging Axiology: Enabling MeaningfulTransdisciplinary Collaboration in Adapted Physical Activity. (United States)

    Peers, Danielle


    In this article, I explore the concept of axiology in the context of adapted physical activity research and analyze its connection to the more commonly discussed paradigmatic assumptions of epistemology and ontology. Following methodological scholars, I argue for an acknowledgment of the pivotal role that axiology already plays in adapted physical activity research and for the potential interdisciplinary and transdisciplinary opportunities that could be enabled by engaging with axiology in more explicit ways. I discuss a number of potential axiological gaps between the field of adapted physical activity and disability communities, arguing that such differences may undermine attempts at doing meaningful transdisciplinary research with such communities. I offer strategies for bridging these axiological gaps, encouraging us to work together in axiologically reflexive ways in order to increase meaningful opportunities for more people with disabilities to be engaged in the movement-based activities and communities of their choice.

  15. Qualitative Insights from a Canadian Multiinstitutional Research Study: In Search of Meaningful E-learning


    Lorraine M. Carter; Vince Salyers; Sue Myers; Carol Hipfner; Caroline Hoffart; Christa MacLean; Kathy White; Theresa Matus; Vivian Forssman; Penelope Barrett


    This paper reports the qualitative findings of a mixed methods research study conducted at three Canadian post-secondary institutions. Called the Meaningful E-learning or MEL project, the study was an exploration of the teaching and learning experiences of faculty and students as well as their perceptions of the benefits and challenges of e-learning. Importantly, e-learning was conceptualized as the integration of pedagogy, instructional technology, and the Internet into teaching ...

  16. The Relationship between Psychological Meaningfulness and Employee Engagement: Moderating Effect of Age and Gender


    Ruswahida Ibnu Ruslan; Md. Aminul Islam; Idris Mohd Noor


    There has been a great deal of interest in employee engagement over the years, and it has become a popular term. However, there is no one universally acceptable definition for employee engagement until now. Employee engagement has been defined in many ways, and its assessment also seems to be similar, as developed by scholars such as Kahn [1] who coins the term psychological meaningfulness. This paper reviews the literature surrounding employee engagement, especially in terms of psychological...

  17. Consumers’ social media brand behaviors: uncovering underlying motivators and deriving meaningful consumer segments


    Dimitriu, Radu; Guesalaga Trautmann, Rodrigo


    The current research identifies the range of social media brand behaviors (i.e., brand touch points) that consumers can exhibit on social media, and subsequently queries a representative sample of consumers with regard to such behaviors. The analysis reveals four underlying motivators for consumers’ social media behaviors, including brand tacit engagement, brand exhibiting, brand patronizing and brand deal seeking. These motivators are used to derive meaningful consumer segments identified as...

  18. Contested Spaces. Meaningful Places. Contemporary Performances of Place and Belonging in Spain and Brazil

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    Maria J. C. Krom


    Full Text Available This essay aims to contribute to current anthropological debate on space and place, analysing in two instances of festival performance how, on the one hand the politics of appropriation of space contributes to the configuration of power relations, and how on the other hand, participants in these festivals engage individually and collectively with physical space(s to create places which they experience as meaningful in terms of identity and belonging.

  19. Developing an instrument to measure emotional behaviour abilities of meaningful learning through the Delphi technique. (United States)

    Cadorin, Lucia; Bagnasco, Annamaria; Tolotti, Angela; Pagnucci, Nicola; Sasso, Loredana


    To identify items for a new instrument that measures emotional behaviour abilities of meaningful learning, according to Fink's Taxonomy. Meaningful learning is an active process that promotes a wider and deeper understanding of concepts. It is the result of an interaction between new and previous knowledge and produces a long-term change of knowledge and skills. To measure meaningful learning capability, it is very important in the education of health professionals to identify problems or special learning needs. For this reason, it is necessary to create valid instruments. A Delphi Study technique was implemented in four phases by means of e-mail. The study was conducted from April-September 2015. An expert panel consisting of ten researchers with experience in Fink's Taxonomy was established to identify the items of the instrument. Data were analysed for conceptual description and item characteristics and attributes were rated. Expert consensus was sought in each of these phases. An 87·5% consensus cut-off was established. After four rounds, consensus was obtained for validation of the content of the instrument 'Assessment of Meaningful learning Behavioural and Emotional Abilities'. This instrument consists of 56 items evaluated on a 6-point Likert-type scale. Foundational Knowledge, Application, Integration, Human Dimension, Caring and Learning How to Learn were the six major categories explored. This content validated tool can help educators (teachers, trainers and tutors) to identify and improve the strategies to support students' learning capability, which could increase their awareness of and/or responsibility in the learning process. © 2017 John Wiley & Sons Ltd.

  20. The Search for Meaningful E-Learning at Canadian Universities: A Multi-Institutional Research Study (United States)

    Salyers, Vincent; Carter, Lorraine; Carter, Alanna; Myers, Sue; Barrett, Penelope


    While e-learning is now characterized by a past and trends within that past, there continues to be uncertainty about how e-learning is defined and conceptualized, whether or not we like e-learning, and whether or not it is as meaningful to us as face to face learning. The purpose of this study was to document the e-learning perceptions of students…

  1. A cost-effective method of achieving meaningful citizen participation in public roadway pipeline studies

    Energy Technology Data Exchange (ETDEWEB)

    Buszynski, M.E.


    Many proponents of gas pipeline studies using the public roadway for their facilities have trouble encouraging public participation. Problems resulting from a lack of public involvement are documented. A public participation process designed to gather meaningful public input is presented through a case study of a public roadway pipeline study in southern Ontario. Techniques are outlined to effectively stimulate public interest and document the public involvement process. Recommendations are made as to the transferability of this process to other jurisdictions.

  2. Meaningful real-life relationships in massively multiplayer online roleplaying games


    Mansikkamäki, E. (Eetu)


    Abstract Massively Multiplayer Online Roleplaying Games are extremely popular with millions and millions of players spending large portions of their free time in these virtual environments. Still the social value and the meaningfulness of the relationships formed within them are questioned by most non-gamers and even some gamers. In the past even academia was mainly concentrating on the negative aspects of gaming but lately...

  3. Initial Development of the Meaningful Learning with Technology Scale (MeLTS) for High-School Students (United States)

    Lee, Chwee Beng


    With the rapid developments in emerging technologies and the emphasis on technologies in learning environments, the connection between technologies and meaningful learning has strengthened. Developing an understanding of the components of meaningful learning with technology is pivotal, as this may enable educators to make more informed decisions…

  4. Sweeping the floor or putting a man on the moon : How to define and measure meaningful work

    NARCIS (Netherlands)

    Both-Nwabuwe, Jitske M.C.; Dijkstra, Maria T.M.; Beersma, Bianca


    Meaningful work is integral to well-being and a flourishing life. The construct of "meaningful work" is, however, consistently affected by conceptual ambiguity. Although there is substantial support for arguments to maintain the status of conceptual ambiguity, we make a case for the benefits of

  5. Sweeping the Floor or Putting a Man on the Moon: How to Define and Measure Meaningful Work. (United States)

    Both-Nwabuwe, Jitske M C; Dijkstra, Maria T M; Beersma, Bianca


    Meaningful work is integral to well-being and a flourishing life. The construct of "meaningful work" is, however, consistently affected by conceptual ambiguity. Although there is substantial support for arguments to maintain the status of conceptual ambiguity, we make a case for the benefits of having consensus on a definition and scale of meaningful work in the context of paid work. The objective of this article, therefore, was twofold. Firstly, we wanted to develop a more integrative definition of meaningful work. Secondly, we wanted to establish a corresponding operationalization. We reviewed the literature on the existing definitions of meaningful work and the scales designed to measure it. We found 14 definitions of meaningful work. Based on these definitions, we identified four categories of definitions, which led us to propose an integrative and comprehensive definition of meaningful work. We identified two validated scales that were partly aligned with the proposed definition. Based on our review, we conclude that scholars in this field should coalesce rather than diverge their efforts to conceptualize and measure meaningful work.

  6. Sentence Processing as a Function of Syntax, Short Term Memory Capacity, the Meaningfulness of the Stimulus and Age (United States)

    Gamlin, Peter J.


    Examines the effects of short term memory (STM) capacity, meaningfulness of stimuli, and age upon listeners' structuring of sentences. Results show that the interaction between STM capacity and meaningfulness (1) approached significance when data were collapsed over both age levels, and (2) was significant for one age level. Tables and references.…

  7. Engaging in Work Even When It Is Meaningless: Positive Affective Disposition and Meaningful Work Interact in Relation to Work Engagement (United States)

    Steger, Michael F.; Littman-Ovadia, Hadassah; Miller, Michal; Menger, Lauren; Rothmann, Sebastiaan


    The central aim of the present study was to assess the predictive value of affective disposition and meaningful work on employee engagement. Specifically, it was proposed that meaningful work moderates the relationship between affective disposition and engagement. Questionnaires were completed by 252 white-collar employees, working in a variety of…

  8. Effects of perceptual load and socially meaningful stimuli on crossmodal selective attention in Autism Spectrum Disorder and neurotypical samples. (United States)

    Tyndall, Ian; Ragless, Liam; O'Hora, Denis


    The present study examined whether increasing visual perceptual load differentially affected both Socially Meaningful and Non-socially Meaningful auditory stimulus awareness in neurotypical (NT, n = 59) adults and Autism Spectrum Disorder (ASD, n = 57) adults. On a target trial, an unexpected critical auditory stimulus (CAS), either a Non-socially Meaningful ('beep' sound) or Socially Meaningful ('hi') stimulus, was played concurrently with the presentation of the visual task. Under conditions of low visual perceptual load both NT and ASD samples reliably noticed the CAS at similar rates (77-81%), whether the CAS was Socially Meaningful or Non-socially Meaningful. However, during high visual perceptual load NT and ASD participants reliably noticed the meaningful CAS (NT = 71%, ASD = 67%), but NT participants were unlikely to notice the Non-meaningful CAS (20%), whereas ASD participants reliably noticed it (80%), suggesting an inability to engage selective attention to ignore non-salient irrelevant distractor stimuli in ASD. Copyright © 2018 Elsevier Inc. All rights reserved.

  9. Meaningful Statistics in Professional Practices as a Bridge between Mathematics and Science: An Evaluation of a Design Research Project (United States)

    Dierdorp, Adri; Bakker, Arthur; van Maanen, Jan A.; Eijkelhof, Harrie M. C.


    Background: Creating coherence between school subjects mathematics and science and making these school subjects meaningful are still topical challenges. This study investigates how students make meaningful connections between mathematics, statistics, science and applications when they engage in a specially developed unit that is based on…

  10. Biotechnologies as a Context for Enhancing Junior High-School Students' Ability to Ask Meaningful Questions about Abstract Biological Processes. (United States)

    Olsher, G.; Dreyfus, A.


    Suggests a new approach to teaching about biochemical cellular processes by stimulating student interest in those biochemical processes that allowed for the outcomes of modern biotechnologies. Discusses the development of students' ability to ask meaningful questions about intra-cellular processes, and the resulting meaningful learning of relevant…

  11. Meaningful learning: The essential factor for conceptual change in limited or inappropriate propositional hierarchies leading to empowerment of learners (United States)

    Novak, Joseph D.


    The construction and reconstruction of meanings by learners requires that they actively seek to integrate new knowledge with knowledge already in their cognitive structure. Ausubel's assimilation theory of cognitive learning has been shown to be effective in guiding research and instructional design to facilitate meaningful learning (Ausubel, The psychology of meaningful verbal learning, New York: Grune and Stratton, 1963; Educational psychology: A cognitive view, New York: Holt, Rinehart and Winston, 1968; The acquisition and retention of knowledge, Dordrecht: Kluwer, 2000). Gowin's Vee heuristic has been employed effectively to aid teachers and students in understanding the constructed nature of knowledge (Gowin, Educating, Ithaca, NY: Cornell University Press, 1981). Situated learning occurs when learning is by rote or at a lower level of meaningful learning. Concept mapping has been used effectively to aid meaningful learning with resulting modification of student's knowledge structures. When these knowledge structures are limited or faulty in some way, they may be referred to as Limited or Inappropriate Propositional Hierarchies (LIPH's). Conceptual change, or more accurately conceptual reconstrution, requires meaningful learning to modify LIPH's. Collaborative group learning facilitates meaningful learning and new knowledge construction. World-wide economic changes are forcing major changes in business and industry placing a premium on the power and value of knowledge and new knowledge production. These changes require changes in school and university education that centers on the nature and power of meaningful learning. New computer tools are available to facilitate teaching activities targeted at modifying LIPH's, and aiding meaningful learning in general.

  12. Psychophysical thresholds of face visibility during infancy

    DEFF Research Database (Denmark)

    Gelskov, Sofie; Kouider, Sid


    The ability to detect and focus on faces is a fundamental prerequisite for developing social skills. But how well can infants detect faces? Here, we address this question by studying the minimum duration at which faces must appear to trigger a behavioral response in infants. We used a preferential...... looking method in conjunction with masking and brief presentations (300 ms and below) to establish the temporal thresholds of visibility at different stages of development. We found that 5 and 10 month-old infants have remarkably similar visibility thresholds about three times higher than those of adults....... By contrast, 15 month-olds not only revealed adult-like thresholds, but also improved their performance through memory-based strategies. Our results imply that the development of face visibility follows a non-linear course and is determined by a radical improvement occurring between 10 and 15 months....

  13. Stimulated Brillouin scattering threshold in fiber amplifiers

    International Nuclear Information System (INIS)

    Liang Liping; Chang Liping


    Based on the wave coupling theory and the evolution model of the critical pump power (or Brillouin threshold) for stimulated Brillouin scattering (SBS) in double-clad fiber amplifiers, the influence of signal bandwidth, fiber-core diameter and amplifier gain on SBS threshold is simulated theoretically. And experimental measurements of SBS are presented in ytterbium-doped double-clad fiber amplifiers with single-frequency hundred nanosecond pulse amplification. Under different input signal pulses, the forward amplified pulse distortion is observed when the pulse energy is up to 660 nJ and the peak power is up to 3.3 W in the pulse amplification with pulse duration of 200 ns and repetition rate of 1 Hz. And the backward SBS narrow pulse appears. The pulse peak power equals to SBS threshold. Good agreement is shown between the modeled and experimental data. (authors)

  14. Threshold Theory Tested in an Organizational Setting

    DEFF Research Database (Denmark)

    Christensen, Bo T.; Hartmann, Peter V. W.; Hedegaard Rasmussen, Thomas


    A large sample of leaders (N = 4257) was used to test the link between leader innovativeness and intelligence. The threshold theory of the link between creativity and intelligence assumes that below a certain IQ level (approximately IQ 120), there is some correlation between IQ and creative...... potential, but above this cutoff point, there is no correlation. Support for the threshold theory of creativity was found, in that the correlation between IQ and innovativeness was positive and significant below a cutoff point of IQ 120. Above the cutoff, no significant relation was identified, and the two...... correlations differed significantly. The finding was stable across distinct parts of the sample, providing support for the theory, although the correlations in all subsamples were small. The findings lend support to the existence of threshold effects using perceptual measures of behavior in real...

  15. Effects of pulse duration on magnetostimulation thresholds

    Energy Technology Data Exchange (ETDEWEB)

    Saritas, Emine U., E-mail: [Department of Bioengineering, University of California, Berkeley, Berkeley, California 94720-1762 (United States); Department of Electrical and Electronics Engineering, Bilkent University, Bilkent, Ankara 06800 (Turkey); National Magnetic Resonance Research Center (UMRAM), Bilkent University, Bilkent, Ankara 06800 (Turkey); Goodwill, Patrick W. [Department of Bioengineering, University of California, Berkeley, Berkeley, California 94720-1762 (United States); Conolly, Steven M. [Department of Bioengineering, University of California, Berkeley, Berkeley, California 94720-1762 (United States); Department of EECS, University of California, Berkeley, California 94720-1762 (United States)


    Purpose: Medical imaging techniques such as magnetic resonance imaging and magnetic particle imaging (MPI) utilize time-varying magnetic fields that are subject to magnetostimulation limits, which often limit the speed of the imaging process. Various human-subject experiments have studied the amplitude and frequency dependence of these thresholds for gradient or homogeneous magnetic fields. Another contributing factor was shown to be number of cycles in a magnetic pulse, where the thresholds decreased with longer pulses. The latter result was demonstrated on two subjects only, at a single frequency of 1.27 kHz. Hence, whether the observed effect was due to the number of cycles or due to the pulse duration was not specified. In addition, a gradient-type field was utilized; hence, whether the same phenomenon applies to homogeneous magnetic fields remained unknown. Here, the authors investigate the pulse duration dependence of magnetostimulation limits for a 20-fold range of frequencies using homogeneous magnetic fields, such as the ones used for the drive field in MPI. Methods: Magnetostimulation thresholds were measured in the arms of six healthy subjects (age: 27 ± 5 yr). Each experiment comprised testing the thresholds at eight different pulse durations between 2 and 125 ms at a single frequency, which took approximately 30–40 min/subject. A total of 34 experiments were performed at three different frequencies: 1.2, 5.7, and 25.5 kHz. A solenoid coil providing homogeneous magnetic field was used to induce stimulation, and the field amplitude was measured in real time. A pre-emphasis based pulse shaping method was employed to accurately control the pulse durations. Subjects reported stimulation via a mouse click whenever they felt a twitching/tingling sensation. A sigmoid function was fitted to the subject responses to find the threshold at a specific frequency and duration, and the whole procedure was repeated at all relevant frequencies and pulse durations

  16. Thresholds of ion turbulence in tokamaks

    International Nuclear Information System (INIS)

    Garbet, X.; Laurent, L.; Mourgues, F.; Roubin, J.P.; Samain, A.; Zou, X.L.


    The linear thresholds of ionic turbulence are numerically calculated for the Tokamaks JET and TORE SUPRA. It is proved that the stability domain at η i >0 is determined by trapped ion modes and is characterized by η i ≥1 and a threshold L Ti /R of order (0.2/0.3)/(1+T i /T e ). The latter value is significantly smaller than what has been previously predicted. Experimental temperature profiles in heated discharges are usually marginal with respect to this criterium. It is also shown that the eigenmodes are low frequency, low wavenumber ballooned modes, which may produce a very large transport once the threshold ion temperature gradient is reached


    Directory of Open Access Journals (Sweden)

    Josip Arnerić


    Full Text Available The objective of extreme value analysis is to quantify the probabilistic behavior of unusually large losses using only extreme values above some high threshold rather than using all of the data which gives better fit to tail distribution in comparison to traditional methods with assumption of normality. In our case we estimate market risk using daily returns of the CROBEX index at the Zagreb Stock Exchange. Therefore, it’s necessary to define the excess distribution above some threshold, i.e. Generalized Pareto Distribution (GPD is used as much more reliable than the normal distribution due to the fact that gives the accent on the extreme values. Parameters of GPD distribution will be estimated using maximum likelihood method (MLE. The contribution of this paper is to specify threshold which is large enough so that GPD approximation valid but low enough so that a sufficient number of observations are available for a precise fit.

  18. Effects of pulse duration on magnetostimulation thresholds

    International Nuclear Information System (INIS)

    Saritas, Emine U.; Goodwill, Patrick W.; Conolly, Steven M.


    Purpose: Medical imaging techniques such as magnetic resonance imaging and magnetic particle imaging (MPI) utilize time-varying magnetic fields that are subject to magnetostimulation limits, which often limit the speed of the imaging process. Various human-subject experiments have studied the amplitude and frequency dependence of these thresholds for gradient or homogeneous magnetic fields. Another contributing factor was shown to be number of cycles in a magnetic pulse, where the thresholds decreased with longer pulses. The latter result was demonstrated on two subjects only, at a single frequency of 1.27 kHz. Hence, whether the observed effect was due to the number of cycles or due to the pulse duration was not specified. In addition, a gradient-type field was utilized; hence, whether the same phenomenon applies to homogeneous magnetic fields remained unknown. Here, the authors investigate the pulse duration dependence of magnetostimulation limits for a 20-fold range of frequencies using homogeneous magnetic fields, such as the ones used for the drive field in MPI. Methods: Magnetostimulation thresholds were measured in the arms of six healthy subjects (age: 27 ± 5 yr). Each experiment comprised testing the thresholds at eight different pulse durations between 2 and 125 ms at a single frequency, which took approximately 30–40 min/subject. A total of 34 experiments were performed at three different frequencies: 1.2, 5.7, and 25.5 kHz. A solenoid coil providing homogeneous magnetic field was used to induce stimulation, and the field amplitude was measured in real time. A pre-emphasis based pulse shaping method was employed to accurately control the pulse durations. Subjects reported stimulation via a mouse click whenever they felt a twitching/tingling sensation. A sigmoid function was fitted to the subject responses to find the threshold at a specific frequency and duration, and the whole procedure was repeated at all relevant frequencies and pulse durations

  19. Determining lower threshold concentrations for synergistic effects

    DEFF Research Database (Denmark)

    Bjergager, Maj-Britt Andersen; Dalhoff, Kristoffer; Kretschmann, Andreas


    which proven synergists cease to act as synergists towards the aquatic crustacean Daphnia magna. To do this, we compared several approaches and test-setups to evaluate which approach gives the most conservative estimate for the lower threshold for synergy for three known azole synergists. We focus...... on synergistic interactions between the pyrethroid insecticide, alpha-cypermethrin, and one of the three azole fungicides prochloraz, propiconazole or epoxiconazole measured on Daphnia magna immobilization. Three different experimental setups were applied: A standard 48h acute toxicity test, an adapted 48h test...... of immobile organisms increased more than two-fold above what was predicted by independent action (vertical assessment). All three tests confirmed the hypothesis of the existence of a lower azole threshold concentration below which no synergistic interaction was observed. The lower threshold concentration...

  20. The Impact of Dynamic RTS Threshold Adjustment for IEEE 802.11 MAC Protocol

    Directory of Open Access Journals (Sweden)

    Mostafa Mjidi


    Full Text Available In recent years, wireless technologies and application received great attention. The Medium Access Control (MAC protocol is the main element that determines the efficiency in sharing the limited communication bandwidth of the wireless channel in wireless local area networks (WLANs. IEEE 802.11 introduced the optional RTS/CTS handshaking mechanism to address the hidden terminal problem as well as to reduces the chance of collision in case of higher node density and traffic. RTS Threshold (RT determines when RTS/CTS mechanism should be used and proved to be an important parameter for performance characteristics in data transmission. We first investigate to find a meaningful threshold value according to the network situation and determine the impact of using or disengaging the RTS/CTS optional mechanism and dynamically adjust the RTS Threshold to maximize data transmission. The results show a significant improvement over existing CSMA/CA and RTS/CTS schemes. Our adaptive scheme performed even better when data rate increases. We verify our proposed scheme both analytically and with extensive network simulation using ns-2.

  1. Threshold Considerations and Wetland Reclamation in Alberta's Mineable Oil Sands

    Directory of Open Access Journals (Sweden)

    Lee Foote


    Full Text Available Oil sand extraction in Alberta, Canada is a multibillion dollar industry operating over 143 km² of open pit mining and 4600 km² of other bitumen strata in northern boreal forests. Oil production contributes to Canada-wide GDP, creates socio-cultural problems, provides energy exports and employment, and carries environmental risks regarding long-term reclamation uncertainties. Of particular concern are the implications for wetlands and water supply management. Mining of oil sands is very attractive because proven reserves of known quality occur in an accessible, politically stable environment with existing infrastructure and an estimated 5.5 billion extractable barrels to be mined over the next five decades. Extraction occurs under a set of limiting factors or thresholds including: limited social tolerance at local to international levels for externalities of oil sand production; water demands > availability; limited natural gas supplies for oil processing leading to proposals for hydroelectric dams and nuclear reactors to be constructed; difficulties in reclaiming sufficient habitat area to replace those lost. Replacement of the 85 km² of peat-forming wetlands forecast to be destroyed appears unlikely. Over 840 billion liters of toxic fluid byproducts are currently held in 170 km² of open reservoirs without any known process to purify this water in meaningful time frames even as some of it leaches into adjacent lands and rivers. Costs for wetland reclamation are high with estimates of $4 to $13 billion, or about 6% of the net profits generated from mining those sites. This raises a social equity question of how much reclamation is appropriate. Time frames for economic, political, and ecological actions are not well aligned. Local people on or near mine sites have had to change their area use for decades and have been affected by industrial development. Examining mining effects to estimate thresholds of biophysical realities, time scales

  2. A technology training protocol for meeting QSEN goals: Focusing on meaningful learning. (United States)

    Luo, Shuhong; Kalman, Melanie


    The purpose of this paper is to describe and discuss how we designed and developed a 12-step technology training protocol. The protocol is meant to improve meaningful learning in technology education so that nursing students are able to meet the informatics requirements of Quality and Safety Education in Nursing competencies. When designing and developing the training protocol, we used a simplified experiential learning model that addressed the core features of meaningful learning: to connect new knowledge with students' prior knowledge and real-world workflow. Before training, we identified students' prior knowledge and workflow tasks. During training, students learned by doing, reflected on their prior computer skills and workflow, designed individualized procedures for integration into their workflow, and practiced the self-designed procedures in real-world settings. The trainer was a facilitator who provided a meaningful learning environment, asked the right questions to guide reflective conversation, and offered scaffoldings at critical moments. This training protocol could significantly improve nurses' competencies in using technologies and increase their desire to adopt new technologies. © 2017 Wiley Periodicals, Inc.

  3. Meaningful and efficient? Enduring challenges to Aboriginal participation in environmental assessment

    International Nuclear Information System (INIS)

    Udofia, Aniekan; Noble, Bram; Poelzer, Greg


    This paper explores the underlying practice-based challenges to meaningful and efficient Aboriginal participation in environmental assessment (EA) - participation that provides meaningful opportunities for Aboriginal communities to shape EA, yet assures a degree of efficiency for project proponents who need to obtain EA approvals in a timely and financially viable manner. We do so based on an analysis of the EA policy community's experience with uranium exploration and mining in Saskatchewan, Canada. Many of the challenges to meaningful and efficient Aboriginal participation that emerged are multi-dimensional, often concerning participation processes, decision-making, and relationships. Although scholars have explored many of these issues and have proposed numerous solutions, challenges persist in practice. Several other issues also emerged from our study that have received limited attention, including the non-commitment to early and ongoing participation by smaller project proponents, and the EA exemption of exploration projects; the limited availability of information to project developers on local right holders and Aboriginal interests; expectations about the integration of traditional knowledge and land use in EA not aligning with the information that is available to proponents; confusion about who is responsible for initiating early participation and consultation processes; the lack of early relationship building with potentially affected communities, particularly by governments; and the lack of other viable avenues, outside EA, for Aboriginal communities to raise more strategic issues of concern that affect traditional lands and treaty rights.

  4. Meaningfulness in work - experiences among employed individuals with persistent mental illness. (United States)

    Leufstadius, Christel; Eklund, Mona; Erlandsson, Lena-Karin


    The aim of the present study was to investigate how people with persistent mental illness, with various types of work and employment conditions, experience and describe the meaningfulness of work. The study had a qualitative approach and twelve informants living in the community were purposefully selected and interviewed according to overarching themes. The interviews were analysed using qualitative content analysis, and all of the authors were involved in the analysis process. The findings resulted in four main themes: 1) work per se has certain characteristics, 2) participation in different contexts gives a feeling of normality, acceptance, belonging and fulfilment of norms and values, 3) work affords structure, energy and a balanced daily life, and 4) work increases well-being and strengthens one's identity. A tentative model is described concerning perceived meaningfulness in work among individuals with persistent mental illness, in which the first three aspects of meaning are a prerequisite for meaning in terms of increased well-being and strengthened identity. Furthermore, it seems important that work has to bring the just right challenge to the individual in order for him or her to perceive the identified aspects of meaningfulness.

  5. An empirically based conceptual framework for fostering meaningful patient engagement in research. (United States)

    Hamilton, Clayon B; Hoens, Alison M; Backman, Catherine L; McKinnon, Annette M; McQuitty, Shanon; English, Kelly; Li, Linda C


    Patient engagement in research (PEIR) is promoted to improve the relevance and quality of health research, but has little conceptualization derived from empirical data. To address this issue, we sought to develop an empirically based conceptual framework for meaningful PEIR founded on a patient perspective. We conducted a qualitative secondary analysis of in-depth interviews with 18 patient research partners from a research centre-affiliated patient advisory board. Data analysis involved three phases: identifying the themes, developing a framework and confirming the framework. We coded and organized the data, and abstracted, illustrated, described and explored the emergent themes using thematic analysis. Directed content analysis was conducted to derive concepts from 18 publications related to PEIR to supplement, confirm or refute, and extend the emergent conceptual framework. The framework was reviewed by four patient research partners on our research team. Participants' experiences of working with researchers were generally positive. Eight themes emerged: procedural requirements, convenience, contributions, support, team interaction, research environment, feel valued and benefits. These themes were interconnected and formed a conceptual framework to explain the phenomenon of meaningful PEIR from a patient perspective. This framework, the PEIR Framework, was endorsed by the patient research partners on our team. The PEIR Framework provides guidance on aspects of PEIR to address for meaningful PEIR. It could be particularly useful when patient-researcher partnerships are led by researchers with little experience of engaging patients in research. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  6. Shifts in the relationship between motor unit recruitment thresholds versus derecruitment thresholds during fatigue. (United States)

    Stock, Matt S; Mota, Jacob A


    Muscle fatigue is associated with diminished twitch force amplitude. We examined changes in the motor unit recruitment versus derecruitment threshold relationship during fatigue. Nine men (mean age = 26 years) performed repeated isometric contractions at 50% maximal voluntary contraction (MVC) knee extensor force until exhaustion. Surface electromyographic signals were detected from the vastus lateralis, and were decomposed into their constituent motor unit action potential trains. Motor unit recruitment and derecruitment thresholds and firing rates at recruitment and derecruitment were evaluated at the beginning, middle, and end of the protocol. On average, 15 motor units were studied per contraction. For the initial contraction, three subjects showed greater recruitment thresholds than derecruitment thresholds for all motor units. Five subjects showed greater recruitment thresholds than derecruitment thresholds for only low-threshold motor units at the beginning, with a mean cross-over of 31.6% MVC. As the muscle fatigued, many motor units were derecruited at progressively higher forces. In turn, decreased slopes and increased y-intercepts were observed. These shifts were complemented by increased firing rates at derecruitment relative to recruitment. As the vastus lateralis fatigued, the central nervous system's compensatory adjustments resulted in a shift of the regression line of the recruitment versus derecruitment threshold relationship. Copyright © 2017 IPEM. Published by Elsevier Ltd. All rights reserved.

  7. The threshold photoelectron spectrum of mercury

    International Nuclear Information System (INIS)

    Rojas, H; Dawber, G; Gulley, N; King, G C; Bowring, N; Ward, R


    The threshold photoelectron spectrum of mercury has been recorded over the energy range (10–40 eV) which covers the region from the lowest state of the singly charged ion, 5d 10 6s( 2 S 1/2 ), to the double charged ionic state, 5d 9 ( 2 D 3/2 )6s( 1 D 2 ). Synchrotron radiation has been used in conjunction with the penetrating-field threshold-electron technique to obtain the spectrum with high resolution. The spectrum shows many more features than observed in previous photoemission measurements with many of these assigned to satellite states converging to the double ionization limit. (paper)

  8. Near threshold expansion of Feynman diagrams

    International Nuclear Information System (INIS)

    Mendels, E.


    The near threshold expansion of Feynman diagrams is derived from their configuration space representation, by performing all x integrations. The general scalar Feynman diagram is considered, with an arbitrary number of external momenta, an arbitrary number of internal lines and an arbitrary number of loops, in n dimensions and all masses may be different. The expansions are considered both below and above threshold. Rules, giving real and imaginary part, are derived. Unitarity of a sunset diagram with I internal lines is checked in a direct way by showing that its imaginary part is equal to the phase space integral of I particles

  9. Thresholds in Xeric Hydrology and Biogeochemistry (United States)

    Meixner, T.; Brooks, P. D.; Simpson, S. C.; Soto, C. D.; Yuan, F.; Turner, D.; Richter, H.


    Due to water limitation, thresholds in hydrologic and biogeochemical processes are common in arid and semi-arid systems. Some of these thresholds such as those focused on rainfall runoff relationships have been well studied. However to gain a full picture of the role that thresholds play in driving the hydrology and biogeochemistry of xeric systems a full view of the entire array of processes at work is needed. Here a walk through the landscape of xeric systems will be conducted illustrating the powerful role of hydrologic thresholds on xeric system biogeochemistry. To understand xeric hydro-biogeochemistry two key ideas need to be focused on. First, it is important to start from a framework of reaction and transport. Second an understanding of the temporal and spatial components of thresholds that have a large impact on hydrologic and biogeochemical fluxes needs to be offered. In the uplands themselves episodic rewetting and drying of soils permits accelerated biogeochemical processing but also more gradual drainage of water through the subsurface than expected in simple conceptions of biogeochemical processes. Hydrologic thresholds (water content above hygroscopic) results in a stop start nutrient spiral of material across the landscape since runoff connecting uplands to xeric perennial riparian is episodic and often only transports materials a short distance (100's of m). This episodic movement results in important and counter-intuitive nutrient inputs to riparian zones but also significant processing and uptake of nutrients. The floods that transport these biogeochemicals also result in significant input to riparian groundwater and may be key to sustaining these critical ecosystems. Importantly the flood driven recharge process itself is a threshold process dependent on flood characteristics (floods greater than 100 cubic meters per second) and antecedent conditions (losing to near neutral gradients). Floods also appear to influence where arid and semi

  10. Double photoionization of helium near threshold

    International Nuclear Information System (INIS)

    Levin, J.C.; Armen, G.B.; Sellin, I.A.


    There has been substantial recent experimental interest in the ratio of double-to-single photoionization of He near threshold following several theoretical observations that earlier measurements appear to overestimate the ratio, perhaps by as much as 25%, in the first several hundred eV above threshold. The authors recent measurements are 10%-15% below these earlier results and more recent results of Doerner et al. and Samson et al. are yet another 10% lower. The authors will compare these measurement with new data, not yet analyzed, and available theory

  11. Color image Segmentation using automatic thresholding techniques

    International Nuclear Information System (INIS)

    Harrabi, R.; Ben Braiek, E.


    In this paper, entropy and between-class variance based thresholding methods for color images segmentation are studied. The maximization of the between-class variance (MVI) and the entropy (ME) have been used as a criterion functions to determine an optimal threshold to segment images into nearly homogenous regions. Segmentation results from the two methods are validated and the segmentation sensitivity for the test data available is evaluated, and a comparative study between these methods in different color spaces is presented. The experimental results demonstrate the superiority of the MVI method for color image segmentation.

  12. Effects of Spinal Cord Stimulation on Pain Thresholds and Sensory Perceptions in Chronic Pain Patients. (United States)

    Ahmed, Shihab U; Zhang, Yi; Chen, Lucy; St Hillary, Kristin; Cohen, Abigail; Vo, Trang; Houghton, Mary; Mao, Jianren


    Spinal cord stimulation (SCS) has been in clinical use for nearly four decades. In earliest observations, researchers found a significant increase in pain threshold during SCS therapy without changes associated with touch, position, and vibration sensation. Subsequent studies yielded diverse results regarding how SCS impacts pain and other sensory thresholds. This pilot study uses quantitative sensory testing (QST) to objectively quantify the impact of SCS on warm sensation, heat pain threshold, and heat pain tolerance. Nineteen subjects with an indwelling SCS device for chronic pain were subjected to QST with heat stimuli. QST was performed on an area of pain covered with SCS-induced paresthesia and an area without pain and without paresthesia, while the SCS was turned off and on. The temperature at which the patient detected warm sensation, heat pain, and maximal tolerable heat pain was used to define the thresholds. We found that all three parameters, the detection of warm sensation, heat pain threshold, and heat pain tolerance, were increased during the period when SCS was on compared with when it was off. This increase was observed in both painful and non-painful sites. The observed pain relief during SCS therapy seems to be related to its impact on increased sensory threshold as detected in this study. The increased sensory threshold on areas without pain and without the presence of SCS coverage may indicate a central (spinal and/or supra-spinal) influence from SCS. © 2015 International Neuromodulation Society.

  13. The threshold of cortical electrical stimulation for mapping sensory and motor functional areas. (United States)

    Guojun, Zhang; Duanyu, Ni; Fu, Paul; Lixin, Cai; Tao, Yu; Wei, Du; Liang, Qiao; Zhiwei, Ren


    This study aimed to investigate the threshold of cortical electrical stimulation (CES) for functional brain mapping during surgery for the treatment of rolandic epilepsy. A total of 21 patients with rolandic epilepsy who underwent surgical treatment at the Beijing Institute of Functional Neurosurgery between October 2006 and March 2008 were included in this study. Their clinical data were retrospectively collected and analyzed. The thresholds of CES for motor response, sensory response, and after discharge production along with other threshold-related factors were investigated. The thresholds (mean ± standard deviation) for motor response, sensory response, and after discharge production were 3.48 ± 0.87, 3.86 ± 1.31, and 4.84 ± 1.38 mA, respectively. The threshold for after discharge production was significantly higher than those of both the motor and sensory response (both pstimulation frequency of 50 Hz and a pulse width of 0.2 ms, the threshold of sensory and motor responses were similar, and the threshold of after discharge production was higher than that of sensory and motor response. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. Comparison between intensity- duration thresholds and cumulative rainfall thresholds for the forecasting of landslide (United States)

    Lagomarsino, Daniela; Rosi, Ascanio; Rossi, Guglielmo; Segoni, Samuele; Catani, Filippo


    This work makes a quantitative comparison between the results of landslide forecasting obtained using two different rainfall threshold models, one using intensity-duration thresholds and the other based on cumulative rainfall thresholds in an area of northern Tuscany of 116 km2. The first methodology identifies rainfall intensity-duration thresholds by means a software called MaCumBA (Massive CUMulative Brisk Analyzer) that analyzes rain-gauge records, extracts the intensities (I) and durations (D) of the rainstorms associated with the initiation of landslides, plots these values on a diagram, and identifies thresholds that define the lower bounds of the I-D values. A back analysis using data from past events can be used to identify the threshold conditions associated with the least amount of false alarms. The second method (SIGMA) is based on the hypothesis that anomalous or extreme values of rainfall are responsible for landslide triggering: the statistical distribution of the rainfall series is analyzed, and multiples of the standard deviation (σ) are used as thresholds to discriminate between ordinary and extraordinary rainfall events. The name of the model, SIGMA, reflects the central role of the standard deviations in the proposed methodology. The definition of intensity-duration rainfall thresholds requires the combined use of rainfall measurements and an inventory of dated landslides, whereas SIGMA model can be implemented using only rainfall data. These two methodologies were applied in an area of 116 km2 where a database of 1200 landslides was available for the period 2000-2012. The results obtained are compared and discussed. Although several examples of visual comparisons between different intensity-duration rainfall thresholds are reported in the international literature, a quantitative comparison between thresholds obtained in the same area using different techniques and approaches is a relatively undebated research topic.

  15. An investigation of mechanical nociceptive thresholds in dogs with hind limb joint pain compared to healthy control dogs. (United States)

    Harris, L K; Whay, H R; Murrell, J C


    This study investigated the effects of osteoarthritis (OA) on somatosensory processing in dogs using mechanical threshold testing. A pressure algometer was used to measure mechanical thresholds in 27 dogs with presumed hind limb osteoarthritis and 28 healthy dogs. Mechanical thresholds were measured at the stifles, radii and sternum, and were correlated with scores from an owner questionnaire and a clinical checklist, a scoring system that quantified clinical signs of osteoarthritis. The effects of age and bodyweight on mechanical thresholds were also investigated. Multiple regression models indicated that, when bodyweight was taken into account, dogs with presumed osteoarthritis had lower mechanical thresholds at the stifles than control dogs, but not at other sites. Non-parametric correlations showed that clinical checklist scores and questionnaire scores were negatively correlated with mechanical thresholds at the stifles. The results suggest that mechanical threshold testing using a pressure algometer can detect primary, and possibly secondary, hyperalgesia in dogs with presumed osteoarthritis. This suggests that the mechanical threshold testing protocol used in this study might facilitate assessment of somatosensory changes associated with disease progression or response to treatment. Copyright © 2017. Published by Elsevier Ltd.

  16. Real-World Massage Therapy Produces Meaningful Effectiveness Signal for Primary Care Patients with Chronic Low Back Pain: Results of a Repeated Measures Cohort Study. (United States)

    Elder, William G; Munk, Niki; Love, Margaret M; Bruckner, Geza G; Stewart, Kathryn E; Pearce, Kevin


    While efficacy of massage and other nonpharmacological treatments for chronic low back pain is established, stakeholders have called for pragmatic studies of effectiveness in "real-world" primary health care. The Kentucky Pain Research and Outcomes Study evaluated massage impact on pain, disability, and health-related quality of life for primary care patients with chronic low back pain. We report effectiveness and feasibility results, and make comparisons with established minimal clinically important differences. Primary care providers referred eligible patients for 10 massage sessions with community practicing licensed massage therapists. Oswestry Disability Index and SF-36v2 measures obtained at baseline and postintervention at 12 and 24 weeks were analyzed with mixed linear models and Tukey's tests. Additional analyses examined clinically significant improvement and predictive patient characteristics. Of 104 enrolled patients, 85 and 76 completed 12 and 24 weeks of data collection, respectively. Group means improved at 12 weeks for all outcomes and at 24 weeks for SF-36v2's Physical Component Summary and Bodily Pain Domain. Of those with clinically improved disability at 12 weeks, 75% were still clinically improved at 24 weeks ( P  < 0.01). For SF-36v2 Physical and Mental Component Summaries, 55.4% and 43.4%, respectively, showed clinically meaningful improvement at 12 weeks, 46.1% and 30.3% at 24 weeks. For Bodily Pain Domain, 49.4% were clinically improved at 12 weeks, 40% at 24 weeks. Adults older than age 49 years had better pain and disability outcomes than younger adults. Results provide a meaningful signal of massage effect for primary care patients with chronic low back pain and call for further research in practice settings using pragmatic designs with control groups. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail:

  17. Heritability estimates derived from threshold analyses for ...

    African Journals Online (AJOL)


    reproductive traits in a composite multibreed beef cattle herd using a threshold model. A GFCAT set of ..... pressure for longevity include low heritabilities, the increased generation interval necessary to obtain survival information, and automatic selection because long-lived cows contribute more offspring to subsequent ...

  18. Regression Discontinuity Designs Based on Population Thresholds

    DEFF Research Database (Denmark)

    Eggers, Andrew C.; Freier, Ronny; Grembi, Veronica

    In many countries, important features of municipal government (such as the electoral system, mayors' salaries, and the number of councillors) depend on whether the municipality is above or below arbitrary population thresholds. Several papers have used a regression discontinuity design (RDD...

  19. Thresholding methods for PET imaging: A review

    International Nuclear Information System (INIS)

    Dewalle-Vignion, A.S.; Betrouni, N.; Huglo, D.; Vermandel, M.; Dewalle-Vignion, A.S.; Hossein-Foucher, C.; Huglo, D.; Vermandel, M.; Dewalle-Vignion, A.S.; Hossein-Foucher, C.; Huglo, D.; Vermandel, M.; El Abiad, A.


    This work deals with positron emission tomography segmentation methods for tumor volume determination. We propose a state of art techniques based on fixed or adaptive threshold. Methods found in literature are analysed with an objective point of view on their methodology, advantages and limitations. Finally, a comparative study is presented. (authors)

  20. Identification of Threshold Concepts for Biochemistry (United States)

    Loertscher, Jennifer; Green, David; Lewis, Jennifer E.; Lin, Sara; Minderhout, Vicky


    Threshold concepts (TCs) are concepts that, when mastered, represent a transformed understanding of a discipline without which the learner cannot progress. We have undertaken a process involving more than 75 faculty members and 50 undergraduate students to identify a working list of TCs for biochemistry. The process of identifying TCs for…

  1. The Resting Motor Threshold - Restless or Resting?

    DEFF Research Database (Denmark)

    Karabanov, Anke Ninija; Raffin, Estelle Emeline; Siebner, Hartwig Roman


    , the RMT of the right first dorsal interosseus muscle was repeatedly determined using a threshold-hunting procedure while participants performed motor imagery and visual attention tasks with the right or left hand. Data were analyzed using repeated-measure ANOVA. Results RMT differed depending on which...

  2. The gradual nature of threshold switching

    International Nuclear Information System (INIS)

    Wimmer, M; Salinga, M


    The recent commercialization of electronic memories based on phase change materials proved the usability of this peculiar family of materials for application purposes. More advanced data storage and computing concepts, however, demand a deeper understanding especially of the electrical properties of the amorphous phase and the switching behaviour. In this work, we investigate the temporal evolution of the current through the amorphous state of the prototypical phase change material, Ge 2 Sb 2 Te 5 , under constant voltage. A custom-made electrical tester allows the measurement of delay times over five orders of magnitude, as well as the transient states of electrical excitation prior to the actual threshold switching. We recognize a continuous current increase over time prior to the actual threshold-switching event to be a good measure for the electrical excitation. A clear correlation between a significant rise in pre-switching-current and the later occurrence of threshold switching can be observed. This way, we found experimental evidence for the existence of an absolute minimum for the threshold voltage (or electric field respectively) holding also for time scales far beyond the measurement range. (paper)

  3. Multiparty Computation from Threshold Homomorphic Encryption

    DEFF Research Database (Denmark)

    Cramer, Ronald; Damgård, Ivan Bjerre; Nielsen, Jesper Buus


    We introduce a new approach to multiparty computation (MPC) basing it on homomorphic threshold crypto-systems. We show that given keys for any sufficiently efficient system of this type, general MPC protocols for n parties can be devised which are secure against an active adversary that corrupts...

  4. Classification error of the thresholded independence rule

    DEFF Research Database (Denmark)

    Bak, Britta Anker; Fenger-Grøn, Morten; Jensen, Jens Ledet

    We consider classification in the situation of two groups with normally distributed data in the ‘large p small n’ framework. To counterbalance the high number of variables we consider the thresholded independence rule. An upper bound on the classification error is established which is taylored...

  5. Intraoperative transfusion threshold and tissue oxygenation

    DEFF Research Database (Denmark)

    Nielsen, K; Dahl, B; Johansson, P I


    Transfusion with allogeneic red blood cells (RBCs) may be needed to maintain oxygen delivery during major surgery, but the appropriate haemoglobin (Hb) concentration threshold has not been well established. We hypothesised that a higher level of Hb would be associated with improved subcutaneous...... oxygen tension during major spinal surgery....

  6. Handwriting Automaticity: The Search for Performance Thresholds (United States)

    Medwell, Jane; Wray, David


    Evidence is accumulating that handwriting has an important role in written composition. In particular, handwriting automaticity appears to relate to success in composition. This relationship has been little explored in British contexts and we currently have little idea of what threshold performance levels might be. In this paper, we report on two…

  7. Grid - a fast threshold tracking procedure

    DEFF Research Database (Denmark)

    Fereczkowski, Michal; Dau, Torsten; MacDonald, Ewen


    A new procedure, called “grid”, is evaluated that allows rapid acquisition of threshold curves for psychophysics and, in particular, psychoacoustic, experiments. In this method, the parameterresponse space is sampled in two dimensions within a single run. This allows the procedure to focus more e...

  8. 49 CFR 80.13 - Threshold criteria. (United States)


    ... exceed $30 million); (4) Project financing shall be repayable, in whole or in part, from tolls, user fees... Transportation Office of the Secretary of Transportation CREDIT ASSISTANCE FOR SURFACE TRANSPORTATION PROJECTS... project shall meet the following five threshold criteria: (1) The project shall be consistent with the...

  9. Low-threshold conical microcavity dye lasers

    DEFF Research Database (Denmark)

    Grossmann, Tobias; Schleede, Simone; Hauser, Mario


    element simulations confirm that lasing occurs in whispering gallery modes which corresponds well to the measured multimode laser-emission. The effect of dye concentration on lasing threshold and lasing wavelength is investigated and can be explained using a standard dye laser model....

  10. Microplastic effect thresholds for freshwater benthic macroinvertebrates

    NARCIS (Netherlands)

    Redondo Hasselerharm, P.E.; Dede Falahudin, Dede; Peeters, E.T.H.M.; Koelmans, A.A.


    Now that microplastics have been detected in lakes, rivers and estuaries all over the globe, evaluating their effects on biota has become an urgent research priority. This is the first study that aims at determining the effect thresholds for a battery of six freshwater benthic macroinvertebrates

  11. Threshold Concepts in Finance: Conceptualizing the Curriculum (United States)

    Hoadley, Susan; Tickle, Leonie; Wood, Leigh N.; Kyng, Tim


    Graduates with well-developed capabilities in finance are invaluable to our society and in increasing demand. Universities face the challenge of designing finance programmes to develop these capabilities and the essential knowledge that underpins them. Our research responds to this challenge by identifying threshold concepts that are central to…

  12. Distribution of sensory taste thresholds for phenylthiocarbamide ...

    African Journals Online (AJOL)

    The ability to taste Phenylthiocarbamide (PTC), a bitter organic compound has been described as a bimodal autosomal trait in both genetic and anthropological studies. This study is based on the ability of a person to taste PTC. The present study reports the threshold distribution of PTC taste sensitivity among some Muslim ...

  13. The acoustic reflex threshold in aging ears. (United States)

    Silverman, C A; Silman, S; Miller, M H


    This study investigates the controversy regarding the influence of age on the acoustic reflex threshold for broadband noise, 500-, 1000-, 2000-, and 4000-Hz activators between Jerger et al. [Mono. Contemp. Audiol. 1 (1978)] and Jerger [J. Acoust. Soc. Am. 66 (1979)] on the one hand and Silman [J. Acoust. Soc. Am. 66 (1979)] and others on the other. The acoustic reflex thresholds for broadband noise, 500-, 1000-, 2000-, and 4000-Hz activators were evaluated under two measurement conditions. Seventy-two normal-hearing ears were drawn from 72 subjects ranging in age from 20-69 years. The results revealed that age was correlated with the acoustic reflex threshold for BBN activator but not for any of the tonal activators; the correlation was stronger under the 1-dB than under the 5-dB measurement condition. Also, the mean acoustic reflex thresholds for broadband noise activator were essentially similar to those reported by Jerger et al. (1978) but differed from those obtained in this study under the 1-dB measurement condition.

  14. Atherogenic Risk Factors and Hearing Thresholds

    DEFF Research Database (Denmark)

    Frederiksen, Thomas Winther; Ramlau-Hansen, Cecilia Høst; Stokholm, Zara Ann


    The objective of this study was to evaluate the influence of atherogenic risk factors on hearing thresholds. In a cross-sectional study we analyzed data from a Danish survey in 2009-2010 on physical and psychological working conditions. The study included 576 white- and blue-collar workers from c...

  15. Near threshold behavior of photoelectron satellite intensities

    International Nuclear Information System (INIS)

    Shirley, D.A.; Becker, U.; Heimann, P.A.; Langer, B.


    The historical background and understanding of photoelectron satellite peaks is reviewed, using He(n), Ne(1s), Ne(2p), Ar(1s), and Ar(3s) as case studies. Threshold studies are emphasized. The classification of electron correlation effects as either ''intrinsic'' or ''dynamic'' is recommended. 30 refs., 7 figs

  16. Cost–effectiveness thresholds: pros and cons (United States)

    Lauer, Jeremy A; De Joncheere, Kees; Edejer, Tessa; Hutubessy, Raymond; Kieny, Marie-Paule; Hill, Suzanne R


    Abstract Cost–effectiveness analysis is used to compare the costs and outcomes of alternative policy options. Each resulting cost–effectiveness ratio represents the magnitude of additional health gained per additional unit of resources spent. Cost–effectiveness thresholds allow cost–effectiveness ratios that represent good or very good value for money to be identified. In 2001, the World Health Organization’s Commission on Macroeconomics in Health suggested cost–effectiveness thresholds based on multiples of a country’s per-capita gross domestic product (GDP). In some contexts, in choosing which health interventions to fund and which not to fund, these thresholds have been used as decision rules. However, experience with the use of such GDP-based thresholds in decision-making processes at country level shows them to lack country specificity and this – in addition to uncertainty in the modelled cost–effectiveness ratios – can lead to the wrong decision on how to spend health-care resources. Cost–effectiveness information should be used alongside other considerations – e.g. budget impact and feasibility considerations – in a transparent decision-making process, rather than in isolation based on a single threshold value. Although cost–effectiveness ratios are undoubtedly informative in assessing value for money, countries should be encouraged to develop a context-specific process for decision-making that is supported by legislation, has stakeholder buy-in, for example the involvement of civil society organizations and patient groups, and is transparent, consistent and fair. PMID:27994285

  17. Multimodal distribution of human cold pain thresholds. (United States)

    Lötsch, Jörn; Dimova, Violeta; Lieb, Isabel; Zimmermann, Michael; Oertel, Bruno G; Ultsch, Alfred


    It is assumed that different pain phenotypes are based on varying molecular pathomechanisms. Distinct ion channels seem to be associated with the perception of cold pain, in particular TRPM8 and TRPA1 have been highlighted previously. The present study analyzed the distribution of cold pain thresholds with focus at describing the multimodality based on the hypothesis that it reflects a contribution of distinct ion channels. Cold pain thresholds (CPT) were available from 329 healthy volunteers (aged 18 - 37 years; 159 men) enrolled in previous studies. The distribution of the pooled and log-transformed threshold data was described using a kernel density estimation (Pareto Density Estimation (PDE)) and subsequently, the log data was modeled as a mixture of Gaussian distributions using the expectation maximization (EM) algorithm to optimize the fit. CPTs were clearly multi-modally distributed. Fitting a Gaussian Mixture Model (GMM) to the log-transformed threshold data revealed that the best fit is obtained when applying a three-model distribution pattern. The modes of the identified three Gaussian distributions, retransformed from the log domain to the mean stimulation temperatures at which the subjects had indicated pain thresholds, were obtained at 23.7 °C, 13.2 °C and 1.5 °C for Gaussian #1, #2 and #3, respectively. The localization of the first and second Gaussians was interpreted as reflecting the contribution of two different cold sensors. From the calculated localization of the modes of the first two Gaussians, the hypothesis of an involvement of TRPM8, sensing temperatures from 25 - 24 °C, and TRPA1, sensing cold from 17 °C can be derived. In that case, subjects belonging to either Gaussian would possess a dominance of the one or the other receptor at the skin area where the cold stimuli had been applied. The findings therefore support a suitability of complex analytical approaches to detect mechanistically determined patterns from pain phenotype data.

  18. Identifying thresholds for ecosystem-based management.

    Directory of Open Access Journals (Sweden)

    Jameal F Samhouri

    Full Text Available BACKGROUND: One of the greatest obstacles to moving ecosystem-based management (EBM from concept to practice is the lack of a systematic approach to defining ecosystem-level decision criteria, or reference points that trigger management action. METHODOLOGY/PRINCIPAL FINDINGS: To assist resource managers and policymakers in developing EBM decision criteria, we introduce a quantitative, transferable method for identifying utility thresholds. A utility threshold is the level of human-induced pressure (e.g., pollution at which small changes produce substantial improvements toward the EBM goal of protecting an ecosystem's structural (e.g., diversity and functional (e.g., resilience attributes. The analytical approach is based on the detection of nonlinearities in relationships between ecosystem attributes and pressures. We illustrate the method with a hypothetical case study of (1 fishing and (2 nearshore habitat pressure using an empirically-validated marine ecosystem model for British Columbia, Canada, and derive numerical threshold values in terms of the density of two empirically-tractable indicator groups, sablefish and jellyfish. We also describe how to incorporate uncertainty into the estimation of utility thresholds and highlight their value in the context of understanding EBM trade-offs. CONCLUSIONS/SIGNIFICANCE: For any policy scenario, an understanding of utility thresholds provides insight into the amount and type of management intervention required to make significant progress toward improved ecosystem structure and function. The approach outlined in this paper can be applied in the context of single or multiple human-induced pressures, to any marine, freshwater, or terrestrial ecosystem, and should facilitate more effective management.

  19. Do multiple body modifications alter pain threshold? (United States)

    Yamamotová, A; Hrabák, P; Hříbek, P; Rokyta, R


    In recent years, epidemiological data has shown an increasing number of young people who deliberately self-injure. There have also been parallel increases in the number of people with tattoos and those who voluntarily undergo painful procedures associated with piercing, scarification, and tattooing. People with self-injury behaviors often say that they do not feel the pain. However, there is no information regarding pain perception in those that visit tattoo parlors and piercing studios compared to those who don't. The aim of this study was to compare nociceptive sensitivity in four groups of subjects (n=105, mean age 26 years, 48 women and 57 men) with different motivations to experience pain (i.e., with and without multiple body modifications) in two different situations; (1) in controlled, emotionally neutral conditions, and (2) at a "Hell Party" (HP), an event organized by a piercing and tattoo parlor, with a main event featuring a public demonstration of painful techniques (burn scars, hanging on hooks, etc.). Pain thresholds of the fingers of the hand were measured using a thermal stimulator and mechanical algometer. In HP participants, information about alcohol intake, self-harming behavior, and psychiatric history were used in the analysis as intervening variables. Individuals with body modifications as well as without body modifications had higher thermal pain thresholds at Hell Party, compared to thresholds measured at control neutral conditions. No such differences were found relative to mechanical pain thresholds. Increased pain threshold in all HP participants, irrespectively of body modification, cannot be simply explained by a decrease in the sensory component of pain; instead, we found that the environment significantly influenced the cognitive and affective component of pain.

  20. Sub-threshold Post Traumatic Stress Disorder in the WHO World Mental Health Surveys (United States)

    McLaughlin, Katie A.; Koenen, Karestan C.; Friedman, Matthew J.; Ruscio, Ayelet Meron; Karam, Elie G.; Shahly, Victoria; Stein, Dan J.; Hill, Eric D.; Petukhova, Maria; Alonso, Jordi; Andrade, Laura Helena; Angermeyer, Matthias C.; Borges, Guilherme; de Girolamo, Giovanni; de Graaf, Ron; Demyttenaere, Koen; Florescu, Silvia E.; Mladenova, Maya; Posada-Villa, Jose; Scott, Kate M.; Takeshima, Tadashi; Kessler, Ronald C.


    Background Although only a minority of people exposed to a traumatic event (TE) develops PTSD, symptoms not meeting full PTSD criteria are common and often clinically significant. Individuals with these symptoms have sometimes been characterized as having sub-threshold PTSD, but no consensus exists on the optimal definition of this term. Data from a large cross-national epidemiological survey are used to provide a principled basis for such a definition. Methods The WHO World Mental Health (WMH) Surveys administered fully-structured psychiatric diagnostic interviews to community samples in 13 countries containing assessments of PTSD associated with randomly selected TEs. Focusing on the 23,936 respondents reporting lifetime TE exposure, associations of approximated DSM-5 PTSD symptom profiles with six outcomes (distress-impairment, suicidality, comorbid fear-distress disorders, PTSD symptom duration) were examined to investigate implications of different sub-threshold definitions. Results Although consistently highest distress-impairment, suicidality, comorbidity, and symptom duration were observed among the 3.0% of respondents with DSM-5 PTSD than other symptom profiles, the additional 3.6% of respondents meeting two or three of DSM-5 Criteria BE also had significantly elevated scores for most outcomes. The proportion of cases with threshold versus sub-threshold PTSD varied depending on TE type, with threshold PTSD more common following interpersonal violence and sub-threshold PTSD more common following events happening to loved ones. Conclusions Sub-threshold DSM-5 PTSD is most usefully defined as meeting two or three of the DSM-5 Criteria B-E. Use of a consistent definition is critical to advance understanding of the prevalence, predictors, and clinical significance of sub-threshold PTSD. PMID:24842116

  1. Are all certified EHRs created equal? Assessing the relationship between EHR vendor and hospital meaningful use performance. (United States)

    Holmgren, A Jay; Adler-Milstein, Julia; McCullough, Jeffrey


    The federal electronic health record (EHR) certification process was intended to ensure a baseline level of system quality and the ability to support meaningful use criteria. We sought to assess whether there was variation across EHR vendors in the degree to which hospitals using products from those vendors were able to achieve high levels of performance on meaningful use criteria. We created a cross-sectional national hospital sample from the Office of the National Coordinator for Health Information Technology EHR Products Used for Meaningful Use Attestation public use file and the Centers for Medicare & Medicaid Services Medicare EHR Incentive Program Eligible Hospitals public use file. We used regression models to assess the relationship between vendor and hospital performance on 6 Stage 2 Meaningful Use criteria, controlling for hospital characteristics. We also calculated how much variation in performance is explained by vendor choice. We found significant associations between specific vendor and level of hospital performance for all 6 meaningful use criteria. Epic was associated with significantly higher performance on 5 of the 6 criteria; relationships for other vendors were mixed, with some associated with significantly worse performance on multiple criteria. EHR vendor choice accounted for between 7% and 34% of performance variation across the 6 criteria. A nontrivial proportion of variation in hospital meaningful use performance is explained by vendor choice, and certain vendors are more often associated with better meaningful use performance than others. Our results suggest that policy-makers should improve the certification process by including more "real-world" scenario testing and provider feedback or ratings to reduce this variation. Hospitals can use these results to guide interactions with vendors. Vendor choice accounts for a meaningful proportion of variation in hospital meaningful use performance, and specific vendors are consistently associated

  2. Construction of meaningful identities in the context of rheumatoid arthritis, motherhood and paid work: A meta-ethnography. (United States)

    Feddersen, Helle; Kristiansen, Tine Mechlenborg; Andersen, Pernille Tanggaard; Hørslev-Petersen, Kim; Primdahl, Jette


    To derive new conceptual understanding about how women with rheumatoid arthritis manage their illness, motherhood and paid work, based on a comprehensive overview of existing knowledge, gained from qualitative studies. Rheumatoid arthritis affects several social aspects of life; however, little is known about how women with rheumatoid arthritis simultaneously manage their illness, motherhood and paid work. Qualitative metasynthesis. A qualitative metasynthesis informed by Noblit and Hare's meta-ethnography was carried out, based on studies identified by a systematic search in nine databases. Six studies were included. Social interactions in the performance of three interdependent subidentities emerged as an overarching category, with three subcategories: subidentities associated with (1) paid work, (2) motherhood and (3) rheumatoid arthritis. Pressure in managing one of the subidentities could restrict the fulfilment of the others. The subidentities were interpreted as being flexible, situational, contextual and competing. The women strove to construct meaningful subidentities by taking into account feedback obtained in social interactions. The subidentities associated with paid work and motherhood are competing subidentities. Paid work is given the highest priority, followed by motherhood and illness is the least attractive subidentity. Because of the fluctuating nature of the illness, the women constantly reconstruct the three interdependent subidentities. When healthcare professionals meet a woman with rheumatoid arthritis, they should consider that she might not accept the subidentity as an ill person. Health professionals should not expect that women will prioritise their illness in their everyday life. This could be included in clinical conversation with the women. © 2017 John Wiley & Sons Ltd.

  3. Meaningful call combinations and compositional processing in the southern pied babbler (United States)

    Engesser, Sabrina; Ridley, Amanda R.; Townsend, Simon W.


    Language’s expressive power is largely attributable to its compositionality: meaningful words are combined into larger/higher-order structures with derived meaning. Despite its importance, little is known regarding the evolutionary origins and emergence of this syntactic ability. Although previous research has shown a rudimentary capability to combine meaningful calls in primates, because of a scarcity of comparative data, it is unclear to what extent analog forms might also exist outside of primates. Here, we address this ambiguity and provide evidence for rudimentary compositionality in the discrete vocal system of a social passerine, the pied babbler (Turdoides bicolor). Natural observations and predator presentations revealed that babblers produce acoustically distinct alert calls in response to close, low-urgency threats and recruitment calls when recruiting group members during locomotion. On encountering terrestrial predators, both vocalizations are combined into a “mobbing sequence,” potentially to recruit group members in a dangerous situation. To investigate whether babblers process the sequence in a compositional way, we conducted systematic experiments, playing back the individual calls in isolation as well as naturally occurring and artificial sequences. Babblers reacted most strongly to mobbing sequence playbacks, showing a greater attentiveness and a quicker approach to the loudspeaker, compared with individual calls or control sequences. We conclude that the sequence constitutes a compositional structure, communicating information on both the context and the requested action. Our work supports previous research suggesting combinatoriality as a viable mechanism to increase communicative output and indicates that the ability to combine and process meaningful vocal structures, a basic syntax, may be more widespread than previously thought. PMID:27155011

  4. Measuring Input Thresholds on an Existing Board (United States)

    Kuperman, Igor; Gutrich, Daniel G.; Berkun, Andrew C.


    A critical PECL (positive emitter-coupled logic) interface to Xilinx interface needed to be changed on an existing flight board. The new Xilinx input interface used a CMOS (complementary metal-oxide semiconductor) type of input, and the driver could meet its thresholds typically, but not in worst-case, according to the data sheet. The previous interface had been based on comparison with an external reference, but the CMOS input is based on comparison with an internal divider from the power supply. A way to measure what the exact input threshold was for this device for 64 inputs on a flight board was needed. The measurement technique allowed an accurate measurement of the voltage required to switch a Xilinx input from high to low for each of the 64 lines, while only probing two of them. Directly driving an external voltage was considered too risky, and tests done on any other unit could not be used to qualify the flight board. The two lines directly probed gave an absolute voltage threshold calibration, while data collected on the remaining 62 lines without probing gave relative measurements that could be used to identify any outliers. The PECL interface was forced to a long-period square wave by driving a saturated square wave into the ADC (analog to digital converter). The active pull-down circuit was turned off, causing each line to rise rapidly and fall slowly according to the input s weak pull-down circuitry. The fall time shows up as a change in the pulse width of the signal ready by the Xilinx. This change in pulse width is a function of capacitance, pulldown current, and input threshold. Capacitance was known from the different trace lengths, plus a gate input capacitance, which is the same for all inputs. The pull-down current is the same for all inputs including the two that are probed directly. The data was combined, and the Excel solver tool was used to find input thresholds for the 62 lines. This was repeated over different supply voltages and

  5. Improving the user experience through practical data analytics gain meaningful insight and increase your bottom line

    CERN Document Server

    Fritz, Mike


    Improving the User Experience through Practical Data Analytics is your must-have resource for making UX design decisions based on data, rather than hunches. Authors Fritz and Berger help the UX professional recognize and understand the enormous potential of the ever-increasing user data that is often accumulated as a by-product of routine UX tasks, such as conducting usability tests, launching surveys, or reviewing clickstream information. Then, step-by-step, they explain how to utilize both descriptive and predictive statistical techniques to gain meaningful insight with that data. You'll be

  6. Cogent:A Case Study of Meaningful Gamification in Education with Virtual Currency

    Directory of Open Access Journals (Sweden)

    Yang Chen


    Full Text Available This paper analyzes students’ experience with Cogent, a virtual economy system used throughout the 4 years of a B.S. degree in a Technology major. The case study explains the rules of the Cogent system and investigates its effectiveness to motivate students to learn. Using focus groups and interviews, we collected qualitative data from students about their experience and perceptions of Cogent. The results indicate that Cogent played an encouraging and motivational role for these students and suggest potential for the successful design and implementation of meaningful gamification systems to promote student motivation and engagement within an educational context.

  7. On the meaningfulness of testing preference axioms in stated preference discrete choice experiments

    DEFF Research Database (Denmark)

    Hougaard, Jens Leth; Tjur, Carl Tue; Østerdal, Lars Peter Raahave


    A stream of studies on evaluation of health care services and public goods have developed tests of the preference axioms of completeness and transitivity and methods for detecting other preference phenomena such as unstability, learning- and tiredness effects, and random error, in stated preference...... discrete choice experiments. This methodological paper tries to identify the role of the preference axioms and other preference phenomena in the context of such experiments and discusses whether or howsuch axioms and phenomena can be subject to meaningful (statistical) tests....

  8. Medicare incentive payments for meaningful use of electronic health records: accounting and reporting developments. (United States)


    The Healthcare Financial Management Association through its Principles and Practices (P&P) Board publishes issue analyses to provide short-term practical assistance on emerging issues in healthcare financial management. In a new issue analysis excerpted in this article, HFMA's P&P Board provides some clarity to the healthcare industry on certain accounting and reporting issues resulting from incentive payments under the Medicare program for the meaningful use of electronic health record (EHR) technology. Consultation on these matters with independent auditors is highly recommended.

  9. Comparisons between detection threshold and loudness perception for individual cochlear implant channels (United States)

    Bierer, Julie Arenberg; Nye, Amberly D


    thresholds had the narrowest dynamic ranges (for σ ≥ 0.5) and steepest growth of loudness functions for all electrode configurations. Conclusions Together with previous studies using focused stimulation, the results suggest that auditory responses to electrical stimuli at both threshold and suprathreshold current levels are not uniform across the electrode array of individual cochlear implant listeners. Specifically, the steeper growth of loudness and thus smaller dynamic ranges observed for high-threshold channels are consistent with a degraded electrode-neuron interface, which could stem from lower numbers of functioning auditory neurons or a relatively large distance between the neurons and electrodes. These findings may have potential implications for how stimulation levels are set during the clinical mapping procedure, particularly for speech-processing strategies that use focused electrical fields. PMID:25036146

  10. Differential equation models for sharp threshold dynamics. (United States)

    Schramm, Harrison C; Dimitrov, Nedialko B


    We develop an extension to differential equation models of dynamical systems to allow us to analyze probabilistic threshold dynamics that fundamentally and globally change system behavior. We apply our novel modeling approach to two cases of interest: a model of infectious disease modified for malware where a detection event drastically changes dynamics by introducing a new class in competition with the original infection; and the Lanchester model of armed conflict, where the loss of a key capability drastically changes the effectiveness of one of the sides. We derive and demonstrate a step-by-step, repeatable method for applying our novel modeling approach to an arbitrary system, and we compare the resulting differential equations to simulations of the system's random progression. Our work leads to a simple and easily implemented method for analyzing probabilistic threshold dynamics using differential equations. Published by Elsevier Inc.

  11. Gamin partable radiation meter with alarm threshold

    International Nuclear Information System (INIS)

    Payat, Rene.


    The Gamin Radiation meter is a direct reading, portable, battery-powered gamma doserate meter featuring alarm thresholds. Doserate is read on a micro-ammeter with a millirad-per-hour logarithmic scale, covering a range of 0,1 to 1000 millirads/hour. The instrument issues an audible warning signal when dose-rate level exceeds a threshold value, which can be selected. The detector tube is of the Geiger-Muller counter, energy compensated type. Because of its low battery drain, the instrument can be operated continously for 1000 hours. It is powered by four 1.5 volt alcaline batteries of the R6 type. The electronic circuitry is housed in a small lightweight case made of impact resistant plastic. Applications of the Gamin portable radiation monitor are found in health physics, safety departments, medical facilities, teaching, civil defense [fr

  12. Rayleigh scattering from ions near threshold

    International Nuclear Information System (INIS)

    Roy, S.C.; Gupta, S.K.S.; Kissel, L.; Pratt, R.H.


    Theoretical studies of Rayleigh scattering of photons from neon atoms with different degrees of ionization, for energies both below and above the K-edges of the ions, are presented. Some unexpected structures both in Rayleigh scattering and in photoionization from neutral and weakly ionized atoms, very close to threshold, have been reported. It has recently been realized that some of the predicted structures may have a nonphysical origin and are due to the limitation of the independent-particle model and also to the use of a Coulombic Latter tail. Use of a K-shell vacancy potential - in which an electron is assumed to be removed from the K-shell - in calculating K-shell Rayleigh scattering amplitudes removes some of the structure effects near threshold. We present in this work a discussion of scattering angular distributions and total cross sections, obtained utilizing vacancy potentials, and compare these predictions with those previously obtained in other potential model. (author) [pt

  13. Edith Wharton's threshold phobia and two worlds. (United States)

    Holtzman, Deanna; Kulish, Nancy


    The American novelist Edith Wharton suffered an unusual childhood neurotic symptom, a fear of crossing thresholds, a condition that might be called a "threshold phobia." This symptom is identified and examined in autobiographical material, letters, diaries, and selected literary fiction and nonfiction left by Wharton to arrive at a formulation not previously drawn together. A fascinating theme-living or being trapped between "two worlds"-runs through much of the writer's life and work. The phobia is related to this theme, and both can be linked more broadly to certain sexual conflicts in women. This understanding of Wharton's phobia, it is argued, throws new light on the developmental issues and conflicts related to the female "oedipal" or triadic phase, characterized by the need to negotiate the two worlds of mother and of father. © 2014 by the American Psychoanalytic Association.

  14. Ultracompact low-threshold organic laser. (United States)

    Deotare, Parag B; Mahony, Thomas S; Bulović, Vladimir


    We report an ultracompact low-threshold laser with an Alq3:DCM host:guest molecular organic thin film gain layer. The device uses a photonic crystal nanobeam cavity which provides a high quality factor to mode volume (Q/V) ratio and increased spontaneous emission factor along with a small footprint. Lasing is observed with a threshold of 4.2 μJ/cm(2) when pumped by femtosecond pulses of λ = 400 nm wavelength light. We also model the dynamics of the laser and show good agreement with the experimental data. The inherent waveguide geometry of the structure enables easy on-chip integration with potential applications in biochemical sensing, inertial sensors, and data communication.

  15. Predicting visual acuity from detection thresholds. (United States)

    Newacheck, J S; Haegerstrom-Portnoy, G; Adams, A J


    Visual performance based exclusively on high luminance and high contrast letter acuity measures often fails to predict individual performance at low contrast and low luminance. Here we measured visual acuity over a wide range of contrasts and luminances (low mesopic to photopic) for 17 young normal observers. Acuity vs. contrast functions appear to fit a single template which can be displaced laterally along the log contrast axis. The magnitude of this lateral displacement for different luminances was well predicted by the contrast threshold difference for a 4 min arc spot. The acuity vs. contrast template, taken from the mean of all 17 subjects, was used in conjunction with individual spot contrast threshold measures to predict an individual's visual acuity over a wide range of luminance and contrast levels. The accuracy of the visual acuity predictions from this simple procedure closely approximates test-retest accuracy for both positive (projected Landolt rings) and negative contrast (Bailey-Lovie charts).

  16. The monolithic double-threshold discriminator

    International Nuclear Information System (INIS)

    Baturitsky, M.A.; Dvornikov, O.V.


    A double-threshold discriminator capable of processing input signals of different duration is described. Simplicity of the discriminator circuitry makes it possible to embody the discriminator in multichannel ICs using microwave bipolar-JFET technology. Time walk is calculated to be less than 0.35 ns for the input ramp signals with rise times 25-100 ns and amplitudes 50 mV-1 V

  17. Muscle Weakness Thresholds for Prediction of Diabetes in Adults. (United States)

    Peterson, Mark D; Zhang, Peng; Choksi, Palak; Markides, Kyriakos S; Al Snih, Soham


    Despite the known links between weakness and early mortality, what remains to be fully understood is the extent to which strength preservation is associated with protection from cardiometabolic diseases, such as diabetes. The purposes of this study were to determine the association between muscle strength and diabetes among adults, and to identify age- and sex-specific thresholds of low strength for detection of risk. A population-representative sample of 4066 individuals, aged 20-85 years, was included from the combined 2011-2012 National Health and Nutrition Examination Survey (NHANES) data sets. Strength was assessed using a handheld dynamometer, and the single highest reading from either hand was normalized to body mass. A logistic regression model was used to assess the association between normalized grip strength and risk of diabetes, as determined by haemoglobin A1c levels ≥6.5 % (≥48 mmol/mol), while controlling for sociodemographic characteristics, anthropometric measures and television viewing time. For every 0.05 decrement in normalized strength, there were 1.26 times increased adjusted odds for diabetes in men and women. Women were at lower odds of having diabetes (odds ratio 0.49; 95 % confidence interval 0.29-0.82). Age, waist circumference and lower income were also associated with diabetes. The optimal sex- and age-specific weakness thresholds to detect diabetes were 0.56, 0.50 and 0.45 for men at ages of 20-39, 40-59 and 60-80 years, respectively, and 0.42, 0.38 and 0.33 for women at ages of 20-39, 40-59 and 60-80 years, respectively. We present thresholds of strength that can be incorporated into a clinical setting for identifying adults who are at risk of developing diabetes and might benefit from lifestyle interventions to reduce risk.

  18. Context-dependent memory in a meaningful environment for medical education: in the classroom and at the bedside. (United States)

    Koens, Franciska; Ten Cate, Olle Th J; Custers, Eugène J F M


    Learning-in-context is a much-discussed topic in medical education. Information is said to be better recalled when the learning environment resembles the later retrieval environment. Godden and Baddeley (1975) showed that divers recalled words better when the recall condition matched the original learning environment, i.e. underwater or on land. Though it is unclear whether the findings can be generalized for medical education, medical educators regularly refer to them. We replicated the Godden and Baddeley study in ecologically more valid conditions for medical education and extended it with meaningful subject matter (namely, a patient case description). Sixty-three clerks were randomized over four conditions, contrasting a clinical (bedside) with an educational (classroom) environment as both learning and recall conditions. Students were asked to recall a list of words and a patient case in the same environment or in the opposite environment as where they learned it. We failed to find a significant same-context advantage for free recall of the list of words and the patient case propositions. However, there does appear to be a slight tendency towards better recall of the case description when learning took place in the clinical environment. In medical education, the context, if conceived as physical surroundings, does not seem to contribute to a same-context advantage. One should be cautious in generalizing the findings of Godden and Baddeley. However, different forms of 'context' other than the physical one used in the Godden and Baddeley study may well enhance learning effects in medical education.

  19. Threshold Learning Dynamics in Social Networks (United States)

    González-Avella, Juan Carlos; Eguíluz, Victor M.; Marsili, Matteo; Vega-Redondo, Fernado; San Miguel, Maxi


    Social learning is defined as the ability of a population to aggregate information, a process which must crucially depend on the mechanisms of social interaction. Consumers choosing which product to buy, or voters deciding which option to take with respect to an important issue, typically confront external signals to the information gathered from their contacts. Economic models typically predict that correct social learning occurs in large populations unless some individuals display unbounded influence. We challenge this conclusion by showing that an intuitive threshold process of individual adjustment does not always lead to such social learning. We find, specifically, that three generic regimes exist separated by sharp discontinuous transitions. And only in one of them, where the threshold is within a suitable intermediate range, the population learns the correct information. In the other two, where the threshold is either too high or too low, the system either freezes or enters into persistent flux, respectively. These regimes are generally observed in different social networks (both complex or regular), but limited interaction is found to promote correct learning by enlarging the parameter region where it occurs. PMID:21637714

  20. Explaining the length threshold of polyglutamine aggregation

    International Nuclear Information System (INIS)

    De Los Rios, Paolo; Hafner, Marc; Pastore, Annalisa


    The existence of a length threshold, of about 35 residues, above which polyglutamine repeats can give rise to aggregation and to pathologies, is one of the hallmarks of polyglutamine neurodegenerative diseases such as Huntington’s disease. The reason why such a minimal length exists at all has remained one of the main open issues in research on the molecular origins of such classes of diseases. Following the seminal proposals of Perutz, most research has focused on the hunt for a special structure, attainable only above the minimal length, able to trigger aggregation. Such a structure has remained elusive and there is growing evidence that it might not exist at all. Here we review some basic polymer and statistical physics facts and show that the existence of a threshold is compatible with the modulation that the repeat length imposes on the association and dissociation rates of polyglutamine polypeptides to and from oligomers. In particular, their dramatically different functional dependence on the length rationalizes the very presence of a threshold and hints at the cellular processes that might be at play, in vivo, to prevent aggregation and the consequent onset of the disease. (paper)